Top Tips for High-Level Disinfection of Ultrasound Probes – Part I

probe storageGiven the need to implement best practices for high-level disinfection in ultrasound, we’ve assembled our most popular disinfection blogs for your convenience at the CIVCO Guidelines Blog. These educational tips can be enhanced by our monthly webinar series. Visit CIVCO.com/Events to view our upcoming CME webinars.

In each series, we will review a broad high-level disinfection guideline to promote a basic understanding of best practices. Thereafter, we will hone in on a few specific areas of concern that are frequently asked during our webinars or by our customers. As always, we will provide sources to substantiate our tips.

Since ultrasound probe cleaning practices are constantly evolving, healthcare workers should always acquire up-to-date information for the products and practices they use. In addition, always refer to the manufacturer’s instructions for use (IFU), labels for use, and your facility’s infection control policies.

1. An instrument that comes in contact with a mucous membrane or non-intact skin is a “semi-critical” device and requires high-level disinfection after each procedure.

“Semi-critical items contact mucous membranes or non-intact skin. This category includes respiratory therapy and anesthesia equipment, some endoscopes, laryngoscope blades, esophageal manometry probes, cystoscopes, anorectal manometry catheters, and diaphragm fitting rings…Provide, at a minimum, high-level disinfection for semi-critical patient-care equipment (e.g., gastrointestinal endoscopes, endotracheal tubes, anesthesia breathing circuits, and respiratory therapy equipment) that touches either mucous membranes or non- intact skin.”
CDC Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008, page 83.

“Other probes such as rectal (and vaginal), cryosurgical, and transesophagael probes or devices also should be high-level disinfected between patients.”
CDC Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008, page 19.

“Semi-critical items minimally require high-level disinfection using chemical disinfectants. Glutaraldehyde, hydrogen peroxide, OPA (ortho-phthalaldehyde), and peracetic acid with hydrogen peroxide are cleared by the Food and Drug Administration (FDA) and are dependable high-level disinfectants provided the factors influencing germicidal procedures are met.”
CDC Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008, page 10.

Spaulding
Classification
Definition Example Disinfection
Critical Object enters sterile tissue Surgical Instruments Sterilization
Semi-Critical Object contacts mucous membranes or non-intact skin Endocavity Probes, Endoscopes High-Level Disinfection
Non-Critical Object contacts intact skin Blood Pressure Cuffs Low- or Mid-Level Disinfection

2. Store ultrasound probes vertically and in a cabinet or clean environment.

In October of 2013, The Joint Commission (TJC) provided guidelines for the storage of semi-critical devices.  As explained in Top Tip #1, ultrasound probes are semi-critical devices.

“Store the device in a manner that will protect from damage or contamination and that is consistent with national guidelines and manufacturers’ recommendations such as hanging vertically in a cabinet and storing in a clean environment.”

ultrasound probe storage cabinet

  • In addition to TJC’s guidelines, here are more ultrasound probe storage pointers:
    Make sure that the probes’ cables and electrical connectors do not come in contact with the probe during handling and storage. Unlike endoscopes, only the probe itself is disinfected.
  • Keep disinfected probes away from dirty probes to avoid cross-contamination.
    Do not use the transducer shipping case for storage.
  • Per Philips’ guidelines, do not bend the flexible shaft of a TEE probe into a circle with a diameter of less than 0.30 m (1 ft).
  • Avoid storing transducers in direct sunlight or in areas of extreme temperatures.
  • The ideal probe storage system should incorporate a fan and HEPA filtered air that aids both in the drying process and provides positive pressure within a cabinet.

To learn more on storage, read our complete storage blog

3. All endocavity probes (vaginal, rectal and tranesophageal) require a sheath or condom in addition to a high-level disinfection.

probe covers“A vaginal probe and all endocavity probes without a probe cover are semi-critical devices because they have direct contact with mucous membranes (e.g., vagina, rectum, pharynx). While use of the probe cover could be considered as changing the category, this guideline proposes use of a new condom/probe cover for the probe for each patient, and because condoms/probe covers can fail, the probe also should be high-level disinfected.“
CDC Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008

4. It is recommended to transport Transesophageal (TEE) probes in a covered container.

Daily transport of ultrasound probes can pose significant challenges to infection control and probe safety for any department, since clean and dirty probes are transported throughout the facility multiple times a day. CIVCO’s new TEE Probe Transport Tray helps you to be compliant with national transport standards and OEM guidelines.

The Joint Commission’s recommendation:
“Remove the device from the room in a covered container…”1

Probe manufacturers (OEMs) provide specific instructions as well: “To avoid damaging the shaft… Do not bend or coil the flexible shaft of the transducer in less than a 1-ft diameter circle”2

CIVCO’s TEE Probe Transport Tray is disposable and made of recyclable water-resistant material. Its reversible clean/dirty lid simplifies your workflow for safe clean and dirty probe transport, and its special design reduces the risk of damage to the TEE probe and prevents cross-contamination.

Stay tuned for part two of our Top Tips of High-Level Disinfection series. Your requests for information are also welcome; please contact us with your questions.

Sources:

  1. CDC, “Guideline for Disinfection and Sterilization in Healthcare Facilities,” 2008
  2. AIUM, “Guidelines for Cleaning and Preparing External- and Internal-Use Ultrasound Probes Between Patients, Safe Handling, and Use of Ultrasound Coupling Gel,” (Approved 5/16/2017)
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