Infection prevention and control in ultrasound - best practice recommendations from the European Society of Radiology Ultrasound Working Group

Abstract

ObjectivesThe objective of these recommendations is to highlight the importance of infection prevention and control in ultrasound (US), including diagnostic and interventional settings.MethodsReview of available publications and discussion within a multidisciplinary group consistent of radiologists and microbiologists, in consultation with European patient and industry representatives.RecommendationsGood basic hygiene standards are essential. All US equipment must be approved prior to first use, including hand held devices. Any equipment in direct patient contact must be cleaned and disinfected prior to first use and after every examination. Regular deep cleaning of the entire US machine and environment should be undertaken. Faulty transducers should not be used. As outlined in presented flowcharts, low level disinfection is sufficient for standard US on intact skin. For all other minor and major interventional procedures as well as all endo-cavity US, high level disinfection is mandatory. Dedicated transducer covers must be used when transducers are in contact with mucous membranes or body fluids and sterile gel should be used inside and outside covers.ConclusionsGood standards of basic hygiene and thorough decontamination of all US equipment as well as appropriate use of US gel and transducer covers are essential to keep patients safe.Main messages • Transducers must be cleaned/disinfected before first use and after every examination. • Low level disinfection is sufficient for standard US on intact skin. • High level disinfection is mandatory for endo-cavity US and all interventions. • Dedicated transducer covers must be used for endo-cavity US and all interventions. • Sterile gel should be used for all endo-cavity US and all interventions.

Patient safety in medical imaging: A joint paper of the European Society of Radiology (ESR) and the European Federation of Radiographer Societies (EFRS)

“…Because adequate ultrasound imaging requires good transducer-toskin contact (or endocavitary or other intracorporeal positioning of a transducer), the potential exists for transmission of infection between patients via transducers. 39,40 Ultrasound gel is another potential means for infection transmission, especially if multi-use gel dispensers are utilised. 39,40 It has been shown that bacterial contamination of ultrasound transducers is significantly higher than that of bus poles and public toilet seats.…”

“…39,40 Ultrasound gel is another potential means for infection transmission, especially if multi-use gel dispensers are utilised. 39,40 It has been shown that bacterial contamination of ultrasound transducers is significantly higher than that of bus poles and public toilet seats. 40,41 Survival times for some viruses, bacteria and fungi on dry inert surfaces (including transducer surfaces) can be up to several months, or even longer if the surface is contaminated with coexistent organic material.…”

“…39,40 It has been shown that bacterial contamination of ultrasound transducers is significantly higher than that of bus poles and public toilet seats. 40,41 Survival times for some viruses, bacteria and fungi on dry inert surfaces (including transducer surfaces) can be up to several months, or even longer if the surface is contaminated with coexistent organic material. 40 A recent survey of European practices regarding ultrasound probe cleaning and decontamination, probe cover and sterile gel use found wide variation among respondents, with no uniformity of approach.…”

“…40,41 Survival times for some viruses, bacteria and fungi on dry inert surfaces (including transducer surfaces) can be up to several months, or even longer if the surface is contaminated with coexistent organic material. 40 A recent survey of European practices regarding ultrasound probe cleaning and decontamination, probe cover and sterile gel use found wide variation among respondents, with no uniformity of approach. 39 Accordingly, the Ultrasound Working Group of ESR published a set of recommendations in 2017 aimed at providing ultrasound users with a set of standards for ultrasound transducer decontamination, use of transducer covers and gel.…”

CLEAR: A Novel Approach to Ultrasound Equipment Homeostasis

“…[9][10][11][12][13][14][15][16] The American Institute of Ultrasound in Medicine (AIUM), the American College of Emergency of Physicians (ACEP), and the European Society of Radiology Ultrasound Working Group specifically address US equipment cleanliness, safety, and maintenance. [9][10][11] The United States Food and Drug Administration and Centers for Disease Control and Prevention also provide guidelines for medical equipment disinfection. 12,13 We have termed this combination of necessary operations for US equipment homeostasis, as it reflects maintenance of the equipment in a perpetual state of readiness to ensure proper functioning for the next use.…”