Mediterranean Journal of Emergency Medicine & Acute Care

A 26-year-old woman presents with a oneday history of lower abdominal cramping. She reports a positive home pregnancy test, with her last menstrual period occurring six weeks ago. On examination, she is hemodynamically stable but has mild tenderness in the suprapubic region. You perform a bedside transvaginal ultrasound confirming a 6-week intrauterine pregnancy with an appropriate fetal heart rate and no adnexal masses. After reassuring her, you arrange follow-up with the on-call OB/GYN and discharge her within 90 minutes of her arrival. As you hand the transvaginal ultrasound probe to the ED technician, they ask for guidance on how to properly clean it. 

Typically, probes used on the skin surface are cleaned after each use by removing visible contamination, followed by disinfection with a lowlevel disinfectant (LLD). LLDs, which are often alcohol- or quaternary ammonium compoundbased, are applied via spray or wipes. 

However, internal probes, such as those used for transvaginal imaging, are more prone to contamination, even when probe covers and LLDs are used. One study reported a condom breakage rate of up to 13% during transvaginal examinations. Another study found bacterial contamination rates of 33.7% after sheath removal, which decreased to 12.9% after LLD cleaning. Similarly, viral contamination rates were 19.4% after sheath removal and dropped to 1.0% following LLD cleaning. Due to the significant risk of crosscontamination, current guidelines recommend highlevel disinfection (HLD) for ultrasound transducers after internal use. 

Traditional HLD systems often utilize chemical solutions like glutaraldehyde or hydrogen peroxide and require a separate device for cleaning. However, in 2023, the FDA approved an HLD solution in a wipe form, which is now available in the U.S. as an alternative to machine-based HLD platforms. These wipes have been approved and used in Europe since 2008.