ACEP Guideline on COVID-19: Ultrasound Machine and Transducer Cleaning

This policy is an addendum to the American College of Emergency Physicians (ACEP) policy Guideline for Ultrasound Transducer Cleaning and Disinfection , 2018.

The ACEP Emergency Ultrasound Section wishes to provide guidance for cleaning and disinfection of ultrasound equipment in the context of the coronavirus disease 2019 (COVID-19) pandemic.

Special guidance regarding COVID-19 includes the following:

• 1. Removal of all nonessential equipment before entering the room of a patient with suspected COVID-19.

• This prevents unnecessary items from contamination by droplets and may include removal of nonessential transducers or extraneous items (eg, peripheral intravenous cannulas, plastic film dressing, bags holding towels).

• 2. Clinicians should follow optimal hand hygiene by washing their hands between treating patients and wearing single-use gloves.

• We recommend that before cleaning, clinicians remove gel and debris, and then use one of the Environmental Protection Agency–recommended products in between each patient encounter to disinfect the probe.¹ Clinicians may find it advantageous to use a double-glove technique to help avoid cross contamination from bare hands during the cleaning process.

• 3. When scanning patients who are at low risk for COVID-19 or are not in droplet precautions, we recommend disinfecting the probe and surfaces that were touched during the examination (screen, keyboard, cable, etc).

• Because of recent knowledge that SARS-CoV-2, the causative agent of COVID-19, can be present on surfaces for days, we recommend disinfecting surfaces that come into contact with the patient (cable and transducer), as well as surfaces that are touched by the clinician (keyboard, screen, handlebar, etc).² We recommend that the clinician remove gel and debris, and then use one of the Environmental Protection Agency–recommended products in between each patient encounter.^{1 , 3}

• 4. In situations in which aerosolization or high-risk procedures can occur, probes and machines should be covered (if possible) and disinfected with low-level disinfection (LLD) after every use.

• We recognize that many clinicians will not have access to transparent covers for ultrasound systems. In those cases, the entire ultrasound system and frequently touched surfaces should be disinfected with LLD solution between each patient encounter.⁴

• When an ultrasound examination is performed for critically ill patients requiring active resuscitation where aerosolization is a risk (intubation, medication nebulization, chest compressions, noninvasive ventilation, etc), the machine and its components should be protected as much as possible.^{1 , 5} This includes use of probe covers (sterile and nonsterile) and may involve draping material such as translucent bags. These covers should be discarded before the patient’s room is exited, taking care to avoid cross contamination, in keeping with local infection control recommendations.

• 5. High-level disinfection is not required when ultrasound probes are used on intact skin.

• Please refer to the current ACEP guideline for transducer cleaning and disinfection to determine when to use high-level disinfection.³ There is no evidence that high-level disinfection offers benefit for disinfection from SARS-CoV-2.

• For ultrasound use during procedures (such as peripheral or central venous access), a sterile probe cover should be used, followed by LLD in accordance with the ACEP guideline for transducer cleaning and disinfection.

• 6. Handheld devices may be covered with device covers for both the touch screen and the probe with its cord. All items should be cleaned with LLD after use on each patient.
• 7. Innovative cleaning solutions should be discussed with local infection control and the vendors supplying the machine.

• The stocking of different solutions and products varies across the country, and some systems are facing shortages of certain products. We recommend that, in conjunction with infection control, physicians and health systems consider common disinfectants for cleaning if there are no alternatives to commercial health care products. Examples would include soap and water, diluted bleach, and ammonium chloride derivatives. This should be discussed with the vendor to prevent inadvertent destruction of machine elements.