Nilufer AKGÜN, Aybüke KEVSER, Serap YAĞCI, Cigdem ATAMAN HATİPOGLU, Yusuf USTUN

Jinekoloji kliniklerinde ultrasonografi probları ve jeli, bakteriyel enfeksiyonların kaynağı olabilir mi?: Üçüncü basamak bir hastane deneyimi

Amaç Bu çalışmanın amacı, ultrasonografi problarının (UP) ve jellerinin bakteriyel kontaminasyon oranlarını ve bunlarla ilişkili hastane enfeksiyonu riskini değerlendirmektir. Bu şekilde, hastane genelinde enfeksiyon riskini azaltmak için UP dezenfeksiyonu protokollerimizin yeterliliğinin değerlendirmesi amaçlanmıştır. Gereçler ve Yöntem Transabdominal (TAP) ve transvajinal ultrason (TVP) prob yüzeyleri ve ultrasonografi jellerinden (UJ) toplam 48 sürüntü örneği alınmış ve mikrobiyoloji laboratuvarında kültüre edilmiştir. Karşılaştırma için, jinekoloji odaları kapı kollarındaki bakteriyel kontaminasyon (12 sürüntü kültürü) analiz edilmiştir. Bu ölçümler, bir ay boyunca her hafta uygulanmış ve her bir probdan, çalışma süresi boyunca 4 kez kültür alınmıştır. Bulgular: Prob kültürlerinden insan deri florasında ve çevrede yaygın olan, patojen olmayan, sekiz mikroorganizma (Staphylococcus epidermidis, S. hominis, S. haemolyticus, S. lugdunensis, Corynebacterium amycolatum, C. aurimucosum) ve iki önemli patojen mikroorganizma (Enterobacter cloacae, Escherichia coli) izole edildi. Metisilin dirençli staphylococcus aureus izole edilmedi. Jel kültürlerinden ise patojenik olmayan organizmalar (S. epidermidis, S. cohnii) izole edildi. Hasta muayene sayısı ve acil değerlendirme durumu açısından kontaminasyon oranlarında da gruplar arasında anlamlı bir fark bulunmadı (p > 0.05). Sonuç: Hastanemizin Kadın Hastalıkları ve Doğum kliniklerinde UP ve jellerinde bakteriyel kontaminasyon tespit edildi. Çoğunlukla patojen olmayan mikroorganizmalar (S. epidermidis, S. hominis, S. haemolyticus, S lugdinensis) saptanmasına rağmen, patojenik iki mikroorganizma da tanımlandı (Enterobacter cloacae, Escherichia coli). Hastane personeli, UP’lerin bakteriyel kontaminasyon için bir araç olabileceğini ve infeksiyöz komplikasyonlara yol açabileceğini unutmamalıdır. Probların kuru, steril olmayan kağıt havlu kullanılarak dekontaminasyonu, cihaza zarar vermeyen, bakteri yükünü de azaltabilen ucuz, basit ve etkili bir yöntemdir.

Anahtar Kelimeler:

bakteriyel kontaminasyon jel, metisiline dirençli Staphylococcus aureus, jinekoloji ve doğum kliniği ultrasonografi probları

Can ultrasound probes and coupling gel in gynaecology and obstetrics clinics be the origin of capable bacterial infections? A tertiary care hospital experience

Background: The aim was to evaluate the bacterial contamination rate of ultrasound probes and gels and the associated nosocomial infection risk. In this way, we aimed to assess whether our ultrasound probe disinfection protocols were effective in reducing the risk of hospital-wide infection. Material and Methods: Forty-eight swab samples were collected from the surfaces of transabdominal (TAP) and transvaginal ultrasound (TVP) probes and adhered to gel bottles, which were then cultured in the microbiology laboratory. In comparison, bacterial contamination of gynecology room door handles (12 swab cultures) was analyzed. These measurements were repeated every week for one month, so that each probe was cultured four times during the study period. Results: Non-pathogenic microorganisms (Staphylococcus epidermidis, S. hominis, S. haemolyticus, S. lugdunensis, Corynebacterium amycolatum, C. aurimucosum) common in human skin flora and the environment and two notable pathogens (Enterobacter cloacae, Escherichia coli) were isolated from the probe cultures. Non-pathogenic organisms (S. epidermidis, S. cohnii) were isolated from gel cultures. Also, no significant differences were also found between groups in contamination rates during various patient examinations and emergencies (p > 0.05). Conclusion: Bacterial contamination was found on ultrasound probes/gels in our department. Although the majority were non-pathogenic microorganisms, two pathogenic microorganisms were also identified. Hospital staff should remember that ultrasound probes can be a tool for bacterial infection and can lead to infectious complications. Decontamination of probes with dry, nonsterile paper towels is a cheap, simple, and effective method that does not damage the device and can also reduce bacterial exposure.

Keywords:

bacterial contamination gel, methicillin-resistant Staphylococcus aureus, gynecology and obstetrics clinic ultrasound transducers,

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1. Spencer P, Spencer R. Ultrasound scanning of post-operative wounds—the risks of cross-infection. Clinical radiology. 1988;39(3):245-6.
2. Koibuchi H, Kotani K, Taniguchi N. Ultrasound probes as a possible vector of bacterial transmission. Medical ultrasonography. 2013;15(1):41-4.
3. M'Zali F, Bounizra C, Leroy S, Mekki Y, Quentin-Noury C, Kann M. Persistence of microbial contamination on transvaginal ultrasound probes despite low-level disinfection procedure. PloS one. 2014;9(4):e93368.
4. Leroy S. Infectious risk of endovaginal and transrectal ultrasonography: systematic review and meta-analysis. Journal of Hospital Infection. 2013;83(2):99-106.
5. Taiwo S. Methicillin resistance in Staphylococcus aureus: a review of the molecular epidemiology, clinical significance and laboratory detection methods. West African journal of medicine. 2009;28(5).
6. Sasahara T, Hayashi S, Morisawa Y, Sakihama T, Yoshimura A, Hirai Y. Bacillus cereus bacteremia outbreak due to contaminated hospital linens. European Journal of Clinical Microbiology & Infectious Diseases. 2011;30(2):219-26.
7. Kac G, Gueneret M, Rodi A, et al. Evaluation of a new disinfection procedure for ultrasound probes using ultraviolet light. Journal of Hospital Infection. 2007;65(2):163-8.
8. Cogen A, Nizet V, Gallo R. Skin microbiota: a source of disease or defence? British Journal of Dermatology. 2008;158(3):442-55.
9. Weist K, Wendt C, Petersen LR, Versmold H, Rüden H. An outbreak of pyodermas among neonates caused by ultrasound gel contaminated with methicillin-susceptible Staphylococcus aureus. Infection Control & Hospital Epidemiology. 2000;21(12):761-4.
10. Gaillot O, Maruéjouls C, Abachin Er, et al. Nosocomial outbreak of Klebsiella pneumoniae producing SHV-5 extended-spectrum β-lactamase, originating from a contaminated ultrasonography coupling gel. Journal of clinical microbiology. 1998;36(5):1357-60.
11. Hayashi S, Koibuchi H, Taniguchi N, Hirai Y. Evaluation of procedures for decontaminating ultrasound probes. Journal of Medical Ultrasonics. 2012;39(1):11-4.
12. Burke JP. Infection control-a problem for patient safety. New England Journal of Medicine. 2003;348(7):651-6.
13. Fowler C, McCracken D. US probes: risk of cross infection and ways to reduce it—comparison of cleaning methods. Radiology. 1999;213(1):299-300.
14. Westerway SC, Basseal JM. Endocavity ultrasound transducers: why high-level disinfection is necessary. Ultraschall in der Medizin-European Journal of Ultrasound. 2020.
15. Ma STC, Yeung A, Chan PKS, Graham CA. Transvaginal ultrasound probe contamination by the human papillomavirus in the emergency department. Emergency Medicine Journal. 2013;30(6):472-5.
16. Casalegno J-s, Le Bail Carval K, Eibach D, et al. High risk HPV contamination of endocavity vaginal ultrasound probes: an underestimated route of nosocomial infection? PloS one. 2012;7(10):e48137.
17. Sanz GE, Theoret J, Liao MM, Erickson C, Kendall JL. Bacterial contamination and cleanliness of emergency department ultrasound probes. Canadian Journal of Emergency Medicine. 2011;13(6):384-9.
18. Karadeniz YM, Kilic D, Altan SK, Altinok D, Güney S. Evaluation of the role of ultrasound machines as a source of nosocomial and cross-infection. Investigative Radiology. 2001;36(9):554-8.
19. Koibuchi H, Hayashi S, Kotani K, et al. Comparison of methods for evaluating bacterial contamination of ultrasound probes. Journal of Medical Ultrasonics. 2009;36(4):187-92.
20. Hedin G, Rynbäck J, Loré B. New technique to take samples from environmental surfaces using flocked nylon swabs. Journal of Hospital Infection. 2010;75(4):314-7.