Improving Quality and Safety in the Endoscopy Unit (Virtual) | October 2024-ASGE infection control guideline

ASGE infection control guideline

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The American Society for Gastrointestinal Endoscopy (ASGE) Quality Assurance in Endoscopy Committee has issued updated guidelines for infection control during gastrointestinal (GI) endoscopy. Originally published in 2008, these guidelines have been revised through a comprehensive review of medical literature and expert consultation. Their primary goal is to minimize the risk of endoscopy-related infections by providing educational guidance rather than setting legal standards of care.<br /><br />GI endoscopy, with millions of procedures annually in the U.S., carries rare occurrences of infectious adverse events. However, recent reports of infections caused by multidrug-resistant organisms (MDROs) linked to duodenoscopes have prompted a reassessment of current infection control practices. Transmission could occur via contaminated equipment or bloodstream routes during procedures. <br /><br />The guidelines highlight the importance of stringent reprocessing of flexible endoscopes, which involves mechanical and detergent cleaning, high-level disinfection (HLD), rinsing, and drying. Disinfection remains challenging due to these instruments being unsuitable for steam sterilization and potential failures in adherence to guidelines.<br /><br />Other key measures include addressing the risk posed by difficult-to-clean components such as the elevator mechanisms of duodenoscopes, which have been linked to outbreaks even in the absence of reprocessing protocol breaches. The transmission of infections through non-endoscopic pathways, notably through improper sterile practices or handling, is also highlighted, underscoring the necessity of comprehensive infection prevention protocols within endoscopy units.<br /><br />The guidelines also emphasize the need for continuous education and training of personnel involved in endoscopic procedures, alongside stringent monitoring for compliance.<br /><br />In conclusion, while the risk of transmission through endoscopy remains low when guidelines are followed, continuous vigilance, appropriate training, and strict adherence to reprocessing protocols are essential to further reducing infection risks. The document also calls for readiness in handling potential outbreaks through effective leadership and institutional policies.

Keywords

ASGE

infection control

gastrointestinal endoscopy

guidelines

multidrug-resistant organisms

duodenoscopes

reprocessing

disinfection

endoscopy training

infection prevention