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The Need For HLD

When decidingto switch to automated HLD systems, patient and staff safety were key considerations,Solovey and Lemke agree. Guidelines approved in April 2014 by the AmericanInstitute of Ultrasound in Medicine describe the use of a hydrogen peroxidenanodroplet emulsion in automated systems as providing “an effective high-leveldisinfectant without toxicity (to staff),” particularly as it pertains toclostridium difficile and the safe and effective disinfection of ultrasoundprobes.

Meta-analysisof peer-reviewed studies have found that low-level disinfection ofendovaginal/rectal probes may leave 12.9 percent of transducers contaminatedwith pathogenic bacteria and 1 percent with frequently occurring viruses,namely HPV, herpes simplex virus and cytomegalovirus.5

Ultrasoundprobes are a potential source of HPV, which is among the most common sexuallytransmitted diseases and often inhabits transvaginal probes. A study conductedin Hong Kong and published in 2012 found that 7.5 percent of the probes used inthe emergency room had DNA from HPV.1 The virus also resists glutaraldehyde andortho-phthalaldehyde, two of the most common disinfectants used in manualsoaking.2

Trophon EPR,which utilizes sonicated hydrogen peroxide, is currently the only system proveneffective in killing HPV, according to research scheduled for publication inthe American Journal of Obstetrics and Gynecology and available online sinceMarch 2016.3 In that study, the authors recommended the use of asonicated hydrogen peroxide disinfectant system rather than aldehyde-typedisinfectants.

In addition, research presented at the 2015 meetingof the Society of Healthcare Epidemiology of America showed that the use ofnebulized 35 percent hydrogen peroxide in an automated system “is able to fullyinactivate HPV, when used according to manufacturer instructions.” The researchersconcluded later that year in the Journal of Medical Virology that “sonicatedhydrogen peroxide offers an effective disinfection solution for ultrasoundprobes. Disinfection methods that are effective against HPV should be adoptedwhere possible.”4