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COVE R S TORY


High-level disinfection of ultrasound probes


A large population-level study has revealed an unacceptable risk of infection following transvaginal and transrectal ultrasound procedures. Nanosonics is calling for improvement in practices for ultrasound probe reprocessing, to reduce the risk of infection.


Patients can be at risk from ultrasound- associated infections when low-level disinfection (LLD) is the standard of care. In order to quantify this risk, Scotland’s National Health Service undertook a retrospective analysis of microbiological and prescription data through linked national health databases. Patient records were examined in the 30-day period following semi-invasive ultrasound probe procedures. The study analysed almost one million patient journeys that occurred during a six- year period from 2010.1


Of the 982,911 patients followed, 330,500 were gynaecological patients; and 60,698 of these gynaecological patients had undergone a transvaginal (TV) ultrasound procedure. These patients were found to be at a 41% greater risk of infection and a 26% greater risk of needing an antibiotic prescription in the 30 days following their transvaginal ultrasound procedure when compared to gynaecological patients who had not undergone a transvaginal ultrasound.


During the study period, 90.5% of facilities


reported that they were performing low- level disinfection for transvaginal ultrasound probes. These patients were at a greater risk of infection due to inadequate reprocessing and the study concluded that: “Failure to comply with [high-level disinfection] will continue to result in an unacceptable risk of harm to patients.”1


The diverse use of ultrasound probes is now prompting a renewed focus on correct probe reprocessing to ensure patient safety. To ensure best practice standards, decontamination experts and ultrasound users need to work together to reduce the risk of infection that is associated with using ultrasound probes.


Ultrasound procedures are performed in various inpatient and outpatient settings by a wide range of health professionals, including sonographers, physicians, nurses, anaesthetists, interventional radiologists, OBGYNs, vascular surgeons, nurse practitioners, and physician assistants. This has increased the use of surface probes to guide procedures such as biopsies, cell retrieval, cannulation, catheterisation,


Automated high-level disinfection


The trophon system is designed to minimise the risks of infection transmission through automated high-level disinfection of transvaginal, transrectal and surface probes. With over 22,500 units operating worldwide, approximately 75,000 people each day are protected from the risk of cross-contamination with trophon. As a fully enclosed system, trophon can be placed at the point of care to maximise patient throughput and cost effectiveness.


The trophon system uses proprietary hydrogen peroxide disinfectant that is


sonically activated to create an ultrafine mist. Free radicals in the mist have superoxidative properties enabling the disinfectant to act quickly and destroy pathogens. These fine mist particles are so small that they reach crevices, grooves and imperfections on the probe surface. Nanosonics works collaboratively with probe manufacturers to carry out extensive probe compatibility testing. More than 1,000 surface and intracavity probes from all major and many specialist probe manufacturers are approved for use with trophon.


6 l WWW.CLINICALSERVICESJOURNAL.COM VOLUME 20 l ISSUE 1 l JANUARY 2021 THE CLINICAL SERVICES JOURNAL


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W W W. C L I N I C A LS E R VI C E S JO U R N A L . C O M


injections, ablations, surgical aspirations, and drainages. Across these procedures, the probe has the potential to contact various patient sites – including intact skin, non- intact skin, mucous membranes and sterile tissue. This presents a complex challenge, as contact with these various body sites requires differing levels of disinfection or sterilisation between patient uses. Failure to adequately clean and disinfect medical devices like ultrasound probes between patients poses a serious risk to patient safety. In 2012, a patient in Wales died from a hepatitis B infection – most likely caused by a failure to appropriately decontaminate a transoesophageal echocardiography probe between patients. As a result of this fatality, a Medical Device Alert was issued by the Medicines and Healthcare Products Regulatory Agency (UK) advising users to appropriately decontaminate all types of reusable ultrasound probes.2


The UK and European guidelines require ultrasound probes that come into contact


JANUARY 2021


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