Personal protective equipment (PPE) is defined by the ...
PERSONAL PROTECTIVE EQUIPMENT
FOR
RADIOLOGY
TECHNOLOGISTS
CE COURSE
By
Mary Stela Gallegos, ABD, RT, (R), (M)
Zapp! Educational Services
(559) 859-4725
Personal Protective Equipment for Radiology Technologists
There are several different objectives in presenting the following material. The first objective of this course is to provide a review of the utilization of “Personal Protective Equipment” (PPE) for all radiology technologists. The second objective is to provide review material regarding “Standard and Transmission-Based Precautions”. Last, this course will also provide a review of three types of latex allergies.
The objectives for the course will be accomplished by the following:
1. Presenting the historical evolution of PPE practices
2. Identifying and describing safe utilization or practices of PPE
3. Presenting and Identifying each type of PPE
4. Illustrating the methodology of donning and removing PPE
5. Presenting and identifying the elements of Standard Precautions
6. List and describing the three components of Transmission-Based Precautions
7. Identifying the elements of the general principles of Standard Precautions
8. Identifying the elements of the general principles of Transmission-Based Precautions
9. Explaining the three types of Latex allergies, symptoms, and pertinent information
According to the Occupational Safety and Health Administration (OSHA), specialized equipment or dedicated clothing worn by employees for their protection against any infectious material is considered Personal Protective Equipment (PPE). Consequently, OSHA plays a major role in regulating workplace health and safety standards. Its strict mandated regulations require use of PPE to protect healthcare personnel from exposure to blood-borne pathogens and infectious diseases. As healthcare employees, radiology technologists must adhere to the PPE practices as set forth by their employers. The healthcare facility must provide radiology technologists with the appropriate PP E, since PPE is required for any potential infectious exposure. This home study course will present:
Section One:
• Historical review of isolation practices
• PPE - utilization, proper sequence for donning and removing
Section Two:
• Universal Precautions
o Standard Precautions
o Transmission-based Precautions
• Infection Preventionists
• Aerobiology relating to Infectious Diseases
Section Three:
• Latex Allergy
o Irritant Contact Dermatitis
o Contact Dermatitis
o Latex Allergy
At the end the first section of this course is a brief review of the issues pertaining to PPE. This section will present a brief discussion regarding safe work practices (i.e., needlesticks) and hand hygiene.
HISTORICAL REVIEW
Isolation Practices
The theory of isolating patients with infectious diseases was first published in a hospital handbook in 1877 (Garner, 1996). The handbook suggested placing patients with infectious diseases in separate hospitals. These hospitals later became known as infectious disease hospitals. Regardless of the segregation, nosocomial infections continued within the infectious disease hospitals because infected patients were not isolated from each other. In addition, aseptic techniques were not practiced by healthcare personnel. By 1890 and 1900, nursing textbooks were eventually recommending utilization of aseptic procedures (Garner, 1996). During this time frame, in order to combat nosocomial infections from spreading, infectious disease hospitals began to isolate patients with the same diseases on different floors. By 1910, patients with infectious diseases were placed in a multi--bed wards, and a “cubicle system” for isolation was implemented throughout U.S. hospitals (Garner, 1996). At that time, the cubicle system for isolation patients, consisted of hospital personnel:
• Using separate gowns
• Washing their hands with antiseptic after patient contact
• Disinfecting objects contaminated by patient
The cubicle system was later imitated by other non-isolation nursing facilities and a “barrier nursing” system was created. By utilizing the cubicle system and the barrier nursing system, general hospitals were able to admit patients with infectious diseases. By the 1950s, U.S. infectious disease hospitals began to close, followed closely by the closing of tuberculosis hospitals in the mid-60s. By the late 60s, in order to meet infectious control needs, general hospitals provided: single-patient isolation rooms; single or multiple patient rooms; or specifically designed isolation rooms. Today, there are different types of designed isolation rooms such as those for TB (Garner, 1996).
In order to combat infectious diseases, in 1970, and again in 1975, the Center for Disease Control and Prevention (CDC) published their manual entitled Isolation Techniques for Use in Hospitals. The CDC created guidelines for infection control and established seven isolation categories:
1. Strict Isolation
2. Respiratory Isolation
3. Protective Isolation
4. Enteric Precautions
5. Wound and Skin Precautions
6. Discharge Precautions
7. Blood Precautions
The precautions recommended for each of the seven categories were determined by the epidemiologic characteristics of the diseases found in each category. By the early 1980s, hospitals were experiencing new epidemics, thus in 1983, the CDC changed their previous manual to the current name, CDC Guidelines for Isolation Precautions in Hospitals.” Then in 1985, due to the HIV epidemic, CDC altered their recommendations dramatically, thus creating Universal Precaution (UP). However, UP did not cover some of the fluids, secretions, and excretions which represented a potential source for nosocomial and community-acquired infections. Consequently, in a joint effort of collaboration, Harborview Medical Center and the University of California, San Diego, created a new system of isolation called the Body Substance Isolation (BSI). Significantly, BSI focused on the isolation of all moist and potentially infectious body substances, such as feces, urine, blood, saliva, sputum, wound drainage, and some other body fluids.
By the early 1990s, many hospitals had incorporated all or some portions of UP and all or some of BSI. Unfortunately, there was mass confusion about which body fluids or substances required precautions under UP or BSI. For example, UP recommended glove use and handwashing for anticipated contact with blood and other specific body fluids, and hands needed to be washed immediately following the removal of gloves. On the other hand, BSI recommended gloves be worn for anticipated contact with any moist body substance, but handwashing after glove removal was not recommend, unless hands were visibly soiled.
In order to address these differences and to create a more uniform concept of isolation for infection control, in 1996, CDC created “Standard Precautions” and “Expanded Isolation Precautions” by combining UP and BSI. (See “Section Two” for a more detailed description). Expanded Precautions was later changed to Transmission-Based Precaution.
UTILAZATION OF PERSONAL PROTECTIVE EQUIPMENT
Most large hospitals and healthcare facilities are currently using the CDCs recommendations for Standard Precautions and Transmission-Based Precautions to determine which type of PPE should be worn, and when it should be used. While providing patient care, radiology technologists should assume that an infectious agent could be present in the patient’s blood or body fluids, including all secretions and excretions. Thus, taking the appropriate precautions, such as using the proper PPE, must be taken. The following criteria are used to determine if PPE is needed, and if so, which type:
• The type of clinical interaction with the patient
• The degree of blood and body fluids contact that can be reasonably anticipated
• By whether the patient has been placed on isolation precautions (i.e. Airborne, Contact, or Droplet Precautions).
Standard Precautions utilize PPE to prevent the transmission of common infectious pathogens to healthcare personnel (including radiology technologists), patients, and visitors in any healthcare setting. Under Standard Precautions, gloves should be used when touching blood, body fluids, secretions, excretions, or contaminated items, and for touching mucous membranes and non-intact skin. A gown should be used during procedures and patient-care activities when contact of clothing and/or exposed skin with blood, body fluids, secretions, or excretions is anticipated. Mask and goggles or face shield should be used during patient-care activities that are likely to generate splashed and sprays of blood, body fluids, secretions, or excretions. Other PPE include mouthpieces, resuscitation bags, pocket mask, or other ventilation devices. Surgical departments may also require hair and shoe covers. It is the employer’s responsibility to provide and maintain PPE for their employees and must ensure that all PPE is clean, in good repair, and replace equipment as needed.
Transmission-Based Precaution (formerly known as Expanded Isolation Precautions) are utilized not only by radiology technologists, but by all healthcare employees, when situations require an employee to wear PPE which is beyond that recommended by Standard Precautions. Transmission-Based Precautions are categorized into three groups but will be discussed in more detail in Section Two: Airborne Precautions; Contact Precautions; and Droplet Precautions.
Airborne Infection Isolation requires that a particulate respirator be worn and use of a negative-pressure isolation room is essential. See Section Two for more detailed information.
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Figure 1.0 Source: (Free to share and use commercially)
Contact Precautions requires gloves and gowns for contact with the patient and/or the environment of care; in some instances, use of this PPE is recommended when entering the patient’s environment. See Section Two for more detailed information.
Droplet Precautions requires the use of a surgical mask within six feet of the patient. See Section Two for more detailed information.
The Occupational Safety and Health Administration (OSHA) which is part of the U.S. Department of Labor, defines blood as human blood, human blood components, and products made from human blood. Furthermore, OSHA explains how occupational exposures to blood and other potentially infectious materials (OPIM) place radiology technologists at risk for infections with blood-borne pathogens.
Table 1.0 presents a list of where pathogenic microorganisms can be found. In addition, pathogenic microorganisms can also be found in saliva and peritoneal fluid. Next, radiology technologists must be aware of any body fluids found in situations in which it is difficult or impossible to differentiate between various types of body fluids. One example of this can be during emergency or trauma cases. Consequently, healthcare facilities have developed safety steps in order to protect their healthcare employees from infectious material contamination. There are four major components to a successful healthcare workers-safety program:
• Engineering controls, (negative pressure rooms for patients with airborne diseases including TB)
• Personal Protective Equipment - presented in this course
• Training and administrative controls (isolation policies and procedures, procedures for recognizing patients with communicable diseases before they expose healthcare workers)
• work practice controls (i.e. not recapping needles)
All four of these components are vital in protecting healthcare workers including radiology technologists from disease transmission. However, due to the limited scope of this course, only PPE will be presented, with Standard and Transmission-based Precautions. All the PPE information presented in this course prevent contact with the infectious agent, or body fluid that may contain the infectious agent by creating a barrier between the radiology technologist and the infectious material: gloves; gowns; mask, goggles, and face shields; and respirators. Gloves protect the hands, gowns protect the skin and/or clothing, mask and respirators protect the mouth and nose, while goggles protect the eyes and face shields protect the entire face. In addition, the design of the respirator is specifically manufactured to protect the respiratory tract from airborne transmission of infectious agents.
Personal Protective Equipment
In today’s market, there are many different types of Personal Protective Equipment which may be used in a radiology department. However, there are three key elements to consider when selecting PPE:
1. Anticipated exposure
2. Durability and appropriateness of PPE
3. Fit
The first major key point is anticipated exposure, which includes large volumes of blood or body fluids that may penetrate the clothing. Anticipated exposure also includes personal touch, splashes, and sprays. When selecting PPE or a combination of PPE, the radiology technologist must consider the patients isolation precaution category. The second key point is the durability and appropriateness of the PPE for the specific task that is to be accomplished. For example, should a gown be selected? If so, does it need to be fluid resistant, fluid proof, or neither? Last, a radiology technologist must be concerned with the proper fitting. In other words, PPE must fit the individual user, and it is up to the healthcare facilities to ensure that all PPE are available in a wide range of sizes, as appropriate for the workforce that must be protected.
Gloves
Gloves are the most common type of PPE used in any healthcare setting. There are several criteria to consider when selecting the appropriate glove:
• Purpose: patient care, environmental services, etc.
• Glove material: vinyl, latex, nitrile, other
• One or two Pairs
• Single-use or reusable
• Sterile or nonsterile
• Size
Most patient-care tasks by radiology technologists require the use of a single pair of ambidextrous, nonsterile gloves made of latex, nitrile, or vinyl. Due to allergy concerns (see section 3), some healthcare facilities have eliminated or limited latex products, including gloves, and now use gloves made of nitrile or other material. Nitrile gloves are made of synthetic rubber, easily disposable, and some are made powder-free. They are very efficient in radiology departments because they contain no latex proteins and provide exceptional resistance to wear and tear.
If there is limited patient contact anticipated, vinyl gloves are frequently available and work well for certain tasks. For example, employees working in the environmental department regularly wear reusable heavy-duty latex or nitrile gloves if handling caustic disinfectants while performing their duties. In addition, radiology technologists may also use vinyl glove while performing some of their duties. Sterile surgical gloves are not generally worn by radiology technologists except in areas such as special procedures, cardiac, or interventional radiography. However, they are worn by radiologists, surgeons, and other healthcare personnel who perform invasive patient procedures. Some surgical procedures may require two pairs of gloves to be worn.
Depending on the type of glove, some do not fit the hand snuggly, especially around the wrist, and should not be used if extensive contact is likely. Gloves should fit comfortably but should not be too tight nor too loose. Gloves should be durable, especially if they are worn for several hours. If gloves are easily torn or damaged, they should be replaced with a more appropriate selection. The purpose of wearing gloves is to protect the radiology technologist, as well as other healthcare employees against contact with infectious material. However, once contaminated, gloves can be a means of spreading infectious material to:
1. oneself
2. to patients and their family
3. to others (i.e. co-workers, venders, etc.)
4. or to environmental surfaces
The method in which an individual uses gloves can influence the risk of disease transmission in a healthcare setting. One basic principle of infection control is “touch contamination”. This rule simply refers to touching “clean” surfaces after touching “contaminated” surfaces while wearing gloves. For example, a radiology technologist may unintentionally adjust their glasses after having touched a patient, thereby making the glasses “touch contaminated”. It is crucial to limit opportunities for touch contamination in order to protect oneself, patients or others, and the surrounding environment. Being aware of the environmental surfaces and avoiding touching them unnecessarily with contaminated gloves will help prevent the spread of infectious material. Surfaces such as light switches, bed controls, and doors can become contaminated if touched by soiled gloves.
If gloves become torn or heavily soiled while performing a radiological procedure, and the exam has not been completed, the radiology technologist must change their gloves before continuing. Gloves must be changed after each patient and discarded in the nearest appropriate receptacle. According to guidelines, gloves that are designated for patient care ought not to be washed and then re-used. An advising tip that many staff members do not realize is that washing gloves does not necessarily make them safe for reuse. In other words, washing gloves does not eliminate all pathogens but can make the gloves prone to tearing or leaking.
Gloves should be stored as recommended by the individual manufacturer. Some gloves require special precautions. For example, Kimberly-Clark’s sterile nitrile gloves storage recommendations are store in a cool and dry place, shield from direct sunlight, intense artificial light, x-ray machines, and other sources of ozone. It is critical that these gloves should not be placed by x-ray machines.
Gowns
A second component of PPE is wearing a protective gown. When selecting a gown as PPE, there are three factors that influence a radiology technologist’s selection:
• intended use
• material components
• clean versus sterile
First, the selection of a PPE gown depends on the intended purpose or usage. Isolation gowns are generally the preferred PPE to protect clothing. Some healthcare facilities have aprons available for occasions where limited contamination is anticipated. If contamination of the arms can be anticipated, a gown is the best selection. Gowns should fit comfortable over the body, cover the complete torso, and have long sleeves that fit snuggly at the wrist.
Another key point when selecting a gown is the material components of the gown. Isolation gowns are made either of a spun-synthetic material or cotton. The material of the gown dictates whether they can be laundered and reused or must be discarded. Spun-synthetic or cotton isolation gowns vary in their degree of fluid resistance, another factor that must be considered in the selection of this garment. Staff must pre-determine if fluid penetration is expected and select a fluid-resistant gown. The last factor in selecting a gown concerns patient risks and whether a clean, rather than sterile, gown should be used. Clean gowns or specialized gowns are generally used for isolation patients, but many facilities have opted to use sterile gowns to reduce infections. Sterile gowns are necessary for performing invasive procedures, such as inserting a central line. In this case, a sterile gown would serve for both patient and the radiology technologist’s protection.
Face Protection
The isolation precautions posted on the patient’s door and the expected level of patient contact will determine the selection of the facial PPE to be used. There are several facial PPE types available to protect all or parts of the face from contact with potentially infectious material. When wearing a mask, it should fit fully over the nose and mouth and prevent fluid penetration. In addition, masks should fit snugly over the entire nose and mouth. Preference is given to PPE masks that can be secured to the head with elastic bands (or strings) and have a flexible nose piece.
Blood-borne pathogens (i.e. hepatitis, HIV, etc.) from blood or other body fluids are hazards for radiology technologists, as well as other healthcare employees. As a safety measure, goggles provide barrier protection for the eyes. However, personal prescription lenses do not provide optimal protection and should not be used as a substitute for goggles. Eyewear retainers can be used to keep glasses tight fitting and helps them from slipping. Goggles with anti-fog features help maintain clarity of vision and should fit snugly over and around the eyes or prescription lenses. Sole protection of eye and face devices should not be relied upon to provide complete protection. Instead, radiology technologists must be aware of their surrounding environment and be prepared to react to the unexpected event. In addition, OSHA regulations may require some large facilities to have emergency eyewash areas and sterile solutions on site. This may be the case for some large radiology departments, due to the chemicals found within the department.
In large hospital settings (i.e. ICU, surgery, Cath labs, etc.) there may be incidents in which facial skin protection is needed or desired in addition to mouth, nose, and eye protection. In these cases, a face shield can be substituted for a mask or goggles. When using a face shield, it should cover the forehead, extend below the chin, and wrap around the side of the face. If used correctly, utilization of face shields will protect radiology technologists from blood-borne hazards encountered in the healthcare setting.
Respiratory Protection
As a healthcare employee, radiology technologists may encounter airborne infectious diseases while performing their duties. Utilization of PPE, such as a respirator will protect all healthcare workers from hazardous or infectious diseases, such as Mycobacterium tuberculosis. Respirators which filter the air before it is inhaled should be used for respiratory protection.
However, since the N95 respirator filters 95% of airborne particles it is the most preferred particulate filtering facepiece respirator among the seven types currently available (CDC, 2018).
It is essential that radiology technologists use these respirators because they are approved by the CDC’s National Institute for Occupational Safety and Health (NIOSH). One benefit of using N95 and N100 respirators is that they contain a filter capable of excluding particles as small as 0.30 microns wide — particles far too small for the eye to see (Shieh, 2018).
The selection of a respirator type, like other PPE, depends on the nature of the exposure and the risk involved. For example, a radiology technologist may wear a N95 particulate respirator upon entering the room of the patient with infectious tuberculosis. However, if the radiology technologist is engaged in a bronchoscopy on the same patient, they may be required to wear a higher level of respiratory protection, such as a powered air-purifying respirator (PAPR).
A powered air-purifying respirator (see Figure 2.0) is used to prevent healthcare worker's such as radiology technologist’s exposure to atmospheric threats. There are many advantages to using PAPR. For example, it allows for less respirator breathing resistance, which makes it an ideal choice for staff members who may not be able to use of a negative pressure respirator. Different PAPR battery-powered systems are capable of filtering different types and concentrations of contaminants by pulling ambient air through the purifying device and into the user's breathing area. The PAPR system’s canister, filter, or cartridge (used to remove the atmospheric contaminants) must be changed periodically. The purpose of the PAPR is to protect the person wearing it by blocking the contaminants or infectious diseases from entering the respiratory track. Another advantage to these systems is that the user has the choice of using a loose hood or a fitted mask. The disadvantage to using PAPR systems is that they can only be used when the contaminants and their concentrations are known because the system uses ambient air.
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Figure 2.0 PAPR Source: (Free to share and use commercially)
HEPA is an acronym for high-efficiency particulate air, which is a type of filter that can trap many tiny particles that other systems would simply recirculate back into the environment of the facility. In extensive healthcare facilities, hospitals are required to have radiology technologists medically (upon employment) evaluated and fitted for respirators. It is the employer’s responsibility:
• fit staff with appropriate respirator size
• fit staff with appropriate respirator type
• for training staff on how and when to use a respirator
The radiology technologist is responsible for checking the fit of the respirator before using it in order to ensure a proper seal. This will optimize the protection needed and provide a sturdier barrier preventing the spread of infectious diseases.
Donning PPE
Before utilizing PPE, the radiology technologist must take the proper precautions before donning the equipment. First, creating a protective barrier before having contact with the patient is essential in order to prevent the spread of infectious diseases. Consequently, donning PPE must be done before patient contact; most often wearing PPE is accomplished before entering the patient’s room. Carelessness and common disregard of proper PPE procedures may exacerbate contamination. Thus, ensuring the proper guidelines for PPE will prevent the spread of infectious diseases. Next, once the radiological procedure has been completed, following the proper removal of the PPE is vital in order to prevent contamination. Upon removal of the PPE it must be placed in a designated receptacle. At this point, the radiology technologist must follow handwashing procedures immediately upon leaving the patient’s room which is important before proceeding with the next radiology patient or procedure.
The precautions needed to be taken (i.e. Standard Precautions and Transmission-Based Precautions) will determine the combination of PPE to be used, and therefore the sequence for donning the proper equipment. The sequence of donning of PPE consists of: donning the gown first; the mask or respirator should be put on next; the goggles or face shield should be donned next; and gloves last.
Before donning a gown, the appropriate type for the task must be selected. The gown should open in the back and secured at the neck and waist (see Figure 3.0). Using two gowns may be necessary if the gowns are too small to fully cover the radiology technologist’s torso. If two gowns are needed, the first gown should be open in the front and the second gown covers the first with the opening to the back.
[pic][pic] Figure 3.0 – Sequence of donning a gown. Courtesy of CDC
When donning a mask or respirator, it is important to adjust it accordingly, so a proper fit is maintained as recommended by the facility. Fortunately, currently PPE masks are offered in a variety of styles and sizes. For example, some masks have elastic bands while others have string ties. The first step when donning masks with string ties is to place the mask over the mouth, nose, and chin. Once the mask is in place, the flexible nose piece is bent to fit the upper bridge of the nose then the upper set of strings are tied at the back of the head while the lower set of strings are tied at the base of the neck (see Figure 4.0 below).
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Figure 4.0 – Correct fit for a face mask with ties. Courtesy of CDC
The second type of mask has elastic bands instead of ties. Many surgical wards will utilize this type of mask, and they are easier to put on. When donning a mask with elastic bands, the first band is stretched over the back of the head while holding the mask firmly over the nose, mouth, and chin. The second band is secured below the ears at the base of the neck. Whether the mask has strings or elastic band, the radiology technologist may have to adjust the mask accordingly in order to avoid touch it while performing radiology procedures.
The selection of a particulate respirator is very critical in preventing the spread of infectious diseases. Utilization of an N95, N99, or N100 and donning one is like putting on a pre-formed mask with elastic bands. However, there are two key differences;
• selection of a respirator for which the user has fit-tested for
• fit checking the device, before entering a potential area with airborne infectious disease
Sometimes the manufacturer’s instructions may differ slightly from those presented in this course. Therefore, radiology technologists must be sure to follow the manufacturer’s instructions for donning particulate respirators. Besides, there may be situations or instances in which employees are may be asked to wear a power air-purifying respirator (PAPR). If this should be the case, the facility is responsible for instructing all employees in the proper use of this device.
Protecting the eyes and face is important when potential splashing of blood or other bodily fluids is anticipated. Consequently, either goggles or face shields should be worn to protect the eyes and face (see Figure 5.0 and Figure 6.0 below). Donning the goggles or face shield is easily accomplished by positioning the device over the face and or eyes then securing it to the head using the attached earpieces or headband. Both devices should be adjusted so that they are comfortable, not too snug or tight, so that procedures can be accomplished without touching either device, thereby preventing the spread of infectious material.
Once the gown, goggles or face shield are in place, the radiology technologist will don a pair of gloves which is the last step of PPE. Again, the selection of gloves is dependent on the anticipated task or role that the radiology technologist will be performing. After selecting the appropriate type of glove, the next step is to select the accurate size. Donning a pair of gloves is accomplished by inserting the hands into the appropriate glove and adjusting it for performability, dexterity and comfort. In order to provide a continuous barrier for protection against infectious diseases, tuck the isolation gown cuffs securely under each glove (see Figure 7.0 below).
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Figure 5.0 – Position of goggles over eyes and secure to head. Courtesy of CDC
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Figure 6.0 – Position of face shield over face and secure on brow. Courtesy of CDC
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Figure 7.0 – Correct donning of gloves with isolation gown. Courtesy of CDC
Safety Issues of PPE
The success of prevention of infectious material is not only dependent on wearing the appropriate PPE, but also on following safety practices while utilizing PPE. For example, avoiding the spread of contamination can be prevented by limiting touching surfaces and items with contaminated gloves. Next, if the gloves become torn or heavily contaminated, they should be replaced immediately. Also, keep in mind that hand hygiene must be performed before donning a new pair of gloves. Nonetheless, once the PPE is in place, the spread of infectious disease can also be prevented by avoiding touching one’s face, hair, or other body parts. Last, it is also vital to limit touching or adjusting the PPE. Yet, there may be situations in which a radiology technologist must risk touching or adjusting their PPE while preforming a radiological procedure. For example, during a portable chest x-ray in the ICU, a combative patient may unintentionally grab or move the radiology technologist’s mask, thereby breaking the barrier of protection. In this situation, it is necessary for the radiology technologist to re-adjust (touch) their mask for their safety.
Safe Work Practices in Radiology
In addition to wearing PPE, the radiology technologist must ensure using safe work practices. Thus, remembering the “touch contamination” rule is essential. Avoid contaminating oneself by keeping their hands away from their face, not touching or adjusting PPE, or other nonessential items such as patient’s items, table, TV remote, or other items found in the patient’s room. The duties of a radiology technologist are many and subsequently, have numerous procedures to perform on any given day. Consequently, radiology technologists may feel pressured due to time constraints and not utilize proper PPE. Unfortunately, preceding proper PPE procedures will not only jeopardize the radiology technologist’s health and safety but will endanger patients and others in the community by spreading infectious diseases. Table 3.0 lists a few examples of safe work practices that radiology technologists can perform in order to block the spread of contagious diseases.
Removing PPE
The sequence for removing PPE is intended to limit opportunities for self-contamination. When removing PPE safely, one must first be able to identify which locations of the PPE are considered “clean” and which are “contaminated.” For example, the outside of the isolation gown and the outside of the goggles, mask, respirator, and face shield are considered “contaminated,” regardless of whether there is visible soil. The outside of the gloves is also contaminated. The areas that are considered “clean” are the parts that will be touched when removing PPE. These include the insides of the gloves, the gown ties and the inside and back of the gown, the ties, elastics, or earpieces of the mask, goggles, and face shield.
Gloves, whether visibly soiled or not, are the first to be removed because they are deemed the most contaminated pieces of PPE. The goggles or face shield may be considered cumbersome and cause interference with another PPE so it should be removed next. Third, in the sequence is the removal of the gown. The last PPE to be removed is the mask or respirator, which happens to have been the first PPE that was donned.
Where to remove PPE
The radiology technologist must decide where to remove their PPE, which depends on the amount and type of PPE they are wearing. If they are only wearing gloves as PPE, they may remove and discard the gloves in the patient’s room. For example, if the radiology technologist is simply wearing latex gloves during a routine radiology procedure, they can remove and discard the gloves in the same room after the procedure is completed. However, if full PPE is worn, following the correct procedure for removing PPE as previously discussed is essential. Removing full PPE should be performed at the doorway of the patient’s room or in an anteroom. For example, hospitals with ICU TB units will have an anteroom, which is where the PPE can be removed. Extreme caution should be taken to confirm that the door between the patient and anteroom has been closed first. Disposal of all PPE is accomplished by placing contaminated items in the designated receptacle. Last, the radiology technologist will perform hand hygiene after removing all PPE.
Removing gloves
As previously mentioned, gloves are the most contaminated pieces of PPE and must be removed first. Using the appropriate technique for removing gloves will ensure that contamination is limited, thus preventing the spread of infectious diseases. According to the CDC (2015), the procedure for removing gloves consist of:
1. Using one gloved hand, grasp the outside of the opposite glove near the wrist
2. Pull and peel the gloves away from the hand
3. The gloves should now be turned inside-out, with the contaminated side now on the inside
4. Hold the removed glove in the opposite gloved hand
5. Slide one or two fingers of the ungloved hand under the wrist of the remaining glove
6. Peel glove off from the inside, creating a bag for both gloves
7. Discard in the waste container (see Figure 8.0 below)
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Figure 8.0 – Sequence for removing gloves. Courtesy of CDC
Removing goggles or face shield
After successfully removing and disposing the contaminated gloves, the next PPE to be removed are the goggles or face shield. Using the appropriate technique for removing them will ensure that contamination is limited thus preventing the spread of infectious diseases. The procedure for removing goggles or face shields consist of:
1. Using hands, grasp the “clean” ear- or headpiece
2. Lift away from face
3. Hold from face and body preventing re-contamination
4. If goggles or face shield are reusable, place them in a designated clean receptacle for reprocessing
5. Discard (if not reusable) in the waste receptacle (see Figure 9.0 below).
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Figure 9.0 – Removing goggles and face shield. Courtesy of CDC
Removing Isolation (Sterile) Gown
After successfully removing and disposing the contaminated gloves, goggles or face shield, the next PPE to be removed is the gown. Using the appropriate technique for removing it will ensure that contamination is limited, thus preventing the spread of infectious diseases. According to the CDC (2015), the procedure for removing gowns consist of:
1. Unfasten the gown ties with the ungloved hands
2. Slip the hands underneath the gown at the neck and shoulders, and peel it away from the shoulders
3. Slide a digit of one hand inside or under the cuff of the opposite arm
4. Grasp the gown from inside then pull the hand into the sleeve
5. Reached across the body and pushed the sleeve off the opposite arm
6. Fold the gown towards the inside and role in a bundle. Note: only the “clean” part of the gown should be visible
7. Discard into a designated waste or linen container (see Figure 10.0 below)
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Figure 10.0 – Removing gown. Courtesy of CDC
Removing a Mask
The last step of removing PPE is that of removing a mask. At this point. All PPE which included the gloves, goggles or face shields, and gowns have been removed and discarded. The last PPE to be removed is the mask. Using the appropriate technique for removing it will ensure that contamination is limited, thus preventing the spread of infectious diseases. The procedure for removing a mask consists of:
1. Do not touch the front of the mask as it is considered contaminated
2. Undo the bottom tie first
3. Undo the top tie, holding onto the mask (by ties) with one hand
4. Lift the mask or respirator away from the face
5. Discard it into the designated waste receptacle (see Figure 11.0 below)
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Figure 11.0 – Removing mask with ties. Courtesy from CDC
Removing a particulate respirator is like the procedure of removing a regular mask. If the particulate respirator mask has elastic bands, (first) lift the bottom elastic band over the head, then remove the top elastic band (see Figure 12.0 below). When following this method, it should be done gradually and with caution to prevent the respirator mask from “snapping” off the face and potentially causing facial injury.
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Figure 12.0 – Removing particulate respirator mask with elastic bands. Courtesy of CDC
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Sharp-related Injuries
Approximately 5.6 million healthcare personnel, including radiology technologists are at risk of occupational exposure to bloodborne pathogens (OSHA, 2019). Bloodborne pathogens can be spread via needlestick or other sharp-related injuries. Needlesticks and other sharps-related injuries continue to be a major peril for radiology technologists. In order to prevent and protect employees from the transmission of infectious diseases from the patient, radiology technologists handling sharp devices or equipment, such as needles, must follow safe work practices. According to the CDC (2015), there 385,000 sharps injuries occur annually by hospital-based employees. Consequently, some of these injuries occur in the radiology department. For example, needle sticks are just one of the common types of injury for radiology technologists (see Table 4.0 below). Radiology technologists are at high risk for back injuries, exposure to bodily fluids, excessive radiation, and airborne pathogens (Jones, n.d.).
According to one organization, there are approximately 600,000 to 800,000 needlesticks annually in the hospital settings (Finnegan, 2017). The potential danger comes from exposure to blood and other potentially infectious material because of unsafe needle devices. Another potential hazard from needlesticks comes from improper handling and disposal of needles and other sharps. Radiology technologists use needles in all modalities while performing procedures. Table 5.0 illustrates a few common needle injuries which occur in healthcare.
To circumvent the spread of contamination, there are numerous possible solutions a radiology technologist may take in order to prevent needlesticks. For example, using safer needle devices or needleless devices will decrease the number of possible needlesticks or other sharps-related injuries. Second, properly handling and disposing of needles and other sharps are essential to reduce contamination and injuries. Consequently, following the Bloodborne Pathogens Standards is vital in reducing needlesticks, thereby minimizing the potential
spreading of infectious pathogens. Bloodborne Pathogens Standards will not be presented in this course as it is outside the score of this report. However, Standard Precautions are an essential concept and has demonstrated effectiveness in preventing the transmission of infectious diseases. However, it focuses heavily on the use of personal protective equipment to provide barriers against spreading infectious diseases. Although PPE such as gloves and gowns provide a barrier to shield skin and mucous membranes from being contaminated by bodily fluids or other contagious pathogens,
most PPE is easily penetrated by sharps and needles. Thus, safe work practices and utilization of Standard Precautions, are essential strategies used to prevent the incidence of sharp injuries transmission of infectious diseases to radiology technologists.
Containerization systems must be in place to meet OSHA regulations. Sharp containers must be puncture-resistant and leak-proof. In addition, sharps containers must have closable tops that prevent accidental spillage. It is also essential to place the sharp container in areas that are easily accessible to radiology technologists. For example, sharp containers can be placed in radiology rooms in which special or interventional procedures are performed. The containers must be maintained in an upright position and not allowed to be overfilled. The color of the container is significant, and red is easily identifiable. Last, per mandated regulations, it is labeled in fluorescent orange (or orange red) with lettering and symbol in a contrasting color (OSHA, 2019b). Of note, sharp containers come in different sizes (See Figure 13.0 below).
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Figure 13.0 Sharp Containers. Copyright: Yahoo images - Free to share and use commercially.
Hand Hygiene
The hands of a radiology technologist play a significant role, especially in the transmission of bloodborne pathogens. There are three types of precautions: Universal Precautions, Standard Precautions, and Transmission-based Precautions. Consequently, hand hygiene is an essential infection control practice and vital to preventing infection transmission from and to a patient, family members, radiology technologists, and other employees.
For many generations, handwashing with soap and water has been considered a measure of personal hygiene, which later became mandated in the healthcare industry. Several organizations have addressed the issue of proper hand hygiene in the healthcare setting. For example, in 1961, the U.S. Public Health Service (PHS) recommendations directed that personnel wash their hands with soap and water for 1 to 2 minutes before and after each patient contact. It was believed at that time, that rinsing hands with an antiseptic agent was less effective than handwashing and the guidelines recommended using antiseptics only in cases where there were no sinks or in emergencies situations. The CDC established guidelines for handwashing practices in hospitals in 1975 and 1985 (Boyce and Pittet, 2002). The CDC current guidelines recommend:
• handwashing with non—antimicrobial soap between patient contacts
• washing with microbial soap before and after performing invasive procedures for caring for patients at high risk
• use of waterless antiseptic agent (i.e., alcohol-based solutions) only in situations where sinks are not available
A third organization, Association for Professionals in Infection Control (APIC) established guidelines for handwashing and hand antisepsis in 1988 and 1995 (Boyce and Pittet, 2002). The guidelines published by APIC were like those listed in the CDC guidelines. However, the 1995 APIC guidelines were somewhat different. They included discussions regarding alcohol-based hand rubs, which they now supported implementing in more clinical settings. A fourth organization, Healthcare Infection Control Practices Advisory Committee (HICPAC) also issued guidelines for hand hygiene in 1995 and 1996 (Boyce and Pittet, 2002). When a multi-drug-resistant pathogen such as Vancomycin-Resistant Enterococci (VRE) or Methicillin-resistant Staphylococcus Aureus (MRSA) was suspected, this organization endorsed using a waterless antiseptic or an antimicrobial soap for handwashing upon leaving the patient’s room.
Although the PHS, CDC, APIC, and HICPAC guidelines have been adopted by most hospitals, adherences of healthcare workers (HCWs) including radiology technologists to the recommended handwashing practices remains low. These recommendations also provided policies and standard practices for handwashing and hand antisepsis in other healthcare settings, including routine radiology patient care.
The radiology technologist must perform hygiene immediately after removing PPE. If their hands have become visibly contaminated during PPE removal, they must wash their hands before continuing to remove PPE. Always wash the hands thoroughly with soap and warm water or, if hands are not visibly contaminated, using an alcohol-based hand rub is recommended. The guidelines recommended by the CDC are based on the most current information available and are intended largely for utilization and implementation in patient care within primary, acute, and tertiary healthcare settings. Some recommendations may be applied for patients receiving care in subacute-care, extended-care, or outpatient-patient facilities. Research and experts have completed few studies to test the efficacy of PPE, Universal Precautions, and Standard Precautions. In recent years, the third type of precaution has been developed, Transmission-based Precautions (replacing Expanded Precautions). Thus, a gap still exists in which the scientific knowledge of epidemiology and the modes of transmission of some diseases is limited.
Personal Protective Equipment is available to shield staff, including radiology technologists, from exposure to infectious agents while performing their duties. It is vital that all radiology technologists know the type of PPE necessary for radiological procedures to be performed and how to use PPE correctly. There are many infectious diseases such as MRSA, Eboli, HIV/AIDS, TB, and Hepatitis (just to name a few). With the emergence of new infectious agents, the World Health Organization, CDC, OSHA, and other organizations have developed in-depth guidelines for the prevention of infectious diseases – which are outside the scope of this course. As the focus of this course is PPE, only a brief discussion on Universal Precautions including Standard Precautions and Transmission-based Precautions will be presented.
SECTION TWO
UNIVERSAL PRECAUTIONS
Standard Precautions
Transmission-based Precautions
(contact, droplet, and airborne)
METHODS FOR PREVENTING THE SPREAD OF PATHOGENS
With the advancement of technology in the medical field, the mortality rate from an infectious disease have decreased. In the United States deaths from infectious diseases over the last 35 years have decreased approximately 19% (Bcheraoui, Mokdad, Dwyer-Lindgren, Bertozzi-Villa, Stubbs, Morozoff, Shirude, Naghavi, and Murray, 2018). A research methodology study steered by the National Center for Health Statistics and U.S. Census Bureau found that between 1980 and 2014 deaths associated from infectious diseases decreased from nearly 42% per 100,000 persons to 34% which is a decrease of almost 8%. One significant decrease was seen in the HIV/AIDS population. This disease which, was relatively unknown in 1980 resulted in dramatic increase of deaths until 1994.
It was not until 1994 when biopharmaceutical researchers discovered protease inhibitors that prevented infected cells from duplicating and spreading the HIV virus. At this point, the fight against AIDS was revolutionized, and deaths per 100,000 decreased dramatically from nearly 16% in 1994 to 2% in 2014. This decrease in death rates from this deathly infectious disease resulted in an 85% mortality drop due to HIV/AIDS. This is a significant win for society as today a 20-year-old infected with HIV has the same life expectancy as the general U.S. population and can now live to the age of 78.
The fight against other infectious diseases continues. For example, from 1980 to 2014, mortality rates from many infectious diseases decreased: meningitis decreased nearly 70%; tuberculosis decreased by 83%; and lower respiratory infection-related deaths decreased by 25% (Bcheraoui, et al, 2018). However, the fight continues, and healthcare industries including radiology departments must follow recommended guidelines such as undertaking and adapting standard precautions: Universal precautions (UP); Standard Precautions (SP): and Transmission-based precautions (TBP).
Previously, it has been presented that employers are required to provide PPE for radiology technologists in order to protect them from exposure to infectious diseases. In addition, OSHA, CDC, and the World Health Organization have established standards for bloodborne pathogens (BBP) exposure in healthcare. The BBP standard applies when employees have occupational exposure to human blood or other potentially infectious materials (OPIM). Any exposure to BBP requires the use of Universal Precautions to prevent contact with these infectious agents. Adhering to Standard Precautions and Transmission-based Precautions in healthcare settings is recommended by the CDC. Its focus is to protect employees including those from radiology from a wider range of infectious disease hazards than the BBP standard. Employers and all staff members should be familiar with several key approaches to infection control, including Universal Precautions, Standard Precautions, and Transmission-based Precautions.
Universal Precautions
Initially recommended by the CDC in the 1985, as a response to the rising epidemic of HIV and AIDS. Universal Precautions (UP) was introduced to healthcare. The purpose was to protect healthcare workers from HIV, HBV, and other infectious diseases found in bloodborne pathogens (BBP) in human blood and certain other body fluids. The newly developed UP guidelines theorized that infection control could be maintained by treating all human blood and certain human body fluids as if they are known to be infectious.
Although the BBP standard incorporates UP, the infection control community no longer uses UP on its own.
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Universal Precaution are a standard set of guidelines aimed at preventing the transmission of bloodborne pathogens from exposure to blood and other potentially infectious materials (OPIM). OPIM is defined by the Occupational Safety and Health Administration (OSHA) as:
• human body fluids: saliva in dental procedures, semen, vaginal secretions, synovial fluid, cerebrospinal fluid, pericardial fluid, peritoneal fluid, amniotic fluid, pleural fluid
• any unfixed tissue or organ (other than intact skin) from a human (living or dead)
• HIV and HBV cells or tissue cultures, organ cultures; and blood, organs, or other tissues from experimental animals infected with HIV or HBV.
• body fluid which is visibly contaminated with blood
• all body fluids cases whereby it becomes difficult or nearly unreasonable to distinguish between body fluids
Universal precautions do not apply to feces or urine, sweat or tears, sputum or nasal secretions, and vomit except for being visibly contaminated with blood. The reason these body fluids are not applicable to Universal Precautions is because their transmission of HIV or Hepatitis B is extremely low or non-existent (Broussard and Kahwaji, 2019). Two years after the CDC created UP, they introduced another set of guidelines called Body Substance Isolation (BSI). According to these new guidelines, direct physical contact with any moist and potentially infectious body substances was to be avoided regardless of blood being visible. Unfortunately, one disadvantage to this new guideline was that it recommended handwashing after removing gloves only if the hands were visibly soiled.
In 1996, the Healthcare Infection Control Practices Advisory Committee (HICPAC) on behalf of the CDC, merged components from both Universal Precaution and Body Substance Isolation and developed the current Standard Precautions (SP). In addition to Standard Precautions, the new guidelines established Transmission-based Precautions (TBP): airborne, droplet, and contact. All elements listed under the Transmission-based Precautions must be incorporated with Standard Precautions.
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The CDC recommends Standard Precautions for the care of all patients, regardless of their diagnosis or presumed infection status.
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Standard Precautions
Standard Precautions pertain to anyone receiving care or treatment, irrespective of their presumed infection status or diagnosis. These guiding principles must be adopted not only by radiology technologist but by all healthcare employees. Standard Precautions directly apply when there is a risk of potential exposure to:
▪ Blood
▪ Except sweat, secretions, and excretions, and all body fluids
▪ Body fluids regardless of whether they contain visible blood
▪ Non-intact skin, and
▪ Mucous membranes.
The purpose of Standard Precautions is to reduce the risk of transmission of microorganisms from both unrecognized and recognized sources of infection in hospitals. These standard guidelines include the use of hand hygiene and PPE, with hand hygiene being the single most important means to prevent transmission of disease. Personal protective equipment is used as a barrier to protect skin, mucous membranes, airway, and clothing. It includes: gowns, gloves, masks, and face shields or goggles (presented in Section One of this course). Table 7.0 lists the general principles incorporated in Standard Precautions.
In the first section of this course, Personal Protective Equipment was presented with vital information for the prevention of infectious diseases. However, radiology technologists must also have a full grasp of the elements found in the guidelines of the Standard Precautions. The following information is not all-inclusive and contains some of the most commonly used recommendations for healthcare workers, including radiology technologists found under the Standard Precaution guidelines (Broussard and Kahwaji, 2019).
Hand Hygiene
The radiology technologist must comply with the following handwashing and hand hygiene criteria:
1. Handwashing with soap and water for at least 40 to 60 seconds
2. Do not use clean hands to turn off the faucet.
3. Perform if hands are visibly soiled, after using the restroom, or if potential exposure to spore-forming organisms.
4. Hand rubbing with alcohol applied generously to cover hands completely.
5. Hands rubbed until dry.
6. Artificial fingernails or extenders are not permissible when direct patient contact is expected in areas of high-risk infections or associated adverse outcomes are expected (i.e., ICU or surgery cases).
Hand Hygiene Indicators
• Prior to any direct patient contact, afterwards, and between patients care or treatment, regardless of wearing gloves or not.
• Immediately following removal of gloves.
• Prior to touching or handling any invasive instrument or device.
• Immediately following any contact with contaminated objects, body fluids, blood, non-intact skin, secretions, excretions, regardless of wearing gloves or not.
• During any patient care, procedure, or treatment; when moving from a contaminated to a clean body site of the patient.
• After touching or contact with inanimate items in the immediate vicinity of the patient.
• At times it may be necessary to wash hands between radiology procedures (even if the same patient) to avoid cross-contamination
Perform hand hygiene ~ in the following clinical situations:
|Hand Hygiene Criteria |Application to Radiology (Examples) |
|Before any direct contact with patients in healthcare |Wash hands before performing radiography |
|Immediately following any contact with contaminated objects, body |Wash hands after performing CT scan on trauma patient |
|fluids, blood, non-intact skin, secretions, excretions, |that is bleeding profusely |
|After touching a patient’s intact skin (i.e., performing vital signs or|Wash hands after moving a patient from gurney to MRI |
|lifting a patient) |table (patient has intact skin) |
|When hands will be touching and moving from a contaminated body site to|Wash hands after completing needle localization on one |
|a clean body site during patient care. |breast, then starting another needle localization on |
| |the other breast |
|After touching or contact with inanimate items in the immediate |Wash hands upon completing portable radiograph after |
|vicinity of the patient. |touching handrails, bedcovers, etc., inside of |
| |patient’s room |
|Immediately after removing gloves |Wash hands after removing gloves upon completing any |
| |radiograph or other imaging such as feet, MRI, or |
| |mammogram |
|Using water and non-antimicrobial or antimicrobial soap, perform hand |Wash hands with antimicrobial soap and water after |
|hygiene if contact with patient having (or suspected of having) spores |performing portable chest x-ray in ER if patient has |
|such as C. difficile or Bacillus anthracis. |possible infectious spores. |
|Artificial fingernails or extenders are not permissible when having |Do not wear artificial fingernails or extenders while |
|direct contact with patients who may be at risk for infection and |performing a mammogram. |
|associated adverse outcomes | |
|Table 8.0(a) Source: CDC, 2019. Isolation Precautions. Retrieved from |Note: these examples of applying hand hygiene are only |
| |a few; other examples are unlimited |
Gloves
The radiology technologist must comply with following donning and removing gloves criteria:
1. Don gloves when touching blood, body fluids, secretions, excretions, mucous membranes, or non-intact skin.
2. Change gloves when there is contact with potentially infected material in the same patient to avoid cross-contamination.
3. Remove gloves before touching surfaces and clean items.
Glove indications
▪ Change gloves between procedures and duties on the same patient if there is a high concentration of microorganisms
▪ Donning gloves is not to be substituted for proper hand hygiene.
▪ Remove gloves immediately after use, and avoid touching non-contaminated items and environmental surfaces
▪ Do not wear the same gloves to care for a different patient, even if you will not be touching the patient
Mask, Goggles, Eye Visor, and or Face Shield
The radiology technologist must comply with following Mask, Goggles/Eye Visor, and/or Face Shield criteria:
1. Wear a mask during procedures that may spray or splash blood, body fluids, secretions, or excretions
2. Wear eye protection during procedures that may spray or splash blood, body fluids, secretions, or excretions.
3. Wear a Face Shield during procedures that may spray or splash blood, body fluids, secretions, or excretions.
4. Remove and replace mask, Goggles, Eye protection, and Face Shield in the event they are contaminated during the procedure and may cause cross-contamination.
Mask, Goggles/Eye Visor, and/or Face Shield indications
▪ Personal prescription eyewear (glasses) may not be deemed adequate. Check with the facilities policy.
▪ Proper disposal is recommended.
▪ Adjust mask, goggles/eye protector, and Face shield appropriately at the onset of patient care to avoid having to re-adjust (touch) them later
▪ Wear one of the following: a face shield that fully covers the front and sides of the face, a mask with attached shield, or a mask and goggles during aerosol-generating procedures (i.e., bronchoscopy, suctioning of the respiratory tract, endotracheal intubation).
Gown
The radiology technologist must comply with following gown criteria:
1. Wear gown to protect skin or clothing during procedures that may spray or splash blood, body fluids, secretions, or excretions.
2. Wear two gowns (see Section One) if one does not fully cover the torso.
3. Gowns are not re-useable regardless of repeated contact with the same patient.
Gown Indications
▪ Select the type of gown that is appropriate for a task and the amount of fluid anticipated.
▪ Remove soiled gown immediately upon completion of a task
▪ Avoid touching gown unnecessarily
Patient-Care Equipment
1. Safeguard that reusable devices and equipment are not used for the care of another patient until they have been thoroughly cleaned (i.e., portable machines, C-arms, cassettes, positioning sponges, etc.).
2. Ascertain single-use items are discarded appropriately
3. Handle used patient-care equipment that is soiled with blood, body fluids, secretions or excretions appropriately to prevent skin and mucous membrane exposures; contamination of clothing; and transfer of microorganisms in organisms to self, other patients or environment
4. Before beginning disinfection and sterilization processes, clean, disinfect, and remove organic substances from any equipment, instrument, or device by following the recommended manufacturing guidelines before performing high-level sterilization.
Needles and Other Sharps
The radiology technologist must comply with the following needle and sharp criteria:
1. Do not break, bend, or directly manipulate used needles.
2. Use appropriate needle (size and type) for an assigned task
Needle and Sharp indications
▪ Recapping is not recommended, but if necessary, “use a one-handed scoop technique only.”
▪ Pay close attention during clean-up
▪ Discard all used sharps in appropriate puncture-resistant containers immediately following procedure/task.
Environmental control
1. Ensure that healthcare facility, including radiology department, has appropriate procedures for preventing transmission of infectious diseases while performing:
• routine care
• cleaning
• disinfection of environmental services
• disinfection of beds, rails, bedside equipment, etc.
• other common surfaces (i.e., light switched, remote control, etc.)
2. Ascertain that these procedures are being followed and enforced guidelines
3. Use disinfectants (EPA approved) with microbiocidal activity against the pathogens most likely to contaminate the patient-care setting. Use as instructed by manufacturer’s instructions.
Linen
1. Handle soiled linen with blood, body fluids, secretions and excretions in the appropriate manner, which prevents contamination of clothing or transmission of infectious microorganisms to other patients and environment.
2. Transport soiled linen with blood body fluids, secretions and excretions carefully by following the proper methods, which prevents transmission of infectious microorganisms.
3. Clean and process soiled linen with blood, body fluids, secretions, and excretions in the appropriate method, which prevents transmission of infectious microorganisms.
4. Used linen, fabrics, and textiles with upmost care to avoid contamination of surfaces and air.
5. Ensure that all laundry chutes (if used) are properly sanitized, sustained, and utilized using methods that minimize spreading of aerosols from the contaminated laundry.
Occupational health and blood-borne pathogens
1. Ensure precautions in preventing injuries when using needles, scalpels, and other sharp instruments or devices in the radiology department.
2. Ensure appropriate handling of sharp equipment during and after radiology procedures.
3. Ensure appropriate handling of used sharp instruments while cleaning.
4. Never recap needles; use the one-hand technique or another mechanical device.
5. Do not remove used needles from the disposable syringe by hand; do not bend, break, or manipulate used needles by hand.
6. Place used disposable syringes and needles, scalpels, blades, and other sharp objects in an appropriate puncture-resistant receptacle.
7. Transfer puncture-resistant container to centralized processing area.
8. As an alternative to mouth-to-mouth resuscitation, use mouthpieces, resuscitation bags, or another ventilation method.
Patient placement
1. When making patient placement-decisions, allow for potential transmission of infectious pathogens. Priority is given to placing high risk patients for transmission to others in a single-patient room.
2. If a private room is not available, consulting with the infection control coordinator is the best alternative regarding patient placement.
3. Place patient who may have an infectious disease in an appropriate isolation room
Evaluate patient placement using the following principles:
• Methods of transmission of the suspected or known infectious pathogen
• Transmission risk factors in the infected patient
• Characteristics or risk elements for adverse outcomes resulting from a HAI in other patients in the area or room being considered for patient-placement
• Availability of single-patient rooms
• Patient options for room-sharing (e.g., co-horting patients with the same infection)
Respiratory hygiene/cough etiquette
1. Educate healthcare personnel – including radiology technologists on the significance of measures to contain respiratory secretions to prevent droplet and spreading of fomite from respiratory agents (i.e., influenza, RSV, adenovirus, parainfluenza virus) in communities.
2. Provide tissues and no-touch receptacles (i.e., foot-pedal-operated lid or open, plastic-lined wastebasket) for disposal of tissues.
3. Provide dispensers of alcohol-based hand rubs and, where sinks are available, supplies for handwashing where convenient.
4. Post signs at all entrances and in strategic places of ambulatory and in-house areas:
a. People with respiratory infection symptoms to cover their mouths/noses when coughing or sneezing.
b. Dispose of soiled tissue appropriately.
c. Perform handwashing after contact with other who have or may have respiratory secretions.
5. Provide educational material and instructions related to hand hygiene in or near lobbies or other confined areas in outpatient and inpatient settings.
6. Make masks available to patients and other symptomatic individuals when entering the facility and encourage them to main a distinct separation (i.e., a distance of at least 3 feet, from others in common waiting areas).
Transmission-Based Precautions (TBP)
The second level of basic infection control is called “Transmission-Based Precautions,” formerly called Expanded Precautions and were created to be utilized in addition to Standard Precautions for patients who may or may not be infected with certain infectious diseases. These patients require additional precautions because of the seriousness of the infectious disease they have and need a higher level of precautions to prevent infection transmission (CDC, 2016).
In many different healthcare settings, the goal of TBP is to help stop the spread of germs from person to person including protecting radiology technologists, as well as patients, their families, and other visitors. Ultimately, stopping germs from spreading across a healthcare setting. There are three different types of Transmission-Based Precautions: Airborne Precautions, Droplet Precautions, and Contact Precautions.
General Principles
Airborne Precautions
These precautions are used in patients with known or suspected infection with pathogens that are spread by airborne transmission, i.e., “airborne droplet nuclei (small-particle residue {5 um or smaller in size} of evaporated droplets.” Examples of pathogens that are airborne include:
• Tuberculosis (TB)
• Measles and Mumps
• Chickenpox (Varicella)
• Disseminated herpes zoster
• Influenza
• Whooping cough (Pertussis)
• Diphtheria
These airborne droplets may remain suspended in the air for long periods of time, or there may be dust particles that contain the infectious pathogens. Airborne microorganisms carried in this method may be dispersed by air currents and may impact the respiratory tract of a susceptible host within the same room, or perhaps from a longer distance. The Airborne disease can spread when an infected person coughs, sneezes, or talks, spewing nasal and throat secretions into the air. Certain viruses or bacteria take flight and hang in the air or land on other people or surfaces. Specialized and methods for air handling and ventilation systems are required to prevent airborne transmission. Table 9.0 lists the general principles incorporated in Airborne Precautions.
Source Control: The first general principle for Airborne Precautions is Source Control. As the patient is the one with the infectious disease (or potential infection), he or she is considered the source of the infectious agent. Therefore, it is crucial to control and limit the source of infection by putting a mask on the patient.
Patient Placement: Constructed by the Guideline for Isolation Precautions, some settings may not have the capability to have complete Airborne Precautions due to limited engineering resources. Consequently, masking the patient and placing the patient in a private room with the door closed will reduce the likelihood of airborne transmission. This procedure can be followed until the patient is either transferred to a facility with an AIIR or returned home. However, the goal is to place patients in a negative pressure isolation room that allows a minimum of 6 to 12 air changes per hour. Multiple patients that have an active infection with the same pathogen, and no other disease, may be roomed together. This process is called “cohorting.” Doors to the room must always remain closed. According to the CDC (2016), consulting an infection control specialist is recommended if cohorting is not an option and a private room is not available.
Room Restriction: Another general principle of Airborne Precaution is to restrict susceptible healthcare personnel such as radiology technologists from entering the room of an infectious patient with an airborne pathogen. Airborne Precautions must be taken with known or suspected patients with measles, chickenpox, disseminated zoster, or smallpox.
PPE: Personal Protective Equipment, as explained in the first section of this course, is important in preventing airborne pathogens. The step includes a fit-tested NIOSH-approved N95 mask or higher-level respirator for radiology technologists and other healthcare personnel. Respirators that filter at least 95% of airborne particles must be worn over the nose and mouth such as N95 and PAPR systems (CDC, 2016).
Transport: As the patient is the source of the infection, it is essential to limit the areas where he/she is transported to. The patient should only be transported outside of his/her room for medically necessary purposes. This will limit the spread of infectious pathogens to others. However, if a patient must be moved or transported outside a room, the patient must wear a mask, if possible, and observe Respiratory Hygiene/Cough Etiquette. If an Airborne Precaution patient is wearing a mask and infectious skin lesions are covered, healthcare personnel such as radiology technologists or transporters who are transporting the patient do not need to wear a mask or respirator during transport.
Immunize: The last general principle of Airborne Precautions is immunization. An important step in the prevention of infectious diseases is to immunize susceptible people immediately following exposure to vaccine-preventable infections such as measles, varicella, or smallpox (CDC, 2016).
Additional Measures
Additional measures can be taken to prevent the spread of infectious pathogens. In addition to using PPE, other measures can include:
• Educating patients and visitors about handwashing (even for airborne diseases)
• Removal of jewelry
• Reducing physical contact (i.e., kissing, etc.)
• Using the “Bare Below the Elbow” rule
• Engineering control methods (ventilation)
Bare Below the Elbows is an initiative aiming to improve the effectiveness of hand hygiene performed by health care workers, including radiology technologists. The general premises of Bare Below the Elbows is that the efficacy of handwashing is improved when healthcare employees do not wear any clothing or item below the elbow. This includes having short and unpainted nails, no long sleeves, no jewelry, and the skin is smooth and uncut.
A Bare Below the Elbows approach complements effective hand hygiene:
❖ no jewelry should not be worn. A single flat ring or band may be worn but should not interfere with effective hand hygiene practice
❖ long sleeves should be avoided. If worn, sleeves should be rolled or pushed up above the elbow so as not to interfere with effective hand hygiene practice
❖ fingernails should be kept short and clean and nail polish should not be worn. Artificial nails (gel or acrylic) should not be worn
❖ cover any skin cuts or abrasion with a waterproof dressing. Employees who have dermatitis should report to employee health services for evaluation as per local procedures (Bennett, 2017).
Engineering control methods include building ventilation, and the effectiveness of ventilation is also known for controlling airborne diseases in single enclosed spaces. Ventilation refers to the supply of outdoor air into a building or a room, and its distribution within it. The general purpose of ventilation in buildings is to provide healthy air for breathing by removing the contaminants from it (Eames, Tang, Li, & Wilson, 2009). Following are three basic elements for building ventilation (natural and mechanical). Hence there are two basic physical principles behind the roles of ventilation in infection control: (1) through dilution of airborne pathogens, and (2) the control of movement of airborne pathogens from one space to another (Eames, Tang, Li, & Wilson, 2009).
Droplet Precautions
Radiology technologists will encounter patients with infectious diseases, so they need to take precautions with patients diagnosed or suspected of having an infection with pathogens that are spread by droplet transmission. This precaution is used in addition to the Standard Precautions. According to research, “Droplets are particles of respiratory secretions droplet nuclei– smaller than 100 μ in diameter (CDC, 2019a). Droplet transmission involves contact of the conjunctivae or the mucous membranes of the mouth or nose of a susceptible person from another person containing (or carrier of) the microorganisms of a specified disease. Transmission may also occur indirectly via contact with contaminated fomites with hands and then mucosal surfaces. These large droplets are generated from the infected person by talking, coughing, or by sneezing - Transmission associated with exposure within three to six feet of the source (CDC, 2017).
The side effects and risks associated with the medical intervention are called iatrogenesis (Peer & Shabir, 2018). In other words, iatrogenic ailments are those where medical providers, drugs (including adverse drug reactions), diagnostics, hospitals, and other medical facilities act as “pathogens” or “sickening agents. Transmission due to medical procedures (i.e., touching a wound, an injection-unsterile, or transplantation of infected material, etc.) is common. Iatrogenesis is the fifth leading cause of death in the world; with about 5%–8% of deaths due to ADRs worldwide and 1.4 million patients are affected by the infections at any given time due to the healthcare system (Peer & Shabir, 2018). Some diseases that can be transmitted estrogenically include MRSA and Creutzfeldt–Jakob disease (injection of contaminated human growth hormone). The droplets can also be transmitted during radiological procedures such as bronchoscopy, ERCP, or suction. The droplets do not remain suspended in the air; therefore, no special air handling or ventilation is required (CDC, 2016). Table 10.0 lists the general principles for Droplet Precautions.
General Principles
Source control: As with Airborne Precautions, the first general principle for Droplet Precautions is Source Control. As the patient is the one with the infectious disease (or potential infection), he/she is considered the source of the infectious agent. Therefore, it is important to control and limit the source of infection by putting a mask on the patient.
Patient Placement: For Droplet Precautions, patients should have private rooms in order to prevent the spread of infectious pathogens. In ambulatory settings, patients who require Droplet Precautions can be placed in an exam room or cubicle as soon as possible with instructions to follow Respiratory Hygiene/Cough Etiquette guidelines. In acute care hospitals, they may be placed in a semi-private room with another patient having the same active infection but no other infection (cohorting). When a private room or cohorting is not available, the infected patient should be placed at least 3 feet away from other patients and visitors (CDC, 2016). The doors to the room may be left open, and no special air management is required. In long-term residential care settings, patient placement is determined on the basis and assessment of individual cases, plus the risk of contagious infections to other patients in the room.
Personal Protective Equipment (PPE): Don mask upon entry into the patient room or patient space. A surgical mask or fit-tested respirator should be worn by radiology technologists and other healthcare personnel who are within 6 feet of a suspected or laboratory-confirmed infectious patient (CDC, 2019b).
Transport: If the patient needs to be moved or transported, it should be for medically necessary or emergency purposes only. If the patient needs to be transported from the room, provide a mask for the patient to wear. Plus, they must also be instructed to follow Respiratory Hygiene/Cough Etiquette.
Contact Precautions
Contact, or touch, is the most common and most significant mode of transmission of infectious agents. Use Contact Precautions when patients have an infectious disease or may have one and presents a hazard to others by spreading contact transmission. Contact transmission can occur when a radiology technologist is touching the patient directly, through contact with the patient’s environment, or by using contaminated gloves or equipment. Patients in Contact Isolation Precautions include those with confirmed or suspected organisms deemed significant by Infection Control and CDC. Table 11.0 lists the general principles for Contact Precautions.
Patient placement: In acute care hospitals, use Contact Precautions to ensure that the patient is placed in a single room or space if available. In long-term residential settings, patient placement is based on decisions balancing risks to other patients. In ambulatory settings, patients are placed in an exam room or cubicle as soon as possible if Contact Precautions are required.
Personal Protective Equipment (PPE): Donning gloves and a gown is required when direct contact with patients or the patient’s room and their environment. Radiology technologists must don PPE upon entering the patient’s room and properly remove PPE before exiting the patient’s room to contain infectious pathogens.
Transport: Don clean PPE to handle the patient at the transport location. When transport or movement is necessary for medical or emergency purposes, cover or contain the infected or colonized areas of the patient’s body. Radiology technologists or radiology staff must perform hand hygiene before and after transporting patients on Contact Precautions. Last, PPE is removed as presented in Section One, and then contaminated PPE must be disposed of appropriately.
Patient-care equipment: To prevent the spread of infectious agents, radiology technologists must use disposable or dedicated patient-care equipment, such as blood pressure cuffs, stethoscopes, or thermometer. If the common use of equipment or supplies for multiple patients is unavoidable, staff must perform hygienic procedures to disinfect equipment prior to using equipment on another patient. A few common use equipment in radiology departments may include sliding boards, sponges for positioning, infant immobilizers, wheelchairs, and lead aprons.
Cleaning and disinfection: The last general principle for Contact Precaution is prioritizing cleaning and disinfecting the patient’s room. It is essential that a Contact Precaution patient’s room is cleaned and disinfected frequently. Their room should be cleaned at least daily and prior to use by another patient if an outpatient setting. Cleaning and disinfecting should be focused on frequently touched surfaces and equipment in the immediate vicinity of the patient.
Other Factors to Consider: An addition guideline for Contact Precaution includes providing appropriate door signage. There are many different designs for Contact Precaution signs; the appropriate one must be posted on the patient’s door (see Figure 14.0). The sign at the door of the hospital room will remind family, friends, and the radiology technologist which precautions are needed.
Figure 14.0 Contact Precaution Signage: Copyright: . Free to share and use commercially
In order to combat the spread of infectious pathogens, it is recommended that health facilities education the patient, family, and visitors. Anyone visiting a patient who has a Contact Precaution sign on their door, must check with the nurse before entering the room or taking anything into or out of the room. All family members, visitors, and radiology technologists must ensure that they follow the isolation precautions. In some situations, family visits or visits may have to be limited. Last, if a patient has been placed under “Contact Precaution”, then no one should not eat or drink in that patient’s room.
The CDC has comprised an extensive list of infectious diseases that require facilities to use Contact Precautions. However, as the focus of this course is not Contact Precautions, only a limited list of infections or conditions is provided. The following is a somewhat condensed list of infections and conditions and their duration which require Contact Precautions:
|Infectious Pathogen |Duration of Isolation |
|Conjunctivitis, viral |duration of illness |
|Diphtheria: cutaneous |duration is until completion and antibiotics and 2 negative cultures 24 hours apart |
|Ebola, Marburg, Crimean-Congo, and Lassa fever viruses |duration of illness |
|Hepatitis A |duration is age-specific in incontinent patients |
|Herpes simplex: neonatal, disseminated, severe, or |duration is until lesions dry and crust |
|mucocutaneous | |
|Herpes zoster: disseminated |duration of illness |
|Lice: head |duration is until 24 hours after initiating effective therapy |
|Multidrug-resistant organisms’ infection or colonization|while evidence of ongoing or increased risk of transmission; or while there are |
| |wounds that cannot be covered) |
|Parainfluenza virus |duration of illness |
|Poliomyelitis |duration of illness |
|Smallpox |duration of illness |
|Staphylococcal furunculosis |duration of illness |
|Staphylococcal scalded skin syndrome, Ritter’s disease |duration of illness |
|Staphylococcus aureus skin infection, major |duration of illness |
|Tuberculosis: extrapulmonary, draining lesions |until clinically improving and drainage has stopped or there are consecutively three |
| |negative cultures |
|Varicella zoster |duration is until lesions crust and dry |
Table 12.0 Source: Broussard and Kahwaji, 2019
Infection Preventionists
The increasing amount of new infectious diseases today has brought about the creation of new roles to combat these deadly pathogens. One such new role is that of an Infection Preventionist. An Infection preventionist use their detective skills to find the bad germs and make sure everyone is following protocols to maintain patient safety and others safe. They strive to keep patients, family members, and visitors safe from infection. In addition, they look at how volunteers, employees such as radiology technologists, and healthcare providers follow infection control procedures. Infection preventionists partner with the healthcare team to make sure everyone is following infection control protocols in order to keep patients safe from healthcare-associated infections and to ensure a high level of quality care.
Their role is to ensure:
1. Healthcare workers perform hand hygiene prior to and immediately following patient care or treatment.
2. Properly sterilizing skin before catheters or other indwelling devices are inserted into the body. Removing these devices when needed, while maintaining them clean.
3. The healthcare workers will wear gloves, gowns, and masks at the right times. This policy also pertains to patients who are in “isolation.” Family, visitors will need to do this too.
4. All patient rooms and any equipment that is used on patients will be clean (APIC, 2019).
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Figure 15.0 Image courtesy of APIC; Available at
The role of Aerobiology in the Transmission of Infectious Diseases
Exposure to airborne diseases is common among all human life especially, those working in the medical arena. Research methodology has grown in the last decade, and experts now have the capability to study infectious diseases in-depth. Researchers have found that viruses, bacteria, fungal spores, and other microorganisms from an infectious agent may disperse over large distances via air currents. This can lead to people inhaling, ingesting, or meet individuals who have had contact with the infectious source. Aerobiology is the study of the processes involved in the movement of microorganisms in the atmosphere from one geographical location to another, including the aerosolized transmission of disease (Fernstrom & Goldblatt, 2013). The aerosolized transmission of infectious pathogens happens with both “droplet” and “airborne” means. Droplet transmission explores the transmission of diseases by expelled particles that are expected to settle on a solid surface rapidly. Typically, infectious particles settle within three feet of the source (Fernstrom & Goldblatt, 2013). When applying the concept of Aerobiology, one can see that in order for a droplet transmission infection to occur, a susceptible individual must be close enough to the source of the infection (i.e., an infected individual) in order for the droplet (infectious microorganism) to make contact with the susceptible individual's respiratory tract, mouth, eyes, nasal passages, etc.,. In contrast, airborne transmission focuses on the transmission of infection particles that are smaller in size and remain suspended in the atmosphere for extended time periods. This is troublesome as the longer the airborne particles remain suspended in the air, the longer the contagious disease exists in the air.
Airborne contaminants present exceptional disadvantages for infectious diseases and infection control. Aerobiology explores how infectious particles are transmitted via airborne and droplet means. Building on the basics of aerobiology, researchers find the common origins of the droplet and airborne infections, which are critical to understanding the epidemiology of diverse airborne pathogens (Fernstrom & Goldblatt, 2013).
SECTION THREE
LATEX ALLERGIES
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Healthcare is the fastest-growing sector of the U.S. economy, employing over 18 million workers with females making nearly 80% of the healthcare work force (CDC, 2017). It is challenging but possible to prevent or reduce healthcare employees such as radiology technologist’s exposure to these hazards. Unfortunately, healthcare workers continue to experience injuries and illnesses in the workplace. One common illness is that of latex allergy. Cases of illness with healthcare workers are among the highest of any industry sector (CDC, 2017). Radiology technologists, as well as others in the healthcare industry, are at risk for developing latex allergy because they use latex gloves frequently. Understanding latex allergy and knowing common sources of latex can help individuals prevent allergic reactions.
Latex products are manufactured from a milky fluid derived from the rubber tree, Hevea brasiliensis (CDC, 2014). Several chemicals are added to this fluid during the processing and manufacturing of commercial latex. Currently, there is no Food & Drug Administration (FDA) approved skin test for latex allergies in the United States (Health.how…, 2019). Latex allergy is often diagnosed from an individual’s history and a positive Radioallergosorbent (RAST) Test (Henochowicz, 2018). RAST test is a blood test used to determine the substances a subject is allergic to.
Types of Reactions to Latex
Latex gloves and other products are made from natural rubber. Medical staff can develop latex sensitivity after repeated exposure and should limit exposure to latex in order to prevent allergic reactions. Consequently, radiology technologists must become aware of the factors relating to latex allergy. There are three types of reactions which can occur in persons using latex products:
• Irritant contact dermatitis
• Allergic contact dermatitis (delayed hypersensitivity)
• Latex allergy (immediate hypersensitivity)
The most public reaction to latex items or products is irritant contact dermatitis. Characteristics of irritant contact dermatitis include the development of dry, itchy, and irritation of skin such as the hands (CDC, 2017). These reactions are
There are several reasons that contribute to this type of reaction:
1. from using gloves
2. exposure to other workplace products
3. exposure to various chemicals
4. from repeated hand washing and drying
5. improper or incomplete hand drying
6. use of cleaners and sanitizers.
Some health care workers develop irritant contact dermatitis from exposure to powders that were supplemented to the gloves. According to researchers, irritant contact dermatitis is not considered an actual or a true allergy (CDC, 2017).
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Figure 16.0 Irritant Contact Dermatitis of Hand: Copyright: (Free to share and use commercially)
Allergic contact dermatitis is also referred to as delayed hypersensitivity or chemical sensitivity dermatitis. It occurs as a result from exposure to the chemicals that are added to latex during harvesting, processing, or manufacturing. These chemicals can cause skin reactions like those cause by poison ivy. Just like the reaction that occurs with poison ivy, the same type of rash usually begins 24 to 96 hours after contact the skin is touched by latex (NIOSH, 2012).
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Figure 17.0 Elbow with contact dermatitis. Curtesy from CDC.
Latex allergy which is also known as immediate hypersensitivity may be a more grave condition or reaction to latex then irritant contact dermatitis or allergic contact dermatitis. According to the CDC (2018), latex contains proteins that may cause sensitization. Experts do not know the exact amount of exposure required to cause symptoms to appear or cause sensitization. However, they have seen that even low levels of protein in latex can trigger some type of reaction or sensitization. Latex reactions may start within minutes of exposure to latex but have been known to occur hours later and can produce various symptoms. Mild forms of reactions to latex involve skin redness, hives, or itching.
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Figure 18.0 Itching - Latex allergy: Courtesy of
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Figure 19.0 Hives – Latex allergy: Courtesy of
More severe respiratory symptoms resulting from latex allergy may occur, such as running nose, wheezing, itchy eyes, scratchy throat, and asthma. In some cases, a patient with latex allergies may have coughing spells, wheezing, or they may have anaphylaxis. This is a potentially life-threatening situation that may cause throat swelling and severe difficulty breathing (Mayo Clinic, 2019). It is rare for a shock to occur, but a life-threatening reaction is not the first sign of latex allergy. Such reactions are like those seen in some allergic person after a bee sting.
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Figure 20.0 Courtesy of
Latex allergy can occur in two ways:
• Direct contact. The most customary cause of latex allergy consists of touching latex-containing items or products (i.e., latex gloves).
• Inhalation. Latex items or products such as gloves, release latex particles, which people can inhale when particles become airborne (Mayo, 2019).
Latex allergy in the healthcare setting may result in potentially serious health issues for radiology technologists, who are often unacquainted with the risks and dangers of latex allergies.
Preventing latex allergy in the workplace is based on current knowledge and common-sense approach to minimizing latex- related health problems. Adoption of the recommendations, such as those presented in Standard Precautions, will ensure a decrease of exposure within the healthcare setting and reduce the risk of developing latex allergies. Many healthcare facilities have taken steps to reduce latex allergies. For example, they will provide workers with non-latex gloves to use when there is a slight possibility of encountering infectious agents. However, when contact with infectious agents is a possibility, then staff can use vinyl, nitrile, or polymer gloves to reduce latex allergies. On the other hand, some facilities have opted to use reduced-protein, powder-free gloves when latex gloves are used for infectious material. Next, appropriate training is given to all staff members on latex allergy. Last, facilities have found it useful to provide a latex allergy questionnaire to patients, family members, or other visitors, and employees such as radiology technologists.
Risk Factors
In addition to radiology technologists and healthcare professionals, there are other people who are at greater risk of developing a latex allergy. Radiology technologists must be aware of all populations at risk for latex allergy and be prepared to aid if a reaction occurs. For example, those patients with severe reactions may require a portable chest radiograph due to difficulty breathing. Other populations at risk for latex allergy are:
1. Individuals that had several operations or medical procedures. Chronic exposure to latex gloves and medical items or products increases the risk of developing latex allergy.
2. Patients with a personal or family history of allergies. They are at increased risk of latex allergy if they nurse additional allergies (i.e., certain foods, hay fever).
3. People with spina bifida. Researchers have noticed a higher risk factor of latex allergy among patients with Spina Bifida. Spinal Bifida is a birth defect that impacts the development of the whole spine. The rationale for the increase in risk among this population is since their disorder subjects them to higher levels of exposure to medical care and frequent medical treatment.
4. Rubber industry workers. Repeated exposure to latex may increase sensitivity.
Prevention
Many common products contain latex, but anyone can typically find a suitable option. In addition to the strategies mention above, there are several other ways to prevent a reaction. According to the Mayo Clinic (2019), in addition to medical supplies, an allergic reaction to latex can be prevented by avoiding these products:
|Medical/Radiology Latex Products |
|Blood pressure cuffs |
|Stethoscopes |
|Intravenous tubing/catheters/other tubing |
|Syringes |
|Electrode pads |
|Surgical masks |
|Dental dams |
|Tourniquets |
|Respirators |
|Tape/adhesives |
|Gloves |
|Table 14.0 |
|Possible Latex Products to be Avoided |
|Dishwashing gloves |
|Some types of carpeting |
|Balloons |
|Rubber toys |
|Hot water bottles |
|Baby bottle nipples |
|Some disposable diapers |
|Rubber bands |
|Erasers |
|Condoms/Diaphragms |
|Swim googles |
|Racket handles/other hand grips |
|Table 15.0 |
The products (above) are only a few items that may contain latex or rubber. For this reason, it is important for everyone to know the symptoms of a latex allergy (please review the symptoms under irritant contact dermatitis, contact dermatitis, and latex allergy). Anyone who is allergic to latex must be sure to inform their doctors, nurses, dentists and other health care professionals such as the radiology technologist about their allergy before any exams or procedures. It is also important to wear a medical alert bracelet that will notify others of the latex allergy.
Appendix A
Handwashing Procedure
By
World Health Organization
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Source: . Copyright: Public domain
References
APIC. (2019). Recognize an Infection Preventionist. Retrieved from
Bcheraoui, C., Mokdad, A.H., Dwyer-Lindgren, L., Bertozzi-Villa, A., Stubbs, R.W., Morozoff, C., Shirude, S., Naghavi, M., and Murray, C. (2018). Trends and Patterns of Differences in Infectious Disease Mortality Among US Countries, 1980-2014. JAMA. 319(12): 1248-1260. Retrieved from
Bennett, S. (2017). Guideline for Bare Below the Elbows. Retrieved from
Boyce, J.M., and Pittet, D. (2002). Guidelines for Hand Hygiene in Healthcare Settings. Retrieved from cid=journal_search_promotion_2018
Broussard, I.M., and Kahwaji, C.I. (2019). Universal Precautions. Retrieved from
CDC. (2014). Latex Allergy A Prevention Guide. Retrieved from
CDC. (2015). Sharp safety for healthcare settings. Retrieved from
CDC. (2016). Transmission-Based Precautions. Retrieved from
CDC. (2017). Healthcare Workers. Retrieved from
CDC. (2018). NIOSH-Approved N95 Particulate Filtering Facepiece Respirators. Retrieved from
CDC. (2019a). Isolation Precautions. Retrieved from
CDC. (2019b). Interim Guidance for the Use of Masks to Control Seasonal Influenza Virus Transmission. Retrieved from
Eames, I., Tang, J.W., Li, Y., & Wilson, P. (2009). Airborne transmission of disease in hospitals. Retrieved from
Fernstrom, A., & Goldblatt, M. (2013). Aerobiology and Its Role in the Transmission of Infectious Diseases. Retrieved from
Finnegan, K. (2017). Phlebotomy: Needle Stick Prevention and Safety. Retrieved from
Garner, J. S. (1996). Guidelines for Isolation in Hospitals. Retrieved from
Google Images (n.d.). Titles vary. Retrieved from Copy Right: Labeled for reuse. Handwashing Flyer. Provided by: WHO. Located at: . Copyright: Public domain
Henochowicz, S.I. (2018). RAST test. Retrieved from /ency/imagepages/19334.htm
Contributors. (2019). "Are there tests you can take to diagnose latex allergies?". Retrieved from
Jones, R. (n.d.). What Are the Common Injuries for a Radiologic Technologist? retrieved from
Let’s Practice Images. Provided by: Google Images. Located at: . Copyright: Labeled for reuse.
Mayo Clinic. (2019). Latex Allergy. Retrieved from
NIOSH. (2012). Fast Facts: How to Prevent Latex Allergies. Retrieved from
. (2019a). Worker protections against occupational exposure to infectious diseases. Retrieved from
. (2019b). Needlestick/Sharps Injuries. Retrieved from
Shieh, M. (2018). How Particulate Respirator Masks Work. Retrieved from
Peer, R.F., & Shabir, N. (2018). Iatrogenesis: A Review on nature, extent, and distribution of healthcare hazards. Retrieved from
Yahoo Images. (n.d.) Titles vary. Retreived from Copy Right: Free to share and use commercially.
PERSONAL PROTECTIVE EQUIPMENT
(PPE)
TEST
1. OSHA defines Personal Protective Equipment (PPE) as:
a. specialized clothing or equipment, worn by anyone for protection against any infectious hazards.
b. specialized equipment, worn by an employee for protection against any infectious material.
c. specialized clothing or equipment, worn by an employee for protection against any infectious material.
d. specialized clothing, equipment, and machinery utilized by an employees and patients for protection against any infectious diseases.
2. The theory of isolation practice was first published in:
a. 1877
b. 1890
c. 1900
d. 1910
3. Universal Precautions were created mainly due to the ______ epidemic in the mid 1980’s.
a. HIV
b. Tuberculosis
c. Swine Flu
d. Influenza
4. Transmission-Based Precautions are categorized in three groups:
a. airborne, contact, universal
b. airborne, contact, droplet
c. universal, standard, body substance
d. standard, contact, droplet
5. The 3 key points to consider when selecting PPE are all the following EXCEPT:
a. anticipated exposure
b. fit
c. durability and appropriateness
d. nosocomial infection
6. Which of the following statements is FALSE regarding gloves?
a. Gloves are the most common type of PPE used in any healthcare setting.
b. Most tasks by radiology technologists require the use of latex or nitrile gloves.
c. If gloves are in good condition, wash them and store for later use.
d. Some healthcare facilities have limited or eliminated use of latex gloves.
7. Some gloves should not be placed next to x-ray machines.
a. True
b. False
8. Read the following statements and determine the correct option.
1. personal prescription lenses do not provide optimal protection
2. OSHA regulations may require facilities to have emergency eyewash areas
3. When using a face shield, it should cover the forehead, chin, and side of face
a. Only “1” and “2” are correct
b. Only “2” and “3” are correct
c. They are all FALSE
d. They are all CORRECT
9. The N95 respirator filters about ____ of airborne particles and excludes particles as small as _______ microns wide.
a. 90%, 0.11
b. 95%, 0.13
c. 95%, 0.30
d. 98%, 0.30
10. Which of the following is the correct sequence for donning PPE.
a. gloves, mask, gown, goggles
b. gown, mask, gloves, goggles
c. gown, mask, goggles, gloves
d. goggles, mask, gown, gloves
11. Which of the following is the correct sequence for removing PPE.
a. gloves, goggles, gown, mask
b. mask, goggles, gown, gloves
c. gloves, gown, goggles, mask
d. mask, goggles, gown, gloves
12. When removing the mask, first……..
a. grab the front of the mask
b. undo the top ties
c. undo the bottom ties
d. lift the mask over your head
13. ___________________ are vital in reducing needlesticks thereby minimizing the potential of spreading infectious pathogens.
a. Standard Precautions
b. Bloodborne Pathogens Standards
c. Transmission-based Precautions
d. Universal Precautions
14. Containerization systems must be in place to meet _________ regulations and must be _________________ and leak-proof.
a. OSHA, puncture-resistant
b. OSHA, plastic
c. HEPA, plastic
d. HEPA, puncture-resistant
15. In the United States deaths from infectious diseases over the last 35 years have decreased approximately ___________.
a. 10%
b. 19%
c. 27%
d. 41%
16. The radiology technologist must comply with following hand washing criteria: Hand washing with soap and water for at least _____________ seconds.
a. 20 to 30
b. 30 to 45
c. 40 to 60
d. 55 to 75
17. When referring to Cough Etiquette, which of the following is BEST practice?
a. Post signs outside – in parking lots
b. Provide dispensers with soap and non-alcohol-based hand rubs
c. Provide tissues to patients, family members, and visitors
d. Provide normal trash cans for disposal of tissues
18. Under Transmission-based Precautions, the first general principle for Airborne Precautions is _______ as the patient is the one with the infectious disease.
a. Source Control
b. Patient Placement
c. Fit-Test
d. Cohorting
19. In reviewing Transmission-based Precautions, patients under Droplet Precautions can be transported ______________________.
a. without a mask
b. when it is medically necessary
c. and do not have to follow Respiratory Hygiene/Cough Etiquette
d. Both “a” and “c”
20. A new role is that of an __________ who uses their detective skills to find the bad germs and make sure everyone is doing the right things to keep patients and others safe.
a. Infection Preventionist
b. Infection Inspector
c. Health Preventionist
d. Healthcare-Associate
21. _______________ is the study of the processes involved in the movement of microorganisms in the atmosphere from one geographical location to another, including the aerosolized transmission of disease.
a. Droplet transmission
b. Airborne transmission
c. Aerobiology
d. Epidemiology
22. With Latex allergy, mild forms of reactions to latex involve:
a. running nose, wheezing, itchy eyes
b. skin redness, hives, or itching
c. scratchy throat and asthma
d. anaphylaxis
23. Which of the following is NOT a sign or symptom of anaphylactic shock?
a. shortness of breath
b. low blood pressure
c. over-active bladder
d. loss of consciousness
24. Latex allergy can occur in two ways: ____________contact (involves touching latex-containing products) and _____________ contact (release latex particles, which you can breathe when airborne). a. direct - droplet b. inhalation - contact c. Immediate hypersensitivity - contact d. direct - inhalation
25. Other populations at risk for latex allergy are ______________?
a. Individuals that have several operations or medical procedures b. Patients with a personal or family history of allergies c. People with spina bifida d. All the above
26. Which of the following latex products is NOT considered a Medical/Radiology product to be avoided?
a. stethoscope
b. tourniquet
c. rubber bands
d. gloves
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Transmission-Based Precautions
• Airborne
• Contact
• Droplet
Pathogenic microorganisms can be found in:
➢ Amniotic fluid
➢ Any fluid containing blood
➢ Blood
➢ Cerebrospinal fluid
➢ Pericardial fluid
➢ Pleural fluid
➢ Semen fluid
➢ Synovial fluid
➢ Vaginal fluid
Table 1.0 Source: CDC, 2012
Examples of “Touch Contamination” in Radiology
1. While performing portable exams, and wearing PPE gloves, do not contaminate: the cassettes or plastic covers, portable machine, (especially the handles), lead aprons, and other items used (i.e. tape, pencils, markers, etc.).
2. When performing an exam on a patient who is soiled (i.e. urine, blood, etc.), do not wipe gloves on clothing.
Can you think of any other examples?
Table 2.0
Powered Air-Purifying Respirator (PAPR)
PAPR is an article of PPE for individuals working in an infectious or polluted air environment. Particulate filters (HEPA only) are required for healthcare facilities. A polluted air environment may include dust, fumes, smoke, harmful gases, chemical vapors, or infectious diseases.
Sequence of Donning PPE
1. Gown
2. Mask or respirator
3. Goggles or face shield
4. Gloves
CDC, 2012
Other examples of safe work practices in Radiology for Preventing spread of infectious diseases
✓ use protective barrier for cassettes (i.e. plastic covers)
✓ clean soiled cassettes after each patient
✓ clean x-ray tube and/or chest board after each patient
✓ clean accessories (i.e. plastic positioning sponges) after use
✓ change linen after each patient
✓ have PPE readily available for use
✓ have antimicrobial soap in room
Table 3.0
Sequence for Removing PPE
1. Gloves
2. Face shield or goggles
3. Gown
4. Mask or respirator
Common types of injury for radiology technologists
• Back injuries
• Needle sticks
• Bodily fluid exposure
• Excessive radiation exposure
• Airborne pathogen exposure
Table 4.0 Source: Jones, n.d.
Common Needle injuries
• Manipulating needle in a patient
• During sharp disposal
• Improper disposal
• During clean-up
• Colliding with sharp or worker
• During recapping
• When transferring or processing specimen
• While handling or passing equipment
• In transit to disposal
Table 5.0 Source: CDC, 2015
Other tips for handling Needles/Sharps
▪ Pay close attention during clean-up
▪ Do not bend or recap contaminated needles (unless no feasible alternative is available)
▪ Do not remove contaminated needles from Sharp container
▪ Do not share or break contaminated sharps
▪ Do not “horseplay” with needles or other sharps
▪ Have needle/sharp container near area where needles may be used
▪ Discard contaminated sharps immediately (or as soon as feasible)
▪ Do not leave contaminated needles unattended
Table 6.0 Source: OSHA, 2019a
Standard Precautions
❖ Handwashing
❖ Gloves
❖ Mask, Eye Protection, Face shield
❖ Gown
❖ Needles and Sharps
❖ Patient Care Equipment
❖ Environment Control
❖ Linen and Textile
❖ Occupational Health & Bloodborne Pathogens
❖ Patient Placement (i.e. ICU, Isolation, etc.)
❖ Respiratory Hygiene/Cough Etiquette
Table 7.0 Source: CDC, 2019a
Airborne Precautions
• Source
• Patient Placement
• Room Restriction
• PPE
• Transport
• Immunize
Table 9.0 Source: CDC, 2016
Droplet Precautions
• Source Control
• Patient Placement
• PPE
• Transportation
Table 10.0 Source: CDC, 2016
Droplet Precautions used for infections spread in large droplets by coughing, talking, or sneezing such as influenza (CDC, 2019a).
Contact Precautions
• Patient Placement
• PPE
• Transport
• Patient-care equipment
• Cleaning & Disinfecting
Table. 11.0 Source: CDC, 2016
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ITEMS THAT MAY CONTAIN LATEX
Personal Protective Equipment: * Gloves * Goggles * Respirator
• Rubber gloves * Surgical masks
Emergency Equipment: * Blood pressure cuffs * Stethoscopes
• Disposable gloves * Oral & nasal airways * Syringes
• [pic][?]"#$)*4BCDEHNOPQSTUZ[hosvwx{|}~€?‚ƒ„…†‡¡¢£³´»ËÎEndotracheal tubes * Tourniquets * Intravenous tubing
• Electrode pads
Hospital Supplies: * Anesthesia masks * Catheters
• Wound drains * Injection ports
• Rubber tops of multidose vials
Table 13.0
Some of the listed products are available in latex-free forms.
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