Abstract
BACKGROUND: Effective hygiene practices are crucial to mitigate infection risks in echocardiographic procedures. We conducted a nationwide survey to assess real-world disinfection standards in Italian echocardiography laboratories, measure adherence to core hygiene indicators, and identify structural determinants of compliance. METHODS: A 35-item questionnaire was distributed to 331 accredited centers. Compliance was defined as adherence to ≥5 of 7 core hygiene indicators. Multivariable logistic regression identified predictors of high compliance. RESULTS: Glove use (92.7%) and probe sheathing (34%-38%) were common, but high-level disinfection (HLD) remained underused (38.2% for surface probes and 64.7% for transesophageal echocardiography [TEE] probes). Only 48.3% of centers had traceability for TEE probe cleaning. Overall, 43.8% of centers achieved high compliance. Independent predictors included female gender (odds ratio [OR]: 2.37, 95% confidence interval [CI]: 1.49-3.75), hospital setting (OR: 2.50, 95% CI: 1.22-5.12), and high procedural volume (OR: 2.32, 95% CI: 1.45-3.71). Compliance varied by care setting, with outpatient clinics generally showing better adherence than emergency and intensive care units. CONCLUSIONS: Significant heterogeneity exists in disinfection practices across Italian echo laboratories, with persistent gaps in HLD, traceability, and environmental hygiene. Compliance was driven by operator characteristics and center-level factors rather than general institutional policies. These findings call for workflow-integrated protocols and targeted training to ensure standardized practice.