The novel coronavirus caused a sharp drop in imaging exams that facilities and imaging centers have seen beginning to recover. At the same time, cleaning equipment, including coils, is more important than ever to prevent the transmission of infection.

We asked industry experts about how imaging centers and departments can ensure their coils are properly sterilized while ensuring a long life for this sensitive and critical equipment.

‘Robust’ disinfection
Coil manufacturer ScanMed has always had a “robust” disinfection policy.

“We’ve ramped this up with the presence of COVID-19,” said Natalie Hussey, ScanMed’s marketing manager

Before distributing its products, the manufacturer cleans everything, including the cable; and it instituted a mask and gloves policy back in February.

As a regular best practice, it’s recommended that facilities perform a thorough cleaning and disinfection upon receipt of any medical device to ensure the safety of healthcare professionals and their patients, said Jason Brownley, R&D manager for MR coils at Innovatus Imaging, even though companies like Innovatus always thoroughly clean and disinfect each coil upon arrival at its facility and ship products in new boxes using new packing materials.

Hussey recommends cleaning the coils both before and after they are used with a patient.

Ray McClellan, president of MRI Technical Services Inc., which provides parts sales and coil repair, noted that it’s important to adhere to the OEM guidelines for cleaning and disinfecting all of the items that come into contact with the patients.

“The OEMs all have specific recommendations for cleaning and disinfecting all of the items which come into contact with the patients, and we recommend that all customers adhere to those guidelines” McClellan said.

When cleaning coils, Philips recommends that customers use a soft cloth dipped in neutral soap or detergent to wipe the surface to remove dirt or contaminants, and then use a dry soft cloth to dry the surface, said Rob Stevens, service operations leader for services and solutions delivery for Philips North America.

For positioning straps, the company recommends using a neutral soap or detergent — they can be machine washed at 40 degrees Celsius/104 degrees Fahrenheit or lower — and to use only after drying. When cleaning the digital coil plug, Philips recommends using alcohol, a soft cloth and cotton swabs to remove dirt or contaminants.

Philips’ recommended disinfectants include isopropanol at 70%, ethanol at 70%, chlorhexidine at 0.5% in 70% ethanol, or 1:200 bleach solution (5 milliliters of bleach in 1 liter of water). A soft cloth should be used with the recommended disinfectant to wipe the equipment surface. When using ethanol, the device needs to be air dried. When using a chlorine-containing disinfectant or a bleach solution, a soft cloth dipped in clean water should be used to clean the residual chlorine disinfectant from the device, then air-dried or wiped dry with a dry soft cloth.

Stevens emphasized that in light of the novel coronavirus, it's important that the cleaning and disinfection of any MR system or components must comply with all applicable laws and regulations within the jurisdiction in which the system is located.

“With this in mind, increased frequency of cleaning and disinfecting may be required due to the novel coronavirus,” Stevens said. “Philips has investigated several disinfection methods and we've determined that the best and safest way to care for Philips equipment is by following the guidelines in the ‘Instruction for Use’ (IFU) document supplied with each system.”

Care should be taken when cleaning both hard-surface and closed-cell soft coils, meaning urethane plastic or foam covered flex coils.

“Careful inspection should be done on soft coils first to make sure there are no breaks in the surface,” McClellan said. “The underlying open-cell foam cannot be disinfected and so the coil should be replaced. It is also recommended to use a black light flashlight for inspection to help highlight any biological contamination, i.e., blood and other bodily fluids, and make sure cleaning is complete.”

Users should contact the manufacturer about damage right away.

"If damage is noticeable on mats, sandbags or earphone sponge pads they should be replaced immediately," Stevens said. "Coils or cables that are cracked or damaged should be removed from patient use and a Philips service representative contacted to repair or replace the damaged components."

Endo-cavity coils follow the same cleaning procedure, but require the use of higher-level disinfectants such as Cidex OPA or Steranios 2% NG, and have their own specialized procedures to follow depending on the model, McClellan said.

Cleaning after COVID
The overall process hasn’t changed much in light of the novel coronavirus, but extra precautions should be taken.

“Although everyone is certainly now more aware of possible contamination, the recommended solutions are generally effective on SARS-COV-2, as listed by the EPA,” although some consideration should be given to additional disinfectant exposure times, McClellan said.

It's important to clean not only the sections of the coil that come in contact with the patient, but also the output cables and housing of the connector, said Wes Solmos, sales manager of MRI Coil Repair.

"Don't forget to pay special attention to the accessory pads that are utilized with the coils," Solmos said. "We often see that these pads are neglected and have stains and tears. These pads can be easily replaced by contacting us directly."

Take care when sterilizing coils to ensure a long lifespan for this critical equipment.

Hussey, of ScanMed, advises using a medical-grade hard surface disinfectant that’s non-corrosive.

“We wipe, we don’t spray,” Hussey said. “Spraying can make parts vulnerable.”

Electrical components are especially sensitive. Make sure to avoid exposing the electrical contacts to cleaners.

“While following the suggested guidelines, make sure not to allow any cleaning or disinfecting solution to get inside any of the coils, especially around electronic parts, and make sure the coils are completely dry before returning them to service,” McClellan said.

Take steps to mitigate damage if contact with the electrical components does occur.

“If a disinfectant does come in contact with electrical contacts, it is recommended that those areas be flushed with alcohol,” Brownley said. “Some OEMs specifically deter the use of chemicals containing amines, strong alkalis, esters, iodine, aromatic or chlorinated hydrocarbons or ketones. Under no condition, should an MR coil be placed in an autoclave or industrial washer that are common means of cleaning, disinfection and sterilization in healthcare facilities.”

Most importantly, the experts stressed that when in doubt, follow the OEM’s guidelines.

Brownley stressed that it’s important that facilities chose a cleaner or disinfectant that is approved by the coil manufacturer and that the recommended processes be followed.

“A percentage of mechanical failures on MR coils can be attributed to either facilities not using an approved chemical or using an approved chemical improperly,” Brownley said.