INS presentation to tackle low-level disinfection technique

May 26, 2022

A presentation at the upcoming annual meeting of the Infusion Nurses Society (INS) will discuss the recent development of a policy statement favoring low-level disinfection (LLD) as a safe and sufficient technique for disinfecting ultrasound transducers used in percutaneous procedures such as ultrasound-guided peripheral IV (UGPIV) catheter insertion.

The multidisciplinary presentation will feature Nancy Moureau, RN, PhD, an internationally recognized vascular access expert and CEO of PICC Excellence, and Natwalee Kittisarapong, DO, an emergency department physician with emergency ultrasound fellowship experience.

 They will discuss the development and implementation of the 2021 Intersocietal Position Statement on transducer cleaning and disinfection, which was created by a task force led by the American Institute of Ultrasound in Medicine (AIUM). The statement advocates the use of LLD effective against bloodborne pathogens as sufficient for ultrasound transducers used in vascular access procedures.

 “As the use of ultrasound guidance for medical procedures increases, guidelines for transducer disinfection must be established to protect patients from infection risk,” says Moureau. “We always want to make sure we’re performing safe practices, but it’s a balance between doing what is necessary without being excessive. Requiring high-level disinfection would impose significant economic and workflow burdens that could actually limit the use of ultrasound guidance, and would ultimately be harmful to patients.”

 The position statement has received the support of 22 health professional organizations—including INS—all together representing more than 800,000 healthcare professionals.

Moureau and Kittisarapong will discuss application of the position statement to UGPIV procedures, as well as transducer management strategies for mitigating infection risks associated with transducers, gel usage, and touch contamination.

The position statement was developed to address a growing debate among practitioners in a wide range of medical specialties regarding how ultrasound transducers should be disinfected between percutaneous procedures.

Some practitioners have supported the use of HLD techniques, which typically involve placing transducers in an apparatus that exposes them to specialized disinfecting chemicals. Meanwhile, other experts have maintained that adequate protection is provided by use of a disposable transducer cover followed by cleaning and LLD, which involves wiping the equipment thoroughly with standard disinfectants.

AIUM organized the intersocietal taskforce to examine the evidence available in published studies. The group concluded that LLD is adequate for percutaneous procedures, especially when transducer covers are used. Moreover, requiring HLD for percutaneous procedures is “not evidence based” and will increase “the possibility of safety events if percutaneous procedures are performed without ultrasound guidance,” the statement says.

According to Kittisarapong, this is especially true in an environment like the emergency department, where clinicians often rely on ultrasound guidance to obtain immediate vascular access for trauma cases and for the significant population of patients with difficult vascular access.

“The use of ultrasound has significantly improved our ability to quickly and safely achieve vascular access in our patients, and it is now the standard of care for many procedures in our department,” says Kittisarapong. “LLD is the only reasonable choice for protecting patient safety while ensuring that ultrasound technology is still widely available.”

Patient safety during vascular access procedures can also be improved with proper implementation of Aseptic Non-Touch Technique (ANTT), which is quickly becoming the global standard for safe aseptic practice. INS added ANTT as a new clinical standard to its 2021 Infusion Therapy Standards of Practice. 

At the INS meeting, a presentation by Stephen Rowley, MSc, RGN, RSCN, and Simon Clare, MRes, RN, of the Association for Safe Aseptic Practice, will cover the basics of ANTT and how clinicians can implement it within their own organizations.

 “Aseptic technique is essential for minimizing contamination, but risk to the patient increases if it’s not done in an effective and consistent manner,” says Rowley. “There is clearly an urgent need for more clinical education on the application of ANTT, as well as greater focus on products that promote standardization to improve aseptic technique in all practice settings.”

 For UGPIV insertion, Moureau recommends using a transparent barrier dressing that facilitates proper ANTT by separating the ultrasound probe and gel from the sterile insertion site, resulting in a safer, gel-free insertion. Manufactured by Parker Laboratories, it is the first dressing designed specifically for use during UGPIV procedures to act as both probe protection and a final transparent dressing cover.

The INS 2022 annual meeting will take place June 4–7, 2022 in Orlando, Fla.

INS release