Infection Control in Ultrasound: Barrier Protection for Transducers in General and Endocavitary Scanning - SD

Introduction

Hi, my name is Tracy Fox,
an instructor at Thomas Jefferson University's Department
of Radiologic and Imaging Sciences,
and this presentation is on transducer covers
for general purpose and endo cavitary scanning.

Ultrasound is used in several specialty areas such
as abdominal, GYN, transrectal, vascular,
interventional procedures such as picc, line insertion,
surgery, anesthesia, and emergency medicine.

These studies require that you understand the procedures
of infection control
and the appropriate use of transducer covers
for non-sterile studies such as open wound scanning.

A completely sterile field is not necessary
for sterile studies completely unfolding
and placing the transducer cover allows the sterile field
to be established, thus promoting patient
and stay of safety, always place drapes on surfaces,
ultrasound equipment,
and instrument trays within the designated sterile field.

This presentation will concentrate on barrier technology
for general purpose and endo cavitary ultrasound.

Infection Control Procedures

Let's begin with an introduction
to the procedures of infection control.

In the healthcare setting, we need to be concerned
with the spread of infectious diseases, including
but not limited to bacteria such
as multi-drug resistant staphylococcus, aria, mrm,
RSA, or MRSA.

Fungi and viruses such as Hepatitis, HIV, herpes simplex,
type two, influenza, and VRE.

The patient's medical history may not present the healthcare
worker with a full picture.

Therefore, we follow what is called universal precautions.

Universal Precautions

The principle of universal precautions is
to treat every patient as if he
or she has a communicable disease.

For non-invasive studies on unbroken skin,
transducer covers are not typically used
unless there is the potential for contamination with blood
or body fluids.

However, in the presence of open sores, skin lesions,
or open wounds, a transducer cover should always be used.

General Purpose Transducer Covers

General purpose transducer covers are available in many
materials, widths and lengths.

Specialized folding techniques of the covers allow
for either a single person
or dual person approach
to application using proper sterile technique

Covers designed
for use in a sterile environment usually provide a long
telescoping extension that will cover the cord
of the transducer extending the sterile field.

Non-Sterile Application

We are working with a clean but not sterile transducer
and a non-sterile probe cover, such as you might use
for routine scanning when there was potential
for contamination of the transducer with blood
or body fluids.

Create an opening in your cover for gel,
then apply gel in the transducer cover.

Once the gel is in the cover,
place the transducer in the cover
and extend the cover down over the length of the cord.

Check carefully and remove any air bubbles that are
between the transducer face and the cover.

Apply elastic bands to secure the cover in place.

Sterile Application: Single Person Approach

First, Establish a sterile field
by opening a sterile drape or procedure kit.

Drop the cover and other contents
of the pack onto the sterile field.

Next, put on sterile gloves Using standard technique,
open the pack to expose the cuff area of the gloves,
Touching only what will be inside of the glove.

Get the first glove on and then the second glove.

Using the single person approach
to applying a general purpose transducer cover,
open the sterile gel packet,
then create an opening in the cover and apply gel.

Once the gel is in the cover.

Place over the array of the transducer
and extend the cover down over the length of the cord,
ensuring proper sterile technique.

Check carefully and remove any air bubbles that are
between the transducer face and the cover.

While remaining in the sterile field,
apply enclosed sterile elastic bands
to secure the cover in place.

Sterile Application: Dual Person Approach

Using the dual person approach
to applying a general purpose transducer cover,
the non-sterile person opens the procedure kit,
placing it onto the sterile tray.

The sterile person opens the sterile gel packet
and creates an opening in the cover and applies gel.

The non-sterile person places the transducer into the cover.

The sterile person then extends the cover down over the
length of the cord, ensuring proper sterile technique.

Check carefully and remove any air bubbles that are
between the transducer face and the cover.

While remaining in the sterile field.

Apply enclosed sterile elastic bands
to secure the cover in place.

Endo Cavitary Scanning

Body orifices are not considered a sterile environment,
so most transvaginal studies do not require the use
of a sterile cover.

The objective of the cover is to prevent gross contamination
of the transducer with blood and or body fluids,
and to prevent the transmission of disease
to the next patient and the healthcare professional.

Transvaginal Transducer Preparation

Let's go through the steps to prepare a transvaginal
transducer for endo cavitary scanning.

We'll begin with the transducer being soaked in a
disinfecting solution
At a minimum.

Gloves and eye protection should be worn
whenever working with a disinfecting solution.

Particularly luter aldehyde based solutions.

Remove the transducer from the disinfecting solution.

The transducer should have been thoroughly cleaned
after the previous use and
before being placed in the disinfecting solution,
thoroughly rinse the sterilizing solution from the
transducer and dry with a soft cloth.

There are several types of transvaginal
transducer covers available.

The most fundamental choice is a cover
that matches the shape and form factor
of the transducer you are using.

Transducer covers are available in sterile
and non-sterile forms in a variety of materials,
including latex and several latex free alternatives, such
as proprietary materials like siv, flex or neo guard.

If you're not sure which cover to use, refer
to your ultrasound manual
for your recommended accessory supplier.

So now that we have an overview of some of the types
of transducer covers that are available,
let's take a look at how the transducer covers are applied.

Apply gel inside the transducer cover
and place the transducer cover onto the transducer.

Check carefully and remove any air bubbles that are
between the transducer face and the transducer cover.

Some labs use elastic bands to secure the cover when done,
wrap or cover the transducer until ready for use

Transrectal Ultrasound

When performing a trans rectal ultrasound.

There are several types of transducer covers available.

Trans recal ultrasound is an invasive procedure
that may involve tissue biopsy
or brachytherapy, cedar marker implantation.

Some transducers use a double cover method
to create a balloon or water bath through which to scan.

This involves placement of one cover
that forms the inner layer.

This cover must include the gel covering
the transducer face.

Both the inner and the outer cover are secured
to the transducer with enclosed elastic bands.

This allows the outer cover to be filled with water
to create a balloon that will displace any air
between the cover and the wall of rectum.

An alternative covering method
for trans rectal procedures may involve use
of an endo cavitary balloon.

This transducer standoff device is an alternative example
of how to perform scanning
and trans peroneal procedures for needle guidance.

Core biopsy, fiducial marker placement, brachytherapy
or cryotherapy, placing the appropriate amount of gel
inside the endo cavity balloon
or on the transducer face aids in scan quality application
and removal of the balloon,

inserting the transducer into the balloon
with the fill tube oriented
and top center of the transducer.

Pull the balloon tightly over the transducer face.

Removing wrinkles or air bubbles

visually orientate the balloon.

So lateral seams are a symmetrical distance from the
longitudinal array.

Use a 30 cc syringe to fill the balloon with saline solution

Aspirate until air is removed.

Do not overinflate the balloon

Hand Washing and Procedure Safety

During the procedure.

It is essential that gloves are worn
to prevent contamination of both operator and machine.

And don't forget, hand washing.

Proper hand washing technique must always be followed
before preparing the transducer and
after the procedure, hands should be washed using soap
and warm running water.

Begin with hands pointing down.

Rub hands vigorously during washing for at least 20 seconds.

First Palm to palm.

Second right palm over left dorsum
and left palm over right dorsum.

Third palm to palm fingers interlaced.

Fourth backs of fingers, two opposing palms
with fingers interlocked.

Fifth rotational rubbing
of right thumb clasped in left palm and vice versa.

Sixth Rotational rubbing backwards
and forwards with clasped fingers
of right hand in left palm and vice versa.

This forces soap and water under fingernails.

Don't forget to include wrists.

Dry hands, well using paper towels

turn off faucet with the towel.

Post-Procedure Care

Once the study is over, remove the cover.

The cover should be disposed of as biohazard, trash,
or as required by your facility.

The transducer should be cleaned with soap
and water, removing all gel
and gross contamination if necessary,
a small brush may be used to clean the crevices
of the transducer, rinse and dry the transducer.

So now that you've seen how to apply a transducer cover
and dispose of it following the exam,
let's review some terminology.

Terminology Review

The terms clean, high level disinfection
and sterilization are oftentimes confused.

It is recommended that users follow the FD AIS issued
guidelines for reprocessing ultrasound
transducer assemblies.

You must also follow the manufacturer guidelines
for the ultrasound system you are using.

Every manufacturer has requirements and limitations
and what materials may be used on the transducer.

To clean something is the physical removal of debris.

We clean the transducer by thoroughly washing it with soap
and water and any sprayer wipes recommended
by your transducer manufacturer.

High level disinfection by comparison is the destruction
of most microbes, including bacteria, viruses, and fungi.

Even with high level disinfection,
bacterial spores may not be killed.

The A IUM recommends use of high level disinfection
for endo cavitary ultrasound transducers,
the transducer should soak for the requisite amount of time
for disinfection to occur.

It is important to always follow the manufacturer guidelines
for preparing and using the disinfection solution.

It is also imperative to refer to your system manual
for approved and compatible solutions
for disinfecting your transducer

personal protection equipment.

PPEs, such as hand
and eye protection should be worn while working
with these solutions.

And the solution should be stored in a well ventilated room
or in a device with a vapor management system.

Follow your facility's guidelines to ensure proper storage.

When we use the term sterilized, it implies
that all microbial life, including spores,
are killed by the process.

No living organisms should remain after sterilization.

It is important to note
that transducer materials can be negatively affected
by temperatures typically used during heat sterilization.

Transducers are not heat stable at high temperatures.

The transducer's pizo electric material can depolarize

depolarization means
that the transducer no longer has the ability
to convert electricity into sound.

Its essential role even in cases
where the PZT does not completely depolarize the crystal's
performance may degrade a process sometimes called aging.

Another practical issue is the effect
of heat upon the epoxy like materials found in the backing
material matching layer
and bonding agents during exposure to elevated temperatures,

these materials may soften
and then re harden in deformed states during cooling.

As a result, alternate methods
of infection control should be considered.

The transducer may then be placed in a clean
but not sterile environment, such as a transducer rack
or on the ultrasound system.

Appropriate cleaning
and disinfection of the ultrasound equipment is essential,
especially when invasive procedures are being performed.

Always follow FDA
and A IOM guidelines as well
as manufacturer recommendations,

and always follow the manufacturer guidelines
for the disinfecting solution you are using.

Potential Problems

As with any process, things can go
wrong during a procedure.

One problem that could be encountered is selecting the
incorrect transducer cover
for the procedure being performed.

Transducer covers are designed
to fit a wide array of transducers.

It is important to make sure your cover is the proper
material width and length to fit your transducer.

Another potential problem is the inadvertent puncture
of the transducer cover during an exam.

While transducer covers are durable
and designed to handle a substantial level of wear
and tear, it is possible to puncture the cover.

It must be assumed that the cover is then contaminated
with blood or body fluids
and must be thoroughly cleaned of any gross contamination
before being placed into the disinfection solution.

If the exam is not complete at the time the sterile barrier
is compromised, the transducer should not be used
until properly recovered.

A third potential problem
that could be encountered is improperly cleaning,
disinfecting, or sterilizing The transducer

after use using a transducer cover at all time allows a
barrier to be established,
thus promoting patient and staff safety.

Summary

To summarize what we have reviewed in this presentation

for ultrasound scanning, the proper use
of barrier protection and the cleaning, disinfecting
and sterilization of ultrasound equipment is essential
to reduce the risk of cross-contamination
and transmission of disease between patients and staff.

Both the operator
and patient need to be protected from communicable diseases
and this is readily achievable with the appropriate use
of the correct transducer cover.

Thank you.