Can ultrasound probes and coupling gel be a source of nosocomial infection in patients undergoing sonography? An in vivo and in vitro study.

Muradali, Derek; Gold, Wayne L.; Phillips, Anne; Wilson, Susan

doi:10.2214/ajr.164.6.7754907

Cited by 88 publications

(72 citation statements)

References 3 publications

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“…Our objective was to ascertain whether the current protocol for probes cleaning and skin disinfection in our units is adequate to prevent cross contamination. Our data show that removal of any visible gel trace by using a simple dry cleaning method of the probe ensures a safe interventional procedure with no septic side effects, results confirmed also by other recent studies [22,42]. Indeed, rigorous skin disinfection with both described alternatives assures safe injection conditions.…”

Section: Discussionsupporting

confidence: 88%

“…Repetitive use of the same transducer in different anatomic areas or between different patients, the small distance between the transducer and injection site raises the question for the true risk of septic complications when performing these kinds of manoeuvres [22][23][24][25][26]. On the other hand, sophisticated disinfection protocols are time consuming and expensive and, at the end, may limit the number of performing physicians.…”

Section: Introductionmentioning

confidence: 99%

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Musculoskeletal ultrasound guided manoeuvres – security profile

Micu¹,

Vlad

Bolboacă

et al. 2014

Med Ultrason

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Background: In daily rheumatology clinical practice, routine interventional musculoskeletal ultrasound (MSUS) guided maneuvers such as aspiration, intraarticular or periarticular drug injections require efficient cleaning and disinfection methods for both transducer and patient's skin. Aim: To study the efficacy of probe and skin disinfection measures after using simple protocols, to identify the prevalence of septic and other drug related side effects after MSUS guided interventions and to quantify the total procedure time. Material and methods: Recruitment of consecutive patients with different joint/ periarticular MSUS guided interventions was made in 3 medical centers. Bacterial load was determined on the transducers footprint after dry cleaning with the removal of any gel trace and on patient's skin after rigorous skin disinfection with either Bethadine or alcohol 70° and Bethadine. Non-sterile gel was used as an ultrasound transmission medium. The time spent for some of the invasive procedures was quantified. Results: Nine hundred and ninety eight MSUS guided interventional maneuvers were performed in 945 patients with inflammatory and degenerative musculoskeletal pathologies. Staphylococcus epidermidis was identified in 13.33% cases of the skin bacterial load analysis and in 37.50% cases of the footprint analysis. In two patients pathogenetic germs were detected on the skin. No septic post-procedural complications were reported. In 0.6% of the cohort other side effects occurred: aseptic osteonecrosis, skin depigmentation at injection site and iatrogenic microcristaline reactions. The median time frame dedicated to the intervention was 6 minutes. Conclusion: Rigorous transducer dry cleaning and Bethadine/ Bethadine and alcohol 70° skin disinfection are efficacious methods. The risk for septic complications and other drug related side effects related to MSUS guided injections is very low in this context. A correct injection technique must accompany the previous requests. Rapid and safe interventional maneuvers reduce the risks and control the costs of the healthcare system.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Musculoskeletal ultrasound guided manoeuvres – security profile

Micu¹,

Vlad

Bolboacă

et al. 2014

Med Ultrason

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“…The swab was immediately placed in a bottle of Brain Heart Infusion broth. This broth was poured onto a Blood Agar Plate [19], and 3) ultrasound probes were immersed in brain-heart infusion broth, which was then inoculated onto agar plates [20]. However, which methods are the most suitable for evaluating bacterial contamination of ultrasound probes remains to be determined Our previous study compared three methods of examining the sensitivity and reproducibility of bacterial detection: "Probe imprinting method" (in which the surface of an ultrasound probe was applied directly to 5% sheep blood agar plates), "Swab streaking method" (using sterile cotton swab moistened with sterile physiological saline, which was then applied to the surface of an ultrasound probe, and then streaked directly onto blood agar plates.…”

Section: Methods For Evaluating Bacterial Contamination Of Ultrasoundmentioning

confidence: 99%

Ultrasound probes as a possible vector of bacterial transmission

2013

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Ultrasound probes are usually in a direct contact with the skin when used for detecting pathologic abnormalities. The probe could be a vector of bacterial transmission, but there have been few studies on this topic. We have made such studies, briefly reviewing 1) the conditions governing a possible bacterial transmission by probe, 2) the deterioration of an ultrasound probe by alcohol disinfection, 3) a suitable method for evaluating bacterial contamination of an ultrasound probe, and 4) the best procedure for decontaminating such probes. This paper may lead to a formal consideration of the relationship between ultrasound probes and their roles in bacterial transmission in clinical practice.

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“…Several studies have investigated contamination and cleanliness of ultrasound probes in various clinical settings and found that bacterial colonization was common [11,14,18,25]. These authors recommended several different cleaning techniques, of which wiping the probe with a nonsterile towel alone or in combination with alcohol wipes were most frequently suggested [11,18].…”

Section: Discussionmentioning

confidence: 99%

Does the Use of Ultrasound Affect Contamination of Musculoskeletal Injections Sites?

Sherman

Ferguson

Davis

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Therapeutic musculoskeletal injections require a clean or sterile skin preparation to minimize the risk of infections. Ultrasound guidance for this procedure requires the use of transmission gel in proximity to the injection site, and its effect on maintaining sterility is unknown. Questions/purposes We asked: (1) Does sterile ultrasound transmission gel increase skin contamination during therapeutic orthopaedic injections? (2) Does nonsterile gel application result in increased contamination? (3) Does a manufacturer-approved ultrasound probe disinfecting agent in the form of 17.2% isopropanol and 0.28% diisobutylphenoxyethoxyethyl dimethyl benzyl ammonium chloride wipes adequately decontaminate the ultrasound transducer? (4) Does 70% isopropyl alcohol effectively decontaminate skin for administration of musculoskeletal injections? Methods Twenty-six healthy volunteers in an outpatient orthopaedic clinical setting were recruited. The subjects' skin was prepared to simulate a therapeutic intraarticular shoulder injection under ultrasound guidance. Four skin swabs for culture from each subject were taken: one sample before preparation with isopropyl alcohol, one sample after skin preparation, one after simulated injection procedure with sterile ultrasound transmission gel using the transducer, and one after mock procedure with nonsterile ultrasound transmission gel. In addition, samples were taken from the nonsterile ultrasound transmission gel and the transducer for culture analysis. Aerobic and anaerobic cultures were incubated during a 5-day period for bacterial species identification. Results Sterile ultrasound gel use results in an increase in skin contamination (odds ratio [OR], 9; 95% CI, 1.4-57.1; p = 0.005). Compared with sterile gel use, application of nonsterile gel did not increase contamination proportion (OR, 1.1; 95% CI, 0.8-1.7; p = 0.56). All cultures from nonsterile gel were negative. None of the samples cultured directly from the ultrasound probe were positive for bacteria (0%). Skin preparation with 70% alcohol decreased the proportion of contamination when compared with unprepared skin (OR, 21.0; 95% CI, 3.1-142.2; p = 0.001). Conclusions Use of ultrasound probes and transmission gel results in greater contamination in simulated intraarticular injections of the shoulder. As such, sterile preparation of the entire injection field, including the

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Can ultrasound probes and coupling gel be a source of nosocomial infection in patients undergoing sonography? An in vivo and in vitro study.

Cited by 88 publications

References 3 publications

Musculoskeletal ultrasound guided manoeuvres – security profile

Musculoskeletal ultrasound guided manoeuvres – security profile

Ultrasound probes as a possible vector of bacterial transmission

Does the Use of Ultrasound Affect Contamination of Musculoskeletal Injections Sites?

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