Incidence of residual bacterial contamination of transvaginal ultrasound probes

  • Shiho Oide
  • Tomoyuki KuwataEmail author
  • Liangcheng Wang
  • Ken Imai
  • Kenro Chikazawa
  • Isao Horiuchi
  • Kenjiro Takagi
  • Ryo Konno
Original Article—Obstetrics & Gynecology



The aim of the study was to investigate if ultrasound probes are reusable medical devices that risk becoming contaminated after a patient examination in Japan.


The level of bacterial contamination on transvaginal ultrasound (TVU) probes following current routine probe cleaning at a university hospital (site A) and a clinic (site B) in Japan was investigated.


A total of 98.1% of probes were found to be contaminated at site A (median CFU 40, IQR 10, 132.5) and 94.1% were found to be contaminated at site B (median CFU 50, IQR 20, 85). Of the contaminated probes, 52.9% at site A and 64.6% at site B harbored potentially pathogenic bacteria including methicillin-resistant Staphylococcus aureus (MRSA).


These findings suggest that there is a high rate of ultrasound probe residual bacterial contamination in Japan.


Cleaning Contamination Decontamination Pathogen Transvaginal ultrasound 



Nanosonics Ltd. (NSW, Australia) provided funding for the microbiological testing as a part of this study.

Compliance with ethical standards

Conflict of interest

All authors declare no conflicts of interest.

Ethical approval

This study was approved by our Institutional Review Board.

Informed consent

Informed consent was not needed because the samples in this study were taken after routine probe cleaning, not directly from each patient.


  1. 1.
    Leroy S. Infectious risk of endovaginal and transrectal ultrasonography: systematic review and meta-analysis. J Hosp Infect. 2013;83:99–106.CrossRefGoogle Scholar
  2. 2.
    Scott D, Fletcher E, Kane H, et al. Risk of infection following semi-invasive ultrasound procedures in Scotland, 2010 to 2016: a retrospective cohort study using linked national datasets. Ultrasound. 2018;26:168–77.CrossRefGoogle Scholar
  3. 3.
    Leroy S, M’Zali F, Kann M, et al. Impact of vaginal-rectal ultrasound examinations with covered and low-level disinfected transducers on infectious transmissions in France. Infect Control Hosp Epidemiol. 2014;35:1497–504.CrossRefGoogle Scholar
  4. 4.
    Medicines and Healthcare Products Regulatory Agency (UK). Medical device alert: reusable transoesophageal echocardiography, transvaginal and transrectal ultrasound probes (transducers) (MDA/2012/037). [updated 2012 June 28; cited 2019 January 8].
  5. 5.
    Abdelfattah R, Aljumaah S, Alqahtani A, et al. Outbreak of Burkholderia cepacia bacteraemia in a tertiary care centre due to contaminated ultrasound probe gel. J Hosp Infect. 2018;98:289–94.CrossRefGoogle Scholar
  6. 6.
    Shaban RZ, Maloney S, Gerrard J, et al. Outbreak of health care-associated Burkholderia cenocepacia bacteremia and infection attributed to contaminated sterile gel used for central line insertion under ultrasound guidance and other procedures. Am J Infect Control. 2017;45:954–8.CrossRefGoogle Scholar
  7. 7.
    Cheng A, Sheng WH, Huang YC, et al. Prolonged postprocedural outbreak of Mycobacterium massiliense infections associated with ultrasound transmission gel. Clin Microbiol Infect. 2016;22:382.e1–11.CrossRefGoogle Scholar
  8. 8.
    Nannini EC, Ponessa A, Muratori R, et al. Polyclonal outbreak of bacteremia caused by Burkholderia cepacia complex and the presumptive role of ultrasound gel. Braz J Infect Dis. 2015;19:543–5.CrossRefGoogle Scholar
  9. 9.
    Oleszkowicz SC, Chittick P, Russo V, et al. Infections associated with use of ultrasound transmission gel: proposed guidelines to minimize risk. Infect Control Hosp Epidemiol. 2012;33:1235–7.CrossRefGoogle Scholar
  10. 10.
    Olshtain-Pops K, Block C, Temper V, et al. An outbreak of Achromobacter xylosoxidans associated with ultrasound gel used during transrectal ultrasound guided prostate biopsy. J Urol. 2011;185:144–7.CrossRefGoogle Scholar
  11. 11.
    Organ M, Grantmyre J, Hutchinson J. Burkholderia cepacia infection of the prostate caused by inoculation of contaminated ultrasound gel during transrectal biopsy of the prostate. Can Urol Assoc J. 2010;4:E58–60.CrossRefGoogle Scholar
  12. 12.
    Jacobson M, Wray R, Kovach D, et al. Sustained endemicity of Burkholderia cepacia complex in a pediatric institution, associated with contaminated ultrasound gel. Infect Control Hosp Epidemiol. 2006;27:362–6.CrossRefGoogle Scholar
  13. 13.
    Hutchinson J, Runge W, Mulvey M, et al. Burkholderia cepacia infections associated with intrinsically contaminated ultrasound gel: the role of microbial degradation of parabens. Infect Control Hosp Epidemiol. 2004;25:291–6.CrossRefGoogle Scholar
  14. 14.
    Weist K, Wendt C, Petersen LR, et al. An outbreak of pyodermas among neonates caused by ultrasound gel contaminated with methicillin-susceptible Staphylococcus aureus. Infect Control Hosp Epidemiol. 2000;21:761–4.CrossRefGoogle Scholar
  15. 15.
    Keizur JJ, Lavin B, Leidich RB. Iatrogenic urinary tract infection with Pseudomonas cepacia after transrectal ultrasound guided needle biopsy of the prostate. J Urol. 1993;149(3):523–6.CrossRefGoogle Scholar
  16. 16.
    Ferhi K, Roupret M, Mozer P, et al. Hepatitis C transmission after prostate biopsy. Case Rep Urol. 2013;2013:797248.Google Scholar
  17. 17.
    Buescher DL, Mollers M, Falkenberg MK, et al. Disinfection of transvaginal ultrasound probes in a clinical setting: comparative performance of automated and manual reprocessing methods. Ultrasound Obstet Gynecol. 2016;47:646–51.CrossRefGoogle Scholar
  18. 18.
    Menon PK, Nagendra A. Comparison of rapid method of DNA extraction using microwave irradiation with conventional phenol chloroform technique for use in multiplex PCR for mec A and fem B genes to identify genotypes of MRSA from cultures. Med J Armed Forces India. 2001;57:194–6.CrossRefGoogle Scholar
  19. 19.
    Uematsu H, Yamashita K, Kunisawa S, et al. Estimating the disease burden of methicillin-resistant Staphylococcus aureus in Japan: retrospective database study of Japanese hospitals. PLoS One. 2017;12:e0179767.CrossRefGoogle Scholar
  20. 20.
    Mlaga KD, Dubourg G, Abat C, et al. Using MALDI-TOF MS typing method to decipher outbreak: the case of Staphylococcus saprophyticus causing urinary tract infections (UTIs) in Marseille, France. Eur J Clin Microbiol Infect Dis. 2017;36:2371–7.CrossRefGoogle Scholar
  21. 21.
    Deutch CE. Limited effectiveness of over-the-counter plant preparations used for the treatment of urinary tract infections as inhibitors of the urease activity from Staphylococcus saprophyticus. J Appl Microbiol. 2017;122:1380–8.CrossRefGoogle Scholar
  22. 22.
    Cui B, Smooker PM, Rouch DA, et al. Differences between two clinical Staphylococcus capitis subspecies as revealed by biofilm, antibiotic resistance, and pulsed-field gel electrophoresis profiling. J Clin Microbiol. 2013;51:9.CrossRefGoogle Scholar
  23. 23.
    Misawa Y, Yoshida A, Okugawa S, et al. First reported case of Staphylococcus condimenti infection associated with catheter-related bacteraemia. New Microbes New Infect. 2014;3:18–20.CrossRefGoogle Scholar
  24. 24.
    Jiang S, Zheng B, Ding W, et al. Whole-genome sequence of Staphylococcus hominis, an opportunistic pathogen. J Bacteriol. 2012;194:4761–2.CrossRefGoogle Scholar
  25. 25.
    Ivić I, Karanović J, Pavičić-Ivelja M. Sepsis with multiple abscesses caused by Staphylococcus warneri: a case report. Open medicine. 2013;8:45–7.Google Scholar
  26. 26.
    Otto M. Staphylococcus epidermidis—the ‘accidental’ pathogen. Nat Rev Microbiol. 2009;7:555–67.CrossRefGoogle Scholar
  27. 27.
    Czekaj T, Ciszewski M, Szewczyk EM. Staphylococcus haemolyticus—an emerging threat in the twilight of the antibiotics age. Microbiology. 2015;161:2061–8.CrossRefGoogle Scholar
  28. 28.
    Panagopoulos GN, Megaloikonomos PD, Liontos M, et al. Pseudomonas oryzihabitans infected total hip arthroplasty. J Bone Jt Infect. 2016;1:54–8.CrossRefGoogle Scholar
  29. 29.
    Guo F-P, Fan H-W, Liu Z-Y, et al. Brain abscess caused by Bacillus megaterium in an adult patient. Chin Med J. 2015;128:1552–4.CrossRefGoogle Scholar
  30. 30.
    Moissenet D, Becker K, Mérens A, et al. Persistent bloodstream infection with Kocuria rhizophila related to a damaged central catheter. J Clin Microbiol. 2012;50(4):1495–8.CrossRefGoogle Scholar
  31. 31.
    Blennow O, Westling K, Fröding I, et al. Pneumonia and bacteremia due to Kytococcus schroeteri. J Clin Microbiol. 2012;50:522–4.CrossRefGoogle Scholar
  32. 32.
    von Eiff C, Kuhn N, Herrmann M, Weber S, Peters G. Micrococcus luteus as a cause of recurrent bacteremia. Pediatr Infect Dis J. 1996;15:711–3.CrossRefGoogle Scholar
  33. 33.
    Bernard K. The genus Corynebacterium and other medically relevant coryneform-like bacteria. J Clin Microbiol. 2012;50:3152–8.CrossRefGoogle Scholar
  34. 34.
    Amis S, Ruddy M, Kibbler CC, et al. Assessment of condoms as probe covers for transvaginal sonography. J Clin Ultrasound. 2000;28:295–8.CrossRefGoogle Scholar
  35. 35.
    Milki AA, Fisch JD. Vaginal ultrasound probe cover leakage: implications for patient care. Fertil Steril. 1998;69:409–11.CrossRefGoogle Scholar
  36. 36.
    Kuwata T, Takahashi H, Matsubara S, et al. Incidence of human papillomavirus contamination of transvaginal probes in Japan and possible contamination prevention strategy. J Med Ultrason. 2016;43:505–8.CrossRefGoogle Scholar

Copyright information

© The Japan Society of Ultrasonics in Medicine 2019

Authors and Affiliations

  • Shiho Oide
    • 1
  • Tomoyuki Kuwata
    • 1
    Email author
  • Liangcheng Wang
    • 1
  • Ken Imai
    • 1
  • Kenro Chikazawa
    • 1
  • Isao Horiuchi
    • 1
  • Kenjiro Takagi
    • 1
  • Ryo Konno
    • 1
  1. 1.Department of Obstetrics and GynecologyJichi Medical University Saitama Medical CenterSaitamaJapan

Personalised recommendations