In the Emergency Department (ED), speed isn’t optional — it’s essential. Clinicians are expected to move quickly, make rapid decisions, and manage high patient volumes, often with limited time and space. Point-of-care ultrasound has become a critical extension of that workflow, supporting everything from vascular access to trauma assessment.
But with that speed comes risk. Are we unintentionally overlooking infection risks in the reprocessing of ultrasound probes between patients? This isn’t about slowing the ED down. It’s about making sure that what feels efficient is also safe, defensible, and aligned with best practices.
Surface ultrasound probes are often perceived as “low risk.” They are used externally, frequently covered, and quickly wiped between patients. In a fast-paced ED environment, this approach can feel both practical and sufficient. However, the reality is more complex.
ED ultrasound use commonly involves:
- • Ultrasound-guided IV insertions
- • Abscess evaluation and drainage
- • Trauma assessments
- • Procedures involving blood and body fluids
According to the Spaulding Classification, devices that contact non-intact skin or mucous membranes are considered semi-critical and require high-level disinfection (HLD). It’s not just the probe type — it’s the intended clinical use that determines the level of disinfection required.
A surface probe used on intact skin for an exam may be appropriate for low-level disinfection (LLD). But that same probe—used minutes later for a difficult IV insertion or on compromised skin—may require a completely different level of reprocessing.
HLD should be considered in the ED and in all situations: if the probe contacts non-intact skin, if there is visible blood or body fluid contamination, if the probe is used for procedural guidance, and if there is potential for cross-contamination between patients. Ultrasound use in the ED also carries additional risks, such as probe covers failing or micro-perforations, contamination that may not be visible to the naked eye, and inconsistent cleaning practices between patients. This creates a grey area where many ED workflows live — and where risk can quietly accumulate.
One of the most common concerns from ED teams when they see infection prevention as part of a new process is: “We don’t have time for that.” It’s a valid concern that must be considered when working with teams in the ED, but it cannot be a reason to skip important steps for patient safety. Between high patient turnover, limited space, competing priorities, and frequent interruptions, the ED team members will find it difficult to convince others that additional steps are crucial to any process. However, the critical point is we aren’t adding more “work,” rather, we are designing workflows that support doing the right work efficiently. Most commonly, the process design is what breaks down, not the intent to do the right thing.
Across facilities, one of the most consistent weak links in ultrasound probe reprocessing is manual cleaning. It relies on perfect, repeatable technique; it can be rushed or interrupted, there is limited visibility or verification, and there is significant variability from person to person. In the ED, these challenges are amplified by pace and pressure.
The assumption that HLD cannot fit into ED workflow is often based on older reprocessing models — ones that required separate rooms, lengthy manual steps, and complex transport processes. Luckily, workflow design has evolved. In fact, when reprocessing is brought closer to the point of care, staff take fewer steps, there are fewer handoffs, and the process becomes more consistent and easier to follow.
A common misconception is that implementing better reprocessing requires major renovation or additional space. In reality, many EDs already have the necessary footprint within existing exam rooms or adjacent areas.
In our previous IP Insights discussion on exam room layout and workflow design, we explored how adjustments in equipment placement, strategic use of underutilized space, and integration into existing room design can simplify the integration of automated equipment. The goal is not to add complexity — it’s to embed safety into the workflow you already have. You can access the full article here: Designing Exam Rooms with Infection Prevention in Mind - CS Medical.
In high-acuity environments like the ED, it’s easy for practices to drift toward what feels “good enough.” From an infection prevention and regulatory perspective, “good enough” is not okay. High-risk processes, such as ultrasound probe high-level disinfection, must be consistently performed, validated, and defensible. This means the levels of disinfection used on reusable medical devices must match the intended clinical use, the process must be standardized and repeatable, and there must be clear alignment between policy and practice.
To strengthen ultrasound reprocessing in the ED, leaders need to review their policies and procedures to ensure proper guidance on when HLD or ultrasound probes should be considered or required. Policies should clearly define when HLD is required for surface probes, how to incorporate this into the daily workflow, and an audit process to ensure compliance and safety.
The Emergency Department will always require speed. That’s not going to change — and it shouldn’t. But speed and safety are not opposing forces. With the right workflow design, a clear understanding of risk, and alignment with clinical use, it is possible to protect patients, support clinicians, and maintain efficiency simultaneously. The opportunity isn’t to slow down the ED — it’s to ensure that even at its fastest, it remains consistent and safe.
If you have an infection prevention question, please visit the IP Insights webpage to contact Jill Holdsworth, Medical Affairs Manager. Infection Prevention Insights - CS Medical
