Expert Insights on Ultrasound Gel Contamination and Proper Disinfection Methods
Healthcare providers use ultrasound technology every day to guide needle insertions for IVs and other medical procedures. However, without proper precautions, ultrasound equipment can become a source of infections. Nancy Moureau, PhD, RN, CRNI, CPUI, VA-BC—a leading expert in vascular access and CEO of PICC Excellence—shares practical guidance on preventing contamination during ultrasound procedures.
This article is the third in a four-part series with Dr. Moureau, who serves on Infection Control Today®’s editorial advisory board.
Why Ultrasound Gel Matters for Patient Safety
Ultrasound transducers require coupling gel to work properly. Since ultrasound cannot transmit sound waves through air, a fluid medium or gel is necessary to visualize the body’s internal structures. However, this essential gel has been identified as a potential source of patient infections.
The Problem with Current Gel Practices
Dr. Moureau has observed significant inconsistency in gel usage across healthcare facilities. “I have walked through a single institution and seen 5 different types of gels used, all of which were nonsterile,” she explains. This creates a serious concern: practitioners may be using nonsterile gel on sterile insertion sites, potentially pushing contamination directly into the bloodstream.
The potential consequences extend beyond surface contamination. While research on this topic is limited, gel entering the bloodstream could embolize and create health problems.
Best Practices for Preventing Gel Contamination
Use Barriers to Keep Gel Away from Insertion Sites
According to Dr. Moureau, the best approach is not using gel directly at the insertion site. Instead, healthcare providers should keep the gel and transducer on the opposite side of a barrier that still allows visualization of blood vessels. This method eliminates concerns about gel type variability and contamination risk.
Implement Complete, Standardized Kits
To reduce variability in gel usage, Dr. Moureau recommends using complete IV start kits or central line insertion kits that include everything clinicians need—including sterile gel packets for central line insertions. These kits should be:
- Optimized for efficiency
- Cost-effective
- Readily available for immediate use
- Consistently stocked across all departments
However, she notes that even IV start kits are not consistently used throughout hospitals, despite peripheral IVs being inserted frequently throughout each day.
Ensure Management Support and Standardization
Healthcare facilities need consistency in practices, with management actively enforcing the use of safety supplies. This includes monitoring and encouraging best practices across all hospital departments, particularly regarding sterile gel use during insertions.
Understanding Current Disinfection Guidelines
What Leading Organizations Recommend
Both the American Institute for Ultrasound in Medicine (AIUM) and the Infusion Nurses Society (INS) provide recommendations for ultrasound-guided vascular access procedures.
Infusion Nurses Society (INS) Guidelines:
- Requires disinfection before and after each use
- Does not specify particular processing methods for transducers
New AIUM Intersocietal Position Statement:
The AIUM recently published an important position statement clarifying practical and safe methods for disinfecting transducers. This statement has been accepted by INS and more than 20 other healthcare organizations.
Clearing Up Confusion: High-Level vs. Low-Level Disinfection
The Spaulding Classification System
Current cleaning and disinfection practices are based on the Spaulding Classification System, first published in 1957. This system requires different levels of disinfection or sterilization depending on how medical devices are used. However, modern devices and procedures require updated interpretation of these rules.
What the Evidence Shows for Percutaneous Procedures
The new Intersocietal Position Statement, endorsed by 22 health professional organizations, clarifies that:
Low-Level Disinfection is Adequate for Percutaneous Procedures
For ultrasound transducers used in percutaneous procedures (through-the-skin procedures like IV insertions), cleaning and low-level disinfection (LLD) effective against bloodborne pathogens are sufficient—provided this aligns with the manufacturer’s instructions.
This is especially true when a cover or barrier prevents the bare transducer from contacting the insertion site directly.
High-Level Disinfection is Required for:
- Transducers contacting mucous membranes
- Endocavitary procedures (anal, oral, or vaginal)
- More invasive procedures
High-level disinfection is more costly and time-consuming and should not be applied to all ultrasound uses.
Why Proper Disinfection Levels Matter
By making disinfection practical, consistent, manageable, and efficient, healthcare facilities can ensure greater standardization across departments. This approach:
- Optimizes critical equipment availability
- Ensures patient safety
- Doesn’t inhibit the beneficial use of ultrasound technology
Benefits of Ultrasound Guidance
Ultrasound guidance significantly improves success rates for intravenous and arterial device insertions by:
- Enabling better vein assessments
- Providing visual guidance for needle placement
- Reducing complications and patient discomfort
Looking Ahead: New Disinfection Technologies
The future holds promise for even more convenient disinfection methods. Novel disinfecting agents are becoming available that can perform not only low-level and intermediate-level disinfection but eventually high-level disinfection through easy-to-use wipes.
Key Takeaways for Healthcare Providers
- Avoid gel contamination by using barriers that keep gel away from insertion sites
- Implement standardized kits that include appropriate sterile supplies, including sterile gel packets
- Follow evidence-based disinfection protocols: Use low-level disinfection for percutaneous procedures and high-level disinfection for procedures involving mucous membranes
- Ensure consistency across all departments through management support and monitoring
- Don’t over-process equipment: Match the disinfection level to the procedure type to maintain efficiency while ensuring patient safety
By following these evidence-based recommendations from leading healthcare organizations, medical facilities can maintain the benefits of ultrasound-guided procedures while effectively preventing healthcare-acquired infections.
For more information on infection prevention and ultrasound technology, Parker Laboratories, Inc. provides resources and products designed to support safe, effective ultrasound procedures.