SJRHEM IP&C Policy for PoCUS
March 2020 – This policy has been adapted to reflect the IP&C issues arising from the current COVID-19 pandemic.
COVID-19
Indications for PoCUS are limited in COVID-19 patients. The usual lung, cardiac and procedural guidance indications may be appropriate in assisting with resuscitation and managing complications. Specific findings in COVID include:
- Focal B-lines and fused B-lines
- Discontinuous, rough appearance to the pleural line, with subpleural consolidation
- Foci of disease located predominantly in the posterior lung fields, particularly in the lower lung fields
- Images can be viewed here
Neither PoCUS, CXR or CT are sufficiently sensitive to provide a diagnosis of COVID. The use of PoCUS should be limited to assisting with resuscitation and managing complications.
Infection Prevention and Control measures for PoCUS vary depending on the following:
- Patient on Standard IP&C Precautions
- Patient on Droplet / Contact IP&C Precautions
- Patient located in COVID Cove – High Consequence Infection Decision Unit
- Patient receiving Aerosol Generating Medical Procedure
All machines have been stripped down to the bare essentials. Manuals, unnecessary leads, etc, have been removed.
1. Patient on Standard IP&C Precautions
- These patients have been screened as low risk for COVID-19, i.e they are presenting with an unrelated pathology.
- Before and after using the ultrasound machine on each patient the following established protocol applies:
- Using the viru/bactericidal hydrogen peroxide wipes, thoroughly clean the:
- Transducers and cables
- Keyboard and cart handles
- Using the viru/bactericidal hydrogen peroxide wipes, thoroughly clean the:
- Only use the ultrasound machine for clinically indicated examinations (No scanning rounds or non-clinical teaching scans).
- In the presence of blood or other bodily fluid contaminants use a transducer sheath.
- Thoroughly clean the machine, as described, above after use.
2. Patient on Droplet / Contact IP&C Precautions
- Some of these patients have been screened as moderate to high risk for COVID-19, i.e they are presenting with an Influenza Like Illness (ILI) and meet the case definition criteria.
- Some of these patients are unable to be screened due to altered LOC or other factors.
- Some of these patients are on Droplet / Contact for other indications e.g Influenza, etc.
- Before and after using the ultrasound machine on each patient the following established protocol applies:
- Using the viru/bactericidal hydrogen peroxide wipes, thoroughly clean the:
- Transducers and cables
- Keyboard and cart handles
- Using the viru/bactericidal hydrogen peroxide wipes, thoroughly clean the:
- A transducer sheath must be used on every patient.
- Use single use ultrasound gel packs, or transfer a required amount of gel onto a disposable receptacle before entering the room.
- During the examination, try not to directly touch the machine controls. Use a transparent polythene drape, e.g. ECG Machine drape, over the keyboard controls.
- Thoroughly clean the machine, as described, above after use.
3. Patient located in COVID Cove – High Consequence Infection Decision Unit
- These patients have been screened as moderate to high risk for COVID-19, i.e they are presenting with an Influenza Like Illness (ILI) and meet the case definition criteria.
- A dedicated ultrasound machine has been located in the HCIDU (COVID Cove)
- These patients all have droplet / contact precautions applied.
- Before and after using the ultrasound machine on each patient the following established protocol applies:
- Using the viru/bactericidal hydrogen peroxide wipes, thoroughly clean the:
- Transducers and cables
- Keyboard and cart handles
- Using the viru/bactericidal hydrogen peroxide wipes, thoroughly clean the:
- A transducer sheath must be used on every patient.
- Use single use ultrasound gel packs, or transfer a required amount of gel onto a disposable receptacle before entering the room.
- During the examination, try not to directly touch the machine controls. Use a transparent polythene drape, e.g. ECG Machine drape, over the keyboard controls.
- Thoroughly clean the machine, as described, above after use.
- After use, move the machine back to its storage area away from the patient beds.
4. Patient receiving Aerosol Generating Medical Procedure (AGMP)
- If possible, try to avoid using PoCUS on patients who are actively receiving an AGMP
- If possible remove ultrasound machine from room during AGMP
- If PoCUS is required during an AGMP then follow the the protocol for Droplet / Contact IP&C Precautions (see above) AND
- In Addition – Cover the entire machine with a transparent drape