Proper reprocessing of flexible endoscopes in gastroenterology practice is a critical element of a comprehensive patient safety and infection control strategy in both the inpatient and outpatient healthcare setting. This effort requires an interprofessional approach consisting of collaboration between the endoscopist and multiple other facility stakeholders including reprocessing professionals, nursing, infection prevention and control, biomedical engineering, and patient safety professionals. Recent advancements in human factors engineering has demonstrated a high reliability in validated and standardized reprocessing efforts for flexible endoscopes with properly trained reprocessing personnel and appropriate resources to execute the overall reprocessing process. A continued and concerted effort must be paid to maintaining the safety of these devices through focus on personnel, processes, and a continued innovative engineering of the devices themselves. While flexible endoscopes play a pivotal role in delivering diagnostic and therapeutic medical capabilities to endoscopists, their use is not without risk and require a comprehensive approach to medical device hygiene and integrated infection prevention and control.

The duodenoscope, a complex endoscopic instrument, is frequently utilized to accomplish the increasing demand for minimally invasive treatments of pancreatic and biliary diseases. It is, in addition, the fundamental tool used to perform endoscopic retrograde cholangiopancreatography (ERCP). However, outbreaks of multidrug resistance organism transmission have occurred in patients undergoing ERCP while adherent to current endoscope manufacturers’ reprocessing guidelines. Evolving evidence suggests that implementation of the current protocols is inadequate to guarantee a pathogen-free duodenoscope. In spite of infection risk, ERCP remains a critical platform in the management of patients with pancreaticobiliary diseases. This manuscript reviews the history and epidemiology of recent duodenoscope-related infections, current challenges to scope reprocessing, and recommendations by regulatory agencies.

Outbreaks of infections related to duodenoscope use have brought attention to the important topic of endoscope reprocessing. Much work has been done to understand why these outbreaks occurred and how to prevent them; however, the adequacy of duodenoscope reprocessing has not been ensured to date. This review summarizes current techniques in duodenoscope reprocessing and future directions to eradicate endoscopically transmitted infections.

In the wake of several highly publicized endoscope-associated multidrug-resistant organism (MDRO) outbreaks, healthcare providers have focused on understanding and improving endoscope reprocessing practices. Microbiological culture of endoscopes has emerged as a critical tool in support of these efforts. As healthcare providers increasingly rely on microbiological culture results to make decisions that impact patient safety, it is important to understand the limitations of the methodology as well as the factors that may impact results. The use of traditional cultures in combination with molecular methods has enabled the investigation of disease transmission during outbreaks. With increased prevalence of MDROs, advanced molecular techniques like whole-genome sequencing provide high resolution data and information on the entire bacterial genome that are needed for thorough investigations and management of transmission events. Elucidation of the true burden of postprocedure patient colonization and infection would benefit from improved clinical lab access to molecular biology tools. Molecular biology tools would facilitate detection of emerging MDROs and ever-increasing diversity of antibiotic resistance genes. Implementation of postprocedure surveillance programs aimed at early recognition of colonized and infected patients could improve appropriate management of endoscope infected patients and guide infection prevention measures to prevent the spread of MDROs.

Endoscopic Retrograde Cholangiopancreatography (ERCP) provides an important medical procedure for patients in a generally safe and effective manner. It can be technically complex, often performed during serious illness, and has the highest potential complication rate of procedures commonly performed by gastroenterologists. The issue of duodenoscope-related infections has been more recently added the list of potential ERCP adverse events. This chapter will take a risk management approach to help the endoscopists understand and manage the risks associated with ERCP, with particular concentration on duodenoscope-related infections. This chapter is written for educational purposes only and cannot be considered legal advice. For specific legal advice, one should consult a health care attorney.

The quality of the endoscopy training varies greatly around the world. Some of this variation may be due to a lack of conscious competence of the trainer, but also the lack of appreciation of how early ergonomic training can influence learning and skills acquisition for the trainee. Ergonomics can either facilitate or negatively impact performance during training and influence potential in independent practice.This chapter focuses on the importance of human factors and ergonomics training to the early endoscopist to optimizing patient outcomes and minimizing risk to the endoscopist. Effective training requires preparation and structure; an educational contract helps create this. Integral to this is ensuring that the agendas of both trainer and the trainee are aligned, along with an approach to the development of realistic learning objectives. These principles are covered in addition to exploring the methods of teaching optimal scope handling. Trainee progression is linked to effective, performance-enhancing feedback. A pragmatic approach to providing effective feedback is suggested.

The endoscopy suite is the central hub of activity where most gastroenterologists spend a majority of their time in clinical practice. With the evolution of more complex diagnostic and therapeutic procedures, an ergonomically designed and dedicated gastrointestinal endoscopic unit is not only desirable but a necessity. Such a unit will ensure optimal workflow efficiency and throughput, as well as both patient and physician safety. It is important to plan meticulously upfront by seeking input from all stakeholders including engineers, physicians, nurses, technicians and architects. This will ensure a highly desirable work environment including procedural areas and the scope cleaning/sterilization section while optimizing patient and instrument flow. The procedure room should be ergonomically designed to allow for adjustability and optimize utilization of space for endoscopists, technicians, nurses, anesthesiologists, and trainees as well as the equipment required to perform the endoscopic procedures. This article provides practical tips on how to plan and develop an endoscopy suite, taking into consideration ergonomic and regulatory aspects, and is based on real life experience with designing a modern gastroenterology procedural suite.

Physician burnout is an increasingly recognized syndrome which not only negatively affects physicians but has a detrimental impact on the overall healthcare system; similar to other physicians, gastroenterologists are susceptible to burnout due to multiple competing responsibilities. Avoiding and treating burnout must utilize a multifaceted approach to enhance recognition among physicians and peers, identify triggers and potential solutions, promote optimal coping mechanisms, and correct systemic issues. While as a medical community we have raised awareness regarding burnout, continued efforts are needed to develop modalities to prevent and mitigate burnout.