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3. Infection control measures


 

E. Specific problems related to individual imaging modalities


 

General Radiography. Satellite X-ray rooms and portable services should be set up outside the main department for performing chest X-rays for patients with suspected and confirmed SARS, designate a specific room in A&E for X-raying suspected cases. The increase in portable chest X-rays may require the purchase of extra cassettes. Cassettes from contaminated areas should be disinfected.

 
 

The highest precautions also should be taken when performing all X-rays in A&E and there should be a high index of suspicion in any patient undergoing a chest X-ray for acute chest symptoms irrespective of the provisional diagnosis. Ideally, all of these radiographs should be reviewed for the possibility of SARS before the next patient is examined. If the likelihood of SARS is high, then the room should be cleaned before the next patient is examined. This is difficult to enforce in practice for two main reasons

  • The radiographic appearances of SARS are usually not specific enough to allow a firm diagnosis in the absence of additional clinical and laboratory data.


  • The radiographic diagnosis of SARS is difficult in the presence of pre-existing lung pathology.


 

CT. Special attention should be paid to cleaning the injection pump and allocating one pump for those patients with suspected / confirmed SARS.

 
 

Ultrasound. Designate rooms and ultrasound machine for high risk patients. Try to designate ultrasound machines to be used in specific areas such as the neonatal unit or bone marrow transplant unit. The examination should be kept as short as possible to answer the clinical question, if appropriate consider CT scan as an alternative examination. When performing abdominal ultrasound attempt to avoid instructing the patient to take deep breaths, if this can not be avoided turn the patient on their side facing away from you. The transducer should be cleaned after each out-patient and covered with disposable covers for all in-patients. Special precautions have to be taken for obstetric patients, designate a specific room and consider stopping non-essential routine dating and morphology screening scans.

 
 

Fluoroscopy/contrast studies. Many of these examinations such as a barium enema, small bowel enema, sialogram and dactocystogram carry a potentially high risk to staff and other patients, therefore the highest level of infection control should be taken in all cases (in-patients and out-patients) and where possible the examination should be avoided all together in those patients with suspected/confirmed SARS. Ensure that staff knows where to dispose of liquids.

 
 

Magnetic resonance imaging. For in-patients metallic items and false teeth should be removed on the ward and the patient mask should not have a metallic bar. The call bell must be covered with a disposable plastic bag. Potentially MR possesses a higher risk of cross infection because of the prolonged period of time in which the patient head and body are in very close proximity to the equipment.
Ensure thorough cleaning of MR machine, coils, injector and room following examination of suspected or confirmed SARS patient.

 
 

Angiography and interventional radiology. A dedicated room and ultrasound machine should be used for suspected and confirmed SARS cases and for all patients the highest level of infection control should be taken.

 
 

Nuclear Medicine. Ventilation scans must not be performed.