The issue of patient-to-patient transmission of infection during endoscopic retrograde cholangiopancreatography (ERCP) continues to evolve. The occurrence of carbapenem-resistant Enterobacteriaceae infections after ERCP reached the awareness of the medical community in 2014 when the Centers for Disease Control and Prevention (CDC) published the findings of their investigation of a suburban Chicago case cluster.1,2 In early 2015, reports of similar outbreaks at several major medical centers across the United States prompted the US Food and Drug Administration (FDA) to issue safety alerts3–5 and convene an FDA expert panel6; there was intense media attention and both the CDC7 and industry8 provided guidance regarding steps for ensuring safe clinical care in the absence of definitive solutions.