title: Musculoskeletal ultrasound guided manoeuvres - a security profile.
abstract: BACKGROUND
  In daily rheumatology clinical practice, routine interventional musculoskeletal ultrasound (MSUS) guided maneuvers such as aspiration, intraarticular or periarticular drug injections require efficient cleaning and disinfection methods for both transducer and patient's skin.
  
  
  OBJECTIVE
  To study the efficacy of probe and skin disinfection measures after using simple protocols, to identify the prevalence of septic and other drug related side effects after MSUS guided interventions and to quantify the total procedure time.
  
  
  METHODS
  Recruitment of consecutive patients with different joint/ periarticular MSUS guided interventions was made in 3 medical centers. Bacterial load was determined on the transducers footprint after dry cleaning with the removal of any gel trace and on patients' skin after rigorous skin disinfection with either Bethadine or alcohol 70° and Bethadine. Non-sterile gel was used as an ultrasound transmission medium. The time spent for some of the invasive procedures was quantified.
  
  
  RESULTS
  Nine hundred and ninety eight MSUS guided interventional maneuvers were performed in 945 patients with inflammatory and degenerative musculoskeletal pathologies. Staphylococcus epidermidis was identified in 13.33% cases of the skin bacterial load analysis and in 37.50% cases of the footprint analysis. In two patients pathogenetic germs were detected on the skin. No septic post-procedural complications were reported. In 0.6% of the cohort other side effects occurred: aseptic osteonecrosis, skin depigmentation at injection site and iatrogenic microcristaline reactions. The median time frame dedicated to the intervention was 6 minutes.
  
  
  CONCLUSIONS
  Rigorous transducer dry cleaning and Bethadine / Bethadine and alcohol 70° skin disinfection are efficacious methods. The risk for septic complications and other drug related side effects related to MSUS guided injections is very low in this context. A correct injection technique must accompany the previous requests. Rapid and safe interventional maneuvers reduce the risks and control the costs of the healthcare system.
authors.affiliation: Rheumatology Division, Rehabilitation Clinical Hospital Cluj-Napoca, Romania. mcmicu@yahoo.com.
authors.forename: Mihaela C
authors.initials: MC
authors.lastname: Micu
authors.affiliation: Rheumatology Department, "Sfânta Maria" Hospital, Bucharest, Romania.
authors.forename: Violeta M
authors.initials: VM
authors.lastname: Vlad
authors.affiliation: Department of Medical Informatics and Biostatistics, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania.
authors.forename: Sorana D
authors.initials: SD
authors.lastname: Bolboacă
authors.affiliation: Radiology Department "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Mihaela
authors.initials: M
authors.lastname: Cârlig
authors.affiliation: Laboratory Unit, Rehabilitation Clinical Hospital Cluj-Napoca, Romania.
authors.forename: Gyorgy I
authors.initials: GI
authors.lastname: Bodizs
authors.affiliation: Biochemistry Department, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca,Romania.
authors.forename: Alina G
authors.initials: AG
authors.lastname: Duţu
authors.affiliation: 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania.
authors.forename: Daniela
authors.initials: D
authors.lastname: Fodor
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000517:prevention & control*; D002648:Child; D004203:Disinfection; D004866:Equipment Contamination / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009141:Musculoskeletal System / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D012867:Skin / Q000382:microbiology*; D018084:Ultrasonography, Interventional / Q000295:instrumentation*; D055815:Young Adult