SARS infection control guidelines for Radiology Department : An example of Taipei Medical University-Wan Fang Hospital Wing Chan, MD Dept. of Radiology,

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

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.

“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.

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.

Value

• To maintain high quality of patient care and

professional respect, especially for our

front-line staffs.

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.

SARS Infection Control Team in Radiology

Chief

Staff Radiologists

Chief Technician

AdministrativeAssistant (1)

Nurse (1)Senior technician (1)

Supervisor technician

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

SARS Infection Control Team in Radiology

Strategies

• Full support to our front-line staffs

• Full supply of prevention requirements to our

staffs

SARS Infection Control Team in Radiology

Work descriptions

• The infectious control team should review the practices in the radiolog

y department, where there is direct patient contact, to help reinforce pr

oper infection control techniques and close any loopholes.

• One member (the leader of technicians) acts as a “policeman” to ensur

e the guidelines are enforced.

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

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.

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.

Segregation

Segregation of staffs

• Radiology department can be divided into

two zones: “contamination” and “clean”

zones by clear notice plates.

Examination requests

• SARS patients : requested order by 9:30PM one day before

• Patients at fever screening station : scheduled by phone

• Other patients: regular time

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.

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.

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.

Radiographic features NOT suggestive for SARS

• Mediastinal or hilar lymphadenopathy

• Cavitation or abscess formation

• Pleural effusions

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.

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.

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)

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.

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.

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.

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

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.

Thank you for your attention

[email protected]