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Endobadl ultrasonography is widely used in obstetric and gynecological imaging, allowing evaluation of the disease in the female reproductive tract and fetal monitoring at all stages of pregnancy. A team led by Dr. Chen Ben David of Rambam Health Care Campus and the Israeli Technion Institute of Technology in Haifa, however, raised concerns about the possibility of infection transmission via internal probes such as endobadl transducers.
"The main concern is that these probes can allow contamination by pathogenic microorganisms and therefore act as vectors, transmitting pathogens between patients," the group wrote.
Contamination under surveillance
The problem is not unique to Israel: internal probe contamination has been the subject of scrutiny around the world. Last fall, a Pennsylvania hospital was sued because poorly cleaned ultrasound probes were used on more than 200 patients for prostate exams or gynecological disorders. And a survey conducted in 2016 by the European Society of Radiology (ESR) found that nearly a third of practitioners do not disinfect transducers after each patient and 11% do not use probe protectors for transbadl or transrectal procedures.
The bad is home to many microorganisms, most of which serve as a defense against bad infections. However, some may cause vaginitis, urinary tract infections or pneumonia and infect women with hepatitis, HIV and HPV. This is why it is crucial to clean the probes properly, the researchers wrote (Isr Med Assoc JJanuary 2019, Vol. 21: 1, pp. 45-49).
A common safety measure for endobadl probes is the use of probe protectors. But they still have a slight risk of rupture during procedures, which has prompted the Centers for Disease Control and Prevention (CDC) to recommend the use of high-level disinfectants in addition to probe guards after each patient . (The US, Canadian, Australian and Scottish medical societies have issued similar recommendations, the researchers noted.) High-level disinfectants destroy most microorganisms, with the exception of those that form endospores.
In 2017, the Israeli Ministry of Health issued guidelines for the correct treatment of endobadl ultrasound probes that followed the CDC recommendation. The guidelines included the following instructions:
- Remove the probe cover.
- Change gloves after cleaning hands.
- Clean the probe with special wipes.
- Clean the probe with a high level disinfectant using a chemical or physical method (ultraviolet light).
But many ob / gyn ultrasound departments find it difficult to comply with these requirements because the process takes time: the disinfectant must dry or dissipate before the probe can be used on the next patient, Dr. Ido explained. Solt, corresponding author. AuntMinnie.com by email.
"As doctors working in highly attended gynecological ultrasound units, we noticed that it was very difficult for doctors to respect this strict disinfection protocol between each patient," he said. .
What is the real risk?
Studies conducted to establish the risk of contamination of endobadl tubes – despite the use of probe caps – revealed a range of 0.98% to 3.4% for bacterial contamination and a range of 1.5% to 14.2% for viral contamination, the researchers wrote. But since there is little research on the real risk of infections in women exposed to contaminated badl probes, the guidelines for cleaning probes are based on the theoretical risk of contamination.
Dr. Ido Solt of the Rambam Health Care Campus.
"Despite the reported risks of contamination of endobadl ultrasound probes and their frequent use in daily practice, few reports have been published on infections occurring after these examinations," the researchers wrote.
The Israeli Ministry of Health's recommendations on the issue are based on CDC standards and the risk of probe failure, which in reality is rarely the case, according to the group. This leaves the practitioners in a dilemma.
"Currently, it is almost impossible to adhere pragmatically to the guidelines of the Israeli Ministry of Health," the researchers wrote.
It is necessary to continue researching the true incidence of infections transmitted by badl probes, which could then illuminate the best practice protocols for disinfection of badl ultrasound transducers, Solt said. AuntMinnie.com.
"We need to develop an easy and fast disinfection protocol without compromising the quality of disinfection," he said.
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