PATIENT CARE AND MANAGEMENT
PROF. EMERLINDA REYES | MIDTERMS
Topic Outline:
● SCHEDULING PATIENT
● PATIENT CARE AND SAFETY (PART 1, 2
AND 3)
● MEDICAL ASEPSIS/INFECTION
CONTROL
● STANDARD PRECAUTIONS (TIER 1)
● TRANSMISSION-BASED PRECAUTIONS
(TIER 2)
L1: SCHEDULING PATIENT
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 can 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, the 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
NPO - from the Latin “nil per os”.
- Meaning nothing by mouth
B. SEQUENCE OF EXAMINATION
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
examination involving the use of barium sulfate
5. Lower gastrointestinal (GI) series (check for
residual contrast material from the previous
examination before proceeding
6. Upper GI series
PATIENT PREPARATION
A. GI SYSTEM OR URINARY SYSTEM
1. Low-residue diet
- Ex. low fiber
Clear Liquid diet
- Ex. tea, gelatin, bouillon
2. NPO for 8 to 12 hours before procedure
3. Cathartics and enemas are used to cleanse the gi
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 radiographer to verify
understanding
B. ALL PROCEDURES
1. Clothing is removed from the area to be
radiographed and replaced by a patient gown
when appropriate
2. All radiopaque objects are removed from the
area of interest
KENJI.V | 1

PATIENT HISTORY
1. Provides information for the radiographer about
the extent of the patient’s injury and the range of
motion the patient can tolerate
2. Assists the radiologist during interpretation of
the radiographs
3. History should begin with the radiographer
introducing himself or herself and verifying the
patient’s name
● Stand with the feet parallel and at right angles to
the lower legs. The feet should
● be 4 to 8 inches apart. Keep body weight equally
distributed on both feet.
● Keep the knees slightly bent; they act as shock
absorbers for the body.
● Keep the buttocks in and the abdomen up and in.
This prevents strain on the back and abdominal
muscles.
RULES FOR PICKING UP OR LIFTING HEAVY
OBJECTS

● When picking up an object from the floor, bend

L2: PATIENT CARE AND SAFETY the knees and lower the
body. Do not bend from the waist.
(PART 1)
● The biceps are the strongest arm muscles and are
effective when pulling; therefore, pull heavy
CARE OF PATIENT’S BELONGINGS
items or patients rather than push them.
● When assisting a patient to move, balance the
● The patient should be taken to the specific
weight over both feet. Stand close to the patient,
dressing area and shown how to close the
flex the gluteal muscles, and bend the knees
dressing room door or draw the curtain of the
to support the load. Use arm and leg muscles to
cubicle while undressing.
assist in the move.
● The patient should be given hangers for
● Always protect the spine. Rather than twisting
clothing.
the body to move a load,
● Purses, jewelry, and other valuables should be
change the foot position instead. Always keep
treated with special care so that they will not
the body balanced over
be lost or stolen.
the feet, which should be spread to provide a
● An envelope or other container large enough to
firm base of support.
accommodate all such items should be
● Make certain the floor area is clear of all objects.
offered to the patient.
● Identifying information should be written on a
receipt, and all items should be tagged and
placed in the designated safety area.
● Do not place value on a patient’s belongings.

BODY MECHANICS

RULES FOR CORRECT UPRIGHT POSTURE

● Hold the chest up and slightly forward with the

waist extended. This allows the
lungs to expand properly and fill to capacity.
● Hold head erect with the chin held in. This puts
the spine in proper alignment,
and there is no curve in the neck.

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MOVING AND TRANSFERRING PATIENTS
PRECAUTIONS WHEN MOVING A PATIENT
FROM THE HOSPITAL ROOM TO THE
IMAGING DEPARTMENT
1. Establish the correct identity of the patient.
Approach the patient and identify yourself and
the reason for being there. Ask to see their
identification wristband. This is extremely
important, as many times the patient has been
transferred to another room since the radiology
request was submitted.
2. Request pertinent information concerning the
patient’s ability to comply with the physical
demands of the procedure while at the nurses’
station.
3. Request information concerning the patient’s
ability to ambulate and any restrictions or
precautions to be taken concerning the patient’s
mobility.
4. Move the patient to the imaging department
according to the necessary restrictions after
greeting and identifying him or her and
providing an explanation of what is to occur.
WHEN THE PROCEDURE IS COMPLETED,
RETURN THE PATIENT TO THE HOSPITAL
ROOM
1. Stop at the appropriate nurses’ station, return the
chart, and inform the unit personnel that the
patient is being returned to the room. Request
help if it is needed at this time.
2. Return the patient to the room, help the patient
get into bed, and make him or her comfortable
and safe. Place the patient’s bed in the position
closest to the floor with the side rails raised and
the call button within reach in case the patient
needs assistance.
ASSESSING THE PATIENT’S MOBILITY
1. Deviations from correct body alignment.
2. Immobility or limitations in range of joint
motion.
3. The ability to walk.
4. Respiratory, cardiovascular, metabolic, and
musculoskeletal problems.
OTHER ASSESSMENT CONSIDERATIONS
1. The patient’s general condition.
2. Range of motion and weight-bearing ability.
3. The patient’s strength and endurance.
4. The patient’s ability to maintain balance.
5. The patient’s ability to understand what is
expected during the transfer.
6. The patient’s acceptance of the move.
7. The patient’s medication history.
THE FOLLOWING RULES SHOULD BE
OBSERVED DURING A MOVE
1. Give only the assistance that the patient needs
for comfort and safety.
2. Always transfer a patient across the shortest
distance.
3. Lock all wheels on beds, gurneys, and
wheelchairs before the move begins.
4. Generally, it is better to move a patient toward
his or her stronger side while assisting on the
patient’s weaker side.
5. The patient should wear shoes for standing
transfers, not slippery socks.
6. Inform the patient of the plan for moving and
encourage him or her to help.
7. Give the patient short, simple commands and
help the patient to accomplish the move.
METHODS OF MOVING PATIENTS
GURNEY
- If the patient is unconscious or unable to cooperate in
the move, the patient’s spine, head, and extremities
must be well supported (use a sliding board or a sheet to
slide the patient from one surface to another)
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 SHEET TRANSFER

● To place a sheet under a patient, use a heavy

draw sheet or a full bed sheet that is folded in
half.
● Have one person stand on each side of the table
or bed at the patient’s side.
● Turn the patient onto his or her side toward the
distal side of the bed or table.
● Place the sheet on the table or bed with the fold
against the patient’s back (A) Place the sheet on the table with the fold
● Roll the top half of the sheet as close to the against the patient’s back.
patient’s back as possible
● Inform the patient that he or she will be turned
onto the side toward the opposite side and will
be moving over the rolled sheet.
● Then turn the patient across the sheet roll and
have the assistant straighten the sheet on the
distal side
● Return the patient to a supine position, and the
transfer may begin.
● If the patient is an adult, three or four people
should participate in the maneuver. (B) Take the top half of the sheet and roll it against the
● One person stands at the patient’s head to guide patient
and support it during the move, with another at
the side of the surface to which
● the patient will be moved, and a third person at
the side of the surface on which the patient is
lying.
● If there are four people, two may stand at each
side.
● The sheet is rolled at the side of the patient so
that it can easily be grasped, close to the
patient’s body.
● In unison (usually on the count of three), the
team transfers the patient to the other surface. (C) After the patient is rolled to the opposite side, the
● Extra care over the metal parts of the rolled half of the sheet is straightened out.
radiographic table’s metal edges should be taken
as well as assuring that the tube housing is
positioned out of the way.

4
 table, and clean the sliding board and the table
with a disinfectant spray.
SLIDING BOARD TRANSFER 14. After washing hands, place clean linen on the
table.
1. Obtain the sliding board and spray it with
antistatic spray if necessary.
2. Obtain the assistance of one other person if the
patient is of average size and weight; if the
patient is large, three people may be necessary to
move the patient safely.
3. Move the patient to the edge of the gurney. One
person should hold the sheet that the patient is
lying on over the top of the patient to keep the
patient from possibly rolling off the gurney.
4. Move the gurney up against the radiographic
table and lock the wheels of the gurney.
5. Assist the patient to turn onto his or her side,
away from the radiographic table, and place the (A) Create a bridge with the board between the table
sliding board under the sheet upon which the and the gurney.
patient was lying.
6. Create a bridge with the board between the edge
of the radiographic table and the edge of the
gurney
7. Place the sheet over the board, and allow the
patient to roll back onto the board.
8. With one person at the side of the radiographic
table and the other at the side of the gurney, slide
the patient over the board and onto the
radiographic table
9. Assist the patient in rolling toward the distal side
of the radiographic table, keeping the patient
secure by holding onto the sheet on which he or (B) Roll the sheet close to the patient and slide the
she was lying. The person standing on the side patient onto the table
of the gurney should remove the sliding board
from under the patient
10. Remove the gurney and perform the
radiographic procedure.
11. When the procedure is completed, the patient
can be transferred back to the gurney by
repeating the steps above.
12. Once the patient is back on the gurney, place a
pillow under the patient’s head, if this is
permitted, and put the side rails of the gurney
up. Place a soft immobilizer over the patient. (C) Remove the sliding board while safely securing
The patient may then be transferred. the patient.
13. When the move is complete, discard the soiled
linen that was used on the radiographic
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 WHEELCHAIR TRANSFER

1. If the patient can assist, instruct him or her to

push up with the upper arm when told to do so.

2. On the count of three, move or help the patient

to a sitting position at the edge of the table.
Before helping the patient to stand, allow him or
her to sit for a moment and regain a sense of
balance. While the patient is “dangling,” place
nonskid slippers on the patient’s feet.

3. If the patient needs minimal assistance to get off

the table, stand at the patient’s side and take the
patient’s arm to help.
(A) Stand in from of the patient and place an arm under
4. If the radiographic table is high, never allow a her shoulders and over across her knees. Assist to a
patient to step down without providing a secure sitting position.
stepping stool. Always stay at the patient’s side
to assist. A telescoping radiographic table must
be placed in the lower position before a patient
is assisted to move off of it. The wheelchair
must be close enough so that the patient can be
seated in the chair with one pivot. Have the foot
supports of the chair up and the wheels locked.

5. The footrests on the wheelchair should then be

put down and the wheels unlocked. A safety belt
should be put across an unsteady patient.

(B) Wheel the wheelchair close to the table pivot and

help the patient sit in the chair.

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 L2: PATIENT CARE AND SAFETY HIGH FOWLER POSITION
(PART 2)
- The patient semi-sits with head raised at an
angle of 45 to 90 degrees off the table.
POSITIONING THE PATIENT FOR DIAGNOSTIC
IMAGING EXAMINATIONS

SUPINE OR DORSAL RECUMBENT POSITION

- The patient is flat on the back. The feet and the

neck will need to be protected when the patient
is lying in this position. A pillow may be placed
under the head to tilt it forward. The feet should
be supported to prevent plantar flexion or foot
SEMI-FOWLER POSITION
drop.
- The patient’s head is raised at an angle of 15 to
30 degrees off the table. The arms must be
supported to prevent pull on the shoulders, and
the feet must be supported to prevent plantar
flexion or foot drop. Pillows or blocks under the
knees must be removed after a brief time (15 to
LATERAL RECUMBENT POSITION
20 minutes) to prevent circulatory impairment

- The patient is on the right or the left side with

both knees flexed. This position relieves
pressure on most bony prominences. The patient
may be supported with pillows or sandbags to
maintain the position

SIMS POSITION

- The patient lies on either the left or right side

PRONE POSITION
with the forward arm flexed and the posterior
arm extended behind the body. The body is
- Patient lies face down. A small pillow should
inclined
support the head to prevent flexion of the
slightly forward with the top knee bent sharply
cervical spine. The patient may be moved down
and the bottom knee slightly bent.
on the table so that the feet drop over the edge,
or a pillow may be placed under the lower legs
at the ankles to prevent footdrops

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 TRENDELENBURG POSITION
PARALYZED LEG, A LEG INJURY, A CAST, OR
- The table or bed is inclined with the patient’s
head lower than the rest of the body. Patients are
occasionally placed in this position during
diagnostic imaging procedures and for
promotion of venous return in patients with
inadequate peripheral perfusion caused by
disease
ASSISTING THE PATIENT TO DRESS AND
UNDRESS
1. Place a long examining gown on the patient.
Instruct him to loosen belt buckles, buttons, or
hooks around the waist and slip the trousers over
the hips. If the patient cannot do this, reach
under the gown and pull the trousers down over
the hips.
2. Have the patient sit down. Squat down in front
of the patient and gently pull the clothing over
the legs and feet to remove it. If the patient is
not able to help, call for an assistant.
IF THE DRESS MUST BE PULLED OVER THE
WOMAN’S HEAD
1. Place a draw sheet over the patient and then help
her remove her slip and brassiere.
2. Help her to put on an examining gown and then
remove the draw sheet.
STEPS TO RE-DRESS A PATIENT WITH A
A BRACE
1. Slide the clothing (pants or skirt) over the feet or
legs as far as the hips while the patient is sitting
and still wearing an examining gown.
2. Have the patient stand and pull the clothing over
the hips if he or she can tolerate it.
3. If the patient is not able to pull the clothing over
the hips alone, have an assistant raise the patient
off the chair so that you may slip the clothing
over the hips and waist.
4. Remove the patient’s arms from the sleeves of
the gown. Have the patient hold the gown over
his or her chest, and carefully pull the shirt over
the head, or put it on one sleeve at a time.
5. When the outside items of clothing are on the
patient, remove the gown from under the
clothes.
THE DISABLED PATIENT
1. Cover the patient with a draw sheet and have an
examining gown ready. Explain what is to be
done and ask the patient to help if he or she is
able. If the patient is paralyzed or unconscious,
summon help before beginning the procedure.
2. Remove the clothing from the less affected side
first and then remove the clothing from the more
affected side and place the clean gown on that
side, making sure to keep the patient covered
with the draw sheet.
3. Next place the clean gown on the affected side
first and tie the gown at the back, if practical.
4. If the patient is wearing an article of clothing
that must be pulled over the head, roll the
garment up above the waist. Then remove the
garment up above the waist. Next, remove the
patient’s arms from the clothing, first from the
unaffected side and then from the affected side.
5. Neatly, gently lift the clothing over the patient’s
head. One person alone should not attempt to
undress a disabled patient; to do so may cause
further injury or discomfort.
8
6. To remove trousers, loosen buckles and buttons
and have the patient raise his buttocks as the
trousers are slipped over his hips. If the patient
is unable to help, have an assistant stand at the
opposite side of the table. After the trousers have
been loosened, have the assistant pull the patient
toward him or her, and then slide the trousers off
one side of the hip. Next, draw the patient
toward the opposite side and have the assistant
slide the trousers of the other hip.
7. Slip the trousers below the knees and off.
8. Fold the clothing and place it in a paper bag on
Which the patient’s name has been printed. If a
relative or a friend accompanies the patient, ask
that person to keep the patient’s clothing. If the
patient is alone, the radiographer is responsible
for caring for the clothing.
L2: PATIENT CARE AND SAFETY
(PART 3)
THE PATIENT WITH AN INTRAVENOUS
INFUSION (IV)
1. If the patient’s gown must be changed, slip the
clothing off the unaffected side first.
2. Carefully slide the sleeve of the unaffected side
over the IV tubing and catheter, then over the
container of fluid. For this step, the container
must be removed from the stand.
3. When replacing the soiled gown with a clean
one, first place the sleeve on the affected side
over the container of fluid, then over the tubing
and onto the arm with the venous catheter in
place. Rehang the bottle of fluid and complete
the change.
4. When moving the arm of a patient who has an
IV catheter in place, support the arm firmly so
that the catheter does not become dislodged.
Remember to keep the bottle of fluid above the
infusion site to prevent blood from flowing into
the tubing.
SKIN CARE
Skin breakdown - can occur in a brief period of time
and result in a decubitus ulcer.
● Mechanical factors that may predispose the skin
to breakdown are immobility, pressure, and
shearing force.
● Immobilizing a patient in one position for an
extended period of time creates pressure on the
skin that bears the patient’s weight.
● Moving a patient to or from a diagnostic
imaging table too rapidly or without adequately
protecting the patient’s skin.
● Friction
● Allowing a patient to lie on a damp sheet or
remain in a wet gown
● Urine and fecal material that remain on the skin
Ischemia - is a restriction in blood supply to tissues,
causing a shortage of oxygen that is needed for cellular
metabolism (to keep tissue alive).
Reactive hyperemia - is the transient increase in organ
blood flow that occurs following a brief period of
ischemia.
● Persons who are most prone to skin breakdown
are the malnourished, the elderly, and the
chronically ill.
● A patient who is elderly and in poor health may
have dehydrated skin an accumulation of fluid in
the tissues (edema), increased or decreased skin
temperature, or a loss of subcutaneous fat that
acts to protect the skin.
9
 PREVENTING DECUBITUS ULCERS
● The areas most susceptible to decubitus ulcers
are the scapulae, the sacrum, the trochanters, the
knees, and the heels of the feet.
● The patient who is on the imaging table for a
long period of time should be allowed to change
position occasionally to keep pressure off the
hips, knees, and heels.
● Special precautions should be taken to protect
the patient’s feet and lower legs during a
position change or transfer.
CAST CARE AND TRACTION
● When moving a patient who is wearing a cast,
slide an opened, flattened hand under the cast.
● Avoid grasping the cast with fingers, since this
may cause indentations if the cast material is sill
damp.
● A cast must be supported at the joints when it is
moved.
● A casted extremity must be moved as a unit with
flat hands supporting it at the joints.
● When moving a patient who has an abduction
bar placed between the legs of a spica cast, it is
imperative that the abduction bar not be used as
a moving or turning device.
TO POSITION A PATIENT WHO IS IN A CAST
● Positioning sponges or sandbags must be on
hand so that the cast can be well supported.
● A recently casted limb usually should be kept
elevated.
● If a cast is allowed to put pressure on the skin in
any area, it may impede circulation or damage
underlying nerves.
SIGNS OF IMPAIRED CIRCULATION OR NERVE
COMPRESSION
Pain: Sudden pain or pain that increases with passive
motion may indicate nerve damage.
Coldness: Fingers or toes distal to a cast should feel
warm.
Numbness: A cast that is too tight may cause numbness,
another sign of nerve damage.
Burning or tingling of fingers or toes: These
symptoms may indicate circulatory impairment.
Swelling: Indicative of edema, swelling may result in
circulatory impairment or nerve
compression.
Skin color changes (to a pale or bluish color): Skin
should remain pink and warm. In dark-skinned
persons, temperature and comparison with the normal
extremity are evaluated.
Inability to move fingers or toes: All fingers and toes
should be able to be moved and fully extended
and flexed.
Decrease in or absence of pulses: These changes may
indicate circulatory impairment.
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ASSISTING THE PATIENT WITH A BEDPAN OR
URINAL

1. If possible, help the patient to reach the lavatory

near the examining room.
➢ Do not allow the patient to go to the
toilet without assistance.
➢ Help the patient put on slippers or shoes,
and wrap the draw sheet around him or
her if no robe is available. Help the
patient off the radiographic table or out
of the wheelchair and lead the patient to
the lavatory
➢ It is not safe to leave the patient
unattended.
2. If the patient can help him or herself in the
lavatory, close the door and tell the patient that
assistance is just outside the door waiting if help
is needed.
➢ If there is no emergency call button,
check on the patient at frequent intervals
to be certain that his or her condition is
stable.

3. After the patient has finished using the lavatory,

help him or her to wash hands if unable to do so.
4. Accompany the patient back to the examination
area and cover the patient to make him or her
comfortable.
5. Return to the lavatory and make certain that it is
clean.
6. The radiographer must wash his or her hands.
1. Before assisting the patient, obtain tissue and a
bedpan with a towel to cover it.
- Close the examining room door, or
screen the patient to ensure privacy.
- Always place a sheet over the patient
while helping her onto the bedpan.
- Put on clean, disposable gloves.

THE BEDPAN 2. Approach the patient and place the bedpan at the
end of the table.
- If the patient can move, place one hand
under the lower back and ask the patient
to raise the hips.

3. Place the pan under the hips.

- Be sure the patient is covered with a
sheet.
- If the patient is unable to sit up, assist
the patient to a sitting position.

11
 - Do not leave a patient sitting on a L3: MEDICAL ASEPSIS/INFECTION
bedpan— he or she is poorly balanced
CONTROL
and may fall.
4. Place the toilet tissue where the patient can
INFECTION CONTROL PRACTICES IN
reach it. Let the patient be alone as much as
HEALTHCARE SETTINGS
possible by turning around and facing away
from the patient, or if the patient can sit by him
or herself, step away from the patient to provide
privacy.
5. When the patient has finished using the bedpan,
put on clean, disposable gloves and help the
patient off the pan. Have the patient lie back,
place one hand under the lumbar spine, and have
the patient raise the hips.
6. Remove the pan, cover it, and empty it in the
lavatory. Rinse it with clean cold water (dump
the water into the toilet, not the sink), and then
MEDICAL ASEPSIS
discard the disposable bedpan in the trash
receptacle.
- insofar as possible, microorganisms have been
7. Offer the patient a wet paper towel or washcloth
eliminated through the use of soap, water,
to wash the hands and a dry towel to dry them.
friction, and various chemical disinfectants.
8. The radiographer must then remove his or her
gloves.
SURGICAL ASEPSIS
IF THE PATIENT IS NOT ABLE TO CLEAN THE
- means that microorganisms and their spores
PERINEAL AREA, THE RADIOGRAPHER WILL
have been completely destroyed by means of
HAVE TO DO THIS
heat or by a chemical process.
NOTE: Wear clean disposable gloves
DRESS IN THE WORKPLACE
1. Take several thicknesses of tissue and fold them
1. Fingernails must be short. Cracked or broken
into a pad. Wipe the patient’s perineum from
nails and chipped nail polish harbor
front to back and drop the tissue into the pan. If
microorganisms that are difficult to remove.
necessary, repeat the procedure until the
2. Shoes must have closed, hard toes.
perineum is clean and dry.
3. Jewelry, such as rings with stones, must not be
2. Cover the pan to take it to the bathroom and
worn.
empty it. If the bedpan is disposable, and the
4. Always wear freshly laundered, washable
patient will not be staying in the department
clothing when working with patients. Laboratory
long enough to use it a second time, the pan may
coats, scrubs, and uniforms must be washed
be discarded.
daily with hot water and detergent. Chlorine
3. Remove the gloves and wash your hands
bleach is recommended for clothes that have
correctly.
become heavily contaminated.
5. A protective gown must be worn when working
with any patient who may soil one’s clothing or
if it is possible that blood or body fluids will
contaminate clothing.

12
 HAIR 8. Rinse hands well under running water. If hands
have been heavily contaminated, repeat steps 6,
● Hair follicles and filaments also harbor 7, and 8.
microorganisms. 9. Clean fingernails with a brush or an orange stick
● Hair must be worn short or in a style that keeps carefully once each day before beginning work
it up and away from your clothing and the and again if hands become heavily
patient. contaminated. Scrubbing heavily contaminated
● Hair should be shampooed frequently. nails with a brush is recommended.
10. Rinse fingers well under running water.
HAND HYGIENE 11. .Repeat washing procedure as described above
after cleaning nails.
- According to CDC guidelines, the term hand 12. Turn off the water. If the handles are hand-
hygiene applies to either handwashing with plain operated, use a paper towel to turn them off to
soap and water, use of antiseptic hand rubs, avoid contaminating hands.
including alcohol-based products, or surgi- cal 13. Dry arms and hands using as many paper towels
hand antisepsis (CDC, 2002). as necessary to do the job well.
14. Use lotion on hands and forearms frequently. It
CDC - Centers for Disease Control and Prevention helps to keep the skin from cracking and thereby
prevents infection.
1. Approach the sink. Do not lean against the sink
or allow clothing to touch the sink because it is
considered to be contaminated. Remove any
jewelry except for a wedding band.
2. Turn on the tap. A sink with foot or knee control
is most desirable but is not always available. If (A) Approach the sink
the faucet is turned on by hand, use a paper and turn on the tap. Do
towel to touch the handles and then discard the not allow your uniform
towel. to touch the sink.
3. Regulate the water to a comfortable warm
temperature.
4. Regulate the flow of water so that it does not
splash from the sink to one’s clothing.
5. During the entire procedure, keep hands and
forearms lower than the elbows. The water will
drain by gravity from the area of least
contamination to the area of greatest (B) Apply soap. Clean
contamination. your hands and knuckles
6. Wet hands and soap them well. Liquid soap is and the areas between
the most convenient. your fingers with a firm,
7. With a firm, circular, scrubbing motion, wash rubbing motion. Clean
your palms, the backs of your hands, each finger, your fingernails with
between the fingers, and finally the knuckles. running water to flush
Wash to at least one inch above the area of away dirt and
contamination. If hands are not contaminated, microorganisms.
wash to one inch above the wrists. Fifteen
seconds should be the minimum time allotted for
this.
13
 6. ESBLs - Extended-spectrum beta-lactamases (ESBLs)
are enzymes that confer resistance to most beta-lactam
antibiotics, including penicillins, cephalosporins, and the
(C) Clean your wrists monobactam aztreonam.
and forearms with a
firm, circular motion. 7. Tuberculosis

“All workplaces in which employees may be exposed

to human blood or body substances
shall formulate a plan to control employee exposure to
pathogenic microorganisms borne by
these substances.” - OSHA

OSHA - Occupational Safety and Health Administration

PERFORM THE FOREGOING PROCEDURE:
1. An infection control policy conforming to OSHA
guidelines must be developed. This policy must specify
• AT THE BEGINNING OF EACH WORKDAY
when personal protective equipment (PPE) is required
• WHEN IN CONTACT WITH A PATIENT’S BLOOD
and how to clean spills of blood or body substances, how
OR BODY SUBSTANCES
to transport specimens to the laboratory, and how to
• WHEN PREPARING FOR INVASIVE
dispose of infectious waste.
PROCEDURES
• BEFORE TOUCHING PATIENTS AT GREATEST
2. All staff must be instructed in the application of these
RISK FOR INFECTION
policies.
• AFTER CARING FOR PATIENTS WITH KNOWN
COMMUNICABLE DISEASES
3. Hepatitis B immunizations are to be provided to staff
who might be exposed to blood or body substances free
STANDARD PRECAUTIONS (TIER 1) of charge.

THE THREAT OF INFECTION WITH: 4. Follow-up care must be provided to any staff member
accidentally exposed to splashes of blood or body fluids
or to needle-stick injuries.
1. HIV - human immunodeficiency virus
5. Personal protective equipment must be readily
2. hepatitis A, B, C, D, E, accessible to any staff member who needs it.

3. MRSA - methicillin-resistant Staphylococcus aureus. 6. Impermeable, puncture-proof containers that are

MRSA is a "staph" germ (bacteria) that does not get disposable must be provided for all used needles,
better with the type of antibiotics that usually cure staph syringes, and other sharps; they must be changed
infections. frequently or when full.

4. VRE - Bacteria known as vancomycin-resistant
enterococci (VRE) are resistant to some powerful
antibiotics.
5. VRSA - Vancomycin Resistant Staphylococcus aureus
7. All health care workers without exception are obliged
to follow Standard Precautions and Tier 2 precautions as
indicated. If an employee or the institution in which he
or she is employed is remiss in this practice, legal action
should be taken to enforce these rules.
14
8. Body substance isolation procedures define body
fluids and substances as infectious (National Safety
Council, 1993). Body substances and fluids that may be
infectious include vaginal secretions, breast milk,
cerebrospinal fluid, synovial fluid, pleural fluid,
peritoneal fluid, pericardial fluid, and amniotic fluid.
Urine, feces, nasal secretions, tears, saliva, sputum, and
any purulent or non- purulent drainage from wounds are
also considered potentially infectious.
Place the used needle
uncapped into a
puncture-resistant
container.
ADDITIONAL INFECTION CONTROL
CONSIDERATIONS
Items to be reused must be placed in designated
puncture-resistant containers for transport to the area
designated for cleaning and disinfecting. Mouthpieces
and resuscitation bags must be kept in all diagnostic
imaging examination and treatment rooms so that
mouth-to-mouth contact with the patient can be avoided
in the event of cardiopulmonary resuscitation
EYE PROTECTION
If the radiographer is in a
patient care situation in which a
spattering of blood or body
fluids is possible, he must
wear goggles to protect his eyes
from becoming contaminated.
These goggles must have side
protectors.
GLOVES
Any time it is potentially possible that a patient’s blood
or body secretions may be touched, disposable, single-
use gloves must be worn.
LATEX SENSITIVITY
Reactions range from local skin reactions to urticaria
(hives) to systemic anaphylaxis, an exaggerated allergic
reaction that can result in death (OSHA,2005).
CLEANING AND PROPER WASTE
The following are guidelines for the disposal of waste or
the cleaning of equipment after each patient use in the
diagnostic imaging department.
1. Wear a fresh uniform each day. Do not place your
uniform with other clothing in your personal closet.
Shoes should be cleaned and stockings should be fresh
each day.
2. Pillow coverings should be changed after each use
by a patient. Linens used for drapes or blankets for
patients should be handled in such a
way that they do not raise dust. Dispose of linens after
each use by a patient.
3. Flush away the contents of bedpans and urinals
promptly unless they are being saved for a diagnostic
specimen.
4. Rinse bedpans and urinals and send them to the
proper place (usually a central supply area) for
re-sterilization if they are not to be reused by the same
patient.
15
5. Use equipment and supplies for one patient only.
After the patient leaves the area, supplies must be
destroyed or re-sterilized before being
used again.
6. Keep water and supplies clean and fresh. Use paper
cups in the diagnostic imaging department and dispose
of them after a single use.
7. Floors are heavily contaminated. If an item to be
used for patient care falls to the floor, discard it or send it
to the proper department to be
recleaned.
8. Avoid raising dust because it carries
microorganisms. When cleaning, use a cloth thoroughly
moistened with a disinfectant.
9. The radiographic table or other imaging or
treatment equipment should be cleaned with a
disposable disinfectant towelette or sprayed with
disinfectant and wiped clean and dried from top to
bottom with paper towels after each patient use.
10. When cleaning an article such as an imaging
table, start with the least soiled area and
progress to the most soiled area. This prevents the
cleaner areas from becoming more
heavily contaminated. Use a good disinfectant cleaning
agent and disposable paper cloths.
11. Place dampened or wet items such as dressings
and bandages into waterproof bags, and close the
bags tightly before discarding them to prevent workers
handling these materials from coming in contact with
bodily discharges. Place in contaminated waste
containers.
12. Do not reuse rags or mops for cleaning until they
have been properly disinfected and dried.
13. Pour liquids to be discarded directly into drains or
toilets. Avoid splashing or spilling them
on clothing.
14. If in doubt about the cleanliness or sterility of an
item, do not use it.
IF IN DOUBT, DISCARD NA!!!!
15. When an article that is known to be contaminated
with virulent microorganisms is to be sent to a central
supply area for cleaning and re-sterilizing, place it in a
sealed, impermeable bag marked “BIOHAZARD.” If
the outside of the bag becomes contaminated while the
article is being placed in the bag, place a second bag
over it.
Place the contaminated bag
into a second bag that is not
contaminated.
16. Always treat needles and syringes used in the
diagnostic imaging department as if they are
contaminated with virulent microbes. Do not recap
needles or touch them after use. Place them
immediately (needle first) in a puncture-proof container
labeled for this purpose. Do not attempt to bend or break
used needles because they may stick or spray you in the
process.
17. Place specimens to be sent to the laboratory in
solid containers with secure caps. If the specimen is
from a patient with a known communicable disease,
label the outside of the container as such. Avoid
contaminating the outside of the container, and place the
container in a clean bag. If a container becomes
contaminated, clean it with a disinfectant before placing
it in the bag. Specimens must be sent to the laboratory
immediately after collection for examination.
18. Medical charts that accompany patients to the
diagnostic imaging department must be kept away from
patient care areas to prevent contamination. Keep charts
in an area where only those directly involved in
patient care may read them.
16

Specimens must be sent to the
laboratory in a clean container
and then encased in an outer
bag.
DISINFECTION
Disinfection - is a term used to describe the removal, by
mechanical and chemical processes, of pathogenic
microorganisms, but frequently not their spores, from
objects or body surfaces.
TRANSMISSION-BASED
PRECAUTIONS (TIER 2)
- designed to place a barrier to the spread of
highly infectious diseases between persons with
such diseases and the persons caring for them.
Three specific routes or modes of disease
transmission may differ with each disease:
• By airborne
• By droplet
• By contact
- Isolation precautions are meant to separate the
patient who has a contagious illness from other
hospitalized patients and the health care
workers.
AIRBORNE ISOLATION
- This method of transmission occurs when
microbes are spread on evaporated droplets that
remain suspended in air or are carried on dust
particles in the air and maybe inhaled by persons
in that room or air space.
- Diseases that are spread by airborne route are
sudden acute respiratory syndrome (SARS),
smallpox, tuberculosis, varicella “chicken pox,”
and rubeola.
When diseases require airborne isolation, the
following precautions are required:
• A private room, negative air-pressure ventilation, and
an N95 respirator mask for health care workers*; a
surgical mask for visitors; door closed.
• Standard Precautions
• A surgical mask for a patient to be transferred within
the hospital.
HOW DO NEGATIVE PRESSURE ROOMS
WORK?
They are called negative pressure rooms because the air
pressure inside the room is lower than the air pressure
outside the room. This means that when the door is
opened, potentially contaminated air or other dangerous
particles from inside the room will not flow outside into
non-contaminated areas.
Instead, non-contaminated filtered air will flow into the
negative pressure room. Contaminated air is sucked out
of the room with exhaust systems, which are built with
filters that clean the air before it is pumped outside of
and away from the healthcare facility.
17
 DROPLET ISOLATION
- Transmission by droplets occurs when droplets
contaminated with pathogenic microorganisms
are placed in the air from a person infected with
a droplet-borne infection.
- Diseases spread by this route are influenza,
rubella, mumps, pertusis (whooping cough),
most pneumonias, diptheria, pharyngitis, scarlet
fever, and meningococcal meningitis.
The following are requirements for precautions for
disease spread by droplet transmission:
• A private room or a room with another person infected
with the same disease; the door may be left open
• A mask for any procedure that requires less than 3 feet
in proximity to the infected patient
• Standard Precautions
CONTACT ISOLATION
Direct contact - occurs when a susceptible person
touches an infected or colonized person’s body surface
in an area where infectious microbes are present.
Colonization - is defined as the presence of
microorganisms on the skin or body surface of an
individual who has no symptoms of the disease.
Indirect contact - occurs when a susceptible person
touches or comes into contact with an object that has
been contaminated with infectious microorganisms.
Fomite - can be a soiled instrument, a used syringe, a
food or beverage container, or contaminated hands.
Diseases transmitted by contact are:
● drug-resistant wound infections;
● gastroenteritis caused by: Clostridium difficile,
Escherichia coli, Rotavirus, Shigella and other
gastrointestinal infectious diseases; hepatitis A;
●
● herpes simplex;
● herpes zoster;
● impetigo;
● scabies;
● drug- resistant gastrointestinal, respiratory, and
skin diseases (i.e. MRSA, VRE, VRSA, ESBL);
● draining abscesses;
● cellulites;
● conjunctivitis;
● diphtheria cutaneous;
● scabies, lice; and
● all multidrug resistant organisms (infection or
colonization).
The following are precautions to prevent disease
spread by contact:
• A private room or a room with another person infected
with the same disease if the patient cannot be relied on to
maintain adequate precautions or is too young to do so.
• Gloves to be worn by health care workers before
entering the patient’s room and removed before leaving
it.
• Wearing a gown if there is a possibility of touching the
patient or items in the room or if the patient is
incontinent or has diarrhea, an ileostomy, a colostomy, or
a draining wound that does not have a barrier dressing in
place
• Careful handling of any dressing materials, linens,
clothing to prevent cross contamination
• Visitors must wash hands before and after entering
room
• Standard Precautions
• Precautions to minimize disease transmission if the
patient is to be transported within the hospital and PPE
as necessary
• Equipment used in patient’s room must stay in patient’s
room.
18
 EXPANDED PRECAUTIONS
Patients that are highly susceptible to becoming
infected:
● neutropenia,
● pronounced immune compromise,
● transplant recipients who may be rejecting the
transplanted organ, and
● others designated by the physician or infection
control officer.
The procedure for expanded precautions follows:
1. Wash hands before entering and after providing care
to the patient
2. Cover gown and gloves are required at all times while
in the patient’s room
3. Regular face masks may be required in select cases
4. Equipment such as stethoscopes, blood pressure cuffs,
and thermometers stay in room
5. No flowers, plants, fresh fruits, or vegetables are
allowed for immune-compromised patients
6. No visitors or staff with signs or symptoms of
infection (colds, rashes, etc.) must go into the room
Have an assistant available and then use the
following procedure:
1. Assemble the supplies and equipment needed.*
Rationale: Prevents loss of time and reduces the risk of
breaking isolation procedure.
2. Stop in area to don protective clothing. Remove any
jewelry that you are wearing and pin it into your uniform
pocket so it will not be lost.
3. Wash hands as for medical aseptic practice.
Rationale for steps 2 and 3: Prevent transmission of
microorganisms
4. If your hair touches your collar, you must wear a cap.
Rationale: Hair collects and transmits microorganisms.
5. Remove a mask from the container and put it on,
making certain that it covers the mouth and nose tightly.
Put on a lead apron.
6. Take a gown from the stack. Hold it in front of you
and let it unfold. Place arms into the sleeves and pull
them on at the shoulders.
7. Tie the back of the gown, making certain that the
gown covers all of your clothing.
8. Put gloves on, making certain that the cuffs of the
gloves cover the cuffs of the gown.
9. Push the machine into the room; introduce yourself to
the patient and explain the procedure. Make necessary
adjustments to the machine at this time.
Rationale: The patient will have less anxiety if he or she
understands what is to occur. It also allows the patient to
refuse the procedure. Once you have touched the patient,
change gloves before touching the machine again.
10. Place the image receptor for the exposure.
11. Remove contaminated gloves and discard them in a
waste receptacle.
12. Put on clean gloves that were placed on the portable
machine before entering the room.
Rationale for steps 10, 11, and 12: Once the patient is
touched, gloves are contaminated. To prevent the
machine from being contaminated, change gloves before
touching it.
13. Make the exposure. If additional exposures are
necessary, change gloves again. Place image receptors in
contaminated plastic covers at the end of the patient’s
bed or on a bedside stand.
19
Rationale: The machine is not to be touched with
contaminated gloves or it will be contaminated. The
image receptors that have been placed near or against the
patient are contaminated and cannot be replaced in the
portable machine until the plastic covers are removed.
3. Untie top gown tie
14. When imaging exposures are completed and before
gloves are contaminated by removing the last image
receptor, push the machine out of the room and notify
the assistant to prepare to receive the image receptors.
4. Remove the first sleeve of the gown
15. Take the covered image receptors to the door of the by placing fingers under the cuff of the
unit where the assistant is waiting. Slide the plastic sleeve and pulling it over the hand
covering back from the cassette and allow the assistant
to remove it.* Discard the contaminated image receptor
covers in the waste receptacle in the patient’s room.

Rationale: Prevents contamination of image receptors 5. Remove the other sleeve with a
that must be taken to another part of the hospital for protected hand inside the gown
processing.

16. Return to the patient. Make the patient comfortable.

Place the bed in the low (closest to the floor) position;
put the side rails up and the call button within the
patient’s reach.
6. Slip out of the gown, and
Rationale: The patient’s safety and comfort are the hold it forward so that the inside
highest priority and must always be every healthcare of the gown is facing the
worker’s first concern. outside

17. Leave the patient’s room, and return to the area

prepared to receive your contaminated garments.

REMOVING CONTAMINATED GARMENTS 7. Place the gown in the waste

container. * If gown has been
contaminated with blood or
infectious material, place it in a
1. Untie waist ties of gown biohazard container.

2. Remove gloves according to the 8. Remove the cap and mask. Place
procedure for removing them in the waste
contaminated gloves, and place
them in the waste receptacle 9. Wash hands.
20
INFECTION CONTROL IN THE NEWBORN AND and return the patient to the hospital room
INTENSIVE CARE AND NURSERIES
6. Adjust the bed to the position that is lowest to the
● Prior to entering the newborn or intensive care floor, put the side rails of the bed up, and give the patient
nursery, the radiographer must carefully clean the call button. Notify the unit staff that the patient has
his portable machine with disinfectant wipes. been returned
● He must request a diaper or cover from the
nursery staff to cover image receptors. 7. Wash hands.
● Hands must be scrubbed for three minutes with
an antibacterial soap before working with all
infants.
● If the infant has or is suspected of having an
infectious disease such as MRSA, VRSA, or
ESBL, Tier 2 precautions are to be used as
specified.

TRANSFERRING THE PATIENT WITH A

COMMUNICABLE DISEASE

The following precautions must be taken to prevent

infecting anyone else and also to prevent
contaminating a room or the equipment:

1. The patient must be transported by wheelchair or

by gurney. If he or she has a disease that may be
transmitted by droplet, airborne, or contact route, place a
mask properly on the patient’s face and wear a gown and
mask to protect yourself.

2. Place a sheet on the gurney or wheelchair and then

cover it completely with a cotton blanket. Wrap the
cotton blanket around the patient and then complete the
transfer.

3. When the patient arrives at the destination, open the

blanket without touching the inside.

4. Place a protective sheet on the radiographic table,

transfer the patient to the table, and place a draw sheet
over him or her. Make the necessary exposures. Arrange
work so that the patient does not have to spend more
time than is necessary in the department.

5. Return the patient to the wheelchair or gurney.

Wrap the cotton blanket around him or her

21