March 6, 2009

Sample Research Proposal on To Enhance the Infection Control Awareness of Radiographers in General Radiography and Ward Radiography

In general, environmental control measures require resources not available in resource-limited settings, some can be implemented, and staff can be trained in their purpose, capabilities, proper operation and maintenance.  Work practice and administrative control measures have the greatest impact on preventing infection transmission within facilities caring for radiographers to prevent exposure to staff and patients as well as to reduce the spread of infection by ensuring rapid and recommended diagnostic investigation and treatment for patients and staff suspected and best be accomplished through the prompt recognition, separation, provision of services and referral of persons with potentially infectious disease. Aside, there has to be components to good work practice and administrative controls:

-          Infection control plan

-          Administrative support for procedures in the plan, including quality assurance

-          Training of staff

-          Education of patients and increasing community awareness

-          Coordination and communication with awareness program

 

 

 

 

 

INFECTION CONTROL PLAN FOR AWARENESS

 

Each facility should have a written infection control plan that outlines a protocol for the prompt recognition, separation, provision of services, investigation and referral of patients with suspected or confirmed diseases.  Early recognition of patients with suspected disease is the first step in the protocol. A staff member should be assigned to screen patients for prolonged duration of cough immediately after they arrive at the facility. Patients with cough should be allowed to enter, register and get a card without standing in line with other patients.  Patients who are identified as infectious suspects on the screening must be given advice on respiratory hygiene/cough etiquette, and provided with a face mask or tissues to cover their mouths and noses. They should then be separated from other patients and requested to wait in a separate well-ventilated waiting area.  Placing symptomatic patients at the front of the line, to quickly provide care and reduce the amount of time that others are exposed to them, is recommended. Also, each facility should have a linkage with treatment center to which those who are diagnosed and if not possible the patient should be referred to the nearest diagnostic center. Every attempt should be made to facilitate this referral as further delays in diagnosis will increase the risk of exposing others to infection.

 

The plan should designate a staff member to be the infection control officer who is responsible for ensuring the infection control procedures are implemented. The plan will include, but not be limited to, the following policy areas:

-          Screening all patients as soon as possible after arrival at the facility to identify persons with symptoms or persons who are being investigated or treated for disease

-          Instructing the above designated persons identified through screening in respiratory hygiene/cough etiquette. This includes instructing them to cover their nose and mouth when coughing for sneezing, and when possible providing face masks or tissues to assist them in covering their mouths

-          Face masks help prevent the spread of M. tuberculosis from the patient to others. The face mask can capture large wet particles near the mouth and nose of the patient, preventing the bacteria from being released into the environment. Face masks could be provided to persons who have a positive symptom screen to wear until they leave the facility. Cloth masks can be sterilized and reused. Paper tissues provided to these persons, with instructions to cover their mouths and noses when coughing or sneezing with attendant risk of stigma.

-          Using and maintaining environmental control measures

-          Training and educating staff on infection control plan

-          Providing voluntary, confidential counseling and testing for staff with adequate access to treatment

-          Monitoring infection control plan's implementation and correcting any inappropriate practices or failure to adhere to institutional policies

 

 

 

Radiology has an important role in outbreak of severe acute respiratory syndrome and in addition, patients may require imaging with other modalities, of which sonography, interventional radiology and angiography and fluoroscopy pose the greatest risk to staff because of prolonged patient contact at close quarters, exposure to bodily fluids. The goal is to reduce the risk of cross-infection between patients as well as reducing the risk of infection to staff. The following is an account of the procedures and guidelines that so far we have put in place, with the close involvement of the hospital infection control team, to try to decrease these risks. In terms of reorganizing services, providing protective apparel to staff and patients, and arranging cleaning of equipment, patients must be assessed for relative risk. Therefore, there believe that when reorganizing the department, inpatients without suspected or confirmed SARS should be physically segregated from the other groups but the same level of infection control measures should be taken as for inpatients with suspected or confirmed SARS. Physical segregation of patients can be achieved using location or time. When possible, facilities for imaging patients with SARS should be situated outside the main department, such as the portable radiography and sonography units used in intensive care. However, equipment for some modalities may not be mobile. In departments that have more than one piece of equipment, it may be possible to dedicate one for SARS and one for non-SARS patients. Alternatively, additional equipment such as a portable CT scanner could be rented. Congestion in the waiting area should be minimized, and waiting areas and patient access should be segregated and clearly marked with barriers and signs. Most departments will be constrained by the amount of equipment and the layout of the department, so the only way to segregate some patients will be by time. Unfortunately, in practice this is quite difficult to implement because the clinical condition of a patient often dictates the timing of the examination.

 

Staff Education

Identify a departmental infection control team to draw up and continually update guidelines and to educate staff. One member must be identified to act as a policeman to ensure the guidelines are enforced. It is imperative that all staff  work as one unit and have regular education sessions. Protocols for each modality and infection control instructions should be posted on the walls in all examination rooms. Staff should also undertake personal measures to reduce infection such as always wearing a mask; not touching the mask and the eyes; washing hands frequently; facing away from colleagues when eating, drinking, and talking; and covering pagers with disposable plastic bags.

 

Procedure for Allocating Appointments

 

Reduce outpatient appointments to allow time to properly undertake infection control measures. Allocate appointments in the sequence of low to high risk, and stress the importance of keeping to outpatient appointment times. Restrict outpatient visitors to those who accompany children, the very sick, and the aged. Finally, clinicians must be prudent in their requests for imaging patients with SARS. Requests should be made only when the examination result will have a major impact on patient treatment and such radiology procedures must be discussed and performed by experienced staff.

 

Procedure for Preparing the Patient

 

Outpatients should be screened for SARS using a questionnaire on their arrival for examination. Those suspected of having SARS should have the appointment postponed and be asked to attend a screening clinic. Patients must follow personal infection control guidelines. Inpatients need careful preparation before arriving in the radiology department. The latest SARS status must be checked because it may have changed since the request was made. IV lines should be placed on the ward, and appropriate consent forms should be signed on the ward and faxed to the radiology department.

 

Patients must follow personal infection control guidelines; if the patient requires oxygen, a nasal cannula and not an oxygen mask should be used. Finally, the examination room should be ready for the patient to reduce waiting time in the department.

 

Procedure for Examining the Patient

 

Staff must change into protective apparel in a designated site close to the examination room, taking special care to follow instructions as to the sequence of preparation. Warning signs must be posted outside the room when suspected or confirmed SARS patients are being scanned. All clinical notes and radiographic packets from the ward should be left on the patient trolley outside the examination room, and staff should avoid handling these items unless doing so is essential. View previous examinations by reloading them onto monitors rather than by requesting old films. Equipment such as the examination couch should be protected by a new sheet that is changed between patients. Two staff members should be present, one to do the transferring and positioning of the patient and the other to operate the control panels. The examination should be shortened when appropriate while still ensuring the clinical question is answered.

 

 

 

 

 

 

 

Procedure After the Examination

 

The patient transporter should be ready to collect patients as soon as the examination is finished. Staff should remove contaminated apparel in designated rooms according to the sequence on the instructions and place linen and laundry in designated bags. The cleaning staff should clean according to infection control guidelines.

 

Problems of Specific Modalities

 

General radiography

 

Satellite radiography and portable services should be set up outside the main department for performing chest radiography of patients with suspected or confirmed SARS. Designate a specific room in the emergency department for examining such patients. The increased demand for portable chest radiographs may require the purchase of extra cassettes. Cassettes from contaminated areas should be disinfected. The greatest precaution also should be taken when performing radiography in the emergency department; have a high index of suspicion regarding any patient undergoing chest radiography for acute chest symptoms, irrespective of the provisional diagnosis.

 

Therefore, the highest level of infection control should be adhered to in all cases; when possible, the examination should be avoided altogether in patients with suspected or confirmed SARS. Ensure that staff know where to dispose of liquids. For inpatients, metallic items and false teeth should be removed on the ward, and the patient's mask should not have a metallic bar. The call bell must be covered with a disposable plastic bag. Potentially, MR imaging poses a high risk of cross-infection because of the prolonged time during which a patient's head and body are in close proximity to the equipment.

 

Areas for Special Attention When Reorganizing the Radiology Department

 

Staff should be rotated to reduce the viral load to individuals in high-risk areas. If possible, staff should have regular allocated times away from work during which they are monitored for signs of infection. An efficient patient transportation service is essential to prevent inpatients from waiting in the radiology department. If patients from the ward require the use of elevators, one elevator must be dedicated to the transportation of suspected or confirmed SARS patients. Resuscitation is a hazardous procedure for staff. The resuscitation trolley must be stocked with protective apparel at all times, staff must be fully protected before starting resuscitation, and resuscitator bags must be fitted with a filter before use.


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