HOCUS POCUS in the ED - Hygienic Operation, Cleanliness, and Unsafe Storage of Point-of-Care Ultrasound within the Emergency Department


Emily Hancock, Dr Richard Chatoor, Dr Michael Davoren, Gillian Ophel, Dr John Preddy, Dr Syed Omar Harris

Background

Point-of-care ultrasound (POCUS) has become an essential piece of diagnostic equipment in emergency departments around the world. However, concerns have been raised as to whether POCUS machines could act as a vector for bacterial and viral transmission when aseptic guidelines are not adhered to.

Methods

An observational audit was conducted on the POCUS machines within the Wagga Wagga Base Hospital (WWBH) Emergency Department (ED) assessing cleanliness and safe storage. Additionally, random bacterial swabs were taken from the ultrasound probe to identify bacterial contamination. Finally, interviews were conducted with WWBH ED staff to evaluate current knowledge and implementation of the Australasian Society for Ultrasound in Medicine (ASUM) guidelines and to identify reasons for poor compliance.

Results

Our study has clearly demonstrated that adherence with ASUM guidelines for cleaning and sterilising POCUS between patients is inadequate with potential for cross infection and nosocomial infections. Used ultrasound gel, dirt and blood were observed visually on the POCUS machine transducers at the time of inspection 37%, 23% and 7% respectively. Furthermore, several potentially pathogenic bacteria were isolated from swabs taken from ultrasound probes prior to use. Finally, we found that the most commonly identified barriers to ASUM guideline adherence were - a lack of education regarding cleaning guidelines and a lack of cleaning equipment.

Conclusion

Compliance with the ASUM guidelines regarding POCUS reprocessing is poor and lower than a level that is clinically acceptable. Incorrect sterilisation and hygiene practices may facilitate bacterial transmission with the potential for nosocomial infections and possibly adverse patient outcomes. The main barriers identified were lack of education and cleaning equipment. We would suggest that an education program should be developed and delivered to all clinicians using POCUS in order to increase compliance with ASUM guidelines. Furthermore, appropriate cleaning equipment should be available to be used prior to patient contact. These recommendations are analogous to hand washing between patient contact.