Transvaginal ultrasound probes are human papillomavirus-free following low-level disinfection: cross-sectional multicenter survey.

OBJECTIVES: To assess the frequency of detection of high-risk human papillomavirus (hrHPV) on transvaginal ultrasound (TVS) probes and keyboards and evaluate operator compliance with national recommendations for prevention of cross-infection during TVS. METHODS: This was a multicenter observational survey involving 46 public and private centers, in the Paris region of France, in which at least five consecutive TVS examinations were performed per day. We audited 676 TVS procedures. We recorded preventive hygiene actions undertaken by the operator at three stages: (1) during TVS; (2) during probe disinfection; and (3) during preparation of the probe for the next TVS. After probe disinfection, we collected one sample from the bare probe and one from the ultrasound keyboard; following probe preparation for the next examination, an additional sample was obtained from the covered probe. The samples were tested for presence of hrHPV DNA using the Cobas® 4800 System. RESULTS: We did not detect hrHPV DNA in samples collected from uncovered or covered probes (0%; 95% CI, 0.00-0.55%). Keyboard samples were positive for hrHPV in two cases (0.3%; 95% CI, 0.04-1.07%). During TVS, the operator avoided touching the keyboard with a hand that had touched the patient's vulva in 86% of cases and held the probe with a gloved hand in 68%. Before probe disinfection, the operator wore new gloves, or performed hand disinfection in 8% of cases. The probe disinfection technique used was adequate in 87% of cases, not performed at all in 12% and insufficient in 1%. Before preparing the probe for the next scan, the operators disinfected their hands or used new gloves in 81% of cases. The probe cover and the coupling gel used complied with recommendations in 98% and 46% of cases, respectively. Of the seven preventive hygiene actions recommended in national guidelines, all were performed in 2%, three to six in 95% and two in 3% of observations. In four (9%) centers, disinfection was not performed in over half the observations. CONCLUSIONS: No evidence of hrHPV DNA was found on TVS probes and probe covers following low-level disinfection, despite suboptimal compliance with hygiene guidelines. Routine TVS practice could be made easier and safer with a global approach to probe disinfection and hand hygiene. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

[Evaluation of the feasibility of ultrasound in a community care outpatient pregnancy assessment clinic for high-risk pregnancies]. / Étude de la faisabilité et de la valorisation de l'échographie focalisée dans un cadre d'explorations fonctionnelles extra-hospitalières pour des grossesses à risque.

OBJECTIVES: To assess the clinical, legal, and technical roles of ultrasound in an outpatient pregnancy assessment clinic, while evaluating the feasibility for these consultations to be performed at home. MATERIALS AND METHODS: We prospectively assessed all consultations from April 3 to May 31, 2013, at the outpatient pregnancy assessment clinic of La Pitié-Salpêtrière, Paris, France. We recorded all procedures and the number and type of ultrasound examination performed, according to their indication. For each consultation, we evaluated whether the routine protocols were sufficient or if the attending obstetrician was asked for advice. Finally, we asked the patients if they would prefer having this consultation in a home-care setting. RESULTS: We recorded 429 consultations (n) for 234 patients (Np). Indications were diabetes (n=106/Np=59), assessment of fetal growth (n=90/Np=43), another single indication (n=106/Np=59), multiple indications (n=46/Np=12), term pregnancies (n=39/Np=30), and a history of abnormal pregnancy (n=27/Np=10). CTG was performed for 91 % of consultations, blood samples for 10 %, and ultrasound for 88 %, which included amniotic fluid evaluation (79 %), umbilical Doppler (69 %), fetal biometries (36 %), uterine artery Doppler (0.7 %), cervical length (2 %), suspicion of breech presentation (4 %) and placenta position (0.7 %). Most of these ultrasound examinations could not be financially value if performed by a midwife. Routine protocols were sufficient for the management of 68 % of these consultations, 26 % required the attending obstetrician, and 6 % were finally low-risk. Performing these consultations in a home-care setting was medically possible and requested by the patient for 16 % of consultations (6 % of patients). CONCLUSION: These are encouraging results to experiment the outpatient pregnancy assessment clinic in a home-care setting, although the financial valorization system in France is poorly adapted.