SBAR MEMORANDUM

DATE:

TO:

FROM:

RE: PRACTICE CHANGES TO ULTRASOUND GEL & LUBRICATING GEL RECOMMENDATIONS

SITUATION

New CDC guidelines have been published on when to use sterile versus non sterile ultrasound gel & lubricant.

Gel or Lubricant Type / Indicated for / Examples
Non Sterile Ultrasound Gel
(multi-patient use-do not use warmers) / Intact skin
Not for sterile procedure or when procedure is next to non-intact skin (surgical site or wound) / Physical Therapy, Sports Medicine, Radiology
Scans: bladder, abdominal, vascular
Sterile Ultrasound Gel (single patient use only) / For mucous membranes
Non-intact skin
Intact skin where sterile procedure will occur
All sterile body sites
When US procedure is next to non-intact skin (surgical site or wound) / TEE (transesophageal echocardiography)
Transvaginal/rectal procedures with or without biopsy
OR procedures
Any invasive procedures in which a device is passed through a tissue (using ultrasound-guided needle aspiration, tissue biopsy, needle/wire localization)
Non Sterile Lubricant / Not indicated for any procedures
Sterile Lubricant
(single patient use only) / Mucous membrane
Non intact skin
All sterile body sites / All endoscopy procedures (OTO, URO, GI, Allergy) with or without biopsy or manipulation
Pelvics with or without biopsy or manipulation
Digital exams of anus/rectum, ostomy, vagina
OB vaginal checks
Anesthesia procedures
OR procedures
SCN-newborns

BACKGROUND

Currently most facility departments are using non sterile ultrasound gel and lubricant gel. The facility has not had an outbreak associated with products that have been either contaminated during manufacture or contaminated during use. However, there have been several very serious bacterial outbreaks. The CDC and The Society for Healthcare Epidemiology of America (SHEA) determined the literature and outbreaks warranted a more stringent approach to ultrasound gel & lubricant.

ASSESSMENT

Currently, there are 4 lubricants used for pelvics, rectal exams, urology, OB checks, etc., only one is sterile.

KY Jelly Lubricant Non sterile
Tube 4oz / Surgilube Jelly Lubricant Non sterile (bacteriostatic)
2oz / Jelly Lubricant Sterile
3GM Individual packet / Gel Lubricant Slippy Stuff
Non sterile .25oz Individual packet
$2.76 / $1.58 / $0.10 ea / $0.34 ea

Medichoice Sterile lubricant 2 oz 1.19

There are 4 ultrasound gels available and they are used for ultrasound procedures, only one is sterile.

intact skin
Gel Scanning Ultraphonic SG
8oz / Gel ultrasound Aquasonic
8 oz / Gel Ultrasonic SCAN
8oz / Gel Ultrasonic Aquasonic 20GM FOIL
Low viscosity
Non scented / Thick viscosity / Thin viscosity / Sterile individually packaged
$2.94 / $1.71 / $1.79 / $1.02

RECOMMENDATIONS:

1.  Identify the type of gel/lubricating products used in the department across the service line and what procedures they are used for.

2.  Standardize product to type of procedures done using the guidelines.

3.  Review Gel/Lubricant Use Procedure with staff.

Gel or Lubricant Type / Indicated for / Examples
NON STERILE ULTRASOUND GEL
(multi-patient use-do not use warmers)
/ Intact skin
CAUTION:
Sterile ultrasound gel will be required for any non-intact skin, example: abd wounds, skin wounds, by surgical incision or dressing, skin where a surgical/sterile procedure is going to be performed / Physical Therapy, Sports Medicine Echocardiogram
Scans: bladder, abdominal, vascular (See Caution statement)
Ankle Brachial Index over intact skin
STERILE ULTRASOUND GEL
(single patient use only)
/ For mucous membranes
Non-intact skin
Intact skin where sterile procedure will occur or has occurred or a dressing exists. All sterile body sites.
Bladder scanning next to a surgical site or dressing / TEE (transesophageal echocardiography)
Transvaginal/rectal procedures with or without biopsy
OR procedures
Any invasive procedures in which a device is passed through a tissue (using ultrasound-guided needle aspiration, tissue biopsy, needle/wire localization, EMG)
SCN-newborns (all body sites)
STERILE LUBRICANT
(single patient use only) / Mucous membrane
Non intact skin
All sterile body sites / All endoscopy procedures (OTO, URO, GI, Allergy) with or without biopsy or manipulation
Pelvics with or without biopsy or manipulation
Digital exams of anus/rectum, ostomy, vagina
OB vaginal checks
Anesthesia procedures
OR procedures
SCN-newborns