High Risk HPV Contamination of Endocavity Vaginal Ultrasound Probes: An Underestimated Route of Nosocomial Infection?

Abstract

BackgroundEndocavity ultrasound is seen as a harmless procedure and has become a common gynaecological procedure. However without correct disinfection, it may result in nosocomial transmission of genito-urinary pathogens, such as high-risk Human Papillomavirus (HR-HPV). We aimed to evaluate the currently recommended disinfection procedure for covered endocavity ultrasound probes, which consists of “Low Level Disinfection” (LLD) with “quaternary ammonium compounds” containing wipes.MethodsFrom May to October 2011 swabs were taken from endovaginal ultrasound probes at the Gynecology Department of the Lyon University Hospital. During the first phase (May–June 2011) samples were taken after the ultrasound examination and after the LLD procedure. In a second phase (July–October 2011) swab samples were collected just before the probe was used. All samples were tested for the presence of human DNA (as a marker for a possible transmission of infectious pathogens from the genital tract) and HPV DNA with the Genomica DNA microarray (35 different HPV genotypes).ResultsWe collected 217 samples before and 200 samples after the ultrasound examination. The PCR was inhibited in two cases. Human DNA was detected in 36 (18%) post-examination samples and 61 (28%) pre-examination samples. After the ultrasound LLD procedure, 6 (3.0%) samples contained HR-HPV types (16, 31, 2×53 and 58). Similarly, HPV was detected in 6 pre-examination samples (2.7%). Amongst these 4 (1.9%) contained HR-HPV (types 53 and 70).ConclusionOur study reveals that a considerable number of ultrasound probes are contaminated with human and HR-HPV DNA, despite LLD disinfection and probe cover. In all hospitals, where LLD is performed, the endovaginal ultrasound procedure must therefore be considered a source for nosocomial HR-HPV infections. We recommend the stringent use of high-level disinfectants, such as glutaraldehyde or hydrogen peroxide solutions.

Papillomavirus

“…One study, aimed at assessing the presence of HPV on frequently used equipment in gynecological practice (glove box, lamp of a gynecological chair, gel tubes for ultrasound, colposcope and speculum), found that 18% of samples were HPV positive, supporting the hypothesis of possible nosocomial transmission (Gallay et al, 2015). HPV transmission by endocavity vaginal ultrasound has been suggested, after high-risk HPV DNA was shown to persist on ultrasound probes despite disinfection with quaternary ammonium wipes and probe cover (Casalegno et al, 2012).…”

A risk for non-sexual transmission of human papillomavirus?

“…However, these barriers have a perforation rate of 1-9% [53][54][55][56]. One study collected 217 samples before and 200 samples after the ultrasound examination [57]. After the ultrasound procedure, 3% of the samples contained high-risk HPV types (16,31,53,58) [57].…”

Contamination des sondes d’échographie endovaginale par les papillomavirus humains

“…Une éventuelle contamination des sondes échogra-phiques par les HPV a été étudiée dans un service de gynécologie lyonnais [11]. La première partie de l'étude a été réalisée à partir de 200 échantillons collectés avec un écouvillon sec dans les 15 minutes suivant la désinfec-tion de la sonde après l'examen aux ultrasons avec une lingette contenant un ammonium quaternaire.…”