GI Unit Leadership: Shaping a High-Performing Endoscopy Unit (On-Demand) | February 2026-ASGE

ASGE_guidelines for safety in GI endo unit

Pdf Summary

The ASGE guideline on safety in gastrointestinal (GI) endoscopy units addresses patient and staff safety beyond traditional infection control, emphasizing unit-specific practices. Triggered by high-profile infectious outbreaks and updated CMS regulations equating endoscopy units with sterile operating rooms, this guideline clarifies that endoscopy environments differ from surgical settings and should have tailored safety standards grounded in evidence.<br /><br />Key facility recommendations include designated clean and dirty endoscope flows to prevent cross-contamination, procedure rooms sized approximately 180 sq ft (rather than the 400 sq ft sterile OR standard), adequate oxygen and suction sources, power backups, and routine checks of emergency equipment. Terminal cleaning protocols should employ proper cleansing and disinfecting agents effective against spores. Recovery areas must ensure patient privacy and monitoring. Supplies, including IV fluids, should be stored properly to avoid contamination.<br /><br />Infection control emphasizes a documented, unit-specific prevention plan led by qualified personnel, incorporating standard precautions: hand hygiene, appropriate use of personal protective equipment (PPE), safe medication administration, and environmental cleaning. PPE use is guided by exposure risk, with gloves and impervious gowns recommended for high-risk tasks; routine use of hair covers, booties, or full sterile OR attire is not supported. Hand hygiene protocols adhere to CDC guidance, emphasizing alcohol-based rubs unless hands are visibly soiled or managing Clostridium difficile cases.<br /><br />Medication safety requires aseptic preparation away from procedure rooms, use of single-dose vials when possible, avoidance of syringe reuse, secure storage with accountability, and clear policies on sharps management. Environmental cleaning mandates adherence to manufacturer instructions and frequent disinfection of high-touch surfaces.<br /><br />Staffing standards recommend a minimum of one registered nurse (RN) for routine endoscopy under moderate sedation, with additional assistance as needed based on procedure complexity. Sedation practices emphasize credentialing, training in sedation level management, and patient monitoring, with moderate sedation monitored by an RN permitted to perform brief tasks and no routine capnography required. Deep sedation mandates dedicated monitoring personnel and may consider capnography.<br /><br />Sedation-related equipment must be regularly checked and monitoring include vital signs and consciousness levels pre-, intra-, and post-procedure. Emergency management requires availability of resuscitation equipment and staff trained in its use.<br /><br />Overall, the guideline advocates for evidence-based, efficient, and cost-conscious safety measures that recognize the unique nature of GI endoscopy units, promoting a culture of safety through clear leadership and communication.

Keywords

GI endoscopy safety

infection control

endoscope reprocessing

patient monitoring

sedation protocols

personal protective equipment

emergency preparedness

environmental cleaning

staffing standards

medication safety