Infection control and radiation safety practices in the radiology department during the COVID-19 outbreak

Diagnostic radiography students' neonatal mobile X-ray imaging infection prevention and control practices

INTRODUCTION

Neonates represent a unique population with complex medical needs. Diagnostic medical imaging is crucial for diagnosing and treating their conditions, often utilising mobile imaging equipment. A key aspect of providing mobile X-ray imaging for neonates is infection prevention and control (IPC). This study investigated the IPC practices of diagnostic radiography students conducting mobile X-ray imaging in neonatal intensive care units (NICUs).

METHOD

This quantitative descriptive cross-sectional study employed purposive sampling and used an online questionnaire to collect data from diagnostic radiography students at a higher education institution in Gauteng, South Africa. The data was analysed using descriptive and inferential statistics.

RESULTS

The survey had a response rate of 51.1% (n=141, N=276), primarily from the second-year cohort (44.7%). Most participants (n=132; 93.6%) had access to dedicated NICU and IPC policies, but only 63.1% (n=89) were familiar with the IPC protocols. The majority of participants (n=134; 95%) recognised the importance of limiting cross-contamination in the NICU. Participants rated their IPC practices as average (n=60; 49.6%) and high (n=64; 45.4%). More reported cleaning the mobile X-ray machine (n=89; 63%) and washing hands (n=114; 81%) before examinations rather than after, with image receptors (n=106; 75%) mostly cleaned after the examination.

CONCLUSION

The IPC practices of diagnostic radiography students during mobile X-ray imaging in the NICU were inconsistent. Most students understood the importance of IPC; however, inconsistencies in cleaning mobile X-ray machines, image receptors and radiographic markers were reported. It is necessary to explore the reasons for these divergent IPC practices to develop strategies to enhance IPC practice compliance.

Bacteria and yeasts of nosocomial importance in a radiology department in an academic hospital

Background

Healthcare-associated infections (HAIs) result in a significant burden on the healthcare sector. Investigations into their epidemiology and possible routes of transmission are important to enable interventions that protect patients and staff. Radiology devices are known to be colonised by microbial organisms that may act as fomites for infection. However, there is a lack of relevant data from the South African setting.

Objectives

The study aimed to determine deficiencies in infection control practices and the microbial colonisation rates and resistance profiles of devices within a radiology department.

Method

A cross-sectional, single-centre study was conducted in a radiology department in Johannesburg, South Africa. An infection prevention and control (IPC) audit was performed, and 143 swabs were collected. Swabs were cultured according to standard microbiological techniques, and focused antimicrobial resistance testing was performed.

Results

Infection prevention and control practices did not align with manufacturer recommendations. A total of 29 positive swabs were obtained (20.3%). Of these, 93.1% (n = 27) were considered commensals, while 6.9% (n = 2) were considered pathogens. No significant antimicrobial resistance mechanisms were detected.

Conclusion

The detection of pathogenic organisms demonstrates the possibility of microbial transmission between patients within the department. Infection control practices are noncompliant and require improvement to mitigate this risk. The threat of microbial dissemination remains.

Contribution

This study demonstrates the prevalence of microbes in a South African radiology department, underscoring the risk of microbial dissemination because of inadequate decontamination practices between patients.

Current Updates on Pathogenesis, Systemic Therapy, and Treatment of Invasive Fungal Infections

Numerous health hazards are associated with fungal infections, ranging from asymptomatic cases to potentially fatal invasive diseases that are especially dangerous for those with impaired immune systems. The main causes behind these diseases are opportunistic fungi, namely Aspergillus, Candida, and Cryptococcus. Invasive fungal infections (IFIs) require a global response that includes the development of vaccines, standardized protocols for diagnosis, potent antifungal medications, and strategies to stop drug-resistant strains. Improving high-risk group diagnosis and treatment is essential to lowering death rates. This review highlights the substantial health concerns associated with fungal infections, especially in immunocompromised individuals, and identifies Aspergillus, Candida, and Cryptococcus as the main pathogens. It highlights the necessity of international efforts, such as the development of novel diagnostic instruments, imaging methods, and antifungal drugs, to combat these invasive infections. The review also addresses the increasing need for novel treatment approaches in light of the developing resistance to widely used antifungal medications. Furthermore, the significance of secretory proteins in fungal pathogenicity and the potential of combination therapy are investigated. It is also suggested that a multimodal strategy be used to fight these illnesses, given the promise of multivalent vaccinations. Overall, this study emphasizes how critical it is to develop better diagnostic and treatment strategies in order to successfully control and lessen the impact of invasive fungal diseases on the health of the world.

Enhancing radiation safety awareness and practices among female radiographers: a comprehensive approach

OBJECTIVE

This study evaluates the level of radiation safety awareness and adherence to protective practices among pregnant female radiographers in the United Arab Emirates, aiming to identify gaps and develop targeted interventions for enhancing occupational safety.

METHODS

Employing a cross-sectional design, the study surveyed 133 female radiographers using a self-developed questionnaire covering demographics, awareness and knowledge, workplace practices, communication, and satisfaction.

RESULTS

The survey showed high awareness among radiographers, with 97% acknowledging radiation risks during pregnancy, although 42.9% had not received formal training. Concerns over long-term health effects were significant, with 66.2% of participants worried about potential impacts. Despite these concerns, 83.5% had been informed about radiation risks and protective measures, indicating active information provision in many workplaces. However, inconsistencies in information dissemination across different work settings were noted.

CONCLUSIONS

The findings highlight the need for standardized radiation safety protocols for pregnant radiographers. The variability in safety training and information dissemination suggests the importance of establishing uniform safety practices. Recommendations include developing comprehensive education and training programs for pregnant radiographers, ensuring open communication for radiation safety and pregnancy-related concerns, and enforcing clear guidelines for workplace accommodations.

Barriers to radiographers' use of radiation safety principles: A qualitative perspective

INTRODUCTION

To minimise the risks associated with ionising radiation, it is necessary for all staff involved to employ specific techniques to reduce radiation exposure of the patient. These techniques include using compression during examinations of the pelvic region and lumbar spine, using a gonad shield, and asking women if they are pregnant. However, some staff do not use these techniques consistently. Increasing compliance requires determining why staff are non-compliant. Thus, this study aims to qualitatively investigate why radiographers do not use these techniques.

METHODS

This qualitative study is based on a cross-sectional electronic survey with open-ended questions. The data were analysed using an inductive qualitative content analysis with quantification of the findings. In total, 111 radiographers from 20 hospitals in Sweden participated.

RESULTS

Three categories appear related to barriers that could obstruct the radiographer from using compression, gonad shields and asking about pregnancy: patient characteristics, interaction between the patient and the radiographer and issues related to the situation and examination.

CONCLUSIONS

The barriers to not using radiation protection measures varied depending on the specific measure. However, the barriers were mainly related to the patient experiencing pain, communication difficulties and cultural reasons. In addition, the lack of adequate and user-friendly equipment was seen as a barrier to applying compression and using gonad shielding.

Infection prevention and control in CT Part 2: Radiographers' and radiology nurses' perceptions of high-risk scenarios contributing to non-adherence to IPC protocols

INTRODUCTION

Adherence to standard and transmission-based precautions in the computed tomography (CT) setting is central to effective infection prevention and control (IPC), yet there is limited evidence about medical imaging (MI) professionals' self-reported predictors of IPC breaches. This is the second of a two-part series on IPC in the CT setting. Part 1 reported on Australian baseline data relating to intravenous contrast media administration and power injectors. Part 2 presents Australian radiographers' and radiology nurses' perceptions of clinical situations that reduce adherence to standard and transmission-based precautions in CT.

METHODS

A self-administered survey was distributed to Australian radiographers and radiology nurses working in CT. Responses to an open-ended question "If I was to not adhere to the standard and transmission-based precautions in the CT department, it is most likely when …" was analysed using inductive coding for themes, followed by deductive analysis mapped to the Systems Engineering Initiative for Patient Safety (SEIPS) model.

RESULTS

Study participants (n = 136) were radiographers (n = 119; 87.5%) and nurses (n = 17; 12.5%). 'Four themes were derived from the inductive analysis: (1) high-risk working conditions, (2) compliance with good practice, (3) attitudes and practice, and (4) quality of communication. Deductive analysis, using the SEIPS domains revealed that predominant issues related to 'Tasks' (43.7%) and 'Organisation' (30.6%) followed by issues related to 'Person' (16.9%), 'Tools and technology' (6.9%) and 'Environment' (1.9%).

CONCLUSION

Multi-faceted pressures on radiology staff may compromise adherence to standard and transmission-based precautions in CT. Task difficulty, time pressures whilst undertaking tasks, and reduced staffing could lead to lower adherence to standard and transmission-based precautions.

IMPLICATIONS FOR PRACTICE

Future studies that focus on evaluation of 'Tasks' and 'Organisation' domains of the SEIPS model may provide further insights to non-adherence behaviours in MI.

A closer look at the utilized radiation doses during computed tomography pulmonary angiography (CTPA) for COVID-19 patients

Introduction

CTPA stands for computed tomography pulmonary angiography. CTPA is an X-ray imaging that combines X-rays and computer technology to create detailed images of the pulmonary arteries and veins in the lungs. This test diagnoses and monitors conditions like pulmonary embolism, arterial blockages, and hypertension. Coronavirus (COVID-19) has threatened world health over the last three years. The number of (CT) scans increased and played a vital role in diagnosing COVID-19 patients, including life-threatening pulmonary embolism (PE). This study aimed to assess the radiation dose resulted from CTPA for COVID-19 patients.

Methods

Data were collected retrospectively from CTPA examinations on a single scanner in 84 symptomatic patients. The data collected included the dose length product (DLP), volumetric computed tomography dose index (CTDIvol), and size-specific dose estimate (SSDE). The organ dose and effective dose were estimated using VirtualDose software.

Results

The study population included 84 patients, 52% male and 48% female, with an average age of 62. The average DLP, CTDIvol, and SSDE were 404.2 mGy cm, 13.5 mGy, and 11.6 mGy\, respectively. The mean effective doses (mSv) for males and females were 3.01 and 3.29, respectively. The maximum to minimum organ doses (mGy) between patients was 0.8 for the male bladder and 7.33 for the female lung.

Conclusions

The increase in CT scans during the COVID-19 pandemic required close dose monitoring and optimization. The protocol used during CTPA should guarantee a minimum radiation dose with maximum patient benefits.

Investigation of the Radiographer's adherence and compliance with radiation protection and infection control practices during COVID-19 mobile radiography

Radiological staff, especially radiographers, work as front liners against the COVID-19 outbreak. This study aims to assess compliance with radiation protection and infection control practices during COVID-19 mobile radiography procedures. This cross-sectional study included 234 radiographers (females, 56%, n = 131; males, 44%, n = 103) who were asked to complete an online questionnaire consisting of demographic data, radiation protection and infection control practices during COVID-19 portable cases, and knowledge and awareness. After informed consent was completed, SPSS statistical software was used for the data analysis. The most common age group of participants ranged from 18 to 25 years old (30.3%, n = 71). Bachelor's degree holders were 74.4% (n = 174). Most radiographers (39.7%, n = 93) had a working experience of 1-5 years, followed by 27.8% (n = 65) with more than 16 years of experience. Most respondents (62.4%, n = 146) handled approximately 1-5 cases daily, the majority of them (56%, n = 131) stated affirmatively they had obtained special training to handle COVID-19, and when inquired if they had received any special allowances for handling COVID-19 suspected/confirmed cases most of them stated negative (73.9%, n = 173). Most participants stated that they always wear a TLD during portable cases (67.1%, n = 157) and a lead apron (51.7%, n = 121). Around 73% (n = 171) knew the latest information on COVID-19 and attended the COVID-19 awareness course. A significant association was found between the work experience of the radiographers and their responses to following the best practices (p = 0.018, α = 0.05). Radiographers who had COVID-19 training (μ = 48.78) tend to adhere more to best practices than those who have not (p = 0.04, α = 0.05). Further, respondents who handled more than 16/more COVID-19 suspected/confirmed cases followed the best practices more (μ = 50.38) than those who handled less (p = 0.04, α = 0.05). This study revealed detailed information on radiation protection and infection control practices during COVID-19 mobile radiography. It has been observed that the participants/radiographers have good knowledge and awareness of radiation protection and infection-control practices. The present results may be used to plan future requirements regarding resources and training to ensure patient safety.