Healthcare Hygiene magazine June 2021 June 2021 | Page 45

vascular access infection prevention

vascular access infection prevention

By Nancy Moureau , RN , PhD , CRNI , CPUI , VA-BC

The Lowdown on Ultrasound Transducer Disinfection : Intersocietal Endorsement for Low-Level Disinfection with UGPIV

The associations of American College of Emergency Physicians ( ACEP ), the American Institute of
Ultrasound in Medicine ( AIUM ), The Association of Professionals in Infection Control and Epidemiology ( APIC ), the Association for Vascular Access ( AVA ), and the Society for Healthcare Epidemiology of America ( SHEA ) each collaborated on an intersocietal position paper ( ISPP ) addressing the issue of disinfection of ultrasound transducers / probes for percutaneous procedures .

In healthcare practices today there is increasing use of advanced ultrasound visualization for vein assessment and percutaneous procedures . Concerns over transmission of microorganisms on ultrasound transducers has driven the need to establish guidelines and policies on the most appropriate type of procedure and disinfection prior to patient use . During percutaneous procedures such as biopsies and vascular access device insertions , the skin is punctured by the needle during the ultrasound guided insertion , exposing the patient to the surface of the transducer , if uncovered . The Spaulding Classification for processing medical devices with disinfection and sterilization recommendations was published in 1957 and is still applied , in many instances , for medical device policies establishing the necessary low or high-level disinfection for equipment used in procedures . More recent publications by various associations have put into question the application of the Spaulding criteria for these percutaneous procedures .

The associations of American College of Emergency Physicians ( ACEP ), the American Institute of Ultrasound in Medicine ( AIUM ), The Association of Professionals in Infection Control and Epidemiology ( APIC ), the Association for Vascular Access ( AVA ), and the Society for Healthcare Epidemiology of America ( SHEA ) each collaborated on an intersocietal position paper ( ISPP ) addressing the issue of disinfection of ultrasound transducers / probes for percutaneous procedures . These organizations recognized the need to clean transducers after procedures to limit transmission of pathogenic organisms . The organizations reviewed the literature , the current level of transducer protection , and formulated a statement that endorsed the use of low-level disinfection for transcutaneous ultrasound transducer cleaning and disinfection when used for percutaneous procedures .
Ultrasound is used for many different procedures , performed both internally with endocavitary use of transducers , and externally on the skin with percutaneous applications . Percutaneous procedures , such as peripheral or central venous catheter placement , are performed through intact skin with needle punctures into a vein . While endocavitary and percutaneous procedures differ in terms of the level of risk , the higher risk with endocavitary ultrasound , the consistent link between the two procedures is that the transducer is typically covered with nonsterile or sterile covers used during the invasive aspect of either procedure to prevent direct contact with the mucous membrane or skin . Simple ultrasound assessment through intact skin is commonly performed without transducer covers with the assumption that low-level disinfection of the transducer was performed prior to the assessment and following the procedure .
The determination of low-level or high-level disinfection has frequently been made according to the Spaulding Classification , or in consideration for patient risk with the procedure . Ultrasound guided peripheral catheter insertion ( UGPIV ) is considered a non-critical application that is sometimes confused with semi-critical according to the ISPP and thus , within the Spaulding recommendations would require high-level disinfection in all instances . Low-level disinfection is recommended for non-critical percutaneous procedures and intended to include UGPIV insertions as a clean process where transducer low-level disinfection has eliminated up to 99 % of pathogens . Ultrasound manufacturers list recommended agents for disinfection that can safely be used and avoid damage to transducers .
High-level disinfection is considered appropriate for sterile semi-critical and critical procedures that involve agents or disinfecting processes designed to sterilize the surface of the transducer . These substances and processes take considerable time , may damage the transducer , and represent a significantly higher cost for the process . According to the ISPP on transducer disinfection , low-level disinfection is adequate for percutaneous procedures , especially when transducer covers are included in the invasive portion of the procedure .
In the ISPP the recommendations describe ultrasound transducers used for percutaneous procedures as similar to handwashing where hands are not sterilized prior to glove application , the covering for the transducer providing the same type of adequate protection during the procedure as gloves for the hands . Transducer covers , both non-sterile and sterile , afford considerable protection from procedural contamination , but must be used in conjunction with gel on the skin , in most cases . Acoustic couplant gel is used for UGPIV insertions and can be a source of contamination when care is not taken in choosing the www . healthcarehygienemagazine . com • june 2021
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