Discover how healthcare professionals redesigned protocols and validated safety measures to continue essential endoscopic procedures during a global health crisis.
When the COVID-19 pandemic swept across the globe in early 2020, healthcare facilities faced an unprecedented challenge: how to continue providing essential medical services while protecting both patients and staff from a highly contagious virus. Nowhere was this dilemma more acute than in endoscopy units, where doctors perform procedures using flexible tubes with cameras to examine the digestive and respiratory systems.
Endoscopes have multiple channels and crevices that could theoretically harbor viral particles between patients 2 .
This is the story of how medical professionals rapidly redesigned entire service delivery systems, validated new safety protocols, and ensured that life-saving diagnostic procedures could continue even during the height of a global health emergency.
Facing this new threat, endoscopy units couldn't operate as usual. The University Hospital of Pisa in Italy, designated as a COVID-19 referral center, implemented a multidisciplinary task force to completely redesign their workflow 2 6 .
Patients underwent SARS-CoV-2 testing via nasopharyngeal swabs or other samples shortly before their procedures 2 .
Screening for COVID-19 symptoms like fever, cough, fatigue, loss of taste or smell, and gastrointestinal issues 6 .
Rescheduling non-urgent elective procedures while maintaining emergency and essential cancer-related endoscopies 6 .
Healthcare workers in endoscopy units faced significant exposure risks, particularly during procedures on the upper digestive tract and airways.
Based on protocols from 6
Endoscope reprocessing refers to the meticulous multi-step cleaning and disinfection process that all reusable endoscopes must undergo between patients. Even before COVID-19, reprocessing was critically important because endoscopes come into contact with mucous membranes and internal body fluids 2 .
While standard reprocessing protocols are effective against many pathogens, the pandemic prompted hospitals to verify and often enhance their approaches specifically for SARS-CoV-2.
Despite theoretical confidence in these enhanced protocols, the healthcare community demanded scientific proof. Researchers at the University Hospital of Pisa designed and executed a crucial experiment to verify the efficacy of their endoscope reprocessing against SARS-CoV-2 1 2 6 .
The experimental results provided much-needed reassurance to the endoscopic community:
| Sample Type | Number Tested | Positive for SARS-CoV-2 | Viral Elimination Efficacy |
|---|---|---|---|
| Bronchoscopes | 5 | 0 | 100% |
| Gastroscopes | 6 | 0 | 100% |
| Colonoscopes | 5 | 0 | 100% |
| Washer-Disinfectors | 2 | 0 | 100% |
| Environmental Surfaces | Multiple | 0 | 100% |
Most significantly, all samples collected from endoscopes after reprocessing tested negative for SARS-CoV-2 1 6 .
| Reprocessing Step | Standard Protocol | Enhanced COVID-19 Protocol |
|---|---|---|
| Pre-cleaning solution | Standard enzymatic detergent | Enhanced virucidal detergent |
| Contact time with disinfectant | Manufacturer's minimum | Extended contact time |
| Environmental cleaning | Standard frequency | Enhanced frequency |
| Staff training | Periodic | Enhanced and more frequent |
| Quality verification | Bacterial culture | Viral PCR testing added |
"The improvement in endoscope reprocessing implemented during the COVID-19 emergency was effective in ensuring the absence of SARS-CoV-2, thus reducing the risk of infections after an endoscopy on COVID-19 patients" 1 .
The successful verification of endoscope reprocessing relied on several specialized reagents and equipment.
| Item | Function | Specific Example |
|---|---|---|
| Viral transport media | Preserve viral integrity during sampling | eSwab 490 CE COPAN swabs 1 |
| Sample concentration devices | Increase detection sensitivity | Macrosep Advance Centrifugal Devices 1 6 |
| SARS-CoV-2 detection | Identify viral RNA | cobas® SARS-CoV-2 Test (Roche) 1 6 |
| Washer-disinfector equipment | Automated high-level disinfection | Soluscope series 4 6 |
| High-level disinfectant | Destroy viruses and other pathogens | Peracetic acid at 900 ppm 6 |
| Cleaning solutions | Remove organic material | Neo Proteozim Plus 500 6 |
Advanced detection methods to identify even trace amounts of viral RNA
Specialized equipment for automated cleaning and disinfection
Application of validated protocols in real healthcare settings
The COVID-19 pandemic forced rapid innovation in endoscopy safety protocols, leading to validated approaches that protected both patients and healthcare workers during a vulnerable time. The comprehensive research demonstrated that with proper protocols, endoscopic procedures could be performed safely even on infectious patients.
The lessons learned extend far beyond the current pandemic. These evidence-based protocols continue to protect patients not just from SARS-CoV-2, but from countless other pathogens that could otherwise find their way from one patient to another through medical equipment.
The scientific verification done during this crisis thus represents a lasting contribution to medical safety—proving that even in darkness, we can find ways to shine a light forward.