Infection Control

Routes of Transmission

A. General Concepts

1. Cycle of infection = All factors involved in the spread

of disease

a. Infectious organism: Pathogen

b. Reservoir of infection: Place where organisms can

thrive

c. Portal of exit: Any avenue available to exit the

body

d. Susceptible host: Person at risk for infection

e. Portal of entry: Any avenue available to enter the

body

f. Mode of transportation: Route taken by pathogens

from reservoir to susceptible host

2. Healthcare Acquired Infections (HAIs)

a. Also called nosocomial infections

b. Approximately 2 million persons acquire HAI per

year

c. CDC estimates 90,000 annual deaths because of

HAIs

d. Most common route of infection involves urinary

catheter

B. Direct Contact Transmission:

1. infected person touches susceptible host, allowing the

infectious organisms to come in contact with susceptible

tissues

2. Fomite: An object that has been in contact with

pathogens comes in contact with susceptible

tissues

C. Airborne transmission: Droplets and dust that are

able to remain suspended in air for extended periods

of time

D. Droplet transmission: Transmitted primarily by coughs,

sneezes, or other methods of spraying onto a nearby

host

E. Common vehicle transmission: Transmitted primarily by

contaminated items such as food, water, medications,

devices, and equipment

F. Vector-borne transmission: Animal or insect contains and

transmits infectious organism to humans

Standard Precautions

A. First tier of transmission-based isolation precautions

B. System that uses barriers to prevent contact with blood,

all body fluids, nonintact skin, and mucous membranes,

if there is a chance of transmission of infection

C. Assumes all body fluids are sources of infection

D. Assumes all patients are infected

E. Guidelines

1. Always wear gloves when any chance of being in contact

with body substances exists

2. Protect clothing by wearing a protective gown or

plastic apron, if a chance of coming in contact with

body substances exists

3. Masks or eye protection must be worn if a chance of

body-substances splashing exists

4. Handwashing is the most effective method to prevent

the spread of infection

5. Uncapped needle syringe units and all sharps must be

discarded in biohazard containers

6. If any contact is made with body substances, the

entire area contacted must be washed completely

with bleach

7. Contaminated articles must be disposed of properly

8. Needles should never be recapped but should be

placed with the syringe in a sharps container

9. Protective masks or mouthpieces should be used when

performing cardiopulmonary resuscitation (CPR), if

providing breaths in addition to chest compression.

Medical Asepsis

A. Includes proper hand hygiene

1. Use alcohol-based hand sanitizer for 15 seconds

2. Conventional handwashing (duration): 30 to 60

seconds

a. Adjust water temperature

b. Wet hands

c. Lather antimicrobial soap into hands and fingers

for at least 20 seconds

d. Rinse clear

e. Dry thoroughly

f. Turn off faucet with paper towel when handles are

present

3. No wearing of artificial nails

B. Microorganisms have been eliminated as much as possible

C. Water and chemicals are used for the disinfection

Surgical Asepsis

A. Complete removal of all organisms from equipment and

the environment in which patient care is conducted

B. Includes complete sterilization of equipment and appropriate

skin preparation

1. Chemical sterilization: Soaking objects in germicidal

solution

2. Boiling: Sterilization with moist heat

• Check identification bracelet to ensure that correct

patient is being transferred

• Explain transfer procedure to patient to gain

cooperation and alleviate fear

• Always use proper body mechanics

• Ensure all appropriate brakes are applied

• Make creative use of sheets and helpers when moving

Patient

3. Dry heat: Placing objects in an oven at temperatures

greater than 329° F

4. Gas sterilization: Items are exposed to a mixture of

gases, which do not harm the materials

5. Autoclaving: Steam sterilization under pressure; most

convenient way to sterilize materials

Sterile Technique

A. Steps to follow in the opening of sterile packs

1. Check expiration date

2. Place pack on a clean surface

3. Break seal and open pack

4. Unfold the first corner of the pack away from you

5. Unfold both sides

6. Pull front portion of the wrap toward you and drop

it

7. Never touch the inner surface

8. If there is an inner wrap, open it using the same

method

9. Separately wrapped sterile items may be added to

the sterile field by opening the pack and allowing

the items to drop onto the sterile field

10. Never allow the container to touch the sterile field

B. Pouring liquids into containers in a sterile field

1. Carefully determine the contents of the container

2. Pour a small amount into a waste receptacle to cleanse

the lip of the bottle

3. Pour the medium into the receptacle, being careful

not to touch the sterile field in the process

C. Sterile objects or fields touched by unsterile objects or

persons are immediately contaminated

D. Avoid reaching across sterile fields

E. If you suspect that an object is contaminated, assume

that it is contaminated

F. Always assume that damp items are contaminated

G. Do not invade the space between a physician and the

sterile field

H. Never abandon a sterile field; it must be under direct

observation at all times

I. Never turn your back on a sterile field

J. Remember: Only from your waist up and in front is

sterile

Gloving

A. Wash hands thoroughly

B. Open outer package containing gloves

C. Open inner package, exposing gloves

D. Approach glove from open end, and touch only inner

surface with opposite hand

E. Put on glove, touching only the folded cuff

F. Pick up other glove with gloved hand under the cuff

G. Place second glove on other hand, and unfold cuff

H. Carefully unfold cuff on both gloves

I. Always keep hands in front of the body without touching

body covering or placing hands under arms

Types of Transmission-Based Precautions

A. Airborne precautions—in addition to standard

precautions

1. Wash hands before patient care

2. Workers and visitors entering patient’s room must

wear particulate respirators

3. Wash hands after patient care

B. Droplet precautions—in addition to standard precautions

1. Wash hands before patient care

2. Surgical masks required for persons coming in close

contact with patient

3. Wash hands after patient care

C. Contact precautions—in addition to standard precautions

1. Wash hands before patient care

2. gloves, and gowns are indicated for individuals coming

in contact with patient

3. Wash hands after patient care

Scheduling of Radiographic Examinations

A. General considerations

1. Schedule in an appropriate and timely sequence to

ensure patient comfort and fiscal responsibility

2. Sequence so that examinations do not interfere with

one another

3. Schedule barium studies last

4. Schedule several examinations in a single day if the

patient is able to tolerate them

5. Seriously ill or weak patients may be able to tolerate

only one examination per day or must have a rest

between examinations

6. If sedation is used, patient must be given time to

recover from sedation before beginning fluoroscopic

studies

7. Thyroid assessment must precede any examinations

involving iodinated contrast media

8. Schedule radiographic examinations not requiring

contrast agents first

9. Total doses of iodinated contrast media should

be calculated if they are to be used in a series of

examinations

10. Schedule patients who have been held NPO (nothing

by mouth) first

11. Schedule pediatric and elderly patients early

12. Schedule diabetic patients early because of their

need for insulin

B. Sequence of examinations

1. Fiberoptic (endoscopy) studies are conducted first in

a series

2. Radiography of the urinary tract

3. Radiography of the biliary system

4. CT studies should be scheduled before examinations

involving the use of barium sulfate

5. Lower gastrointestinal (GI) series (check for residual

contrast material from previous examinations before

proceeding)

6. Upper GI series

Patient Preparation

A. GI system or urinary system

1. Low-residue diet (e.g., low fiber) or clear liquid diet

(e.g., tea, gelatin, bouillon)

2. NPO for 8 to 12 hours before procedure

3. Cathartics and enemas are used to cleanse the GI system

4. If scheduled as an outpatient

a. Patient must clearly understand the routine for

proper preparation

b. Patient should be asked to explain the procedure

back to the radiographer to verify understanding

B. All procedures

1. Clothing is removed from area to be radiographed

and replaced by patient gown when appropriate

2. All radiopaque objects are removed from area of

Interest

Patient History

A. Provides information for the radiographer about the

extent of the patient’s injury and the range of motion

the patient can tolerate

B. Assists the radiologist during interpretation of the

radiographs

C. History should begin with the radiographer introducing

himself or herself and verifying the patient’s name

D. Types of questions asked to obtain a patient’s history

(depending on type and site of injury)

1. How did your injury occur?

2. When did your injury occur?

3. Where is your pain?

4. Do you have tingling or numbness?

5. Do you have any weakness?

6. Were you unconscious after your injury?

7. Why did your physician order this examination?

8. Have you experienced shortness of breath or been

coughing?

9. Have you experienced a fever or heart problems?

10. Have you experienced any nausea, vomiting, or

diarrhea?

11. Have you had previous surgery on this area?

12. Is there any family history of problems in this area

Medicolegal Aspects of Practice

A. Torts

Violations of civil law

Also known as personal injury law

Injured parties have a right to compensation for injury

B. Intentional misconduct

1. Assault

a. Patient is apprehensive about being injured

b. Imprudent conduct of radiographer that causes fear

in patient is grounds for an allegation of civil assault

2. Battery

a. Unlawful touching or touching without consent

b. Harm resulting from physical contact with

radiographer

c. May also include radiographing the wrong patient

or the wrong body part or performing radiography

against a patient’s will

3. False imprisonment

a. Unjustified restraint of a person

b. Care must be taken when using restraint straps

or having other individuals assist with holding a

patient still

4. Invasion of privacy

a. Violation of confidentiality of information

b. Unnecessarily or improperly exposing the patient’s

body

c. Unnecessarily or improperly touching a patient’s

body

d. Photographing patients without their permission

5. Libel: Written information that results in defamation

of character or loss of reputation

6. Slander: Orally spreading false information that results

in defamation of character or loss of reputation

7. Manipulation of electronic data that is ethically

wrong and legally questionable:

a. using the wrong processing algorithm

b. altering the exposure indicator

c. cropping/masking anatomy postexposure

C. Unintentional misconduct (negligence)

1. Neglect or omission of reasonable care

2. Based on doctrine of the reasonably prudent person

3. Reasonably prudent person doctrine: Based on how a

reasonable person with similar education and experience

would perform under similar circumstances

4. Gross negligence: Acts that show reckless disregard for

life or limb

5. Contributory negligence: Instance in which the injured

person is a contributing party to the injury

D. Four conditions needed to establish malpractice

1. Establishment of standard of care

2. Demonstration that standard of care was violated by

the radiographer

3. Demonstration that loss or injury was caused by

radiographer who is being sued

4. Demonstration that loss or injury actually occurred

and is a result of the negligence

E. Respondeat superior

1. “Let the master answer”

2. Legal doctrine stating that an employer is held liable

for an employee’s negligent act

F. Rule of personal responsibility: Individuals are responsible

for their own actions

G. Res ipsa loquitur

1. “The thing speaks for itself ”

2. Legal doctrine stating that the cause of the negligence

is obvious (e.g., forceps left inside a patient during

surgery)

H. Charting

1. Using electronic medical record or writing on the

patient’s chart by radiographer

2. Varies by institution

3. Radiographer’s responsibilities in this regard must be

carefully outlined during new employee orientation

4. Write clear statements regarding patient’s condition

and patient’s reaction to contrast agents; write

amount of contrast material injected

5. Must be clearly stated on the chart

6. Information must also include the date and time of

the occurrence

7. Radiographer must sign chart entries using institutional

protocol

8. In case of error, correct electronically or strike over

once and rewrite correct entry; never erase or obscure

erroneous information

I. Radiographic images

1. Radiographic images are legal documents, whether

electronic or on film

2. Images must include the following information:

a. Patient identification

b. Anatomic markings, including left and right

markers

c. Carefully placed markings on each radiograph

using lead markers

d. Date of exposure

e. Markings placed on the image following exposure

may not be legally admissible

3. Retention of images

a. Varies according to state law

b. Normally maintained for 5 to 7 years after the

date of the last radiographic examination (mammograms

and black lung images are kept for the

life span of the patient)

c. Files on minors are normally retained for 5 to 7

years after the minor reaches age 18 or 21, depending

on the state of residence

J. Patient’s rights

1. Patient’s bill of rights from the American Hospital Association

provides for patient consent or refusal of any

procedure; the patient has the right to the following:

a. Respectful care

b. Obtain up-to-date and understandable medical

information regarding diagnosis, treatment, and

likely outcomes

c. Be involved in the decision-making process

throughout diagnosis and treatment

d. Have an advance directive (living will, health care

proxy, durable power of attorney) on file

e. Privacy in all aspects of diagnosis and treatment

f. Complete confidentiality

g. View medical records of the case

h. Expect that a hospital will respond to a request for

needed care and services

i. Be informed of business or educational relationships

that may affect treatment and care

j. Consent to or decline participation in research

studies

k. Continuity of care and other options for care

beyond the hospital

l. Be informed of hospital policies and procedures

related to diagnosis and treatment

m. Be informed of all resources available for resolving

disputes

n. Be informed of charges for services and payment

options

2. Implied consent

a. Provides for care when patient is unconscious

b. Based on assumption that patient would approve

care if conscious

3. Valid consent

a. Also called informed consent

b. Patient must be mentally competent

c. Consent must be offered voluntarily

d. Patient must be adequately informed

e. Patient must be of legal age

f. Requires that radiographer or radiologist carefully

explain all aspects of procedure and risks

involved

g. Requires that explanation be provided in lay terms

the patient understands

4. Health Insurance Portability and Accountability Act

(HIPAA)

a. Passed by US Congress and enacted under rules

and regulations of US Department of Health and

Human Services

b. Hospitals must put in place policies and procedures

regarding the release of patient information

c. Patient must provide clear permission for release

of any information to outside parties (e.g., medical,

financial, employment)

d. Patient must be informed in writing of how the

released information will be used

e. Patient must be allowed to view and copy records

and amend records as needed

f. Any history of information sharing must be disclosed

to the patient

g. Patient must freely provide consent for information

to be shared

h. Patient has the right to restrict sharing of

information

i. Patient may file a complaint regarding a violation

of HIPAA

5. Do not resuscitate order (DNR)

a. Also called no code

b. May be placed on file when the quality of life

has seriously declined or the patient’s condition

is terminal

c. Agreement is between the physician and the

patient (or the designated person holding power

of attorney if the patient is incompetent)

d. The agreement or appropriate notation is made on

the patient’s chart

6. Advance directive

a. Patient provides directives regarding medical care

before becoming incapacitated

b. Patient may do this so that directions are in place

should the patient be unable to communicate

wishes regarding care

c. Copies should be provided to physician, attorney,

family member, and medical record

7. Durable power of attorney

a. Patient provides for another person (personal representative)

to make decisions regarding medical

care if the patient is unable to communicate

b. This personal representative may sign informed

consent forms for the patient

c. The patient and personal representative should

communicate clearly ahead of time the patient’s

thoughts regarding extraordinary methods of

treatment and end-of-life wishes

K. American Registry of Radiologic Technologists (ARRT)

Mission and Standards of Ethics

1. The accompanying box contains the ARRT Mission

Statement, Standards of Ethics Preamble, and Rules

of Ethics

2. The Standards of Ethics promote the goals of the

Mission Statement

3. The Standards of Ethics are comprised of the Code of

Ethics (not listed here) and the Rules of Ethics

4. The Code of Ethics serves as a guide for what radiologic

technologists aspire to become as professionals

5. The Rules of Ethics are mandatory, enforceable, and

carry sanctions for violations

6. The Standards of Ethics also include a section addressing

administrative procedures,