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.
Ofstead’s literature review highlights that even when endoscope reprocessing is done in accordance with current guidelines, contamination often persists. This includes the presence of organic residues and viable microorganisms, which pose a risk of infection transmission.
Many healthcare facilities struggle to maintain consistent adherence to reprocessing protocols. Factors include inadequate training, time constraints, and lack of standardized procedures, which contribute to variability in outcomes.
The complex design of endoscopes, including duodenoscopes, makes them difficult to clean effectively to ensure that HLD or sterilization eliminate microbes. Biofilms can form inside channels, shielding pathogens from disinfectants and increasing the risk of patient exposure.
To reduce the risk of reprocessing failures, the review recommends multifaceted interventions including extensive training and competency testing for technicians, audits, optimizing cleaning to prevent the accumulation of soil and biofilm, and moving toward sterilization.
Visual inspection is key to evaluating the effectiveness of pre-cleaning, manual cleaning, HLD or sterilization, drying, and storage. Tools such as lighted magnification and borescopes are essential for detecting endoscope defects and identifying suboptimal practices.
The author urges infection preventionists and clinicians to advocate for improved training, better equipment design, and institutional investment in quality assurance programs. The goal is to shift from a compliance mindset to a safety-first culture.
This is the second webinar dedicated to “Endoscope processing effectiveness: A reality check and call to action!”, presented by ASP Continuous Education.
26th June 2025
- Ofstead & Associates, Inc. CEO since 1996
- Epidemiologist with a Master of Science in Public Health degree
30 years of experience in real-world research on infection prevention and device processing - Often published in PROCESS, AJIC, CHEST, Endoscopy International Open, Journal of Urology, AORN Journal ,and AAMI’s BI&T.
- Reviewer for several peer-reviewed journals and serves on AJIC’s editorial board.
- Leading device processing and infection control educator and highly regarded speaker at local, national, and international conferences, including APIC, ID Week, CDC’s immunization summit and international conference on emerging infectious diseases, ANSI/AAMI, AORN, HSPA, SGNA, ASGE, AGA, and FDA.
- Developed and taught numerous continuing education sessions.
- Active AAMI Workgroup 84 voting member who contributed to ST91 and TIR99
Consider whether HLD is sufficient for patient safety… consider the benefits moving towards sterilization.
What can you do to make endoscope reprocessing safer? Do something!
Have a plan for getting started. Dare to look into your processes and your scopes. Meet with stakeholders to develop strategies.
- Reprocessing Often Fails in Real-World Settings – Despite adherence to current guidelines, high-level disinfection frequently fails to eliminate microbial contamination from endoscopes, causing outbreaks of infection. This highlights a critical gap between protocol and practice.
- Biofilm and Device Design Complicate Cleaning – The intricate design of flexible endoscopes—including duodenoscopes—makes them prone to biofilm formation, which protects microbes from disinfectants and increases infection risk.
- Routine Surveillance and Auditing Are Essential – The article calls for routine visual inspection and audits of reprocessing practices. These measures may contribute to optimizing reprocessing outcomes.
- Training and Accountability Must Improve – Inconsistent staff training, lack of competency assessments, and time pressures contribute to reprocessing failures. Institutions should invest in education, oversight, and accountability.
- Benefits of Sterilization – Sterilization provides a larger margin-of-safety and higher reduction in microbial load than HLD, and offers other benefits. These include the automation of critical steps, the elimination of risks associated with storing wet scopes, and the prevention of post-reprocessing contamination during storage.
- A Cultural Shift Is Needed – The researchers urge a shift from a compliance-based mindset to a safety-first culture. Infection preventionists and clinicians should advocate for systemic improvements and evidence-based practices to improve patient safety.
