[…] ultrasound probes: 1. External ultrasound probes that come into contact with intact skin require cleaning and low‐level disinfection between uses according to the manufacturer’s instructions. 4 2. Internal ultrasound probes that come into contact with mucous membranes require cleaning with enzymatic detergent followed by high‐level disinfection according to the manufacturer’s instructions. A clean probe cover should be applied prior to use and removed prior to cleaning. For sterile procedures, a sterile probe cover should be used. 4 Page 2 of 3 HPV Traditionally, high‐level disinfection of internal ultrasound probes has been accomplished through immersion of the instruments in either glutaraldehyde or ortho‐phthalaldehyde. Human papillomavirus (HPV), a common human pathogen, has been found on ultrasound probes, especially those used for vaginal scans 5. A recent study tested the susceptibility of HPV to commonly used clinical disinfectants including ethanol, isopropanol, glutaraldehyde, ortho‐ phthalaldehyde, phenols, peracetic acid‐silver (PAA‐silver) and hypochlorite 6. The results of the study indicated that only oxidizing chemistries such as hypochlorite and 1.2% PAA‐silver‐based disinfectant were able to produce >99.99% reduction in infectivity of HPV. All other disinfectants showed slight or no reduction in infectivity. The main concern arising from this study is the conclusion that HPV is resistant to most high‐level disinfectants. At this time, the best recommendation that can be made is employing an oxidizing‐based high‐level disinfectant with label claims for non‐enveloped viruses. Other considerations such as instrument compatibility with the disinfectant, as well as employee health and safety, should be included in product selection. Immersion of probes in fluids requires attention to the individual device's ability to be submerged. Although some scan heads, as well as large portions of the cable, may safely be immersed up to the connector to the ultrasound scanner, only the scan heads of other models may be submerged. Before selecting a method of disinfection, consult the instrument manufacturer regarding the compatibility of the to‐be‐used agent with the probes. The ultrasound transducer handle may also be a reservoir for microbial contaminants and a potential source of cross‐infection. In some instances, patients come into direct contact with handles or indirect contact may occur via the healthcare provider’s hands or probe cover. It is also recommended that probe handles should be disinfected according to the manufacture’s recommendations 7,8 . Environment Cleaning and Disinfection A recent study sampled trans‐abdominal and trans‐vaginal transducer cords, keyboards and gel 9. Skin and environmental organisms were isolated along with the opportunistic pathogens. The study recommended a review of current guidelines to include keyboard and cord disinfection and gel handling. Other areas, such as the examination bed and rails, door handles and benchtop surfaces, may also act as sources of cross‐infection. Infection prevention and control measures should include hand hygiene prior to and following every examination. Exam tables, rails and keyboards should be disinfected after each patient. Probe holders, cords and gel bottles should be cleaned and disinfected at the start and end of each day. Gel bottles should never be "topped‐up". Empty bottles should be cleaned and disinfected prior to refilling. The ultrasound machine should be cleaned at least once a week. Page 3 of 3 Conclusion Adequate probe reprocessing and procedure set up is essential. The level of preparation depends on the type of examination performed. Routine high‐level disinfection of internal probes between patients is mandatory, plus the use of a high‐quality single‐use probe cover to avoid gross contamination during the examination. Given the recent evidence that HPV may not be sensitive to the commonly employed high‐level disinfectants, it seems prudent to employ disinfectants that use oxidizing chemistries. The manufacturer’s recommendations should be ...
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