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Thom C, Livingstone K, Ottenhoff J, Han D, Martindale J, Moak J. Comparison of transvaginal ultrasound utilization between radiology and point of care ultrasound in first trimester pregnancy. Am J Emerg Med 2024; 80:143-148. [PMID: 38604108 DOI: 10.1016/j.ajem.2024.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/12/2024] [Accepted: 03/31/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Transvaginal (TVUS) and transabdominal ultrasound (TAUS) are both utilized in the evaluation of early pregnancy patients. While many practitioners using point of care ultrasound (POCUS) will generally not pursue TVUS in cases where an intrauterine pregnancy (IUP) is visualized on TAUS, this may not be true in Radiology performed ultrasound. OBJECTIVES To evaluate for differences in transvaginal ultrasound (TVUS) utilization between Radiology performed (RP) ultrasound and point of care ultrasound (POCUS) by Emergency Department (ED) physicians in early pregnancy patients. Secondarily, to assess length of stay (LOS) differences and the impact of specialized emergency ultrasound training on TVUS utilization. METHODS This was a retrospective study at a single academic ED. Study population was all ED patients who underwent first trimester ultrasound during the one year period of March 1, 2021 to February 28, 2022. Variables evaluated were chief complaint, gestational age, LOS, TAUS and TVUS utilization, ultrasound findings, and ultrasound specialty training of the ED physician. RESULTS There were 133 cases of POCUS ultrasound and 254 cases of RP ultrasound. All cases had TAUS imaging performed. Median LOS for patients when POCUS was utilized was 207 min (IQR 151-294) and 258 min (IQR 208-328) for those only using RP ultrasound, p ≤ 0.001. In the POCUS cohort, 38% (95% CI 30%-46%) received TVUS, while 94% received TVUS in the RP cohort (95% CI 90%-96%), p ≤ 0.001. Patients seen by ED faculty with ultrasound specialty training had TVUS 53% of the time (95% CI 41%-65%), while those seen by other ED faculty had TVUS 79% (95% CI 74%-83%) of the time, p = 0.035. CONCLUSION POCUS in early pregnancy is associated with a significant reduction in TVUS usage. We suspect that POCUS users elect not to pursue TVUS after an IUP is identified on TAUS, while technicians perform protocol-based TVUS irrespective of TAUS findings. Patients seen by ultrasound trained ED physicians are less likely to receive TVUS.
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Affiliation(s)
| | | | | | - David Han
- University of Virginia Health System, USA
| | | | - James Moak
- University of Virginia Health System, USA
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Chen L, Zhang H, Chang F, Yu H, Lu M, Zhao J, Ma X, Zhou H, Zhou L, Tan J, Wang J, Luo D, Chen M, Yin L. A multicenter study on the effects of different methods of disinfecting medical external-use ultrasound probes. Am J Infect Control 2024; 52:167-175. [PMID: 37295679 DOI: 10.1016/j.ajic.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/02/2023] [Accepted: 06/03/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Microbial contamination of external-use ultrasound probes is a serious and overlooked issue. We assessed the effects of different methods of disinfecting medical external-use ultrasound probes. METHODS On-site disinfection experiments were conducted at 10 hospitals; the tips and sides of external-use ultrasound probes were sampled before and after disinfection, and 3 disinfection methods were assessed (use of a new ultraviolet [UV] ultrasound probe disinfector, wiping with ordinary paper towels or cleaning with disinfectant wipes). RESULTS For the new UV probe disinfector, the median microbial death rates for the tips and sides of the external-use ultrasound probe were 93.67% and 97.50%, respectively, which were higher than those for wiping with paper towels and cleaning with disinfectant wipes (12.50% and 10.00% and 20.00% and 21.42%, respectively); the rates of microorganisms exceeding the standard were 15.0% and 13.3%, respectively, which were lower than those for wiping with paper towels and cleaning with disinfectant wipes (53.3% and 60.0% and 46.7% and 38.3%, respectively). The death rates of different species of microorganisms were high, ranging from 87.5% to 100%. CONCLUSIONS The new UV ultrasound probe disinfector significantly reduced the risk of potential nosocomial infections according to the low microbial death rate for conventional disinfection methods.
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Affiliation(s)
- Lingling Chen
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China; Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China; Ultrasound Medical Quality Control Center of Sichuan Province, Chengdu, Sichuan, China
| | - Hongmei Zhang
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China; Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China; Ultrasound Medical Quality Control Center of Sichuan Province, Chengdu, Sichuan, China
| | - Fan Chang
- Department of Clinical Laboratory Medicine, Sichuan Academy of Medical Sciences & Sichuan Province People's Hospital, Chengdu, Sichuan, China
| | - Hua Yu
- Department of Clinical Laboratory Medicine, Sichuan Academy of Medical Sciences & Sichuan Province People's Hospital, Chengdu, Sichuan, China
| | - Man Lu
- Department of Ultrasound, Sichuan Cancer Hospital, Chengdu, Sichuan, China
| | - Jing Zhao
- Department of Ultrasound, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, Sichuan, China
| | - Xiaojuan Ma
- Department of Ultrasound, Chengdu First People's Hospital, Chengdu, Sichuan, China
| | - Hong Zhou
- Department of Ultrasound, Chengdu Third People's Hospital, Chengdu, Sichuan, China
| | - Liuying Zhou
- Department of Ultrasound, Chengdu Women's and Children's Central Hospital, Chengdu, Sichuan, China
| | - Jing Tan
- Department of Ultrasound, the People's Hospital of Wenjiang District, Chengdu, Sichuan, China
| | - Jingyu Wang
- Department of Ultrasound, the First People's Hospital of Longquanyi District, Chengdu, Sichuan, China
| | - Dingqiang Luo
- Department of Ultrasound, Sichuan Tianfu New Area People's Hospital, Chengdu, Sichuan, China
| | - Min Chen
- Department of Ultrasound, Sichuan Modern Hospital, Chengdu, Sichuan, China
| | - Lixue Yin
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China; Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China; Ultrasound Medical Quality Control Center of Sichuan Province, Chengdu, Sichuan, China.
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Salerno A, Lewiss RE. Rekindling the Relevance of Obstetrical Transvaginal POCUS: Overcoming Barriers to Ensure Patient-Centered Care. POCUS JOURNAL 2023; 8:106-108. [PMID: 38099157 PMCID: PMC10721291 DOI: 10.24908/pocus.v8i2.16855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Affiliation(s)
- Alexis Salerno
- Assistant Professor of Emergency Medicine, Department of Emergency Medicine, University of Maryland School of Medicine
| | - Resa E Lewiss
- Professor of Emergency Medicine, The University of Alabama at Birmingham
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Schinas G, Polyzou E, Spernovasilis N, Gogos C, Dimopoulos G, Akinosoglou K. Preventing Multidrug-Resistant Bacterial Transmission in the Intensive Care Unit with a Comprehensive Approach: A Policymaking Manual. Antibiotics (Basel) 2023; 12:1255. [PMID: 37627675 PMCID: PMC10451180 DOI: 10.3390/antibiotics12081255] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/27/2023] Open
Abstract
Patients referred to intensive care units (ICU) commonly contract infections caused by multidrug-resistant (MDR) bacteria, which are typically linked to complications and high mortality. There are numerous independent factors that are associated with the transmission of these pathogens in the ICU. Preventive multilevel measures that target these factors are of great importance in order to break the chain of transmission. In this review, we aim to provide essential guidance for the development of robust prevention strategies, ultimately ensuring the safety and well-being of patients and healthcare workers in the ICU. We discuss the role of ICU personnel in cross-contamination, existing preventative measures, novel technologies, and strategies employed, along with antimicrobial surveillance and stewardship (AMSS) programs, to construct effective and thoroughly described policy recommendations. By adopting a multifaceted approach that combines targeted interventions with broader preventive strategies, healthcare facilities can create a more coherent line of defense against the spread of MDR pathogens. These recommendations are evidence-based, practical, and aligned with the needs and realities of the ICU setting. In conclusion, this comprehensive review offers a blueprint for mitigating the risk of MDR bacterial transmission in the ICU, advocating for an evidence-based, multifaceted approach.
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Affiliation(s)
- Georgios Schinas
- Department of Medicine, University of Patras, 26504 Patras, Greece; (G.S.); (E.P.); (C.G.); (K.A.)
| | - Elena Polyzou
- Department of Medicine, University of Patras, 26504 Patras, Greece; (G.S.); (E.P.); (C.G.); (K.A.)
- Department of Internal Medicine and Infectious Diseases, University General Hospital of Patras, 26504 Patras, Greece
| | | | - Charalambos Gogos
- Department of Medicine, University of Patras, 26504 Patras, Greece; (G.S.); (E.P.); (C.G.); (K.A.)
| | - George Dimopoulos
- 3rd Department of Critical Care, Evgenidio Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Karolina Akinosoglou
- Department of Medicine, University of Patras, 26504 Patras, Greece; (G.S.); (E.P.); (C.G.); (K.A.)
- Department of Internal Medicine and Infectious Diseases, University General Hospital of Patras, 26504 Patras, Greece
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Desai SR, Tang L, Hwang NC. Infection Control for Perioperative Ultrasonography and Echocardiography. J Cardiothorac Vasc Anesth 2022; 36:4440-4448. [PMID: 36123263 DOI: 10.1053/j.jvca.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/04/2022] [Accepted: 08/12/2022] [Indexed: 11/11/2022]
Abstract
Ultrasound technology has revolutionized point-of-care diagnostics, decision-making, and the guidance of interventional procedures in Anesthesiology and Perioperative Medicine. Recent literature has highlighted important infection control considerations when performing transesophageal or transthoracic echocardiography, point-of-care ultrasound, and ultrasound-guided procedures. This narrative review focuses on operator precautions and disinfection methods and summarizes key recommendations from the international Echocardiography and Radiology Societies.
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Affiliation(s)
- Suneel Ramesh Desai
- Department of Anaesthesiology, Singapore General Hospital, Singapore; Department of Cardiothoracic Anaesthesia, National Heart Centre, Singapore; Department of Surgical Intensive Care, Singapore General Hospital, Singapore
| | - Leonard Tang
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - Nian Chih Hwang
- Department of Anaesthesiology, Singapore General Hospital, Singapore; Department of Cardiothoracic Anaesthesia, National Heart Centre, Singapore.
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Ultrasound-Guided Great Saphenous Vein Access: Revisiting an Old Friend in a New Location. J Emerg Med 2022; 62:191-199. [PMID: 34996672 DOI: 10.1016/j.jemermed.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 08/27/2021] [Accepted: 10/12/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Early recognition of difficult intravenous (i.v.) access and use of ultrasound-guided techniques prior to multiple attempts are important steps in improving patient care in the emergency department (ED). Success rates for ultrasound-guided peripheral i.v. (PIV) cannulation are affected by depth, size of target vessel, and predictability of anatomy. The great saphenous vein (GSV) in the medial distal thigh may provide an alternative site for ultrasound-guided cannulation in cases of difficult peripheral venous access. OBJECTIVES Our objective was to determine the feasibility of ultrasound-guided GSV PIV placement as an alternative site for patients with difficult i.v. access. METHODS Participants were prospectively enrolled from a convenience sample of patients presenting to the ED in June and July 2019. Inclusion criteria were age 18 years and older, and a history of difficult i.v. access or two unsuccessful nursing staff attempts. Ultrasound-guided access was conducted with an in-plane or out-of-plane approach on the basis of proceduralist preference. RESULTS Twenty patients were enrolled; 1 patient withdrew consent prior to cannulation. GSV cannulation was successful in 14 (73.7%) of the 19 patients. Phlebotomy, blood transfusion, i.v. medications including norepinephrine, and i.v. computed tomography contrast medium were successfully performed via GSV access. No reported infection, thrombosis, or extravasation was identified throughout the cannulation dwell time, hospitalization, or for 72 h after discharge. CONCLUSION Ultrasound-guided GSV PIV placement is a feasible alternative in situations of difficult i.v. access. No unforeseen complication or safety issue was identified. Blood products, medications, and contrast medium were successfully administered safely.
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Burton L, Bhargava V, Kong M. Point-of-Care Ultrasound in the Pediatric Intensive Care Unit. Front Pediatr 2022; 9:830160. [PMID: 35178366 PMCID: PMC8845897 DOI: 10.3389/fped.2021.830160] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/29/2021] [Indexed: 12/30/2022] Open
Abstract
Ultrasonography has been widely used in medicine for decades but often by specific users such as cardiologists, obstetricians, and radiologists. In the last several years, the use of this imaging modality has moved to the bedside, with clinicians performing and interpreting focused point of care ultrasonography to aid in immediate assessment and management of their patients. The growth of point of care ultrasonography has been facilitated by advancement in ultrasound-related technology and emerging studies and protocols demonstrating its utility in clinical practice. However, considerable challenges remain before this modality can be adopted across the spectrum of disciplines, primarily as it relates to training, competency, and standardization of usage. This review outlines the history, current state, challenges and the future direction of point of care ultrasonography specifically in the field of pediatric critical care medicine.
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Van Kalsbeek D, Enroth K, Lyden E, Rupp ME, Smith CJ. Improving hospital-based point-of-care ultrasound cleaning practices using targeted interventions: a pre-post study. Ultrasound J 2021; 13:43. [PMID: 34664118 PMCID: PMC8522855 DOI: 10.1186/s13089-021-00244-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) devices are becoming more widely used in healthcare and have the potential to act as fomites. The objective of this project was to study the thoroughness of cleaning of POCUS machines before and after a quality improvement initiative. We designed a mixed-methods, pre/post study which took place over the course of one year at a university-affiliated health center. Cleaning rates of four ultrasound machines used by hospital medicine and critical care medicine services were evaluated using fluorescent marking. Interventions targeted physicians' knowledge of best practices and improved access to cleaning supplies. Pre- and post-intervention cleaning rates were compared using a generalized linear model. The impact of the corona virus disease of 2019 (COVID-19) pandemic on baseline cleaning rates was also evaluated. Physicians' attitudes and knowledge of cleaning practices were evaluated via unpaired pre/post surveys. RESULTS There was significant improvement in thoroughness of cleaning following intervention (pre 0.62, SE 0.05; post 0.89, SE 0.07), p < 0.0001). There was no difference in baseline cleaning rates before (0.63, SE 0.09) and after (0.61, SE 0.1) the onset of the COVID-19 pandemic (p = 0.78). Post-intervention surveying found improved understanding of guideline-based cleaning practice, better performance on knowledge-based questions, and fewer reported barriers to machine cleaning. CONCLUSION Thoroughness of cleaning of POCUS machines can be improved with practical interventions that target knowledge and access to cleaning supplies.
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Affiliation(s)
- Daniel Van Kalsbeek
- Department of Internal Medicine, 982055 Nebraska Medical Center, Omaha, NE, 68198-2055, USA.
| | - Karl Enroth
- Department of Internal Medicine, 982055 Nebraska Medical Center, Omaha, NE, 68198-2055, USA
| | - Elizabeth Lyden
- Department of Biostatistics, 984375 Nebraska Medical Center, Omaha, NE, 68198-4375, USA
| | - Mark E Rupp
- Department of Internal Medicine, Division of Infectious Diseases, 985400 Nebraska Medical Center, Omaha, NE, 68198-5400, USA
| | - Christopher J Smith
- Department of Internal Medicine, Division of Hospital Medicine, 986430 Nebraska Medical Center, Omaha, NE, 68198-6430, USA
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Choi J, Lee M, Lee Y, Song Y, Cho Y, Lim TH. Effectiveness of Plasma-Treated Hydrogen Peroxide Mist Disinfection in Various Hospital Environments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9841. [PMID: 34574763 PMCID: PMC8467658 DOI: 10.3390/ijerph18189841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/14/2021] [Accepted: 09/14/2021] [Indexed: 11/30/2022]
Abstract
Hospital environments are associated with a high risk of infection. As plasma-treated hydrogen peroxide mist disinfection has a higher disinfection efficacy, we tested the efficacy of plasma-treated hydrogen peroxide mist disinfection on several surfaces in various hospital environments. Disinfection was performed in 23 rooms across different hospital environments, including hospital wards, outpatient departments (OPDs), and emergency rooms. A total of 459 surfaces were swabbed before/after disinfection. Surfaces were also divided into plastic, metal, wood, leather, ceramic, silicone, and glass for further analyses. Only gram-positive bacteria were statistically analyzed because the number of gram-negative bacteria and mold was insufficient. Most colony-forming units (CFUs) of gram-positive bacteria were observed in OPDs and on leather materials before disinfection. The proportion of surfaces that showed a percentage decrease in CFU values of more than 90% after disinfection were as follows: OPDs (85%), hospital wards (99%), and emergency rooms (100%); plastic (97%), metal (83%), wood (84%), leather (81%), and others (87%). Plasma-treated hydrogen peroxide mist disinfection resulted in a significant decrease in the CFU values of gram-positive bacteria in various environments. Plasma-treated hydrogen peroxide mist disinfection is an effective and efficient method of disinfecting various hospital environments.
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Affiliation(s)
- Jongbong Choi
- Department of Biomedical Engineering, Hanyang University, Seoul 04763, Korea; (J.C.); (M.L.)
| | - Minhyuk Lee
- Department of Biomedical Engineering, Hanyang University, Seoul 04763, Korea; (J.C.); (M.L.)
| | - Yangsoon Lee
- Department of Laboratory Medicine, College of Medicine, Hanyang University, Seoul 04763, Korea;
| | - Yeongtak Song
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Korea; (Y.S.); (Y.C.)
| | - Yongil Cho
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Korea; (Y.S.); (Y.C.)
| | - Tae Ho Lim
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Korea; (Y.S.); (Y.C.)
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Andolfo A, Maatoug R, Peiffer-Smadja N, Fayolle C, Blanckaert K. Emergency ward ultrasound: clinical audit on disinfection practices during routine and sterile examinations. Antimicrob Resist Infect Control 2021; 10:25. [PMID: 33516268 PMCID: PMC7847554 DOI: 10.1186/s13756-021-00896-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 01/21/2021] [Indexed: 11/10/2022] Open
Abstract
Context In the emergency ward, where the use of ultrasound is common (including for sterile procedures), ward equipment is constantly exposed to high risks of microbiological contamination. There are no clear guidelines for disinfection control practices in emergency departments, and it is not known how emergency ward doctors follow good hygiene practices. Method A multi-centre audit was conducted in 16 emergency services from Northern France regional hospitals, in form of a questionnaire. It was proposed to all emergency ward physicians. We excluded questionnaires when physicians mentioned that they did not use ultrasound on a daily basis. The questionnaire was designed using existing hygiene and ultrasound disinfection practices guidelines from varying French medical societies. It included three different clinical scenarios: (a) ultrasound on healthy skin, (b) on injured skin, and (c) ultrasound-guided punctures. All questions were closed-ended, with only one answer corresponding to the guidelines. We then calculated compliance rates for each question, each clinical situation, and an overall compliance rate for all the questions. Results 104 questionnaires were collected, and 19 were excluded. For the 85 analysed questionnaires, the compliance rates were 60.4% 95% CI [56.4–64.7] for ultrasound on healthy skin, 70.9% 95% CI [66.3–76.1] on injured skin and 69.4% 95% CI [65.1–73.6] for ultrasound-guided punctures. The overall compliance rate for the compliance questions was 66.1% 95% CI [62.8–69.1]. Analysis of the questionnaires revealed severe asepsis errors, misuse of gel, ignorance of infection control practices to be applied in the context of ultrasound-guided puncture and exposure of the probe to body fluids. Conclusion This study details areas for quality improvement in the disinfection of emergency ultrasound scanner use. Consequently, we propose a standardized protocol based upon the recommendations used for the questionnaire drafting, with a visual focus on the low compliance points that have been revealed in this audit. This protocol has been distributed to all the medical emergency services audited and included in the emergency resident’s ultrasound learning program.
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Affiliation(s)
- A Andolfo
- Service d'accueil des urgences/Structure mobile d'urgence et de reanimation, Centre Hospitalier de Dunkerque, 59140, Dunkirk, France.
| | - R Maatoug
- AP-HP, Service de Psychiatrie Adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, Sorbonne Université, 75013, Paris, France
| | - N Peiffer-Smadja
- French Institute for Medical Research (Inserm), Infection Antimicrobials Modelling Evolution (IAME), UMR 1137, University Paris Diderot, Paris, France.,National Institute for Health Research Health Protection Research Unit in Healthcare. Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - C Fayolle
- Service de Réanimation et Unité de Soins Continus, Centre Hospitalier de Dunkerque, 59140, Dunkirk, France
| | - K Blanckaert
- Centre d'appui et de prevention des infections associees aux soins (CPIAS) Pays de la Loire, Centre Hospitalier Universitaire de Nantes, 44093, Nantes, France
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Dehbozorgi A, Mousavi-Roknabadi RS, Hosseini-Marvast SR, Sharifi M, Sadegh R, Farahmand F, Damghani F. Diagnosing skull fracture in children with closed head injury using point-of-care ultrasound vs. computed tomography scan. Eur J Pediatr 2021; 180:477-484. [PMID: 33118087 PMCID: PMC7594935 DOI: 10.1007/s00431-020-03851-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 11/28/2022]
Abstract
Diagnostic and therapeutic interventions in children for traumatic brain injury, which is known as the most important complication in trauma, require special attention. This study aimed to evaluate the accuracy of point-of-care ultrasound (POCUS) in diagnosing skull fracture in children with closed head injury in comparison with computed tomography (CT) scan. The current prospective cross-sectional study was conducted on children (0-14 years old), who were referred to the emergency department of a general teaching hospital in Shiraz, southern Iran (January-March 2018), with close head injury and were suspected of bone fracture. The participants were selected using a convenience sampling. The results of POCUS performed by emergency medicine (EM) residents were compared with the results of CT scan, which was reported by radiologists and considered a gold standard. Then, diagnostic tests were calculated. A total of 168 children were enrolled, with the mean ± standard deviation age of 6.21 ± 3.99. The most affected areas in the skull were the frontal (34.5%) and occipital areas (33.3%). POCUS had a sensitivity and specificity of 81.8% (95%CI, 48.2-97.7%) and 100% (95%CI, 97.7-100%), respectively. Positive and negative predictive values were 100% and 98.7%, with an accuracy of 98.8% in comparison with CT scan in the diagnosis of skull fracture.Conclusion: The results showed that POCUS with a portable ultrasonography machine, performed by the EM's physicians, have high diagnostic precision and can be considered a tool in the management of patients with closed head injury. What is Known: • Some studies have investigated the accuracy of ultrasound in diagnosing skull bone fractures in children with closed head injury, but before conducting this survey, no definite evidence recommended POCUS for skull fracture in children with closed head trauma in the ED. What is New: • POCUS with a portable ultrasonography machine, performed by the EM's physicians, has high diagnostic precision and can be considered a tool in the management of patients with closed head injury.
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Affiliation(s)
- Afsaneh Dehbozorgi
- Emergency Medicine Department, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Seyed Rouhollah Hosseini-Marvast
- Emergency Medicine Department, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. .,Emergency Medicine Department, Faculty of Medicine, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, 7193711351, Iran.
| | - Mehrdad Sharifi
- Emergency Medicine Department, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Robab Sadegh
- Emergency Medicine Department, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Faramarz Farahmand
- Emergency Medicine Department, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Damghani
- Emergency Medicine Department, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Moureau N, Gregory E G. Survey of ultrasound-guided peripheral intravenous practices: a report of supply usage and variability between clinical roles and departments. ACTA ACUST UNITED AC 2020; 29:S30-S38. [PMID: 33104435 DOI: 10.12968/bjon.2020.29.19.s30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The purpose of this study was to investigate ultrasound-guided peripheral intravenous (UGPIV) supply usage practices by clinicians working in vascular access, in emergency departments (EDs), or in other roles. METHODOLOGY In 2019, a voluntary cross-sectional descriptive survey was conducted via SurveyMonkey. Data collected included demographics, practice-oriented information, procedural activities, and supplies used for UGPIV insertions. Frequency distributions and results of Fisher's exact test and one-way analysis of variance were reported using R v.3.5.2. RESULTS A total of 26,649 surveys were distributed with a response rate of 5.5% (n = 1475). Forty-eight percent of respondents (n = 709) indicated that they worked in a vascular access role, 310 (21%) worked in an ED, and 455 (31%) categorized their role as other. Clinically meaningful differences existed in all variables for UGPIV procedures and supplies between departments (P < 0.0001) and in all care settings. Using an investigatorconstructed overall metric of supplies used, important differences were demonstrated between personnel supply use in vascular access roles and other roles (P < 0.0001) and personnel in EDs and other roles (P < 0.0001). CONCLUSIONS Use of supplies for UGPIV insertions varies by department. The variability in supply usage for UGPIV insertions revealed by this survey suggests a need for clinical education on guideline application and evaluation of compliance with policies to promote standardization of supplies for UGPIV insertion.
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Affiliation(s)
- Nancy Moureau
- PhD, RN, CRNI, CPUI®, VA-BCTM, PICC Excellence, Inc., Hartwell, GA; Griffith University, Brisbane, Australia; Alliance for Vascular Access Teaching and Research (AVATAR) Group Queensland Griffith University, Brisbane, Australia; Infinity Infusion Nursing, Satsuma, AL
| | - Gilbert Gregory E
- EdD, MSPH, PStat, SigmaStats® Consulting, LLC., Charleston, SC; Biostatistics and Medical Writing, Real World Evidence Strategy & Analytics, ICON Commercialisation & Outcomes Services, North Wales, PA
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Raissaki M, Vakaki M, Kotziamanis A, Alexopoulou E, Koumanidou C, Karantanas A. Operation of ultrasonography services in a dedicated paediatric hospital and a university hospital in Greece under the COVID-19 pandemic. Pediatr Radiol 2020; 50:1325-1332. [PMID: 32638053 PMCID: PMC7339090 DOI: 10.1007/s00247-020-04725-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/27/2020] [Accepted: 05/18/2020] [Indexed: 12/13/2022]
Abstract
Ultrasonography (US) is one of the most common diagnostic imaging tests in children. During the coronavirus disease 2019 (COVID-19) pandemic, it is important to operate with a plan designed to protect health care workers, to prevent transmission of infection from child and parents to another child or an accompanying person in the US suite, and to save valuable protective material and resources. Measures during routine US in children can be challenging both in general hospitals with paediatric units and in dedicated paediatric hospitals. Special considerations include: a) cancellation or rescheduling of unnecessary imaging tests, b) a relevant questionnaire on the request form informing about patient and accompanying person's symptoms and likely exposure in addition to general triage, c) appropriate patient and parent protective measures, d) recruitment and selection of US machines in different protected areas depending on the possibility or certainty for the infection, e) regular personnel protective measures and personal hand hygiene, f) routine disinfection of probes and adjacent surfaces and g) machine/room deep disinfection, if required. Our purpose is to present the modified US services in children during the COVID-19 pandemic in two hospitals based on the instructions of the national organization of public health in Greece and what is known about the mode of transmission of the virus.
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Affiliation(s)
- Maria Raissaki
- Department of Radiology, University Hospital and Medical School, University of Crete, Stavrakia Voutes, 71110, Crete, Greece.
| | - Marina Vakaki
- Paediatric Radiology Department, "P&A.Kyriakou" Children's Hospital, Athens, Greece
| | | | - Efthymia Alexopoulou
- Department of Radiology, General University Hospital Attikon, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Chrisoula Koumanidou
- Paediatric Radiology Department, "P&A.Kyriakou" Children's Hospital, Athens, Greece
| | - Apostolos Karantanas
- Department of Radiology, University Hospital and Medical School, University of Crete, Stavrakia Voutes, 71110, Crete, Greece
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Ilyas F, Burbridge B, Babyn P. Health Care-Associated Infections and the Radiology Department. J Med Imaging Radiat Sci 2019; 50:596-606.e1. [PMID: 31623975 PMCID: PMC7104925 DOI: 10.1016/j.jmir.2019.07.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 07/01/2019] [Accepted: 07/29/2019] [Indexed: 12/12/2022]
Abstract
Health care-associated infections (HCAIs) are a significant concern for both health care workers (HCWs) and patients. They are a major contributing factor of disease in industrialized countries, and are responsible for significant morbidity, mortality, and a direct annual financial loss of $6-7 billion in North America alone. They are an increasingly challenging health issue due to multidrug-resistant pathogens such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococci among others, along with an increasing number of susceptible patients. Over the last three decades, the risk of HCAIs has increased in the radiology department (RD) in part because of an increased number of patients visiting the department and an increase in the utilization of imaging modalities. In this review, we will discuss how patients and staff can be exposed to HCAIs in the RD, including contaminated inanimate surfaces, radiology equipment, and associated medical devices. As the role of medical imaging has extended from primarily diagnosis to include more interventions, the implementation and development of standardized infection minimization protocols and infection control procedures are vital in the RD, particularly in interventional radiology. With globalisation and the rapid movement of people regionally, nationally, and globally, there is greater risk of exposure to contagious diseases such as Ebola, especially if infected patients are undiagnosed when they travel. For effective infection control, advanced training and education of HCWs in the RD is essential. The purpose of this article is to provide an overview of HCAIs as related to activities of the RD. We will discuss the following major topics including the variety of HCAIs commonly encountered, the role of the RD in HCAIs, transmission of infections to patients and HCWs in the RD, standard infection prevention measures, and the management of susceptible/infected patients in the RD. We shall also examine the role of, and the preparedness of, HCWs, including RD technologists and interventional radiologists, who may be exposed to undiagnosed, yet infected patients. We shall conclude with a brief discussion of the role of further research related to HCAIs. Learning Objectives After the completion of this review article, the readers will • Understand the exposure and role of radiology department in health care-associated infections, • Know the causes/modes/transmission of infections in radiology department, • Be conscious of standard disinfection protocols, • Be aware of current and future strategies required for the effective control of health care-associated infection in the radiology department. This is a CME article and provides the equivalent of 2 hours of continuing education that may be applied to your professional development credit system. A 10-question multiple-choice quiz follows this reading. Please note that no formalized credit (category A) is available from CAMRT.
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Affiliation(s)
- Fatima Ilyas
- Department of Medical Imaging, University of Saskatchewan, Royal University Hospital, 103 Hospital Drive, Saskatoon, Saskatchewan, Canada.
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15
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Pichon M, Lebail-Carval K, Billaud G, Lina B, Gaucherand P, Mekki Y. Decontamination of Intravaginal Probes Infected by Human Papillomavirus (HPV) Using UV-C Decontamination System. J Clin Med 2019; 8:jcm8111776. [PMID: 31653074 PMCID: PMC6912769 DOI: 10.3390/jcm8111776] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/17/2019] [Accepted: 10/22/2019] [Indexed: 12/03/2022] Open
Abstract
Background: This three-step study evaluated ultraviolet-C (UV-C) efficacy against human papillomavirus (HPV) found on vaginal ultrasound probes. Methods: The first two steps evaluated UV-C disinfection of vaginal ultrasound probes in routine condition. During the first phase, the probe (n = 100) was sampled after a complete cleaning and disinfection protocol, i.e., cleaning with chemically impregnated wipes, followed by UV-C. During the second phase, the probe (n = 47) was sampled after cleaning and UV-C. The final step consisted of applying mixes of HPV on a dedicated, covered probe (n = 15) then sampling the cover, the probe after removal of the cover, after cleaning, and after UV-C. HPV detection was performed using CLART® HPV2 PCR (Genomica, Madrid, Spain). Results: In the first phase, no probes were found to be positive for both DNA after UV-C. In the second phase, eight probes were found to be positive after cleaning (seven with human DNA and one with HPV) and negative after UV-C. In the final phase, one probe was found to be positive for HPV for each sample except after UV-C. Conclusions: Covers followed by a chemically impregnated wipe are not sufficient to ensure patient safety during vaginal ultrasound examinations. UV-C is effective in routine conditions against contaminations found on vaginal ultrasound probes, especially HPV.
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Affiliation(s)
- Maxime Pichon
- University Hospital of Poitiers, Bacteriology and Infection Control Laboratory, Infectious Agents Department, 86021 Poitiers CEDEX, France.
| | - Karine Lebail-Carval
- Hospices Civils de Lyon, Département de Chirurgie Gynécologique, Hôpital Femme-Mère-Enfant, 69000 Lyon-Bron, France.
| | - Geneviève Billaud
- Hospices Civils de Lyon, Laboratoire de Virologie, Institut des Agents Infectieux, Groupement Hospitalier Nord, 69317 Lyon CEDEX 04, France.
| | - Bruno Lina
- Hospices Civils de Lyon, Laboratoire de Virologie, Institut des Agents Infectieux, Groupement Hospitalier Nord, 69317 Lyon CEDEX 04, France.
| | - Pascal Gaucherand
- Hospices Civils de Lyon, Département de Chirurgie Gynécologique, Hôpital Femme-Mère-Enfant, 69000 Lyon-Bron, France.
| | - Yahia Mekki
- Hospices Civils de Lyon, Laboratoire de Virologie, Institut des Agents Infectieux, Groupement Hospitalier Nord, 69317 Lyon CEDEX 04, France.
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Krepkogorskiĭ NV, Ignat'ev IM, Bredikhin RA. [Use of thermal imager in preparation of non-reversed autovein for femoropopliteal bypass grafting]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2019; 25:118-123. [PMID: 31149998 DOI: 10.33529/angio2019215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Presented herein is an original method of preparing a bypass graft (a non-reversed autovein for femoropopliteal and femorotibial bypass grafting) and assessment of quality of valvulotomy using a thermal imager. The study included a total of 31 patients. All patients subdivided into 2 groups were subjected to bypass grafting operations with the use of a non-reversed autovein. In group 1 (n=16) prior to applying a bypass graft we assessed its patency with the use of an original method by means of a thermal imaging camera. In group 2 (n=15) assessment of graft patency after destruction of valves was not performed. In group 1 there were no bypass graft thromboses in the postoperative period, whereas three (20%) patients in group 2 developed bypass graft thrombosis within the first 24 postoperative hours, requiring repeat operation. Bypass graft thrombosis was caused in all cases by insufficiently destroyed valves of the venous transplant. There were no lethal outcomes within 1 year postoperatively. Control ultrasonographic examination after 1 year revealed bypass graft thrombosis in two (13.3%) patients in group 2, leading to the development of critical ischaemia and gangrene in one (6.6%) of these patients and later on requiring limb amputation at the level of the femur. A conclusion drawn is that thermal imaging makes it possible to intraoperatively assess quality of valvulotomy in using a non-reversed autovein as a bypass graft and to improve the results of surgical treatment.
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Affiliation(s)
- N V Krepkogorskiĭ
- Interregional Clinical and Diagnostic Centre, Kazan, Russia; Department of Cardiovascular and Endovascular Surgery of the Faculty of Advanced Training and Professional Retraining of Specialists, Kazan State Medical University of the RF Ministry of Public Health, Kazan, Russia
| | - I M Ignat'ev
- Interregional Clinical and Diagnostic Centre, Kazan, Russia; Department of Cardiovascular and Endovascular Surgery of the Faculty of Advanced Training and Professional Retraining of Specialists, Kazan State Medical University of the RF Ministry of Public Health, Kazan, Russia
| | - R A Bredikhin
- Interregional Clinical and Diagnostic Centre, Kazan, Russia; Department of Cardiovascular and Endovascular Surgery of the Faculty of Advanced Training and Professional Retraining of Specialists, Kazan State Medical University of the RF Ministry of Public Health, Kazan, Russia
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Prats MI, Nelson BP, Gold DL, Branditz LD, Boulger CT, Bahner DP. CLEAR: A Novel Approach to Ultrasound Equipment Homeostasis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:767-773. [PMID: 30121948 DOI: 10.1002/jum.14757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 06/20/2018] [Accepted: 06/20/2018] [Indexed: 06/08/2023]
Abstract
Protocols for the sanitation and maintenance of point-of-care ultrasound (US) equipment are lacking. This study introduces the CLEAR protocol (clean, locate, energize, augment supplies, and remove patient identifiers) as a tool to improve the readiness of US equipment, termed US equipment homeostasis. The state of US equipment homeostasis in the emergency department of a single academic center was investigated before and after implementing this protocol, with an improvement in outcomes. These findings demonstrate that the CLEAR protocol can improve US homeostasis. CLEAR can function as a teaching tool to promote homeostasis as well as a checklist to assess compliance.
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Affiliation(s)
- Michael I Prats
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Bret P Nelson
- Department of Emergency Medicine, Division of Emergency Ultrasound, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Delia L Gold
- Department of Pediatrics, Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Lauren D Branditz
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Creagh T Boulger
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - David P Bahner
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Evaluation of emergency department ultrasound machines for the presence of occult blood. CAN J EMERG MED 2018; 21:395-398. [PMID: 30277177 DOI: 10.1017/cem.2018.447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Bedside ultrasound in the emergency department is a common diagnostic tool, especially when evaluating trauma patients. Many trauma patients have blood on their chest and abdomen that may contact the probe during examination. The primary aim of this study was to investigate whether occult blood contamination was present on the emergency department ultrasound machine, both after daily use and after use in trauma. METHODS For a period of 31 days, the ultrasound machine at the trauma centre emergency department in Saskatoon, Saskatchewan, was tested once daily and following all Level 1 traumas. The ultrasound machine probes and keyboard were swabbed, and contamination was detected using a commercially available phenolphthalein blood testing kit. Any visible blood contamination was also noted. The machine was then cleaned following each positive test and re-tested to ensure the absence of contamination. RESULTS Over the study period, the ultrasound machine tested positive for occult blood contamination on 10% of daily tests and on 43% of assessments after its use in trauma. The curvilinear probe was most frequently contaminated (daily, 6%; trauma, 26%), followed by the keyboard (daily, 3%; trauma, 26%), but both lacked visible contamination. CONCLUSIONS In this single centre study, there was evidence of occult blood on the emergency department ultrasound machine after both routine use and major trauma cases, highlighting the need for a standardized cleaning and disinfection protocol.
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O'Connor TP, Garton N, Jones C, Estephan M, Lu M, Adler D. Emergency physician utilization of transvaginal ultrasound after initiation of revised sterilization protocol. Am J Emerg Med 2018; 37:789-791. [PMID: 30201239 DOI: 10.1016/j.ajem.2018.08.077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 10/28/2022] Open
Affiliation(s)
| | - Nathan Garton
- University of Rochester Medical Center (URMC), United States
| | - Courtney Jones
- University of Rochester Medical Center (URMC), United States
| | | | - Michael Lu
- University of Rochester Medical Center (URMC), United States
| | - David Adler
- University of Rochester Medical Center (URMC), United States
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Liang SY, Riethman M, Fox J. Infection Prevention for the Emergency Department: Out of Reach or Standard of Care? Emerg Med Clin North Am 2018; 36:873-887. [PMID: 30297010 PMCID: PMC6203442 DOI: 10.1016/j.emc.2018.06.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Stephen Y Liang
- Division of Emergency Medicine, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8072, St Louis, MO 63110, USA; Division of Infectious Diseases, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8051, St Louis, MO 63110, USA.
| | - Madison Riethman
- Communicable Disease, Clark County Public Health, Center for Community Health, 1601 East Fourth Plain Boulevard, Building 17, PO Box 9825, Vancouver, WA 98666, USA
| | - Josephine Fox
- Infection Prevention, Barnes-Jewish Hospital, Mailstop 90-75-593, 4590 Children's Place, St Louis, MO 63108, USA
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21
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Transducer Disinfection for Evaluation and Insertion of Peripheral and Central Catheters for Vascular Access Teams and Clinicians. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.java.2018.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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How Safe Is the Ultrasonographically Guided Peripheral Internal Jugular Line? Ann Emerg Med 2017; 71:132-137. [PMID: 28969927 DOI: 10.1016/j.annemergmed.2017.08.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Indexed: 11/23/2022]
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Gottlieb M, Sundaram T, Holladay D, Nakitende D. Ultrasound-Guided Peripheral Intravenous Line Placement: A Narrative Review of Evidence-based Best Practices. West J Emerg Med 2017; 18:1047-1054. [PMID: 29085536 PMCID: PMC5654873 DOI: 10.5811/westjem.2017.7.34610] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/12/2017] [Accepted: 07/10/2017] [Indexed: 11/30/2022] Open
Abstract
Peripheral intravenous line placement is a common procedure in emergency medicine. Ultrasound guidance has been demonstrated to improve success rates, as well as decrease complications and pain. This paper provides a narrative review of the literature focusing on best practices and techniques to improve performance with this procedure. We provide an evidence-based discussion of preparation for the procedure, vein and catheter selection, multiple techniques for placement, and line confirmation.
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Affiliation(s)
- Michael Gottlieb
- Rush University Medical Center, Department of Emergency Medicine, Chicago, Illinois
| | - Tina Sundaram
- Rush University Medical Center, Department of Emergency Medicine, Chicago, Illinois
| | - Dallas Holladay
- Rush University Medical Center, Department of Emergency Medicine, Chicago, Illinois
| | - Damali Nakitende
- Rush University Medical Center, Department of Emergency Medicine, Chicago, Illinois
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Russotto V, Cortegiani A, Raineri SM, Giarratano A. Bacterial contamination of inanimate surfaces and equipment in the intensive care unit. J Intensive Care 2015; 3:54. [PMID: 26693023 PMCID: PMC4676153 DOI: 10.1186/s40560-015-0120-5] [Citation(s) in RCA: 156] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 12/02/2015] [Indexed: 11/24/2022] Open
Abstract
Intensive care unit (ICU)-acquired infections are a challenging health problem worldwide, especially when caused by multidrug-resistant (MDR) pathogens. In ICUs, inanimate surfaces and equipment (e.g., bedrails, stethoscopes, medical charts, ultrasound machine) may be contaminated by bacteria, including MDR isolates. Cross-transmission of microorganisms from inanimate surfaces may have a significant role for ICU-acquired colonization and infections. Contamination may result from healthcare workers’ hands or by direct patient shedding of bacteria which are able to survive up to several months on dry surfaces. A higher environmental contamination has been reported around infected patients than around patients who are only colonized and, in this last group, a correlation has been observed between frequency of environmental contamination and culture-positive body sites. Healthcare workers not only contaminate their hands after direct patient contact but also after touching inanimate surfaces and equipment in the patient zone (the patient and his/her immediate surroundings). Inadequate hand hygiene before and after entering a patient zone may result in cross-transmission of pathogens and patient colonization or infection. A number of equipment items and commonly used objects in ICU carry bacteria which, in most cases, show the same antibiotic susceptibility profiles of those isolated from patients. The aim of this review is to provide an updated evidence about contamination of inanimate surfaces and equipment in ICU in light of the concept of patient zone and the possible implications for bacterial pathogen cross-transmission to critically ill patients.
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Affiliation(s)
- Vincenzo Russotto
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anaesthesia, Analgesia, Intensive Care and Emergency, University Hospital Paolo Giaccone, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Andrea Cortegiani
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anaesthesia, Analgesia, Intensive Care and Emergency, University Hospital Paolo Giaccone, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Santi Maurizio Raineri
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anaesthesia, Analgesia, Intensive Care and Emergency, University Hospital Paolo Giaccone, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Antonino Giarratano
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anaesthesia, Analgesia, Intensive Care and Emergency, University Hospital Paolo Giaccone, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
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