Ultrasound room infection control and disinfection

We can use educational materials to educated our sonographers and point out what other clinics are doing to test and clean the ultrasound rooms, to see if there are any infected Areas that the sonographers missed to clean ,before and after each patient ,and this include the ultrasound bed, ultrasound machine, the transducers, transducer cables, the gel bottle, the gel bottle holder, the ultrasound desk including the computer and attachments, door knobs and light switches .

This short course that I don’t on line is dealing with Health care-acquired infection (HAI). This is the infection that acquired by patient from day one to day 3 after don’t the diagnostic imaging or treatment in any hospital or clinic. It cost lives, money and losing of jobs to so many as per the centre of disease control.

It was proven that pathogens are present on patient skin and on the transducers and it can be transmitted to other patient and to the technologist.

They recommend that technologist must clean hand before and after each patient with proper hygiene. Always were gloves in both hands, and nowadays always wear mask. Wipe off the conductive gel from the transducers and clean them before and after each patient.

Transducer cable must be clean after you done the exam. The gel bottle nose must be wiped off with antiseptic agent. Some of those bacterial agents that was found on the transducer surface, cables, gel bottle and gel holder, ultrasound bed close to feet or head areas, the ultrasound key board especially the track ball, the computer mouse and desk , some of these bacterial agents are ;

Methicillin- resistant, Staphylococcus aureus, Pseudomonas, Acinetobacter species, Candida albicans, E coli ,human papiloma virus ( HPV), fungus infections, lice, blood, and HEPATITIS B and C. have been detected on the ultrasound machines, cables, transducers gel bottles, gel holder, were detected by culture of these areas as per CDC and AIUM in the US.

Many sonographers are unaware of this risk some blame the limited time between patients or patients who arrive late and taken time from the next case and that will lead to time restrain on cleaning many areas that need to be cleaned.

Sonographers and diagnostic technologist must start the learning at school and learn how and where to do so before they move to the job market and when they do get a job, part of their protocol must be the infection control of the area he/ she will be working in and the general protocol of the infection area at the place.

Larger clinic and medical centre should hire an infection control nurse to deal with all the educational issues or at least hire them as casual to teach your staff once every 4 months with full day workshop and one to one teaching , then taken sample and check them in a lab to find out where is the infected areas that need more attention. The infection control person must have an ultraviolet light detector to check for infected areas.

There is glow powder agent that we can buy and use for the detection of infection agents on the ultrasound machines, transducers, ECG, pillows, cables and work stations. This powder will show you the infected areas when you turn off the light, you will see the glow powder under ultraviolet light. You can use this method anywhere at your house, clinics, factories and any place that you want to check the level of infection.

Ultraviolet light robot , that can be rented to disinfect the room.

For covid-19 case in your room or suspected covid-19

 You must have all your protected gears. Ensure that all unnecessary materials are removed from the machine and the basket.

For Patients on DROPLET precautions, once the ultrasound is completed, remain inside the room with PPE on.

Sanitize gloves and then: Visually inspect the machine for any gel, bodily fluid or debris

Clean with low level disinfectant spray, soap + water, or approved wipe for a list of approved wipes check EPA site Using approved wipe, disinfect all machine surfaces including:

Surfaces that either come into contact with the patient surfaces that are frequently touched by the technologist or close to it, such as transducer cord and the gel bottle.

 Please remember that there is a “wet time” associated with all wipes, check the manufactures recommendation for patients on AIRBORNE precautions, once the ultrasound is completed, remain inside the room with PPE on.

 Clean with low level disinfectant spray, soap and water, or approved wipe while still in PPE, move the machine as far from the patient as possible. Using approved wipes, disinfect all machine surfaces including:

  Probes and cords,  The keyboard,  The screen,  The power cord ,The lid , The wheels ,Wells or buckets built into the machine gel bottles and wipes containers. most sonographers have no time to do all of this because the managers and clinic directors give them very short time to do each exam and this have to be worked out with the managers to find cleaning time to protect everyone .

please remember that there is a “wet time” associated with all wipes, check the manufacturers recommendation .Consider cleaning again immediately after leaving the room Maintain wet for required amount of time before considering the device decontaminated * In addition to the above, follow the policies of institutional infection control

Preventing transmission of infection requires all healthcare practitioners to implement both standard and transmission-based precautions, regardless of suspected or confirmed COVID-19. Standard precautions for COVID-19 as outlined by the Centers for Disease Control and Prevention in 2020 include:

Ultrasound practitioners with specific health problems that place them at greater risk (as detailed by local occupational health guidelines) are to be excluded from performing ultrasound Ensure the ultrasound practitioners has undergone infection control training and fit testing for respirators, if required (for example N95 and FFP3)

EV transducer disinfection station

In order to reduce the risk of transmission, it is important to (i) respect the time of scheduled visits, (ii) widen the appointment intervals in order to prevent crowding in the waiting room and (iii) space the seats to at least 6 feet (2 meters) apart.

Limit the number of visitors in the examination room to a maximum of 1, preferably with no children. During the pandemic, it is reasonable not to allow trainees or students to participate. Encourage use of alternative mechanisms for patient and visitor interactions such as video-call applications on cell phones or tablets.

If the status of a patient is confirmed as COVID-19 infected, it would be preferable to scan at the end of the clinic list so that the equipment and room will undergo vigorous cleaning and disinfection (see below).

Hand hygiene: All ultrasound practitioners should perform hand hygiene before and after all patient contact, contact with potentially infectious material (e.g. linen from patient room), and before and after removing personal protective equipment (PPE) including gloves.

The slide on the left it show the powder glow under UV light indicates bacteria on the transducer , compared to the slide on the right side the clean transducer.

 Hand hygiene should be performed using an alcohol-based hand rub (60-95% alcohol) or washing hands with soap and water for at least 20 seconds. If hands are visibly soiled, use soap and water before the alcohol-based hand rub. Latex-free disposable gloves should be used during the ultrasound examination and changed after each patient.

Scanning should, as much as possible, be performed with one (clean) hand and transducer and having the other hand semi-clean but in contact with the keyboard.

Applying gel would be with the semi-clean hand dispensing clean gel (see below) with post procedure thorough cleaning of the gel bottle using a low-level disinfectant (LLD). See details on gel use below.

If required to scan patient in an isolation room, ultrasound practitioners, as all attending medical staff, should don personal protective equipment (PPE, respirator, goggle, face protective shield, surgical gown and gloves) prior to entry of isolation room, where the level of PPE is set by institutional guidelines. Personal protective equipment (PPE): Any reusable PPE (e.g. gowns) must be properly cleaned and decontaminated. Specific PPE recommendations when caring for a patient with suspected or confirmed COVID-19 infection include: Respirator or face-mask:

As ultrasound practitioners are in close contact with patients, surgical face masks are essential to offer protection. These must be put on before entry into the patient room or care area. N95 respirators or respirators that offer a higher level of protection should be used instead of a face mask when performing or present for an aerosol-generating procedure, particularly for use in the intensive care unit. It is important to perform hand hygiene after removal of the respirator or face mask.

Eye protection (for ultrasound practitioners in the critical care setting): This includes goggles or a disposable face shield that must be put on when entering the patient room or care area. Reusable eye protection (e.g., goggles) must be cleaned and disinfected according to manufacturer's reprocessing instructions prior to re-use. Disposable eye protection should be discarded after use. An individual risk assessment should be carried out prior to/at the time of providing care to the patient.

Gloves: Wearing clean, non-sterile gloves upon entry into the patient room or care area is essential for all ultrasound practitioners. Once the ultrasound examination is complete, remove and discard gloves when leaving the patient room or care area and immediately perform hand hygiene.

Gowns: Wearing a clean isolation gown upon entry into the patient room or care area is essential. Reusable gowns should be discarded in a dedicated container for linen and laundered. Disposable gowns should be discarded after use. If there are shortages of gowns, they need to be prioritized for aerosol-generating procedures and high contact patient care activities that provide opportunities for transfer of pathogens to the hands and clothing.

Steve Ramsey, PhD,Public Health. MSc in medical sonography.

Okotoks, Alberta .