Disinfection and Sterile Techniques

  • Sean Maley
  • Alison Thurber


Point-of-care ultrasound (POCUS) is expanding with an increasing role in clinical decision-making and as an adjunct for clinical procedures. As transducers come into contact with more patients, sonologists must keep in mind the potential for a transducer to transmit pathogens between patients. Cleaning and disinfection of medical equipment is a necessary step to prevent the spread of infectious disease. Infections and deaths related to healthcare-associated infections burden the US healthcare system by $28 to $33 billion annually. In spite of this, there are no universally adhered-to guidelines for the disinfection of ultrasound probes. Across institutions, transducer decontamination practices vary widely. A recent trend has shown increasing stringency by hospitals and medical centers in enforcing strict decontamination practices, sometimes more than recommended. In this chapter, we will discuss probe contamination risks, disinfection recommendations, and several options for covering the ultrasound probe.


Ultrasound Probe contamination Probe cover Transducer Ultrasound disinfection Sterilization Ultrasound cleaning 


  1. 1.
    Centers for Disease Control and Prevention. Guideline for disinfection and sterilization in healthcare facilities, 2008. Centers for Disease Control and Prevention website; 2008. Accessed 26 Nov 2014.
  2. 2.
    Mirza W, Imam S, Kharal S, et al. Cleaning methods for ultrasound probes. J Coll Physicians Surg Pak. 2008;18(5):286–9.PubMedGoogle Scholar
  3. 3.
    Frazee B, Fahimi J, Lambert L, et al. Emergency department ultrasonographic probe contamination and experimental model of probe disinfection. Ann Emerg Med. 2011;58(1):56–63.CrossRefGoogle Scholar
  4. 4.
    Backhouse S. Establishing a protocol for the cleaning and sterilization/disinfection of ultrasound transducers. Br Med Ultrasound Soc Bull. 2003;11(1):37–9.Google Scholar
  5. 5.
    Mullaney P, Munthali P, Vlachou P, et al. How clean is your probe? Microbiological assessment of ultrasound transducers in routine clinical use, and cost effective ways to reduce contamination. Clin Radiol. 2007;62:694–8.CrossRefGoogle Scholar
  6. 6.
    Chu K, Obaid H, Babyn P, et al. Bacterial contamination of ultrasound probes at a tertiary referral university medical center. Am J Roentgenol. 2014;203:928–32.CrossRefGoogle Scholar
  7. 7.
    Moran G, Krishnadasan A, Gorwitz R, et al. Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med. 2006;355(7):666–74.CrossRefGoogle Scholar
  8. 8.
    Kumar N, David M, Boyle-Vavra S, et al. High S aureus colonization prevalence among patients with SSTIs and controls in an urban emergency department. J Clin Microbiol. 2014. Scholar
  9. 9.
    Gillespie J, Arnold K, Noble-Wang J, et al. Outbreak of Pseudomonas aeruginosa infections after transrectal ultrasound-guided prostate biopsy. Urology. 2007;69:912–4.CrossRefGoogle Scholar
  10. 10.
    Bancroft E, English L, Terashita D, et al. Letters to the editor: outbreak of Escherichia coli infections associated with a contaminated transesophageal echocardiography probe. Infect Control Hosp Epidemiol. 2013;34(10):1121–2.CrossRefGoogle Scholar
  11. 11.
    Weist K, Wendt C, Petersen L, et al. An outbreak of pyodermas among neonates caused by ultrasound gel contaminated with methicillin-susceptible Staphylococcus Aureus. Infect Control Hosp Epidemiol. 2000;21(12):761–4.CrossRefGoogle Scholar
  12. 12.
    AIUM Official Statements. Guidelines for cleaning and preparing external- and internal-use ultrasound transducers between patients & safe handling and use of ultrasound coupling gel.
  13. 13.
    Rutala W. APIC guideline for selection and use of disinfectants. Am J Infect Control. 1996;24:313–42.CrossRefGoogle Scholar
  14. 14.
    Gray R, Williams P, Dubbins P, et al. Decontamination of transvaginal ultrasound probes: review of national practice and need for national guidelines. Clin Radiol. 2012;67:1069–77.CrossRefGoogle Scholar
  15. 15.
    Hoyer R, Adhikari S, Amini R. Ultrasound transducer disinfection in emergency medicine practice. Antimicrob Resist Infect Control. 2016;5:12.CrossRefGoogle Scholar
  16. 16.
    Miyague AH, Mauad FM, Martins Wde P, Benedetti AC, Ferreira AE, Mauad-Filho F. Ultrasound scan as a potential source of nosocomial and cross infection: a literature review. Radiol Bras. 2015;48(5):319–23.CrossRefGoogle Scholar
  17. 17.
    ACEP Policy Statement. Guideline for ultrasound transducer cleaning and disinfection. Ann Emerg Med. 2018;72(4):e45–7.CrossRefGoogle Scholar
  18. 18.
    GE Transducer Cleaning and Disinfection Guidelines. GE Healthcare 2013. Accessed 13 Dec 2014.
  19. 19.
    Vickery K, Gorgis V, Burdach J, et al. Evaluation of an automated high-level disinfection technology for ultrasound transducers. J Infect Public Health. 2014;7:153–60.CrossRefGoogle Scholar
  20. 20.
    Guidelines for cleaning and preparing external- and internal-use ultrasound probes between patients. American Institute of Ultrasound in Medicine; 2014. Accessed 26 Nov 2014.
  21. 21.
    Jimenez R, Duff P. Sheathing of the endovaginal ultrasound probe: is it adequate? Infect Dis Obstet Gynecol. 1993;1:37–9.CrossRefGoogle Scholar
  22. 22.
    Milki A, Fisch J. Vaginal ultrasound probe cover leakage: implications for patient care. Fertil Steril. 1998;69(3):409–11.CrossRefGoogle Scholar
  23. 23.
    M’Zali F, Bounizra C, Leroy S, et al. Persistence of microbial contamination on transvaginal ultrasound probes despite low-level disinfection procedure. PLoS One. 2014;9(4):e93368. Scholar
  24. 24.
    Casalegno J, Carval K, Eibach D, et al. High risk HPV contamination of endocavity vaginal ultrasound probes: an underestimated route of nosocomial infection? PLoS One. 2012;7(10):e48137. Scholar
  25. 25.
    Ma S, Yeung A, Chan P, Graham C. Transvaginal ultrasound probe contamination by the human papillomavirus in the emergency department. Emerg Med J. 2012;30:472–5. Scholar
  26. 26.
    Johnson S, Proctor M, Bluth E, et al. Evaluation of a hydrogen peroxide-based system for high-level disinfection of vaginal ultrasound probes. J Ultrasound Med. 2013;32:1799–804.CrossRefGoogle Scholar
  27. 27.
    Amis S, Ruddy M, Kibbler C, et al. Assessment of condoms as probe covers for transvaginal sonography. J Clin Ultrasound. 2000;28(6):295–8.CrossRefGoogle Scholar
  28. 28.
    Rooks V, Yancey M, Elg S, Brueske L. Comparison of probe sheaths for endovaginal sonography. Obstet Gynecol. 1996;87(1):27–9.CrossRefGoogle Scholar
  29. 29.
    Fry A, Meagher S, Vollenhoven B. Letters to the editor: a case of anaphylactic reaction caused by exposure to a latex probe cover in transvaginal ultrasound scanning. Ultrasound Obstet Gynecol. 1999;13:373–9.CrossRefGoogle Scholar
  30. 30.
    Muller BA, Steelman VJ. Case report of latex aerosolization from a transesophageal echocardiogram machine. Allergy Asthma Proc. 2004;25(3):191–4.PubMedGoogle Scholar
  31. 31.
    Adhikari S, Blaivas M, Morrison D, Lander L. Comparison of infection rates among ultrasound-guided versus traditionally placed peripheral intravenous lines. J Ultrasound Med. 2010;29:741–7.CrossRefGoogle Scholar
  32. 32.
    Charalambous C, Tryfonidis M, Sadiq S, et al. Septic arthritis following intra-articular steroid injection of the knee – a survey of current practice regarding antiseptic technique used during intra-articular steroid injection of the knee. Clin Rheumatol. 2003;22:386–90.CrossRefGoogle Scholar
  33. 33.
    Sherman T, Ferguson J, Davis W, et al. Does the use of ultrasound affect contamination of musculoskeletal injection sites? Clin Orthop Relat Res. 2014.
  34. 34.
    Provezano D, Liebert M, Steen B, et al. Investigation of current infection-control practices for ultrasound coupling gel: a survey, microbiological analysis, and examination of practice patterns. Reg Anesth Pain Med. 2013;38(5):415–24.CrossRefGoogle Scholar
  35. 35.
    Chuan A, Tiong C, Maley M, et al. Decontamination of ultrasound equipment used for peripheral ultrasound-guided regional anaesthesia. Anaesth Intensive Care. 2013;41(4):529–34.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Sean Maley
    • 1
  • Alison Thurber
    • 2
  1. 1.Northwest Medical CenterTucsonUSA
  2. 2.Emergency Medicine, SUNY Upstate University HospitalSyracuseUSA

Personalised recommendations