por John R. Fischer
, Senior Reporter | June 15, 2020
A number of safety precautions can protect healthcare workers from contracting and spreading COVID-19 when overseeing ultrasound exams, according to a new study.
A group of physicians at Singapore General Hospital have developed and implemented a guide for clinically updating the step-by-step workflow of diagnostic ultrasound to prevent the nosocomial transmission of the virus to frontline service providers.
“Nosocomial transmission of coronavirus disease (COVID-19) to frontline healthcare workers is well known, and healthcare workers may inadvertently become vectors for onward transmission,” said the authors in their study. “Ultrasound service providers are at significant risk because scanning usually requires prolonged close patient contact. The bulky ultrasound equipment may also facilitate fomite transmission of disease. With increasing use of point-of-care and portable diagnostic US services, the risk is substantial.”
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The guidelines instruct that inpatient scans be vetted for clinical urgency and COVID-19 status. Singapore General Hospital also divides US services into the tertiary hospital and a colocated community hospital, and requires rooms with negative pressure ventilation to be used solely for isolation case scans. Ultrasound equipment is inspected to prevent failure during the exam and covered with disposable plastic, and all patients and visitors are required to wear face masks, with each patient restricted to one accompanying person.
Outpatient ultrasound services are physically segregated into two locations, general ultrasound and subspecialty ultrasound. Every outpatient request is vetted and prioritized according to clinical urgency, with inpatients forbidden to move to the outpatient scan area, to prevent cross contamination.
The hospital allows for abbreviated scan protocols, although scanning time may not be significantly shortened. Sick patients who are unable to fully cooperate with the exam must be treated carefully so as to protect against breaks in staff protection.
Patients not suspected of having the virus arrive at a specified ultrasound imaging center through a predefined route, while those who are confirmed or suspected to have it receive portable bedside US service by a sonographer and an attending radiologist. Intensive care patients or those in reverse isolation due to an immunocompromised state also receive portable bedside US service. The authors recognize that pairing an on-duty radiologist and sonographer together does reduce throughput but asserts that it is essential to ensure no repeat scans or additional imaging will be needed.
“This is in contrast to our regular inpatient portable US workflow in which a trained sonographer performs the scan alone and uploads the images (usually for several patients consecutively), and the images are then sent to a dedicated radiologist for reporting,” said first author Dr. Apoorva Gogna in a statement, adding that simple steps such as rearranging seating in outpatient waiting areas can help US departments abide by social distancing guidelines.
In addition, two imaging staff members are designated as a non-patient contact and a direct patient contact to prevent the number of people potentially exposed to the disease. Staff, mostly segregated by location or time, can also be assigned to standby teams to cover personal shortages.
The findings were published in the American Journal of Roentgenology (AJR)