Abstract
BackgroundEndocavity ultrasound is seen as a harmless procedure and has become a common gynaecological procedure. However without correct disinfection, it may result in nosocomial transmission of genito-urinary pathogens, such as high-risk Human Papillomavirus (HR-HPV). We aimed to evaluate the currently recommended disinfection procedure for covered endocavity ultrasound probes, which consists of “Low Level Disinfection” (LLD) with “quaternary ammonium compounds” containing wipes.MethodsFrom May to October 2011 swabs were taken from endovaginal ultrasound probes at the Gynecology Department of the Lyon University Hospital. During the first phase (May–June 2011) samples were taken after the ultrasound examination and after the LLD procedure. In a second phase (July–October 2011) swab samples were collected just before the probe was used. All samples were tested for the presence of human DNA (as a marker for a possible transmission of infectious pathogens from the genital tract) and HPV DNA with the Genomica DNA microarray (35 different HPV genotypes).ResultsWe collected 217 samples before and 200 samples after the ultrasound examination. The PCR was inhibited in two cases. Human DNA was detected in 36 (18%) post-examination samples and 61 (28%) pre-examination samples. After the ultrasound LLD procedure, 6 (3.0%) samples contained HR-HPV types (16, 31, 2×53 and 58). Similarly, HPV was detected in 6 pre-examination samples (2.7%). Amongst these 4 (1.9%) contained HR-HPV (types 53 and 70).ConclusionOur study reveals that a considerable number of ultrasound probes are contaminated with human and HR-HPV DNA, despite LLD disinfection and probe cover. In all hospitals, where LLD is performed, the endovaginal ultrasound procedure must therefore be considered a source for nosocomial HR-HPV infections. We recommend the stringent use of high-level disinfectants, such as glutaraldehyde or hydrogen peroxide solutions.
Highlights
Human papillomavirus (HPV) is recognized as the major etiological cause of invasive cervical cancer and cervical intraepithelial neoplasia worldwide [1,2,3]
The high risk genotypes have been found to be closely associated with cervical cancer [3,4] and high grade cervical intraepithelial neoplasia
A study has reported that HPV 16 remains infectious for at least 7 days on a wet surface [7]. These results suggest that fomites represent a possible nosocomial source of HPV infection [8]
Summary
Human papillomavirus (HPV) is recognized as the major etiological cause of invasive cervical cancer and cervical intraepithelial neoplasia worldwide [1,2,3]. More than 100 human HPV genotypes, classified into high risk (e.g. HPV 16, 18) and low risk types (e.g. HPV 6, 11) [2], are known to infect the anogenital tract [4]. The high risk genotypes have been found to be closely associated with cervical cancer [3,4] and high grade cervical intraepithelial neoplasia. Little is known on a possible nosocomial source of HPV infection. It may result in nosocomial transmission of genito-urinary pathogens, such as highrisk Human Papillomavirus (HR-HPV). We aimed to evaluate the currently recommended disinfection procedure for covered endocavity ultrasound probes, which consists of ‘‘Low Level Disinfection’’ (LLD) with ‘‘quaternary ammonium compounds’’ containing wipes
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