Endoscope-associated infections: A brief summary of the current state and views toward the future

World-wide reports of duodenoscope-associated outbreaks of multidrug resistant micro-organisms are an indication that transmission of infection via contaminated endoscopes occurs more frequently than previously thought. To reduce the incidence of endoscope contamination, open communication between manufacturers, institutions, and government agencies is urgently needed. Endoscope risk factor studies and thorough investigation of outbreaks by experts are instrumental in lowering and ultimately eliminating infections. These studies should yield improvements in endoscope design, endoscope reprocessing, as well as hospital surveillance and infection control measures. Current reprocessing methods have a very small margin of safety, allowing no room for error. Strictly following the manufacturer's instructions regarding reprocessing does not adequately guarantee complete removal of micro-organisms. New reprocessing measures to reduce contamination show promising results, but they are costly to implement and do not assure zero contamination risk. Redesign of endoscopes to facilitate better cleaning and ultimately sterilization instead of disinfection might provide a solution. Going forward, the focus should extend beyond the forceps elevator to include the entire instrument since every aspect of the duodenoscope can be contaminated by infectious organisms. Single-use duodenoscopes would completely eliminate the risk of transmission of exogenous micro-organisms, but they not the Food and Drug Administration-approved, and are likely to be costly and of unproven efficacy. Indeed, balancing cost-effectiveness of any redesign or use of disposable endoscopes with the actual risk of transmitting exogenous micro-organisms will ultimately determine which solutions are adopted and utilized.