title: High risk HPV contamination of endocavity vaginal ultrasound probes: an underestimated route of nosocomial infection?
abstract: BACKGROUND
  Endocavity ultrasound is seen as a harmless procedure and has become a common gynaecological procedure. However without correct disinfection, it may result in nosocomial transmission of genito-urinary pathogens, such as high-risk Human Papillomavirus (HR-HPV). We aimed to evaluate the currently recommended disinfection procedure for covered endocavity ultrasound probes, which consists of "Low Level Disinfection" (LLD) with "quaternary ammonium compounds" containing wipes.
  
  
  METHODS
  From May to October 2011 swabs were taken from endovaginal ultrasound probes at the Gynecology Department of the Lyon University Hospital. During the first phase (May-June 2011) samples were taken after the ultrasound examination and after the LLD procedure. In a second phase (July-October 2011) swab samples were collected just before the probe was used. All samples were tested for the presence of human DNA (as a marker for a possible transmission of infectious pathogens from the genital tract) and HPV DNA with the Genomica DNA microarray (35 different HPV genotypes).
  
  
  RESULTS
  We collected 217 samples before and 200 samples after the ultrasound examination. The PCR was inhibited in two cases. Human DNA was detected in 36 (18%) post-examination samples and 61 (28%) pre-examination samples. After the ultrasound LLD procedure, 6 (3.0%) samples contained HR-HPV types (16, 31, 2×53 and 58). Similarly, HPV was detected in 6 pre-examination samples (2.7%). Amongst these 4 (1.9%) contained HR-HPV (types 53 and 70).
  
  
  CONCLUSIONS
  Our study reveals that a considerable number of ultrasound probes are contaminated with human and HR-HPV DNA, despite LLD disinfection and probe cover. In all hospitals, where LLD is performed, the endovaginal ultrasound procedure must therefore be considered a source for nosocomial HR-HPV infections. We recommend the stringent use of high-level disinfectants, such as glutaraldehyde or hydrogen peroxide solutions.
authors.affiliation: Laboratory of Virology, Centre de Biologie et Pathologie Est, Hospices Civils de Lyon, Lyon, France. jean-sebastien.casalegno@chu-lyon.fr
authors.forename: Jean-sebastien
authors.initials: JS
authors.lastname: Casalegno
authors.forename: Karine
authors.initials: K
authors.lastname: Le Bail Carval
authors.forename: Daniel
authors.initials: D
authors.lastname: Eibach
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Valdeyron
authors.forename: Gery
authors.initials: G
authors.lastname: Lamblin
authors.forename: Hervé
authors.initials: H
authors.lastname: Jacquemoud
authors.forename: Georges
authors.initials: G
authors.lastname: Mellier
authors.forename: Bruno
authors.initials: B
authors.lastname: Lina
authors.forename: Pascal
authors.initials: P
authors.lastname: Gaucherand
authors.forename: Patrice
authors.initials: P
authors.lastname: Mathevet
authors.forename: Yahia
authors.initials: Y
authors.lastname: Mekki
mesh_terms: D000891:Anti-Infective Agents, Local / Q000494:pharmacology; D003428:Cross Infection / Q000517:prevention & control / Q000635:transmission / Q000821:virology; D004279:DNA, Viral / Q000235:genetics; D004202:Disinfectants / Q000494:pharmacology; D004203:Disinfection / Q000379:methods / Q000592:standards; D004866:Equipment Contamination / Q000517:prevention & control / Q000706:statistics & numerical data; D005260:Female; D005976:Glutaral / Q000494:pharmacology; D006801:Humans; D006861:Hydrogen Peroxide / Q000494:pharmacology; D027383:Papillomaviridae / Q000145:classification / Q000187:drug effects / Q000235:genetics*; D030361:Papillomavirus Infections / Q000517:prevention & control / Q000635:transmission / Q000821:virology*; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D013997:Time Factors; D014463:Ultrasonography / Q000295:instrumentation* / Q000379:methods; D014621:Vagina / Q000821:virology*
chemical_list: D000891:Anti-Infective Agents, Local; D004279:DNA, Viral; D004202:Disinfectants; D006861:Hydrogen Peroxide; D005976:Glutaral