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

Faculty:

Susan J. Gross, MD, FRCSC, FACOG, FACMG President and CEO, The ObG Project

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

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.

Read Disclaimer & Fine Print

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

Related ObG Topics:

Managing an Obstetric Office Practice During COVID-19

COVID-19 Guidance: Key Highlights for Healthcare Professionals

ACOG COVID-19 FAQs for Obstetrical Care