SMFM Patient Safety Guideline: Reducing the risk of transmitting infection by transvaginal ultrasound examination.

Recent surveys have shown widespread lapses in the procedures used to reduce the risk of transmitting infection via medical devices. Transvaginal ultrasound examination has the potential to transmit vaginal infections, including human papillomavirus (HPV). Areas of particular concern are the use of probe covers with high rates of leakage, use of disinfectants that are not effective against HPV, and use of coupling gel from multiple-use containers. We review these issues and recommend four steps to reduce the risk of transmitting infection. First, during every transvaginal ultrasound exam, the probe should be covered with a sterile, single-use "viral barrier" cover or a condom. Second, sterile, single-use ultrasound gel packets should be used. Third, after every examination, the probe should be cleaned to remove any visible gel or debris. Fourth, after cleaning, the probe should undergo high-level disinfection using an agent with proven efficacy against HPV, including hydrogen peroxide, hypochlorite, or peracetic acid. Glutaraldehyde, ortho-phthalaldehyde, phenols, and isopropyl alcohol have virtually no efficacy against HPV.