Knowledge Hub

High-Level Disinfection When and Why?

Knowing what disinfection to apply is based on the Spaulding Classification

Under the Spaulding classification the ultrasound probe is classified into non-critical probe, semi-critical probe and critical probe, determined by how the probe comes in contact with the patient’s procedure site and the level of cross-infection risk.1-6

Non-critical probe is low-level disinfected or intermediate level disinfection as the probe contacts intact skin or non-infected skin and the potential cross-infection risk is low.

Semi-critical probe is high-level disinfected as the probe may contact non-intact skin (wound or burn) or mucus membrane and the potential risk of cross-infection is considered medium to high.

Critical probe should be sterilised, if not possible can be high-level disinfected and placed inside a sterile cover to prevent the contamination of a sterile field. The potential risk of cross-infection is considered high.

Disinfection Levels

Sterilization: All viable microorganisms must be killed.

High-level disinfectants: All viable microorganisms must be killed,  except a small number of bacterial spores.

Intermediate-level disinfectants: kills vegetative bacteria, mycobacteria, most viruses and most fungi, but do not kill bacterial spores.

Low-level disinfectants: Kills vegetative bacteria, except mycobacteria, fungi, non-enveloped viruses and bacterial spores.

Global Guidelines

Semi-critical & critical ultrasound probes must receive as a minimum high-level disinfection (HLD)

USA : CDC 2008, AIUM 2003

Canada : College of Sonographers 2013

Australia : ASUM /ACIPC 2017

Germany : DEGUM 2018

England : BMUS 2017,

England: Hospital Infection Society 2018

France : Ministry of Health 2019

Belgium : Ministry of Health 2019

Israel : Ministry of Health 2017

Ireland : Ministry of Health 2017

Wales : Ministry of Health 2014

Scotland : Ministry of Health 2017

Saudi Arabia : Ministry of Health 2019

European Federation of Ultrasound (ESFUMB) 2017

World Federation of Ultrasound (WFUMB) 2017

European Society of Radiology (ESR) 2017

Local Guidelines Favor Automation

European Society of Radiology (ESR) states transducer covers are essential and high-level disinfection is mandatory for endocavity ultrasound and all interventions.1

HPS/HFS (Scotland) guidelines concluded that there is an ongoing risk to patient safety with regards to decontamination of semi-invasive ultrasound probes.2

HSE (Ireland) (HSE) guidelines favored the use of an automated  and the manual multi-wipe system is the least preferred option to reduction cross- infection risk.3

President of the French Society of Hospital Hygiene guidelines recommends disinfection for endocavity ultrasound probes.4

ECMUS, WFUMB recommend High-level disinfection as a minimum standard for the disinfection of endocavitary ultrasound probes.5-6


  1. .Nyhsen, C. M., et al. (2017). “Infection prevention and control in ultrasound – best practice recommendations from the European Society of Radiology Ultrasound Working Group.” Insights Imaging 8(6): 523-535.
  2. French Ministry of Health issues guidance requiring disinfection of endocavitary ultrasound probes
  3. Health Service Executive (HSE) Quality Improvement Division (2017). HSE Guidance for Decontamination of Semi-crical Ultrasound Probes; Semi-invasive and Non-invasive Ultrasound Probes. Document: QPSD-GL-028-1.
  4. Health Facilities Scotland, NHS National Services Scotland, Health Protection Scotland. Scotland, March 2016. NHS Scotland Guidance for Decontamination of Semi-Critical Ultrasound Probes; Semi-invasive and Non-invasive Ultrasound Probes. Document: HPS/HFS Version 1.0.
  5. Kollmann, C. and K. Salvesen (2017). “Best Practice recommendations for cleaning and disinfection of ultrasound transducers whilst maintaining transducer integrity.” European Committee for Medical Ultrasound Safety (ECMUS).