What Are the Hidden Costs of Manual Ultrasound Probe Reprocessing?
Key Takeaways:
Manual ultrasound probe reprocessing may appear less expensive upfront, but it can also introduce challenges that may outweigh those initial savings, including process variability/compliance issues, staff exposure to high-level disinfectants, and patient safety risks. Various medical researchers and organizations - including AAMI, SDMS, and ECRI – all point to specific advantages of automated high-level disinfection (HLD) systems.
What Is the Cost of Processing Variability and Failing to Maintain Compliance?
Process variability is a frequently discussed challenges relating to manual probe reprocessing. Because manual HLD depends on individual technique, achieving consistent results across different staff members and departments can sometimes be difficult.
As stated in AAMI TIR99, although manual high-level disinfection is still commonly utilized in healthcare settings, it "is not the preferred method due to safety and hazard concerns to the users and inconsistencies in the process from person to person." 1
Even after training, process variability can occur because of:
- Heavy workloads/conflicting priorities 2
- Inconsistent training 2
- Human error 3
How well employees are ultimately able to perform reprocessing is directly contingent on the inconsistencies in their processes.
What Is the Cost to Staff Safety?
The risks associated with manual probe reprocessing go beyond compliance and workflow considerations. 4
In recent years, there has been increased concern around sonographer exposure to disinfectants, with AAMI ST91:2021 in particular explicitly cautioning against manual high-level disinfection of endoscopes. According to Mary Ann Drosnock, director of Clinical Affairs at Healthmark Industries and a member of AAMI’s Endoscope Reprocessing Working Group, “We do not recommend that [sonographers] disinfect scopes manually at all.”
Drosnock explained that traditional soaking methods often expose staff to chemical fumes, noting that "people thought 'longer is better,' but this creates fumes that are harmful to staff." 4
Exposure to disinfectants can produce serious adverse health effects for individuals exposed to them. As a result, industry professionals – like Mary Ann Drosnock - and organizations have begun to advocate for employing automated disinfection techniques whenever feasible.
One such organization, ECRI, lists staff safety as a primary advantage of automated systems, citing that automated HLD:
•is easier to use
•reduces the risk of spilling HLD solution
•eliminates fumes hazardous to employees and the environment
•improves disinfection effectiveness 5
These advantages represent more than just operational convenience; they may directly affect the daily health/safety of employees who perform device reprocessing each day.
What is the Cost to Patient Safety?
But deficient probe reprocessing can also impact patient safety, as well.
A systematic review evaluated seven documented infection outbreaks associated with ultrasound procedures.
Key finding from the review included:
- Every outbreak involved failures in probe decontamination
- Every outbreak was considered preventable 6
The authors’ conclusions substantiate mounting evidence indicating an association between poor-quality probe cleaning/disinfection and increased infection risk among patients undergoing diagnostic ultrasound examinations.
In her study, "Evaluation of an Automated High-Level Disinfection Technology for Ultrasound Transducers," Karen Vickery concluded that automated reprocessors "reduce the risks of operator error and can improve patient and operator safety by preventing exposure to toxic chemicals." She further noted that adoption of next-generation disinfection technologies "may help to decrease infection risk and improve patient safety." 7
Looking Beyond the Price Tag: What Costs Should Healthcare Facilities Consider?
At first glance, manual probe reprocessing may appear to be cheaper than using an automated system; however, the actual cost of manual systems extends far beyond the price of disinfectants and labor, with some aspects opening healthcare facilities to potential other risks.
Common limitations of manual systems can include:
- Variability in processes across procedures 3
- Greater compliance challenges 8
- Documentation inconsistencies
As a result, multiple organizations and experts—including the Centers for Disease Control and Prevention (CDC) 9, the Society of Diagnostic and Medical Sonography (SDMS) 10, and the Association for the Advancement of Medical Instrumentation (AAMI) 1—have identified automated high-level disinfection systems as the preferred approach for achieving safer, more consistent, and more effective probe reprocessing.
When evaluating reprocessing strategies, healthcare organizations should consider not only the direct costs of disinfection, but also the hidden operational, compliance, safety, and patient-care costs that may accompany manual workflows.
Manual vs. Automated Probe Reprocessing
Manual HLD | Automated HLD |
Greater process variability | Standardized workflow |
Higher dependence on operator technique | Reduced operator variability |
Manual documentation | Automated documentation (when available) |
Increased chemical exposure | Reduced chemical exposure |
Greater training variability | Standardized process |
References:
#1: AAMI TIR99:2024; Processing of dilators, transesophageal and ultrasound probes in health care facilities
#2: Fatima I, Alfa M, Olson N, DeGagne P. EVOTECH ® endoscope cleaner and reprocessor (ECR) simulated-use and clinical-use evaluation of cleaning efficacy. BMC Infectious Diseases. 2010;10(1):1-14. doi:10.1186/1471-2334-10-200
#3: Siwe H, Van Landegem M, De Vriese S, et al. A non-inferiority trial comparing manual and automated high-level disinfection for reprocessing of transabdominal and transvaginal ultrasound probes. Antimicrobial resistance and infection control. Published online 2026. doi:10.1186/s13756-026-01777-
#4: ST91: Extensive Updates for Endoscope Cleaning, Patient Safety. Journal of Clinical Engineering. 2022;47(2):69-71. doi:10.1097/JCE.0000000000000517
#5: ECRI. Cleaning and Disinfecting Diagnostic Ultrasound Transducers: Our Recommendations
#6: de Souza Hajar K, Quartim de Moraes Bruna C, Uchikawa Graziano K. Infection Transmission Associated With Contaminated Ultrasound Probes: A Systematic Review. AORN journal. 2022;115(1):42-51. doi:10.1002/aorn.13572
#7: Vickery K, Gorgis VZ, Burdach J, Patel D. Evaluation of an automated high-level disinfection technology for ultrasound transducers. Journal of infection and public health. 2014;7(2):153-160. doi:10.1016/j.jiph.2013.09.008
#8: Ofstead CL, Wetzler HP, Snyder AK, Horton RA. Endoscope reprocessing methods: a prospective study on the impact of human factors and automation. Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates. 2010;33(4):304-311. doi:10.1097/SGA.0b013e3181e9431a
#9: CDC. Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008
#10: SDMS. SONOGRAPHER BEST PRACTICES FOR INFECTION PREVENTION AND CONTROL: Reprocessing the Ultrasound Transducer
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