Ultrasound and COVID-19: AIUM and WFUMB Guidance on Transmission Precautions
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Discuss ways to prevent SARS-CoV-2 transmission in an ultrasound unit 2. Describe ultrasound cleaning transducer procedures during the COVID-19 pandemic
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from through , participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
NOTE: Information and guidelines may change rapidly. Check in with listed references in ‘Learn More – Primary Sources’ to best keep up to date
Various organizations have released documents to help ultrasound units navigate practical issues during the COVID-19 pandemic. The American Institute of Ultrasound in Medicine (AIUM) has released guidance, adapted from the World Federation for Ultrasound in Medicine and Biology (WFUMB). Due to the lack of data, the authors of these documents point out that statements should be considered ‘suggestions’ vs evidence-based guidance. In addition, they note that individual ultrasound practices should refer to their local governments and/or CDC.
“Implement both standard and transmission-based precautions, regardless of suspected or confirmed COVID-19”
Transmission-based precautions for ultrasound practitioners include
Surgical mask | Gloves | Gown | Eye protection
Consider every patient to be potentially SARS-CoV-2 infected
To limit risk of transmission
Lengthen appointment times
Minimize patients in waiting room and maintain ≥6 foot spacing
Give patients and caregivers masks on arrival
No visitors in the exam room
AIUM includes students and trainees among those who should not be in the exam room
Rooms should be cleaned and disinfected as if each person has COVID-19
If patient known or suspected COVID-19 positive
Use respirators (e.g., N95) rather than surgical masks when exposed to aerosol-generating procedure (e.g., intubation) especially in ICU
Gowns (in case of shortage, prioritize for aerosol-generating procedures)
As ultrasound practitioners are in close contact with patients, surgical facemasks are essential to offer protection
These must be put on before entry into the patient room or care area
When available, N95 respirators or respirators that offer a higher level of protection should be used instead of a facemask when performing or present for an aerosol-generating procedure, particularly for use in the intensive care unit
Perform hand hygiene before and after the following
All patient contact
Contact with potentially infectious material (e.g. linen from patient room)
Removing PPE (including gloves)
Alcohol-based hand rub (60-95% alcohol) or
Soap and water (≥20 seconds) | Use soap prior to alcohol-based hand rub if hands soiled
Use latex free disposable gloves during the exam | Change between each patient
One hand on transducer and other on keyboard
Hand on keyboard is considered ‘semiclean’ because there may potentially be virus caught in the crevices of the machine | Use this ‘semiclean’ hand to apply gel
Between cases: Clean bottle and wipe down touched surfaces with low-level disinfectant (LLD)
Additional precautions include
Ultrasound practitioners with underlying health problems (i.e., those disorders included in ‘at risk’ category): Limit exposure where possible
Ensure infection control training and fit testing for respirators (e.g. N95) if needed
Patients in isolation (confirmed or suspected COVID-19)
Use PPE prior to entering room
Respirator (e.g., N95) or facemask | goggle or face protective shield | Surgical gown | Gloves
Transducer Cleaning and Disinfection
Non-critical devices (low risk)
Transducers that come into contact with intact skin
Us a low or intermediate level disinfection, which will denature most bacteria, some fungi and some viruses, such as COVID-19, influenza A and human immunodeficiency virus (HIV)
Semi-critical devices (medium risk)
Transducers that come into contact with non-intact skin, blood, body fluids and mucous membranes (e.g., vaginal probes)
Use a high-level disinfection (HLD) method
Single-use transducer cover is mandatory
Critical devices (high risk)
Transducers used for invasive procedures (e.g. needle guidance during biopsies, aspirations, drainages) and possible risk of blood or body fluid exposure
Use sterilization (if compatible) or HLD
Sterile transducer covers are mandatory
The WFUMB states that the only change in the context of COVID-19 is that
…all external probes must undergo cleaning followed by low level disinfection to denature any presence of SARS-CoV-2 e.g. transducers used for transabdominal scanning, lung ultrasound or in the pediatric or emergency department setting
It is important to note that the low level disinfectant for COVID-19 is approved for use on ultrasound transducers and has proven viricidal efficacy
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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