Shine on Flexible Endoscope Reprocessing - Canada - ASP Learning Lab

Shine on
Flexible
Endoscope
Reprocessing

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Shine on
Flexible
Endoscope
Reprocessing

Round
Table

28
January

Webinar
Series
  2. /
  3. ASP Summit
  4. /
  5. Shine on Flexible Endoscope Reprocessing


Mr. David Bellamy photo
Web.1 • May 28
What's New on Flexible Endoscopes Reprocessing Guidelines?
Speaker:
Mr. David Bellamy
Learn More →
Cori Ofstead, MSPH photo
Web.2 • June 26
Endoscope processing effectiveness: A reality check and call to action!
Speaker:
Cori Ofstead, MSPH
Learn More →
Monique Barakat, MD PhD photo
Web.4 • October 29/30
Improving Flexible Endoscope Reprocessing: the importance of drying and a role for artificial intelligence
Speaker:
Monique Barakat, MD PhD
Learn More →
Web.1 • May 28
What's New on Flexible Endoscopes Reprocessing Guidelines?
Mr. David Bellamy photo
Mr. David Bellamy
Vice President- World Federation of Hospital Sterilization Sciences, Sterilizing Services Department Manager- NSW Health
Experienced Consultant for Decontamination and Sterilisation projects, Protocols and Certifications
Sydney, Australia

SYNOPSIS:

Flexible endoscopes remain among the most challenging reusable medical devices to clean, disinfect, and sterilize. This webinar will explore the most recent updates in international and national guidelines, highlighting critical changes aimed at improving patient safety and infection prevention. Participants will gain practical insights into the rationale behind updated protocols, including enhanced drying procedures, storage conditions, microbiological surveillance, and staff competency. The session is designed for CSSD professionals, endoscopy nurses, infection preventionists, and healthcare managers involved in endoscope handling and reprocessing.

 

EMEA : 8:00 am BST London | 9:00 am CET Amsterdam & Cape Town | 10:00 am Moscow | 11:00 am Dubai

 

topic icon
Enhanced Cleaning and
Pre-Cleaning Protocols
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Drying and
Storage Requirements
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Microbiological Surveillance and
Quality Assurance
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Competency, Documentation, and
Traceability
questions

QUESTIONS:

  • When should pre-cleaning of an endoscope begin?
  • How long can a reprocessed flexible endoscope be stored before it must be reprocessed again (without use) in your country?
  • How often should microbiological surveillance of reprocessed endoscopes be conducted in high-risk areas (e.g., ERCP)?
  • How often should staff competency in endoscope reprocessing be formally assessed?
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Web.2 • June 26
Endoscope processing effectiveness: A reality check and call to action!
Cori Ofstead, MSPH photo
Cori Ofstead, MSPH
CEO at Ofstead & Associates, Inc.
Minesota, USA

SYNOPSIS:

Flexible endoscopes, due to their complex design and exposure to biological materials during procedures, are challenging to reprocess effectively. They are heavily exposed to blood, mucus, and other secretions during procedures and may harbor billions of microbes before processing. Guidelines recommend thorough cleaning and high-level disinfection (HLD) or sterilization after each use.

While high-level disinfection (HLD) is intended to eliminate most pathogens, Ofstead’s review of real-world evidence from 2019 to 2024 found that HLD often failed to eradicate all microbes, leaving patients at risk of infection (“Endoscope processing effectiveness: A reality check and call to action for infection preventionists and clinicians” published in AJIC 2025). This webinar summarizes key evidence and underscores the urgent need for sterile processing professionals, infection preventionists, clinicians, and healthcare leaders to reevaluate and strengthen their endoscope reprocessing protocols to mitigate infection risks.

 

EMEA : 8:00 am BST London | 9:00 am CET Amsterdam & Cape Town | 10:00 am Moscow | 11:00 am Dubai

topic icon
Persistent Contamination
Despite Reprocessing
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Gaps in Reprocessing
Protocols and Compliance
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Biofilm Formation and
Device Design Challenges
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Need for Quality
Improvement
topic icon
Risk Assessment
Strategies
topic icon
Call to Action for Infection
Preventionists and Clinicians


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Web.4 • October 29/30
Improving Flexible Endoscope Reprocessing: the importance of drying and a role for artificial intelligence
Monique Barakat, MD PhD photo
Monique Barakat, MD PhD
Associate Professor of Pediatrics & Medicine Divisions of Pediatric and Adult Gastroenterology and Hepatology
Stanford University School of Medicine
Stanford, CA USA

SYNOPSIS:

This webinar addresses the challenge of endoscope-transmitted infections, emphasizing the critical role of inadequate drying as a major contributing factor. After introducing the issue and key risk factors, drying will be highlighted as the central focus. Evidence from the literature shows that residual fluid is frequently detected in endoscope channels upon inspection, emphasizing the importance of routine evaluation of clinically used flexible endoscopes. The prevalence of inadequate drying will be discussed, along with contributing practices such as Simethicone use and suboptimal reprocessing practices. Various drying methods—including drying cabinets, automated systems, and manual approaches—will be compared, outlining their respective advantages and disadvantages while highlighting strategies to reduce human error and improve patient safety.

Finally, the session will consider the practical demands of endoscope inspection and introduce the emerging role of AI-assisted inspection, supported by pilot data and demonstration videos.

 

Option#1: October 29  EMEA  5:00 pm BST London | 6:00 pm CET Amsterdam & Cape Town | 7:00 pm Moscow | 8:00 pm Dubai

Option#2: October 30 EMEA  8:00 am BST London | 9:00 am CET Amsterdam & Cape Town | 10:00 am Moscow | 11:00 am Dubai

topic icon
The Challenge of
Endoscope Transmitted Infections
topic icon
Importance of Drying to Prevent
Endoscope-Transmitted Infections
topic icon
Endoscope Channel Inspection has Revealed
that Most Endoscope Drying is Inadequate
topic icon
There are Approaches for
Effective Endoscope Drying
topic icon
Role for AI in
Endoscope Reprocessing & Drying
questions

QUESTIONS:

  • What are the significant consequences of endoscope-transmitted infections?
  • Why is complete drying of endoscopes essential in preventing infections?
  • What has direct visualization of endoscope channels shown regarding endoscope drying?
  • What is the evidence-based approach to effective endoscope drying?
  • How can artificial intelligence (AI) improve the endoscope inspection process?
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General Announcement

Modern medicine relies heavily on endoscopic procedures due to their minimal invasiveness and lower costs compared to surgical methods. The development of endoscopes has facilitated the transition from mere visualization to diagnostic and therapeutic procedures that were previously unattainable without invasive techniques. 1,2 

Endoscopic procedures play a crucial role in cancer screening, particularly in the detection of colorectal cancer among other pathologies. 3 

The global volume of endoscopic procedures performed annually varies according to different sources. Some data suggest that approximately 200 million procedures are conducted worldwide, with gastrointestinal procedures accounting for approximately 133 million and respiratory procedures around 10 million. Factors such as an aging population, improvements in preventive healthcare, and advancements in technology are expected to contribute to an increase in these figures. 4 

Infections associated with endoscopic procedures are among the potential complications, which also include bleeding, perforation, and cardiorespiratory events. Unfortunately, the incidence of these infections is not well documented compared to healthcare-associated infections. The type of infection varies according to the endoscopic procedure and the patient’s condition, ranging from mild infections to severe cases such as bacteremia, sepsis, septic shock, or even death. 5-8 

Endoscopic Retrograde Cholangiopancreatography (ERCP) procedures are particularly concerning due to their association with post-procedure cholangitis in 2 to 4% of cases. Additionally, ERCP procedures have been linked to outbreaks caused by multi-drug-resistant bacteria, specifically carbapenem-resistant Enterobacterales, which are challenging to treat and carry high morbidity and mortality rates. Structural modifications to duodenoscopes intended to facilitate physicians’ work have inadvertently complicated the reprocessing of these devices. 5-8 

Endoscopes can harbor microorganisms that may cause infections if not properly reprocessed. Moreover, even with adequate reprocessing, there may still be microorganisms present in the equipment that is ready for use.9 

Biofilms play an important role in the contamination of endoscopic reprocessing. Inadequate removal of biofilms and improper storage of endoscopes can affect the effectiveness of the process.10-13 

Endoscopic reprocessing requires the application of appropriate reprocessing procedures at every stage, including cleaning, disinfection, storage, and documentation for traceability, as regulated by standards.14-16 

Flexible endoscopy encompasses a large variety of heat sensitive, complex and intensively used medical devices with high risk for patients.22 

Optimizing the reprocessing of flexible endoscopes presents various challenges. To address these, it is important to enhance the expertise of professionals, improve endoscopic reprocessing units, reconsider the classification of flexible endoscopes within the Spaulding system, and consider implementing sterilization.17-21 

References :

  1. Ponsky JL, Strong AT. A History of Flexible Gastrointestinal Endoscopy. Surg Clin North Am. 2020;100(6):971-992. doi:10.1016/j.suc.2020.08.013
  2. Kurniawan N, Keuchel M. Flexible Gastro-intestinal Endoscopy – Clinical Challenges and Technical Achievements. Comput Struct Biotechnol J. 2017;15:168-179. Published 2017 Jan 18. doi:10.1016/j.csbj.2017.01.004
  3. Săftoiu A, Hassan C, Areia M, et al. Role of gastrointestinal endoscopy in the screening of digestive tract cancers in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy. 2020;52(4):293-304. doi:10.1055/a-1104-5245
  4. Grand View Research. Endoscopy Procedures Estimates Market Size Report, 2030. Published 2024. Accessed April 7, 2025. https://www.grandviewresearch.com/industry-analysis/endoscopy-procedures-estimates-market-report.
  5. The Lancet Gastroenterology Hepatology. Scoping the problem: endoscopy-associated infections. Lancet Gastroenterol Hepatol. 2018;3(7):445. doi:10.1016/S2468-1253(18)30168-7
  6. Spach, D. H., Silverstein, F. E., & Stamm, W. E. (1993). Transmission of infection by gastrointestinal endoscopy and bronchoscopy. Annals of internal medicine, 118(2), 117–128. https://doi.org/10.7326/0003-4819-118-2-199301150-00008
  7. Haak J, Klempien I, Hans JB, et al. Endoscope-associated outbreak of OXA-181-carbapenemase-producing Klebsiella pneumoniae and its implications for hygiene management. J Hosp Infect. 2025;158:19-28. doi:10.1016/j.jhin.2025.01.016
  8. Ofstead CL, Dirlam Langlay AM, Mueller NJ, Tosh PK, Wetzler HP. Re-evaluating endoscopy-associated infection risk estimates and their implications. Am J Infect Control. 2013;41(8):734-736. doi:10.1016/j.ajic.2012.10.008
  9. Epstein, L., Hunter, J. C., Arwady, M. A., Tsai, V., Stein, L., Gribogiannis, M., Frias, M., Guh, A. Y., Laufer, A. S., Black, S., Pacilli, M., Moulton-Meissner, H., Rasheed, J. K., Avillan, J. J., Kitchel, B., Limbago, B. M., MacCannell, D., Lonsway, D., Noble-Wang, J., Conway, J., … Kallen, A. J. (2014). New Delhi metallo-β-lactamase-producing carbapenem-resistant Escherichia coli associated with exposure to duodenoscopes. JAMA, 312(14), 1447–1455. https://doi.org/10.1001/jama.2014.12720
  10. Larsen, S., Russell, R. V., Ockert, L. K., Spanos, S., Travis, H. S., Ehlers, L. H., & Mærkedahl, A. (2020). Rate and impact of duodenoscope contamination: A systematic review and meta-analysis. EClinicalMedicine, 25, 100451. https://doi.org/10.1016/j.eclinm.2020.100451
  11. Roberts CG. The role of biofilms in reprocessing medical devices. Am J Infect Control. 2013;41(5 Suppl):S77-S80. doi:10.1016/j.ajic.2012.12.008Zong Z, Li M, Li J, et al. A study of the efficacy of bacterial biofilm cleanout methods for endoscope reprocessing. J Clin Microbiol. 2010;48(6):1898-1903. doi:10.1128/JCM.06221-11
  12. Zong Z, Li M, Li J, et al. A study of the efficacy of bacterial biofilm cleanout methods for endoscope reprocessing. J Clin Microbiol. 2010;48(6):1898-1903. doi:10.1128/JCM.06221-11. ​ASM Journals+2PMC+2giejournal.org+2
  13. Alfa MJ, Singh H. Impact of wet storage and other factors on biofilm formation and contamination of patient-ready endoscopes: a narrative review. Gastrointest Endosc. 2020;91(2):236-247. doi:10.1016/j.gie.2019.08.043.
  14. Association for the Advancement of Medical Instrumentation. ANSI/AAMI ST91:2021. Flexible and semi-rigid endoscope processing in health care facilities. Arlington, VA: Association for the Advancement of Medical Instrumentation; 2021.
  15. Day LW, Muthusamy VR, Collins J, et al. Multisociety guideline on reprocessing flexible GI endoscopes and accessories [published correction appears in Gastrointest Endosc. 2021 Nov;94(5):1019. doi: 10.1016/j.gie.2021.09.026.]. Gastrointest Endosc. 2021;93(1):11-33.e6. doi:10.1016/j.gie.2020.09.048
  16. Beilenhoff U, Biering H, Blum R, et al. Reprocessing of flexible endoscopes and endoscopic accessories used in gastrointestinal endoscopy: Position Statement of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology Nurses and Associates (ESGENA) – Update 2018. Endoscopy. 2018;50(12):1201-1219.
  17. Ofstead CL, Hopkins KM, Buro BL, Eiland JE, Wetzler HP. Challenges in achieving effective high-level disinfection in endoscope reprocessing. Am J Infect Control. 2020;48(3):309-315. doi:10.1016/j.ajic.2019.09.013
  18. Varghese MM, Memic S, Torres-Teran MM, Cadnum JL, Rutala WA, Donskey CJ. Evaluation of a new technology for terminal sterilization of flexible endoscopes using hydrogen peroxide gas plasma. Infect Control Hosp Epidemiol. Published online January 27, 2025. doi:10.1017/ice.2024.236
  19. Patel A, Jain N. Flexible Endoscopes: Terminal Sterilization and Impact to Patient Safety. Biomed Instrum Technol. 2020;54(s1):80-83. doi:10.2345/0899-8205-54.s3.80
  20. Omidbakhsh N, Manohar S, Vu R, Nowruzi K. Flexible gastrointestinal endoscope processing challenges, current issues and future perspectives. J Hosp Infect. 2021;110:133-138. doi:10.1016/j.jhin.2021.01.021
  21. Ofstead CL, Smart AG, Hurst LL, Lamb LA. Endoscope processing effectiveness: A reality check and call to action for infection preventionists and clinicians.  Am J Infect Control. Published online April 9, 2025. doi:10.1016/j.ajic.2025.04.003
  22. World Federation for Hospital Sterilization Sciences: WFHSS Guidelines (Chapter 9) – Flexible Endoscopy Reprocessing Principles – https://guidelines.wfhss.com/frontpage/flexible-endoscopy/, accessed on 8/4/2025
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