key: cord-0799985-k3o8mkig
authors: Moulthrop, Amy J.; Kolarczyk, Lavinia M.; Teeter, Emily G.
title: Preventing Contamination During Transesophageal Echocardiography in the Face of the COVID-19 Pandemic: A Glo Germ Experience
date: 2021-02-26
journal: J Cardiothorac Vasc Anesth
DOI: 10.1053/j.jvca.2021.02.051
sha: 422d5238409857c2a73049f305f09ef6c9bc317c
doc_id: 799985
cord_uid: k3o8mkig

nan

Coronavirus 2 (SARS-CoV-2) occurs primarily from droplets expelled during face-to-face contact. However, contact with contaminated surfaces may lead to transmission. 2 Glo Germ™ is a commercially available liquid/gel or powder used to simulate contamination and teach methods of infection control. 3 Under ultraviolet light, Glo Germ™ produces a fluorescent glow that serves as a surrogate of environmental contamination. Experiments with Glo Germ™ have been helpful for marking the extent of contamination during procedures such as endotracheal intubation and extubation. 4, 5 Glo Germ™ has also been used to evaluate new techniques, such as a closed technique for supraglottic airway-guided intubation. 6 We felt that Dr. Jain's design would be an excellent candidate for a qualitative simulation of contamination control using Glo Germ™.

To test the effectiveness of this novel method, we compared containment of pathogens with a covered probe versus an uncovered TEE probe. After a configuration as described in Dr. water, and alcohol. The test was repeated one more time using an uncovered TEE probe.

Contamination was visible on the echocardiographer's hand, a wide region of the mannequin's face, and the surface underneath the mannequin (Figure 3 ).

There are limitations to this simulated demonstration. The Heartworks ® TEE simulator mannequin does not have a removable bite block; thus, the end of the probe cover was not as securely positioned in the teeth as it would be on a patient. This likely contributed to the minimal perioral spread of Glo Germ™. A major limitation to this simulation is that a mannequin cannot replicate the moisture and soft tissue structures of a human. For example, saliva may collect around the distal end of the probe cover in the mouth, increasing the risk of contact with infectious secretions. This risk may be reduced by double gloving, intentionally operating the probe several inches above the mouth of the patient, and placing the entire probe in a disinfectant bag or container to be sterilized using appropriate protocols.

Despite the significant limitations of this simulation, this test suggests that this protective cover represents a simple, economical, and widely accessible means to reduce contact with infectious secretions. As noted by Dr. Jain, this protective cover does not limit the imaging capabilities of the echocardiographer. Custom TEE probe covers can be twice as costly as standard ultrasound probe covers and may not be available at some institutions. In addition to taking the appropriate precautions and wearing personal protective equipment, this test supports that a standard ultrasound probe cover may reduce contamination risk of personnel and equipment. Future experimentation should include quantification of contamination reduction as well as testing with echocardiographers who are utilizing this setup for the first time. Before definitively recommending this method as a means of contamination control, there is a clear need for follow-up testing, such as a pilot study with human subjects to test safety and effectiveness. 

Letter to the Editor: Preventing Contamination During Transesophageal Echocardiography in the Face of the COVID-19 Pandemic

Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review

The use of UV fluorescent powder for COVID-19 airway management simulation training

Clear plastic drapes may be effective at limiting aerosolization and droplet spray during extubation: implications for COVID-19

Supraglottic Airway-Guided Intubation During the COVID-19 Pandemic: A Glo Germ Follow-up