Feasibility of extracts of common Philippine succulents as ultrasound acoustic gel alternatives

@#<p style="text-align: justify;"><strong>Background.</strong> Ultrasound remains to be an ideal imaging tool for the diagnosis of various conditions in the body. However, the cost and unavailability of the commercial acoustic gel continue to hamper the tool's diagnostic value in low-resource communities.</p><p style="text-align: justify;"><strong>Objectives.</strong> The study aims to investigate the feasibility of extracts of common Philippine succulents as ultrasound acoustic gel, based on image quality parameters, organoleptic characteristics, spreadability, pH, and viscosity.</p><p style="text-align: justify;"><strong>Methods.</strong> Aloe Vera, common houseleek, burro's tail, snake plant, echeveria, crown of thorns, panda plant, and jade plant were extracted and filtered before subjecting them for a physical evaluation. The evaluation analyzed the organoleptic characteristics, spreadability, pH, and viscosity of the formulated gels. The commercial acoustic gel was used as the reference gel. Three experienced ultrasonographers blindly evaluated a total of 243 images obtained using the formulated gels based on four image quality parameters.</p><p style="text-align: justify;"><strong>Results.</strong> The formulated gels had optimal appearance, texture, homogeneity, and pH value. However, all of the extracts had a lower viscosity than the commercial reference gel. The extract obtained from the burro's tail exhibited the highest viscosity among the tested extracts. There was no significant difference in the image quality parameters among the commercial and formulated gels.</p><p style="text-align: justify;"><strong>Conclusion.</strong> The extracts obtained from the succulents are feasible as an acoustic gel for ultrasound imaging based on the physical and image quality analyses. The tested plants are readily available and easy to produce compared to commercial acoustic gel.</p>

Ultrasound gel as a source of hospital outbreaks: Indian experience and literature review

Purpose: Hospital outbreaks are observed increasingly worldwide with various organisms from different sources such as contaminated ultrasound gel, intravenous (IV) fluids and IV medications. Among these, ultrasound gel is one of the most commonly reported sources for Burkholderia cepacia complex (Bcc) outbreaks. In this study, we describe our experience on investigation and the management of Bcc bacteraemia outbreak due to contaminated ultrasound gel from a tertiary care centre, South India. Materials and Methods: Over a 10-day period in October 2016, seven children in our Paediatric intensive care unit (ICU) were found to have bacteraemia with Bcc isolated from their blood culture. Repeated isolation of the same organism with similar antimicrobial susceptibility pattern over a short incubation period from the same location, confirmed the outbreak. An active outbreak investigation, including environmental surveillance, was carried out to find the source and control the outbreak. Isolates were subjected to multi-locus sequence typing (MLST) and global eBURST (goeBURST) analysis. Results: Environmental surveillance revealed contaminated ultrasound gel as the source of infection. MLST and goeBURST analysis confirmed that the outbreak was caused by a novel sequence type 1362 with the same clonal complex CC517. The outbreak was controlled by stringent infection control measures, withdrawal of contaminated ultrasound gel from regular usage and implementing the practice of using ultrasonogram (USG) probe cover for USG screening and guided procedures. Conclusion: This report highlights the importance of early identification of an outbreak, prompt response of the ICU and infection control teams, sound environmental and epidemiological surveillance methods to identify the source and stringent infection control measures to control the outbreak. Contaminated ultrasound gel can be a potential source for healthcare-associated infection, which cannot be overlooked.