The ASGE Quality Course: Improving Quality and Safety in the Endoscopy Unit (On-demand) | November 2025-Infection Control in GI Endoscopy: Global Overview

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This comprehensive overview by Dr. Rahul Pannala summarizes infection control challenges and preventive strategies associated with gastrointestinal endoscopy worldwide. The session reviews endogenous infections (originating from the patient’s own flora) and exogenous infections (transmitted between patients or from healthcare workers).<br /><br />Endogenous infection risks vary by procedure, with bacteremia rates ranging from 2% to 23% depending on the endoscopic intervention. Factors such as therapeutic interventions, malignancy, immunosuppression, and incomplete drainage increase these risks. Prevention includes careful patient selection and sometimes prophylactic antibiotics.<br /><br />Exogenous infections can occur patient-to-staff via needle sticks, blood splashes, aerosol inhalation, or direct contact; healthcare workers are at risk for infections like H. pylori, influenza, tuberculosis, COVID-19, and others. Universal precautions—meticulous hand hygiene, personal protective equipment, safe medication practices, proper handling of equipment, immunizations, and post-exposure protocols—are essential to minimize these risks.<br /><br />Patient-to-patient transmission mainly arises from inadequate endoscope reprocessing, equipment damage, or improper handling of IV tubing and medications. While infections linked to standard forward-viewing endoscopes have declined with adherence to reprocessing guidelines and high-level disinfection (HLD), side-viewing duodenoscopes pose greater complexity. These specialized scopes have been involved in multiple outbreaks worldwide, with contamination linked to the device’s complex design, especially the elevator mechanism, human error, damage, and contamination from cleaning water.<br /><br />Enhanced duodenoscope reprocessing strategies include double HLD, sterilization, microbiological culturing and quarantine, repeat full reprocessing, use of single-use scopes, and improved staff training. However, some methods show limited benefit outside outbreaks. Addressing these challenges requires multidisciplinary efforts, adherence to standardized protocols, ongoing research, and potentially device redesign.<br /><br />In summary, infection risks in endoscopy are multifactorial but can be substantially mitigated through rigorous infection control practices, standardized reprocessing protocols, universal precautions, and focused attention on specialized endoscopes. Continued vigilance and innovation remain crucial for patient and staff safety.

Asset Subtitle

Rahul Pannala, MD, MPH, FASGE

Meta Tag

Concept Endoscopy

Concept Infection Transmission

Concept Endoscope Reprocessing

Concept Duodenoscope

Concept Endogenous Infection

Keywords

gastrointestinal endoscopy

infection control

endogenous infections

exogenous infections

endoscope reprocessing

duodenoscope contamination

universal precautions

high-level disinfection

healthcare worker safety

preventive strategies

Endoscopy

Infection Transmission

Endoscope Reprocessing

Duodenoscope

Endogenous Infection