title: Are therapeutic ultrasound units a potential vector for nosocomial infection?
abstract: OBJECTIVE
  Nosocomial infections present a widespread problem in today's healthcare environment, with a significant number of patients acquiring an infection annually. With the contemporary transition of immunocompromised and high-risk patients to community-based care, therapeutic ultrasound has the potential to be a vector of infection in the physiotherapy setting. The purpose of the present study was to determine the degree of contamination on therapeutic ultrasound transducer heads and ultrasound gel after routine clinical use, and to evaluate the efficacy of recommended infection control procedures.
  
  
  METHODS
  The study consisted of two phases. Using a prospective cross-sectional design, microbiological cultures were obtained from 44 transducer heads and 43 gels. Subjects were drawn from a variety of physiotherapy practice settings. All samples containing more than five colony forming units per cm2 were considered contaminated. Following these measurements, a repeated-measures design was used to re-evaluate the 44 transducer heads for the amount and type of bacteria present after cleaning with a 70% alcohol wipe.
  
  
  RESULTS
  Twenty-seven per cent of transducer heads and 28% of gels were contaminated. Transducer heads showed fairly low levels of contamination across the sample, with the majority of organisms isolated found in normal skin and environmental flora. Gels were heavily contaminated with opportunistic and potentially pathogenic organisms, including Stenotrophomonas maltophilia, Staphylococcus aureus, Acinetobacter baumannii and Rhodotorula mucilaginosa. No multi-resistant organisms were identified. Cleaning with 70% alcohol significantly reduced the level of contamination on transducer heads (p < 0.01).
  
  
  CONCLUSIONS
  Therapeutic ultrasound equipment is a potential vector for nosocomial infection in physiotherapy patients. The risk of infection from transducer heads can be effectively removed by cleaning with 70% alcohol between patients. Further research into possible strategies to reduce the risk of infection from ultrasound gels is needed.
authors.affiliation: School of Health Sciences, University of South Australia, North Terrace, Adelaide, Australia.
authors.forename: Siobhan
authors.initials: S
authors.lastname: Schabrun
authors.forename: Lucy
authors.initials: L
authors.lastname: Chipchase
authors.forename: Heather
authors.initials: H
authors.lastname: Rickard
mesh_terms: D040981:Acinetobacter baumannii / Q000472:pathogenicity; D001424:Bacterial Infections / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission*; D003428:Cross Infection / Q000209:etiology* / Q000382:microbiology / Q000635:transmission*; D003430:Cross-Sectional Studies; D004203:Disinfection / Q000379:methods; D004866:Equipment Contamination / Q000517:prevention & control; D005782:Gels; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000379:methods; D011446:Prospective Studies; D013211:Staphylococcus aureus / Q000472:pathogenicity; D020615:Stenotrophomonas maltophilia / Q000472:pathogenicity; D014159:Transducers / Q000382:microbiology; D014464:Ultrasonic Therapy / Q000009:adverse effects / Q000295:instrumentation*
chemical_list: D005782:Gels