An Outbreak of<i>Pseudomonas aeruginosa</i>Respiratory Tract Infections Associated with Intrinsically Contaminated Ultrasound Transmission Gel

Chittick, Paul; Russo, Victoria; Sims, Matthew; Robinson-Dunn, Barbara; Oleszkowicz, Susan C.; Sawarynski, Kara E.; Powell, Kimberly; Makin, Jacob; Darnell, Elizabeth M.; Boura, Judith; Boyanton, Bobby L.; Band, Jeffrey D.

doi:10.1086/671268

Cited by 23 publications

(20 citation statements)

References 10 publications

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“…To date, the role of US in the context of intravascular arterial catheter infection is not clear. The use of an additional device, such as ultrasound, may complicate AC insertion and set the stage for breaches in aseptic non-touch technique, and the gel used for optimizing visibility may increase the risk of catheter infection [22,23]. However, a shorter insertion time and fewer insertion attempts may counterbalance the risk for infection.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound guidance and risk for intravascular catheter-related infections among peripheral arterial catheters: a post-hoc analysis of two large randomized-controlled trials

Buetti

Ruckly

Lucet

et al. 2020

Ann. Intensive Care

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Background: The impact on infectious risk of ultrasound guidance at insertion remains controversial in short-term arterial catheters (ACs). The present study investigated the association between ultrasound guidance (US) during AC insertion and major catheter-related infections (MCRI), catheter-related bloodstream infections (CR-BSI) or colonization, using univariate and multivariate marginal Cox model for clustered data. The skin colonization at catheter removal was evaluated to explain our results. Results: We used individual data from two multicenter randomized-controlled trials (RCTs) that included a total of 3029 patients, 10 ICUs and 3950 ACs. US guidance was used for 386 (9.8%) catheter placements. In the univariate Cox model analysis, AC insertion with US versus without US exhibited similar risks for MCRI (HR 0.86, CI 95% 0.27-2.72, p = 0.79), CR-BSI (HR 0.87, CI 95% 0.20-3.72, p = 0.85) and catheter colonization (HR 1.31, CI 95% 0.92-1.86, p = 0.13). After adjustment on confounders, risks associated with US guidance remained similar versus non-US for MCRI (HR 0.71, CI 95% 0.23-2.24, p = 0.56), CR-BSI (HR 0.71, CI 95% 0.17-3.00, p = 0.63) and catheter colonization (HR 0.92, CI 95% 0.63-1.34, p = 0.67). No differences between US and non-US for MCRI, CR-BSI and colonization were observed according to the insertion site, radial or femoral. At catheter removal, the skin colonization was similar between US and non-US groups (p = 0.69). Conclusions: Using the largest dataset ever collected from large multi-centric RCTs conducted with relatively consistent insertion and maintenance catheter protocols, we showed that the risk of infectious complications for ACs inserted under US guidance is not superior compared to those inserted without US guidance. Trial registration These studies were registered within ClinicalTrials.gov (numbers NCT01629550 and NCT 01189682).

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Section: Discussionmentioning

confidence: 99%

Ultrasound guidance and risk for intravascular catheter-related infections among peripheral arterial catheters: a post-hoc analysis of two large randomized-controlled trials

Buetti

Ruckly

Lucet

et al. 2020

Ann. Intensive Care

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“…Another study reported K. penumoniae, resistant to third generation cephalosporins, contaminated ultrasound coupling gel and infected both adult female and neonatal patients in an obstetrics and gynecology department [ 12 ]. In 2013, Chittick et al discovered P. aeurginosa, in ultrasound gel, as the source of infection in patients who received a transthoracic echocardiogram during hospitalization [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Ultrasound transducer disinfection in emergency medicine practice

Hoyer

Adhikari

Amini

2016

Antimicrob Resist Infect Control

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BackgroundExternal ultrasound transducer disinfection is common practice in medicine. Unfortunately, clinically significant organisms, such as methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, and Klebsiella pneumonia spread throughout healthcare facilities via direct contact despite disinfection protocols. Ultrasound transducers and coupling gel provide potential vectors for pathogen transmission, especially in immunocompromised and high-risk patient populations. Our objective was to conduct a survey to investigate the variety of cleaning solutions or sanitary wipes used and evaluate current standard practice for transducer disinfection across emergency medicine training programs in the United States.FindingsEighty-three academic emergency medicine programs participated in this study. Eighty-seven percent (95 % CI 80–94 %) of responding programs do not have a mandated protocol or standard contact time for transducer disinfection. Ninety percent (95 % CI 84–96 %) of institutions use disinfectant solution or disinfectant wipes, as the standard of practice, to cleanse ultrasound transducers after every use.ConclusionsCurrently, there is a great deal of variability with regard to non-endocavitary transducer disinfection protocols that seems to stem from the vast number of disinfectant products and ultrasound manufacturer disparate recommendations. In order to mitigate risk to patients and reduce health care costs linked to nosocomial infections; healthcare providers, ultrasound companies, and disinfectant manufacturers must develop a universal use disinfectant and a standard protocol for ultrasound device disinfection for noncritical device disinfection in the emergency department.Electronic supplementary materialThe online version of this article (doi:10.1186/s13756-016-0110-y) contains supplementary material, which is available to authorized users.

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“…To our knowledge, there are no reports of musculoskeletal infection attributable to contaminated ultrasound transmission gel; however, there are several reports of gel serving as a source for nosocomial infection [7,19,20,29]. Although there are reported cases in which the manufacturer contaminated the gel, the majority are believed to have occurred through cross-contamination from inappropriate use patterns [7,19,20,29]. Recognizing this, the FDA has made recommendations for safe use of ultrasound gel [28].…”

Section: Discussionmentioning

confidence: 99%

Does the Use of Ultrasound Affect Contamination of Musculoskeletal Injections Sites?

Sherman

Ferguson

Davis

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Therapeutic musculoskeletal injections require a clean or sterile skin preparation to minimize the risk of infections. Ultrasound guidance for this procedure requires the use of transmission gel in proximity to the injection site, and its effect on maintaining sterility is unknown. Questions/purposes We asked: (1) Does sterile ultrasound transmission gel increase skin contamination during therapeutic orthopaedic injections? (2) Does nonsterile gel application result in increased contamination? (3) Does a manufacturer-approved ultrasound probe disinfecting agent in the form of 17.2% isopropanol and 0.28% diisobutylphenoxyethoxyethyl dimethyl benzyl ammonium chloride wipes adequately decontaminate the ultrasound transducer? (4) Does 70% isopropyl alcohol effectively decontaminate skin for administration of musculoskeletal injections? Methods Twenty-six healthy volunteers in an outpatient orthopaedic clinical setting were recruited. The subjects' skin was prepared to simulate a therapeutic intraarticular shoulder injection under ultrasound guidance. Four skin swabs for culture from each subject were taken: one sample before preparation with isopropyl alcohol, one sample after skin preparation, one after simulated injection procedure with sterile ultrasound transmission gel using the transducer, and one after mock procedure with nonsterile ultrasound transmission gel. In addition, samples were taken from the nonsterile ultrasound transmission gel and the transducer for culture analysis. Aerobic and anaerobic cultures were incubated during a 5-day period for bacterial species identification. Results Sterile ultrasound gel use results in an increase in skin contamination (odds ratio [OR], 9; 95% CI, 1.4-57.1; p = 0.005). Compared with sterile gel use, application of nonsterile gel did not increase contamination proportion (OR, 1.1; 95% CI, 0.8-1.7; p = 0.56). All cultures from nonsterile gel were negative. None of the samples cultured directly from the ultrasound probe were positive for bacteria (0%). Skin preparation with 70% alcohol decreased the proportion of contamination when compared with unprepared skin (OR, 21.0; 95% CI, 3.1-142.2; p = 0.001). Conclusions Use of ultrasound probes and transmission gel results in greater contamination in simulated intraarticular injections of the shoulder. As such, sterile preparation of the entire injection field, including the

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An Outbreak ofPseudomonas aeruginosaRespiratory Tract Infections Associated with Intrinsically Contaminated Ultrasound Transmission Gel

Cited by 23 publications

References 10 publications

Ultrasound guidance and risk for intravascular catheter-related infections among peripheral arterial catheters: a post-hoc analysis of two large randomized-controlled trials

Ultrasound guidance and risk for intravascular catheter-related infections among peripheral arterial catheters: a post-hoc analysis of two large randomized-controlled trials

Ultrasound transducer disinfection in emergency medicine practice

Does the Use of Ultrasound Affect Contamination of Musculoskeletal Injections Sites?

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