Sonography Gel

Good infection prevention practice: using ultrasound gel

Background and purpose of this communication

Contaminated ultrasound gel has been associated with outbreaks of infection in various settings and identified as a potential vector for infection.[1-9] Standard ultrasound gel is not produced as a sterile product. Ultrasound and ultrasound-guided procedures are conducted routinely both in radiology and clinical areas, including use in high dependency care and among patients with immunosuppression. There is currently little available guidance on good practice in use of ultrasound gel for the UK setting.

This document provides interim guidance on the safe use of ultrasound gel to reduce risk of transmission of infection. It has been in part adapted from guidance produced elsewhere and should be considered in the wider context of standard infection prevention and control precautions.[10,11]

Which type of ultrasound gel to use

Sterile ultrasound gel must be used:

  • for invasive procedures, that is any ultrasound-guided procedure that involves passing a device through tissue such as intravenous line insertion or fine needle aspirate (this includes ‘viewing/initial assessment’ of the site by ultrasound prior to undertaking an aseptic procedure)
  • where there is contact with non-intact skin
  • where there is contact with mucous membrane (for example for transrectal or transvaginal procedures)
  • for examinations on immunocompromised, neonatal intensive care or critically ill hospitalised patients (such as in high-dependency or intensive-care settings)

Non-sterile ultrasound gel may be used:

  • during low risk, general examinations on intact skin, not relating to a procedure or immediately prior to a procedure

Safe use of ultrasound gel

For sterile ultrasound gel:

  • ensure that only unopened sachets and containers that are labelled as ‘sterile’ are used
  • do not reuse once opened, either with other patients or stored and reused with the same patient, as sterile gels are single-use only

For non-sterile ultrasound gel:

  • we recommend use of pre-filled bottles in preference to re-filling reusable bottles
  • remove gel from skin after the procedure using a clean paper towel, tissue or wipe and clean or cleanse the skin using patient skin wipes or equivalent
  • nozzles of bottles should not come into contact with the patient, staff or instruments
  • if the nozzle comes into contact with the patient’s skin, the bottle should be discarded

General principles

Ensure to check and only use products within their expiry date and discard any product that has exceeded expiry or has exceeded the manufacturer’s recommended time after opening.


University Hospitals of North Midlands NHS Trust 
Coronavirus, News

UHNM staff part of SIREN study which finds past COVID-19 infection provides some immunity for at least five months


15 January 2021

Initial reports from the national SIREN study say that antibodies from past COVID-19 infection provide 83% protection against reinfection for at least 5 months. The study was designed to understand whether prior infection with SARS-CoV2 (the virus that causes COVID-19) protects against future infection with the same virus. It has been led by Public Health England (PHE) and UHNM has taken part in the innovative programme. 

Public Health England has been regularly testing tens of thousands of healthcare workers across the UK since June for new COVID-19 infections as well as the presence of antibodies, which suggest people have been infected before.

250 staff signed up to take part in the study at UHNM, which requires participants to present for fortnightly testing for Covid-19. 

Dr Chris Duff, Consultant Clinical Scientist, and SIREN Principal Investigator at UHNM said: “These initial findings from the SIREN study show how research is giving us better understanding of whether past COVID-19 infection may provide some protection against future reinfection. I’m thrilled that hundreds of staff volunteered to take part, and thank them for their on-going commitment to this research. Running SIREN has required huge effort by teams across the Trust, involving many staff across Research & Innovation, Pathology and Phlebotomy, and I would like to recognise their continued hard work in making it possible for us to conduct this important research at UHNM.”

So far UHNM has processed nearly 1,000 antibody tests and nearly 1,500 swab PCR tests for SIREN since Sept from 250 staff.

Reinfections in people with antibodies were rare, with experts identifying 44 potential reinfections among 6,614 participants who showed evidence of previous infection. However, experts have cautioned those with immunity may still be able carry the virus in their nose and throat and therefore have a risk of transmitting to others.

PHE scientists working on the study have concluded naturally acquired immunity as a result of past infections provide 83% protection against reinfection, compared to people who have not had the disease before. This appears to last at least for five months from first becoming sick. 

While the SIREN study will continue to assess whether protection may last for longer, this means people who contracted the disease in the first wave may now be vulnerable to catching it again.

Professor Susan Hopkins, Senior Medical Advisor at Public Health England and the SIREN study lead said: “This study has given us the clearest picture to date of the nature of antibody protection against COVID-19 but it is critical people do not misunderstand these early findings.

“We now know that most of those who have had the virus, and developed antibodies, are protected  from reinfection, but this is not total and we do not yet know how long protection lasts. Crucially, we believe people may still be able to pass the virus on.

“This means even if you believe you already had the disease and are protected, you can be reassured it is highly unlikely you will develop severe infections but there is still a risk that you could acquire an infection and transmit to others. Now more than ever it is vital we all stay at home to protect our health service and save lives.

“We are immensely grateful to our colleagues in the NHS for giving up their time to volunteer, and whose continued participation at a time of great stress is making this research possible.”

SIREN study leaders are clear this first report provides no evidence towards the antibody or other immune responses from COVID-19 vaccines, nor should any conclusions to be drawn on their effectiveness. The SIREN study will consider vaccine responses later this year. 

Public Health England continues to stress the importance of following the stay at home rules and remembering hands, face, space – whether you have had the virus or not.

  • Public Health England’s SIREN (SARS-CoV-2 Immunity & Reinfection EvaluatioN) study has performed regular antibody and PCR testing on 20,787 healthcare workers, including frontline clinical staff and those in non-clinical roles, from 102 NHS trusts since the study commenced in June. 6,614 of these participants tested positive for COVID-19 antibodies upon recruitment.
  • Of the 44 potential reinfections identified by the study, 2 were designated “probable” and 42 “possible”, based on the amount of confirmatory evidence available. If all 44 cases were confirmed, it would represent an 83% rate of protection from reinfection, while if only the two “probable” reinfections were confirmed, the rate would be 99%. Further research is ongoing to clarify this range.
  • The study found that antibody protection after infection lasts for at least five months, on average, and scientists are currently studying whether protection may last for longer. This means that many people who contracted the disease in the first wave may now be vulnerable to catching it again.
  • Both of the two “probable” reinfections reported having experienced COVID-19 symptoms during the first wave of the pandemic, but were not tested at the time. Both patients reported that their symptoms were less severe the second time. None of the 44 potential reinfection cases were PCR tested during the first wave, but all tested positive for COVID-19 antibodies at the point of recruitment to the study.
  • This analysis occurred prior to the widespread dissemination of the new variant VOC202012/01, further work is underway in the laboratory to understand whether and to what extent antibodies also provide protection from this variant and future analysis will assess the impact of VOC202012/01 on symptomatic and asymptomatic infections in healthcare workers.
  • The study will continue to follow participants for 12 months to explore how long any immunity may last, the effectiveness of vaccines and to what extent people with immunity are able to carry and transmit the virus.
Coronavirus, News

Recoveries and single-digit fatalities in KSA stay steady

RIYADH — Coronavirus cases in Saudi Arabia remained below the 200-mark on Sunday, with 176 new infections reported over the past 24 hours across the Kingdom, according to a statement from the Ministry of Health.

The ministry announced five more deaths over the past 24 hours due to complications caused by COVID-19, marking single-digit fatalities for many days since the outbreak of the pandemic in the Kingdom.

This brings the total number of confirmed infections in the Kingdom to 364,929 and the virus-related death toll to 6,323.

The ministry also reported 146 new recoveries over the past 24 hours, raising the total number of people free from the deadly virus to 356,687, with the recovery rate rising to 97.74 percent.

The Riyadh region reported the highest number of infections with 62 cases, followed by the Makkah region with 34 and the Eastern region with 32 cases.

The remaining cases were detected in different other regions of the Kingdom.

With the recoveries and new cases numbers staying steady, the active cases in Saudi Arabia have also dropped to 1,919 out of which 319 were critical cases. — SG


Chris Whitty
Coronavirus, News

Covid: ‘Most dangerous time’ of the pandemic, says Prof Whitty

The UK will go through the “most dangerous time” of the pandemic in the weeks before vaccine rollout has an impact, England’s chief medical officer has warned.

Prof Chris Whitty urged people to minimise all unnecessary contact with others.

The next few weeks will be “the worst” of the pandemic for the NHS, he said. Thousands more people are due to receive a vaccine this week after seven mass centres opened across England.

NHS England said hundreds of more GP-led and hospital services would also open later this week. But with all centres, people will need to wait until they receive an invitation.

The government is aiming to offer vaccinations to around 15 million people in the UK – the over-70s, older care home residents and staff, frontline healthcare workers and the clinically extremely vulnerable – by mid-February.

Health Secretary Matt Hancock will set out the government’s vaccine delivery plan at a news conference later. He said the proposals would be the “keystone of our exit out of the pandemic”.

Outlining the vaccine rollout in Scotland, First Minister Nicola Sturgeon confirmed that ministers aim to give all over-80s the first dose of the vaccine over the next four weeks.

The Welsh Government plans to offer a vaccine to all over-50s and everyone who is at greater risk by spring.

In Northern Ireland, which is rolling out vaccines for care workers, health trusts have seen the busiest 48 hours since the start of the pandemic.

Mr Hancock said on Sunday about two million people in the UK had been vaccinated so far. Over the weekend, the UK passed the milestone of 80,000 deaths with coronavirus since the start of the pandemic.

Map showing where England's vaccination centres and mass vaccination sites are, as well as the UK's hospital hubs



Works start on £3.4m Staffordshire healthcare facility

Due for completion in September, the new £3.4million medical facility, located on Lichfield Road, will bring first-class healthcare facilities to the community, relieving the pressure of local hospitals.

The new single-storey centre will consist of 12 consulting rooms, five treatment rooms, a healthcare and phlebotomy room, and a health education space with an adjoining pharmacy unit, and will be built on a site previously occupied by a residential care home, which has been vacant since 2008.

Providing a much-needed upgrade to the current healthcare facilities, the centre will be replacing services provided by the Darwin Medical Practice – located on Hudson Drive approximately 300 metres away from Greenwood House, ensuring improved and accessible facilities for the area.

There will also be 61 onsite parking spaces created and surroundings will be landscaped, with the centre using the existing road entrance for the former care home.

The scheme has been funded by NHS England’s Estates and Technology Transformation Fund, which aims to improve healthcare services for patients across the country with modernised facilities and technology.

Procured through the Staffordshire County Council framework, G F Tomlinson has been selected to provide construction works for the site, and this is the fifth project the contractor has procured through the framework since 2016.

“The importance of good quality healthcare is important, now more than ever, and the new medical centre will provide optimised and accessible facilities for the local community which are currently inadequate, meeting the demands of the ageing population in Burntwood.

We’re pleased to be partnering with Staffordshire County Council once again to provide vital public service buildings for the wider community, instilling confidence that they have access to good healthcare whenever they need it.”

Chris Flint, director of G F Tomlinson

“Part of the strategy for reducing demand on our hospitals from ageing communities is to provide more facilities and services close to residents.

“This development, reusing a dormant plot of land that has long been earmarked for the purpose, will provide additional capacity for the local GP practice and means people in Burntwood can look forward to a new, state-of-the-art facility that meets the community’s needs.”

Alan White, leader of Staffordshire County Council and former cabinet member for health, care and wellbeing


BBC Covid Stats
Coronavirus, News

Covid-19 in the UK: How many coronavirus cases are there in your area?

Daily cases at record level

Coronavirus cases are now rising fast again, driven by a new variant of the virus thought to be much more easily transmissible than other strains.

A further 54,940 confirmed cases were announced by the government on Sunday – down, like Saturday, on Friday’s record total of 68,000.

Around one in 50 people in England are estimated to have the virus, according to a new estimate from the Office for National Statistics (ONS).

Chart shows daily cases are continuing to increase

It is thought the infection rate was much higher than was evident from the reported number of cases during the first peak in spring. Testing capacity was too limited to detect the true number of daily cases.

After the first peak in April, infections started rising again in July, with the rate of growth increasing sharply in September and October. It fell in November before rising steeply in December.

Although the new variant is now spreading more rapidly than the original version, it is not believed to be more deadly.

Short presentational grey line

Where are cases high?

Cases are rising steeply in nearly all parts of the UK, while London, the South East and East have the highest estimated rate of people with coronavirus in England.

On Friday, London Mayor Sadiq Khan declared a “major incident” in the capital and said the spread of Covid was “out of control”.

Chart shows daily cases rising in all parts of UK

Coronavirus across the UK

Tap or click to see how many cases per 100,000 in the latest week

map showing where the hotspots are for coronavirus cases in the UK

Daily deaths remain high

The average number of daily deaths began to rise again in September, following the first peak in spring.

On Sunday, the government announced a further 563 deaths. Friday had seen the highest daily figure since the start of the pandemic, with 1,325 deaths announced.

However, Friday’s total probably included some deaths not reported earlier because of delays over the Christmas holidays.

Of Sunday’s total, 498 were in England, 45 in Wales, 17 in Northern Ireland and 3 in Scotland.

Chart shows daily deaths are continuing to increase

Rules were amended over the summer to include deaths in the coronavirus total only if they occurred within 28 days of a positive test. Previously in England, all deaths after a positive test were included.

England has seen the majority of UK deaths from Covid-19. Using the 28-day cut-off, there have been about 70,000.


Covid-19 Vaccine rollout
Coronavirus, News

Why you have to wait for your COVID-19 vaccine

People most at risk from the complications of COVID-19 are being offered the vaccine first.

In the UK, there are 2 approved COVID-19 vaccines. They both require 2 doses to provide longer-lasting protection. Both have been shown to be effective in clinical trials and have a good safety record.

An independent group of experts has recommended that the NHS first offers these vaccines to those at highest risk of catching the disease and of suffering serious complications or dying from COVID-19. This includes older adults in care homes and frontline health and social care workers.

When more vaccine becomes available, the vaccines will be offered to other people at risk as soon as possible.

Eligible groups

You should have the vaccine when it is offered if you are:

  • living in a care home for older adults
  • a frontline health care worker
  • a frontline social care worker
  • a carer working in a care home for older residents

Then the vaccine will also be offered in age order to:

  • those aged over 80 years
  • those aged over 75 years
  • those aged over 70 years
  • adults on the NHS shielded patient list
  • those aged over 65 years
  • adults under 65 years with long term conditions (see conditions below)

Those aged 50 to 64 will be offered it later.

Clinical conditions list:

  • a blood cancer (such as leukaemia, lymphoma or myeloma)
  • diabetes
  • dementia
  • a heart problem
  • a chest complaint or breathing difficulties, including bronchitis, emphysema or severe asthma
  • a kidney disease
  • a liver disease
  • lowered immunity due to disease or treatment (such as HIV infection, steroid medication, chemotherapy or radiotherapy)
  • rheumatoid arthritis, lupus or psoriasis
  • have had an organ transplant
  • had a stroke or a transient ischaemic attack (TIA)
  • a neurological or muscle wasting condition
  • a severe or profound learning disability
  • a problem with your spleen, example sickle cell disease, or you have had your spleen removed
  • are seriously overweight (BMI of 40 and above)
  • are severely mentally ill

At the same time as the adults under 65 years with long term conditions the vaccine will also be offered to:

  • adults who provide regular care for an elderly or disabled person
  • younger adults in long stay nursing and residential settings

Please wait your turn. If you are not in the groups above, you will have to wait for a COVID-19 vaccination until more supplies are available. When more vaccine becomes available we will be offering it to more groups of the population.


Urinary Tract Infection

Don’t Ignore These 4 Serious Urinary Health Symptoms

ESPECIALLY DURING A time when many people are navigating if and when it’s essential to visit a health care professional, it’s wise to know the signs or symptoms of some severe health concerns. When it comes to your urological health, there are a few “red flags” that should not be ignored and require immediate medical attention.

Blood in the urine. Urine that’s red or tinged with blood is never a symptom to ignore. It’s also essential to understand that the urine doesn’t need to appear bright red for blood to be present in it. Sometimes, it may have a pink or brown appearance, or it may be tinged with blood streaks or droplets. When this is the case, an urgent call to your health care provider is necessary. Blood in the urine can be a sign of easy-to-treat conditions, including urinary tract infections. However, even if a person with blood in their urine is diagnosed with a UTI, there may be other underlying problems that are causing the blood to be present. Blood in the urine is also a symptom of kidney infection, kidney stones and bladder and kidney cancers, so it’s important to have it evaluated immediately.

Urinary urgency. The term urinary urgency describes a strong and consistent urge to urinate – in some cases, with little to no urine expelled from the urethra. Again, this is a general symptom that can indicate a UTI, an issue with the prostate gland in men, an overactive bladder in men or women or certain types of cancer, including bladder cancer. Even if not accompanied by other symptoms, the frequent need to urinate without being able to expel urine from the bladder must be evaluated and treated by a qualified physician. Urinary urgency can also be a problem even if normal to high volumes of urine are being produced. In these cases, the cause could be uncontrolled diabetes, excess fluid intake, excess diuretic use or a loss of the kidney’s ability to concentrate urine.

Urinary retention. Beyond the feeling of needing to urinate and having a weak stream of urine, the sudden inability to urinate is a medical emergency. This problem usually occurs in men over age 50, who may be dealing with the prostate gland’s enlargement. Women with enlarged uterus, pelvic mass or pelvic prolapse may also experience urinary retention. Other causes in men and women can include a tumor or another obstruction in the urinary tract, as well as bladder stones. Left unchecked, urinary retention can lead to chronic UTIs, damage to the bladder and even chronic kidney disease. In many cases, simple urine or blood tests can help health care providers get to the bottom of what’s causing the problem.

Pain during urination. Whether it’s a burning or stinging sensation, or more of a dull ache in the urethra, pain while urinating is not normal and signifies that something within the urinary tract is wrong. Though UTIs are a common cause of painful urination, there are plenty of others, including prostatitis (inflammation of the prostate gland) in men, a sexually transmitted infection such as gonorrhea and interstitial cystitis (inflammation of the lining of the bladder), and kidney stones. Each of these conditions is cause for immediate medical attention.


News, Sepsis

Calls for greater awareness of ‘preventable’ sepsis deaths

The symptoms

Without quick treatment, sepsis can lead to organ failure and death.

Among children aged five years or less, symptoms include:

  • mottled, bluish or pale skin complexion
  • lethargy and difficulty waking up
  • skin cold to the touch
  • fast breathing
  • a rash that does not fade when pressed
  • fits or convulsions

For older children and adults, symptoms include:

  • high or low body temperature
  • chills and shivering
  • fast heartbeat
  • fast breathing

People are being urged to watch out for the warning signs of sepsis after the condition led to hundreds of “preventable” deaths in Tayside and Grampian hospitals last year.

More than 3,500 confirmed cases of sepsis – an infection of the blood which causes the body to create a strong immune response – were recorded in NHS Tayside hospitals over the past five years.

In the last full year where data is available, 26 people lost their lives to blood poisoning in Tayside and it was recorded as a secondary cause in 133 deaths.

Of the 3,556 confirmed cases, only 2,445 attended accident and emergency units.

In the Grampian area, 29 people died and sepsis was a secondary cause in 137 deaths.

Calls for greater awareness

The figures were revealed by the Scottish Conservatives, whose MP Andrew Bowie has urged people to report any early signs amid concerns fewer people are seeking help.

The West Aberdeenshire and Kincardine MP said: “Any death through a preventable illness is one too many.

“Too many people are dying from something that can be avoided by early detection and administration of antibiotics.”

He said the national charity Sepsis Research (FEAT) had carried out research which showed public awareness of the main symptoms is not cutting through.

“There is also anecdotal evidence that people aren’t reporting possible symptoms due to the pandemic,” he added.

“The reasons why are understandable but the danger in this can’t be overstated.”

“Range of improvement work”

Early symptoms of sepsis include fever and chills, an elevated heart rate and breathing faster than normal.

As the infection progresses blood pressure falls and organs are at risk of failure.

An NHS Tayside spokeswoman said the health authority had carried out a range of improvement work over the past few years to improve early recognition of the signs of sepsis in patients when they are admitted to hospital.

“This includes workshops for junior doctors, clinical working groups and applying the One Hour Sepsis bundle of medical therapies,” she said.

“This improvement work has led to an increase in the number of cases being identified as sepsis as awareness of the condition and its symptoms grows.”

An NHS Grampian spokesman said: “Anyone can develop sepsis after a minor injury or infection. It can affect people of any age or condition of health.

“If you suspect sepsis you should seek urgent advice from your GP. If your GP practice is closed, phone NHS 24 on 111. If sepsis is suspected, you’ll usually be referred to hospital for further diagnosis and treatment. Sepsis is a medical emergency.

“If you or someone you care about has a rapid progression of these symptoms phone 999. Time is critical when it comes to treating sepsis and every hour counts.”

In cases of severe sepsis, or sepsis shock, signs can include nausea, muscle pain, slurred speech or loss of consciousness as well as the above symptoms.

If detected early, the condition can be treated through a dose of antibiotics. However, if sepsis shock develops then hospital admission is likely.

When caught early, patients will often recover with no lasting after effects.

More can be found on the NHS Inform website.

Covid-19 Keep Apart
Coronavirus, News

Covid: Regional rules ‘probably going to get tougher’, says Boris Johnson

Regional restrictions in England are “probably about to get tougher” to curb rising Covid infections, the prime minister has warned.

Boris Johnson told the BBC stronger measures may be required in parts of the country in the coming weeks.

He said this included the possibility of keeping schools closed, although this is not “something we want to do”.

Labour leader Sir Keir Starmer has called for new England-wide restrictions within 24 hours.

Sir Keir said coronavirus was “clearly out of control” and it was “inevitable more schools are going to have to close”.

It comes as the UK recorded more than 50,000 new confirmed Covid cases for the sixth day in a row, with 54,990 announced on Sunday.

An additional 454 deaths within 28 days of a positive test result have also been reported, meaning the total by this measure is now above 75,000.

Speaking on BBC One’s Andrew Marr Show, Mr Johnson said he stuck by his previous prediction that the situation would be better by the spring, and he hoped “tens of millions” would be vaccinated in the next three months.

But he added: “It may be that we need to do things in the next few weeks that will be tougher in many parts of the country. I’m fully, fully reconciled to that.”

“And I bet the people of this country are reconciled to that because, until the vaccine really comes on stream in a massive way, we’re fighting this virus with the same set of tools.”