Universal Precautions and Infection Prevention Protocol for Ultrasound Devices and Room during COVID-19: A Literature Review

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Nicole Marley
Raquel Teichroeb
Fatima Tul Zahra


Corona virus (SARS-CoV-2) is a lipid-enveloped virus that is responsible for the wide spread of COVID-19, a severe respiratory illness. Asymptomatic carriers in conjunction with high infectivity rates increase the risk of transmission. Infection prevention in sonographers and their patients directly relies on disinfection protocols for both ultrasound machines and environment. A broad, literature review was conducted using search engines and literature databases to find information regarding best Canadian evidence-based practices for proper disinfection. Low-level disinfectant is widely considered effective against SARS-CoV-2 and should be used to eliminate viral particles on shared surfaces. Whenever possible, single use, disposable items should be used to reduce cross contamination. Developing proper guidelines and educating sonographers will minimize the risk of exposure and improve ultrasound safety during this pandemic.

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1. Piscaglia F, Stefanini F, Cantisani V, et al. Benefits, open questions and challenges of the use of ultrasound in the COVID-19 pandemic era. The views of a panel of worldwide international experts. Eur J Ultrasound [Internet]. 2020 Apr 15 [cited 2020 May 28]; Available from: http://www.thieme-connect.de/DOI/DOI?10.1055/a-1149-9872 DOI: 10.1055/a-1149-9872
2. Shan X, Huang Y, Kou H, et al. Suggestions on prevention and control of COVID-19 in ultrasound department. Advanced Ultrasound in Diagnosis and Therapy [Internet]. 2020;4(2):84–9. Available from: http://www.journaladvancedultrasound.com:81/article/2020/2576-2516/2576-2516-4-2-84.shtml DOI: 10.37015/AUDT.2020.200022
3. Government of Ontario. How Ontario is responding to COVID-19 [Internet]. Ontario.ca. 2020 [cited 2020 May 28]. Available from: https://www.ontario.ca/page/how-ontario-is-responding-covid-19#section-0
4. Centers for Disease Control and Prevention. 2009 H1N1 pandemic [Internet]. Centers for Disease Control and Prevention (CDC). 2019 [cited 2020 Jun 4]. Available from: https://www.cdc.gov/flu/pandemic-resources/2009-h1n1-pandemic.html
5. Centers for Disease Control and Prevention. Interim infection prevention and control recommendations for patients with suspected or confirmed coronavirus disease 2019 (COVID-19) in healthcare settings [Internet]. Centers for Disease Control and Prevention. 2020 [cited 2020 Jun 12]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html
6. Basseal JM, Westerway SC, McAuley T. COVID-19: Infection prevention and control guidance for all ultrasound practitioners. Australian Journal of Ultrasound in Medicine [Internet]. 2020 Apr 29 [cited 2020 May 28];23(2):90-95. Available from: https://lrc.michener.ca:3576/doi/10.1002/ajum.12210 DOI: 10.1002/ajum.12210
7. Abramowicz JS, Akiyama I, Evans D, et al. World Federation for Ultrasound in Medicine and Biology position statement: How to perform a safe ultrasound examination and clean equipment in the context of COVID-19. Ultrasound Medicine Biol [Internet]. 2020 Apr 4;1–7. Available from:
/ DOI: 10.1016/j.ultrasmedbio.2020.03.033
8. Auwaerter PG. Coronavirus COVID-19 (SARS-CoV-2) Johns Hopkins ABX Guide [Internet]. Johns Hopkins Medicine. 2020 [cited 2020 Jun 4]. Available from: https://www.hopkinsguides.com/hopkins/.//view/Johns_Hopkins_ABX_Guide/540747/all/Coronavirus_COVID_19__SARS_CoV_2_?refer=true
9. Ma I. COVID-19 POCUS information summary page [Internet]. Canadian Internal Medicine Ultrasound. 2020 Apr 21 [cited 2020 May 28]. Available from: https://docs.google.com/viewer?a=v&pid=sites&srcid=ZGVmYXVsdGRvbWFpbnxjYWxnYXJ5aW11c3xneDozNGU3YmFiYjM0MTUyZDdk
10. Buonsenso D, Piano A, Raffaelli F, et al. Point-of-Care Lung Ultrasound findings in novel coronavirus disease-19 pnemoniae: a case report and potential applications during COVID-19 outbreak. Eur Rev Med Pharmacol Sci [Internet]. 2020 Mar;24(5):2776–80. Available from: https://lrc.michener.ca:4280/32196627/ DOI: 10.26355/eurrev_202003_20549
11. Ma IWY, Somayaji R, Rennert-May E, et al. Canadian Internal Medicine Ultrasound (CIMUS) recommendations regarding internal medicine point-of-care ultrasound (POCUS) use during coronavirus (COVID-19) pandemic. Can J Gen Intern Med [Internet]. 2020 Apr 1;15(2):8–11. Available from: https://cjgim.ca/index.php/csim/article/view/438 DOI: 10.22374/cjgim.v15i2.438
12. Public Health Ontario. At a glance: Disinfectant tables [Internet]. 2018 [cited 2020 Jun 14]. Available from: https://www.publichealthontario.ca/-/media/documents/A/2018/at-a-glance-ipac-pss-disinfectant-tables.pdf?la=en
13. Shahid S, Alexander S, Bonthu M, et al. American College of Emergency Physicians COVID-19 field guide: Ultrasound cleaning [Internet]. American College of Emergency Physicians. 2020 [cited 2020 May 28]. Available from: https://www.acep.org/corona/covid-19-field-guide/work-safety/ultrasound-cleaning/
14. The Association for Medical Ultrasound. Guidelines for cleaning and preparing external- and internal-use ultrasound transducers and equipment between patients as well as safe handling and use of ultrasound coupling gel [Internet]. American Institute of Ultrasound in Medicine; 2020 [cited 2020 May 22]. Available from: https://www.aium.org/officialStatements/57
15. Kim DJ, Jelic T, Woo MY, et al. Just the Facts: Recommendations on point-of-care ultrasound use and machine infection control during the coronavirus disease 2019 pandemic. Can J Emerg Med Care [Internet]. 2020 Apr 9;4(2):1–5. Available from: https://lrc.michener.ca:4280/32268930/ DOI: 10.1017/cem.2020.364
16. Poon LC, Abramowicz JS, Dall’Asta A, et al. ISUOG Safety Committee Position Statement on safe performance of obstetric and gynecological scans and equipment cleaning in context of COVID‐19. Ultrasound Obstet Gynecol [Internet]. 2020 Mar 23;55(5):709–12. Available from: https://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/uog.22027 DOI: 10.1002/uog.22027
17. Alberta Health Services. POCUS COVID-19 IP&C Protocol - Handheld devices cheat sheet [Internet]. 2020 Mar 27 [cited 2020 May 28]. Available from: https://docs.google.com/viewer?a=v&pid=sites&srcid=ZGVmYXVsdGRvbWFpbnxjYWxnYXJ5aW11c3xneDozNGQ1YjI3YWE5YjdlNmM2
18. Alberta Health Services. POCUS COVID-19 IP&C Protocol - Cart-based devices cheat sheet [Internet]. 2020 Mar 27 [cited 2020 May 28]. Available from: https://docs.google.com/viewer?a=v&pid=sites&srcid=ZGVmYXVsdGRvbWFpbnxjYWxnYXJ5aW11c3xneDo1ZTIyYWNmZGI4ZjVlYTU
19. Khurana A, Sharma KA, Bachani S, et al. SFM India oriented guidelines for ultrasound establishments during the COVID 19 pandemic. J Fetal Med [Internet]. 2020 Apr 11;1–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7150531/ DOI: 10.1007/s40556-020-00254-7
20. Provincial Infectious Diseases Advisory Committee (PIDAC). Best practices for environmental cleaning for prevention and control of infections in all health care settings, 3rd edition [Internet]. Public Health Ontario. 2018 Apr [cited 2020 Jun 12]. Available from: https://www.publichealthontario.ca/-/media/documents/b/2018/bp-environmental-cleaning.pdf?la=en
21. Canadian Association of Radiologists. Radiology resumption of clinical services [Internet]. 2020 May [cited 2020 Jun 14] p. 1–29. Available from: https://car.ca/wp-content/uploads/2020/05/CAR-Radiology-Resumption-of-Clinical-Services-Report-May-En-Final-May-13.pdf
22. Rubin GD, Ryerson CJ, Haramati LB, et al. The role of chest imaging in patient management during the COVID-19 pandemic: A multinational consensus statement from the Fleischner Society. Radiology [Internet]. 2020 Apr 7;296(1):172-180. Available from: https://car.ca/wp-content/uploads/2020/05/CAR-Radiology-Resumption-of-Clinical-Services-Report-May-En-Final-May-13.pdf DOI: 10.1148/radiol.2020201365
23. Qu J, Yang W, Yang Y, et al. Infection control for CT equipment and radiographers’ personal protection during the coronavirus disease (COVID-19) outbreak in China. Am J Roentgenol [Internet]. 2020 Apr 30;1–5. Available from: https://www.ajronline.org/doi/10.2214/AJR.20.23112 DOI: 10.2214/AJR.20.23112
24. Mossa-Basha M, Meltzer CC, Kim DC, et al. Radiology department preparedness for COVID-19: Radiology scientific expert panel. Radiology [Internet]. 2020 Mar 16 [cited 2020 Jun 10]; Available from: https://pubs.rsna.org/doi/full/10.1148/radiol.2020200988 DOI: 10.1148/radiol.2020200988