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Investigation of Current Infection-Control Practices for Ultrasound Coupling Gel: A Survey, Microbiological Analysis, and Examination of Practice Patterns
  1. David A. Provenzano, MD*,
  2. Michael A. Liebert, BA*,
  3. Barbara Steen, BSN, MPH,
  4. Debra Lovetro, MT-ASCP and
  5. David L. Somers, PhD, PT
  1. *Institute for Pain Diagnostics and Care, Ohio Valley General Hospital; †Ohio Valley General Hospital, McKees Rocks; and ‡Department of Physical Therapy, John G. Rangos Sr. School of Health Sciences, Duquesne University, Pittsburgh, PA.
  1. Address correspondence to: David A. Provenzano, MD, Institute for Pain Diagnostics and Care, Ohio Valley General Hospital, 500 Pine Hollow Rd, McKees Rocks, PA 15136 (e-mail: davidprovenzano{at}


Background and Objectives Ultrasound coupling gel may serve as a vector for the spread of bacteria and has been the causative agent for significant health care–associated infections. The purpose of this study was to document existing infection-control procedures and level of contamination present within nonsterile ultrasound gel from several clinical departments at a single institution. A second purpose was to examine the effectiveness of clinician education and manufacturer-based ultrasound additives on ultrasound gel contamination and in vitro bacterial proliferation, respectively.

Methods Compliance with Health Canada recommended infection-control policies were determined by survey. Contamination of in-use ultrasound gel bottles was determined by inspecting cultures after 72 hours of incubation. After infection-control education, a 28-day interval assessment was used to examine contamination rates in newly provided ultrasound gel. The ability of ultrasound gel containing parabens to prevent bacterial growth was examined in cultures grown with and without ultrasound gel.

Results Practitioners were not compliant with Health Canada recommendations, but the baseline ultrasound gel contamination rate within these departments was only 2.5%. Education in infection control did not improve the contamination rate over 28 days. Contamination was discovered in ultrasound gel supplied directly from the manufacturer. Ultrasound gel suppressed but did not prevent bacterial growth in a species- and time-specific manner.

Conclusions The source of contamination for in-use ultrasound gel may be of manufacturer or human origin. Because additives to the ultrasound gel are not bactericidal, sterile ultrasound gel should be used for invasive and high-risk cases, and improving infection-control policies is warranted.

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  • The authors declare no conflict of interest.

    This study was not supported by any grants or by any manufacturer or third-party research funding.

    This work was presented in part at the American Society of Regional Anesthesia and Pain Medicine Annual Pain Medicine Meeting, November 2011. All work for this project was completed at Ohio Valley General Hospital, McKees Rocks, PA.

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