iLearning Recorded Webinar
Risk Analysis: Identifying Practice Gaps

Utilizing Today's Guidelines and Evidence Based Practice in Endoscope Reprocessing



The purpose of this recorded webinar is to present information on potential practice gaps where reprocessed or patient-ready scopes can be recontaminated before use on the next patient.  This session will utilize the current established professional guidelines and best practices to develop a risk analysis of endoscope reprocessing.  Each of the nine steps of flexible endoscope reprocessing will be evaluated and discussed to allow the participant to establish their current level of infection risk, exposure or transmission to patients, using evidence-based practice to support each step.  An assessment tool will be reviewed during the presentation.

Target Audience

This CNE activity is intended primarily for RNs with a responsibility for or an interest in endoscope processing and ensuring safe patient care in the endoscopy suite. The presentation will also be of interest to allied healthcare personnel and MDs involved in endoscopy.

Learner Objectives

Upon completion of this presentation, participants will be able to:
1) Explain evidence-based practice and its application in professional society guidelines to support GI practice recommendations.
2) Review supporting research evidence in each of the nine steps in flexible endoscope reprocessing to determine how improper techniques can impact patient safety in the GI Suite
3) Discuss steps needed to complete an assessment of the GI suite when preparing for an audit.

Teaching Methodology

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

Contact Hours

Upon successful completion of the entire online program 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 view 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 eLearning 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.


Recorded Webinar Video

Suggested Readings

AAMI (2011). TIR 30: A compendium of processes, materials, test methods, and acceptance criteria for cleaning reusable medical devices. Arlington, VA: Association for the Advancement of Medical Instrumentation.

Alfa, M.J. (2000). Methodology of reprocessing reusable accessories. Gastrointestinal Clinics of North America, 10 (2), 361-378.

Alfa, M.J. (2013). Monitoring and improving the effectiveness of cleaning medical and surgical devices. American Journal of Infection Control, 41 (S56-S59).

Alfa, M.J. (2006). Automated washing with the Reliance Endoscope Processing System and its equivalence to optimal manual cleaning. American Journal of Infection Control, 34 (9), 561-70.

Alfa, M.J., Olson, N., DeGagne, P., Jackson, M. (2002). A survey of reprocessing methods, residual viable bioburden, and soil levels in patient-ready endoscopic retrograde cholangiopancreatography duodenoscopes used in Canadian Centers. Infection Control Hospital Epidemiology, 23 (4), 198-206.

Alfa, M.J., Singh, H., Duerksen, D.R., Schultz, G., Reidy, C., DeGagne, P., Olson, N. (2017). Improper positioning of the elevator lever of duodenoscopes may lead to sequestered bacteria. American Journal of Infection Control, S0196-6553 (17) 30908-2. doi: 10.1016/j.ajic.2017.07.021.

ANSI/AAMI ST91 (2015). Flexible and semi-rigid endoscope processing in healthcare facilities. Retrieved from

Bajolet, O., Ciocan, D., Vallet, C., et al. (2013). Gastroscopy-associated transmission of extended-spectrum beta-lactamase-producing Pseudomonas aeruginosa. Journal of Hospital Infection, 83 (4), 341-343.

British Society of Gastroenterology (2014). Guidance on decontamination of equipment for gastrointestinal endoscopy. (external link)

CDC (2018). Healthcare Infection Control Practices Advisory Committee (HICPAC). (external link)

Kovaleva, J., Peters, F.T., van der Mei, H.C., Degener, J.E. (2013). Transmission of infection by flexible gastrointestinal endoscopy and bronchoscopy. Clinical Microbiology Reviews, 26 (2), 231-254.

Lind, N., Ninemeier, J.D., Bird, B.T. (2007). Central Service Technical Manual. Chicago, IL: IAHCSMM.

Marion, K., Freney, J., James, G., Bergeron, E., Renaud, F.N., Costerton, J.W. (2006). Using an efficient biofilm detaching agent: an essential step for the improvement of endoscope reprocessing protocols. Journal of Hospital Infection, 64 (2), 136-142

Merritt, K., Hitchins, V.M., Brown, S.A. (2000). Safety and cleaning of medical materials and devices. Journal Biomedical Materials Research, 53 (2), 131-136.

Molina-Navarro, C., Bhatia, B.S., Awogu, O., Ochai, J. (1999). The re-use of irrigating equipment for flexible cystoscopy is not safe. British Journal Urology (International), 83 (9), 948-53.

Muscarella, L.F. (2006). Inconsistencies in endoscope-reprocessing and infection-control guidelines: the importance of endoscope drying. American Journal of Gastroenterology, 101 (9), 2147-2154.

Pajkos, A., Vickery, K., Cossart, Y. (2004). Is biofilm accumulation on endoscope tubing a contributor to the failure of cleaning and contamination? Journal Hospital Infection, 58 (3), 224-229.

Parente, D. (2007). Could biopsy port valves be a source for potential flexible endoscope contamination? Infection Control Today, 11 (6).(external link)

Roberts, C.G. (2013). The role of biofilms in reprocessing medical devices. American Journal of Infection Control, 41 (5 Suppl), 577-580.

United Kingdom Department of Health (2016). Choice framework for local policy and procedures 01-06: Decontamination of flexible endoscopes: operational management. pp. 10,15, 19, 30-42v (external link)



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