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DECONTAMINATION


Improving outcomes in TOE probe reprocessing


Although procedures involving transesophageal (TOE) ultrasound probes are associated with a low rate of patient infection, they can be a potential source of infection from contaminated equipment. Erica Taube PhD discusses best practice in reprocessing these medical devices to ensure patient safety.


Transoesophageal echocardiography (TOE*) consists of passing a probe containing an ultrasound transducer at its tip into a patient’s oesophagus. Because the oesophagus is so close to the heart, very clear images of heart structures, valves and arteries can be obtained. It is used during cardiac surgery for diagnostic, monitoring and treatment, providing life-saving applications in critical and emergency care.1 In the context of COVID-19, the risk of contamination of equipment and personnel is very high during TOE procedures due to droplets and aerosols containing virus. Although data on the efficacy against SARS- CoV-2 are currently not available, most coronaviruses are inactivated by disinfectants validated according to EN 14476.2 Peracetic acid for example possesses such properties. No additional steps beyond those currently recommended are needed


for cleaning and reprocessing ultrasound transducers. However, the recommended protocols must be strictly adhered to.3-6 Due to the absence of internal channels, TOE probes are easier to clean and disinfect as compared to lumened endoscopes, since all surfaces are readily accessible. However, TOE probes present an additional challenge since the handle is not watertight and cannot be immersed in any liquid. Currently, the most common means of reprocessing is the use of cleaning and disinfectant wipes. TOE is associated with a low rate of patient infection. Nevertheless, some critical cases have occurred. One patient died from hepatitis B due to poor decontamination technique of the TOE probe (use of a disinfectant wipe).7


An outbreak of


multidrug-resistant germs involved 42 patients, four of which died of pneumonia.8 Considerable extra expenses amounted to 266 k€ (extended hospital stay, antibiotics, laboratory costs, manhours). Other complications have been linked to surface damage of the probe (pneumonia, three septic shock deaths, one endocarditis death)9 or faulty insertion technique leading to GI perforation, bleeds, and seven deaths.10 This illustrates why stringent standards of decontamination must be applied.


Guidelines


As opposed to digestive and respiratory endoscopy, guidance for reprocessing TOE probes has appeared only in recent years. The Healthcare Infection Society11


rates


automated reprocessing of TOE probes as best practice. This guidance is however already outdated since it does not mention existing automated systems specifically designed to clean and/or disinfect TOE probes using liquid chemicals.


Sidem BM-33T SEPTEMBER 2020 The American Society of Echocardiography12


Soluscope Serie TEE


provides detailed guidance: 1) Point of care wipe down 2) Transport in a container 3) Cleaning with an enzymatic cleaner and prolonged rinse 4) Electrical leakage testing (required for IAC accreditation) 5) High-level disinfection with documentation 6) Rinsing 7) Drying 8) Storage in a well-ventilated dust- free cabinet (a positive-pressure HEPA-filtered cabinet is optimal). These guidelines are also unaware that automated washer-disinfectors are now available for TOE probes.


The advantage of using an automated


washer-disinfector is clearly illustrated in the report by Noël et al8


in which a nosocomial


outbreak of multidrug-resistant germs was halted when the TOE probe was withdrawn from use and the hospital department switched from manually reprocessing their


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