NOTE: Information and guidelines may change rapidly. Check in with listed references in ‘Learn More – Primary Sources’ to best keep up to date

SUMMARY:

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.

General Precautions

• “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

• Respiratory protection
  • Use respirators (e.g., N95) rather than surgical masks when exposed to aerosol-generating procedure (e.g., intubation) especially in ICU
• Eye protection
• Gloves
• Gowns (in case of shortage, prioritize for aerosol-generating procedures)
• AIUM states

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

KEY POINTS:

• Hand hygiene
  • 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)
  • Method
    • 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

Learn More – Primary Sources:

AIUM: Quick Guide on COVID-19 Protections —Patient and Ultrasound Provider Protection

WFUMB Position Statement: How to perform a safe ultrasound examination and clean equipment in the context of COVID-19

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