Ultrasound is often used by vascular access teams and nurses to guide certain vascular access procedures, such as placing PICC lines or difficult access peripheral IVs (PIVs). Improving patient safety and outcomes is needed for vascular access interventions, and there are other specific considerations when using ultrasound.
Infection prevention in vascular access is a widely discussed topic, and this post will outline research and guidelines specific to ultrasound-guided procedures.
Medical facilities exist to care for and improve the health of their patients. However, a major concern for patients is the risk of getting an infection during a procedure or hospital stay. Healthcare-associated infections (HAIs) are acquired while patients receive health care for another condition1 and can occur 48 to 72 hours after treatment.2
A previous blog post took you through the necessary steps for cleaning ultrasound transducers in How to Clean an Ultrasound Probe. Cleaning is a fundamental step that cannot be skipped before you disinfect the ultrasound probe. Now we’ll go over the process of high-level disinfecting an ultrasound probe. Since there’s a lot to cover, we’ve broken it up into two parts.
Cleaning is a mandatory first step in the high-level disinfection process of intracavity ultrasound transducers, such as transesophageal and endocavity probes. Healthcare workers may use ‘pre-cleaning’ and ‘cleaning’ interchangeably.
Properly cleaning the probe optimizes the disinfection process and the American Institute for Ultrasound in Medicine (AIUM) states that “adequate transducer preparation is mandatory.”1 If you skip the cleaning step or perform it inadequately, you will compromise the entire disinfection or sterilization process.
Fine needle aspiration biopsies (FNAs) are common procedures performed by physicians around the world, in facilities large and small. An FNA procedure utilizes thinner needles (21-27 gauge) to extract tissue samples from a patient’s discovered lesion, which pathology uses to diagnose whether the lesion is malignant or benign1. FNAs can be done on many anatomic sites, but are typically performed on a lymph node, thyroid gland, breast, liver, or pancreas2.
Infection prevention and control is a major focus of healthcare facilities to 1) lower the risk of patients contracting healthcare acquired infections (HAIs), 2) reduce costs that occur with HAIs, and 3) maintain compliance with The Joint Commission (TJC).
In 2017, The Joint Commission released new data showing that many hospitals seeking accreditation continue to struggle with meeting infection control Standard IC.02.02.01: “The hospital reduces the risk of infection associated with medical equipment, devices, and supplies.”1 It is well known that the process of cleaning and high-level disinfecting ultrasound probes (which are considered semi-critical devices per the CDC, FDA, and Spaulding Classification) is crucial for infection control and patient safety.2
Proper reprocessing of devices involves a multi-step workflow that must be managed carefully to ensure the risk of contamination is controlled and minimized at every step. Because the process is a progressive workflow, the effectiveness of each reprocessing step is only as reliable as the steps before and after it.
Why is it so important to practice sterile technique during vascular access procedures as a part of the overall infection control protocol in ultrasound? Before we help answer that question, let’s look at a few numbers regarding some of the potential complications from vascular access procedures1,2:
Patient safety and maintaining The Joint Commission (TJC) accreditation standards are two of the most important (if not THE most important) objectives of today’s healthcare administrators and practitioners. However, they are often two of the most difficult objectives of which to achieve 100% satisfaction or compliance.
When ultrasound is used for point-of-care needle guided procedures, including vascular access or regional anesthesia, it is recommended by the FDA and the CDC that a single-use, disposable probe cover be used on the ultrasound probe for each procedure.