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1. Education and infection control enforcement. Set up an infection control team to set guidelines, continually update measures and enforce infection control.
   
   Regular education sessions ensuring all staff (cleaners, workmen, clerical staff, secretaries, nurses, radiographers and radiologists) are involved and work as one unit. Clearly laid out protocols and infection control guidelines should be posted on the walls in all relevant rooms to remind staff.



2. Department layout. Where possible locate some modalities for SARS patients outside the main department. In the main department, waiting areas and access should be segregated. Minizise waiting area congestion. Separate in-patient and out-patient waiting areas and segregate suspected or confirmed SARS patients from all other patients. Designate areas for changing and disposal of contaminated apparel -these sites should be near the examination rooms. Ensure staff are informed and instructions for putting on and removing apparel are posted in these rooms.



3. Staffing. Staff should be rotated to reduce the viral load to individuals in high risk areas. If manpower allows, staff should have regular allocated time periods way from work during which they are monitored for signs of infection. Special arrangements must be taken for pregnant staff.



4. Appointment booking. Reduce number of booked appointments to give staff the time to carry out infection control.
   
   Try to minimise transfer of request forms between patients and staff and among staff. In-patient requests should be faxed or phoned to Radiology Department (rather than attending clinicians visiting Department).
   
   Advise out-patients to attend punctually at scheduled examination times and with the minimum number of accompanying persons. Restrict out-patient visitors to those accompanying children, very sick or aged relatives.
   
   If patients can only be segregated by time ensure the allocation of appointments is graduated from low risk to high risk patients.
   
   Relative risk status of patient should be indicated on request form.
   
   Relative risk status of in-patients should be re-checked by calling on ward before transfer to Radiology Department.



5. Lifts and porters. If access to radiology is by lift, ensure that one lift is designated for use only by patients with suspected/confirmed SARS. It is essential that the portering service is prompt so that patients with SARS do not spend time waiting around X-ray departments



6. Screening out-patients for SARS. Outpatients should be screened for SARS using a questionnaire on arrival. Those with suspected SARS will have their appointment postponed and asked to attend screening clinic.



7. Co-ordination. When guidelines for an individual modality are set up, ensure the impact on other modalities is taken into account (such as time arrangements for examining SARS patients).



8. Handling of films. Reduce handling of films and notes by reloading previous examinations onto monitors rather than requesting old films.



9. Resuscitation. This is a high risk area for staff. Ensure everyone is fully protected before starting resuscitation. The nursing officer should make sure that all the necessary protective equipment (facial shields, gloves, isolation gowns, and caps) is available on the emergency trolley in sufficient quantity. All staff should familiarise themselves with the procedure so they can prepare themselves quickly. Call the hospital resuscitation team. Even though the situation may be critical, make sure you are fully protected before you commence the resuscitation. Maintain airway and breathing by Ambu bag. Make sure the Ambu bag is connected with a filter before using it for resuscitation. Do not intubate, wait for the hospital resuscitation team.



10. Portable examinations. Designate portable machines. Ensure staff knows where to change and dispose of contaminated apparel, and how to clean or arrange for cleaning of equipment after use.



11. Requesting examinations. Clinicians must be prudent in their request of imaging especially in SARS patients. Requests should only be made when the examination result will have a major impact on patient management.



12. Room cleaning. Cleaning staff should have clear instructions and a checklist of things to clean in any given room. Unused equipment should be covered with sheets prior to examination of suspected or confirmed SARS patients.