Abstract
ContextIn the emergency ward, where the use of ultrasound is common (including for sterile procedures), ward equipment is constantly exposed to high risks of microbiological contamination. There are no clear guidelines for disinfection control practices in emergency departments, and it is not known how emergency ward doctors follow good hygiene practices.MethodA multi-centre audit was conducted in 16 emergency services from Northern France regional hospitals, in form of a questionnaire. It was proposed to all emergency ward physicians. We excluded questionnaires when physicians mentioned that they did not use ultrasound on a daily basis. The questionnaire was designed using existing hygiene and ultrasound disinfection practices guidelines from varying French medical societies. It included three different clinical scenarios: (a) ultrasound on healthy skin, (b) on injured skin, and (c) ultrasound-guided punctures. All questions were closed-ended, with only one answer corresponding to the guidelines. We then calculated compliance rates for each question, each clinical situation, and an overall compliance rate for all the questions.Results104 questionnaires were collected, and 19 were excluded. For the 85 analysed questionnaires, the compliance rates were 60.4% 95% CI [56.4–64.7] for ultrasound on healthy skin, 70.9% 95% CI [66.3–76.1] on injured skin and 69.4% 95% CI [65.1–73.6] for ultrasound-guided punctures. The overall compliance rate for the compliance questions was 66.1% 95% CI [62.8–69.1]. Analysis of the questionnaires revealed severe asepsis errors, misuse of gel, ignorance of infection control practices to be applied in the context of ultrasound-guided puncture and exposure of the probe to body fluids.ConclusionThis study details areas for quality improvement in the disinfection of emergency ultrasound scanner use. Consequently, we propose a standardized protocol based upon the recommendations used for the questionnaire drafting, with a visual focus on the low compliance points that have been revealed in this audit. This protocol has been distributed to all the medical emergency services audited and included in the emergency resident’s ultrasound learning program.
Highlights
Ultrasound systems are reusable medical devices that are increasingly used in the emergency ward
Analysis of the questionnaires revealed severe asepsis errors, misuse of gel, ignorance of infection control practices to be applied in the context of ultrasound-guided puncture and exposure of the probe to body fluids
Good procedural practice recommendations for probe disinfection are currently available for semi-critical devices such as endocavitary ultrasound probes (EUP)
Summary
Background Ultrasound systems are reusable medical devices that are increasingly used in the emergency ward. Andolfo et al Antimicrob Resist Infect Control (2021) 10:25 and more different types of examinations on their own, including invasive procedures [1]. The ultrasound probe is usually classified as a non-critical device by Spaulding’s historical classification, and it only requires low level disinfection after patient contact [2]. Good procedural practice recommendations for probe disinfection are currently available for semi-critical devices such as endocavitary ultrasound probes (EUP). The examinations carried out using these devices involve contacts with a mucous membrane, and sometimes an invasive sampling (e.g. prostate biopsies). General recommendations concerning good disinfection practices between two examinations were issued by the French Public Health institution in 2008, [6] and have been reinforced in 2016 [7], in a context of growing healthcareassociated infections
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