HLDs You Should Know About

HLDs You Should Know About

Healthcare workers whose job it is to reprocess soiled transesophageal echocardiogram (TEE) ultrasound probes are often having to handle and come into contact with high-level disinfectants (HLDs) in order to make these instruments safe for patients. These HLDs are a necessary part of the reprocessing procedure and cannot be avoided. According to the CDC, reprocessing semi-critical items (like TEE probes) with HLDs should be enough to prevent the transmission of infection as HLDs are designed for the, “complete elimination of all microorganisms… except for a small number of bacterial spores.”

Unfortunately, however, these HLDs are rather harsh and can pose a potential risk to those who are exposed to them day after day. Fortunately, by using systems that protect you from exposure via the use of vapor management filters, these HLDs pose little threat to healthcare workers. Let’s look at four HLDs commonly used to reprocess TEE ultrasound probes and find out what the risks are and how to mitigate them.


The CDC states that, “Glutaraldehyde is a saturated dialdehyde that has gained wide acceptance as a high-level disinfectant and chemical sterilant.” Glutaraldehyde is very widely used because of its combined ability to high-level disinfect while being gentle and preventing corrosion on most probes. Despite these positive characteristics, glutaraldehyde has some serious hazards associated with it.

Long-term exposure to glutaraldehyde fumes has been shown to lead to occupational asthma, eye irritation, and rhinitis. The best way to prevent exposure to the harmful vapors of glutaraldehyde is by using an automated TEE probe disinfector to shield users.

Orthophthalaldehyde (OPA)

OPA is a commonly used alternative to glutaraldehyde due to its wider pH operating range and decreased odor. According to the CDC, OPA, “is not known to irritate the eyes and nasal passages, does not require activation or exposure monitoring, and has a 12-minute high-level disinfection claim in the United States.” It can actually be more effective in some cases than glutaraldehyde. While there is the definite benefit of less irritating fume exposure when using OPA, it is not without its risks.

OPA can cause burns and contact dermatitis when exposed to skin and mucous membranes. OPA can be dangerous because, since it is difficult to smell, user may not be aware that they are being exposed to potentially harmful fumes. This makes proper filtration through a vapor management filter containing sufficient amounts of activated carbon vital for operator safety.

Peracetic Acid

Peracetic acid is a highly effective HLD with three clinical trials demonstrating that it had, “excellent microbial killing and no clinical failures leading to infections.” Furthermore, peracetic acid is leaves no residue and is sporicidal even at low temperatures. Since peracetic acid is so effective, it is becoming more widely used.

Along with this added efficiency, peracetic acid also boasts some increased risks. It is highly toxic, corrosive, and flammable. Peracetic acid may also cause extreme discomfort and irritation to the upper respiratory tract if fumes are inhaled.

Hydrogen Peroxide

Hydrogen peroxide has proven an effective HLD against various microorganisms and is stable when stored properly. However, if not stored under just the right conditions, hydrogen peroxide is flammable and potentially explosive. According to the CDC, “This product has not been used long enough to evaluate material compatibility to endoscopes and other semi-critical devices, and further assessment by instrument manufacturers is needed.”

Fumes from hydrogen peroxide can irritate the lungs and even cause fluid to build up in the lungs. Hydrogen peroxide can be corrosive to skin and mucous membranes. It can also cause eye irritation and rhinitis.

Staying Safe

With all these potential risks, how can you keep yourself safe from these potentially harmful substances and their irritating vapors?

One way to help mitigate some of the risk associated with HLDs is by wearing personal protective equipment (PPE). Refer to your facility's procedures on PPE for handling HLDs. While proper PPE is helpful, it is not sufficient to completely protect those handling HLDs from harmful vapors.

The most effective way of minimizing the risks associated with HLDs is by investing in an automated TEE probe reprocessor, like TEEClean or the TD 100. Both devices are fitted with advanced vapor management filtration systems that adsorb and neutralize vapors released during the high-level disinfection process. These vapor management filters are each impregnated with several pounds of activated carbon. All that activated carbon is necessary to provide the residence time necessary to capture and neutralize HLD fumes. This ensures that the air around these devices is safe for staff members to breathe, keeping them healthy and keeping your facility operating at its best.

Additionally, with our automated reprocessors, users can almost entirely avoid coming into contact with HLDs because HLDs come in foil-sealed, single-use bottles. Splashes and spills are trapped within the disinfectant reservoirs while fumes are captured. Using these systems greatly mitigates any risk associated with the continued use of HLDs, keeping staff members safe and able to focus on their passion: helping patients get and stay healthy.

About CS Medical

CS Medical LLC has pioneered the automated disinfection process for Transesophageal ultrasound probes with the development and release of the TD 100® Automated TEE Probe Disinfector. In 2005, the TD 100 was the first FDA cleared automated disinfection process with printed verification for Transesophageal ultrasound probes. During the disinfection process, the TEE probe receives high-level disinfection in (5) five minutes from TD-5® or TD-8® followed by (5) five complete rinse cycles before disinfection confirmation is acknowledged and a report is printed. The verification report indicates probe contact time with the high-level disinfectant as well as the average temperature of the single-use disinfectant during each cycle.

For more than 15 years and over 4 million high-level disinfections, the TD 100 Automated TEE Probe Disinfector has eliminated manual reprocessing of delicate and expensive TEE ultrasound probes while also providing a repeatable and FDA cleared disinfection process. The TEEClean® Automated TEE Probe Cleaner Disinfector will continue the TD 100's work by automating the required cleaning process for the TEE probe before high-level disinfection. TEEClean, with electronic record data logging, printed verification reporting, FDA cleared cleaning, and high-level disinfection will be the standard of care for TEE ultrasound probes.

CS Medical's TEE Complete Care® products provide quality device care and storage by minimizing healthcare operational costs, improving service readiness and increasing regulatory compliance.

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