Since the lungs are the main organ involved, imaging techniques play an important role in supporting the diagnosis. Chest X-ray and computed tomography (CT) examinations were effective methods for the screening and diagnosis of this infectious disease. Examination with nonstandard infection prevention procedures leads to high risks of hospital cross-infection in the radiology department. Thus, it is of critical importance to implement proper infection prevention and control practices in radiology departments to reduce cross-infection and protect medical professionals. This article clarifies the detailed Infection Prevention and Control (IPC) measures to be followed by the radiation workers and the disinfection of diagnostic radiology equipment and the workplace, with the aim of further normalizing the clinical procedures of radiological staff and to reduce the infection risk to staff, patients, and visitors.
- Infection Risk to Healthcare Workers in the Radiology Department
- International COVID-19 Infection Prevention and Control (IPC) Measures at the Healthcare Facility Level
In December 2019, a cluster of patients with pneumonia associated with a novel coronaviruses were registered in Wuhan City, Hubei Province of China. This virus was officially named by the World Health Organization (WHO) as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease (COVID-19) for the disease it causes. This new disease has spread rapidly, mainly through droplets and contact. Until 11 October, 2021, there have been more than 237,000,000 worldwide, of confirmed cases. This epidemic has overwhelmed health care systems worldwide and has caused many cases of covid-19 between healthcare workers.
Medical imaging plays an essential role in the diagnosis and treatment of COVID-19, and proper IPC measures can reduce the chances of cross-infection and protect medical personnel, patients, and hospital visitors.
Infection Risk to Healthcare Workers in the Radiology Department
Front-line healthcare workers are at high risk of infection due to their close personal exposure to patients with SARS-CoV-2. Initial estimates suggest that front-line healthcare workers could account for 10–20% of all diagnoses. A study in the United Kingdom and the United States conducted in 2020 by Nguyen L. et al. showed that the risk of reporting a positive test for COVID-19 was 3.4 times higher for medical workers than for general community and, unfortunately, this may contribute to further spread of COVID-19 in healthcare institutions and general community. Radiology personnel are among those on the forefront in the fight against COVID-19, and most of them had less experience when working with COVID-19 patients. Radiological examinations conducted with nonstandard prevention procedures lead to high risks of hospital cross-infection in the radiology department.
Radiology personnel, due to their close contact to COVID-19 patients, are at high risk of becoming infected. And examinations conducted with nonstandard infection prevention procedures lead to higher risks of hospital cross-infection within the radiology department.
International COVID-19 Infection Prevention and Control (IPC) Measures at the Healthcare Facility Level
Infection prevention and control (IPC) is the practice of preventing or stopping the spread of infections during healthcare delivery in healthcare facilities. IPC practices are of critical importance in protecting the functioning of healthcare services and mitigating the risk of cross-infection.
- Rapid identification of suspect COVID-19 cases
- Screening/triage at initial healthcare facility encounter and rapid implementation of source control
- Limiting the entry of healthcare workers and/or visitors with suspected or confirmed COVID-19
- Immediate isolation and referral for testing
- Safe clinical management
- Adherence to IPC practices
- Appropriate use of personal protective equipment (PPE).
COVID-19 IPC measures aims to prevent COVID-19 transmission within healthcare institutions and ensure the safety of staff, patients, and visitors.
The application of the IPC measures in radiology departments are focused primarily on controlling transmission routes such as droplet, contact surface, and aerosol transmissions.
Working environment precautions
Patient screening is recommended to be undertaken at the time of radiologic examination scheduling and in all outpatient imaging settings. Although all patients and visitors are screened at the entrance to hospitals, an identification of patients at risk for contracting COVID-19 is recommended at the radiology front desk.
A dedicated radiological examinations route must be established. Contaminated areas, suspected contaminated areas, and clean areas need to be clearly separated to accommodate the three categories of patients. Patients are to be masked during imaging and procedures.
For the contaminated area, an independent, well-ventilated medical imaging examination room is needed. The duration of the examination should be minimized as much as possible. In this room, dedicated radiological examination equipment and a film printer should be available. If a dedicated examination room (such as a CT room) cannot be separated from others, strict equipment deep cleaning with air disinfection with a maximum air volume of 4000 m3/h are required after the current patient scan and between patient encounters.
Additionally, a movable ultraviolet light (the intensity of the ultraviolet light must be higher than 70 μW/cm2 per meter) should be used for examination room disinfection three times a day when examinations are not taking place, for more than 30 minutes each time. Non plastic equipment surfaces, radiation protection items, and doorknobs should be disinfected with a solution that is at least 75% alcohol or with alcohol-containing wipes after each scan. If technologists are uncertain of the material in an equipment surface, they should contact the equipment vendor to determine appropriate methods for disinfection. Caution should be exercised when using disinfectant sprays, as they may penetrate equipment, resulting in short circuits, metal corrosion, or other damage.
After the completion of the examination of a suspected/confirmed COVID-19 case, air and contact surfaces should be thoroughly decontaminated.
Requirements for individual personnel protection in the radiology department
An IPC Officer needs to be designated for directing and supervising the disinfection and infection prevention procedures in the radiology department.
After ensuring at a minimum procurement of adequate hand hygiene supplies, proper hand hygiene practices are strictly recommended for all radiographers to prevent the spread of COVID-19 virus. Health care workers should perform hand hygiene using the proper technique and according to the instructions known as “My 5 Moments for Hand Hygiene,” in particular, before putting on PPE and after removing it; when changing gloves; after any contact with a patient with suspected or confirmed COVID-19 virus, their waste, or the environment in the patient’s immediate surroundings; after contact with any respiratory secretions; before food preparation and eating; and after using the toilet.
Figure 1: WHO 5 Moments of Hand Hygiene, (WHO, 2016)
The use of the personal protective equipment (PPE) is suitable for medical staff who have close contact with suspected or confirmed patients. Personnel should wear disposable isolation aprons or gowns, protective goggles or face shields, medical face masks, disposable latex gloves, and disposable shoe covers, and strictly implement hand hygiene.
Airborne precautions are reserved for those patients who are critically ill or who are undergoing aerosol-generating procedures (bronchoscopy, intubation, nebulization, or open suction). Airborne precautions are not necessary with patients receiving mechanical ventilation as the system is considered a closed system. These infection prevention and control measures include the use of Respirator N95 and isolation gowns, in addition to the eye goggles/face shield and the disposable gloves. PPE donning and doffing protocols must be developed and followed by all staff, in the correct sequence, in order to reduce the possibility of self-contamination or exposure to the virus.
Figure 2: Recommended PPE in the context of COVID-19, (WHO, 2020)
Other preventive measures should be implemented at the radiology department, such as the implementation of “social distancing” strategies for staff and the reduction of the number of staff at the department to those that are essential to prevent the spread of this virus within the hospital. This can be achieved by enhancing remote consultations by video and telephone, conducting remote staff meetings.
Radiographers adhering to the COVID-19 IPC measures, such as proper hand hygiene and safe use of PPE prevent the spread of the virus within the healthcare facility.
Radiological examination plays an irreplaceable role in the diagnosis of patients with COVID-19. Front-line radiology personnel must have a great command of the specific COVID-19 IPC requirements to prevent a further spread of the virus. A screening of suspected/confirmed cases with a specific patient flow revision, a proper room decontamination, along with the proper hand hygiene and the safe and proper use of PPE are among the most important IPC measures. Continuous guidance and training on these infection prevention and control measures, along with an adequate supply of the necessary resources are recommended in order to ensure higher compliance with these preventive measures, and therefore a lower rate of cross-infection and potential fatalities.
- Na Zhu, Dingyu Zhang, Wenling Wang, Xingwang Li, Bo Yang, Jingdong Song, Xiang Zhao, Baoying Huang, P, Weifeng Shi, Roujian Lu, Peihua Niu, Faxian Zhan, “A Novel Coronavirus from Patients with Pneumonia in China, 2019,” The new England Journal of Medecine, pp. 727-733, 2020.
- World Health Organization, “Coronavirus disease 2019 (COVID-19)-Situation Report,” 23 April 2020. [Link]
- World Health Organization, “WHO Coronavirus (COVID-19) Dashboard,” 11 October 2021. [Link]
- Martínez Chamorro, Díez Tascón, Ibáñez Sanz, S.Ossaba Vélez, S. Borruel Nacentaa, “Radiologic diagnosis of patients with COVID-19,” Elsevier Public Health Emergency Collection, pp. 56-73, 2021.
- Long H. Nguyen, David A. Drew, Amit D. Joshi, Chuan-Guo Guo, M.S.Wenjie Ma,,Raaj S. Mehta, Daniel R. Sikavi, Chun-Han Lo, Sohee Kwon, Mingyang Song, “Risk of COVID-19 among frontline healthcare workers and the general community: a prospective cohort study,” National Institutes of Health, 2020.
- Yantao Niua, Junfang Xiana, Ziqiao Leib, Xiao Liua, Quanfu Sunc, “Management of infection control and radiological protection in diagnostic radiology examination of COVID-19 cases,” Radiation Medicine and Protection, pp. 75-80, 2020.
- World Health Organization, “INTERIM RECOMMENDATION,” 1 April 2020. [Link]
- Centers for Disease Control and Prevention, “COVID-19 Overview and Infection Prevention and Control Priorities in non-US Healthcare Settings,” 26 February 2021. [Link]
- World Health Organization, “Infection prevention and control health-care facility response for COVID-19,” 20 October 2020. [Link]
- Mahmud Mossa-Basha, Carolyn C. Meltzer , Danny C. Kim, Michael J. Tuite, K. Pallav Kolli, Bien Soo Tan, “Radiology Department Preparedness for COVID-19: Radiology Scientific Expert Review Panel,” Radiology, vol. 296, no. 2, 2020.
- Jieming Qu, Wenjie Yang, Yanzhao Yang, Le Qin, Fuhua Yan, “Infection Control for CT Equipment and Radiographers’ Personal Protection During the Coronavirus Disease (COVID-19) Outbreak in China,” American Journal of Roentgenology, pp. 940-944, 2020.
- Saad Alhumaid, Abbas Al Mutair, Zainab Al Alawi, Murtadha Alsuliman, Gasmelseed Y. Ahmed, Ali A. Rabaan, Jaffar A. Al-Tawfiq & Awad Al-Omari , “Knowledge of infection prevention and control among healthcare workers and factors influencing compliance: a systematic review,” Antimicrobial Resistance & Infection Control, vol. 86, no. 3, 2021.
Disclaimer: The information provided on this website is intended to provide useful information to radiologic technologists. This information should not replace information provided by state, federal, or professional regulatory and authoritative bodies in the radiological technology industry. While Medical Professionals strives to always provide up-to-date and accurate information, laws, regulations, statutes, rules, and requirements may vary from one state to another and may change. Use of this information is entirely voluntary, and users should always refer to official regulatory bodies before acting on information. Users assume the entire risk as to the results of using the information provided, and in no event shall Medical Professionals be held liable for any direct, consequential, incidental or indirect damages suffered in the course of using the information provided. Medical Professionals hereby disclaims any responsibility for the consequences of any action(s) taken by any user as a result of using the information provided. Users hereby agree not to take action against, or seek to hold, or hold liable, Medical Professionals for the user’s use of the information provided.