Cleaning and Disinfection of Point-of-Care Ultrasound Machines

Summary:

  1. Put on a new pair of gloves. Remove probe cover if used.
  2. Remove all gross debris with an AF3 wipe (gray top tub) or a soapy washcloth
  3. Using a new AF3 wipe, disinfect all probes and cords, regardless of use, as well as all touch screens, handles, buttons/knobs, keyboards and gel bottles.
  4. This must be done after every exam. Please allow the disinfectant 3 minutes to act prior to performing the next exam.

See below for more a more detailed review of guideline-based cleaning and disinfection as well as links to institutional and organizational policies and guidelines.


COVID-19 UPDATE:

Point-of-care ultrasound has been useful in the management of patients with confirmed or suspected COVID-19 infection, but the machines have potential to spread this deadly disease. Please only use these devices on suspected or confirmed COVID patients if it will impact management (i.e. DO NOT scan a patient solely for educational purposes or if you are not an experienced user). If a machine is used on a COVID patient, please follow the recommendations below.

  1. Follow institutional guidelines for personal protection and disinfection, as usual
  2. Remove all unnecessary materials from the machine prior to entering the room (ex extra gel bottles, educational materials, marking pens, etc.). Use single-use gel packets and discard in the room if available.
  3. Perform exam. If the patient is at high risk to aerosolize (being intubated or bronched, coughing), consider using probe covers and draping a gown or clean sheet over the machine, if able. This can be cumbersome but potentially reduces the load of contaminant. Handheld devices can often be fully covered using a ziplock bag and probe cover.  Use probe covers for invasive procedures or exams over dirty or non-intact skin, as usual.
  4. When done examining the patient and preparing to leave the room, and while still in full PPE, remove any probe covers, etc. and wipe off gross debris with an AF3 wipe.
  5. Using a new AF3 wipe, disinfect the ENTIRE machine, including portions not typically recommended for non-COVID patients such as the back of the screen, the base and body, and the power cord. Remember to wipe down the gel bottle, if used.
  6. Doff PPE per guidelines and remove the machine from the room with you. Allow the machine to sit for 3 minutes prior to proceeding to the next step
  7. While wearing a new pair of gloves, repeat step 5 using a new AF3 wipe.
  8. Allow the machine to sit for 3 minutes prior to performing the next exam.

Point-of-care ultrasound is becoming an increasingly popular tool in the physician’s arsenal. Ultrasound components can be contaminated with pathogenic organisms and it is not uncommon for an ultrasound machine and its probes to encounter multiple patients and providers within a short period of time. We must keep in mind this ability to act as a fomite and pay attention to our cleaning practices to protect both ourselves and our patients.

Most current guidelines agree with each other and are based on the Spaulding classification. This categorizes medical equipment into different classes based on where they are used (ie clinic vs OR) and how contaminated they get (ie use on skin vs in an open surgical site). If used appropriately, machines/transducers used for POCUS fall under the ‘noncritical’ category and require cleaning followed by low-level disinfection.

The ultrasound machine and transducers must be cleaned after every exam. Ideally, this is done while still in or just outside of the patient’s room. After donning a new pair of gloves, remove the probe cover (if present) and remove all visible gross debris with an AF3 wipe or a soapy washcloth. A washcloth can be helpful for heavily soiled machines. If a washcloth is used, the machine must be allowed to dry before moving on to the next step. Next, using a new AF3 wipe, disinfect (ie wipe down) all probes, probe cords, touch screens, handles, keyboards, gel bottles and any other surfaces that the provider or patient came into contact with. Please disinfect ALL probes and cords regardless of use. This redundancy ensures our machines are properly disinfected. Once disinfected, the machines must be allowed 3 minutes before being used again. This allows the disinfectant adequate time to act.

Probe covers must be used for any exam during which the probe could contact bodily fluids or breached epidermis. This is most commonly encountered during procedural use, such as central venous access, arterial puncture or ultrasound guided injections, but also includes scans over infected or soiled tissue. The sterility of the probe cover is based on the exam being performed (ie a sterile cover is needed for CVC placement; a non-sterile cover can be used to scan over a recent puncture site or draining abscess). Probes used on clean, intact skin do not require a probe cover.

Please avoid using the machines on patients with confirmed or suspected sporogenic infection (most commonly C. dif). Spores are not neutralized by the AF3 wipes and require bleaching (yellow/orange top tub) which rapidly accelerates breakdown of certain parts of the machines.

 


 AIUM’s Guidelines for cleaning ultrasound machines

 ACEP’s guidelines for cleaning ultrasound machines

 ACEP’s COVID19 based guidelines for cleaning ultrasound machines

NMC’s Disinfection and Sterilization guidelines:

NMC’s Disinfection and Sterilization Policy

How to reach NMC Disinfection and Sterilization guidelines


Thank you for doing your part to keep the NMC a safe place to practice and receive care. Contact Daniel Van Kalsbeek, Karl Enroth or Chris Smith with questions or concerns about this page in general. Please contact infection control for questions specific to disinfection policies.

Created June 2020 

Most recent update January 2021