Menu

A+ A A-

Download article

DOI: https://doi.org/10.22263/2312-4156.2021.5.15

Dikareva E.A., Pimanov S.I.
Ultrasound examination and the risk of iatrogenic infections development
Vitebsk State Order of Peoples’ Friendship Medical University, Vitebsk, Republic of Belarus

Vestnik VGMU. 2021;20(5):15-22.

Abstract.
Ultrasound examination is used in all areas of modern medicine and occupies the leading positions in non-invasive instrumental diagnostics. Ultrasound is believed to be safe for patients. At the same time, there is a dangerous effect of ultrasound, manifested by bacterial and viral contamination of ultrasound equipment and the examined patients. Numerous studies have convincingly shown that ultrasound is dangerous in terms of iatrogenic contamination of a patient with bacterial, fungal and viral infections.
Each ultrasound examination includes contact between the probe of the device and the patient’s skin, or his/her mucous membranes, or sterile tissues during intraoperative examinations. When the ultrasonic sensor comes into contact with the patient’s body, it may become contaminated with pathogenic and opportunistic microorganisms. It is also possible to contaminate the ultrasound equipment and the hands of a doctor who conducts this study. All this will subsequently contribute to the microorganisms transmission to other subjects being examined. Therefore, every patient should be considered as a potential source of pathogenic microorganisms and viruses.
The purpose of the work was to analyze the literature data on bacterial and viral contamination during ultrasound examination.
Key words: ultrasound examination, microbial contamination, iatrogenic pathology.

References

1. Pimanov SI. Ultrasound diagnostics in gastroenterology. Moscow, RF: Prakt meditsina; 2016. 415 р. (In Russ.)
2. Westerway SC, Basseal JM, Brockway A, Hyett JA, Carter DA. Potential infection control risks associated with ultrasound equipment – a bacterial perspective. Ultrasound Med Biol. 2017 Feb;43(2):421-426. doi: http://dx.doi.org/10.1016/j.ultrasmedbio.2016.09.004
3. Mullaney PJ, Munthali P, Vlachou P, Jenkins D, Rathod A, Entwisle J. How clean is your probe? Microbiological assessment of ultrasound transducers in routine clinical use, and cost-effective ways to reduce contamination. Clin Radiol. 2007 Jul;62(7):694-8. doi: http://dx.doi.org/10.1016/j.crad.2007.01.002
4. Australasian Society for Ultrasound in Medicine. Guidelines for reprocessing ultrasound transducers by the australasian society for ultrasound in medicine and the australasian college for infection prevention and control. AJUM. 2017 Feb;20(1):30-40. doi: http://dx.doi.org/org/10.1002/ajum.12042
5. Koibuchi H, Kotani K, Taniguchi N. Ultrasound probes as a possible vector of bacterial transmission. Med Ultrason. 2013 Mar;15(1):41-4. doi: http://dx.doi.org/10.11152/mu.2013.2066.151.hk1upp2
6. Whitehead EJ, Thompson JF, Lewis DR. Contamination and decontamination of doppler probes. Ann R Coll Surg Engl. 2006 Sep;88(5):479-81.  doi: http://dx.doi.org/10.1308/003588406X114866
7. Frazee BW, Fahimi J, Lambert L, Nagdev A. Emergency department ultrasonographic probe contamination and experimental model of probe disinfection. Ann Emerg Med. 2011 Jul;58(1):56-63. doi: http://dx.doi.org/10.1016/j.annemergmed.2010.12.015  
8. Sanz GE, Theoret J, Liao MM, Erickson C, Kendall JL. Bacterial contamination and cleanliness of emergency department ultrasound probes. CJEM. 2011 Nov;13(6):384-9. doi: http://dx.doi.org/10.2310/8000.2011.110409
9. Sykes A, Appleby M, Perry J, Gould K. An investigation of the microbiological contamination of ultrasound equipment. Br J Infect Control. 2006;7(4):16-20. doi: http://dx.doi.org/10.1177/14690446060070040501
10. Sartoretti T, Sartoretti E, Bucher C, Doert A, Binkert C, Hergan K, et al. Bacterial contamination of ultrasound probes in different radiological institutions before and after specific hygiene training: do we have a general hygienical problem? Eur Radiol. 2017 Oct;27(10):4181-4187. doi: http://dx.doi.org/10.1007/s00330-017-4812-1
11. Bancroft EA, English L, Terashita D, Yasuda L. Outbreak of Escherichia coli infections associated with a contaminated transesophageal echocardiography probe. Infect Control Hosp Epidemiol. 2013 Oct;34(10):1121-3. doi: http://dx.doi.org/10.1086/673160
12. Paz A, Bauer H, Potasman I. Multiresistant Pseudomonas aeruginosa associated with contaminated transrectal ultrasound. J Hosp Infect. 2001 Oct;49(2):148-9. doi: http://dx.doi.org/10.1053/jhin.2001.1056
13. M'Zali F, Bounizra C, Leroy S, Mekki Y, Quentin-Noury C, Kann M. Persistence of microbial contamination on transvaginal ultrasound probes despite low-level disinfection procedure. PLoS One. 2014 Apr 2;9(4):e93368. doi: http://dx.doi.org/10.1371/journal.pone.0093368
14. Hayashi S, Koibuchi H, Taniguchi N, Hirai Y. Evaluation of procedures for decontaminating ultrasound probes. J Med Ultrason. 2012 Jan;39(1):11-4. doi: http://dx.doi.org/10.1007/s10396-011-0332-9
15. Karadenz YM, Kiliç D, Altan SK, Altinok D, Güney S. Evaluation of the role of ultrasound machines as a source of nosocomial and cross-infection. Invest Radiol. 2001 Sep;36(9):554-8. doi: http://dx.doi.org/10.1097/00004424-200109000-00009
16. Weist K, Wendt C, Petersen LR, Versmold H, Rüden H. An outbreak of pyodermas among neonates caused by ultrasound gel contaminated with methicillin-susceptible Staphylococcus aureus. Infect Control Hosp Epidemiol. 2000 Dec;21(12):761-4. doi: http://dx.doi.org/10.1086/501729
17. Gaillot O, Maruéjouls C, Abachin E, Lecuru F, Arlet G, Simonet M, et al. Nosocomial outbreak of Klebsiella pneumoniae producing SHV-5 extended-spectrum beta-lactamase, originating from a contaminated ultrasonography coupling gel. J Clin Microbiol. 1998 May;36(5):1357-60. doi: http://dx.doi.org/10.1128/JCM.36.5.1357-1360.1998
18. Kac G, Podglajen I, Si-Mohamed A, Rodi A, Grataloup C, Meyer G. Evaluation of ultraviolet C for disinfection of endocavitary ultrasound transducers persistently contaminated despite probe covers. Infect Control Hosp Epidemiol. 2010 Feb;31(2):165-70. doi: http://dx.doi.org/10.1086/649794
19. Lessa F, Tak S, Devader SR, Goswami R, Anderson M, Williams I, et al. Risk of infections associated with improperly reprocessed transrectal ultrasound-guided prostate biopsy equipment. Infect Control Hosp Epidemiol. 2008 Apr;29(4):289-93. doi: http://dx.doi.org/10.1086/533546
20. Gillespie JL, Arnold KE, Noble-Wang J, Jensen B, Arduino M, Hageman J, et al. Outbreak of Pseudomonas aeruginosa infections after transrectal ultrasound-guided prostate biops. Urology. 2007 May;69(5):912-4. doi: http://dx.doi.org/10.1016/j.urology.2007.01.047
21. Organ M, Grantmyre J, Hutchinson J. Burkholderia cepacia infection of the prostate caused by inoculation of contaminated ultrasound gel during transrectal biopsy of the prostate. Can Urol Assoc J. 2010 Jun;4(3):E58-60. doi: http://dx.doi.org/10.5489/cuaj.857
22. Olshtain-Pops K, Block C, Temper V, Hidalgo-Grass C, Gross I, Moses AE, et al. An outbreak of Achromobacter xylosoxidans associated with ultrasound gel during transrectal ultrasound guided prostate biopsy. J Urol. 2011 Jan;185(1):144-7. doi: http://dx.doi.org/10.1016/j.juro.2010.08.093
23. Williamson DA, Barrett LK, Rogers BA, Freeman JT, Hadway P, Paterson DL. Infectious complications following transrectal ultrasound-guided prostate biopsy: new challenges in the era of multidrug-resistant Escherichia coli. Clin Infect Dis. 2013 Jul;57(2):267-74. doi: http://dx.doi.org/10.1093/cid/cit193
24. Ferhi K, Haertig A, Mozer P, de la Taille A, Roupret M, Van Glabeke E, et al. A case of hepatitis C virus possible transmission following a transrectal ultrasound guided prostate biopsy. Prog Urol. 2013 Mar;23(3):222-4. doi: http://dx.doi.org/10.1016/j.purol.2013.01.002
25. Leroy S. Infectious risk of endovaginal and transrectal ultrasonography: systematic review and meta-analysis. J Hosp Infect. 2013 Feb;83(2):99-106. doi: http://dx.doi.org/10.1016/j.jhin.2012.07.014
26. Amis S, Ruddy M, Kibbler CC, Economides DL, MacLean AB. Assessment of condoms as probe covers for transvaginal sonography. J Clin Ultrasound. 2000 Jul-Aug;28(6):295-8. doi: http://dx.doi.org/10.1002/1097-0096(200007/08)28:6<295::aid-jcu5>3.0.co;2-g
27. Combs CA, Fishman A. A proposal to reduce the risk of transmission of human papilloma virus via transvaginal ultrasound. Am J Obstet Gynecol. 2016 Jul;215(1):63-7. doi: http://dx.doi.org/10.1016/j.ajog.2016.03.014
28. Casalegno J, Le Bail Carval K, Eibach D, Valdeyron M-L, Lamblin G, Jacquemoud H, et al. High risk HPV contamination of endocavity vaginal ultrasound probes: an underestimated route of nosocomial infection? PLoS One. 2012;7(10):e48137. doi: http://dx.doi.org/10.1371/journal.pone.0048137
29. Abramowicz JS, Akiyama I, Evans D, Fowlkes JB, Marsal K, Sayeed Y, ter Haar G, et al. World federation for ultrasound in medicine and biology position statement: how to perform a safe ultrasound examination and clean equipment in the context of COVID-19. Ultrasound Med Biol. 2020 Jul;46(7):1821-1826. doi: http://dx.doi.org/10.1016/j.ultrasmedbio.2020.03.033
30. Centers for Disease Control and Prevention. Outbreak of Pseudomonas aeruginosa respiratory tract infections in cardiovascular surgery associated with contaminated ultrasound gel used for transesophageal echocardiography – Michigan, December 2011-January 2012. MMWR Morb Mortal Wkly Rep. 2012 Apr;61:262-4.
31. Chittick P, Russo V, Sims M, Robinson-Dunn B, Oleszkowicz S, Sawarynski K, et al. An outbreak of Pseudomonas aeruginosa respiratory tract infections associated with intrinsically contaminated ultrasound transmission gel. Infect Control Hosp Epidemiol. 2013 Aug;34(8):850-3. doi: http://dx.doi.org/10.1086/671268
32. Oleszkowicz SC, Chittick P, Russo V, Keller P, Sims M, Band J. Infections associated with use of ultrasound transmission gel: proposed guideldines to minimize risk. Infect Control Hosp Epidemiol. 2012 Dec;33(12):1235-7. doi: http://dx.doi.org/10.1086/668430
33. Jacobson M, Wray R, Kovach D, Henry D, Speert D, Matlow A. Sustained endemicity of Burkholderia cepacia complex in a pediatric institution, associated with contaminated ultrasound gel. Infect Control Hosp Epidemiol. 2006 Apr;27(4):362-6. doi: http://dx.doi.org/10.1086/503343
34. Kramer A, Schwebke I, Kampf G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis. 2006 Aug;6:130. doi: http://dx.doi.org/10.1186/1471-2334-6-130

Information about authors:
Dikareva E.A. – Candidate of Medical Sciences, associate professor of the Chair of Internal Diseases & Ultrasound Diagnostics of the Faculty for Advanced Training & Retraining, Vitebsk State Order of Peoples’ Friendship Medical University;
Pimanov S.I. – Doctor of Medical Sciences, professor, head of the Chair of Internal Diseases & Ultrasound Diagnostics of the Faculty for Advanced Training & Retraining, Vitebsk State Order of Peoples’ Friendship Medical University.

Correspondence address: Republic of Belarus, 210009, Vitebsk, 27 Frunze ave., Vitebsk State Order of Peoples’ Friendship Medical University, Chair of Internal Diseases & Ultrasound Diagnostics of the Faculty for Advanced Training & Retraining. E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Elena A. Dikareva.

Поиск по сайту