In infection prevention, we often say: “You can’t disinfect what isn’t clean.” Yet in real-world practice, this fundamental principle is where breakdowns happen most often. As new technologies enter the market—UV disinfection systems, automated high-level disinfection (HLD) devices, and other rapid-cycle solutions—there is increasing focus on speed and efficiency. But from an infection prevention standpoint, speed should never overshadow process integrity. At the end of the day, no matter what system you use, the most critical & first step will always be the same: CLEANING.
Cleaning is the most important, and most vulnerable, step to successful HLD. Unfortunately, the focus has turned to speed with the HLD cycle only, without regard to the critical steps that have to be completed before you even get there. As the foundation of effective disinfection, cleaning of ultrasound probes is the step that needs incredible attention to detail with frequent checks to ensure compliance. Without effective cleaning, probes cannot be disinfected.
Guidelines from organizations like the Centers for Disease Control and Prevention and the Association for the Advancement of Medical Instrumentation consistently emphasize:
- Organic material (blood, gel, bioburden) must be removed prior to disinfection
- Residual soil can inactivate disinfectants or block their effectiveness
- Inadequate cleaning can lead to failed HLD—even if the device completes its cycle
From an IP perspective, this makes cleaning the most important and critical step in the entire process of high-level disinfecting an ultrasound probe. Manual cleaning creates many steps that introduce variability into the workflow and has the highest risk for human error.
If cleaning fails, everything that follows fails too. And when we evaluate new technologies through that lens, the difference between processes becomes clear—not by what they promise at the end, but by how they protect the patient from the very beginning.
In today’s environment, there is increasing emphasis on faster disinfection cycles. Shorter turnaround times are often presented as a key advantage when evaluating reprocessing systems. From an infection prevention perspective, however, this raises red flags and risk concerns. My IP brain raises an important question when evaluating new technology, quicker HLD cycles and turnaround times:
What value does speed provide if the probe was not adequately cleaned first?
High-level disinfection is only effective when it is performed on a properly cleaned surface. If organic material remains on the probe, disinfectants may not fully contact the surface, microorganisms can be shielded by residual soil and the disinfection process may be compromised—regardless of cycle time.
Guidance from the CDC and AAMI is clear: Adequate cleaning is required before any disinfection step to ensure effectiveness.
This means that a 90 second disinfection cycle on a poorly cleaned probe is not safe. This means that a “fast” automated HLD system does not reduce risk if manual cleaning variability remains. This means the overall safety of the entire process is determined before the device is even placed in a high-level disinfectant. From a workflow standpoint, prioritizing speed without addressing cleaning introduces a false sense of security. From a patient safety standpoint, it introduces risk and potential patient harm.
Thinking like an infection preventionist, everyone should be asking the same questions with the patient in mind. Instead of focusing on how fast the HLD cycle is, ask how well the probe is cleaned prior to HLD beginning. Instead of focusing on turnaround time, ask how consistent the manual cleaning of the probe is prior to HLD. Consider the variability that may exist between team members when performing manual cleaning prior to HLD and how standardized and consistent training is.
This leads us to the ultimate conclusion—HLD speed cannot and will not compensate for inadequate cleaning. In order to ensure patient safety, the cleaning process must be done in a consistent, standardized and repeatable manner each and every time. When selecting HLD equipment, cleaning should not be overlooked; prioritize automation that supports consistent and repeatable cleaning processes to promote patient safety and infection prevention in your facility.
