Archana Angrup, Rimjhim Kanaujia, Manisha Biswal, Pallab Ray
Am J Infect Control. 2022 Feb 12;S0196-6553(22)00078-5.
In this systematic review, the authors examine 14 studies pertaining to outbreaks of Burkholderia cepacian complex in healthcare facilities, all of which were determined to have directly resulted from contaminated ultrasound gel. By evaluating the intrinsic and extrinsic reasons for the gels’ contamination in each case, the authors were able to identify clear, applicable protocols for healthcare personnel to implement as part of their efforts to manage and prevent future ultrasound gel-based infections.
Each of the 14 Burkholderia cepacian complex (Bcc) outbreaks examined was determined to have resulted from ultrasound gel that had become contaminated. Of the 14 outbreaks that were studied, eight of the cases resulted from intrinsic contamination of the ultrasound gel (i.e. contamination from the gels’ manufacturing site), while four of the outbreaks stemmed from extrinsic contamination (i.e. contamination from the clinical environment). In total, Bacteremia was determined to be present in ten of the included studies, with urinary tract infections appearing in four studies and intraperitoneal infection, surgical site infections, and vaginitis appearing in one outbreak study each. B. cepacian was the most commonly isolated organism across the studies, with B. cepacia, B. contaminans, and B. stabilis all also being identified.
Based on the findings of the individual studies, the authors of the systematic review formulated several specific protocol recommendations for healthcare personnel to implement into their practice to help reduce the risk of further ultrasound gel contamination and spread. Specific recommendations include carefully inspecting and ensuring sterility of ultrasound gel before use, performing thorough removal of ultrasound gel from both patients and probes in between sessions, educating staff on proper environmental cleaning and disinfection processes, and conducting precise, thorough epidemiological investigations of any outbreaks that occur.
Through the course of their research, the authors of the review concluded that ultrasound gel is susceptible to contamination and poses a potential infection risk within the ultrasound suite. To mitigate this risk, the authors suggest the implementation of several protocols. These include performing a thorough inspection and discarding of contaminated batches of ultrasound gel prior to use, cleaning ultrasound probes with alcohol spray and wiping away ultrasound gel from patients’ bodies with chlorhexidine in between uses, conducting regular hygiene education and audits among staff to ensure compliance, and ensuring that infection control teams provide a prompt response in the event of an infection outbreak, including identifying the extrinsic and/or intrinsic route of contamination and notifying all relevant stakeholders – including manufacturers and concerned healthcare facilities - about the contaminated product.