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Re: endovag probesFrom: DuboseTerryJ@uams.eduWed Apr 4 08:24:38 2001
This has been a recent discussion on the Australian listserv. The following is a lot of what was exchanged... starting with a message this morning from one of Joan Baker's first year sonography students. Obviously sonographic gel and transducers can be a infective vector. It all depends upon how you clean the transducers... and how much rigor is required. For me, I still prefer individual sterilized surgical lubs for endovaginal transducers. Hope this helps. Terry J. DuBose, M.S., RDMS, Assistant Professor Director, Diagnostic Medical Sonography Program CHRP, University of Arkansas for Medical Sciences Little Rock, Arkansas, USA 501-686-6510 http://www.io.com/~dubose/ <http://www.io.com/~dubose/> http://www.uams.edu/CHRP/dmshome.htm <http://www.uams.edu/CHRP/dmshome.htm> http://www.obgyn.net/us/panel/panel.htm <http://www.obgyn.net/us/panel/panel.htm> I was able to find the article by going to the Journal of Clinical Microbiology, click on the archives, then go the issue section and plug in May 1998. The article was really complicated and in depth with identifying the source of the infection, identification, and all the stuff microbiologists do with bugs. Anyway, the gist of the article (at least what I wanted to know) was that the Emergency Room at that hospital had dumped their gel into a wide-mouthed container for "ease of lubricating the transvaginal probes". The actual act of contamination was not addressed, and I would assume was unknown and could be from just about any form of transmission, if the container was open to the air. The article says, then, that this was a form of cross-contamination between patients by the unusual means of the contaminated gel. The link was that all women had been transvaginally scanned prior to admission to the hospital, so that answers my question as to route of transmission to the moms. The probes and other US equipment were found to be clean of K. pneumoniae, so it was only the gel. The moms transmitted the infection to the babes either before or at delivery, so I am assuming this was an ascending infection to the babes from the vagina. The article found that K. pneumoniae could survive in the warmed gel for about 4 months. But the best part, is that it sounds as though this is not going to be a big problem for us as sonographers, as long as we treat the gel like we would treat our eyedrops--don't touch the tip to anything, and don't let it sit around opened on the shelf forever! The hospital did follow-up studies of warmed gel, in the same warmer, same brand of gel, etc.--only kept it in the manufacturer's bottle rather than dumping it into a different container--and the studies were all negative for Klebsiella. Thanks for the help in getting started on learning how to answer my own questions! Paula Husky One of Joan Baker's first year students at BCC Paula Husky, first year BCC Actually there is a body of literature that shows that sonographic coupling gel is/can be a vector for infections. If you go to the following web site and do a search: http://www.obgyn.net/medline.asp I used this question, and selected "fuzzy logic" to sort for the subject: Your MEDLINE Query: "Is ultrasonic gel a vector for infections" Here are the results... I am also pasting some of the abstracts at the bottom of this message: CONCEPT MAPPINGS: DISEASE [VECTOR] () sign) DOPPLER ULTRASOUND [ULTRASONIC] (Synonym) GELS [GEL] (MeSH® Explosion) INFECTION [INFECTIONS] (MeSH® Explosion) SHOCKWAVES ULTRASONIC [ULTRASONIC] (Synonym) ULTRASONICS [ULTRASONIC] (MeSH® Explosion) ULTRASONOGRAPHY [ULTRASONIC] (MeSH® Explosion) ULTRASOUND [ULTRASONIC] (Synonym) RESULT SET: 200 documents displayed out of 2113315 documents found DATE RANGE: 1995 to 2001 In spite of all of this, gel warmers have been used for over 25 years without any epidemic outbreaks. We used a simple heating pad covered with a clean towel for over 15 years. I think the largest risk of growing some nasty bug is going to be in gel bottles that are refilled from a large, bulk bottle. Patient comfort is also a consideration, and warm gel does make the exams more comfortable. Hope this helps. Terry J. DuBose, M.S., RDMS, Assistant Professor Director, Diagnostic Medical Sonography Program CHRP, University of Arkansas for Medical Sciences Little Rock, Arkansas, USA 501-686-6510 http://www.uams.edu/CHRP/dmshome.htm http://www.obgyn.net/us/panel/panel.htm Forwarded to you from Aries Systems Corporation <KWEB-SERVER> at the request of * ELECOMM CORPORATION <DuBose@io.com[QIANYONGZHU@HOTMAIL.COM]> UI - 95274530 TI - Can ultrasound probes and coupling gel be a source of nosocomial infection in patients undergoing sonography? An in vivo and in vitro study [see comments] SO - AJR Am J Roentgenol 1995 Jun;164(6):1521-4 AU - Muradali D AU - Gold WL AU - Phillips A AU - Wilson S AD - Department of Diagnostic Imaging, Toronto Hospital, Ontario, Canada. AB - OBJECTIVE. At our institution, ultrasound probes are wiped with a clean, dry, soft, absorbent paper towel after each procedure as a basic standard of probe disinfection. However, it was unclear if this provided a sufficient level of decontamination. This study was designed to determine if the ultrasound probe and coupling gel can act as a vector of nosocomial infection and to describe a cost-effective method of probe handling that allows optimal control of infection. SUBJECTS AND METHODS. In the first part of the study, the ultrasound probe was exposed to the disrupted skin of patients recruited from our inpatient population, using our routine scanning technique to look for subcutaneous collections. Twenty-seven patients were scanned: 17 with surgical wounds, seven with surgical drains, four with enteric stomas, three with biopsy sites, and three with ulcers or excoriation. Fifteen patients had a discharge associated with their disrupted skin, and seven patients had culture-proved skin infections. Each probe was wiped with a clean, dry paper towel after scanning, then immersed in a brain-heart infusion (BHI) broth, and the solution was cultured. In the second part of the study, the ultrasound probe was exposed to a large inoculum of bacteria. Sixty-one probes were used to scan fields of confluent growth of bacteria on agar plates. Twenty-six probes were cleaned by wiping with a dry, clean paper towel, and 25 probes were cleaned by wiping with a dry, clean paper towel followed by immersion in Hibidil (0.05% chlorhexidine weight/volume). Ten probes functioned as controls and were not cleaned after exposure to the bacteria. Each probe was then immersed in BHI broth, and the solution was cultured. In the third part of the study, the coupling gel was evaluated as a culture medium for bacterial growth. Twenty-five agar plates were inoculated with a confluent growth of bacteria. Half of the surface of each agar plate was covered with coupling gel, and the remaining surface was left unexposed. The resulting bacterial growth on each side of the plates was compared. RESULTS. One of the 27 probes exposed to patients with disrupted skin grew Staphylococcus epidermidis (skin flora). For probes exposed to a large inoculum of bacteria, we found no statistically significant difference in the number of probes that showed bacterial growth on culture between probes cleaned by wiping with a towel and those cleaned with Hibidil. Furthermore, the resulting bacterial growth in both sets of probes was scant and was not considered clinically significant. All 10 control probes showed clinically significant growth in all cases. As for evaluation of the coupling gel as a culture medium, the gel permitted bacterial growth and did not show any evidence of bacteriocidal or bacteriostatic properties. CONCLUSION. Ultrasound probes that are wiped with a paper towel until they are visibly clean do not contribute to nosocomial infections. Additional antiseptic solutions such as Hibidil are not necessary. We suggest that probes be simply wiped with a clean, dry, nonsterile paper towel between procedures, including probes used on contaminated scanning fields, open wounds, and cutaneous infections. After the final procedure of the day, probes should be cleaned with a liquid cleaning solution such as Hibidil to remove all traces of coupling gel, which could support the overnight growth of bacteria. This would decontaminate the probes and prevent the overnight growth of bacteria. This method would be both a cost-effective and time-efficient protocol for controlling infection. TI - An outbreak of pyodermas among neonates caused by ultrasound gel contaminated with methicillin-susceptible Staphylococcus aureus. SO - Infect Control Hosp Epidemiol 2000 Dec;21(12):761-4 AU - Weist K AU - Wendt C AU - Petersen LR AU - Versmold H AU - Ruden H AD - Institute of Hygiene, Free University of Berlin, Germany. AB - OBJECTIVE: To investigate an outbreak of methicillin-susceptible Staphylococcus aureus (MSSA) infections in a neonatal clinic. DESIGN: Prospective chart review, environmental sampling, and genotyping by two independent methods: pulsed-field gel electrophoresis (PFGE) and randomly amplified polymorphic DNA polymerase chain reaction (RAPD-PCR). A case-control study was performed with 31 controls from the same clinic. SETTING: A German 1,350-bed tertiary-care teaching university hospital. RESULTS: There was a significant increase in the incidence of pyodermas with MSSA; 10 neonates in good physical condition with no infection immediately after birth developed pyodermas. A shared spatula and ultrasound gel were the only identified infection sources. The gel contained MSSA and was used for hip joint sonographies in all neonates. PFGE and RAPD-PCR patterns from 6 neonates and from the gel were indistinguishable and thus genetically related clones. The case-control study revealed no significant risk factor with the exception of cesarean section (P=.006). The attack rate by days of hip-joint sonography between April 15 and April 27, 1994, was 11.8% to 40%. CONCLUSIONS: Inappropriate hygienic measures in connection with lubricants during routine ultrasound scanning may lead to nosocomial S. aureus infections of the skin. To our knowledge this source of S. aureus infections has not previously been described. UI - 98450700 TI - Ultrasound instruments as possible vectors of staphylococcal infection. SO - J Hosp Infect 1998 Sep;40(1):73-7 AU - Ohara T AU - Itoh Y AU - Itoh K AD - Department of Clinical Pathology, Jichi Medical School, Tochigi Prefecture, Japan. AB - In this study, we evaluated whether ultrasound instruments are important in the spread of nosocomial staphylococcal infections. Following genomic typing by pulsed-field gel electrophoresis, it was apparent that ultrasound procedures transferred colonizing staphylococci from a patient's skin to the ultrasound instruments. Staphylococcus aureus survived in the transmission medium for longer than in water. Furthermore, S. aureus was more resistant to the ultrasonic medium than Pseudomonas aeruginosa, also a significant cause of hospital-acquired infections. To prevent staphylococcal transmission by ultrasound equipment, we recommend disinfection of the probe and removal of the medium after each examination. IS - 0195-6701 LA - English PT - JOURNAL ARTICLE EM - 199902 UI - 98233892 TI - Nosocomial outbreak of Klebsiella pneumoniae producing SHV-5 extended-spectrum beta-lactamase, originating from a contaminated ultrasonography coupling gel. SO - J Clin Microbiol 1998 May;36(5):1357-60 TA - J Clin Microbiol VI - 36 IP - 5 PG - 1357-60 DP - 1998 AU - Gaillot O AU - Maruejouls C AU - Abachin E AU - Lecuru F AU - Arlet G AU - Simonet M AU - Berche P AD - Laboratoire de Microbiologie, Faculte de Medecine Necker-Enfants Malades, Paris, France. gaillot@necker.fr. AB - Klebsiella pneumoniae resistant to ceftazidime was isolated from six adult women and two neonates hospitalized between July and November 1993 in the Department of Obstetrics and Gynecology of Boucicaut Hospital (Paris, France). The epidemiological investigation revealed a notably short delay (less than 48 h) between admission and contamination of the six adults and peripartum transmission to the neonates. The only environmental source of ceftazidime-resistant K. pneumoniae was the ultrasonography coupling gel used in the emergency room. Phenotypic (biotyping and antibiotyping) and genotypic (plasmid profile and pulsed-field gel electrophoresis) analysis of all the clinical isolates indicated the spread of a single strain. It produced SHV-5 and TEM-1 beta-lactamases, as demonstrated by isoelectric focusing and gene sequencing. The risk of cross-contamination in ultrasonography procedures is usually low and had not been associated so far with bacteria producing an extended spectrum beta-lactamase (ESBL). Furthermore, this is the first time an epidemic of an SHV-5 ESBL-producing member of the family Enterobacteriaceae has been reported from a French hospital. PT - JOURNAL ARTICLE TI - Physical methods of reducing the transmission of nosocomial infections via ultrasound and probe. SO - Clin Radiol 1998 Mar;53(3):212-4 TA - Clin Radiol VI - 53 IP - 3 PG - 212-4 DP - 1998 AU - Abdullah BJ AU - Mohd Yusof MY AU - Khoo BH AD - Department of Radiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. AB - Nosocomial infections are posing an increasingly serious problem in the hospital setting. With the increasing use of ultrasound in medical diagnosis, there is the potential for transmission of nosocomial infections via the ultrasound transducer and coupling gel. We evaluated the use of different membranes (three types of commercially available household cling film, condom, surgical glove and Opsite) applied over the ultrasound probe to determine if these were safe, convenient, cost-effective and did not impair the performance parameters of the ultrasound probe. None of the membranes impaired the physical scanning parameters using a Multi-Purpose Tissue/Cyst Phantom. The cling film was ideal for general use in terms of cost and convenience as well as safety. For sterile use the Opsite was better overall compared to the surgical glove, though it costs significantly more. The condom and surgical glove, though safe, were not very convenient to use for scanning. -----Original Message----- From: Carol Barden [mailto:bardiegrub@bigpond.com] Sent: Sunday, April 01, 2001 5:32 AM To: ASA Newsgroup Subject: Fw: Gel Warmers Australian Sonographer's Association Newsgroup - http://sonography.listbot.com/
>----- Original Message ----- From: Carol Barden To: ASA Newsgroup Sent: Wednesday, March 28, 2001 5:47 PM Subject: Fw: Gel Warmers
>----- Original Message ----- From: Carol Barden Sent: Tuesday, March 27, 2001 8:43 AM Subject: Gel Warmers Hello All, I wonder if anyone can help with this little problem. I have been approached by someone in rural WA. Their gel warmer broke (baby bottle warmer) and a requisition was filled in for replacement. This opened a can of worms in the hospital and the department is not allowed to have a gel warmer until the management have written documentation that warming the gel does not cause growth of bacteria etc... and is in fact safe to do so. I was involved in an informal study many years ago but nothing was formally written. The gel at that time under various conditions did not grow anything. Hoping to hear from someone......................thanks. Carol
-- Carol Barden AMS
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