Cleaning EV transducers; was: RE: About Glutaraldehyde
From: T Dubose (tjdubose@chrp.uams.edu)
Mon Jul 21 09:39:22 1997
This is an important topic that cuts across all areas of sonography.
As such I am taking the liberty of forwarding this message to the
OBGYN.net list. Perhaps there is someone on that list that has looked
closely at these problems. If not that list should be made aware of
them.
Peace, Terry J. DuBose
>
>On 7-19-97 JPBaker wrote:
>
><I sent out a request for information about Cidex or Omnicide (a.k.a.
>Glutaraldehyde) but received only one reply from Annette Smith. I checked
>with Terry and he informed me that he did not receive anything. So here it
>is again please respond if you have any advice.
>
>I received a call from a sonographer asking if I had any information on
>problems related to Cidex, or Omnicide. (Their lab has been using Omnicide
>to sterilize their TEE probes.
>Four echocardiographers in their lab is suffering from complications from
>using Omnicide, their symptoms are headaches, SOB, coughing, dizzy spells,
>hoarseness, respiratory infections, burning eyes. All also have chronic
>dermatitis. They have all been medically diagnosed and are receiving
>inhalers for their asthma. They have proven that the problem is the
>chemical but seem unable to get rid of it.
>Does anyone have a good reference that they could lookup and use regarding
>these very toxic chemicals? Are sonographers typically very knowledgable
>about these products and their side effects? I have been told that there is
>a spray that works but I am not sure I would like a TV or TEE scan after
>the use of only a spray? Does anyone have information on this? especially
>the toxicity of spraying into the room a chemical of this type.
>Since I am not sure if this is going out would a some of you just say
>message received so at least I know that I am doing the right thing to send
>out this message!!!>
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>Dear JP Baker:
>
>This answer is specifically for TV probes.
>
>We have several issues to confront here:
>1) The length of time of an efficient soak to kill all microbes
>2) The length of time before the Cidex will damage the scan-head
>3) The portion of the transducer allowed to be soaked
>4) The human "laziness" factor
>5) The toxicity of the glutaraldehyde.
>6) Alternate ways to clean the probe
>7) Location of the soaking canister
>
>I just started working as an ultrasound department manager in another
>hospital. I am investigating the use of Cidex. This substance is definitely
>toxic. The hospital is trying to cut down on the use of Cidex and similar
>glutaraldehyde products as much as possible. The toxicity of glutaraldehyde
>is a reality. It should be used in a well-ventilated area away from constant
>human inhalant areas. The sonographers could not tolerate the fumes from
>this chemical. So, before I came to this facility, they decided to put the
>canisters in the janitor's broom closet away from the ultrasound rooms. I do
>not agree with the use of Cidex at all . . . and I do not agree to make the
>janitor's closet into a soaking area for vaginal probes. My quest is to
>find an acceptable alternative.
>
>According to our infection control nurse, the length of time of an efficient
>soak to kill all microbes is an hour. The length of time that this Cidex
>might damage the scan head is more than an hour. So . . . how much time does
>it take for glutaraldehyde to damage the scanheads? One hour four times a
>day? One hour and ten minutes? One hour eight times a day? For how many
>weeks? I called ATL and their answer was that the longer the soak, the more
>chance of scanhead damage. They would not give me a definitive answer as to
>total length of time. Their recommendation( in writing) is one hour . . .
>but how many times a day? They would not say. Then I spoke to two service
>reps, and both recommended that no more than ten minute soak for the scan
>head is safe. This is just a verbal recommendation: this is not in writing
>from the company. Nevertheless, a ten minute soak is useless, according to
>our infection control nurse . . . ...so soaking in Cidex is not the answer.
>
>The other factor is the portion of the transducer that they allow be soaked.
> I think it is hilarious that the portion that we soak is the distal part and
>not the handle or the cable. The distal part is the portion covered by the
>latex. To me, I think the handle and the cord need more cleaning than the
>distal part, because body fluid has more chance of contaminating the
>uncovered part of the transducer. The answer is not soaking in Cidex, but an
>extra long latex cover that protects the rod, the handle, and some of the
>cord. Has anyone thought of manufacturing such a cover? I have not seen any
>in the supply magazines.
>
>Still, another factor is the human laziness problem. Now I'm talking about
>the radiology residents who are on call, not the staff sonographers.
> Overall, many of these doctors (not all) have been very irresponsible.
> After use, they just plop the transducer in the Cidex and go on their merry
>way. They leave the probe in the soak indefinitely and don't even bother
>rinsing it before the next patient. How clean can that be? Again, here the
>Cidex is not the answer . . .
>
>What is the answer is a good washing in the sink with bacterial
>detergent/soap and water! According to the infection control nurse, this
>will remove 99.99% of all infectious material. Then a good 10-20 second wipe
>after the sink washing with a wipe or a spray. Then dry with a towel and
>then hang it up. This should do the trick. To be extra clean, the operator
>can wash and wipe it again just before the next use with an anti-viral wipe
>(such as bleach and water) or sporicidin. Each manufacturer should have a
>list of acceptable disinfectant agents in a form of a convenient spray or
>towelette wipe which they approve for BOTH transducer and cord. .
>
>I would like to know from all of you out there what the protocols are
>concerning disinfection of intra-cavitary probes. I know that if I were the
>patient, I certainly would not want a probe soaked in Cidex to be used . . .
>what if I became contaminated with some of that nasty chemical? I would
>rather have the probe, handle, and cord thoroughly cleaned with detergent and
>then wiped with a disinfectant and covered with a clean extra long and thick
>latex cover. As a sonographer I really would not want to handle such a
>chemical.
>
>I welcome any other suggestions . . . oh and I am really going to get after
>the manufacturers of the equipment to give me some honest information.
>Suzanne Hettena RT RDMS
>
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