High Level Disinfection
When and Why?

Know what disinfection to apply is based on the Spaulding Classification

Under the Spaulding classification the ultrasound probe is classified into non-critical probe, semi-critical probe and critical probe, determined by how the probe comes in contact with the patient’s procedure site and the level of cross-infection risk.1-6

  • Non-critical probe is low level disinfected or intermediate level disinfection as the probe contacts intact skin or non-infected skin and the potential cross-infection risk is low.
  • Semi-critical probe is high level disinfected as the probe may contact non-intact skin (wound or burn) or mucus membrane and the potential risk of cross-infection is considered medium to high.
  • Critical probe should be sterilised, if not possible can be high level disinfected and placed inside a sterile cover to prevent the contamination of a sterile field. The potential risk of cross-infection is considered high.

Disinfection Levels

trophonEPR Spaulding Classification for Ultrasound Disinfection
Ultrasound Probe Disinfection
  • Sterilisation: All viable microorganisms must be killed.
  • High level disinfectants: All viable microorganisms must be killed,  except a small number of bacterial spores.
  • Intermediate level disinfectants: kills vegetative bacteria, mycobacteria, most viruses and most fungi, but do not kill bacterial spores.
  • Low level disinfectants: Kills vegetative bacteria, except Mycobacteria, fungi, non-enveloped viruses and bacterial spores.

Global Guidelines

Semi-Critical & Critical Ultrasound probes must receive as a minimum High Level Disinfection (HLD)

  • USA : CDC 2008, AIUM 2003
  • Canada : College of Sonographers 2013
  • Australia : ASUM /ACIPC 2017
  • Germany : DEGUM 2018
  • England : BMUS 2017,
  • England: Hospital Infection Society 2018
  • France : Ministry of Health 2019
  • Belgium : Ministry of Health 2019
  • Israel : Ministry of Health 2017
  • Ireland : Ministry of Health 2017
  • Wales : Ministry of Health 2014
  • Scotland : Ministry of Health 2017
  • Saudi Arabia : Ministry of Health 2019
  • European Federation of Ultrasound (ESFUMB) 2017
  • World Federation of Ultrasound (WFUMB) 2017
    European Society of Radiology (ESR) 2017

Local Guidelines favour automation

European Society of Radiology (ESR) states transducer covers are essential and High level disinfection is mandatory for endocavity ultrasound and all interventions.1

HPS/HFS (Scotland) guidelines concluded that there is an ongoing risk to patient safety with regards to decontamination of semi-invasive ultrasound probes.2

HSE (Ireland) (HSE) guidelines favoured the use of an automated  and the manual multi-wipe system is the least preferred option to reduction cross- infection risk.3

President of the French Society of Hospital Hygiene guidelines recommends disinfection for endocavity ultrasound probes.4

ECMUS, WFUMB recommend High-level disinfection as a minimum standard for the disinfection of endocavitary ultrasound probes.5-6

European & UK Guidelines
  1. .Nyhsen, C. M., et al. (2017). “Infection prevention and control in ultrasound – best practice recommendations from the European Society of Radiology Ultrasound Working Group.” Insights Imaging 8(6): 523-535.

  2. French Ministry of Health issues guidance requiring disinfection of endocavitary ultrasound probes https://solidarites-sante.gouv.fr/soins-et-maladies/qualite-dessoins-et-pratiques/securite/article/prevention-des-risques-d-infection-associes-a-l-utilisation-dessondes-d.

  3. Health Service Executive (HSE) Quality Improvement Division (2017). HSE Guidance for Decontamination of Semi-crical Ultrasound Probes; Semi-invasive and Non-invasive Ultrasound Probes. Document: QPSD-GL-028-1.

  4. Health Facilities Scotland, NHS National Services Scotland, Health Protection Scotland. Scotland, March 2016. NHS Scotland Guidance for Decontamination of Semi-Critical Ultrasound Probes; Semi-invasive and Non-invasive Ultrasound Probes. Document: HPS/HFS Version 1.0.

  5. Kollmann, C. and K. Salvesen (2017). “Best Practice recommendations for cleaning and disinfection of ultrasound transducers whilst maintaining transducer integrity.” European Committee for Medical Ultrasound Safety (ECMUS).
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