Infection prevention for point of care ultrasound (POCUS) in COVID-19

Critical Summary

• Coronavirus disease 2019 (COVID-19) is caused by the novel coronavirus SARSCoV-2.¹ Associated clinical syndromes may include viral pneumonia and acute respiratory distress syndrome.²
• Point of care ultrasound (POCUS) is a front-line triage and monitoring tool in the management of COVID-19 as it is portable, rapid to deploy, does not emit ionising radiation, and can provide actionable clinical data.^3,4
• Users of POCUS need to consider the best way to disinfect probes used.

Diagnosis and Management of COVID-19 Using Ultrasound

The World Health Organisation (WHO) have identified pneumonia, severe pneumonia, and acute respiratory distress syndrome (ARDS) as COVID-19 associated clinical syndromes that may be investigated using medical imaging.² Ultrasound has been identified as a primary tool for the management of COVID-19.^3,4 Procedures may include lung ultrasound, transthoracic echocardiography and in severe cases central venous access and thoracentesis to manage pleural effusion (Table 1). Ultrasound has several advantages over CT and MRI including greater scalability, easy and rapid deployment at point of care and no ionising radiation.³

Ensuring the Safety of Patients and Staff During the Management of COVID-19

The high transmissibility of SARS-CoV-2 means infection control practices are essential for preventing hospital acquired COVID-19. During patient care, ultrasound probes may become contaminated with SARS-CoV-2. Generally speaking, the Spaulding classification would be applied to determine the level of disinfection required based on the next use (Table 1).^5,6 During the COVID-19 outbreak, facilities may decide to perform a higher level of disinfection than that required by Spaulding (Table 1). Recent guidelines have suggested some settings could perform more frequent HLD of ultrasound equipment.^7,8 This includes ICUs since the patient population is typically immunocompromised and more predisposed to infection.⁷

HLD: high level disinfection. LLD: low level disinfection. %Minimum disinfection level is based on the Spaulding classification.^5,6 *Patients presenting to emergency departments may have unexpected lesions or dermatitis around the scanning area which would render the probe semi-critical, requiring HLD before use. #While not mandated by the Spaulding classification, facilities may decide to use a higher level of reprocessing for a greater margin of safety. ^Sterilisation is required for critical probes; HLD with use of a sterile sheath is acceptable if sterilisation is not possible.⁶

The Benefits of HLD Against SARS-CoV-2

As SARS-CoV-2 is a novel enveloped virus, disinfection efficacy tests have generally not been performed against this virus to date. By definition, HLD inactives all microbial life, except for some bacterial spores within a standard cycle.6 This efficacy spectrum includes enveloped viruses. Enveloped viruses are considered the most susceptible group of organisms to inactivation by disinfectants.^5,6

Benefits of Automation to Clinical Workflows

Manual disinfection methods are inherently variable, the effects of which may become amplified under high clinical workload. Using an automated and validated disinfection process means that critical parameters (e.g., contact time, temperature, concentration) are controlled and all surfaces of the probe head and handle are disinfected.

View our POCUS in COVID-19 Clinical Bulletin

The trophon family includes the trophon EPR and trophon2 devices, which share the same core technology of 'sonically-activated' hydrogen peroxide.