Case Study: Standardising Ultrasound Probe Decontamination Across Cardiff and Vale University Health Board

The partnership between Cardiff & Vale University Health Board, Canon Medical, and Nanosonics successfully standardised ultrasound probe decontamination across the region’s major hospitals. 

Background 

Cardiff and Vale University Health Board (CAV-UHB), one of the largest Health Boards in Wales, which includes University Hospital of Wales (UHW), University Hospital Llandough (UHL) and Cardiff Royal Infirmary (CRI), provides extensive specialist, tertiary, and emergency care, supporting high-volume imaging services across radiology, maternity, podiatry, A&E, and specialist outpatient services to a population of around 472,400 people living in Cardiff and the Vale of Glamorgan. 

Alongside the introduction of a new ultrasound probe and imaging fleet introduced by Canon Medical in 2023, the health board identified the importance of including automated high-level disinfection (HLD) with trophon devices within the tender specification for the imagery equipment, expanding on the number of existing trophon devices already installed in the Health Board. This was in recognition of the benefits of a standardised approach to HLD of ultrasound probes across the various sites. The timing of this project aligned with the newly published WHTM guidance, WHTM 01-06 Part F: Decontamination of Semi-Critical Ultrasound Probes; Semi-invasive and Non-invasive Ultrasound Probes1. This prompted the launch of a board-wide standardisation for the decontamination process of ultrasound probes. 

Challenges 

Cardiff and Vale University Health Board (CAV UHB) was already very familiar with trophon devices, having introduced the first generation of trophon EPR devices in 2014. However, the Health Board recognised there were still several departments using a manual process for HLD, including a manual 3-stage wipe process, as well as a variety of other applications for low-level disinfection. This fragmented landscape resulted in inconsistent workflows and variable compliance and SOPs, particularly in departments with no experience of automated HLD.  

Objectives 

CAV-UHB set out to create a more standardised approach to the disinfection process, addressing inconsistent practices with manual wiping through the widespread use of automated HLD. This approach also ensured compliance with both local and national guidelines, and introduced a consistent and OEM-aligned pre-cleaning process for use prior to HLD. The Health Board aimed to raise the standard of decontamination, whilst also improving workflow efficiency & traceability and maintaining probe integrity. It was critical to include training and support for staff responsible for decontamination so that every department could adopt and adhere to the new practices.  

Solution 

Collaboration between Canon Medical, Nanosonics, and CAV-UHB enabled the implementation of a coordinated rollout of automated HLD technology. A total of 47 trophon2 devices were procured as part of the Canon Managed Equipment Service (MES) and deployed across the health board, combining new installations with upgrades to existing trophon EPR devices. To support consistent decontamination, a pre-cleaning protocol using a compatible, OEM approved wipe (Incidin OxyWipe / OxyWipe NG) was introduced as part of the MES.  

The implementation programme included comprehensive on-site installation and validation, led by the Nanosonics field engineering team, as well as detailed tagging and logging of all probes across departments. Our dedicated Clinical Applications Specialists delivered training to over 140 staff at UHW, CRI, and UHL sites, accompanied by in-field support and validation during go-live.  

By December 2023, approximately 90% of ultrasound staff were engaged with the new trophon2 workflows. For many departments, this represented their first exposure to validated automation and HLD, significantly raising the standard of practice across the health board. 

Outcomes  

The programme led to a standardised disinfection protocol, and familiarised SOPs across all three hospital sites, replacing previously inconsistent and manual processes. Staff reported substantial improvements in workflow and ease of use, particularly in departments newly transitioned to automation. Variability across sites reduced markedly, supporting smoother patient throughput and more reliable infection prevention practices. Follow-up assessments conducted one year after installation showed that probe condition remained excellent, with no reports of damaged probes. This demonstrates the compatibility of both the pre clean step with Incidin OxyWipe /Oxywipe NG and HLD with trophon2 devices, ensuring long-term preservation of probes. 

In parallel, the training and support programme offered by Nanosonics supported the workforce with a consistent understanding of infection prevention principles, as well as offering more widespread education and understanding around the application for HLD.  This contributed to a noticeable cultural shift away from manual wiping towards confidence in validated automated HLD. 

Conclusion  

The partnership between Cardiff & Vale University Health Board, Canon Medical, and Nanosonics successfully standardised ultrasound probe decontamination across the region’s major hospitals. Two years after implementation, the new process remains the gold standard for decontamination at CAV-UHB. With 47 trophon units deployed, a unified pre-cleaning protocol using Incidin OxyWipe/OxyWipe NG, and a well-trained workforce, the health board achieved significant improvements in infection prevention, workflow efficiency, probe longevity, audit readiness, and established a consistent, sustainable approach to high-level disinfection 

Stakeholder Testimonial

“The partnership agreement outlined in this case study builds on a decade of progress in implementing such automated technologies across NHS Wales. The adoption of validated systems has been a central objective of the newly developed guidance, WHTM 01/06 Part F. Alongside this, the emphasis on consistent pre-cleaning practices and strengthened educational support ensures that the entire decontamination ‘life cycle’ is given equal priority. 

John Prendergast AE(D) 
Principal Decontamination Engineer, NHS Wales Shared Services Partnership/Specialist Estates Services 

References 

1. Welsh Health Technical Memorandum Decontamination of flexible endoscopes Part F: Decontamination of Semi-Critical Ultrasound Probes; Semi-invasive and Non-invasive Ultrasound Probes, published 2023