Author: Gail Crawford

Clean, Clean, Clean – Minimise Risk, Minimise Exposure!

Posted on by Gail Crawford

Clean, Clean, Clean – Minimise Risk, Minimise Exposure!

Clean, Clean, Clean – Minimise Risk, Minimise Exposure, “Social Distance”…. this is all I have heard for the past two weeks.  But still as Sonographers we can’t “Socially Distance”.

Everyone is implementing strict guidelines in the Health Profession as to who can be seen/assessed and who should be rebooked at a later date following a quarantine period. Private practices that I am involved with now only allow the patient in the room, unless a carer or guardian is required (limiting any unnecessary exposure from a third person).  This includes obstetric patients, so sadly no partners are allowed.  Facetime is being implemented at some locations for partner interaction😊

Sonographers in the hospital settings are being regularly updated with strict protocols around dealing with COVID-19 positive or suspected positive patients.  Appropriate PPE is being provided, along with detailed cleaning instructions, scan times etc.

But what I wanted to focus on was looking after ourselves “The Sonographer” and those other health practitioners that are in close contact with a patient for extended periods of time, in the LOW risk setting (i.e. no current indication of COVID-19 exposure).

Patients will continue needing our essential ultrasound services.  Pregnant women will need their routine screening, we will be needed to exclude ectopic pregnancies, DVTs and appendicitis.  Acute Cholecystitis cases will still need our attention.  We might see a drop in Musculoskeletal as sporting activities are limited, but may in time to come, need to perform chest Ultrasounds for suspected pneumonia.

How can we minimise our risk and exposure?  This is a fast-moving entity.  Some key learnings that have been consolidated are:

COVID 19 (Officially – SARS-CoV-2)

·        Can be airborne for up to 3 hours.

·        Can remain active on hard/shiny surfaces for up to 72 hours

·        Can remain traceable on porous surfaces(Cardboard/Paper/Fabrics) for up to 24 hours

Work Attire:

  • If you don’t have scrubs, or a uniform. Consider some easy-care cotton clothing (used solely for work).
  • Ensure sleeves are short (to ensure optimal hand washing techniques).
  • Remove uniform at work, bag and bring home (could bag in pillowcase). Everything into the wash immediately.  Hot wash with detergent is recommended.
  • Shoes (closed in specific for work). Leave at the clinic/or at the front door before entering the home, reducing the risk of the virus entering the home.

Hand Cleanliness:

  • We are all aware that hand cleanliness is essential; it goes without saying…. Gloves at all times. Ensure hand washing techniques with soap and water  are up to date/hand sanitiser is utilised appropriately.

Ultrasound room:

  • Remove all unnecessary items from the room.
  • No bed linen to be used, with beds to be cleaned after every patient.
  • Ultrasound Machine and probes to be cleaned after every patient.
  • Clean the door handles and desk/ keyboard regularly through the day.

Please review the cleaning products you are using:

Word of Warning………

  • Ensure cleaning products kill viruses not just “Bacteria”.
  • Refer to your specific Ultrasound vendor in relation to probe cleaning (As probes can be sensitive to some cleaning products). All vendors have released appropriate cleaning products to combat COVID-19.

US Environmental Protection agent list of disinfectants for use against SARS-CoV-2, can be found at his website:

https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2

Face Masks (Appropriate PPE):

As sonographers we can’t socially distance. I know a lot of sonographers in LOW risk clinics are concerned about PPE, especially face masks.

We are all aware that correct specification face masks are in short supply – N2/N95 masks (95% effective). – PLEASE ensure that if using these, please use correctly and maintain a full seal.

Guidelines: https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/diseases-infection/infection-prevention/transmission-precautions/p2n95-mask

Dr Jill Lee Cheng Sim (Singapore), also suggested as a barrier “3 ply masks”, for low risk personal (these don’t have a complete seal and thus tiny particles can get through).  But it is a good baseline.

Alternatively, due to short supply I have been researching “cloth masks”.  My mother has kindly made a prototype and currently making more for my Sonographer friends and colleagues.  There is very limited research on the topic and with such a fast paced virus pandemic, not a great deal of time to trial.  From a research paper in 2013 Davies et al conclusion was  “Our findings suggest that a homemade mask should only be considered as a last resort to prevent droplet transmission from infected individuals, but it would be better than no protection”. https://www.ncbi.nlm.nih.gov/pubmed/24229526.

“In a low risk setting I think this is definitely feasible”

Lunch/Tea Room:

  • Avoid sharing cups/ mugs in the tearoom. Take your own keep cup if you use the staff room and avoid the communal tea towels etc.  Always maintain personal hygiene etiquette (Social Distancing). As this is how health care workers in Wuhan enabled the disease unknowingly.
  • Also pay attention to frequently used areas such as toilets/bathrooms, light switches/door handles. Use appropriate hand washing/hand sanitising techniques.

Minimise examination time:

  • Scans should be performed efficiently to reduce patient contact time (but by no means does this mean reducing the quality of the examination). This means if a bladder is 3/4 full for a renal, scan them as they present. If the scan requires further prep to be diagnostic, rebook them. Do not leave patients in the room or department to fill. For obstetrics scans, send the patient offsite for a walk and then rescan.

Mental Health:

  • While the entire world is grappling to contain the coronavirus, there is a huge emotional and physiological side to this virus. Please everyone be mindful of your mental health.  Continue talking to your peers about your concerns.  Let’s work at a team to get through this together.  Keep up your physical health (exercise is a fantastic stress release), take up a hobby, stay connected with friends and family and remember this is only temporary.  We CAN and WILL get through this.

We all need to stick together at these tough times.  Stay safe.

Please feel free to touch base with questions/discussion or if you would like a homemade mask (Just as a low risk temporary measure)😊

Gail

Director/Tutor Sonographer/Sonographer

Integrated Ultrasound Education

gail@iuc.consulting.com.au

 

Other articles which may be of interest:

 

References:

  1. Davies A, Thompson KA, Giri K, Kafatos G, Walker J, BennettA.   Testing the efficacy of homemade masks: would they protect in an influenza pandemic? Disaster Med Public Health Prep.2013 Aug;7(4):413-8. doi: 10.1017/dmp.2013.43.
  2. Neeltje van Doremalen, Trenton Bushmaker, Dylan H. Morris, Myndi G. Holbrook, Amandine Gamble, Brandi N. Williamson, Azaibi Tamin, Jennifer L. Harcourt, Natalie J. Thornburg, Susan I. Gerber, James O. Lloyd-Smith, Emmie de Wit, Vincent J. Munster. Aerosol and Surface Stability of SARS-CoV -2 as Comparted with SARS-CoV-1.  New England Journal of Medicine, 2020; DOI: 1056/NEJMc2004973
  3. National Institute of Allergy and Infectious Diseases’ Laboratory of Virology in the Division of Intramural Research in Hamilton, New England Journal of Medicine, 2020
  4. https://www.huffingtonpost.com.au/entry/how-long-coronavirus-live-clothing-washing_l_5e724927c5b6eab779409e74
  5. https://ww2.health.wa.gov.au/~/media/Files/Corporate/general%20documents/Infectious%20diseases/PDF/Coronavirus/COVID19-Environmental-Cleaning-for-workplaces.pdf
  6. https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2
  7. https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/diseases-infection/infection-prevention/transmission-precautions/p2n95-mask

 

COVID-19 – “The Sonographers Dilemma”

Posted on by Gail Crawford

COVID-19 – “The Sonographers Dilemma”

This is a personal account of my feelings, thoughts and learnings as a Sonographer/Tutor Sonographer in a Private Practice setting in Australia!

Are your anxiety levels running high?  Mine are!

I’m worried about my elderly Grandparents (90 and 92), my parents, and all of those friends and family in the community who have weaker immunity.

How is this Corona Virus Pandemic going to play out in your region?

How do we as Sonographers help contain the spread, and keep ourselves safe when we are UNABLE to  maintain “Social distancing”.  As Sonographers our patients are close, and we are often in the room with them for 20-30 minutes at a time.

Currently in Australia where I am based, confirmed numbers are relatively low.  But anxiety levels are excessive.  My question especially as a Sonographer in a Private Practice setting, is how do we keep ourselves safe/limit our exposure, to the active virus?  How do we ensure that we don’t contribute to the spread? To our patients and our loved ones?

Currently we are following the Australian Government Department of Health Guidelines (https://www.health.gov.au/)

  • People who have been overseas in the past 14 days are required to self-isolate and will not be examined (can postpone appointment)
  • People who have come into contact with a confirmed case of COVID-19 are also required to self-isolate for 14 days and will not be examined (can postpone appointment)
  • People who have a fever are also asked to re-schedule their appointment.

But what about those people who may have contracted the virus via community transmission (unknowingly) and are asymptomatic.  These are the people we sonographers my encounter.

I watched the ISUOG webinar on the 17/03/2020  and want to share “ my personal key learnings” from the speakers.  The entire webinar can be found at:

Prof Francesco Castelli (Italy), accentuated how quickly the virus spreads, and that it is highly infectious amongst health workers.   He also said that often first testing of the virus can provide a False negative reading…. So be cautious.  If clinical symptoms fit, then treat as COVID-19 as precaution.  He also said that once testing positive, it may take up to 3 weeks for a patient to be non-infectious (not be contagious).

Dr Jill Lee Cheng Sim (Singapore), discuss how the Singaporean health care system had learnt from the SARS outbreak in 2009, where 25% of health care workers were infected.  To date on 1% of health care workers have been infected with the COVID-19 virus.

This is attributed to:

  • Protective equipment and good infection control training.
  • General preventative measures and PPE use.

Also remember to support colleagues, be aware of Mental and social health.

Prof Liona Poon (HK) stated that they wear a mask at all times whilst at work and that even at lunch personal hygiene etiquette (Social Distancing) should be maintained.  This is how health care workers in Wuhan enabled the disease unknowingly.  The appropriate masks have been stated as N2/N95.  That staff in Hong Kong also change their clothes and shower prior to coming home.  Preventing any spread via clothing.

A guide to the correct use of the N2/N95 mask can be found at this site:

https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/diseases-infection/infection-prevention/transmission-precautions/p2n95-mask

I have started implementing my learnings from Tuesdays nights Webinar immediately.  Here is a photo of me with my new fashion accessory  “N2 mask” (Getting use to the feeling on my face)….. trying not to hyperventilate😊

I am continuing with all my usual behaviours also.  Gloving for all patients, cleaning the room and probes thoroughly between patients.

Changed my clothes prior to leaving work and showered as soon as I got home!

We all need to stick together at these tough times.  Stay safe.

Please feel free to touch base with questions/discussion😊

Gail

Director/Tutor Sonographer/Sonographer (Integrated Ultrasound Education)

Email: gail@iuc.consulting.com.au

 

 

 

Aortic Dissection – Not something you see every day!

Posted on by Gail Crawford

Aortic Dissection – Not something you see every day!

When you are asked to perform an Abdominal Ultrasound examination, with vague clinical history = “Ongoing back/loin pain for 10 years”.

My first thought is pathology such as: ? Kidney pathology ? Genuine Back pain.  NOT Aortic dissection.

 

What causes an Aortic Dissection?

The Aorta is one of the major blood vessels that transports blood around the body.  It’s wall is made up of three layers:

  • Tunica intima, tunica media and tunic adventitia.

A dissection occurs with a tear in the intima.  Blood enters this space and tears the intima layer away from the media layer, in effect generating a false channel/lumen.

In some life-threatening cases, it can cause a rupture in all three layers.  Alternatively, if it only affects one or two layers, resulting in generalised back/flank pain can be felt and is treatable if detected early.

True cause is unknown, however Aortic dissections generally occur in:

  • Males aged 50-70.
  • > high blood pressure
  • Conditions such as Marfans Syndrome, Ehlers-Danlos Syndrome, Turners Syndrome.
  • Rare complication of Third Trimester pregnancy and post-partum.
  • Blunt trauma.
  • Complication following surgery i.e. Mitral valve replacement.
  • Use of cocaine.

Following the Stanford classification there is two types of Dissections:

  • Type A which involves the ascending aorta and arch – Surgical Management required.
  • Type B involves the descending aorta – Medical management and blood pressure monitoring.
  • Patients can also have a combination of both – This was the case with my particular patient.

Symptoms:

Generally, symptoms can be similar to that of a heart attack, however specifically the following are indicators:

  • Chest/back pain (Sever)
  • Sudden onset of abdominal pain (Sever)
  • Abnormal blood pressures/change in pulses between arms
  • Loss of consciousness.
  • Leg pain/difficulty walking
  • Shortness/loss of breath

Ultrasound appearances on Ultrasound:

  • Intimal flap on Ultrasound, has both a high sensitivity and specificity for a dissection.

Ultrasound being portable, rapid and easily accessible makes initially diagnosis ideal.

Optimal Imaging for correct diagnosis:

  • Plain Chest Xray (CXR) – Aortic Dissection can be overlooked on a CXR in 12-18% of cases.
  • Arterial enhanced contract CT (CTA). Gold Standard.
  • Multi-planar transesophageal echocardiography.
  • Rapid non contrast MRI (Good for review, but maybe utilised more in acute evaluation).
  • Conventional digital subtraction Angiography (DSA) (However generally replaced by CTA).

Treatment:

  • Surgery – Removal of the dissected aorta or blocking of the channel where blood is entering into the aortic wall is performed. Reconstruction is made with synthetic grafts/stents/tubing, and mesh.
  • Medication – Medication is used to lower blood pressure and prevent the dissection from getting worse.
  • Follow up treatment – Generally lifelong blood pressure medication and ongoing CTA/MRI for review.

References: