Don’t Stop with Disinfecting Surfaces – Clean the Air to Decrease COVID-19

Protecting ultrasound providers during the COVID-19 pandemic requires going a step further than simply disinfecting surfaces – the air in ultrasound departments should be disinfected, too.

That’s the recommendation from a group of ultrasound experts from China. Representatives from four medical organizations collaborated this year to produce the first recommendation about air sanitation during the outbreak. They published their guidance in the Oct. 12 Ultrasound in Medicine and Biology.

“Given that patients undergoing ultrasound examination might be virus carrying or infected, or suspicious for infection (symptomatic or asymptomatic), it is of great importance to have good protection for the healthcare staff (including doctors, nurses, medical assistants, and technicians) during work,” said the team led by Luo Yukun, Ph.D., professor in the diagnostic ultrasound department at Chinese People’s Liberation Army General Hospital in Beijing. “Since in the department of ultrasound the healthcare workers are close contacted with patients who might be infected or virus carrying, it is extremely important to offer protection to them.”

This new advice underscores how what the industry knows about the COVID-19 virus continues to grow and change.

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The team divided their suggestions into two main categories – designated spaces for healthcare providers and patients and personal protective equipment (PPE). They based their recommendations on existing hygiene standards, practitioner experience, and existing literature.

Most importantly, the team said departments must designate certain individual areas to be strictly used by patients or providers. For example, they said, each group should be relegated to separate hallways. In addition, some areas should be off-limits except to providers, and departments should create two buffer zones where providers can put on and take off PPE.

Following these measures is critical, they said because it will help keep track of what resources have been used and contaminated and strengthen the efforts to minimize exposure and transmission. The team also recommends disinfecting all surfaces, such as door handles, keyboards, floors, and ultrasound probes and machines. Using probe and plastic machine covers when it is feasible – especially with patients suspected of infection – could also be beneficial.

The team also offered clarity around the recommendations for greater air disinfection. Rooms reserved for patients without known or suspected COVID-19 infection should be ventilated for at least 30 minutes in both the morning and evening, and ultraviolet light should be added after all patients have been seen for the day, as well.

However, rooms used for patients who are suspected of infection must undergo a more stringent protocol. Alongside the daily ventilation measures, the team also said departments should also use a 3-percent hydrogen peroxide spray or a UV lamp for 60 minutes after each patient. Putting a plasma air disinfection machine in the COVID-19 rooms could also help combat exposure and transmission.

In addition, the authors reiterated existing PPE guidelines, advocating that everyone in the department – not just providers working directly with the ultrasound equipment – wear work coats, latex gloves, surgical masks, and disposable hairnets. These PPE should be changed every 4-to-6 hours, they said. But, they went a step further, recommending that providers wear isolation gowns with patients who have known infection and full-face respirators and other tertiary PPE for the riskiest procedures, ultrasound-guided aerosol-generating procedures.

To dispose of or process this equipment, the team offered this guidance:

• Dispose of medical waste items in dedicated trash cans.
• Soak anti-fog goggles in electrolyzed-oxidizing disinfectant for 5 minutes or chlorine-containing 1,000 mg/L disinfectant for 30 minutes.
• Wipe face shield with 75-percent medical alcohol.
• Change working coat every day or put under UV light in dressing room for 30 minutes.
• Disinfect work shoes with UV light when necessary.

Despite not being a popular screening method in China, the team said, handheld ultrasound has proven beneficial with COVID-19 patients in other countries in a variety of healthcare settings.

“Ultrasound examination, having the advantages of convenience, quickness, non-invasiveness, radiation free, bedside available,” they said, “is a cost-effective, real-time technique which was reported to be an important role in the diagnosis and treatment of COVID-19.”

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