title: Investigation of current infection-control practices for ultrasound coupling gel: a survey, microbiological analysis, and examination of practice patterns.
abstract: OBJECTIVE
  Ultrasound coupling gel may serve as a vector for the spread of bacteria and has been the causative agent for significant health care-associated infections. The purpose of this study was to document existing infection-control procedures and level of contamination present within nonsterile ultrasound gel from several clinical departments at a single institution. A second purpose was to examine the effectiveness of clinician education and manufacturer-based ultrasound additives on ultrasound gel contamination and in vitro bacterial proliferation, respectively.
  
  
  METHODS
  Compliance with Health Canada recommended infection-control policies were determined by survey. Contamination of in-use ultrasound gel bottles was determined by inspecting cultures after 72 hours of incubation. After infection-control education, a 28-day interval assessment was used to examine contamination rates in newly provided ultrasound gel. The ability of ultrasound gel containing parabens to prevent bacterial growth was examined in cultures grown with and without ultrasound gel.
  
  
  RESULTS
  Practitioners were not compliant with Health Canada recommendations, but the baseline ultrasound gel contamination rate within these departments was only 2.5%. Education in infection control did not improve the contamination rate over 28 days. Contamination was discovered in ultrasound gel supplied directly from the manufacturer. Ultrasound gel suppressed but did not prevent bacterial growth in a species- and time-specific manner.
  
  
  CONCLUSIONS
  The source of contamination for in-use ultrasound gel may be of manufacturer or human origin. Because additives to the ultrasound gel are not bactericidal, sterile ultrasound gel should be used for invasive and high-risk cases, and improving infection-control policies is warranted.
authors: Institute for Pain Diagnostics and Care, Ohio Valley General Hospital, McKees Rocks, PA 15136, USA. davidprovenzano@hotmail.com
authors: David A
authors: DA
authors: Provenzano
authors: Michael A
authors: MA
authors: Liebert
authors: Barbara
authors: B
authors: Steen
authors: Debra
authors: D
authors: Lovetro
authors: David L
authors: DL
authors: Somers
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D003625:Data Collection / Q000379:methods; D004349:Drug Packaging / Q000592:standards; D004866:Equipment Contamination / Q000517:prevention & control*; D005782:Gels / Q000592:standards*; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000592:standards*; D018084:Ultrasonography, Interventional / Q000379:methods / Q000592:standards*
chemical_list: D005782:Gels