In view of the challenges of the current Corona virus (COVID-19) pandemic and with the aim of protecting both patients and ultrasound providers (physicians, sonographers, allied professionals), the European Academy of Neurology Scientific Panel on Neurosonology is issuing the following recommendations for the performance of neurosonology investigations.
- Each country should follow follows national and international guidelines for the performance of routine or targeted neurosonology investigations. The decision as to what constitutes an elective or an emergency examination is to be decided locally.
- Elective examinations should be postponed, especially in elderly or in high risk patients.
- The ultrasound room should be cleaned thoroughly and disinfected each morning/day and all contents should be wiped with a compatible disinfectant: ultrasound machine monitor, computer keyboard and mouse, stretchers, transducers holders, gel container, door handles, cabinet knobs, light switches, chairs and all other furniture or equipment. Gel containers and transducers could be protected with transparent plastic foil that should be changed after each patient. At the end of the day, soiled linen should be handled using two pairs of gloves and disposed of in the appropriate container without shaking the linen. The room and equipment should undergo terminal cleaning using appropriate disinfectant. Hands should be washed for 20 seconds afterwards and disinfected with appropriate disinfectant (containing medical alcohol of at least 70%).
- Transducers and ultrasound equipment must be cleaned with a compatible disinfectant after each patient, in accordance with local guidelines. Gel containers and transducers could be protected with transparent plastic foil cover which should be changed after each patient.
Protecting the patient and ultrasound providers
- Screen all patients and visitors using standardized checklists for symptoms of acute respiratory infection and risk factors for COVID infection. Triage should be undertaken before the patient arrives to the ultrasound unit/laboratory; for this purpose, it may be appropriate to contact the patient by telephone call before arriving at the hospital, clinic or ultrasound laboratory. In some countries control points at hospital/surgery entries have been installed. Visitors should stay outside the hospital/surgery or at least examination room.
- Ultrasound providers with specific health problems that place them at greater risk (as detailed by local occupational health guidelines) may be excluded from performing elective ultrasound examinations.
- Always use a three-ply surgical mask when performing ultrasound scans. Latex-free disposable gloves should be used during the ultrasound examination and changed after each patient.
- Appropriate hand hygiene is imperative before and after direct patient contact. If it is not possible to wash hands, hand sanitizer can be used.
Neurosonology examination of patients with suspected or confirmed COVID-19 infection
- All attending medical staff should use appropriate protective equipment: N95 or FFP2 masks, goggles or face protective shield, full-sleeved gown and extended cuff gloves prior to entering the examination room.
- A bedside scan with the patient in situ is strongly recommended, whenever possible applying the above mentioned procedure for transducers and equipment cleaning and disinfection.
- If possible, it is recommended to have at least one dedicated ultrasound machine for patients with suspected/probable/confirmed COVID-19 infection.
- If the patient must be scanned in the clinic, this should be done at the end of the session, as the room and equipment will subsequently require a deep clean.
- Whenever possible, use telemedicine methods (i.e. for discussion of difficult or challenging cases, remote second opinion etc.)
Other considerations:
- Quarantine and isolation of doctor/sonographer may be required after contact with a patient who was not considered to be at risk of COVID-19 infection but was subsequently tested positively, and this doctor/sonographer should follow facility work schedule arrangements, with immediate reporting to local authorities about possible exposure to COVID-19.
- Additional ultrasound capacity may be required for anticipated increase in demand for emergency examinations, thus non-essential examinations should be deferred or cancelled to minimize exposure of an at-risk group of patients to potential COVID-19 contact in the hospital environment.
- If possible, designated team members to perform neurosonology examinations for acute Stroke patients, and designated rooms for follow up visits.
Authors: Milija Mijajlovic, David Skoloudik, Manfred Kaps, Claudio Baracchini
References
WFUMB Position Statement: How to perform a safe ultrasound examination and clean equipment in the context of COVID-19.
AIUM Quick Guide on COVID-19 Protections-Patient and Ultrasound Provider Protection.
CDC. Center for Disease Control Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings. 2020.
National Center for Immunization and Respiratory Diseases (NCIRD) DoVD. Environmental Cleaning and Disinfection Recommendations. www.cdc.gov/coronavirus/2019-ncov/community/organizations/cleaning-disinfection.html.
Agency USEP. List N: Disinfectants for Use Against SARS-CoV-2. www.epa.gov/pesticide-registration/list-n-disinfectantsuse-against-sars-cov-2. Published March 20, 2020.