To reduce ultrasound probe cross infection risk, you need to know why and when to perform the high level disinfection (HLD) process.
Why HLD ultrasound probes?
HLD ensures that you deliver a standard of care for patient and staff safety during ultrasound procedures while maximizing compliance.
1. Deliver Patient and Staff Safety
If certain standards of care are not met, the consequences can be serious.
- Patients have previously been put at risk of infection transmission due to inadequate cleaning or disinfecting and non-compliance with recommended reprocessing procedures1
- 1 in 25 hospital patients will have at least one health-care acquired infection (HAI) on any given day2
- Up to 70% of HAIs are preventable using existing infection prevention practices 3
- Death has been associated with improperly reprocessed ultrasound probes4
- First population-level study of its kind reveals increased risk of infection and antibiotic prescriptions following semi-invasive ultrasound probe procedures5
2. Maximize Compliance
HLD is mandated by the CDC as the minimum standard in ultrasound probe reprocessing for semi-critical procedures (i.e. intracavity and surface ultrasound probes that contact mucous membranes or non-intact skin). Unfortunately this minimum standard is not always being met.
Multiple guidelines now recommend HLD between patients to reduce the risk of cross contamination.
Infection-control professionals need to ensure that their internal policies are consistent with these national guidelines to ensure compliance.
“Even if probe covers have been used, clean and high-level disinfect”.6CDC Guidelines 2008
“Routine high-level disinfection of internal probes between patients is mandatory”.7AIUM Guidelines 2014
“Joint commission alert is a another wake-up call for awareness of improper HLD or sterilization”.8TJC alert 2014
GUIDELINE ALERTS – NON-COMPLIANCE ISSUES
When to HLD?
HLD should be performed on ultrasound probes that are used in semi-critical procedures, as defined by the Spaulding Classification. Applying the correct level of disinfection is based on the procedure the probe is going to be used for on the next patient.
Ultrasound probes used in examinations that may have a remote chance of contacting dry/cracked skin (or other non-intact skin) and bodily fluids (including blood) should be minimally high level disinfected.6,7
If the patient is high-risk or the skin is not intact then general purpose probes should be high level disinfected.
Heat-sensitive devices can be HLD, at a minimum, when sterilization cannot be done due to the potential damage to the device.
High Level Disinfection (HLD):
Is one of three disinfection levels used in hospital and clinics for reprocessing ultrasound probes.
HLD results in the complete elimination of all microorganisms in or on a probe, except for bacterial spores, large numbers of which may remain.6,9
- Semi-critical probes should be high level disinfected even if a sheath is used5
- Critical probes should be sterilized, or can also be high level disinfected and used with a sterile sheath5
- Ultrasound probes used in examinations that may have a remote chance of contacting dry/cracked skin (or other non-intact skin) and bodily fluids (including blood) should be minimally high level disinfected5,6
- Non-intact skin includes any breakage or damage to healthy intact skin, including but not limited to dry/cracked skin, wounds, cuts, incisions, lacerations, gashes, grazes, abrasions, avulsions, eczema, rashes and burns
- If the intended use of an ultrasound probe should change prior to or during a procedure, the ultrasound probe should be reprocessed appropriately before commencing or continuing the examination
Sterilization: All viable microorganisms must be destroyed
SEMI-CRITICAL: A device that may come into contact with intact mucous membranes and does not ordinarily penetrate sterile tissue. These devices should minimally receive high-level disinfection, which is defined as the destruction of all vegetative bacteria, mycobacteria, enveloped and non-enveloped viruses, fungal spores, and some bacterial spores5.
High Level Disinfection: All viable microorganisms must be destroyed, except a small number bacterial spores
NON-CRITICAL: Devices that do not ordinarily contact the patient or contact only intact skin. These devices should be low-level disinfected.
Low Level Disinfection: Most vegetative bacteria and viruses destroyed, except bacterial spores, mycobacteria, fungi, or small non-lipid viruses.
- CDC Health Alert Network September 11, 2015. Available from: http://emergency.cdc.gov/han/han00382.asp.
- Scott, RD. The Direct Medical Costs of Healthcare-Acquired Infections in US Hospitals and the Benefits of Prevention, Centers for Disease Control and Prevention. 1–13, 2009.
- GOV.UK Medical Safety Alert; Reusable transoesophageal echocardiography, transvaginal and transrectal ultrasound probes (transducer) – failure to appropriately decontaminate. (https://www.gov.uk/drug-device-alerts/medical-device-alert-reusable-transoesophageal-echocardiography-transvaginal-and-transrectal-ultrasound-probes-transducers-failure-to-appropriately-decontaminate)
- Health Protection Scotland, NHS National Services Scotland. NHSScotland Risk Based Recommendations for the Decontamination of Semi-Invasive Ultrasound Probes: Risk of infection following semi-invasive ultrasound procedures in Scotland, 2010 to 2016. Version 1.0. October 2017. Accessible at: http://www.hps.scot.nhs.uk/pubs/detail.aspx?id=3366
- Rutala WA, Weber DJ, HICPAC. Guideline for Disinfection and Sterilization in Healthcare Facilities. USA: Centers for Disease Control; CDC 2008. (https://www.cdc.gov/infectioncontrol/pdf/guidelines/disinfection-guidelines.pdf)
- American Institute of Ultrasound in Medicine. Guidelines for cleaning and preparing external and internal-use ultrasound probes between patients. AIUM Official Statement. Online at: http://www.aium.org/officialStatements/57. Accessed March 8, 2016.
- Electronically accessed:Joint Commission Alert is Another Wake-Up Call for Awareness of Improper HLD or Sterilization. http://www.infectioncontroltoday.com/articles/2014/08/joint-commission-alert-is-a-another-wakeup-call-for-awareness-of-improper-hld-or-sterilization.aspx
- Federal Drug Administration. Guidance for Industry and FDA Reviewers: Content and Format of Premarket Notification [510(k)] Submissions for Liquid Chemical Sterilants/High Level Disinfectants. 2000.
- American National Standards Institute (ANSI), Association for the Advancement of Medical Instrumentation (AAMI). ST58:2013 Chemical sterilization and high-level disinfection in health care facilities.