Transvaginal US Probe Contamination by HPV in the ED
Transvaginal US Probe Contamination by HPV in the ED
Objective To determine if human papillomavirus (HPV) DNA can be detected on the transvaginal sonography (TVS) probe in the emergency department (ED) and whether the current barrier method plus disinfection can prevent HPV contamination of the TVS probe.
Methods This was a two-part cross-sectional study. In the first part, surveillance samples were taken from the TVS probe for HPV DNA detection daily for 2 months. In the second part, patients presenting with early pregnancy complications were identified in the ED and high vaginal swabs were taken for HPV DNA testing. Several probe swabs were taken to identify if contamination was possible in cases where the procedure was done on an HPV carrier.
Results A total of 120 surveillance samples were obtained, nine of which (7.5%) tested positive for HPV DNA. In the second part, 76 women were recruited, of whom 14 (18.4%) were HPV carriers. After the procedure and disinfection of the probe, three out of the 14 probe samples (21%) were HPV DNA positive.
Conclusions HPV is commonly encountered in the ED and contamination of the TVS probe with HPV is possible. Although it is difficult to prove the viability and infectivity of the virus, vigilant infection control measures should be maintained.
Human papillomavirus (HPV) is the most common sexually transmitted disease worldwide with 10%–20% of both men and women having molecular evidence of HPV infection. The cumulative risk of acquiring HPV infection is reported to be 45% at 3 years after the first sexual relationship, and the overall prevalence is 25% in sexually active young women. Most infections are subclinical and transient. Risk factors for infection include earlier age of coitarche, more sexual partners, smoking and reduced immunity. Nevertheless, infection is common even in those without identifiable risk factors.
HPV is a circular double-stranded DNA virus consisting of more than 150 genotypes. There is a well-established relationship between cervical neoplasia and certain HPV subtypes, namely types 16, 18, 31, 33 and 45. Persistent infection with these high-risk HPVs may lead to abnormal cervical cell changes, increasing the risk of cervical cancer. Among those high-risk HPV types, types 16 and 18 together cause about 70% of all cases of cervical cancer. Other types of sexually transmitted HPV (type 6 and 11) are responsible for genital condylomata.
Bedside ultrasound examination is gaining importance in the everyday practice of the emergency department (ED). The use of ultrasonography is mainly focused on biliary disease, intrauterine pregnancy and abdominal aortic aneurysms, as well as looking for peritoneal fluid and pericardial temponade in trauma patients. Many studies have demonstrated that emergency physician performed ultrasonography can be very useful in the management of early pregnancy bleeding, with potential reductions in the length of inpatient stay under the care of the gynaecology team. Patients identified as having an intrauterine pregnancy can be safely discharged from ED with proper advice and an early follow-up appointment at an early pregnancy assessment clinic. This decreases treatment time in the ED by 55%, and saves total costs of 63% per patient without major adverse outcomes. In our department, there was a dramatic reduction in the number of gynaecological admissions from 75% to 26% when we introduced this in 2009.
The use of transvaginal sonography (TVS) has consequently become more popular in EDs in recent years. The TVS probe is routinely protected by a condom, acting as a physical barrier to contamination. Studies have shown that the perforation rate of these condoms ranged from 0.9% to 5%. One large scale study showed that the condom perforation rate was 2%, with 65% of the leakage points being <10 cm from the tip. With these expected perforation rates, staff are advised to follow the proper steps for disinfection of the TVS probe after each scan to prevent cross-infection.
There are few studies on this issue of TVS probe contamination with HPV in the ED. It is unclear whether the current disinfection method is sufficient to clear up the virus in cases of contamination.
The aims of the study were (1) to determine if any HPV DNA could be detected on the TVS probe and its contamination rate and (2) to evaluate if HPV DNA was detectable on a TVS probe which was used on patients with confirmed vaginal or cervical HPV infection despite following the recommended barrier method and disinfection procedure.
Abstract and Introduction
Abstract
Objective To determine if human papillomavirus (HPV) DNA can be detected on the transvaginal sonography (TVS) probe in the emergency department (ED) and whether the current barrier method plus disinfection can prevent HPV contamination of the TVS probe.
Methods This was a two-part cross-sectional study. In the first part, surveillance samples were taken from the TVS probe for HPV DNA detection daily for 2 months. In the second part, patients presenting with early pregnancy complications were identified in the ED and high vaginal swabs were taken for HPV DNA testing. Several probe swabs were taken to identify if contamination was possible in cases where the procedure was done on an HPV carrier.
Results A total of 120 surveillance samples were obtained, nine of which (7.5%) tested positive for HPV DNA. In the second part, 76 women were recruited, of whom 14 (18.4%) were HPV carriers. After the procedure and disinfection of the probe, three out of the 14 probe samples (21%) were HPV DNA positive.
Conclusions HPV is commonly encountered in the ED and contamination of the TVS probe with HPV is possible. Although it is difficult to prove the viability and infectivity of the virus, vigilant infection control measures should be maintained.
Introduction
Human papillomavirus (HPV) is the most common sexually transmitted disease worldwide with 10%–20% of both men and women having molecular evidence of HPV infection. The cumulative risk of acquiring HPV infection is reported to be 45% at 3 years after the first sexual relationship, and the overall prevalence is 25% in sexually active young women. Most infections are subclinical and transient. Risk factors for infection include earlier age of coitarche, more sexual partners, smoking and reduced immunity. Nevertheless, infection is common even in those without identifiable risk factors.
HPV is a circular double-stranded DNA virus consisting of more than 150 genotypes. There is a well-established relationship between cervical neoplasia and certain HPV subtypes, namely types 16, 18, 31, 33 and 45. Persistent infection with these high-risk HPVs may lead to abnormal cervical cell changes, increasing the risk of cervical cancer. Among those high-risk HPV types, types 16 and 18 together cause about 70% of all cases of cervical cancer. Other types of sexually transmitted HPV (type 6 and 11) are responsible for genital condylomata.
Bedside ultrasound examination is gaining importance in the everyday practice of the emergency department (ED). The use of ultrasonography is mainly focused on biliary disease, intrauterine pregnancy and abdominal aortic aneurysms, as well as looking for peritoneal fluid and pericardial temponade in trauma patients. Many studies have demonstrated that emergency physician performed ultrasonography can be very useful in the management of early pregnancy bleeding, with potential reductions in the length of inpatient stay under the care of the gynaecology team. Patients identified as having an intrauterine pregnancy can be safely discharged from ED with proper advice and an early follow-up appointment at an early pregnancy assessment clinic. This decreases treatment time in the ED by 55%, and saves total costs of 63% per patient without major adverse outcomes. In our department, there was a dramatic reduction in the number of gynaecological admissions from 75% to 26% when we introduced this in 2009.
The use of transvaginal sonography (TVS) has consequently become more popular in EDs in recent years. The TVS probe is routinely protected by a condom, acting as a physical barrier to contamination. Studies have shown that the perforation rate of these condoms ranged from 0.9% to 5%. One large scale study showed that the condom perforation rate was 2%, with 65% of the leakage points being <10 cm from the tip. With these expected perforation rates, staff are advised to follow the proper steps for disinfection of the TVS probe after each scan to prevent cross-infection.
There are few studies on this issue of TVS probe contamination with HPV in the ED. It is unclear whether the current disinfection method is sufficient to clear up the virus in cases of contamination.
The aims of the study were (1) to determine if any HPV DNA could be detected on the TVS probe and its contamination rate and (2) to evaluate if HPV DNA was detectable on a TVS probe which was used on patients with confirmed vaginal or cervical HPV infection despite following the recommended barrier method and disinfection procedure.
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