Webinar - Biofilm in Endoscopy

Author: Cheri Ackert-Burr, RN, DNP, BAED, CNS, CNOR, AGTS



Every patient is entitled to a perfectly clean, pathogen free endoscope. Strict adherence to current guidelines should ensure this, but the emergence of biofilm as a factor in endoscope contamination must be acknowledged. Ongoing studies will dictate changes in policy and practice. This independent study activity is intended to explore the impact of biofilm in the Endoscopy Unit and encourage participants to implement necessary changes in their own practice area.

Target Audience

This independent study is intended primarily for RNs with an interest in the prevention of cross-contamination and infection caused by biofilm in GI Endoscopy practice. Perioperative nurses may also benefit. It will also be of interest to GI nursing associates, allied healthcare personnel and MDs involved in endoscopy.

Learner Objectives

Upon completion of this presentation, participants will be able to:

  1. Discuss the concept of biofilm communities in industry and in the human body
  2. Explain the relationship between biofilm and endoscope contamination
  3. Relate findings from studies and literature to clinical area observation and practice
  4. State three best practices of disinfection which are particularly important in biofilm elimination
Teaching Methodology

Participants will complete the web-based learning activity. They will read the article, then register to take the post-test and complete the evaluation on the website. They will submit the documentation as directed. A bibliographic reference is included for those wishing additional information.

Contact Hours

Upon completion of the entire program, achieving a score of 80% on the post-test, and submission of required documentation, participants will be granted 1 contact hour. No partial credit will be granted.


Provider approved by the California Board of Registered Nursing, Provider Number 08747, the District of Columbia Board of Nursing, Provider Number 50-574, the Florida Board of Registered Nursing, Provider Number 50-574, the Georgia Board of Registered Nursing, Provider Number 50-574 and the West Virginia Board of Examiners for Registered Professional Nurses, Provider Number 50-26112.

It is the responsibility of the licensee to verify acceptance of contact hours for relicensure.

ABCGN: According to the criteria of the American Board of Certification for Gastroenterology Nurses, the approved hours in this activity are are considered GI Specific (Category 5) for the purpose of recertification by contact hours through the ABCGN.  

CBSPD: This program has been pre-approved by the Certification Board for Sterile Processing and Distribution for 1.0 contact hour.

IAHCSMM: This program has been approved by the International Association of Healthcare Central Service Materiel Management for 1.0 contact hour.

NCCT: This program is acceptable for surgical technologist recertification by the National Center for Competency Testing.

  1. Successful completion: Participants will read the module, then register online, achieve a score of 80% on the post-test and submit required documentation. An active printer connection is required to print the certificate of completion. 
  2. Conflict of interest: Planners disclose no conflict of interest. The author is a consultant working independently to provide nursing education in endoscopy and infection prevention. As a paid consultant, the author has declared affiliations that could be perceived as posing a potential conflict of interest. In the interest of quality CNE, the author has signed a statement agreeing to present information fairly and without bias.
  3. Commercial company support: Fees are underwritten by education funding provided by Cantel Medical. 
  4. Non-commercial company support: None.
  5. Alternative/Complementary therapy: None
Certificate Issue / Replacement

Participants successfully completing the activity and submitting required documentation will be permitted to print a certificate of completion. Participants are advised to retain the certificate for eight years following activity completion.

Replacement of misplaced certificate is available from Educational Dimensions. There is a fee for this service. Request a replacement by contacting us.

Guide to Study

Detailed instructions for completing this iLearning activity

The following steps will assist you in your successful completion of this eLearning Activity.

  1. Read the content or view the recorded presentation. If you want contact hours at the completion of studying the eLearning material, you will be required to register, complete an evaluation and take a post-test prior to printing your Certificate of Completion. We urge you to complete the eLearning activity once you have started. However, if you do need to come back later, you can sign in with your email and eLearning ID.
  2. First Time Visitors will be asked to register using an email address as your User Name. Make a note which email address you have used. Then you will create an eLearning ID using a combination of at least 6-10 letters or numbers. Please make a note of your eLearning ID and if for some reason you forget, you may request that your eLearning ID be sent to you. The web site is secured by Trustwave.
  3. Return Visitors: If you have registered already you do not need to register again. Just Sign In using your email and eLearning ID.
  4. Evaluation Form: Once you have registered or signed in you will be asked to complete an evaluation form and submit it. This is required to obtain the Certificate of Completion.
  5. Post-test: A post-test, based on the content of the eLearning activity, will need to be taken. A passing score of 80% is required. This is required to obtain the Certificate of Completion.
  6. Printing Your Certificate of Completion: Once you have successfully passed the post-test you will be able to print your Certificate of Completion. You will be given an opportunity to verify the information that will be printed on your certificate. Please make sure your printer is ready to print. You will not have access to the certificate page on later visits unless you contact us. Once you choose to print the Certificate of Completion, it will not be possible to make corrections. To obtain a corrected certificate you will need to contact Educational Dimensions. Fees may apply.
  7. Browser recommendations: We require using an up-to-date browser with JavaScript enabled. You must enable cookies from this site in order to access the secure areas.
  8. If you encounter any technical problems during this eLearning activity, please contact us.

iLearning Activity

Suggested Readings
  1. Alfa M.J., Howie R., "Modeling microbial survival in buildup biofilm for complex medical devices," BMC Infectious Disease, May 2009, 8(9): 56.
  2. Aumeran et al., "Multidrug-resistant Klebsiella pneumoniae outbreak after endoscopic retrograde cholangiopancreatography," Endoscopy, 2010; 42(11): 895-899.
  3. Buckingham-Meyer, K., Goeres, D.M. and Hamilton, M.A. "Comparative evaluation of biofilm efficacy tests," Journal of Microbiological Methods, August 2007; 20(2): 236-244.
  4. Donlan, R., Costerton, J., "Biofilms: Survival Mechanisms of Clinically Relevant Microorganisms," Clinical Microbiology Reviews, April 2002; 15(2): 167–193.
  5. Habash, M., Reid, G., "Microbial Biofilms: Their Development and Significance for Medical Device-Related Infections," Journal of Clinical Pharmacology, 1999; 39:887-898.
  6. Kovaleva J., et al., "Mimicking disinfection and drying of biofilms in contaminated endoscopes," Journal of Hospital Infection, December 2010; 76(4): 345-350.
  7. McLaughlin-Borlace, L., Stapleton, F., Matheson, M., Dart, J.K.G., "Bacterial biofilm on contact lenses and lens storage cases in wearers with microbial keratitis," Journal of Applied Microbiology, 1998; 84: 827–838.
  8. Muscarella, L., "Investigation and prevention of infectious outbreaks during endoscopic retrograde cholangiopancreatography," Endoscopy, 2010; 42: 957-959.
  9. Nelson, D. B., Jarvis, W. R., Rutala, W. A., et al., (2003). "Multi-society guideline for reprocessing flexible gastrointestinal endoscopes," Infection Control and Hospital Epidemiology, 24(7), 532-537. This document is also known as "The SHEA (Society for Healthcare Epidemiology of America) Document".
  10. Pajkos, A., Vickery, K., Cossart, Y., "Is biofilm accumulation on endoscope tubing a contributor to the failure of cleaning and decontamination?" Journal of Hospital Infection, 2004; 58: 224-229.
  11. VanHaecke, E., Remon, J.P., Moors, M., Raes, F., DeRudder, D., VanPeteghem, A., "Kinetics of Pseudomonas aeruginosa Adhesion to 304 and 316-L Stainless Steel: Role of Cell Surface Hydrophobicity", Applied and Environmental Microbiology, March 1990; 56 (3): 788-795.
  12. Whiteley, R.K., Pajkos, A., Vickery, K., "Biofilms and their importance in infection control," Journal of Gastroenterological Nurses College of Australia, 2001; 11 (3): 18-22.

Internet References
"Life Sciences: Biofilms, friend or foe?" EUROPA: European Commission, published 11/19/2007, accessed 12/2010.

"FDA-Cleared Sterilants and High Level Disinfectants with General Claims for Processing Reusable Medical and Dental Devices - March 2009", accessed 1/2011.

Photographic References
Lewis, D.L., Environmental Research Laboratory, US Environmental Protection Agency, Athens, GA 30613, USA

Dirckx, P., Center for Biofilm Engineering, Montana State University



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