INTRODUCTION

Great importance must be put on the maintenance of a safe and clean clinical environment for the patients. Within the diagnostic imaging department it should be recognised that all patients have the potential to carry and transmit organisms. It has been shown that nosocomial infections (those occurring in a hospital setting) can be reduced considerably with the introduction of basic hygiene procedures.¹ In order to prevent the transfer of infections it is important to be aware of the specific organisms that can cause infection and the mode of transfer so that the cycle of replication can be disrupted.

DISEASES AND ORGANISMS

A disease is a condition causing symptoms of an illness, which occurs when cells or molecules within the body stop functioning properly. For example, a disease can be caused through aging, the effects of chemicals, or arise from gene mutation/alteration.

There are four main groups of pathogenic organism which can cause diseases, some of which are harmless to the host when sited in the correct place; for example there are organisms living in the bowel which cause infection when they enter the urinary or respiratory tracts.

CROSS-INFECTION

An infection occurs when other organisms, e.g. bacteria, viruses, fungi or protozoa, enter or come into contact with the body and multiply. The organisms can cause direct damage or prompt an immune response, which causes symptoms to manifest, e.g. fever.

Infections can be:

The cross transfer of a pathogenic organism from one individual to another (cross-infection) can occur in the following ways:

Therefore, it is essential that the equipment, environment and healthcare professional are subject to varying levels of cleanliness dependent on the clinical requirement (Table 5.1). There arethree main levels of cleanliness that exist with regards to equipment and surfaces: clean, disinfected and sterilised.

Table 5.1 The purpose and contraindications of cleansing agents

Cleaning agents	Purpose in department	Contraindications for use
Chlorhexidine gluconate solution 2.5%	For cleansing the skin prior to a procedure	Not for hard surfaces
Chlorhexidine gluconate 0.015%, cetrimide 0.15% (e.g. Savlon/Tisept/Sterets)	Pre-injection Skin sterilisation Bottle tops

Not for hard surfaces or open wounds Chlorhexidine gluconate solution 2.5% (e.g Hibiscrub) None Detergent, sanitiser, blue bleach powder (sodium hypochlorite) For body fluids and spillages Not for skin Cleansing foam (e.g. Esemtan) Antimicrobial deodorising foam Not for hard surfaces, floors, etc. Povidone iodine 7.5% (e.g. Videne antiseptic solution) A rapid acting non-irritating aqueous iodine solution For skin only. Not for hard surfaces, floors, etc. Alcohol impregnated wipes For hard surfaces and skin Not for open wounds Sodium chloride 0.9% solution For skin and open wounds None ‘Decon’ For neutralising radioactive spills None

IMAGING EQUIPMENT CLEANING

It is not practically possible to disinfect by immersion or sterilise large items of equipment such as an X-ray tube or table; however, measures can be employed to maintain a level of visual cleanliness. It is recommended that there should be changes of linen on X-ray table mattresses and a fresh gown for each patient after each examination. However, there are considerations of time and environmental issues to be considered so that the changing of the mattress linen after each patient could be replaced by the use of paper roll to cover the sheet, which must be fresh for each patient. The sheet must also be changed following an infectious patient or if soiling has occurred. Naturally, the sheet should also be changed at regular intervals; for example after a clinic session or daily, dependant on the patient throughput of the room.

The used gowns and bed linen must be collected and sent to the laundry in the appropriate coloured linen bag. A white plastic or terylene/polyester bag is used for routine linen that is not fouled or infected. Any linen which is heavilysoiled with blood, faeces, urine or other bodily fluids should be placed in a sealed red water-soluble bag covered with an outer red plastic or terylene/polyester bag.²

Research has shown up to one third of nosocomial infections may be prevented by adequate cleaning of hospital equipment.³ Within the diagnostic imaging department the equipment most commonly in contact with the patient is an image receptor; that is, a cassette or digital device. These should be wiped clean after each patient using alcohol or bactericide impregnated wipes. There should also be a protocol in place for regular and frequent cleaning of all equipment within the X-ray room to reduce risk of infection. It is not only the patient contact surfaces which require regular cleaning but also those operated by the practitioner. The control panel and X-ray tube controls are also at risk of harbouring bacteria from the operator and contact with the patient and therefore would also benefit from frequent cleaning using alcohol or bactericide impregnated wipes.

In some situations, when a patient with a known infection requires imaging, it may be necessary to carry out a method similar to that of ‘barrier nursing’. Barrier nursing is carried out to reduce the risk of cross-transfer of infection between staff and patients. A patient with a known infection (e.g. MRSA) should be imaged at the end of a session/day so as to give time for thorough cleaning of the area and to reduce contact with other patients in the department. It is necessary to have two practitioners in order to provide a ‘clean’ and ‘dirty’ person. The ‘dirty’ person who is dressed in gloves, apron and mask is responsible for positioning the patient and image receptor whilst the ‘clean’ person sets the exposure and manipulates the X-ray equipment, thus reducing the opportunity to transfer the infection.

PERSONAL HYGIENE

The following aspects of personal hygiene must be observed:

ASEPTIC TECHNIQUE

Many hospital procedures, including surgical operations, require the use of sterile equipment to prevent the introduction of organisms. They also require a sterile field, which can be defined as a region for work within which it is deemed to be sterile. All items and materials placed within the sterile field must also be sterile. The contamination of the field by air-borne bacteria is minimised by the flow of ‘scrubbed’ air; for example, in operating theatres.

Within an imaging department an aseptic technique may be required for dressing following the insertion of a drainage tube or during a specialised procedure such as a biopsy. Initially, in order to set up the sterile trolley it is necessary to carry out a basic hand wash. The trolley shelves should then be wiped down with a hard surface disinfectant before any items are placed on it. The individual setting up the trolley should then stock the trolley with the following, ensuring that the items are in date and sterile where appropriate (Fig. 5.4):

The sterile pack should only be opened immediately prior to the procedure and only the corners of the outer paper should be pulled back. The inner wrappings should only be removed or touched by an individual who has performed an aseptic hand wash and is wearing a pair of sterile gloves.

Following completion of the procedure all used objects should be either disposed of in the correct receptacle or returned to the sterile supplies department for re-sterilisation and re-issue (Table 5.2).

Extreme caution must be shown with any used ‘sharp’ items to avoid a needlestick injury. If an individual is pricked or cut by a needle or scalpel the following procedure should be followed:

FLUOROSCOPIC EXAMINATION PREPARATION

Practitioners or radiologists usually perform fluoroscopic procedures with assistance to ensure that patient care is maintained to a high standard. The main examinations that take place in a fluoroscopy room are:

SPECIALIST PROCEDURE PREPARATION

A range of specialist procedures are carried out within a diagnostic imaging department, from angiography to embolisation. The trolley setting should be adapted to the size required for the procedure. There are many different catheters that might be required during the course of the special procedure and the relevant one should be selected prior to its commencement (Fig. 5.6).

The patient will probably be an inpatient due to the requirement for sedation and possible surgical intervention, dependant on the outcome of the procedure. In this instance, the patient’s identification needs to be checked against the wristband as well as asked verbally. The special procedures require informed consent from the patient, which should be obtained by the practitioner or radiologist performing the examination. It is possible that postoperative observations of pulse; respiration, blood pressure and angiopuncture site will be required.

RECORD KEEPING

Records within a diagnostic imaging department can range from a request card to observation sheets and accident forms. Record keeping is an integral part of the healthcare professional’s practice as identified by the Health Professionals Council 2003.⁵

In today’s litigious society any record can be called upon during criminal procedures, Trust investigations and professional disciplinary investigations. The most common faults in record keeping are failure to document an incident or recording inaccurate accounts of events.⁶

There is a requirement to document all drugs administered; this includes all contrast and other drugs used during radiological examinations.