PoCUS – Infection Prevention and Control

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:

  1. Patient on Standard IP&C Precautions
  2. Patient on Droplet / Contact IP&C Precautions
  3. Patient located in COVID Cove – High Consequence Infection Decision Unit
  4. 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
  • 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
  • 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
  • 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