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User Guide: When to high level disinfect your ultrasound probe - ASUM/ACIPC guidelines

Posted by Nanosonics on 18-Nov-2017 16:39:36

To reduce ultrasound probe cross infection risk, it is really important to know when to perform the high level disinfection (HLD) process.


Why is it important?

If you don't properly reprocess your ultrasound probes between every patient use, you could be putting your patients at risk of serious infection. What's more, you may also be breaching compliance. Learn more here.

In recent years there has been a proliferation in ultrasound probe use.

With the development of new types of ultrasound procedures across a wide range of departments, ultrasound is now the most widely used and rapidly growing diagnostic modality in Australia and New Zealand.1 With ultrasound usage ever on the increase, the risk of infection from improperly reprocessed ultrasound probes has also grown.

You'll find ultrasound in use across departments ranging from traditional radiology/imaging, emergency and trauma centres, cardiology units, ICUs, maternity hospitals, private women's health clinics (including IVF centres) and urology departments, with millions of procedures being undertaken every week.

This is a real challenge for those responsible for infection prevention. With the huge variety of treatment and probe types it is important to ensure you are aware of requirements and apply correct and effective disinfection treatment to your ultrasound probes.

HLD must be applied to all semi-critical procedure probes.

Are you unsure as what constitutes a 'semi-critical' procedure? Do you apply high level disinfection to intracavity probes only?

We've put together a useful guide telling you exactly what sort of probe procedure requires the application of HLD before use. Note that the disinfection treatment you apply is always determined by what your probe is to be used for on the next patient (not what procedure has just been undertaken).

When to HLD with trophon download now!






1. ACIPC-ASUM. Guidelines for Reprocessing Ultrasound Transducers. Australasian Journal of Ultrasound in Medicine. 2017;20(1):30-40.

Topics: Ultrasound Probe Infection Risk, Women's Health

Outbreaks caused by infections from ultrasound procedures

Posted by Nanosonics on 30-Oct-2017 17:41:58

Outbreaks and deaths caused by infections from ultrasound procedures

Ultrasound Blood HR cmyk 02-2.jpg 

In September 2017, 2 patients died from septic shock following an outbreak traced to contaminated ultrasound gel used in central line placements. Earlier in 2017, 11 ICU patients across 4 Australian hospitals developed infections following ultrasound guided central line placements and fluid drainages.

Outbreaks and deaths caused by infections from ultrasound procedures

In recent years, ultrasound use has proliferated across various clinical departments with many invasive procedures now being performed under ultrasound guidance (Figure 1). Ultrasound guided procedures such as line placements and biopsies require the use of sterile gel and appropriately reprocessed ultrasound probes.


NAN0030 Diagram for ultrasound_V03.jpg

In September 2017, 2 patients died from septic shock following an outbreak traced to contaminated ultrasound gel used in central line placements. The source was confirmed by isolation of the same bacterium Burkholderia cepacia from patient blood cultures. The outbreak involved 14 patients in total and was published in the Journal of Hospital Infection. A few months prior, the Australian Therapeutic Goods Administration (TGA) received reports of an outbreak of Burkholderia cenocepacia in 11 patients who had undergone ultrasound guided central line placements or ultrasound-guided fluid drainages. Investigations similarly identified contaminated ultrasound gel as the source and the TGA recalled the gel product. This investigation was published in the American Journal of Infection Control. Several publications now demonstrate that the inadvertent use of contaminated ultrasound gel in ultrasound guided procedures can result in serious outbreaks. There have been several alerts issued in the past by regulatory agencies including the CDC, FDA and Health Canada on infection risk with contaminated ultrasound gels used in ultrasound guided interventional procedures. These are detailed along with other outbreaks in Appendix 1. 


While these cases clearly demonstrate that contaminated gel can lead to infections, they also underscore the need to ensure that the ultrasound probe is appropriately reprocessed prior to use in these procedures.

Central catherer insertions.jpg

As the probe and gel may contact the sterile tissue of the puncture site the ultrasound probe is classified as a critical device and must undergo sterilization or high-level disinfection and be used with a sterile sheath (Figure 2).

 Ultrsound Probe with Sheath.jpgAs with many infection control issues, the presence of contaminated gel in these outbreaks has allowed infections to be traced and attributed to the ultrasound procedure. Causality can be established based on the same strain of organism being isolated from each patient and from the gel itself. Such situations provide a window into what is likely a broader problem. The role of ultrasound probes and gel in central line associated bloodstream infections (CLABSI) is likely underappreciated as it is difficult to link a particular infection to the ultrasound process versus other steps in the line placement procedure. While ultrasound-guided invasive procedures represent significant risk, endocavitary ultrasound procedures have also been associated with serious infections. The Medicines and Healthcare Products Regulatory Agency (UK) issued an alert in 2012 for all healthcare facilities to review their decontamination policies and procedures related to reusable transoesophageal echocardiography, transvaginal and transrectal ultrasound probes. This was in immediate response to a patient death from hepatitis B transmission from a procedure with an improperly reprocessed transoesophageal echocardiography probe.5 A further case of a patient contracting hepatitis C infection after undergoing transrectal prostate biopsy was reported in 2013. In this case the source of infection was suspected to be the use of improperly reprocessed ultrasound probes or needle guides that had biofilms deposited on them.

Given the widespread and broadening use of ultrasound, it is important to review standard procedures to ensure that they are consistent with the latest guidelines for use of ultrasound probes. Guidelines in USA, Canada, UK and Australia all require a minimum of HLD or sterilization for endocavitary procedures contacting mucous membranes and ultrasound guided surface probe procedures where there is a risk of contact with sterile tissue. These requirements apply even if the probe is used with a sterile sheath. For further information download the Clinical Bulletin

Download Clinical Bulletin




Topics: Ultrasound Probe Infection Risk

ASUM/ACIPC new ultrasound probe reprocessing guidelines approve automated system

Posted by Nanosonics on 27-Oct-2017 14:57:52

New guidelines may affect you...


You may be aware of the new national Guidelines for Reprocessing Ultrasound Transducers recently issued in Australia by the Australasian Society for Ultrasound in Medicine (ASUM), jointly with the Australasian College for Infection Prevention and Control (ACIPC).

The new guidelines place emphasis on applying HLD not just to intracavity probes, but also to all surface probes used in semi-critical procedures. They state that “If the transducer comes in direct contact with non-intact skin, blood or mucous membranes transducers should be cleaned [and undergo] HLD”.

Download ASUM/ACIPC Guidelines

This development in Australia is part of a growing international trend in recognising the risks associated with potential cross contamination of ultrasound transducers and the importance of implementing strict controls to mitigate these risks.

The World Federation for Ultrasound in Medicine and Biology (WFUMB) have also just released their Guidelines for cleaning transvaginal ultrasound transducers between patients, which recommend HLD for semi-critical probes (including surface probes that contact non-intact skin).

Download WFUMB Guidelines


Topics: Ultrasound Probe Infection Risk