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The spread of infections in hospitals or any other healthcare environment is a major challenge that has faced the medical care field worldwide. These infections are spread in all health care departments. A major effort in ultrasound examinations involves decontamination. The machine and the probe in use act as the main vectors in the spread of infections. In the United States, there are about 1.7 million nosocomial infections reported annually. Up to 99,000 deaths linked to these hospital acquired infections are also reported, according to studies. The ultrasound sector is one of the leading sources of the deadly germs since, unlike many other department, the medical tools used here in particular the transducer, are in direct contact with the patient. Furthermore, this apparatus is reused by all patients. This creates room for a higher chance of infection spread from one patient to another. With proper prevention and control measures in place; however, these infections can be curtailed (Eze, Okaro &Ohagwu, 2009).
The medical providers can ensure safety in the ultrasound procedures by observing basic measures such as cleanliness and cooperation. Simple hygiene procedure such as washing hands before and after handling the patients and apparatus could reduce the level of infection. The University of Iowa hospital records the lowest infection incidences in America by observing the most basic of precautions; wearing gloves regardless of test and transducer disinfection after every test.These infections may come from the patients who are infected with nosocomial pathogens such as staphylococcus and the Salmonella species. The pathogens may also arise from cross infection among the patients or to the sonographer if no control measures are in place to prevent these infections. This research paper will focus on spread and control of nosocomial infections in the Ultrasound laboratory. The paper will also identify the importance of this information to medical practitioners (Eze, Okaro &Ohagwu, 2009).
Literature Review
In any sonography department, care should be taken to ensure that disease transmission among patients is prevented. Infections are easily transmitted because the transducers used in sonography are reused on different patients. This creates a risk of indirect transmission of pathogens if proper sterilization and or disinfection are not carried out. The transducers are only sterilized using liquid chemicals since other methods of sterilization are incompatible. The sterilization procedure involves a complete removal of all types of microbes such as bacteria and viruses. To ensure a medical device is safe for use on another patient without the threat of an infection, it should be cleaned thoroughly and then perfectly disinfected. High level disinfection should be used since mid-level and low–level disinfection techniques are not very effective. The high-level disinfection ensures complete destruction of all microbes except the highly resistant bacterial spores. Depending on the type of microorganisms in contact with the transducer, low-level disinfection which has the ability to eliminate viruses, bacteria and some classes of fungi may be used. The method can not be used on Myco bacterium tuberculosis and bacterial spores as they are resistant (Turnstall, 2010).
In order to prevent or lower the chances of spreading infections among patients, the practitioners need to understand how to classify the risks associated with each test.This will be important in determining the most appropriate method of disinfecting or sterilizing. A medical expert, Dr.Spaulding came up with a classification model in 1968 in which the equipment is sterilized or disinfected based on the degree of risk of a test.According to him; the items are categorized as critical, semi-critical and non-critical. This model is in use in many practices world wide. Transducers used on sterile and the vascular tissues are considered high risk or critical in nature. These items are carefully sterilized using a sterile sheath and gel before and after use. If this is not available, the item should be disinfected using the high-level specification (Turnstall, 2010).
The objects that are used on mucous membranes and the non intact skin are classified as semi-critical. The body areas they come into contact with fall under the intermediate risk category and include rectal, Trans-esophageal echocardiography, vaginal, aspiration, biopsy and the non intact skin sections. High–level disinfection is used on the transducers between the patients. A probe cover should always be used during the procedure. Before cleaning a transducer, a biopsy guide needs to be removed first if it was used in the process. This is followed by high-level disinfection. On occasion that the transducer has an in built needle guide channel, then a higher risk exists since the internal lumen has a higher risk for contamination and there fore should be disinfected with a high level disinfectant. Sterile water is always used to rinse transducers used in biopsy procedures although alcohol would be most preferable since residual water always forms a culture medium for bacterial growth. Non critical items are used in low risk body parts in particular intact skin areas such as head, torso, and neck. These areas are also infested by infections and therefore it’s advisable that the disinfection used can eliminate them. In some incidences the transducer may even require high level disinfection (Tunstall, 2010).
To effectively clean transducers, all organic and inorganic materials have to be removed immediately after use before disinfection. These include, blood, pus and mucosal secretions as well as salts, calcium and iron and mostly act as barriers to the disinfection procedure. If the transducer was used on critical and semi-critical procedures, the sterile sheath should be first removed and disposed. The transducers are easy to clean using a gauze pad, running water and a liquid soap. The transducer is then dried with a paper towel. It’s recommended that non critical transducers be disinfected after cleaning( Muradali,Gold, Philips,&Wilson,1995).
The use of disinfectants and antiseptics to sterilize the transducers may be carried out interchangeably. This is because disinfectants eliminate the inanimate objects while antiseptics eliminate the living microbes. To check effectiveness of sterilants, chemical test strips are employed to counter check the glutaraldehyde concentration. According to Environmental Protection Agency (EPA), any disinfectant that has no tuberculocidal power is registered as a low-level while the intermediate level is considered the perfect tuberculocidal. A high-level disinfectant is one that has power to eliminate viruses, fungi, mycobacterium tuberculosis, bacteria and also a variety of spores (Rutala, Gergen & Weber, 2007).
Another technique of ensuring sterility of the transducers involves the use of probe covers, sterile sheath or condom. These are; however not a guarantee of sterility as they can fail. High percentages of perforations have been traced in these items. The probe covers, most of which are latex are not compatible with latex-sensitive patients as they because allergic reactions. Sonographic gel is a potential contaminant since it forms a culture medium for bacterial growth (Muradali, Gold, Philips & Wilson, 1995). Furthermore, sterile gel is expensive and majority of the procedures require the use of sterile gel. It’s also vital to take care of transducer cables and keyboards as they act as potential transmitters of infection (Sykes, Appleby, Perry & Gould, 2006).
From the research, the lesson learnt is that sonographers ought to develop workable protocols to ensure the patients stay in an infection-free environment. The practice of sonography should be closely monitored by relevant authorities to ensure compliance. Universal regulations should also be employed world wide to ensure standardized services in all laboratories and all professionals in the field constantly retrained on emerging issues in the field (Eze, Okaro & Ohagwu, 2009).
Conclusion / Discussion
            Patient safety is an important component of medical practice. In ultrasound section of any health center infection control should be given optimal priority. Precaution should be taken to ensure cross infection from viral and bacterial agents as well as other blood borne pathogens is curtailed. Knowledge on the use of transducers, probe covers, coupling agents and disinfection of surfaces is important to medical care givers. Health care givers can use cost-effective methods without compromising on patient or their own health (Turnstall, 2010).According to many studies; majority patients have no idea about nosocomial infections. This therefore increases their chance to acquire these infections as they do not know how to prevent it.There is therefore a need to create awareness among patients so as to reduce the incidences of infection. To ensure success in control of these infections, all procedures touching on Sonography should be given optimum attention and vigilance. Instructions in Manuals accompanying the apparatus used in the Sonography section should be followed to the letter as a guide in reduction of infections. A general precaution in handling blood and other body fluids is among the basic steps to be observed.
Various governments have enacted laws governing the use of ultrasound machines. In the United States for instance, it’s unlawful to sell ultrasound apparatus to unqualified medical practioners.The law also demands that all records pertaining the sale of ultra sound machines be registered. All these measures are aimed at reducing the number of infections and deaths. The law goes on further to demand that any institution using the ultra sound machine, keeps the apparatus as outlined by the law, hires only professionals with qualifications indicated in the Act. This is aimed at ensuring professional use of the apparatus by only qualified practioners.In a nut shell, by observing the following simple guidelines the incidence of nosocomial infections would be eradicated. This entails reduction of contamination in the environment mainly by minimizing contact between the patient and ultrasound apparatus. The use of coupling gel on a single patient package as well as limiting the contact between the patient and the probe is also highly encouraged. Another precautionary measure most ignored involves limiting contact between the ultrasound machine, the probe and the keyboard. It’s also important that, the probe is left on the bed after every examination. The disinfection practices necessary need to be carried out including thorough washing of the examiner’s hands, cleaning of probes followed by air drying .The ultrasound machine also requires regular cleaning including the probe holder. These basic rules could see the battle against nosocomial infections successfully won.

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