Becker's Clinical Quality & Infection Control

51 Executive Briefing Sponsored by: U ltrasound is a versatile medical technology used in almost every healthcare department across a spectrum of specialties and procedures. Infection preventionists (IPs) and quality and risk managers understand the challenges of ensuring system wide compliance with best practice ultrasound infection prevention and the need to respond to clinical developments. Nanosonics is dedicated to developing solutions for facilities that partner with these responses, enabling standardization and clinical integration to enhance patient and staff safety. Ultrasound risk Studies demonstrate ultrasound probes can be contaminated with microorganisms after patient use, even with the use of probe sheaths. Over 90% of transvaginal ultrasound probes can be contaminated with bacteria after use and almost 50% of ultrasound probes in emergency and ICU settings can be contaminated. 1-3 Studies also show that even after low level disinfection with wipes and sprays ultrasound probes can be contaminated with virus and bacteria, including pathogens that cause sexually transmitted infections like human papillomavirus and Chlamydia trachomatis. 1,4,5 Standard precautions dictate every patient must be assumed to be infectious to help break the chain of infection transmission. In medical device disinfection, this means applying the Spaulding classification to the probe before use on a patient (Figure 1). 6 Spaulding forms the basis of medical device disinfectant regulation, Federal guidelines and National standards, 7-12 and is also adopted internationally. Figure 1. The Spaulding classification divides infection transmission risk based on the type of patient tissue the device will contact during use, which determines the level of disinfection. 6-12 If sterilization of critical ultrasound probes is not possible, CDC permits HLD and the probe must be used with a sterile sheath. 7 A landmark epidemiological study by the Scottish health authority reported an increased risk of infection in the 30 days following an endocavitary ultrasound scan, where low level disinfection was the practiced standard of care. 13 The study followed almost 1 million patient journeys retrospectively through linked national patient datasets between 2010 and 2016. Under Spaulding, endocavitary probes contact mucous membranes and are semi-critical, minimally requiring high level disinfection (HLD) and a sheath. The Scottish government has mandated HLD for semi-critical probes since 2016, in line with minimum USA standards. 14 Surface ultrasound probes can also carry infection transmission risks. An intraoperative probe was the source of an outbreak, involving patients undergoing hepatic surgeries with the contaminated device. 15 Improper probe reprocessing was identified as one of the factors. Another study found ultrasound was associated with increased bloodstream infection risk when used to guide central line insertions at the femoral and jugular sites. Contaminated gel was ruled out and confounding variables such as number of insertion attempts were controlled. 16 Surface probes can be non-critical, semi-critical or critical depending on their use; it's important Spaulding is applied to help manage infection risk. Managing the risk A 2018 U.S. National survey of IPs revealed the landscape of ultrasound use throughout healthcare. 17 Over 80% of respondents indicated ultrasound was used in radiology, obstetrics and gynecology, emergency, cardiology, operating room, adult intensive care and vascular/vein clinics. At least 50% of respondents indicated ultrasound was used in a further six departments. Consider the diversity of environments across these departments. Each has ultrasound users performing specialized procedures, who may be different to reprocessing staff. In some cases, reprocessing will occur at point of care, in others at a central location. Each department may have varying adherence to facility ultrasound use and reprocessing policy. The majority (92%) of respondents in the survey preferred standardization of facility wide products and processes for reprocessing ultrasound probes. 17 Traceability is required for sterilization and HLD and can also benefit from standardization. A traceability system links the reprocessing record to the unique probe and the patient on whom the probe is used. 12,18 Traceability is essential in outbreak investigations to determine the extent of notifications and device recalls. In non-outbreak settings, it allows facilities to demonstrate they meet their duty of care to patients and surveyors for reimbursement. 18 In 2017 The Joint Commission found a 'Lack of monitoring or documentation of sterilization or HLD of equipment…' in locations which included those that typically use ultrasound (e.g. ERs, OB/GYN clinics). 19 Ultrasound infection prevention workflow standardization: Unlocking risk management

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