Guidelines Proposed to Slash Infection Risk from Ultrasound Gel

The recommendations are based on the authors’ own experiences with an outbreak traced to contaminated ultrasound transmission gel. They outlined their proposal in an article published in the December 2012 issue of Infection Control and Hospital Epidemiology, a journal of the Society for Healthcare Epidemiology of America.

The investigators, from the Beaumont Health System (Royal Oak, MI, USA), found atypical clusters of Pseudomonas aeruginosa in a cardiovascular surgery intensive-care unit during regular infection-control surveillance in December 2011. The outbreak was found to have arisen from ultrasound transmission-gel bottles that were contaminated during the manufacturing process and that were being utilized for intraoperative transesophageal echocardiography. Eventually, this information led to a national recall of the product.

These gels contain methyl benzoate or parabens that suppress, but not kill, the growth of bacteria. However, earlier research has shown that ultrasound gels do not have antimicrobial characteristics and could act as a channel for bacterial growth. Contaminated gels have been found to be the source of other outbreaks of infection in the last 20 years. “After our investigation of the Pseudomonas outbreak last year linked the source of the outbreak to contaminated ultrasound gel, we were surprised to find that very little guidance is available on appropriate uses for different ultrasound gel products,” said Susan Oleszkowicz, MPH, lead author of the article.

In their article, the authors defined preliminary guidelines for recommended uses of ultrasound transmission gels, calling on professional societies and manufacturers of ultrasound to take an active role in developing recommendations for the intended and correct use of the gels. Suggestions included (1) the need for sterile, single-dose ultrasound gel in any invasive procedures involving fresh surgical wounds or nonintact skin; (2) sterile, single-dose ultrasound gel should be used with critically ill children or newborns; lastly, multidose, nonsterile gel can still be used on intact skin; however, containers should be sealed correctly when not in use, and replaced when empty, instead of refilled.

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