Ultrasound infection prevention workflow standardization: Unlocking risk management

Ultrasound 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. 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.
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. Spaulding forms the basis of medical device disinfectant regulation, Federal guidelines and National standards, and is also adopted internationally.
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. 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.

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. 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.Surface probes can be 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. 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.

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. 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. 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.

Automation naturally supports standardization and policy compliance by minimizing human factors. A study from endoscopy found adherence to reprocessing guidelines increased from 1.4% to 75.4% with increasing automation of the steps. Staff were happier, with physical discomfort diminishing with automation.20 In ultrasound, manual disinfection methods can also be prone to human error, as the user needs to verify and record the critical parameters are met each time on all surfaces of the probe. In the survey, 91% of respondents preferred to use automated processes for probe reprocessing.

trophon®2: leader in automated ultrasound probe HLD

Nanosonics trophon® is the global standard of care in ultrasound probe HLD helping protect patients from the risk
of cross contamination. The trophon family includes trophon® EPR and trophon®2 which share the same core technology of sonically activated hydrogen peroxide. trophon is bactericidal, fungicidal, virucidal and mycobactericidal.

Every day, 80,000 patients are protected from cross contamination risk because the ultrasound probe used in their procedure has undergone HLD with trophon. Over 22,000 units are used across North America, in over 5,000 hospitals and clinics including all luminary hospitals.

trophon is designed with point of care placement in mind to support staff and patient safety, throughput and cost effectiveness. trophon uses a proprietary hydrogen peroxide disinfectant that is sonically activated to create a mist in the probe chamber, penetrating crevices, grooves and imperfections on the probe body and handle. trophon is a closed, automated HLD device and mitigates the risk of exposure to hazardous chemicals often associated with manual methods.

The trophon department. HLD process is standardized in every department.  The critical parameters are automatically controlled and validated by the device, further verified with a chemical indicator each cycle. trophon efficacy has been demonstrated in peer review with microbiological studies and in clinical settings. Nanosonics’ second generation device, trophon2, launched in 2018 and is enabled with AcuTrace® RFID technology to deliver digitized capture of the reprocessing record.

Nanosonics AuditProTM: Your key to infection prevention standardization

The new Nanosonics AuditPro provides facilities with the opportunity to improve and standardize ultrasound infection control compliance across all ultrasound procedures, supporting the management of organizational and facility risk and patient care.

Nanosonics AuditPro comprises a mobile scanning device (MSD) for ultrasound users coupled with sophisticated software to manage compliance. The MSD uniquely sits with the ultrasound console at point of care enabling users to incorporate infection control considerations as part of everyday practice. With built in education as part of the workflow, users qualify every procedure against the Spaulding classification for probe disinfection requirements, standardizing the infection prevention decision every time.

The software combines ultrasound patient procedures and probe disinfection information, including HLD records from the trophon2 device, and interrogates data captured through the clinical workflow to create non-compliance notifications and intuitive information rich dashboards. Together, trophon2 and AuditPro mitigate risk to patients and healthcare facilities, arming healthcare staff, IPs and risk and quality managers with tools to drive compliance.

Discover how Nanosonics AuditPro can standardize your ultrasound infection prevention practices, help you meet accreditation requirements and deliver best practice patient care across your organization. 


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