Laurel, MD, December 9, 2021—Cleaning and low-level disinfection (LLD) effective against bloodborne pathogens are safe and sufficient procedures for disinfecting ultrasound transducers used in percutaneous procedures, according to an intersocietal position statement issued by the American Institute of Ultrasound in Medicine (AIUM), a healthcare professional organization dedicated to advancing the safe and effective use of medical ultrasound.1
Appearing in the peer-reviewed Journal of Ultrasound Medicine, the statement was issued to clear up confusion over disinfection practices and ensure that ultrasound equipment remains both safe and available. Originally published in February 2021, the statement was recently republished with the support of 20 healthcare organizations, together representing more than 790,000 physicians, nurses, infection control professionals, and other healthcare professionals.
“Our hope is that having the support of so many organizations will encourage the widespread adoption of appropriate disinfection practices in clinical and professional settings, bringing significant benefits to patients,” says AIUM CEO Glynis Harvey, CAE.
Debate Over Disinfection Practices
The position statement was developed to address a growing debate over disinfection practices among practitioners in a wide range of medical specialties, explains Oliver Kripfgans, PhD, a medical ultrasound physicist and research associate professor at the University of Michigan who spearheaded development of the statement.
In many advanced medical procedures, ultrasound is a valuable tool for guiding needles, catheters, and other devices that are inserted through the skin. Such percutaneous procedures include vascular access, arthrocentesis, paracentesis, pericardiocentesis, thoracentesis, lumbar puncture, and the delivery of regional anesthesia.
The current debate stems from confusion over how ultrasound transducers should be disinfected between such procedures. Some practitioners have supported the use of high-level disinfection (HLD) techniques, which typically involve placing transducers in an apparatus that exposes them to specialized disinfecting chemicals such as glutaraldehyde or a mist of hydrogen peroxide. Many hospitals and infection control staff have gone along with such recommendations because of infection concerns during the pandemic, thinking that HLD would provide an extra margin of safety.
Meanwhile, other experts have maintained that adequate protection is provided by use of a disposable transducer cover followed by cleaning and LLD, which involves wiping the equipment thoroughly with standard disinfectants.
To clarify these issues, the AIUM organized an intersocietal taskforce to examine the evidence available in published studies. The taskforce concluded that ultrasound-guided percutaneous procedures can be safely performed in conjunction with cleaning and LLD techniques, noting that transducer covers or other approved mechanical barriers protect the sterility of the procedure. Moreover, evidence showed that rare cases of infection are typically linked to the use of nonsterile or contaminated coupling gels, failure to use a transducer cover, or improper cleaning—but not to the use of LLD techniques.
Balancing Patient Safety and Ultrasound Access
Equally important, the taskforce found that recommendations for HLD are “not evidence-based and will result in unwarranted and unnecessary use of resources.” Since few hospitals and clinics can afford the equipment and staff resources needed to perform HLD for a high volume of daily procedures, the increase in policies requiring HLD may lead to a reduction in the use of ultrasound during percutaneous procedures—an unfortunate consequence with serious implications.
“There was great concern that we were actually harming patients by requiring high-level disinfection,” says Kripfgans—a concern highlighted by the real-world experience of one of the intersocietal taskforce members.
In an incident described by emergency medicine physician Christopher Kumetz, MD, a patient with a heart issue had a significant delay in diagnosis because the clinic’s sole transducer was unavailable for use while undergoing high-level disinfection. Continuing to impose such requirements for performing HLD between percutaneous procedures, he says, “would destroy point-of-care ultrasound.”
With the support of the 20 signatory organizations (listed below), the AIUM is now launching an educational campaign to publicize the position statement and encourage the adoption of LLD techniques “to ensure that this invaluable tool remains available to every patient who can benefit from it,” says Harvey.
Initial funding for the educational campaign has been provided by Parker Laboratories, Inc. (Fairfield, NJ), a worldwide leader in ultrasound products for more than 60 years.
The American Institute of Ultrasound in Medicine is a multidisciplinary medical association of more than 9,000 physicians, sonographers, scientists, students, and other healthcare professionals. Established in the early 1950s, AIUM is dedicated to advancing the safe and effective use of ultrasound in medicine through professional and public education, research, development of guidelines, and accreditation.
1. Intersocietal position statement: disinfection of ultrasound transducers used for percutaneous procedures [corrected version]. J Ultrasound Med. First published online, 16 November 2021; doi: 10.1002/jum.15653.
American Academy of Emergency Medicine (AAEM)1
American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM)
American College of Emergency Physicians (ACEP)
American College of Osteopathic Obstetricians and Gynecologists (ACOOG)
American College of Radiology (ACR)
American Medical Society for Sports Medicine (AMSSM)2
American Institute of Ultrasound in Medicine (AIUM)
American Registry for Diagnostic Medical Sonography (ARDMS)
American Registry of Radiologic Technologists (ARRT)
American Society of Anesthesiologists (ASA)3
Association for Professionals in Infection Control and Epidemiology (APIC)
Association for Vascular Access (AVA)
Emergency Nurses Association (ENA)
Infusion Nurses Society (INS)
International Society of Ultrasound in Obstetrics and Gynecology (ISUOG)
Point-of-Care Ultrasound Certification Academy (POCUS)
Society for Healthcare Epidemiology of America (SHEA)
Society for Maternal-Fetal Medicine (SMFM)
Society of Breast Imaging (SBI)
Society of Radiologists in Ultrasound (SRU)
1. Independently, the Emergency Ultrasound Section of the American Academy of Emergency Medicine (EUS-AAEM) has also endorsed the position statement.
2. The AMSSM board has voted to Affirm for Value the position statement.
3. The ASA Council has approved support with the following notation: "Since the document has neither been presented to nor approved by either the ASA Board of Directors or House of Delegates, it is not an official or approved statement or policy of the society. Variances from the recommendations contained in the document may be acceptable based on the judgment of the responsible anesthesiologist."
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