Endoscope processing effectiveness: A reality check and call to action for infection preventionists and clinicians

BACKGROUND: Flexible endoscopes are heavily exposed to blood, mucus, and other secretions during procedures and may harbor billions of microbes before processing. Guidelines recommend thorough cleaning and sterilization or high-level disinfection (HLD) after each use. METHODS: This review describes evidence on the effectiveness of HLD from a robust review of peer-reviewed journals, adverse events reports posted by the Food and Drug Administration, and other government reports published during 2019-2024. RESULTS: Although HLD theoretically eliminates viruses, fungi, and bacteria (except a few resilient spores), numerous studies found it did not reliably eliminate microbes in real-world settings, and a large proportion of endoscopes harbored substantial bioburden and potential pathogens. Dozens of endoscopy-associated outbreaks have been reported in the past 5years, including several involving multidrug-resistant organisms. When contaminated endoscopes or endoscopy-associated infections were discovered, investigators commonly found that personnel were skipping essential steps or doing them improperly. DISCUSSION: To reduce infection risk and enhance patient safety, infection preventionists, clinicians, sterile processing and departmental managers, and other leaders should review the evidence, perform risk assessments, and implement proactive strategies for quality improvement in their facilities.