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Journal of Diagnostic Medical Sonography. Infection Control and Hospital Epidemiology. The Cincinnati Childrens blog features thoughts and perspectives from our experts on all things pediatric health. 2013;34(8):850-3, 7. Insights Imaging. The types of procedures for which a medium viscosity gel may be a more appropriate choice include: These gels tend to be preferred for procedures that involve large surface areas. Well send you a link to a feedback form. "`9 C:6W!J* Gaillot O, Maruejouls C, Abachin E, Lecuru F, Arlet G, Simonet M. Nosocomial Outbreak of Klebsiella pneumoniae Producing SHV-5 Extended-Spectrum -Lactamase, Originating from a Contaminated Ultrasonography Coupling Gel. It has a sticky consistency, allowing it to be spread over the skin without dripping or running off. If you have an opportunity to experience an ultrasound scan in the future, please do not feel uncomfortable with ultrasound gel. p88u$J03B3,59 r~"kR!*.=q.o9!g_SMkr>nXMa=b$bUF_.wM-DBJ#R 74 0 obj <> endobj For these procedures, the energy being transmitted is electrical instead of acoustic. 2000;21(12):761-4, 25. Gel should be stored according to manufacturers guidelines in areas free of excessive moisture and sources of potential contamination. Ultrasound in Medicine and Biology. This document provides guidance on the safe use of ultrasound gel to reduce risk of transmission of infection arising from these products. The ultrasound gel doesnt have to be warm, but it is kept warm for patients. American Journal of Infection Control. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. Spratt HG, Levine D, Tillman L, Physical therapy clinic therapeutic ultrasound equipment as a source for bacterial contamination. 84 0 obj <>/Filter/FlateDecode/ID[<9B13191353F58B4988C0C9FABC5DB64A>]/Index[74 25]/Info 73 0 R/Length 67/Prev 177535/Root 75 0 R/Size 99/Type/XRef/W[1 2 1]>>stream However, the larger the difference in acoustic characteristics between the two tissues, the stronger the reflection and the stronger the echo (white on the screen) appears. Ultrasound Transducer The warming of gel is not recommended unless there is a clinical benefit that outweighs applying gel at room temperature. It is suitable for all procedures where a viscous gel is required. So although it might be a messy exam, an ultrasound study is an excellent tool for imaging our young patients. The CWG recommends removing gel and advising patients to wash the area when feasible. EcoVue is a water-soluble ultrasound gel that wipes off easily, without drying, flaking, or leaving a residue behind. NHS Digital. 2021;10(1):1, Journal of Ophthalmic Inflammation and Infection. You can change your cookie settings at any time. endstream endobj 75 0 obj <> endobj 76 0 obj <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Type/Page>> endobj 77 0 obj <>stream The core working group recommend that if the tip of a pre-filled bottle touches another surface/person, the bottle tip should be cleaned with a disinfectant wipe immediately. Provenzano DA, Liebert MA, Steen B, Lovetro D, Somers DL, Investigation of current infection-control practices for ultrasound coupling gel: A survey, microbiological analysis, and examination of practice patterns. [Korean] . It includes additional guidance including on scenarios when sterile gel is recommended and what types of gel containers should be used. Such outbreaks have typically included serious clinical infections (1 to 5, 8). Specifically designed to warm EcoVue Ultrasound Gel.. To help us improve GOV.UK, wed like to know more about your visit today. Because there are differing opinions by researchers and experts as to whether it is a dangerous toxin or a harmless compound, HR Pharmaceuticals has opted out of using them in our products, including EcoVue Ultrasound Gel. Wavelength Low Viscosity Ultrasound Gel is a thin and runny gel for use as a conductive agent in therapeutic ultrasound, diagnostic imaging and other external procedures. [Korean] , . Although standard disinfection procedures can be effective at removing microbes from sites where these procedures are to take place, application of contaminated ultrasound gel could allow penetration of microbes into skin ducts, glands and follicles where they are less accessible to disinfectant (20 to 22). Furthermore, in many situations, it is not possible to remove 100% of the gel. endstream endobj startxref 19. Medium viscosity gels are general purpose and are suitable for a wide variety of procedures. Ultrasound image should show the difference between the tissues in body (normal-lesion, etc. Olshtain-Pops K, Block C, Temper V, Hidalgo-Grass C, Gross I, Moses AE, and others, An outbreak of achromobacter xylosoxidans associated with ultrasound gel used during transrectal ultrasound guided prostate biopsy. Check benefits and financial support you can get, Ultrasound gel: good infection prevention practice, When to use sterile and non-sterile ultrasound gel, Appendix 1: types of gel containers mentioned in this guidance, nationalarchives.gov.uk/doc/open-government-licence/version/3, which gel to use in various clinical situations is available here, Guidelines for Professional Ultrasound Practice, Guidelines for infection prevention and control in Sonography: Reprocessing the In view of prolonged use and storage of gel, exposure to air (facilitating bacterial replication), and the potential for multiple patient exposures, the group recommended that only pre-filled disposable bottles are used (9, 25). Also, it is reported that bacteria exist in the gel in some cases, so it is recommended to discard the gel immediately if it is used at the wound site or in children or newborns. 2012;33(12):1235-7, 32. They are 20 grams of just the right amount of nonsterile gel, which reduces product waste and eliminates the risk of cross contamination. Journal of Hospital Infection. 100% Privacy. There is a risk of infection if contaminated gel is left on a patients skin and minimal evidence to inform what constitutes adequate removal. BMC Proc. clinicians and practitioners using ultrasound gel in their practice in healthcare settings, including: any user such as: sonographers, radiologists, intensivists, midwives, vascular access specialists, emergency department and medical clinicians, physiotherapists, nurses, and health care assistants, healthcare providers (NHS and independent) of facilities providing ultrasound services, this guidance should be considered in the wider context of standard IPC precautions, though patient safety is paramount, the environmental impact associated with adhering to this guidance needs to be considered, while evidence and expert consensus have been used to inform this guidance, local risk assessments could be used to augment these recommendations, for invasive procedures, that is any ultrasound-guided procedure that involves passing a device through skin into sterile tissue, such as intravenous line insertion or fine needle aspirate, if an invasive procedure is likely or planned on or near the site in the following 24 hours this includes viewing or initial assessment of a site by ultrasound prior to undertaking an (aseptic) invasive procedure. They also enhance skin health of the patient. In such circumstances, preceding use of non-sterile gel should not delay the procedure, but particular emphasis should be placed on appropriate gel removal and thorough antiseptic skin preparation in line with local policy for the procedure. The Journal of the Korean Orthopaedic Association Volume 48 Number 5. Journal of Clincial Microbiology. Free Ground Shipping over $75 (restrictions apply), Home Electrotherapy Transmission Gel / Lotion. The use of sterile gel 24 hours before a likely or planned invasive procedure was considered by the subject matter experts from the CWG as a pragmatic precaution to mitigate the risk of infection. Used for sterile or non-sterile gel. Wang M ZL, Xia S, Wu H, Zhang R, Fan M, Wang T. An investigation on surgical-site infection among post cesarean section patients with Burkholderia cepacia contaminated ultrasonic couplant. 12. As a result, therapists will normally prefer a gel with greater staying power for these treatments, i.e. 2021;11(1):12, 14. 2. S[U7Y4zG3*dHXJcuq+,),i%KRW.siCzsvqo;]iwBz6v=.qs ,;lzl!=WdNS>C W,q B:\X&T!v |AYLmY {Pphl,6g}|c$}#Mkj@^ w!?/D]q! Higher viscosity gels tend to be preferred by most sonographers, especially when performing: As a result, higher viscosity gels tend to be preferred for procedures such as the following: Higher viscosity are also generally preferred for longer lasting non ultrasound procedures. The gel packets and bottles are kept in a warmer to ensure patient comfort during the exam. 98 0 obj <>stream 1991;35(4):627-31, 23. 2019;47(9):1157-9, 29. 2006;11(2):61-71, Antimicrobial Resistance and Infection Control. Hello? To solve this situation, the gel is used. This replaces interim guidance first published by Public Health England (PHE), now the UK Health Security Agency (UKHSA), in January 2021 and is an outcome of close collaboration between UKHSA and key stakeholders with expertise relating to the use of ultrasound in UK settings (see Production and feedback section). Immunocompromised individuals should be determined by clinical risk assessment, where practical, and are at increased risk of infection and/or adverse outcome from exposure to contaminated ultrasound gel (1, 16). Sterile ultrasound gel in single-use containers should be used in the following scenarios: Non-sterile ultrasound gel in single use and multi-patient use containers may be used: to avoid wastage, single use non-sterile ultrasound gel sachets may be preferable in areas where gel is used infrequently. 2017;45(9):954-8, An outbreak of Pseudomonas aeruginosa respiratory tract infections associated with intrinsically contaminated ultrasound transmission gel. Helping to maintain the patients skin health. These types of gels have more staying power and cling to the skin more than lower viscosity gels. Journal of Ophthalmic Inflammation and Infection. Dec. 2012 , Volume. Higher viscosity gels will tend to resist gravity more. Contains ultrasound gel for current use on more than one patient bottle is not refillable and is discarded when empty after one month or on expiry date, whichever comes first. The outside of the bottle and other ultrasound equipment can act as a potential source of contamination and spread microbes between patients (28, 29). Selwyn S, Ellis H, Skin Bacteria and Skin Disinfection Reconsidered. Hell M, Abel C, Albrecht A, Wojna A, Chmelizek G, Kern JM, and others, Burkholderia cepacia outbreak in obstetric patients due to intrinsic contamination of non-sterile ultrasound gel. Note: use of these containers is not recommended. Weist K, Wendt C, Petersen LR, Versmold H, Ruden H, An outbreak of pyodermas among neonates caused by ultrasound gel contaminated with methicillin-susceptible Staphylococcus aureus. Im @Radiologist. In the Ultrasound Division, we write the expiration date on every bottle as soon as it is opened. during examinations in areas involving intact skin: in examinations that do not involve invasive procedures, more than 24 hours prior to a probable invasive procedure at or near the same site, ensure healthcare workers carry out hand hygiene before and after use of ultrasound gel, gel should be stored according to manufacturers instructions in an area that is dry and away from potential sources of contamination, dispose of container if it appears soiled, is damaged or is out of date, ensure that only unopened sachets and containers that are labelled as sterile are used, do not reuse the container or sachet once opened, either with other patients or stored and reused with the same patient, as sterile gels are single use only, gel should not be decanted from a larger container into other bottles, use single-use sachets or pre-filled, multi-patient disposable bottles, once opened, date the bottle and dispose of it when either empty, after one month or on expiry date, whichever comes first, clean the whole bottle, including the tip, with a disinfectant wipe between uses, tip/nozzle of bottle should not come into contact with anything if it does, clean immediately with a disinfectant wipe, after the procedure remove all residual gel from the patients skin and advise patients to wash area when feasible, if an invasive procedure is subsequently undertaken within 24 hours of the use of non-sterile gel at or near to the site, then ensure all residual gel is removed, and the skin is thoroughly cleaned using antiseptic skin preparation in line with local policy for the procedure (note: sterile ultrasound gel should normally be used in advance of invasive procedures as detailed in the, use dry heat warmers instead of warm water, gel bottles should be kept upright in warmers and not inverted, warmers should be cleaned regularly according to the manufacturers instructions, where these exist, or clean according to local guidance, Medicines and Healthcare products Regulatory Agency, National Health Service (NHS) England and NHS Improvement, National Health Service (NHS) Supply Chain, National Infusion and Vascular Access Society, representatives from Public Health Wales, Public Health Agency Northern Ireland and NHS National Services Scotland, people with cancer who are undergoing active chemotherapy, people with lung cancer who are undergoing radical radiotherapy, people with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment, people having immunotherapy or other continuing antibody treatments for cancer, people having other targeted cancer treatments that can affect the immune system, such as protein kinase inhibitors or PARP inhibitors, people who have had bone marrow or stem cell transplants in the last 6 months or who are still taking immunosuppression drugs, people with severe respiratory conditions including cystic fibrosis, severe asthma and severe chronic obstructive pulmonary disease (, people with diseases that significantly increase the risk of infections (such as severe combined immunodeficiency (, people on immunosuppression therapies sufficient to significantly increase risk of infection. Because opened gel bottles should be thrown away after one month, the CWG recommends that single-use sachets would reduce waste in low-use areas. Journal of Urology. 1998;39:309-14. In addition, the energy is being transmitted into the patients body instead of the other way around. Lotions can usually be used as alternatives to general purpose medium viscosity gels. While getting a clear image is the goal of using ultrasound gel, it should not compromise the comfort or safety of your patient. Water baths have been identified as a means of contamination for medical gel and other medical supplies/instruments, supporting the recommendation that dry heat should be used if gel is warmed (25, 31, 32). @#G%-fUK ^#9`*"LY9V+ C+&@lq\^W879=qZ^[(2r^;T]wD[7HQ`':2zddKFT Formulated to be 35% thicker than the original formula. However, the same principle applies. %%EOF Physiotherapy theory and practice. Dont include personal or financial information like your National Insurance number or credit card details. There are rare skin side effects such as contact dermatitis. 50 . In other words, the gel can also insert into the human body. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gov.uk. News stories, speeches, letters and notices, Reports, analysis and official statistics, Data, Freedom of Information releases and corporate reports. Antimicrobial Resistance and Infection Control. Susan C. Oleszkowicz et al. It also reduces or eliminates static. This is why these gels are also known as transmission gels. In other words, when the acoustic resistance of the two media is made equal by using gel, ultrasonic waves are transmitted to body without reflection. Some patients prefer to use a lotion instead of a gel for their ultrasound procedures. endstream endobj 78 0 obj <>stream Note: use of these bottles is not recommended. And, as always, our single-use packets are available in a sterile option that provides peace of mind that you are not introducing microbes to your patients skin. This updated guidance clarifies the aims, implications, and user groups targeted. They are also preferable when the procedure does not last very long. Another important goal in the use of an ultrasound gel is not to compromise the safety or comfort of the patient. 5. Outbreak investigations show that non-sterile gel can cause infections if used before or during an invasive procedure, on mucus membranes, or near non-intact skin (1, 3 to 6, 9, 12 to 17).