Transvaginal ultrasound probes are human papillomavirus‐free following low‐level disinfection: cross‐sectional multicenter survey

Abstract

Objectives To assess the frequency of detection of high‐risk human papillomavirus (hrHPV) on transvaginal ultrasound (TVS) probes and keyboards and evaluate operator compliance with national recommendations for prevention of cross‐infection during TVS. Methods This was a multicenter observational survey involving 46 public and private centers, in the Paris region of France, in which at least five consecutive TVS examinations were performed per day. We audited 676 TVS procedures. We recorded preventive hygiene actions undertaken by the operator at three stages: (1) during TVS; (2) during probe disinfection; and (3) during preparation of the probe for the next TVS. After probe disinfection, we collected one sample from the bare probe and one from the ultrasound keyboard; following probe preparation for the next examination, an additional sample was obtained from the covered probe. The samples were tested for presence of hrHPV DNA using the Cobas® 4800 System. Results We did not detect hrHPV DNA in samples collected from uncovered or covered probes (0%; 95% CI, 0.00–0.55%). Keyboard samples were positive for hrHPV in two cases (0.3%; 95% CI, 0.04–1.07%). During TVS, the operator avoided touching the keyboard with a hand that had touched the patient's vulva in 86% of cases and held the probe with a gloved hand in 68%. Before probe disinfection, the operator wore new gloves, or performed hand disinfection in 8% of cases. The probe disinfection technique used was adequate in 87% of cases, not performed at all in 12% and insufficient in 1%. Before preparing the probe for the next scan, the operators disinfected their hands or used new gloves in 81% of cases. The probe cover and the coupling gel used complied with recommendations in 98% and 46% of cases, respectively. Of the seven preventive hygiene actions recommended in national guidelines, all were performed in 2%, three to six in 95% and two in 3% of observations. In four (9%) centers, disinfection was not performed in over half the observations. Conclusions No evidence of hrHPV DNA was found on TVS probes and probe covers following low‐level disinfection, despite suboptimal compliance with hygiene guidelines. Routine TVS practice could be made easier and safer with a global approach to probe disinfection and hand hygiene. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Endocavity Ultrasound Transducers: Why High-Level Disinfection Is Necessary

“…The studies by both Lucet et al and Benet et al contradict these studies [36,37]. The Lucet group audited 676 TV transducers to screen for HR-HPV and found no evidence of contamination post-cover removal and LLD [36]. Benet et al concluded from a retrospective cohort of 50,244 patients tested for HIV and 105,955 patients tested for HCV that exposure to TV, TR or TOE transducers in the 12 months preceding testing was not associated with an increased risk of infection [37].…”

“…The studies by both Lucet et al and Benet et al contradict these studies [36,37]. The Lucet group audited 676 TV transducers to screen for HR-HPV and found no evidence of contamination post-cover removal and LLD [36].…”

“…The lack of reported outbreaks of infection associated with the use of TV or TR transducers and the failure to find evidence of bloodborne pathogen transmission in the studies by Lucet [36] and Benet [37] has been leveraged as support for LLD of these devices. Despite these study findings, there have been several case reports of potential pathogen transmission from endocavity transducers.…”

Time‐effectiveness and convenience of transvaginal ultrasound probe disinfection using ultraviolet vs chlorine dioxide multistep wipe system: prospective survey study

“…Chlorine dioxide has well‐documented bactericidal, mycobacterial and sporicidal properties and has become a popular HLD method 20 , 37 . Although studies have reported complete decontamination following the use of chlorine dioxide wipes, recent work suggests the ongoing presence of bacterial growth on some of the probes evaluated 18 , 38 , 39 .…”

Minimizing cross transmission of SARS-CoV-2 in obstetric ultrasound during COVID-19 pandemic

“…Choosing the optimal method to disinfect these transducers need to consider other pathogens aside from SARS-CoV-2 [7,32]. Although most commercially available disinfecting wipes (LLD) cannot eliminate all microorganisms; they are still effective against common viral pathogens such as human papillomavirus (HPV), human immunodeficiency virus (HIV), and coronaviruses [57].…”