Background: Over the past three decades, healthcare providers have increasingly recognized point-of-care ultrasound (POCUS) as a valuable tool and have been integrating it into routine practice. Ultrasound machines have the potential to act as fomites. Clinically relevant infectious organisms have been found on ultrasound probes and gels even when they aren’t visibly soiled. Thus, POCUS has the potential to act as a fomite for pathogens which are known to prolong hospital stays, escalate healthcare costs and increase mortality. We designed a project that evaluated baseline cleaning rates of POCUS machines and perceived barriers to guideline-based cleaning practices. We then implemented interventions and studied the impact.
Methods: We used a fluorescent targeting method to objectively evaluate the cleaning rates of four cart-based ultrasound machines that were primarily used for POCUS on hospitalized patients. A mixed-methods, pre/post-study of POCUS machine cleaning practices was conducted over a one-year period at a 700-bed tertiary care center in the Midwest. Barriers to adherence to guideline-based POCUS machine cleaning were identified via survey. Interventions targeting the highest yield barriers were designed and employed. This included a website that outlined best practices for POCUS cleaning and disinfection, a 3-minute instructional video, a summary of cleaning steps, and links to best-practice guidelines from our institution and relevant professional societies. Placards were placed on POCUS machines which included a summary of cleaning steps and a QR code to access the website for just-in-time training. We improved access to cleaning materials by ensuring that each machine had a dedicated container of disinfecting wipes at all times. Pre-intervention and post-intervention cleaning rates were compared using a generalized linear mixed model. An ad hoc analysis was carried out to study the COVID-19 pandemic’s influence on cleaning rates prior to intervention. Post-intervention surveying was performed.
Results: Surveying identified lack of knowledge and insufficient access to cleaning supplies as the primary barriers to guideline-based POCUS cleaning. A multi-pronged educational campaign was designed and implemented, and access to cleaning supplies was improved. There was a significant improvement in cleaning rates following these interventions (p<0.0001). The pandemic alone did not significantly influence cleaning rates (p=0.78). Post-intervention surveying suggested an improved understanding of guideline-based cleaning practice and increased assess to cleaning supplies.
Conclusions: We were able to significantly improve the cleaning rate of point-of-care ultrasound machines using practical and cost-conscious interventions. Lack of knowledge and inadequate access to cleaning supplies are barriers to guideline-based POCUS cleaning. By targeting these domains with practical, economical and sustainable interventions we were able to significantly improve the cleaning rates of four point-of-care ultrasound machines used primarily by internal medicine and critical care medicine providers at a Midwest tertiary care center. We believe these issues are not isolated to our institution and that our interventions can be applicable across a broad range of practice. If the improvement in cleaning rates that we obtained can prevent even a single case of hospital acquired infection, they yield a positive return in terms of preventable healthcare spending.