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Specific care for diagnostic ultrasound services during the COVID-19 outbreak - v1.2

Coronaviruses can cause different pathological processes, from a flu-like condition to the common cold, to severe acute respiratory failure. The new virus is a strain of the coronavirus family that until then had not been identified in humans (SARS-CoV-2).

The virus is transmitted from person to person when droplets containing viral particles from a patient or an asymptomatic carrier come into contact with mucous membranes in the mouth, nose or eyes of healthy individuals.

Among the main preventive measures for contamination are social isolation, avoiding close or direct contact with other individuals, maintaining a social distance between 1.5 m and 2.0 m; avoid touching the face; wash your hands often with soap and water or apply alcohol gel to your hands.

However, during ultrasound exams, proximity to patients is inevitable, since the doctor needs to touch the patient with the transducer to acquire diagnostic images. On the other hand, the safety of doctors, as well as that of all health professionals, who cannot be omitted in times of health crisis like this, must have absolute priority. Thus, the Brazilian College of Radiology and Diagnostic Imaging (CBR), in line with other scientific societies, took the initiative to disseminate this document, emphasizing the importance of carrying out the exams with maximum security.

 

1) Security starts with proper indication of the exam. You should not expose patients to unnecessary risk or occupy health teams with tests that will not add relevant information to the patient's conduct. Exams check-up as well as several exams "routine" can be postponed for more opportune moments. Only this attitude reduces the risk of contamination for individuals, who will not travel to the services, and allows medical teams to direct their time and effort to care for those who really need it.

 

2) We encourage study aimed at the patient's complaint or the prescribing physician's diagnostic suspicion, in order to reduce the examination time.

And finally, individual protection measures that are different from specific scenarios must be implemented.

 

Scenario 1: ultrasound examination performed on an outpatient patient WITHOUT respiratory symptoms

The patient does not need to wear a mask. The use of PPE is not formally recommended for those who perform the ultrasound examination.

Scenario 2: ultrasound examination performed on an outpatient WITH respiratory symptoms

The patient must wear a mask with minimum filtration equivalent to PFF1, like surgical masks since entering the clinic

For the doctor it is indicated:

Use of a mask with minimum filtration equivalent to PFF2 - N95;

Disposable, non-sterile gloves;

Long sleeve waterproof apron, preferably disposable;

Goggles or full face shield.

Scenario 3: ultrasound examination performed on an inpatient patient WITHOUT respiratory symptoms

The patient does not need to wear a mask. The use of PPE is not formally recommended for those who perform the ultrasound examination.

Scenario 4: ultrasound examination performed on an inpatient WITH respiratory symptoms

The patient must wear a mask with minimum filtration equivalent to PFF1

For the doctor it is indicated:

Use of a mask with minimum filtration equivalent to PFF2 - N95;

Disposable, non-sterile gloves;

Long sleeve waterproof apron, preferably disposable;

Goggles or full face shield.

 

CLEANING AND ANTI-SPEECH OF ULTRASOUND EQUIPMENT AND TRANSDUCERS

Another point is the cleaning and antisepsis of ultrasound equipment and transducers. The coronavirus is surrounded by a lipid capsid that makes it particularly sensitive to disinfectants for routine use. There is evidence that the virus effectively inactivates with appropriate procedures that include the use of common disinfectants in diagnostic clinics and in hospital settings. The World Health Organization (WHO) suggests that “the complete cleaning of the surfaces of the environment with water and detergent, followed by the application of disinfectants commonly used at the hospital level” are effective and sufficient procedures to inactivate the new coronavirus.

The device can be cleaned with a tissue soaked in 70% alcohol.

To clean the transducers, disinfection must be effective for any transmissible pathogen, which can be done with several products:

  • Based on sodium hypochlorite as Dakin's liquid (0.5% active sodium hypochlorite solution);
  • Based on quaternary ammonia (QUAT), taking care that the total concentration for use must be less than 0.8%;
  • Based on hydrogen peroxide accelerated to a maximum of 0.5%;
  • Based on alcohol or alcohol and quaternary ammonia (QUAT). The alcohol content cannot exceed 70%;

 

It must be taken into account that not all cleaning solutions are compatible with the transducers. Therefore, it is recommended to consult the maintenance and cleaning manuals for each device, which contains information on which products can be used to ensure patient safety without damaging the equipment.

CONDUCTIVE GEL

To avoid contamination of the ultrasound gel, it is recommended to cover the bottle, tube or oilcan after each use. When applying the gel, do not allow the gel container to touch the patient's skin or the transducer surface.

REPORT ROOMS

Adequate cleaning of countertops, keyboards and mice in the report rooms can be done with common products, including alcohol at 70%.

For cases without suspicion of COVID-19, without epidemiology and without respiratory symptoms, the usual disinfection is performed and the room (and the equipment) is released for exams, shortly thereafter. After performing tests on patients with high suspicion and / or with confirmed COVID-19, it will be necessary to proceed with the disinfection recommended above and the room (and the equipment) can be used again afterwards if the patient has all the recommended PPE. If aerosols have been produced and / or some patient's discharge has been released, after disinfection, wait 2 hours to use it.

click here to download the PDF document.

            Sources:

  1. Wilder-Smith A, Chiew CJ, Lee VJ. Can we contain the COVID-19 outbreak with the same measures as for SARS? The Lancet Infectious Disease, Mar 2020, doi: 10.1016 / S1473-3099 (20) 30129-8
  2. Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. The Journal of Hospital Infection, Mar 2020, 104: 246-251.
  3. Siddharta, A., Pfaender, S., Vielle, NJ, Dijkman, R., Friesland, M., Becker, B. et al. Virucidal Activity of World Health Organization-Recommended Formulations Against Enveloped Viruses, Including Zika, Ebola, and Emerging Coronaviruses. J Infect Dis. 2017; 215: 902–906.
  4. Ki, HK, Han, SK, Son, JS, and Park, SO Risk of transmission via medical employees and importance of routine infection-prevention policy in a nosocomial outbreak of Middle East respiratory syndrome (MERS): a descriptive analysis from a tertiary care hospital in South Korea. BMC Pulm Med. 2019; 19: 190

 

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