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Ezeh UC, Achlatis E, Crosby T, Kwak PE, Phillips MS, Amin MR. The Effectiveness of Ultraviolet Smart D60 in Reducing Contamination of Flexible Fiberoptic Laryngoscopes. Laryngoscope 2023; 133:3512-3519. [PMID: 37485725 DOI: 10.1002/lary.30869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/12/2023] [Accepted: 06/21/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE To compare the effectiveness of disinfection protocols utilizing a ultraviolet (UV) Smart D60 light system with Impelux™ technology with a standard Cidex ortho-phthalaldehyde (OPA) disinfection protocol for cleaning flexible fiberoptic laryngoscopes (FFLs). METHODS Two hundred FFLs were tested for bacterial contamination after routine use, and another 200 FFLs were tested after disinfection with one of four methods: enzymatic detergent plus Cidex OPA (standard), enzymatic detergent plus UV Smart D60, microfiber cloth plus UV Smart D60, and nonsterile wipe plus UV Smart D60. Pre- and post-disinfection microbial burden levels and positive culture rates were compared using Kruskal-Wallis ANOVA and Fisher's two-sided exact, respectively. RESULTS After routine use, approximately 56% (112/200) of FFLs were contaminated, with an average contamination level of 9,973.7 ± 70,136.3 CFU/mL. The standard reprocessing method showed no positive cultures. The enzymatic plus UV, microfiber plus UV, and nonsterile wipe plus UV methods yielded contamination rates of 4% (2/50), 6% (3/50), and 12% (6/50), respectively, with no significant differences among the treatment groups (p > 0.05). The pre-disinfection microbial burden levels decreased significantly after each disinfection technique (p < 0.001). The average microbial burden recovered after enzymatic plus UV, microfiber plus UV, and nonsterile wipe plus UV were 0.40 CFU/mL ± 2, 0.60 CFU/mL ± 2.4, and 12.2 CFU/mL ± 69.5, respectively, with no significant difference among the treatment groups (p > 0.05). Micrococcus species (53.8%) were most frequently isolated, and no high-concern organisms were recovered. CONCLUSION Disinfection protocols utilizing UV Smart D60 were as effective as the standard chemical disinfection protocol using Cidex OPA. LEVEL OF EVIDENCE NA Laryngoscope, 133:3512-3519, 2023.
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Affiliation(s)
- Uche C Ezeh
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Efstratios Achlatis
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Tyler Crosby
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Paul E Kwak
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Michael S Phillips
- Division of Infectious Disease, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Milan R Amin
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
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Desai SR, Tang L, Hwang NC. Infection Control for Perioperative Ultrasonography and Echocardiography. J Cardiothorac Vasc Anesth 2022; 36:4440-4448. [PMID: 36123263 DOI: 10.1053/j.jvca.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/04/2022] [Accepted: 08/12/2022] [Indexed: 11/11/2022]
Abstract
Ultrasound technology has revolutionized point-of-care diagnostics, decision-making, and the guidance of interventional procedures in Anesthesiology and Perioperative Medicine. Recent literature has highlighted important infection control considerations when performing transesophageal or transthoracic echocardiography, point-of-care ultrasound, and ultrasound-guided procedures. This narrative review focuses on operator precautions and disinfection methods and summarizes key recommendations from the international Echocardiography and Radiology Societies.
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Affiliation(s)
- Suneel Ramesh Desai
- Department of Anaesthesiology, Singapore General Hospital, Singapore; Department of Cardiothoracic Anaesthesia, National Heart Centre, Singapore; Department of Surgical Intensive Care, Singapore General Hospital, Singapore
| | - Leonard Tang
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - Nian Chih Hwang
- Department of Anaesthesiology, Singapore General Hospital, Singapore; Department of Cardiothoracic Anaesthesia, National Heart Centre, Singapore.
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Murata H, Vanegas C, Ogami-Takamura K. Ultrasound-guided regional anesthesia in COVID-19 and future pandemics: infection control. Curr Opin Anaesthesiol 2021; 34:648-653. [PMID: 34231548 PMCID: PMC8452256 DOI: 10.1097/aco.0000000000001034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Infection control is inherent in ultrasound-guided regional anesthesia practice, because ultrasound transducer and coupling gel can be vectors for pathogen transmission. We reviewed the current standards and recommendations of ultrasound transducer cleaning, disinfection, and safe handling of ultrasound equipment. Based on the available data, we propose a set of practical recommendations applicable to coronavirus disease 2019 (COVID-19) pandemic and future epidemics. RECENT FINDINGS Regional anesthesia is often preferred over general anesthesia for COVID-19 patients. Avoidance of general anesthesia reduces the need for aerosol generating procedures. Administration of ultrasound-guided regional anesthesia and surgery under regional anesthesia in COVID-19 patients requires careful infectious precautions to prevent the viral spread through the use equipment. SUMMARY Ultrasound machine, transducer and coupling gel can serve as a vector for transmission of pathogens. In the era of COVID-19 pandemic, standardized strategies are recommended to minimize the risk of spread of COVID-19 to both patients and the healthcare providers.
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Affiliation(s)
- Hiroaki Murata
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | - Keiko Ogami-Takamura
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Macroscopic Anatomy, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Schmitz J, Kossow A, Oelmeier de Murcia K, Heese S, Braun J, Möllmann U, Schmitz R, Möllers M. Disinfection of Transvaginal Ultrasound Probes by Ultraviolet C - A clinical Evaluation of Automated and Manual Reprocessing Methods. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2020; 41:681-687. [PMID: 31238382 DOI: 10.1055/a-0874-1971] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE Since pathogens can be transmitted to patients via transvaginal ultrasound probes, it is of particular importance that cleaning and disinfection are performed adequately. This study was designed to do a qualitative comparison of a low-level disinfection technique with disinfectant-impregnated wipes and an automated disinfection technique using ultraviolet C radiation in a clinical setting. MATERIALS AND METHODS The transvaginal ultrasound probes used in two groups of 160 patients were compared in a prospective controlled study regarding the effectiveness of manual low-level disinfection (Mikrozid sensitive wipes) and automated disinfection using ultraviolet C radiation (Antigermix AS1). Microbiological samples were taken from the whole surface of the probe before and after the disinfection process. RESULTS Before disinfection, 98.75 % (316/320) of the samples showed bacterial contamination. After automated and manual disinfection, the contamination rates were 34.2 % (54/158, automated) and 40.5 % (64/158, disinfectant wipes) (p > 0.05). Pathogens with the potential to cause healthcare-associated infections, such as Enterococcus faecalis and Klebsiella pneumoniae, were removed completely by both techniques. Manual disinfection showed a lower contamination rate after disinfection of bacteria that usually belong to the vaginal, pharyngeal and skin flora (disinfectant wipes 10.6 %, 11/104, automated 32.5 %, 38/117) (p < 0.001). CONCLUSION For the clinical routine, automated disinfection with ultraviolet C is a promising technique for transvaginal ultrasound probes because of the simple handling and time efficiency. In our study, this method was completely effective against nosocomial pathogens. However, the study didn't show any significant difference in terms of effectiveness compared to low-level wipe disinfection.
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Affiliation(s)
- Johanna Schmitz
- Department of Obstetrics and Gynecology, University Hospital Münster, Germany
| | | | | | - Sandra Heese
- Department of Obstetrics and Gynecology, University Hospital Münster, Germany
| | - Janina Braun
- Department of Obstetrics and Gynecology, University Hospital Münster, Germany
| | - Ute Möllmann
- Department of Obstetrics and Gynecology, University Hospital Münster, Germany
| | - Ralf Schmitz
- Department of Obstetrics and Gynecology, University Hospital Münster, Germany
| | - Mareike Möllers
- Department of Obstetrics and Gynecology, University Hospital Münster, Germany
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Azi LMTDA, Fonseca NM, Linard LG. SBA 2020: Regional anesthesia safety recommendations update. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2020. [PMID: 32636024 PMCID: PMC9373527 DOI: 10.1016/j.bjane.2020.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The purpose of the Brazilian Society of Anesthesiology (SBA)’s Regional Anesthesia Safety Recommendations Update is to provide new guidelines based on the current relevant clinical aspects related to safety in regional anesthesia and analgesia. The goal of the present article is to provide a broad overview of the current knowledge regarding pre-procedure asepsis and antisepsis, risk factors, diagnosis and treatment of infectious complications resulting from anesthetic techniques. It also aims to shed light on the use of reprocessed materials in regional anesthesia practice to establish the effects of aseptic handling of vials and ampoules, and to show cost-effectiveness in the preparation of solutions to be administered continuously in regional blockades. Electronic databases were searched between January 2011 (final date of the literature search for the past SBA recommendations for safety in regional anesthesia) and September 2019. A total of 712 publications were found, 201 of which were included for further analysis, and 82 new publications were added into the review. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used to assess the quality of each study and to classify the strength of evidence. The present review was prepared by members of the SBA Technical Standards Committee.
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Affiliation(s)
- Liana Maria Tôrres de Araújo Azi
- Universidade Federal da Bahia (UFBA), Departamento de Anestesiologia e Cirurgia, Salvador, BA, Brazil; Hospital Universitário Professor Edgard Santos, Centro de Ensino e Treinamento em Anestesiologia, Salvador, BA, Brazil; Comissão de Norma Técnicas da Sociedade Brasileira de Anestesiologia (SBA), Salvador, BA, Brazil.
| | - Neuber Martins Fonseca
- Comissão de Norma Técnicas da Sociedade Brasileira de Anestesiologia (SBA), Salvador, BA, Brazil; Universidade Federal de Uberlândia (UFU), Faculdade de Medicina, Disciplina de Anestesiologia, Uberlândia, MG, Brazil; Universidade Federal de Uberlândia (UFU), Faculdade de Medicina, Centro de Ensino e Treinamento em Anestesiologia, Uberlândia, MG, Brazil; Coordinator of the Comitê de Estudo de Equipamentos Respiratórios e de Anestesiologia da ABNT, and Delegate and representative of the SBA Board at the Technical Committee 121/ISO - Anesthetic and Respiratory Equipment, Uberlândia, MG, Brazil
| | - Livia Gurgel Linard
- Hospital Geral do Estado 2 and of Hospital Roberto Santos, Salvador, BA, Brazil
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Azi LMTDA, Fonseca NM, Linard LG. [SBA 2020: Regional anesthesia safety recommendations update]. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2020; 70:398-418. [PMID: 32636024 PMCID: PMC9373527 DOI: 10.1016/j.bjan.2020.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 01/26/2020] [Accepted: 02/08/2020] [Indexed: 12/24/2022]
Abstract
The purpose of the Brazilian Society of Anesthesiology's (SBA) Regional Anesthesia Safety Recommendations Update is to provide new guidelines based on the current relevant clinical aspects related to safety in regional anesthesia and analgesia. The goal of the present article is to provide a broad overview of the current knowledge regarding pre-procedure asepsis and antisepsis, risk factors, diagnosis and treatment of infectious complications resulting from anesthetic techniques. It also aims to shed light on the use of reprocessed materials in regional anesthesia practice to establish the effects of aseptic handling of vials and ampoules, and to show cost-effectiveness in the preparation of solutions to be administered continuously in regional blockades. Electronic databases were searched between January 2011 (final date of the literature search for the past SBA recommendations for safety in regional anesthesia) and September 2019. A total of 712 publications were found, 201 of which were included for further analysis, and 82 new publications were added into the review. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used to assess the quality of each study and to classify the strength of evidence. The present review was prepared by members of the SBA Technical Standards Committee.
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Affiliation(s)
- Liana Maria Tôrres de Araújo Azi
- Universidade Federal da Bahia (UFBA), Departamento de Anestesiologia e Cirurgia, Salvador, BA, Brazil; Hospital Universitário Professor Edgard Santos, Centro de Ensino e Treinamento em Anestesiologia, Salvador, BA, Brazil; Comissão de Norma Técnicas da Sociedade Brasileira de Anestesiologia (SBA), Salvador, BA, Brazil.
| | - Neuber Martins Fonseca
- Comissão de Norma Técnicas da Sociedade Brasileira de Anestesiologia (SBA), Salvador, BA, Brazil; Universidade Federal de Uberlândia (UFU), Faculdade de Medicina, Disciplina de Anestesiologia, Uberlândia, MG, Brazil; Universidade Federal de Uberlândia (UFU), Faculdade de Medicina, Centro de Ensino e Treinamento em Anestesiologia, Uberlândia, MG, Brazil; Coordinator of the Comitê de Estudo de Equipamentos Respiratórios e de Anestesiologia da ABNT, and Delegate and representative of the SBA Board at the Technical Committee 121/ISO - Anesthetic and Respiratory Equipment, Uberlândia, MG, Brazil
| | - Livia Gurgel Linard
- Hospital Geral do Estado 2 and of Hospital Roberto Santos, Salvador, BA, Brazil
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Abstract
Promoting patient safety and increasing health care quality have dominated the health care landscape during the last 15 years. Health care regulators and payers are now tying patient safety outcomes and best practices to hospital reimbursement. Many health care leaders are searching for new technologies that not only make health care for patients safer but also reduce overall health care costs. New advances in ultrasonography have made this technology available to health care providers at the patient's bedside. Point-of-care ultrasound assistance now aids providers with real-time diagnosis and with visualization for procedural guidance. This is especially true for common deep needle procedures such as central venous catheter insertion, thoracentesis, and paracentesis.There is now mounting evidence that clinician-performed point-of-care ultrasound improves patient safety, enhances health care quality, and reduces health care cost for deep needle procedures. Furthermore, the miniaturization, ease of use, and the evolving affordability of ultrasound have now made this technology widely available. The adoption of point-of-care ultrasonography has reached a tipping point and should be seriously considered the safety standard for all hospital-based deep needle procedures.
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8
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Abstract
BACKGROUND Sterile and clean working conditions are one of the keystones of medical practice and this is also true for ultrasound-guided regional anesthesia. The routine clinical practice in ultrasound-guided regional anesthesia does not always comply with the principles of sterile and clean working conditions in medicine: therefore, patients are exposed to potential hazards regarding the transmission of pathogens via the ultrasound equipment. OBJECTIVE This article deals with the question of whether sterile working conditions in ultrasound-guided regional anesthesia are a relevant topic with medical and economic implications. Is it possible to implement the general recommendations for sterile working conditions in ultrasonography for the specific application of ultrasound-guided regional anesthesia? MATERIAL AND METHODS A search of the available literature and published guidelines in the field of sterile working conditions with ultrasound was carried out. RESULTS The association between cross-infections and ultrasound equipment is undeniable. Many methods for cleansing and disinfection of ultrasound equipment have been published. All these methods are associated with advantages and disadvantages. The direct sterilization of ultrasound probes with high-percentage alcohol can damage ultrasound probes (especially linear). The use of self-adhesive sterile ultrasound probe covers is a practical method to achieve sterile working conditions in ultrasound-guided regional anesthesia. CONCLUSION The use of sterile ultrasound probe covers and sterile ultrasound contact media is an important prerequisite to avoid cross-infection between patients. An appropriate scientific evaluation should serve as evidence in this field.
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Buescher DL, Möllers M, Falkenberg MK, Amler S, Kipp F, Burdach J, Klockenbusch W, Schmitz R. Disinfection of transvaginal ultrasound probes in a clinical setting: comparative performance of automated and manual reprocessing methods. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:646-651. [PMID: 26426683 DOI: 10.1002/uog.15771] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/17/2015] [Accepted: 09/26/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Transvaginal and intracavitary ultrasound probes are a possible source of cross-contamination with microorganisms and thus a risk to patients' health. Therefore appropriate methods for reprocessing are needed. This study was designed to compare the standard disinfection method for transvaginal ultrasound probes in Germany with an automated disinfection method in a clinical setting. METHODS This was a prospective randomized controlled clinical study of two groups. In each group, 120 microbial samples were collected from ultrasound transducers before and after disinfection with either an automated method (Trophon EPR®) or a manual method (Mikrozid Sensitive® wipes). Samples were then analyzed for microbial growth and isolates were identified to species level. RESULTS Automated disinfection had a statistically significantly higher success rate of 91.4% (106/116) compared with 78.8% (89/113) for manual disinfection (P = 0.009). The risk of contamination was increased by 2.9-fold when disinfection was performed manually (odds ratio, 2.9 (95% CI, 1.3-6.3)). Before disinfection, bacterial contamination was observed on 98.8% of probes. Microbial analysis revealed 36 different species of bacteria, including skin and environmental bacteria as well as pathogenic bacteria such as Staphylococcus aureus, enterobacteriaceae and Pseudomonas spp. CONCLUSIONS Considering the high number of contaminated probes and bacterial species found, disinfection of the ultrasound probe's body and handle should be performed after each use to decrease the risk of cross-contamination. This study favored automated disinfection owing to its significantly higher efficacy compared with a manual method. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- D L Buescher
- Department of Obstetrics and Gynecology, University Hospital Muenster, Muenster, Germany
| | - M Möllers
- Department of Obstetrics and Gynecology, University Hospital Muenster, Muenster, Germany
| | - M K Falkenberg
- Department of Obstetrics and Gynecology, University Hospital Muenster, Muenster, Germany
| | - S Amler
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - F Kipp
- Institute of Hygiene, University of Muenster, Muenster, Germany
| | - J Burdach
- Catalyst Consultants, Sydney, Australia
| | - W Klockenbusch
- Department of Obstetrics and Gynecology, University Hospital Muenster, Muenster, Germany
| | - R Schmitz
- Department of Obstetrics and Gynecology, University Hospital Muenster, Muenster, Germany
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10
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Suresh V, Asish K, Devi PS. Improvised glove barrier for ultrasound probe protection. Anesth Essays Res 2015; 9:448-9. [PMID: 26712997 PMCID: PMC4683508 DOI: 10.4103/0259-1162.158003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Varun Suresh
- Department of Anaesthesia and Critical Care, Medical College, Thrissur, Kerala, India
| | - K Asish
- Department of Anaesthesia and Critical Care, Medical College, Thrissur, Kerala, India
| | - P Sathee Devi
- Department of Anaesthesia and Critical Care, Medical College, Thrissur, Kerala, India
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Marhofer P, Fritsch G. Sterile working in ultrasonography: the use of dedicated ultrasound covers and sterile ultrasound gel. Expert Rev Med Devices 2015; 12:667-73. [PMID: 26325163 DOI: 10.1586/17434440.2015.1084872] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Ultrasound is currently an important tool for diagnostic and interventional procedures. Ultrasound imaging provides significant advantages as compared to other imaging methods. The widespread use of ultrasound also carries the risk of drawbacks such as cross-infections. A large body of literature reports this possibly life-threatening side effect and specific patient populations are particularly at risk (e.g., neonates). Various methods of ultrasound probe disinfection are described; however, none of the mechanical or chemical probe disinfection procedures is optimal and, in particular, disinfection with high concentration of alcohol might be associated with ultrasound probe damage. The preparation of ultrasound probes with dedicated probe covers is a useful alternative for sterile working conditions. One ultrasound probe cover discussed in this paper is directly glued on to the ultrasound probe without the use of ultrasound coupling gel. By the use of sterile ultrasound coupling gel at the outer surface, additional effects on aseptic working conditions can be obtained.
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Affiliation(s)
- Peter Marhofer
- a 1 Department of Anaesthesia, Intensive Care Medicine and Pain Therapy, Medical University of Vienna , A-1090 Vienna, Austria
| | - Gerhard Fritsch
- b 2 Department of Anesthesiology, Perioperative Medicine, and Critical Care Medicine, Paracelsus Medical University , Salzburg, Austria
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Shokoohi H, Armstrong P, Tansek R. Emergency department ultrasound probe infection control: challenges and solutions. Open Access Emerg Med 2015; 7:1-9. [PMID: 27147883 PMCID: PMC4806800 DOI: 10.2147/oaem.s50360] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Point-of-care ultrasound (US) has become a cornerstone in the diagnosis and treatment of patients in the emergency department (ED). Despite the beneficial impact on patient care, concern exists over repeat use of probes and the role as a vector for pathogen transmission. US probes are used for various applications, with the level of infection risk, based on the Spaulding Classification, ranging from noncritical with common practice to semicritical with endocavitary probes. To date, the most closely studied organisms are Staphylococcus aureus and human papilloma virus. Current evidence does confirm probe colonization but has not established a causative role in human infection. Based on current literature, US use during invasive procedures remains an infection control concern, but routine use on intact skin does not appear to cause significant risk to patients. Various barrier methods are available, each with indications based on extent of procedure and likelihood of contact with mucosal surfaces. Additionally, chemical cleansing methods have been shown to be effective in limiting probe contamination after use. New technologies utilizing ultraviolet light are available and effective but not widely used in the ED setting. As our understanding of the critical factors in US probe cleaning and disinfection improves, it is important to assess the challenges found in our current practice and to identify potential solutions to improve practices and procedures in infection control across the spectrum of US probe use in various applications in the ED. This article serves as a summary of the current literature available on infection control topics with the utilization of point-of-care US, and discusses challenges and potential solutions to improve the current practice of probe-related infection control.
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Affiliation(s)
- Hamid Shokoohi
- Department of Emergency Medicine, George Washington University Medical Center, Washington DC, USA
| | - Paige Armstrong
- Department of Emergency Medicine, George Washington University Medical Center, Washington DC, USA
| | - Ryan Tansek
- Department of Emergency Medicine, George Washington University Medical Center, Washington DC, USA
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Infection Related to Ultrasound-Guided Single-Injection Peripheral Nerve Blockade. Reg Anesth Pain Med 2015; 40:82-4. [DOI: 10.1097/aap.0000000000000181] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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M'Zali F, Bounizra C, Leroy S, Mekki Y, Quentin-Noury C, Kann M. Persistence of microbial contamination on transvaginal ultrasound probes despite low-level disinfection procedure. PLoS One 2014; 9:e93368. [PMID: 24695371 PMCID: PMC3973690 DOI: 10.1371/journal.pone.0093368] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 03/04/2014] [Indexed: 11/18/2022] Open
Abstract
AIM OF THE STUDY In many countries, Low Level Disinfection (LLD) of covered transvaginal ultrasound probes is recommended between patients' examinations. The aim of this study was to evaluate the antimicrobial efficacy of LLD under routine conditions on a range of microorganisms. MATERIALS AND METHODS Samples were taken over a six month period in a private French Radiology Center. 300 specimens derived from endovaginal ultrasound probes were analyzed after disinfection of the probe with wipes impregnated with a quaternary ammonium compound and chlorhexidine. Human papillomavirus (HPV) was sought in the first set of s100 samples, Chlamydia trachomatis and mycoplasmas were searched in the second set of 100 samples, bacteria and fungi in the third 100 set samples. HPV, C. trachomatis and mycoplasmas were detected by PCR amplification. PCR positive samples were subjected to a nuclease treatment before an additional PCR assay to assess the likely viable microorganisms. Bacteria and fungi were investigated by conventional methods. RESULTS A substantial persistence of microorganisms was observed on the disinfected probes: HPV DNA was found on 13% of the samples and 7% in nuclease-resistant form. C. trachomatis DNA was detected on 20% of the probes by primary PCR but only 2% after nuclease treatment, while mycoplasma DNA was amplified in 8% and 4%, respectively. Commensal and/or environmental bacterial flora was present on 86% of the probes, occasionally in mixed culture, and at various levels (10->3000 CFU/probe); Staphylococcus aureus was cultured from 4% of the probes (10-560 CFU/probe). No fungi were isolated. CONCLUSION Our findings raise concerns about the efficacy of impregnated towels as a sole mean for disinfection of ultrasound probes. Although the ultrasound probes are used with disposable covers, our results highlight the potential risk of cross contamination between patients during ultrasound examination and emphasize the need for reviewing the disinfection procedure.
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Affiliation(s)
- Fatima M'Zali
- Université Bordeaux Segalen, Microbiologie Fondamentale et Pathogénicité Unité Mixte de Recherche 5234, Bordeaux, France
| | - Carole Bounizra
- Université Bordeaux Segalen, Microbiologie Fondamentale et Pathogénicité Unité Mixte de Recherche 5234, Bordeaux, France
| | - Sandrine Leroy
- Centre Hospitalier Universitaire de Nîmes, Service de Biostatistique, Epidémiologie Clinique, Santé Publique, Informatique Médicale, Nîmes, France
| | - Yahia Mekki
- Laboratoire de Virologie, Centre de Biologie et Pathologie Est, Hospices Civils de Lyon, Lyon, France
| | - Claudine Quentin-Noury
- Université Bordeaux Segalen, Microbiologie Fondamentale et Pathogénicité Unité Mixte de Recherche 5234, Bordeaux, France
| | - Michael Kann
- Université Bordeaux Segalen, Microbiologie Fondamentale et Pathogénicité Unité Mixte de Recherche 5234, Bordeaux, France
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Casalegno JS, Le Bail Carval K, Eibach D, Valdeyron ML, Lamblin G, Jacquemoud H, Mellier G, Lina B, Gaucherand P, Mathevet P, Mekki Y. High risk HPV contamination of endocavity vaginal ultrasound probes: an underestimated route of nosocomial infection? PLoS One 2012; 7:e48137. [PMID: 23110191 PMCID: PMC3480505 DOI: 10.1371/journal.pone.0048137] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 09/20/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Endocavity 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. METHODS From 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). RESULTS We 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). CONCLUSION Our 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.
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Affiliation(s)
- Jean-sebastien Casalegno
- Laboratory of Virology, Centre de Biologie et Pathologie Est, Hospices Civils de Lyon, Lyon, France
- * E-mail: (JSC); (YM)
| | | | - Daniel Eibach
- Laboratory of Virology, Centre de Biologie et Pathologie Est, Hospices Civils de Lyon, Lyon, France
- European Public Health Microbiology Training Programme, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | - Gery Lamblin
- Gynecology Obstetrics Departement, Hospices Civils de Lyon, Lyon, France
| | - Hervé Jacquemoud
- Technical Support Departement, Hospices Civils de Lyon, Lyon, France
| | - Georges Mellier
- Gynecology Obstetrics Departement, Hospices Civils de Lyon, Lyon, France
| | - Bruno Lina
- Laboratory of Virology, Centre de Biologie et Pathologie Est, Hospices Civils de Lyon, Lyon, France
| | - Pascal Gaucherand
- Gynecology Obstetrics Departement, Hospices Civils de Lyon, Lyon, France
| | - Patrice Mathevet
- Gynecology Obstetrics Departement, Hospices Civils de Lyon, Lyon, France
| | - Yahia Mekki
- Laboratory of Virology, Centre de Biologie et Pathologie Est, Hospices Civils de Lyon, Lyon, France
- * E-mail: (JSC); (YM)
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Current world literature. Curr Opin Anaesthesiol 2012; 25:629-38. [PMID: 22955173 DOI: 10.1097/aco.0b013e328358c68a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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