000			05003nam a22006497a 4500
008			140323s20152015 xxu||||| |||| 00| 0 eng d
022			_a0009-921X
040			_aOvid MEDLINE(R)
099			_a25163689
245			_aDoes the use of ultrasound affect contamination of musculoskeletal injections sites?.
251			_aClinical Orthopaedics & Related Research. 473(1):351-7, 2015 Jan.
252			_aClin Orthop. 473(1):351-7, 2015 Jan.
253			_aClinical orthopaedics and related research
260			_c2015
260			_fFY2015
266			_d2015-03-23
501			_aAvailable online through MWHC library: 2008 - present, Available in print through MWHC library: 1999 - 2003
520			_aBACKGROUND: Therapeutic musculoskeletal injections require a clean or sterile skin preparation to minimize the risk of infections. Ultrasound guidance for this procedure requires the use of transmission gel in proximity to the injection site, and its effect on maintaining sterility is unknown.
520			_aCONCLUSIONS: Use of ultrasound probes and transmission gel results in greater contamination in simulated intraarticular injections of the shoulder. As such, sterile preparation of the entire injection field, including the adjacent skin where the gel and probe are applied, may be prudent. Future studies are needed to determine if such a preparation decreases contamination and thereby infection rates related to musculoskeletal injections.
520			_aLEVEL OF EVIDENCE: Level II, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
520			_aMETHODS: Twenty-six healthy volunteers in an outpatient orthopaedic clinical setting were recruited. The subjects' skin was prepared to simulate a therapeutic intraarticular shoulder injection under ultrasound guidance. Four skin swabs for culture from each subject were taken: one sample before preparation with isopropyl alcohol, one sample after skin preparation, one after simulated injection procedure with sterile ultrasound transmission gel using the transducer, and one after mock procedure with nonsterile ultrasound transmission gel. In addition, samples were taken from the nonsterile ultrasound transmission gel and the transducer for culture analysis. Aerobic and anaerobic cultures were incubated during a 5-day period for bacterial species identification.
520			_aQUESTIONS/PURPOSES: We asked: (1) Does sterile ultrasound transmission gel increase skin contamination during therapeutic orthopaedic injections? (2) Does nonsterile gel application result in increased contamination? (3) Does a manufacturer-approved ultrasound probe disinfecting agent in the form of 17.2% isopropanol and 0.28% diisobutylphenoxyethoxyethyl dimethyl benzyl ammonium chloride wipes adequately decontaminate the ultrasound transducer? (4) Does 70% isopropyl alcohol effectively decontaminate skin for administration of musculoskeletal injections?
520			_aRESULTS: Sterile ultrasound gel use results in an increase in skin contamination (odds ratio [OR], 9; 95% CI, 1.4-57.1; p=0.005). Compared with sterile gel use, application of nonsterile gel did not increase contamination proportion (OR, 1.1; 95% CI, 0.8-1.7; p=0.56). All cultures from nonsterile gel were negative. None of the samples cultured directly from the ultrasound probe were positive for bacteria (0%). Skin preparation with 70% alcohol decreased the proportion of contamination when compared with unprepared skin (OR, 21.0; 95% CI, 3.1-142.2; p=0.001).
546			_aEnglish
650			_a*Bacteria/de [Drug Effects]
650			_a*Cross Infection/pc [Prevention & Control]
650			_a*Disinfectants/tu [Therapeutic Use]
650			_a*Disinfection/mt [Methods]
650			_a*Equipment Contamination/pc [Prevention & Control]
650			_a*Injections, Intra-Articular/ae [Adverse Effects]
650			_a*Skin/de [Drug Effects]
650			_a*Ultrasonography, Interventional/ae [Adverse Effects]
650			_a2-Propanol/tu [Therapeutic Use]
650			_aAdult
650			_aAged
650			_aBacteria/ip [Isolation & Purification]
650			_aBenzalkonium Compounds/tu [Therapeutic Use]
650			_aCross Infection/di [Diagnosis]
650			_aCross Infection/mi [Microbiology]
650			_aGels/ae [Adverse Effects]
650			_aHumans
650			_aMiddle Aged
650			_aOdds Ratio
650			_aRisk Assessment
650			_aRisk Factors
650			_aShoulder
650			_aSkin/mi [Microbiology]
650			_aTime Factors
650			_aTreatment Outcome
650			_aUltrasonography, Interventional/is [Instrumentation]
651			_aMedStar Washington Hospital Center
657			_aJournal Article
700			_aArgintar, Evan
790			_aArgintar E, Davis W, Ferguson J, Russo M, Sherman T
856			_uhttp://dx.doi.org/10.1007/s11999-014-3903-4 _zhttp://dx.doi.org/10.1007/s11999-014-3903-4
942			_cART _dArticle
999			_c1015 _d1015