John Davis Bell‚MD, President
John Davis Bell‚MD President

Relative to infection control for patient safety, a recent study noted 71% of reusable medical scopes deemed ready for use on patients tested positive for bacteria at three major U.S. hospitals. The paper underscores the infection risk posed by commonly used endoscopes. It signals a lack of progress by manufacturers, hospitals and regulators in reducing contamination despite numerous reports of superbug outbreaks and patient deaths, experts say. The rates of infections after endoscopic procedures performed at ambulatory surgical centers in the U.S. are far higher than previously thought, according to Johns Hopkins researchers.1 This study is only one of many that has been published in a last three years signaling the frequency of failures in process, storage, and transportation hazards associated with endoscopy.

For example, another definitive article published in Gut indicates that at some outpatient sites, the risk for post-procedural infection can be up to 100 times higher than expected. This epidemiological study noted that infections have been thought to occur at a rate of approximately one per million endoscopic procedures. However, and surprisingly, the rate is actually slightly higher than 1 per 1000 for screening colonoscopy, about 1.6 per 1000 for non-screening colonoscopy, and greater than 3 per 1000 for esophagogastroduodenoscopy (EGD).2


Historically, infection control in the endoscopy unit has focused on reprocessing of endoscopes. Recently publicized documentation of infection related to GI endoscopy have highlighted the need to address other potential gaps in the endoscopy care continuum impacting patient safety. These areas requiring increased scrutiny include failure to follow established reprocessing guidelines, inadequate pre-cleaning methods, high level process failures, improper selection or dilution of disinfecting agents, inadequate staff training and quality assurance, lack of necessary equipment, and inadvertent re-contamination, cross-contamination, or both during storage and transport. In review of hundreds of healthcare facilities, AACI has shown that few if any endoscopy centers validate their process to assure that endoscopes reach their intended level of decontamination at point of use.


AACI’s contribution to this known patient hazard is a guideline for transport, decontamination (or sterilization), and storage of flexible and semi-rigid gastrointestinal endoscopes, bronchoscopes, and other surgical endoscopes (including ureteroscopes and choledochoscopes). For more information visit


  1. Cori L. Ofstead, MSPH , Otis L. Heymann, BA, Mariah R. Quick, MPH, John E. Eiland, RN, MS, Harry P. Wetzler, MD, MSPH: Residual moisture and waterborne pathogens inside flexible endoscopes: Evidence from a multisite study of endoscope drying effectiveness: American Journal of Infection Control: June 2018 (Volume 46, Issue 6, Pages 689–696)
  2. Wang, P. et. al. (Johns Hopkins), Rates of infection after colonoscopy and esophagogastroduodenoscopy in ambulatory surgery centres in the USA: Gut 2018;67:1626–1636.