sars infection control guidelines for radiology department
TRANSCRIPT
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SARS infection control guidelines for Radiology
Department : An example of Taipei Medical
University-Wan Fang Hospital
Wing Chan, MD
Dept. of Radiology, School of Medicine, Taipei Medical University and TMU-Wan Fang Hospital, Taipei, Taiwan,
Republic of China
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SARS and X-rays
• SARS is a form of lung injury characterized by epithelial-
cell proliferation and an increase in macrophages in the
lung.
• Chest radiography has a crucial role in diagnosis and
monitoring of disease progress in the treatment of patients
with SARS.
• This causes major problems for a radiology department that
has to offer a service to all patients, sometimes using the
same equipment, in the same room, by the same staff.
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“SARS infection control guidelines for Radiology Department”
• This presentation is an account of our guidelines that have
been published in Chinese Journal of Radiology in June of
2003 (Chan WP, Liao Y-M. Chin J Radiol 2003;28:167-173)
• We have put the guidelines in place with the close
involvement to the hospital infection control team to try our
best to decrease the risks.
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Policies
• Radiology Department has been categorized as “high risk
area” for SARS infection control in hospitals.
• The major role in SARS control is segregation of SARS
from non-SARS patients by equipments, examination rooms
and time.
• The goals in SARS control are to reduce the risk of
infection as much as possible to our staffs as well as cross
infection between patients.
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Value
• To maintain high quality of patient care and
professional respect, especially for our
front-line staffs.
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SARS in Wan Fang Hospital
• Till June 1, 03, a total of 43 patients with SARS was
admitted in our hospital.
• Our radiological technicians performed portable X-rays in
negative-pressure rooms for 423 times.
• No in-hospital infections to our staffs or cross infections
between patients were noted.
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SARS Infection Control Team in Radiology
Chief
Staff Radiologists
Chief Technician
AdministrativeAssistant (1)
Nurse (1)Senior technician (1)
Supervisor technician
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SARS Infection Control Team in Radiology
Goals
• Zero in-hospital infections to our staffs
• Zero cross infections between patients
• Maintain high quality of patients care
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SARS Infection Control Team in Radiology
Strategies
• Full support to our front-line staffs
• Full supply of prevention requirements to our
staffs
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SARS Infection Control Team in Radiology
Work descriptions
• The infectious control team should review the practices
in the radiology department, where there is direct
patient contact, to help reinforce proper infection
control techniques and close any loopholes.
• One member (the leader of technicians) acts as a
“policeman” to ensure the guidelines are enforced.
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Categorization of patients
• Outpatients without suspected / confirmed SARS
• Outpatients with suspected SARS*
• Inpatients without suspected / confirmed SARS*
• Inpatients with suspected / confirmed SARS*
* Need highest infection control measures
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Categorization of patients
Segregation of patients
• Segregation of patients by location and equipments: three portable X-rays for performing those patients in fever screening station, negative-pressure room, and ICU, respectively.
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Categorization of patients
Segregation of patients
• Segregation of patients by time: Noon-2:00 for in-patients without SARS in the main department; late evening for in-patients with SARS for CT scan examinations.
• Congestion of waiting area should be minimized or avoided.
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Segregation
Segregation of staffs
• Radiology department can be divided into
two zones: “contamination” and “clean”
zones by clear notice plates.
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Examination requests
• SARS patients : requested order by 9:30PM one day before
• Patients at fever screening station : scheduled by phone
• Other patients: regular time
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Examination requests
Examination policies
• Chest films are not suggestive for screening patients
without fever.
• Attention should be given on the following patients
without remarkable symptoms of fever: renal disease,
DM, long-term steroid treatment, cancer, and immobile
patients.
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Examination requests
Examination policies
• Requests for imaging studies only are made when the
examination result will have a major impact on patient
treatment.
• All examinations should be shortened but still ensuring
the clinical question is answered.
• Reduce out-patients appointments to reduce overload.
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Radiographic features suggestive for SARS
• Initial chest radiographs can be normal (<15%).
• Common initial radiographic features: air-space consolidation, ground-glass attenuation, nodules, and mixed consolidation and nodules.
• Initial normal radiograph or unifocal lung lesion had a better prognosis outcome.
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Radiographic features NOT suggestive for SARS
• Mediastinal or hilar lymphadenopathy
• Cavitation or abscess formation
• Pleural effusions
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X-Rays
• Chest PA view only
• Taken by computerized digital X-rays
• Allocate patients in the sequence of low to high risk for fever screening, and mild to severe for SARS patients in performing X-rays.
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CT scan
• Isolated ventilation system for CT room
• Patient and staffs should follow the SARS infection guidelines
• For patients who have fever and contact history, HRCT can be
performed when chest films reveal negative findings.
• Consider CT as an alternative examination to sonogram for
patients of whom other causes of fever should be ruled out.
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X-rays machines
• Three portable X-rays in performing SARS patients,
fever screening, and ICU patients, respectively.
• Disinfection after performing each patient (by 70%
alcohol for metallic surfaces)
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Staffing and visitors
• No conferences or meetings is allowed
• No visitors is allowed entering our department
• Cleaning staffs should be followed by one of our nurse during their cleaning duty.
• Two teams of radiological technicians to perform examinations in fever screening station and SARS patients in negative-pressure rooms, respectively.
• Rotating staffs twice a month to reduce work overload and viral load.
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Control Supervision
• Two staffs should be worked together for portable X-
rays, one as a control supervision to review all
procedures
• Regular practices for protection dressing before
performing portable X-rays procedures
• All of our staffs should record their own body
temperature before 10AM.
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Room Cleaning
• For general areas, the cleaning schedule are cleaned twice (AM, PM) daily.
• For all telephones, fax machines, computer keyboards, table surfaces are cleaned twice daily.
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Personal Care
• Always wearing mask
• Washing hands frequently
• Not touching the mask and the eyes
• Pay attention to every steps in details in performing procedures or examinations
• Avoid duty overload
• Avoid wear working uniform to go back home
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Conclusion
• To set-up a “SARS infection guidelines in
Radiology Department” only is the first step
in SARS infection control. A continuous and
regular education, practice, and control
supervision are the key factors to achieve a
good infection control outcome.