After patients fell ill with contaminated ultrasound gel, hospital bosses warned staff.
A new Patient Safety Alert has been sent to NHS hospitals by the UK Health Security Agency (UKHSA) stating a firm link has been identified between outbreaks of a bug and the use of non-sterile ultrasound gel.
Burkholderia cepacia or B. cepacia refers to a bug that is found in soil, water and other bacteria.
Patients who are at high risk of developing serious infections can be affected by it. Symptoms include a fever, wheezing, shortness or breath, and congestion.
UKHSA reported 144 cases since 2010, all of which were linked to the use of ultrasound gel.
Hospitals were informed by the body that cases had’spread across a broad age range’ so far and were “predominantly hospitalized patients in England”.

This stock photo shows a doctor performing an ultrasound on a pregnant patient. The UK Health Security Agency sent a new Patient Safety Alert to NHS Hospitals today
Patients ‘cared in critical care settings’ are also covered.
Warning: The nature and availability of information suggested that there could be a variety of clinical presentation, some with severe illness.
“While we don’t know of any deaths due to B. cepacia infections in this outbreak it’s possible it could have contributed to some patient’s suffering.”
Multiple samples from a single brand ultrasound gel were used to recover the bug.
Now it has been removed from the central NHS stock.
UKHSA stated in the alert that only single-use sterilized ultrasound gel should be used by hospitals for multiple procedures.
They include any invasive procedures or ultrasound performed within the first 24 hours after an invasive procedure.
Sterile gel must also be used for severely immunocompromised patients and all procedures in high-dependency or intensive care settings, including neonatal intensive care units.
If a nonsterile gel will be used, the container must have a single-use pouch or a disposable plastic bottle.
Also, hospitals were told not to use large containers of ultrasound gel for decanting.
UKHSA consultant for public health, Dr James Elston said that a UKHSA investigation had previously found contaminated ultrasound gel in cases of Burkholderia Cepacia among hospital patients.
“To prevent future cases of the infection we remind healthcare professionals to adhere to guidelines regarding safe use and disposal of ultrasound gel.”