Ultrasound Infection Prevention Recommendations in Response to COVID-19

American Institute of Ultrasound in Medicine (AIUM) Guidelines for Cleaning and Preparing External- and Internal-Use Ultrasound Transducers and Equipment Between Patients as well as Safe Handling and Use of Ultrasound Coupling Gel

Updates to AIUM’s ultrasound transducer cleaning guidelines specific to COVID-19 include:

“Cleaning involves all ancillary equipment involved in the procedure at hand. A cover sheet may be used as a physical barrier between the keyboard/console and the operator, in addition to LLD cleaning.”

Barriers used for internal and interventional percutaneous procedures must be single-use transducer covers that meet the sterility requirements of the procedure.

World Federation for Ultrasound in Medicine & Biology (WFUMB) How to perform a safe ultrasound examination and clean equipment in the context of COVID-19

“If available, equipment covers, such as for the ultrasound scanner console, will enhance the workflow, as LLD of mechanical keyboards and console controls is time-consuming. It is important to note that if the cover is contaminated, it must be cleaned, and the presence of a cover does not preclude the need for cleaning the equipment at regular intervals.”

Cleaning “is an important first step since any remaining gel can act as a barrier to the disinfectant thus diminishing its efficacy.” “Ineffective cleaning prior to disinfection can limit the effectiveness of the chemical disinfection.”

“Ultrasound gel has been associated with numerous outbreaks and in the context of the COVID-19 pandemic, it is recommended that single-use, non-sterile gel packets are used for any external ultrasound examination with a probable or confirmed COVID-19 case.”

American College of Emergency Physicians (ACEP) COVID-19 Field Guide

“Remove all nonessential equipment prior to entering the room of a suspected COVID-19 patient. This prevents unnecessary items from contamination by droplets and may include removal of nonessential transducers or extraneous items (eg, peripheral IV cannulas, plastic film dressing, bags holding towels).”

“In situations where aerosolization or high-risk procedures can occur, probes and machines should be covered, if possible, and disinfected with low-level disinfection (LLD) after every use.”

College of Intensive Care Medicine Prevention of pathogen transmission during ultrasound use in the Intensive Care Unit: Recommendations from the College of Intensive Care Medicine Ultrasound Special Interest Group (USIG) Adapt and expand the 2017 ASUM/ACIPC transducer reprocessing guidelines to the specifics of intensive care medicine and provide advice to the ICU practitioners and health care administrators.
  • “Sterile sheaths are mandatory for semi-critical procedures such as ultrasound-guided vascular access and critical procedures such as intra-operative ultrasound as well as during transrectal and trans-vaginal studies.”
  • “Home-made solutions such as plastic bags, cling film, surgical gloves or transparent film dressing should not substitute sterile probe covers as these do not offer a consistent barrier.”
American Society of Regional Anesthesia (ASRA) and European Society of Regional Anesthesia (ESRA) COVID-19 Joint Statement
  • “Regional Anesthesia (RA) is preferred over General Anesthesia (GA) for patients with COVID-19 to reduce the risk of transmission”
  • Recommends the use of ultrasound for peripheral nerve blocks
  • “Ensure the use of plastic covers to protect ultrasound equipment”
American Society of Echocardiography (ASE) ASE Statement on Protection of Patients and Echocardiography Service Providers During the 2019 Novel Coronavirus Outbreak “patients under investigation or confirmed with COVID-19 may still require TEEs in several clinical situations…TEE probes should undergo cleaning in the room (including the handle and chord), then be transferred in a closed container to be immediately disinfected according to the manufacturer’s recommendations.”
International Society of Ultrasound in Obstetrics & Gynecology (ISUOG) ISUOG Safety Committee Position Statement: safe performance of obstetric and gynecological scans and equipment cleaning in the context of COVID-19
  • Use of single-use gel packs is recommended as opposed to gel containers
  • Consider transducer cover for non-endoluminal probes
  • Consider covering cord of ultrasound transducer

ACEP Document

Source: American College of Emergency Physicians