University of Makati College of Allied Health Studies Center of Graduate and New Programs

UNIVERSITY OF MAKATI
COLLEGE OF ALLIED HEALTH STUDIES

CENTER OF GRADUATE AND NEW PROGRAMS
ASSESSMENT OF THE IMPLEMENTATION OF COVID-19 SAFETY

PROTOCOLS IN THE RADIOLOGY DEPARTMENT OF A PRIVATE
HOSPITAL IN LA UNION: BASIS FOR CQI
A Thesis Proposal
Presented to the
Center of Graduate and New Programs
College of Allied Health Studies
University of Makati
In Partial Fulfillment of the Requirements

for the Degree Master of Science in Radiologic Technology
Major in Clinical Supervision
by
MICHAEL JOHN E. FLORES
December 2021
1
CHAPTER I
INTRODUCTION AND ITS BACKGROUND
This chapter presents the background of the study,
statement of the problem, objective of the study, significance of the study,
scope and delimitations, conceptual framework, and the operational
definition of terms.
INTRODUCTION
“Pandemics are large-scale outbreaks of infectious disease that
can greatly increase morbidity and mortality over a wide geographic area
and cause significant economic, social, and political disruption. Evidence
suggests that the likelihood of pandemics has increased over the past
century because of increased global travel and integration, urbanization,
changes in land use, and greater exploitation of the natural environment
(Jones and others 2008; Morse 1995). These trends likely will continue
and will intensify. Significant policy attention has focused on the need to
identify and limit emerging outbreaks that might lead to pandemics and to
expand and sustain investment to build preparedness and health capacity
(Smolinsky, Hamburg, and Lederberg 2003).
Since man is living in a world wherein threat of life and death are
already a part of their daily lives, safety and preservation of life are now
2
more important than that of leisure and travels. The word and experience
of pandemic to people are now more talked about and so the use of the
different things like face mask and face shield are now observed as a
means to avoid being infected with this Covid-19 (Maddox, 2017).
“The international community has made progress toward preparing
for and mitigating the impacts of pandemics. The 2003 severe acute
respiratory syndrome (SARS) pandemic and growing concerns about the
threat posed by avian influenza led many countries to devise pandemic
plans (U.S. Department of Health and Human Services 2005). Delayed
reporting of early SARS cases also led the World Health Assembly to
update the International Health Regulations (IHR) to compel all World
Health Organization member states to meet specific standards for
detecting, reporting on, and responding to outbreaks (WHO 2005). The
framework put into place by the updated International Health Regulations
contributed to a more coordinated global response during the 2009
influenza pandemic (Katz 2009). International donors also have begun to
invest in improving preparedness through refined standards and funding
for building health capacity (Wolicki and others 2016).”
By the time that the Covid-19 confirmed cases rise, the
international community or so the global community have already been
working together in order to have answer to our biggest struggle,
challenged and problem of all times, the pandemic brought by Covid-19.
3
The Research and couple of experiments were done in order to come up
with that of Vaccine, in which people and nations are very hopeful on
these vaccines, that when people got fully vaccinated, he/she will have a
lower chance to be infected by Covid-19.
This study will serve as an Conscientization to those people
who are blinded by the things they are wanting to have what they usually
have and wanting to do what they usually do in their daily lives not thinking
of the threat that this virus may do to them, to those people who work hard
to implement the safety protocols to prevent this virus from infecting
people and worst to take the life of people who is much concern with their
life because of those people who take this pandemic for granted.
Background of the Study
As the rapid spread of COVID-19 led to the temporary closures of
radiology practices and imaging centers earlier this year, exam volumes
dropped between 40 and 90 percent. Hospitals re-allocated resources to
combat the wave of infected patients, overwhelming staff and leading to
both bed and equipment shortages in many areas. Non-urgent imaging,
including screening exams and cancer patient follow-up, was halted (Lui,
2020).
According to Kreamer, the world is facing an unprecedented global
pandemic in the form of the coronavirus disease 2019 (COVID-19) which
4
has ravaged all aspects of life, especially health systems. Radiology
services, in particular, are under threat of being overwhelmed by the sheer
number of patients affected, unless drastic efforts are taken to contain and
mitigate the spread of the virus. Proactive measures, therefore, must be
taken to ensure the continuation of diagnostic and interventional support
to clinicians, while minimizing the risk of nosocomial transmission among
staff and other patients. This article aims to highlight several strategies to
improve preparedness, readiness and response towards this pandemic,
specific to the radiology department.
As the coronavirus disease 2019 (COVID-19) pandemic
accelerates, global health care systems have become overwhelmed with
potentially infectious patients seeking testing and care. Preventing spread
of infection to and from health care workers (HCWs) and patients relies on
effective use of personal protective equipment (PPE)—gloves, face
masks, air-purifying respirators, goggles, face shields, respirators, and
gowns. A critical shortage of all of these is projected to develop or has
already developed in areas of high demand. PPE, formerly ubiquitous and
disposable in the hospital environment, is now a scarce and precious
commodity in many locations when it is needed most to care for highly
infectious patients. An increase in PPE supply in response to this new
demand will require a large increase in PPE manufacturing, a process that
5
will take time many health care systems do not have, given the rapid
increase in ill COVID-19 patients (Rutala, 2020).
“The threat of COVID-19 has become worldwide and reached as of
the moment, June 10, 2021, this pandemic has reached 220 countries and
territories with the live count coronavirus cases of 175,165,633; death
count of 3,776,625; and recovered cases of 158,674,741 as of June 10,
2:32 PM. The country that leads the most Coronavirus cases is the United
States of America with the total number of 34,264,727 cases. Among
Asian countries, India tops the most number of cases with the total
number of 29,182,072 cases and Philippine is seated on the number 5
spot with the total number of 1,286,217 cases with 22,190 deaths and
1,210,027 recoveries.” (Worldometers, 2021) “In Ilocos Region alone,
there are 24,527 cases in which 22,191 are recovered cases and 615 are
casualties or deaths and 1,721 active cases.” (NEDA, 2021) “In La Union
only, there are 1,058 total number of cases in which there are 91 active
cases, 941 recovered cases, 26 deaths and 7, 605 suspected cases (224
are admitted and 31 on Home Quarantine).” (LGU-La Union, 2021)
Among those figures of COVID cases in La Union, there are few that a
front-liner or medical practitioner came from the Radiology Department in
one of the Private Hospital in La Union. Indeed, as the researcher has
first-hand experienced how this Covid-19 has threatened and devastated
lives locally and internationally.
6
The cases where the medical practitioners or front-liners are
involved motivated the researcher to determine the degree of
preparedness, implementation, and execution of protocols in the hospital
especially in the Radiology Department. The Proper implementation of
these protocols will lessen the cases or isolate Corona Virus Disease
cases and thus can prevent the disease to further spread and prevent to
infect the medical practitioners or front-liners. When it comes to
preparedness, the researcher wants to determine if there are adequate
materials that are needed in admitting patients to be examined or tested
inside the vicinity of the hospital. Lastly, the researcher wants to determine
the degree of these protocols being executed or performed by the medical
practitioners or front-liners.
The researcher aims to know the extent of implementation of
COViD- 19 safety protocols in the radiology department of a private
hospital in La union as basis for CQI. By conducting this research, the
researcher is expected to find out gaps o areas for improvement and
come up with suggestions and recommendations along enhanced
implementation of SOPs in the Radiology Department in one of the Private
Hospitals in La Union.
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Statement of the Problem
This study aims to assess the level of implementation of COViD-19
safety protocols in the radiology department of a private hospital in la
union as a basis for CQI.
Specifically, it would seek to answer the following questions:
1. What is the demographic profile of the respondents based on:
1.1. Age;
1.2. Department;
1.3. Profession/position in the hospital; and
1.4. Length of service in the hospital?
2. What is the mean level of implementation of the COVID-19 safety
protocols in the radiology department as assessed by?
a) Radiologic technologists
b) Radiologists
c) Nurses
d) Residents
e) ICC
3. What is the mean level of satisfaction of patients as to the implementation of
COVID-19 safety protocols in the radiology department of a private
hospital in la union as a basis for CQI?
4. Is there a significant difference in the overall mean level of
implementation of COVID-19 safety protocols in the radiology
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department when the respondents are grouped according to
their demographic profile?
5. Is there a significant relationship between the overall mean level
of implementation of the COVID-19 safety protocols and the
mean level of patient satisfaction?
6. Based on the findings gathered through survey, supplemented
with qualitative comments, what are the gaps identified and
what enhancements can be done in the existing protocol to
address the said gaps?
Hypotheses
There is no significant difference in the level of implementation of COVID-
19 safety protocols in the radiology department when the respondents are
grouped according to their demographic profile.
There is no significant relationship between the level of implementation of
the COVID-19 safety protocols and the mean level of patient satisfaction.
Significance of the Study
The researcher, then, finds this study on the Impact of Covid-19 to
Patient’s Safety in the Radiology Department in one of the Private Hospital
in La Union relevant to the present world that we are living in because this
9
is what we are experiencing, and this is the reason of the fear and anxiety
that we are facing on this present time.
The results will also merit the following:
The Patient can benefit from the result of the study if the
researcher can give the importance and so implement in the Radiology
Department the Standard Safety Protocol which is significant for their own
safety in being catered to the said medical service.
The Radiologist also being engaged in and interact with the
patients and so to the Radiologic Technologist be the one to lead the
group, checks his companions and so knows all the more the significance
of having the standard safety protocols be observed.
The Hospital Administration can benefit from the output of the
study by being obedient to the rules and regulations being implemented in
the Hospital not only to the Radiology Department but also to the other
medical departments.
Future Researcher can also benefit from the study in gathering
data for their own research that is closely related to this study on The
Impact of Covid-19 to Patient’s Safety in the Radiology Department in one
of the Private Hospital in La Union.
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Scope and Limitations of the Study
The study will be conducted during August 2021. In spite of the fact
that this research is important for future research, there were still
limitations that were considered. The study used a quantitative approach
focused on designing a specific questionnaire with reliability, content, and
face validity in order to the implementation of COVID-19 safety protocols
in the radiology department of a private hospital in la union as a basis for
CQI.
Definition of Terms
IATF-EID – Task Force under Department of health that “warns the public
from engaging with individuals, groups, organizations and/or institutions
who use the seal of the Inter-Agency Task Force for the Management of
Emerging Infectious Disease without authority.” (Department of Health,
2021)
Pandemic - term used for an outbreak of a disease that occurs over a
wide geographic area and typically affects a significant proportion of the
population.
Protocols – the administrative policies and procedures or provide
guidance for the day-to-day operation of the system
Radiology – the medical discipline that uses medical imaging to diagnose
and treat diseases within the bodies of animals and humans.
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Radiologist – completed the appropriate post-graduate training and
interprets medical images, communicates these findings to other
physicians by means of a report or verbally, and uses imaging to perform
minimally invasive medical procedures
Private Hospital – an institution that is built, staffed, and equipped for the
diagnosis of disease; for the treatment, both medical and surgical, of the
sick and the injured; and for their housing during this process. AS
APPLIED TO YOUR RESEARCH?
Standard Operating Procedure (SOP) – term used for a set of step-by-
step instructions compiled by an organization to help workers carry out
routine operations. SOP’s aims to achieve efficiency, quality output and
uniformity of performance, while reducing miscommunication and failure to
comply with industry regulations.
12
CHAPTER II
REVIEW OF RELATED LITERATURE AND STUDIES
PLEASE INTRODUCE THE CHAPTER
The coronavirus disease 2019 (COVID-19) pandemic began in
December 2019 in Wuhan, China. The outbreak is due to severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
Approximately 81 000 patients have been infected in China. Although
infection rates are said to be controlled in China through severe public
health measures, Italy (more than 10 000 cases) and Iran (more than 8000
cases) have seen exponential increases in the number of infected
individuals (Valdez, 2020).
According to Lui, other than China, Italy, and Iran, most countries
have had approximately 2 months to prepare their responses to the
COVID-19 pandemic. These responses are led by public health authorities
of national governments in coordination with local governments and
hospitals. Because of the nature of the emergency in China, chest CT
findings (eg, peripheral ground-glass infiltrates and/or organizing
pneumonia) temporarily became part of official diagnostic criteria of
COVID-19 as a surrogate for viral nucleic acid testing. With improved
disease understanding, chest CT findings are no longer part of the
diagnostic criteria for COVID-19. Instead, at present, the focus of most
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radiology departments outside of China has shifted from diagnostic
capability to preparedness.
Radiology preparedness is a set of policies and procedures directly
applicable to imaging departments designed to (a) achieve sufficient
capacity for continued operation during a health care emergency of
unprecedented proportions, (b) support the care of patients with COVID-
19, and (c) maintain radiologic diagnostic and interventional support for
the entirety of the hospital and health system (Alhamari, 2020).
Priorities for COVID-19 Preparedness
Early detection and limiting exposure of health care workers,
employees, and patients, especially critically ill patients. The hospitals
have implemented screeners at all hospital entrances to check those
coming in for symptoms that could be related to SARS-CoV-2 infection or
with risk factors related to travel or exposure. The radiology front desk
serves as a screening site, with similar screening to that performed at the
hospital front door. Patients who present with respiratory symptoms who
are undergoing outpatient imaging or procedures have their studies
canceled and are asked to follow up with their primary care physician. For
inpatients with suspected or confirmed COVID-19, all non-emergent
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imaging and procedures are delayed until diagnosis is confirmed and they
recover from their illness and are considered noncontagious (Terry. 2020).
Seennar et, al. use of radiography and chest CT. Despite reports
from China and initial concerns from the U.S. Centers for Disease Control
and Prevention (CDC) regarding unreliable test performance, our current
reverse-transcription polymerase chain reaction (RT-PCR) assay for
SARS-CoV-2 viral nucleic acid is estimated to have a sensitivity of 95%–
97%. Our laboratory also has a turnaround time of less than 1 day, making
RT-PCR an easy, accurate, and less resource-intensive examination. Our
laboratory has been performing more than 500 tests per day, covering our
system but also other regional systems, with approximately 10% positive
results. Inconclusive results are seen in a small subset, which are then
sent for confirmation to Washington state laboratories.
Sensitivity and specificity of chest CT for COVID-19 are reported to
be 80%–90% and 60%–70%, respectively. Thus, imaging is reserved for
those cases where it will impact patient management and is clinically
indicated or to evaluate for unrelated urgent and/or emergent indications.
This typically occurs in cases where an alternative diagnosis is being ruled
out or being considered for acute symptom worsening. In our current
workflow and with the accuracy and rapidity of RT-PCR testing, there is no
15
need for immediate CT imaging. In addition, if symptom worsening is
thought to be secondary to COVID-19, imaging would not change
management, as current treatment consists of oxygen and supportive care
(Norman, 2020).
When possible, imaging is performed at sites with less foot traffic
and with fewer critically ill patients in that area to avoid secondary patient
and staff exposure. Considerations are also being made to implement
containment zipper (a room isolation tarp barrier with a zipper for room
access) to separate the control area from the CT scanner room. Imaging
is performed in the imaging center nearest to the patient and, if possible,
at the ambulatory clinic (Hamet, 2020). This approach limits the transit of
contagious patients and potential exposure of others. When possible,
portable imaging is performed (both portable radiography and portable CT
in patient rooms) to limit equipment, room, and hallway decontamination
requirements.
Imaging in patients who are suspected of being COVID-19 positive
or who have positive results at RT-PCR testing. For these patients, droplet
precaution is employed. Patients are masked during imaging and
procedures. Deep cleaning of the room is performed after each patient. Air
exchange processes are not employed due to patient masking. After
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imaging, the room downtime typically ranges from 30 minutes to 1 hour for
room decontamination and passive air exchange. Airborne precautions
are reserved for those patients who are critically ill or who are undergoing
aerosol-generating procedures (bronchoscopy, intubation, nebulization, or
open suction). Airborne precautions are not necessary with patients
receiving mechanical ventilation as the system is considered a closed
system. The decision to remove patients from isolation is determined by
hospital infection control staff. Those staff members consider RT-PCR
results, imaging findings, clinical characteristics, potential exposures, and
risk factors and comorbidities into their decision-making (Dorsey, 2020).
Staff protection. Our hospital systems, in coordination with the
state, have worked to reduce the need to bring patients to major hospitals
and clinics. This will help protect our vulnerable patient population and
university employees. Harborview Medical Center, Seattle, instituted a
team of physicians and nurses that go out to the homes of patients
suspected of having SARS-CoV-2 to perform testing and evaluation. In
coordination with the Seattle Flu Study and Gates Foundation, University
of Washington has begun issuing SARS-CoV-2 testing kits for home use.
University of Washington Medical Center Northwest Hospital, Seattle, has
implemented drive-through testing for university employees who are
symptomatic. The university has placed a moratorium on travel for all
employees for 1 month (Glidden, 2021).
17
According to Azari, maintenance of radiology department
operations. In radiology, we have focused on providing the ability for
radiology faculty to work from home if needed for isolation. For those who
are not suspected of having been exposed or infected but are concerned
about potential exposures, we have created radiology outposts and
isolated reading rooms across our enterprise, including single-station
reading rooms in our hospitals as well as in our outpatient imaging
centers. Staff that do not need to be on-site and who can work remotely
(eg, including coders, billers, and schedulers) are directed to work from
home. The majority of hospital staff–related meetings now use
videoconferencing rather than having in-person attendance. For those
meetings that cannot be virtual, a determination of the necessity of the
meeting is made by department leadership and those determined as
nonessential are cancelled.
Infection control measures
All on site employees were provided with 3-ply face masks with ear-
loop in addition to a face shield which was readily available to all
technicians and radiologists for use during direct patient care. Hand
sanitizers were available throughout the radiology department especially
in areas where COVID-19 patients were imaged. Employees were asked
to carry alcohol spray bottles for hand hygiene if frequent hand washing
18
was not feasible. Full personal protective equipment (PPE) (including N95
respirators, long-sleeved disposable fluid repellent gown, and gloves)
were provided for staff in close or direct contact with patients. Mossa-
Basha et al. from the University of Washington, school of medicine
described precautionary measures such as the use of N95 filtering face
piece respirators, powered air-purifying respirators (PAPR), and HEPA
filtration systems to increase air exchange in the imaging suits except for
MRI.
The infection control team in our hospital arranged tutorials to
technologists and radiologists teaching them methods of donning and
doffing of PPE and the measures that should be taken to disinfect the
imaging room in between patients’ scans. In addition, medical engineers
provided support for the best practices to disinfect the different scanners.
Due to the travel ban and the interrupted medical supply chain, there were
PPE shortage in a very brief short times which was quickly addressed by
the institution. Upon following these measures, low infection rate without
recorded morbidity among our faculty and staff was achieved (Cherry,
2020).
Screening and dealing with exposed or sick employees
According to King, the temperature of all on-site radiology
employees was measured daily upon hospital arrival. PCR screening was
performed to all employees who were in contacts to proven cases.
19
Symptomatic individuals with positive tests were quarantined in
transmission-based precautions until at least two consecutive respiratory
specimens become negative with improvement of respiratory symptoms
(mainly cough and/or shortness of breath) and resolution of fever without
the use of fever-reducing medications (test-based strategy). Asymptomatic
individuals with positive PCR results would also be in transmission-based
precautions until having negative test results from at least two consecutive
respiratory specimens collected within 24 h (test-based strategy).
With the increase in number of COVID-19 positive cases,
employees were isolated only if they developed upper respiratory tract
symptoms. Symptom-based strategy was followed for symptomatic
individuals who would remain in transmission-based precautions or
isolation until at least 10 days have passed since the symptom(s) onset
provided that at least 24 h (initially 3 days) have passed since symptoms
have been resolved, that is, resolution of fever without the use of fever-
reducing medications with improvement in respiratory symptoms (cough
and/or shortness of breath) (Magomadov, 2020).
On the other hand, in the Philippines, asymptomatic COVID-19
exposed employee was required to return to work and PCR tests were not
performed; however, PCR tests were performed only for employee
exhibiting upper respiratory tract symptoms.
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Radiology staff wellness
In difficult times, caring for the mental and social wellbeing is as
important as physical health. Although we are physically apart, we had to
be connected, communicating. Socialization promotes health and safety
feeling. We actively encouraged all employees in the radiology department
to interact through the various social media network. We launched a
Radiology family WhatsApp group in which faculty members would send
daily hopeful, cheerful, and encouraging messages to all members. Also,
any achievements were recognized and mentioned in that group. In
addition, we launched a financial support WhatsApp group. Monetary
contributions were donated pay the support staff and families who were
financially affected by the pandemic. Furthermore, monthly department
council meetings have continued using Cisco’s WebEx video conferencing
platform. Similarly, Morale-building activities have been promoted in other
universities globally. For instance, University of Cincinnati offered virtual
fitness challenges. Similarly, university of Wisconsin offered virtual yoga
sessions and encouraged one-on-one communication especially for
vulnerable staff, while New York University organized regular virtual coffee
hours (Melendez, 2020).
Radiological examinations and patients’ safety
After discussing with the referring physicians, it was decided that
elective imaging studies or procedures were to be postponed in order to
21
protect vulnerable patients and staff from infection and promote physical
distancing. In addition, through phone calls, outpatients who had
scheduled elective procedures were notified to reschedule their
examination; however, imaging procedures for critically ill and oncology
patients were not rescheduled (Hosny, 2020).
In order to implement precautionary measures on patients’ arrival, it
was decided that the radiology request has to clearly indicate whether the
patient was a confirmed or suspected COVID-19 case.
Imaging is not usually indicated for suspected COVID-19 cases
with mild clinical features unless they are at risk of disease progression.
However, in resource-constrained environment where COVID-19 testing
was not available, imaging was indicated for suspected patients
presenting with moderate to severe symptoms and signs suggesting high
probability of the disease. Emmert-Streib et. al, Moreover, being highly
sensitive and having short test-to-result time interval compared to PCR,
CT referrals have tremendously increased in our department. CT may
demonstrate typical features for COVID-19 or suggests an alternative
diagnosis, necessitating rapid triage for those patients. After confirmation
of COVID-19, further imaging is indicated if the imaging would alter the
clinical management (such as stroke, or suspected pulmonary
thromboembolism, or suspected intracranial hemorrhage).
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Accessing picture archiving and communication system and
workflow restructuring
Before COVID-19 pandemic, our department had implemented
home access to picture archiving and communication system (PACS) (Fuji
synapse), but with very limited use, as we relied predominantly on
physical existence within the hospital. Physical existence was essential for
one on one interactions between the radiologists and residents for
teaching purposes, also between the referring clinicians and technologists.
Accessing PACS was only limited to the on-call shifts. In addition,
accessing PACS from home was not a common practice because
radiologists could not ensure reliable and stable internet connection, a
challenge commonly seen in developing countries (Vagal, 2020).
According to Fang, the state and university officials had worked
diligently to improve the internet access in the country and across the
university. To achieve physical distancing, encouraging the radiologists to
access PACS from home for remote reporting and workflow restructuring
was the only convenient solution. It not only enabled physical distancing
but also ensured interpretation of various radiological examinations in
timely manner during the pandemic. Fortunately, due to limited resources
and difficulty of purchasing workstations for home PACS, our radiologists
updated their personal computers to act as PACS workstations. Similar
efforts deploying home PACS in other Radiology departments in the world
23
were also documented. The radiology department at University of
Washington School of Medicine and the University of Alabama at
Birmingham upgraded their PACS servers and provided more home
workstations for radiologists. The University of Alabama at Birmingham
primarily provided workstations for emergency, abdominal, cardiothoracic,
musculoskeletal, and neuroradiology sections. Nuclear medicine was
provided an alternative route enabling them to log into their hospital
workstation.
As imaging volume for non-emergency cases was markedly
diminished and to promote physical distancing, our daily work routine
schedules were restructured for radiologists, residents, and technologists.
Only two or three readers (residents and instructor level) were present in
person per room with at least 6 feet apart. At least one radiologist should
be available on-site to provide residents and technologists with support
and reassurance. In addition, an on-call radiology senior faculty was
present for 24-h support (Mossa – Basha 2020).
Slanetz et. al, on the contrary, with the increase in the number of
thoracic imaging cases over time, and with the construction of 2 new
university dedicated quarantine and field hospitals for COVID-19 patients
care, the working hours of thoracic imaging team were restructured again
for the increased demands for rapid reporting of chest X-rays and CT
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scans. In addition, more radiologists from other radiology subspecialties
were recruited (after being trained on reporting of Chest CT for COVID-
19). Moreover, regular on site and virtual multidisciplinary meetings were
held to discuss our newly adopted reporting structure, and the radiological
and clinical data of admitted COVID-19 cases. Multidisciplinary teams
included members from thoracic imaging group, pulmonologists, internal
medicine, geriatric medicine, intensive care unit, infection control unit,
public health, and community medicine. Additionally, differential diagnosis
of the radiological findings was usually discussed with the clinicians and
pulmonologists over the phone if more clinical information was needed.
Increase awareness of COVID-19 imaging features
At the institutional level, video awareness campaigns were initiated
across the university. The “Treat and Teach” telemedicine initiative which
launched in 2016 to reach remote and under privileged areas had become
more on demand when the pandemic started (Crystal, 2016).
According to Dreyer, at the radiology department level, awareness
of the radiological features and patterns of COVID-19 on chest X-ray and
CT images was our main goal. Distant teaching strategy was desperately
needed to educate all radiologists (from residents to professors) about the
specific radiological features of COVID-19 in order to be consistent in our
reporting language when we discuss suspected cases with the clinicians
or dictate our final reports. The thoracic imaging radiologists and pediatric
25
radiologists delivered online webinars featuring detailed information about
the Chest X ray and CT findings of COVID-19 infection in adults and
children. While, we adopted the structured reporting for chest CT
endorsed by the Radiological Society of North America (RSNA), Society of
Thoracic Radiology, and the American College of Radiology [19], Covid-19
Reporting and Data system (CO-RAD) has been applied in other
institutions when reporting suspected cases of COVID-19. On the other
hand, the department of radiology in New York University discouraged the
use of the term “COVID-19” within their radiology reports due to the great
overlap between COVID-19 imaging findings and other diagnoses
(atypical pneumonia, drug reaction, organizing pneumonia). Imaging helps
provide baseline estimation of the extent of pulmonary affection and to
indicate alternative diagnoses.
Radiologists were also encouraged to attend various webinars
about COVID-19 hosted by Egyptian society of radiology, ESR (ESR-
Connect), and RSNA. Furthermore, images of X-rays and CT images of
confirmed COVID-19 cases were privately shared on a newly launched
emergency radiology WhatsApp group for networking while preserving
patient confidentiality. Most of the recent publications discussing COVID-
19 imaging features and management plans were also shared among the
radiology faculty members (Chace, 2020).
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Coronavirus disease 2019 (COVID-19), which is caused by a novel virus
called Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2),
was first reported in Wuhan City, China last December 31, 2019. The
Philippines recorded its first case of COVID-19 on January 30, 2020 and
on the same date, the World Health Organization (WHO) considered it as
a Public Health Emergency of International Concern (PHEIC). With the
rising numberof cases with distribution of the disease to more than 100
countries, the WHO declared COVID-19 disease as a pandemic on March
11, 2020. The following day, the Philippine government, recognizing that
this disease poses a public health threat, raised the Code Alert Level to
Code Red Sublevel Two. This necessitated the issuance of subsequent
guidelines for the effective management and control of the disease
including the strategy to strengthen the surge capacity of health facilities in
addressing the potential increase in COVID-19 cases. Regarding case
management on a community transmission scenario, the interim guidance
on critical preparedness, readiness and response by the World Health
Organization (WHO) dated March 7, 2020, recommends designation of
referral hospitals as part of the surge plans for health facilities. By
designating hospitals that will prioritize the management of COVID-19
severe and critical cases, care and resources can be focused to COVID-
19 patients through better infection prevention and control measures,
more efficient monitoring of cases and inventory of supplies, more
27
strategic approach for human resources for health, and a maximized
facility capacity (i.e. COVID-19 positive wards). The Department of Health
(DOH) hereby issues interim guidelines for the designation of COVID-19
referral hospitals.
Synthesis
The review of related literature and studies underscored the
impact of Covid-19 pandemic to the medical staffs especially to the
patients being catered to WITH medical services of the Radiology
Department. The study focuses on the assessment of implementation of
the safety protocols handed down by the Inter-Agency Task Force under
the Department of Health to one of the Private Hospitals in La Union to
ensure the safeness of the people going in and out of the hospital.
28
CHAPTER III
METHODOLOGY
This section deals with the research design, methods and
procedures used in conducting this study. It includes the description
of the methods of the studies, sources of data, research
instruments, data gathering procedure and statistical treatment of
data.
Research Design
This study made use of quantitative approach particularly
cross-sectional survey research supplemented with qualitative
comments. researcher-made tool was used to determine level of
implementation of covid 19 protocols in the Radiology Department
in one of the Private Hospital in La Union. Patients will also be
administered with the patient satisfaction survey form.
The correlational method was used to establish the
relationship between perceived level of implementation of COVID
19 protocols of Medical Practitioners and Patients.
Population, Sample Size, and Sampling Technique
This study is conducted to the medical practitioners and the
patients in Radiology Department in one of the Private Hospital in La
Union for 2021. This study aims to assess the implementation of covid-19
29
safety protocols in the radiology department of a private hospital in La
Union: basis for CQI. The questionnaire will help to find out the perception
of radiologic technologists in this pandemic if it is dangerous or a threat for
them or a tool that helps to improve and enhance their work.
Data Gathering Instrument.
The questionnaire on the profile of the respondents is a
personal information sheet was used to gather the patient and the
Respondent’s Gender, age, occupation. The questions prepared by the
researcher is basically focused on the safety protocols implemented by
Inter-Agency Task Force for the Management of Emerging Infectious
Disease answerable with yes or no And always, seldom, and never, lastly
with that of the satisfaction of patients and staffs which is answerable with
satisfied and not satisfied.
Data Gathering Procedure
Before conducting the study, the researcher requested
permission from the head of the Radiology Department of the Hospital
through letter of request. The questionnaire, then, was personally
distributed, administered, and retrieved by the researcher himself.
The data gathered were tabulated, organized, and statistically
treated to find out if the protocols handed down by Department of Health
30
through Inter-Agency Task Force for the Management of Emerging
Infectious Disease in the hospital is followed or properly implemented so
that CQI is in place
Research Locale
The study will be conducted in the Radiology Department, one of
the Ancillary DepartmentS OF one of the Private Hospitals in La Union. It
has Computerized Tomography-Scan (CT-Scan), Magnetic Resonance
Imaging (MRI), Ultrasound SERVICES. The Radiology Department
accommodates Patients with certain or uncertain pulmonary, bone,
abdominal, Initial and Standard Trauma.
TREATMENT OF DATA
After the data are all gathered, the results on the demographic
profile and the rest of the results on the questionnaire were encoded. The
data was recorded in Microsoft Office Excel, the accurate result was then
presented to the study. To address the study questions, the data was
quantitatively evaluated. All of the data that were gathered and encoded
was intended to be confidential information and only the researchers had
the access to it. The information was analyzed using descriptive statistics.
In the study of Kaur P. et al., (2019), descriptive statistics help to describe
31
and understand the features of the specific data set by giving short
summaries about the sample and measures of the data.
Ethical Considerations
This Research done by the researcher certifies that this research’s
purpose is to determine the Impact of Covid-19 to Patient’s Safety in the
Radiology Department in one of the Private Hospital in La Union as a part
of the requirement of the University of Makati - College of Allied Health
Studies Center of Graduate and New Programs on Master of Science in
Radiologic Technology. The researcher will float questionnaires to the
Medical Practitioners and Patients in the Radiology Department of the
purpose of the research, their right to refuse to participate, the
understanding of the boundaries of confidentiality of this research and
their right to have a copy of the results of this research if they wish to have
so.
Statistical Treatment
The following statistical tools were in analyzing the data
gathered in the study:
1. The level used in determining the profile of the
respondents.
32
2. Weighted mean was used to indicate the level of
preparedness and so the obedience of the people to follow
the safety protocols.
3. The simple correlation analysis was used to find whether
the Medical practitioner and Patient have significant
relationship with that of giving importance to safeness in
conducting medical services.
Paradigm of the Study
Figure 1 entitled as a Research Paradigm is the visual of the flow of
this study, a guiding pattern that this study WILL adhere to. The research
WILL MAKE USE OF THE made use of the Independent Variable –
Dependent Variable.
33
INPUT PROCESS OUTPUT

LEVEL OF
 RESEARCHER  IMPLEMENTATION OF
MADE-TOOL TO ADMINISTRATION COVID-19 SAFETY
ASSESS THE OF THE TOOL TO PROTOCOLS IN THE
LEVEL OF PATIENTS AND RADIOLOGY
IMPLEMENTATIO RADIOLOGY DEPARTMENT OF A
N TO COVID – DEPARTMENT PRIVATE HOSPITAL IN
19 Protocols LA UNION
 Data Analysis
Patient CQI: GAP ANALYSIS
satisfaction AND ACTION PLAN
survey tool
Figure 1. Paradigm of the Study
The purpose of this study is to determine the LEVEL OF

implementation of Covid-19 safety protocols in the radiology department of
a private hospital in la union AS basis for CQI.
The Input is the factor which can be measured, manipulated, or

selected by the researcher to determine its relationship to an observed
phenomenon. Thus, the input is the protocols of private hospitals in
implementing the new normal.In this study the processes involve are data
gathering, survey, and data analysis.
The Output is the factor being observed and measured to
determine the effect of the Input which is all about “Assessment

INPUT PROCESS of the OUTPUT
Implementation of Covid-19 Safety
 Level of Protocols in the Radiology Department The Impact
 Data Gathering
compliance of the New
of a Private Hospital in La Union: Basis For CQI”.  Survey Normal
 Operations Protocols in
strategies  Data Analysis the
34
Operations of
 Number of Okada Manila
guests
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42
Appendix A
ASSESSMENT OF THE IMPLEMENTATION OF COVID-19 SAFETY
PROTOCOLS IN THE RADIOLOGY DEPARTMENT OF A PRIVATE
HOSPITAL IN LA UNION: BASIS FOR CQI
Survey
Thank you for taking part in this survey, which should take you less than
30 minutes to complete. The information you provide will assist the
Researcher in the Assessment of the Implementation of Covid 19
Protocols in the Radiology Department of a private Hospital in La Union.
Please be assured that this survey is anonymous, your responses will not
be associated with your name, and no identifiable information on any
individuals will be shared or presented in the survey results.
Name (Optional): _______________________ Date:
__________
Gender: ______________________________
Age:___________
Position of the interviewed staff:
o Medical Doctor
o Radiologic technologist
o Nurse
o Others (mention)
43
As a health care worker, how I avoid the risk of catching COVID-19 while
screening and assessing the patients?
Items Yes No
Gloves
Surgical face mask
Disposable, fluid resistant gown
Eye protection
Regular hand hygiene
N 95 Face mask
f
INSTRUCTIONS: In your own perspective inside the Radiology

Department of a Private Hospital in La Union how was the implementation
of Covid -19 Protocols being observed? Write the number that fits your
reality on the line before each question. 0 | Never 1 | Seldom 2 |
Sometimes 3 | Often 4| Always.
S.No. In your own Never Seldom Sometimes Often Always

perspective inside 0 1 2 3 4
the Radiology
Department of a
Private Hospital in
La Union how was
the implementation
of Covid -19
Protocols being
observed?
1
Staffs on duty wear
mask?
2
44
Hand sanitizing or
Washing Before
and after patient
handling
3
Staffs on duty wear
isolation gowns at
all time?
4
Staffs on duty wear
gloves
5.
Staffs on duty wear
face shields
6.
Thus social
distancing is being
observed in the
radiology
department?
Few sections on this questionnaire was adapted from JMIR Public Health
Surveillance 2020 (cited in the methodology) and special thanks to
Dr.AkshayaSrikanthBhagavathula, IPHCMHS, UAE University, more
details https://publichealth.jmir.org/2020/2/e19160/ B. District Hospital C.
CHC /CHC+
What are exist of the following at the screening facility?

Items Screening
Facility
Yes No
Screening Tents/Facilities
Hand wash with water facility
Hand wash solution/Soap
Sanitizer
Toilet
People use masks or other clothes to cover their face
(nose/mouth)
Availability of functional Infra-red Thermometer
Healthcare workers’ Perception Againts COVID-19
45
Questions Yes No
A. COVID-19 symptoms appear in 2-14 days
B. COVID-19 is fatal
C. Flu vaccinated is sufficient for preventing COVID-19
D. During the outbreak, eating well-cooked and safely

handled meat is safe
E. Sick patients should share their recent travel history with

healthcare providers
F. Disinfect equipment’s and working area in wet markets at

least once a day
G. Washing hands with soap and water can help in

prevention of COVID-19 transmission
Do you feel that the PPE available to you is adequate to protect you when
managing patients with COVID-19 Available is defined as recommended +
in stock can be used by the respondent?
A. Not confident at all
B. A little confident
C. Somewhat confident
D. Confident
E. Very confident
Have you received formal training in the use of the recommended PPE for
airborne transmitted infections at your institution? (tick all that apply)
A. Yes, at commencement of employment at my current institution
B. Yes, within the last 2 months due to the COVID-19 pandemic
46
C. Yes, at some other time but not in the last 2 months
D. No
47

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UNIVERSITY OF MAKATI

COLLEGE OF ALLIED HEALTH STUDIES

ASSESSMENT OF THE IMPLEMENTATION OF COVID-19 SAFETY

In Partial Fulfillment of the Requirements

MICHAEL JOHN E. FLORES

INTRODUCTION AND ITS BACKGROUND

This chapter presents the background of the study,

statement of the problem, objective of the study, significance of the study,

scope and delimitations, conceptual framework, and the operational

“Pandemics are large-scale outbreaks of infectious disease that

and cause significant economic, social, and political disruption. Evidence

century because of increased global travel and integration, urbanization,

changes in land use, and greater exploitation of the natural environment

expand and sustain investment to build preparedness and health capacity

(Smolinsky, Hamburg, and Lederberg 2003).

means to avoid being infected with this Covid-19 (Maddox, 2017).

“The international community has made progress toward preparing

respiratory syndrome (SARS) pandemic and growing concerns about the

threat posed by avian influenza led many countries to devise pandemic

plans (U.S. Department of Health and Human Services 2005). Delayed

update the International Health Regulations (IHR) to compel all World

Health Organization member states to meet specific standards for

detecting, reporting on, and responding to outbreaks (WHO 2005). The

framework put into place by the updated International Health Regulations

contributed to a more coordinated global response during the 2009

influenza pandemic (Katz 2009). International donors also have begun to

invest in improving preparedness through refined standards and funding

for building health capacity (Wolicki and others 2016).”

By the time that the Covid-19 confirmed cases rise, the

international community or so the global community have already been

working together in order to have answer to our biggest struggle,

challenged and problem of all times, the pandemic brought by Covid-19.

The Research and couple of experiments were done in order to come up

lower chance to be infected by Covid-19.

This study will serve as an Conscientization to those people

to implement the safety protocols to prevent this virus from infecting

Background of the Study

As the rapid spread of COVID-19 led to the temporary closures of

dropped between 40 and 90 percent. Hospitals re-allocated resources to

combat the wave of infected patients, overwhelming staff and leading to

both bed and equipment shortages in many areas. Non-urgent imaging,

According to Kreamer, the world is facing an unprecedented global

pandemic in the form of the coronavirus disease 2019 (COVID-19) which

has ravaged all aspects of life, especially health systems. Radiology

services, in particular, are under threat of being overwhelmed by the sheer

mitigate the spread of the virus. Proactive measures, therefore, must be

taken to ensure the continuation of diagnostic and interventional support

to clinicians, while minimizing the risk of nosocomial transmission among

improve preparedness, readiness and response towards this pandemic,

specific to the radiology department.

As the coronavirus disease 2019 (COVID-19) pandemic

accelerates, global health care systems have become overwhelmed with

potentially infectious patients seeking testing and care. Preventing spread

effective use of personal protective equipment (PPE)—gloves, face

masks, air-purifying respirators, goggles, face shields, respirators, and

gowns. A critical shortage of all of these is projected to develop or has

already developed in areas of high demand. PPE, formerly ubiquitous and

disposable in the hospital environment, is now a scarce and precious

commodity in many locations when it is needed most to care for highly

infectious patients. An increase in PPE supply in response to this new

demand will require a large increase in PPE manufacturing, a process that

increase in ill COVID-19 patients (Rutala, 2020).

“The threat of COVID-19 has become worldwide and reached as of