Infection Control PDF

used to treat malignant or chronic diseases, which decrease the patient’s Nosocomial infection resistance to infection; antimicrobial Infections acquired in the course of medical care. therapy...

used to treat malignant or chronic diseases, which decrease the patient’s Nosocomial infection resistance to infection; antimicrobial Infections acquired in the course of medical care. therapy, which may alter the normal flora This term is most often applied to infections of the body and encourage growth of contracted in an acute care hospital; however, it resistant strains of microbes. also applies to infections patients receive while in  Equipment - Instruments such as extended care facilities, outpatient clinics, and catheters, intravenous tubing, cannulas, behavioral health institutions. Infections respiratory therapy equipment, and contracted at birth by infants of infected mothers gastrointestinal tubes that have not been are also classified as nosocomial. adequately cleaned and sterilized.  Contamination during medical procedures Iatrogenic infection - Microbes transmitted during dressing Nosocomial infection changes, catheter insertion, or any that results from a invasive procedure may introduce particular treatment infective organisms if correct technique is or therapeutic not used. procedure. Factors that Increase the Potential for Nosocomial Infection: - Age Community-acquired infection - Inadequate rest and exercise Refers to an - Heredity instance when a - Personal habits person who enters - Nutritional status a healthcare - Health history facility has an - Stress existing infection. - Inadequate defenses The bloodstream and the urinary tract are Exogenous vs. Endogenous common sites of nosocomial infections -- long- Exogenous term use of vascular access devices (VAD) and  Infections that are caused by retention of urinary catheters. Early removal of microorganisms that are not normal flora urinary catheters, intravenous catheters, and Endogenous other types of invasive treatment devices is A person acquires an infection in the recommended. health care setting as a result of an overgrowth of normal flora Healthcare Acquired Infections (HAIs) a. Also called nosocomial infections b. Approximately 2 million persons acquire HAI per year c. CDC estimates 90,000 annual deaths because of HAIs d. Most common route of infection involves Factors that Encourage Nosocomial Infection: urinary catheter  Environment - Air contaminated with infectious agents; other patients who have Microorganisms infectious diseases; visitors; contaminated PATHOGEN – A MICROORGANISM KNOWN TO food; contaminated instruments; hospital PRODUCE DISEASE. personnel. Four Major Groups  Therapeutic regimen - Bacteria - classified according to Immunosuppressive and cytotoxic drugs their shape, which may be  spherical (cocci), oblong (bacilli), e. Portal of entry: Any avenue available to enter spiral (spirilla), or pleomorphic the body (lacking a definitive shape). f. Mode of transportation: Route taken by Tuberculosis, Syphilis, Tetanus, pathogens from reservoir to susceptible host Gonorrhea Fungi - cells that require an Terms to remember!!! aerobic environment to live and Pathogenicity - refers to the causative reproduce. Fungi exist in two forms: organism’s ability to cause disease. yeasts and molds. Virulence - refers to the causative Viruses - are the smallest organism’s ability to grow and multiply microorganisms known to produce with speed. disease in humans. Viruses must Invasiveness - is the term used to describe invade a host cell in order to the organism’s ability to enter tissues. survive and reproduce. Examples Specificity - characterizes the organism’s viral diseases are influenza, the attraction to a particular host. common cold; mumps; measles; Reservoir - a human being, an animal, a HIV (AIDS); and hepatitis A, B, C, D, plant, water, food, earth, or any and E. combination of organic materials. Parasites - organisms that live on  Infection is transmitted by direct or or in other organisms at the indirect contact, by droplet, by vehicle, by expense of the host organ which is vector, or by airborne route. either classified as protozoa or  Carrier – a person who transmits disease- helminths. causing organisms with no apparent signs/symptoms of the disease. Elements Needed to Transmit Infection  Direct Contact - When a person or an 1. An infectious agent and a reservoir of animal with a disease or his blood or body available organisms. fluids are touched by another person 2. An environment in which the pathogenic through touching, kissing, injection, sexual microbes can live and multiply. intercourse, etc. 3. A portal of exit from the reservoir.  Indirect contact - is defined as the transfer 4. A means of transmission. of pathogenic microbes by touching 5. A portal of entry into a new host. objects (called fomites) that have been contaminated by an infected person such as dressings, instruments, clothing, dishes, etc.  Droplet contact - involves contact with infectious secretions that come from the conjunctiva, nose, or mouth of a host or disease carrier as the person coughs, sneezes, or talks. Droplets can travel from approximately 3 to 5 feet.  Vehicle route of transmission - includes food, water, drugs, or blood contaminated General Concepts with infectious microorganisms. Cycle of infection = All factors involved in the  Airborne route of transmission - indicates spread of disease that residue from evaporated droplets of a. Infectious organism: Pathogen diseased microorganisms is suspended in b. Reservoir of infection: Place where organisms the air for long periods of time. This can thrive residue is infectious if inhaled by a c. Portal of exit: Any avenue available to exit the susceptible host. body d. Susceptible host: Person at risk for infection  called T cells, macrophages, and neutrophils. Together, the components of this highly complex system attempt to destroy invading antigens. o Colostrum - is the fluid initially secreted by the mammary glands of the new mother. If given to the infant during breastfeeding, it protects the infant, because the infant’s body is not capable of producing antibodies for itself. o Vaccines - are administered to produce artificial immunity to a number of diseases that have been extremely  Vectors - are insect or animal carriers of pathogenic. Attenuated Vaccine - made disease. They deposit the diseased from living microbes where the microbes by stinging or biting the human pathogenic microbe is rendered less host. pathogenic. *** Immune-suppressed persons are at great risk of acquiring infections such as persons with Autoimmune Diseases - occur when substances chronic diseases such as diabetes mellitus or identical to one’s own tissues stimulate antibody cancer or those who are poorly nourished or production and these substances react with the fatigued. host’s tissues in an adverse manner. In other words, one’s own antibodies destroy healthy Direct Contact Transmission: tissue. Examples are rheumatoid arthritis, A. infected person touches susceptible host, systemic lupus erythematosus, and multiple allowing the infectious organisms to come in sclerosis. contact with susceptible tissues B. Fomite: An object that has been in contact with ***An immunocompromised pathogens comes in contact with susceptible person is unable to neutralize, tissues destroy, or eliminate invading C. Airborne transmission: Droplets and dust that antigens from his or her body are able to remain suspended in air for extended systems. This condition may periods of time be present at birth, may be D. Droplet transmission: Transmitted primarily by the result of malnutrition, or coughs, sneezes, or other methods of spraying maybe the result of medical onto a nearby host treatment, disease, injury, or E. Common vehicle transmission: Transmitted an unknown cause later in life. primarily by contaminated items such as food, water, medications, devices, and equipment F. Vector-borne transmission: Animal or insect contains and transmits infectious organism to The Process of Infection humans  Incubation stage - the pathogen enters the body and may lie dormant for a short Body’s defense against disease period, then begins to produce o Antigens - are foreign or unrecognizable nonspecific symptoms of the disease. organic substances that invade the body  Prodromal stage - more specific symptoms and induce it to produce antibodies. of the particular disease are exhibited. o Antibodies – are protein substances The microorganisms increase and the produced by a particular white blood cell, disease become highly infectious. the lymphocyte, or, more specifically, the  Full disease stage - the disease reaches its B cell. B cells work with other lymphocytes fullest extent or, in some cases, produces  only vague, subclinical symptoms; Nosocomial Infection Related to Specific however, the disease continues to be Organisms highly infectious. 1. Methicillin-resistant Staphylococcus  Convalescent stage - the symptoms aureus (MRSA) - Persons who are diminish and eventually disappear. Some transferred from nursing homes, dialysis diseases disappear, but the microbe that patients, aged and debilitated, intensive caused the disease goes into a latent care patients, and all persons who have phase. Examples of these diseases are been hospitalized for a long period of time malaria, tuberculosis, and herpes are most susceptible to MRSA. Some infections. diseases produced by MRSA are decubitus ulcers, pneumonia, endocarditis, bacteremia, osteomyelitis, and septic thrombophlebitis. 2. Vancomycin-resistant S. aureus (VRSA) 3. Vancomycin-resistant Enterococcus (VRE) - Enterococcus is a part of the normal flora in the gastrointestinal tract; however, it is capable of causing disease when it affects blood, urine, or wounds. It is resistant to normal handwashing procedures and adheres to objects in the health care environment and is difficult to remove. Infectious Diseases VRE is thought to be the second most  HIV - Human Immunodeficiency Virus - a causative microbe for nosocomial retrovirus but could be controlled. infections.  AIDS - Acquired Immunodeficiency 4. Bacteremia and fungemia - Bacteremia is Syndrome the result of bacteria in the bloodstream. *** Immediately report to your superior any Fungemia is the result of fungi in the accidental exposure to HIV or AIDS sustained bloodstream. Both are usually the result while working with an infected person! of microbes entering the blood by way of  Viral Hepatitis - an inflammation of the vascular access devices (VAD). cells of the liver that is initially acute, but, 5. Clostridium difficile - C. difficile is a spore- in some cases, may render its victims forming bacteria that release toxins into chronic carriers of the disease. Healthcare the bowel that are resistant to workers most often contract hepatitis B disinfectants and so can be easily spread from needle-stick injuries. from the hands of health care providers.  Tuberculosis - a recurrent, chronic disease This results in pseudomembranous colitis caused by the spore-forming and can produce profound sepsis. Mycobacterium Tuberculosis affecting the 6. Extended-spectrum beta-lactamase (ESBL) lungs. This is a treatable disease if it is - is an ever-increasing threat to treatment diagnosed and treatment is begun early in by antibiotic therapy such as E. coli and its course. If left untreated, massive many gram-negative bacteria. destruction of lung tissue and respiratory failure may result. Infection Control Practices *** Tuberculin testing is required of all Medical asepsis - microorganisms have healthcare workers on a yearly basis to detect been eliminated through the use of soap, possible exposure to infected persons. This is a water, friction, and various chemical skin test called the PPD test. If there is a positive disinfectants. tuberculin reaction, a chest x-ray is done. If there Surgical asepsis - microorganisms and is an indication of need, a prophylactic course of their spores have been completely treatment is begun. destroyed by means of heat or by a chemical process.  Fingernails must be short. Cracked or should be the minimum time allotted for broken nails and chipped nail polish this. harbor microorganisms that are difficult to  Rinse hands well under running water. remove. Shoes must have closed, hard  Dry arms and hands using as many paper toes. Jewelry, such as rings with stones, towels as necessary. must not be worn. A plain wedding band Use lotion on hands and forearms and a wristwatch are the only pieces of frequently. It helps to keep the skin from jewelry that are acceptable for the cracking and thereby prevents infection. healthcare worker to wear in the patient care setting. Medical and Surgical Asepsis Laboratory coats, scrubs, and uniforms Any medical procedure that involves penetration must be washed daily with hot water and of body tissues (an invasive procedure) requires detergent. Chlorine bleach is the use of a surgical aseptic technique. This recommended for clothes that have includes major and minor surgical procedures, become heavily contaminated. A administration of parenteral medications, invasive protective gown must be worn when imaging procedures, catheterization of the working with any patient who may soil urinary bladder, tracheostomy care, and dressing one’s clothing or if it is possible that blood changes. or body fluids will contaminate clothing. Antiseptics – is the term used to refer to Hair is a major source of staphylococcal solutions used to disinfect the skin. contamination. Hair must be worn short Disinfection - many microorganisms as or in a style that keeps it up and away possible are eliminated from the surfaces from your clothing and the patient. Hair by physical or chemical means. should be shampooed frequently. The best means of preventing the spread Medical Asepsis of microorganisms is hand hygiene. Hand A. Includes proper hand hygiene hygiene applies to either handwashing 1. Use alcohol-based hand sanitizer for 15 with plain soap and water, use of seconds antiseptic hand rubs, including alcohol- 2. Conventional handwashing (duration): 30 based products, or surgical hand to 60 seconds antisepsis. a. Adjust water temperature b. Wet hands Handwashing Technique c. Lather antimicrobial soap into hands and  Do not lean against the sink or allow fingers for at least 20 seconds clothing to touch the sink d. Rinse clear  If the faucet is turned on by hand, use a e. Dry thoroughly paper towel to touch the handles and f. Turn off faucet with paper towel when then discard the towel. handles are present  Regulate the flow of water so that it does 3. No wearing of artificial nails not splash from the sink to one’s clothing. B. Microorganisms have been eliminated as much  During the entire procedure, keep hands as possible and forearms lower than the elbows. C. Water and chemicals are used for the  Wet hands and soap them well. Liquid disinfection soap is the most convenient.  With a firm, circular, scrubbing motion, Methods of Sterilization wash your palms, the backs of your hands,  Steam Under Pressure: Items are double- each finger, between the fingers, and wrapped and placed in an autoclave. finally the knuckles. Wash to at least one Autoclaves are manufactured to sterilize inch above the area of contamination. If by gravity displacement and dynamic air hands are not contaminated, wash to one removal. High-speed sterilizers or flash inch above the wrists. Fifteen seconds sterilization is an abbreviated gravity displacement method   Chemical Sterilization: Referred to as low- 5. If the sterility of an item is questionable, it is temperature sterilization. A maximum not to be considered sterile. temperature of 54 degrees C to 60 degrees C of gaseous sterilization is used. Sterile Technique An antimicrobial and sporicidal agent A. Steps to follow in the opening of sterile packs must be used. 1. Check expiration date  Ethylene Oxide: Used for items that 2. Place pack on a clean surface cannot withstand moisture and high 3. Break seal and open pack temperatures. All items sterilized in this 4. Unfold the first corner of the pack manner must be cleansed and dried since away from you water united with ethylene oxide forms 5. Unfold both sides ethylene glycol, which cannot be 6. Pull front portion of the wrap eliminated by aeration and is toxic. toward you and drop it 7. Never touch the inner surface Surgical Asepsis 8. If there is an inner wrap, open it A. Complete removal of all organisms from using the same method equipment and the environment in which 9. Separately wrapped sterile items patient care is conducted may be added to the sterile field B. Includes complete sterilization of by opening the pack and allowing equipment and appropriate skin the items to drop onto the sterile preparation field 1. Chemical sterilization: Soaking 10. Never allow the container to touch objects in germicidal solution the sterile field 2. Boiling: Sterilization with moist B. Pouring liquids into containers in a sterile field heat 1. Carefully determine the contents of the 3. Dry heat: Placing objects in an container oven at temperatures greater than 2. Pour a small amount into a waste 329° F receptacle to cleanse the lip of the bottle 4. Gas sterilization: Items are 3. Pour the medium into the receptacle, exposed to a mixture of gases, being careful not to touch the sterile field which do not harm the materials in the process 5. Autoclaving: Steam sterilization C. Sterile objects or fields touched by unsterile under pressure; most convenient objects or persons are immediately contaminated way to sterilize materials D. Avoid reaching across sterile fields E. If you suspect that an object is contaminated, Rules of Surgical Asepsis to Remember assume that it is contaminated 1. Sterile objects and persons must be kept F. Always assume that damp items are separate from those that are nonsterile. contaminated 2. Anything that drops below the tabletop or G. Do not invade the space between a physician the sterile person’s waistline is no longer and the sterile field sterile and may not be brought up to the H. Never abandon a sterile field; it must be under sterile tabletop. The only parts of the direct observation at all times sterile gown considered sterile are the I. Never turn your back on a sterile field areas from the waist to the shoulders in J. Remember: Only from your waist up and in front and the sleeves from 2 inches above front is sterile the elbow to the cuffs. 3. If one sterile person must pass another, Standard Precaution (Tier 1) they must pass back-to-back. If a needle-stick or sharps injury occurs, 4. The sterile person faces the sterile field report the incident immediately. and keeps sterile gloves above the waist in Items to be reused must be placed in front of his chest. The sterile person must designated puncture-resistant containers avoid touching any area of his body.  for transport to the area designated for because they may stick or spray you in the cleaning and disinfecting. process. If exposure to blood or body fluids is  Place specimens to be sent to the possible, wear gloves, gown, mask, and laboratory in solid containers with secure eye protection! caps. Specimens must be sent to the laboratory immediately after collection for Gloving examination. Specimens must be sent to A. Wash hands thoroughly the laboratory in a clean container and B. Open outer package containing gloves then encased in an outer bag. C. Open inner package, exposing gloves D. Approach glove from open end, and touch Disinfection only inner surface with opposite hand Disinfection - is a term used to describe E. Put on glove, touching only the folded cuff the removal, by mechanical and chemical F. Pick up other glove with gloved hand processes, of pathogenic microorganisms, under the cuff but frequently not their spores, from G. Place second glove on other hand, and objects or body surfaces. unfold cuff Always disinfect items before using them. H. Carefully unfold cuff on both gloves Sterilization is also an option. I. Always keep hands in front of the body If the patient is coughing and sneezing, without touching body covering or placing the patient must be provided with tissues hands under arms and a place to dispose of them. The patient should be removed from a Cleaning and Proper Waste Disposal crowded waiting room to prevent  Floors are heavily contaminated. If an item infecting other persons. to be used for patient care falls to the floor, Put on gloves, a gown, a mask and goggles discard it or send it to the proper if necessary. department to be recleaned. After the patient has been cared for and  Avoid raising dust because it carries leaves the imaging department, wash your microorganisms. When cleaning, use a hands thoroughly and then disinfect the cloth thoroughly moistened with a imaging table and anything in the room disinfectant. that the patient has touched. Then  The radiographic table or other imaging or remove your gown, goggles, and gloves treatment equipment should be cleaned and scrub your hands again. The room with a disposable disinfectant towelette or used for imaging of patients with airborne sprayed with disinfectant and wiped clean diseases should be left vacant for a and dried from top to bottom with paper designated amount of time before towels after each patient use. bringing another patient into that room.  When cleaning an article such as an imaging table, start with the least soiled Standard Precautions area and progress to the most soiled area. A. First tier of transmission-based isolation This prevents the cleaner areas from precautions becoming more heavily contaminated. Use B. System that uses barriers to prevent contact a good disinfectant cleaning agent and with blood, all body fluids, nonintact skin, and disposable paper cloths. mucous membranes, if there is a chance of  Always treat needles and syringes used in transmission of infection the diagnostic imaging department as if C. Assumes all body fluids are sources of infection they are contaminated with virulent D. Assumes all patients are infected microbes. Do not recap needles or touch E. Guidelines them after use. Place them immediately 1. Always wear gloves when any chance of (needle first) in a puncture-proof being in contact with body substances container labeled for this purpose. Do not exists attempt to bend or break used needles  2. Protect clothing by wearing a protective Droplet Isolation gown or plastic apron, if a chance of This happens when a patient sneezes, coughs, coming in contact with body substances talks, or deposits infection from his or her eyes, exists nose, or mouth in other ways, and these droplets 3. Masks or eye protection must be worn if a are inhaled or internalized in other ways to an chance of body-substances splashing uninfected person. Usually, droplets are not exists spread for more than 3 feet by coughing, sneezing, 4. Handwashing is the most effective method or talking. Diseases spread by this route are to prevent the spread of infection influenza, rubella, mumps, pertussis (whooping 5. Uncapped needle syringe units and all cough), most types of pneumonia, diphtheria, sharps must be discarded in biohazard pharyngitis, scarlet fever, and meningococcal containers meningitis. 6. If any contact is made with body 1. A private room or substances, the entire area contacted same with must be washed completely with bleach another person 7. Contaminated articles must be disposed of infected with properly disease; door may 8. Needles should never be recapped but be left open should be placed with the syringe in a 2. A mask for any sharps container procedure that 9. Protective masks or mouthpieces should requires less than be used when performing 3 feet in proximity cardiopulmonary resuscitation (CPR), if to the infected patient providing breaths in addition to chest 3. Standard Precautions compression. Contact Isolation Transmission Based Precautions (Tier 2)  Direct contact occurs when a susceptible  Isolation precautions are meant to person actually touches an infected or separate the patient who has a contagious colonized person’s body surface in an area illness from other hospitalized patients where infectious microbes are present. and from the health care workers. The  Indirect contact occurs when a method chosen depends on how the susceptible person touches or comes into pathogenic microorganism is transmitted contact with an object that has been and on the reliability of the patient with contaminated with infectious the disease. microorganisms. These contaminated objects are called fomites. Airborne Isolation  Diseases transmitted by contact are drug- Air currents carry microorganisms, and special air resistant wound infections; gastroenteritis handling and ventilation are required to prevent caused by: Clostridium difficile, infectious microbes from circulating. Diseases Escherichia coli, Rotavirus, Shigella, and that are spread by airborne route are sudden other gastrointestinal infectious diseases; acute respiratory syndrome (SARS), smallpox, hepatitis A; herpes simplex; herpes zoster; tuberculosis, varicella “chicken pox,” and rubeola. impetigo; scabies; drug-resistant 1. A private room, negative air-pressure gastrointestinal, respiratory, and skin ventilation, and an N95 respirator mask diseases (i.e. MRSA, VRE, VRSA, ESBL); for health care workers; a surgical mask draining abscesses; cellulitis; conjunctivitis; for visitors; door closed diphtheria cutaneous; scabies, lice; and all 2. Standard Precautions multidrug-resistant organisms (infection 3. A surgical mask for a patient to be or colonization). transferred within the hospital 1. A private room or a room with another person infected with the same disease if  the patient cannot be relied on to 6. No visitors or staff with signs or symptoms maintain adequate precautions or is too of infection (colds, rashes, etc.) must go young to do so. into room. 2. Gloves to be worn by health care workers *** To enter and leave a unit with expanded before entering the patient’s room and precautions, the radiographer will need the removed before leaving it. assistance of another radiographer or member of 3. Wearing a gown if there is a possibility of the nursing team who is caring for the patient in touching the patient or items in the room the unit. or if the patient is incontinent or has diarrhea, an ileostomy, a colostomy, or a Patients with Neutropenia draining wound that does not have a A. Have a decrease in white blood cell count barrier dressing in place. B. Neutropenia may be caused by 4. Careful handling of any dressing materials, chemotherapy, immunotherapy, bone linens, and clothing to prevent cross- marrow transplant contamination. C. Radiographers caring for patients with 5. Visitors must wash their hands before and neutropenia must carefully follow hospital after entering the room. protocol so as not to transmit something 6. Standard Precautions. to the patient that they cannot resist 7. Precautions to minimize disease D. Some institutions continue to use a similar transmission if the patient is to be form of isolation called 'reverse isolation' transported within the hospital and PPE as necessary. Things to Always Consider 8. Equipment used in the patient’s room Types of Transmission-Based Precautions must stay in the patient’s room. A. Airborne precautions—in addition to standard precautions Expanded Precautions 1. Wash hands before patient care Patients with neutropenia, pronounced immune 2. Workers and visitors entering compromise, transplant recipients who may be patient’s room must wear rejecting the transplanted organ, and others particulate respirators designated by the physician or infection control 3. Wash hands after patient care officer are susceptible to diseases contracted via B. Droplet precautions—in addition to standard direct or airborne contact. As radiographer, you precautions must adhere to a strict method of entering and 1. Wash hands before patient care leaving the isolation unit, which encompasses 2. Surgical masks required for persons airborne, droplet, and contact precautions. These coming in close contact with patient are known as expanded precautions or strict 3. Wash hands after patient care isolation. C. Contact precautions—in addition to standard precautions 1. Wash hands before entering and after 1. Wash hands before patient care providing care to patient. 2. gloves, and gowns are indicated for 2. Cover gown and gloves are required at all individuals coming in contact with patient times while in patient’s room. 3. Wash hands after patient care 3. Regular face mask may be required in select cases. Infection Control in the Newborn and Intensive 4. Equipment such as stethoscopes, blood Care Nurseries pressure cuffs, and thermometers stay in Mobile Radiography room. A. Requires two people, designated “dirty” 5. No flowers, plants, fresh fruits, or and “clean”; the “clean” radiographer vegetables are allowed for immune- handles the portable x-ray machine and compromised patients. controls while the first “dirty” radiographer touches only the patient;  both must wash hands before and after mask properly on the patient’s face and the procedure wear a gown and mask to protect yourself. B. If protective cap is indicated, it should be 2. Place a sheet on the gurney or wheelchair put on and all hair should be tucked inside and then cover it completely with a cotton C. Mask should be put on next, completely blanket. Wrap the cotton blanket around covering the nose and mouth the patient and then complete the transfer. D. Gown should be put on and tied securely 3. When the patient arrives at the at the back and neck destination, open the blanket without E. Gloves should be put on and pulled over touching the inside. the end of the sleeve of the gown 4. Place a protective sheet on the F. Radiographic IR should be placed in a radiographic table, transfer the patient to protective plastic cover the table, and place a draw sheet over him G. Enter patient’s room and follow all or her. Make the necessary exposures. isolation guidelines that have been posted Arrange work so that the patient does not H. After the radiographic exposure is made have to spend more time than is I. Remove IR from the vicinity of the patient necessary for the department. J. Open the end of the protective covering 5. Return the patient to the wheelchair or K. “Clean” radiographer handling the gurney. Wrap the cotton blanket around equipment should remove cassette from him or her and return the patient to the the open end of the cover hospital room. L. When leaving the patient’s isolation room, 6. Adjust the bed to the position that is carefully remove attire and leave it in lowest to the floor, put the side rails of the room bed up, and give the patient the call 1. Untie waist belt of protective gown button. Notify the unit staff that the 2. Remove gloves patient has been returned. a. Pull off one glove by 7. Wash hands. grasping the cuff and inverting it as it is pulled off Patients in Radiology Departments b. Remove second glove by A. Identify precaution and follow guidelines inserting clean fingers B. Isolation patients should never spend time inside the cuff and waiting in the hallway inverting it as it is removed C. Carefully cover x-ray table with a sheet 3. Untie neck and back strings from D. Work in pairs so that only one gown radiographer is in contact with the patient 4. Remove mask by using strings only (dirty) while the other radiographer 5. Remove gown by holding it away manipulates the equipment (clean); both from the body as it is removed wash hands 6. Carefully wash hands E. Carefully cover patient with protective 7. Use paper towels to touch faucet sheets and blankets when returning handles patient to the wheelchair or cart M. After portable x-ray unit is moved safely F. All contaminated materials must be placed outside the room, it should be cleaned in an appropriate discard bag thoroughly before it is returned to the radiology G. Carefully clean off x-ray table and any department other equipment with which the patient came in contact Transferring a Patient with a Communicable H. Remove gloves and carefully wash hands Disease 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