title: Impact of vaginal-rectal ultrasound examinations with covered and low-level disinfected transducers on infectious transmissions in france.
abstract: BACKGROUND
  The risk of cross-infection from shared ultrasound probes in endorectal and vaginal ultrasonography due to low-level disinfection (LLD) is difficult to estimate because potential infections are also sexually transmitted diseases, and route of contamination is often difficult to establish. In France, the widely used standard for prevention of infections is through the use of probe covers and LLD of the ultrasound transducer by disinfectant wipes. We performed an in silico simulation based on a systematic review to estimate the number of patients infected after endorectal or vaginal ultrasonography examination using LLD for probes.
  
  
  METHODS
  We performed a stochastic Monte Carlo computer simulation to produce hypothetical cohorts for a population of 4 million annual ultrasound examinations performed in France, and we estimated the number of infected patients for human immunodeficiency virus (HIV), herpes simplex virus, hepatitis B virus, hepatitis C virus, human papilloma virus, cytomegalovirus, and Chlamydia trachomatis. Modeling parameters were estimated by meta-analysis when possible.
  
  
  RESULTS
  The probability of infection from a contaminated probe ranged from 1% to 6%, depending on the pathogen. For cases of HIV infection, this would result in approximately 60 infected patients per year. For other common viral infections, the number of new cases ranged from 1,600 to 15,000 per year that could be attributable directly to ultrasound and LLD procedures.
  
  
  CONCLUSIONS
  Our simulation results showed that, despite cumulative use of probe cover and LLD, there were still some cases of de novo infection that may be attributable to ultrasound procedures. These cases are preventable by reviewing the currently used LLD and/or upgrading LLD to high-level disinfection, as recommended by the US Centers for Disease Control and Prevention.
authors.affiliation: Laboratoire de Biostatistique, Epidémiologie, Santé Publique et Informatique Médicale, Centre Hospitalier Universitaire (CHU) de Nîmes, Nîmes, France; and EA 2415 Unit, Montpellier 1 University, Montpellier, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Leroy
authors.forename: Fatima
authors.initials: F
authors.lastname: M'Zali
authors.forename: Michael
authors.initials: M
authors.lastname: Kann
authors.forename: David J
authors.initials: DJ
authors.lastname: Weber
authors.forename: David D
authors.initials: DD
authors.lastname: Smith
mesh_terms: D003198:Computer Simulation; D003428:Cross Infection / Q000517:prevention & control; D018562:Disease Transmission, Infectious / Q000517:prevention & control / Q000706:statistics & numerical data; D004203:Disinfection / Q000379:methods / Q000592:standards; D004866:Equipment Contamination / Q000517:prevention & control*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D012007:Rectum / Q000000981:diagnostic imaging / Q000382:microbiology; D018570:Risk Assessment; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control; D014159:Transducers / Q000382:microbiology; D014463:Ultrasonography / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D014621:Vagina / Q000000981:diagnostic imaging / Q000382:microbiology