The HOCUS in PoCUS! Healthcare-associated infection and other challenges arising with Point of Care Ultrasound (PoCUS) Percutaneous Cannulation in emergency and critical care


Point of Care Ultrasound (PoCUS) Percutaneous Cannulation is increasingly used globally in emergency and critical care settings as routine practice and a core skill of practitioners. There is an ever-increasing body of evidence demonstrating its efficacy and safety as the prefer method for percutaneous cannulation for particular patient groups and presenting conditions. The practice is, however associated with significant risks to patients, in particular for healthcare-associated infections such as bloodstream infection and associated sepsis.


This paper presents a critical review of the literature that examines the risk of healthcare-associated infection and other hospital associated complications associated with PoCUS Percutaneous Cannulation. It reports a recent outbreak of Burkholderia cenocepacia bacteraemia and infection in 11 intensive and emergency departments patients caused by contaminated sterile ultrasound gel used for central line insertion and sterile procedures within four hospitals across Australia. It examines these events and the genesis and publishing of recent ASUM/ACIPC Ultrasound Probe Reprocessing Guidelines.


While the popularity Point of Care Ultrasound (PoCUS) Percutaneous Cannulation is ever-increasing, measures to protect patients from procedure-associated bacteraemia have not been as forthcoming. There are significant issues with a lack of systematic cleaning and decontamination of the equipment of this semi-critical device poor that is associated with both the high demand for its use in emergency care settings and a lack of recognition of the risks of healthcare-associated infection. A lack of formal accreditation of practitioners in the use of PoCUS poses significant risks to patients.


Point of Care Ultrasound (PoCUS) Percutaneous Cannulation has become a core skill in emergency medicine and nursing practice. Formal training and certification of practitioners together with formal decontamination procedures is required to ensure not only the efficacy of the procedure but also to its safety with respect to the significant risks of healthcare-associated infection.


Professor Ramon Shaban is Editor-in-Chief of the Australasian Emergency Nursing Journal. As an emergency nurse and credentialled expert infection control practitioner with an extensive background in clinical sciences and practice, his inter-professional expertise in infectious diseases, infection control and emergency care are the basis of a highly successful and integrated program of teaching, practice, and research. Professor Shaban is the Inaugural Clinical Chair and Professor of Infection Prevention and Control at the University of Sydney and Western Sydney Local Health District, within the Sydney Nursing School and Marie Bashir Institute for Infectious Diseases and Biosecurity. He is a member of the Australian Government Strategic and Technical Advisory Group on Antimicrobial Resistance, a member of the Australian Commission on Safety and Quality in Healthcare Healthcare-associated Infection Advisory Committee, and was 2016-2017 President of the Australasian College for Infection Prevention. He is a member of the World Health Organization Global Outbreak and Response Network, and in 2016 Ramon served as Technical Advisor (Antimicrobial Resistance) to the World Health Organization. Ramon is particularly interested in the role of emergency clinicians in the management, prevention and control of infectious diseases and healthcare-associated infection.