Ultrasound probe with an ultrasound probe cover on

While many healthcare facilities view patient safety as a pressing concern, some may not realize the danger posed by ultrasound imaging. Since ultrasound does not expose patients to radiation, it has a reputation of safety and rightfully so. However, clinicians using ultrasound for their exams or procedures should be aware of the infection control threat it poses to their patients.

The infection control concerns surrounding ultrasound are the primary reason behind a variety of infection prevention guidelines which have been issued in recent years. The European Society of Radiology recently conducted a survey of its members and asked them a variety of questions regarding ultrasound infection control practices. One key finding of the study was frightening: 29% of respondents stated they did not disinfect the ultrasound probe after each patient.

It cannot be understated that ultrasound probes can very well be a vector of infection. The medical imaging community has witnessed the exponential growth of ultrasound in recent decades. While the general public may still associate the modality with prenatal checkups, gone are the days when ultrasound was primarily used by sonographers on pregnant women.

Ultrasound is now used widely across a variety of clinical areas, including urology, cardiology, and radiology. Physicians have found that the mobility and ease of use offered by the modality, especially point-of-care ultrasound, make it an ideal choice when taking the patient to the imaging suite is not the most suitable option. Ultrasound isn’t just present for exams either: the modality can now be found in interventional settings as well.

Moreover, ultrasound has now seen extensive use in emergency medicine and in the intensive care unit (ICU). During the COVID-19 pandemic, point-of-care ultrasound was a top pick for physicians examining and treating suspected or confirmed COVID-19 patients. The ability to bring imaging into the patient’s room minimized the risk of infecting patients outside of the COVID-19 ward. However, its use in such a high-risk environment also signified new infection control threats.

With all this discussion surrounding ultrasound infection control, it is easy to lose sight of the best practices. Using ultrasound probe covers (sterile or non-sterile), the right kind of gel, and the appropriate disinfectant can reduce the risk of pathogenic transmission. But does using an ultrasound probe cover substitute disinfection? The short answer is no.

Ultrasound probe covers: a layer of security, not a replacement

While ultrasound probe covers provide a physical barrier to infection, they cannot replace proper disinfection. The purpose of the ultrasound probe cover is two-fold: they reduce the risk of cross-contamination while also protecting the device itself from damage that could be inflicted by contact with blood, soil, or other bodily fluids.

It is important to note that probe covers are typically used when the ultrasound probe is moving over non-intact skin, which includes areas of broken skin such as a biopsy site. This means, as stated above, that the cover will protect the device from costly damage. Using a probe on non-intact skin or in contact with mucous membranes (mouth, rectum, vagina) without a probe cover could easily harm the device and poses a significant health risk to patients.

In a similar fashion, failing to cover the probe could lead to cross-contamination if it comes into contact with the patient’s blood or bodily fluids. Contact with non-intact skin also signifies that the risk of transmitting a healthcare-associated infection to the patient is higher. As a result, endocavity, or general purpose procedures where is non-intact skin present, are considered critical or semi-critical procedures in accordance with the Spaulding classification.

Ultrasound disinfection reduces the risk of healthcare-associated infections

While non-critical ultrasound exams may not require a probe cover, all exams and procedures, regardless of Spaulding rating, require some level of disinfection. Depending on the nature of ultrasound use, clinicians will have to choose between a low-level disinfectant and a high-level disinfectant.

Low-level disinfectants are those used in non-critical procedures where the transducer comes into contact with intact skin only. These procedures or exams tend to carry a lower risk than semi-critical or critical procedures where the transducer comes into contact with mucous membranes and/or blood and other bodily fluids.

Regardless of the lower level of risk carried by non-critical exams, it is still recommended that clinicians perform disinfection between each patient. Failing to do so can facilitate pathogen colonization on the device. It is especially important since probe covers are not used during non-critical procedures, thus making the disinfectant the first and only line of defense against healthcare-associated infections.

In semi-critical and critical procedures, your facility’s infection control protocols may recommend high-level disinfection. As previously mentioned, these procedures can many times take place in interventional settings where sterility is of the utmost importance. To ensure that the ultrasound probe does not break the sterile field, properly covering the device with a sterile probe cover is necessary. In addition, high-level disinfection should be performed on the transducer. Examples of high-level ultrasound disinfection include standardized automated validated systems and immersion baths, such as those containing glutaraldehyde. Another option on an international scale is approved multistep disinfectant wipes or sprays which are validated for high-level disinfection, but these are not an option for American facilities as they are not yet FDA-approved.

Probe covers and disinfection work in tandem

It is important for ultrasound users to have a clear understanding of the infection control process for the modality. Probe covers do not replace disinfectants and disinfectants do not replace probe covers. While probe covers may not be used in every procedure, its role is unique and cannot be omitted even if a high-level disinfectant, for example, is used on the device.

Healthcare providers should have a comprehensive view of ultrasound infection control where they view each aspect of the process (disinfectants, probe covers, sterile gel, etc.) as an asset rather than a quick fix or replacement. By properly incorporating each step in the process, clinicians can elevate patient safety during these procedures and keep ultrasound secure. Not only does this improve patient outcomes but it can also lower the costs tied to healthcare-associated infections and improperly reprocessed probes.

Learn more about how your facility can maximize patient safety during ultrasound-guided exams and procedures here. We also invite you to download our free white paper on ultrasound infection control here.

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