Endoscopic Infection Control Practices

Endoscopic procedures have transformed diagnosis and therapy in gastroenterology and pulmonology, yet they carry inherent risks of patient-to-patient transmission of microorganisms. Complex designs, including narrow channels, right-angle bends and elevator mechanisms, can trap organic debris and foster biofilm formation, challenging traditional cleaning and disinfection protocols. High-level disinfection and, in some cases, low-temperature sterilisation are adopted in accordance with risk-based frameworks to mitigate these risks. Surveillance sampling, automated reprocessing equipment and drying programmes further enhance safety by verifying the absence of residual microbial contamination. Recent advances encompass enhanced device design, automated monitoring of chemical and mechanical parameters, and the emergence of disposable endoscopes to obviate reprocessing lapses. Stringent global guidelines underscore training, competency assessment and quality management systems to ensure consistency across diverse healthcare settings. The confluence of engineering innovations, microbiological insights and policy initiatives continues to drive improvements in endoscope reprocessing, with the ultimate aim of eradicating healthcare-associated infections linked to endoscopic interventions.

Research from Nature Portfolio

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Research from all publishers

Recent clinical trials have evaluated duodenoscopes with disposable elevator caps, demonstrating a marked reduction in persistent microbial contamination following high-level disinfection, without compromising procedural success or safety in endoscopic retrograde cholangiopancreatography. A global prospective case series of single-use duodenoscopes reported high completion rates of complex procedures, broad operator satisfaction and the elimination of reprocessing-associated infection risk across multiple centres. Complementing these device-focused studies, a contemporary review of the Spaulding classification system highlighted the need to elevate certain high-risk flexible endoscopes to critical status, advocating low-temperature sterilisation modalities, robust automated cleaning and real-time monitoring to address biofilm resilience and emerging pathogens in modern healthcare environments.

Endoscopic Infection Control Practices publication trend

The graph below shows the total number of articles in endoscopic infection control practices across all publications each year (not limited to Nature Index journals).

Technical terms

Duodenoscope: A specialised flexible endoscope with an elevator mechanism used for endoscopic retrograde cholangiopancreatography.

High-level disinfection (HLD): A chemical process that eliminates all microorganisms except high numbers of bacterial spores on semi-critical items.

Spaulding classification: A system categorising medical devices by infection risk (critical, semi-critical, non-critical) to define appropriate reprocessing levels.

Biofilm: A structured community of microorganisms encased in an adhesive extracellular matrix, often resistant to disinfectants.

Endoscope reprocessing: The complete cycle of cleaning, disinfection or sterilisation, inspection and storage designed to prepare an endoscope for safe reuse.

References

1. Effect of Disposable Elevator Cap Duodenoscopes on Persistent Microbial Contamination and Technical Performance of Endoscopic Retrograde Cholangiopancreatography. JAMA Internal Medicine (2023).
2. Global prospective case series of ERCPs using a single-use duodenoscope. Endoscopy (2023).
3. A review of Spaulding's classification system for effective cleaning, disinfection and sterilization of reusable medical devices: Viewed through a modern-day lens that will inform and enable future sustainability. The Science of The Total Environment (2023).
4. APSIC guidelines for disinfection and sterilization of instruments in health care facilities. Antimicrobial Resistance & Infection Control (2018).
5. Surveillance of Endoscopes: Comparison of Different Sampling Techniques. Infection Control and Hospital Epidemiology (2017).