Mullins Kevin, Burnham Kevin, Henricson Erik K, Cohen Stuart, Fair James, Ray Jeremiah W
Department of Physical Medicine and Rehabilitation, University of California, Davis, California, USA.
Department of Surgery, Division of Emergency Medicine, University of Utah, Salt Lake City, Utah, USA.
J Ultrasound Med. 2020 Oct;39(10):1957-1963. doi: 10.1002/jum.15300. Epub 2020 Apr 27.
To provide a descriptive analysis for species identification of culture and Gram stain results from ultrasound transducers and multiuse ultrasound transmission gel bottle tips in active clinical use and to compare bacterial cultures from ultrasound transducers before and after aseptic cleansing.
A prospective blinded descriptive analytic study of 18 distinct clinical care sites within a single primary clinical institution was conducted. Before and after a disinfectant towel cleanse, transducers were pressed against tryptic soy agar contact plates. Plates were deidentified and submitted for blind incubation, Gram staining, and species identification with microsequencing. Results were classified as clinically relevant (CR) or non-clinically relevant. In total, 188 samples were analyzed: 80 from ultrasound transducers before and cleansing, 13 from multiuse gel bottle tips before and after cleansing, and 2 precleansing samples from the data collector's pen and badge.
Fifty-nine precleansing samples (73.8%) grew cultures with CR bacteria, and 21 samples (26.3%) did not. Staphylococcus simulans represented 31.0% of all positive culture samples. Thirteen postcleansing samples (16.3%) grew cultures with CR bacteria, equating to a 78.0% reduction of CR bacterial growth (likelihood ratio, 57.10; P < .001).
Ultrasound transducers have a notable CR bacterial burden and may serve as potential infective vectors. Aseptic cleansing effectively eliminates most of the bacterial load from ultrasound transducers, but some bacteria persist, presenting a risk of nosocomial infection with ultrasound-guided interventions. These findings support American Institute of Ultrasound in Medicine 2018 guidelines intended to ensure an appropriate level of transducer preparation based on the examination type while emphasizing rational infection control measures to minimize the risk of potential patient harm.
对临床实际使用的超声换能器及多用途超声耦合剂瓶头的培养和革兰氏染色结果进行物种鉴定的描述性分析，并比较无菌清洁前后超声换能器的细菌培养情况。
在单一主要临床机构内的18个不同临床护理点进行前瞻性盲法描述性分析研究。在使用消毒毛巾清洁前后，将换能器压在胰蛋白酶大豆琼脂接触平板上。平板进行去识别处理后送去进行盲法培养、革兰氏染色以及用微测序法进行物种鉴定。结果分为临床相关（CR）或非临床相关。总共分析了188个样本：80个来自清洁前的超声换能器，13个来自清洁前后的多用途凝胶瓶头，以及2个来自数据收集笔和徽章的清洁前样本。
59个清洁前样本（73.8%）培养出含CR细菌的菌落，21个样本（26.3%）未培养出。模仿葡萄球菌占所有阳性培养样本的31.0%。13个清洁后样本（16.3%）培养出含CR细菌的菌落，相当于CR细菌生长减少了78.0%（似然比，57.10；P <.001）。
超声换能器有显著的CR细菌负荷，可能作为潜在的感染载体。无菌清洁有效消除了超声换能器上的大部分细菌负荷，但仍有一些细菌残留，在超声引导干预时存在医院感染风险。这些发现支持美国超声医学学会2018年的指南，该指南旨在根据检查类型确保换能器有适当的准备水平，同时强调合理的感染控制措施以尽量减少对患者潜在伤害的风险。
