•

•
•
•
1.
Eye contact: Flush eyes with water for 15 minutes or until irritation
subsides. Consult a physician immediately.
Skin contact: Remove any affected clothing; wash skin thoroughly
with gentle soap and water.
Inhalation: Remove from exposure; if breathing has stopped, begin
cardiopulmonary resuscitation; call emergency number and a
physician.
Ingestion: Do not induce vomiting; call emergency number and
Poison Control Center.
Diagnostic imaging personnel must understand the potential hazards of
scalds or burns that may occur in their department. Although the
radiographer does not commonly deal with heating pads and hydrotherapy,
they do present potential hazards and must be handled safely.
Hot beverages must be kept away from children. Coffee and tea
equipment used in staff lounges must be kept in safe working order and
deactivated when empty or not in use. If a patient is offered a hot beverage,
it should be at a temperature that will not scald anyone if it is accidentally
spilled.
Radiation Safety
It is the responsibility of a radiographer to protect patients and personnel
from radiation exposure. Although the benefit of rapid medical diagnosis by
exposure of the patient to radiation outweighs the associated risks, radiation
exposure must be kept to a consistently low level.
Ionizing radiation in excessive amounts or in amounts higher than the
accepted level in a brief period can result in either illness to the recipient or
a potential genetic disturbance to the descendants of the recipient. Other
factors that can increase the risk of suffering the adverse effects of ionizing
radiation are the patient’s age at exposure, sensitivity of exposed cells, and
the size and area of the body exposed. The very young, the very old, and
pregnant women are the most vulnerable to adverse effects of radiation.
The goal of the radiographer must be to limit the amount of ionizing
radiation in the patient, others in the vicinity, and personnel. To do this, the
following precautions must be taken:
Maintain exposure to a level as low as reasonably achievable.
2.
3.
4.
Minimize the length of time the patient or others in the vicinity are
placed in the path of the x-ray beam.
Maximize the distance between the source of the ionizing radiation
and the person exposed to it.
Maximize the shielding from exposure of the patient and others in the
vicinity of the radiation.
Time: Use the shortest exposure time possible. Remember that
radiation dosage increases with fluoroscopic imaging.
Distance: The closer a person is to the radiation beam, the greater the
exposure. The larger the field of radiation, the greater the risks of
scattering the ionizing radiation and the greater the exposure risk.
Increasing distance from the source greatly reduces the exposure
risk of the radiographer and others in the vicinity.
Shielding: Shielding persons who are unable to reduce their exposure
either by limiting time or by increasing distance is the third
alternative for protection from ionizing radiation. Shielding is done
by setting up a protective barrier, usually lead or an equivalent,
between the source of the ionizing radiation and the subject
involved, whether the patient or others in the vicinity. There are
primary and secondary barriers. Primary barriers are usually made
of lead or similar material; they are designed to withstand being
struck by the beam exiting the x-ray tube without allowing passage
of ionizing radiation. Secondary barriers are designed to prevent
passage of scatter and leakage, rather than direct radiation.
The radiographer’s obligation is to ascertain that all persons who are
involved in or in the vicinity of a radiographic procedure are provided with
appropriate protective apparel to shield them from ionizing radiation. This
includes the patient, the physician, nurses, observers, and radiographers.
Shielding can include personal protective apparel (PPA), such as a lead
apron, lead gloves, a gonadal shield, a thyroid shield, and lead goggles (Fig.
4-11). Lead aprons must contain no less than 0.25-mm lead (Pb). Most
aprons are 0.5-mm Pb. This will reduce the amount of radiation to less than
25% of the intensity of the primary beam.
FIGURE 4-11 Lead apron, thyroid shield, lead goggles, and radiation monitor should all be
worn while in the room when the beam is energized.
The use of gonadal shielding to protect male and female reproductive
organs (ovaries and testes, respectively) is of vital importance. This is of
particular importance when the patient is a child or an adult of childbearing
age. There are several types of gonadal shields, including flat and molded
contact shields. The minimum requirement of lead content for gonadal
shielding is 0.5-mm Pb.
The radiographer must use technical expertise to minimize patient’s
exposure to radiation. This includes beam limitation, technique selection,
filtration, intensifying screens, and grids. Explanations of these techniques
are beyond the scope of this text; their use is discussed in detail in other
radiologic technology courses. Additionally, the radiographer has the
responsibility to understand the technical aspects of the profession so that
the number of repeat radiographs necessary to achieve the diagnostic
purpose is minimized. The need to frequently repeat exposures should be
cause to put critical thinking skills to work to assess and solve the problems
that are being encountered. Assess communication with the patient as well
as the skills necessary to properly position the patient and set the proper
technical factors to achieve a diagnostic radiograph on the first attempt.
Estimates of patient exposure to ionizing radiation must be able to be
calculated in the radiographic imaging department. These estimates denote
the amount of radiation an average patient undergoing a given procedure
would expect to receive based on standard technique charts. The amount of
exposure actually received is less than these estimates. All radiographic
imaging equipment must also be inspected for radiation safety at regularly
scheduled times. The state and TJC usually require maintenance of all
inspection records. It is the responsibility of the technologist to monitor the
amount of radiation that is being delivered. The control panels of all
radiographic equipment details the mAs (current) and kVp (voltage) that are
being used. With the recent outcry of radiation burns that have occurred
because of poor monitoring of equipment, legal action will be scrupulously
watched. Technologists may be held legally liable for excessive exposure to
radiation. In 2011, the “Image Gently” and “Image Wisely” campaigns were
initiated to bring awareness to pediatric and adult radiation protection from
excessive radiation.
Lead aprons and other protective apparels must be inspected
periodically for quality control purposes. This apparel must be hung
carefully over a wide bar or on special hangers when not in use. To fold or
drop them may jeopardize their integrity by causing cracks in the lead.
These cracks will allow radiation to get through the apron and to the person
wearing it.
The radiographer and any health care worker who works in constant
contact with ionizing radiation must be monitored to assess the amount of
exposure to it. This may be done by wearing a radiation-monitoring badge
sensitive to low-radiation doses. A specialized company processes the
badge on a monthly or quarterly basis. The results are then returned to the
institution and must be made available to all occupational persons who wear
the badge.
Special precautions must be taken to prevent exposing pregnant
patients and pregnant health care workers to ionizing radiation. This is
particularly true during the early weeks of pregnancy, when particular fetal
tissues are especially sensitive to radiation. This is why it is critical to ask
the female patient if there is any possibility of her being pregnant and also
when her last menstrual period was. Pregnant workers who “declare”
themselves to be pregnant are monitored with a second badge called a fetal
badge worn at the abdomen. Rotations in the department are varied so as to
limit the amount of exposure to radiation. The occupational dose limit for a
fetus must not exceed 0.5 rem during the entire gestation. The exposure
must be limited to no more than 0.05 rem in any month.
To minimize radiation exposure, the radiographer should not hold the
patient during a procedure on a routine basis. Sandbags and positioning
sponges should be used if possible. If this is not feasible, then a relative or a
person who is not working regularly in radiography should be requested to
assist. If all these are not possible, the technologist must stand out of the
primary beam, wear the appropriate PPA, and not hold on a routine basis.
Summary
When an outpatient arrives in the diagnostic imaging department, it is often
necessary for that patient to undress entirely or partially for the diagnostic
examination or treatment. Always show the patient where and how to do so
in a sensitive manner to spare the patient embarrassment.
It is the responsibility of the radiographer to provide the patient with a
safe place for personal belongings. Remember that the patient may treasure
an article of clothing or jewelry that may not seem valuable. Everything that
belongs to the patient must be treated as if it were of value.
If a patient is unable to undress alone, offer assistance. Give assistance
in a matter-of-fact manner that does not violate the patient’s privacy.
Patients must be kept clean and dry while in the diagnostic imaging
department. It is the radiographer’s duty to change the disabled patient’s
gown and covering if they become wet or soiled. Do this in a prescribed
manner to ensure privacy, safety, and comfort. Correct body mechanics
must always be used. When moving or lifting in the workplace, keep the
weight close to the body and maintain a firm base of body support. This is
accomplished by having the feet slightly spread out and knees flexed. Never
twist or bend the body at the waist when lifting a heavy load. Weight should
be pulled, not pushed. Use arm and leg muscles, not the spine for lifting.
The three ways of moving patients are by gurney, by wheelchair, or by
ambulation. When moving and lifting a patient, assess the patient and
resolve potential problems before beginning the transfer. The plan for
moving the patient should be explained, and the patient’s help should be
enlisted before beginning. Always notify the ward personnel when taking a
patient to or from a hospital room. The use of enough assistants and
equipment such as a smooth mover facilitates the move and protects
personnel and the patient from possible injury.
When a patient is on the radiographic table or on a gurney in the
diagnostic imaging department, the body must be in good alignment. If the
patient is moved to a particular position for an examination, restore correct
body alignment as soon as possible.
There are times when immobilizers must be used for the safety of the
adult patient. When immobilizers are required, apply them according to the
manufacturer’s directions and the policy of the institution. Do not
immobilize a patient without an order by a physician. A patient that is
immobilized should be attended to at all times and the immobilizer released
at least every two hours. Follow the correct manner of documenting
immobilization use.
Take care to prevent the patient’s skin from being damaged while being
cared for in the diagnostic imaging department. This can be done by
preventing injury that may come from immobility, pressure, shearing force,
or friction. Patients most susceptible to skin breakdown are the
malnourished, the elderly, and the chronically ill. Take special care to
protect these patients from injuries to their integumentary system, because
they may result in a decubitus ulcer that can take months to heal. Also, take
extra precautions when caring for a patient who is wearing a cast or who is
in traction. Observe the patient’s extremities for evidence of
neurocirculatory impairment, which may result from the pressure of a cast
on the skin. Some symptoms of neurocirculatory impairment that are easily
detected are pain, coldness, numbness, burning or tingling of fingers or
toes, swelling, color changes of the skin, and an inability to move fingers or
toes. If these symptoms are noted, change the patient’s position and report
the problem to the physician immediately. Do not release a traction
apparatus while taking a radiographic image. If the procedure cannot be
completed because of the traction bar, request assistance from the nurse in
charge of the patient.
The radiographer must be on guard to protect patients and other staff
members from accidents in hospitals. Most falls and injuries to patients can
be prevented if the radiographer is knowledgeable about the patient’s
condition and comfort. The radiographer must understand the precautions to
take to prevent fire and the correct procedures to follow if a fire occurs.
Prevention of accidents caused by faulty electrical equipment or poisoning
and the correct use and disposal of hazardous materials are also the
radiographer’s professional obligation.
Unnecessary exposure to radiation to the patient and personnel is the
responsibility of the radiographer. Excessive amounts of radiation from
improper technical factors or from repeat exposures have an adverse effect
on living tissue. The very young, the very old, and pregnant women are
particularly susceptible to adverse effects of ionizing radiation. Precautions
to prevent excessive exposure involve knowledge, technical expertise, and
constant vigilance.
CASE STUDY
Today, you are assigned to work in room 5, which is where the inpatients are
radiographed. Midmorning you receive a request to perform an abdominal series on an
87-year-old female patient, Wilma Schanck, who must come down by gurney. By the
time the patient arrives in your room, it is only 30 minutes before your lunch break. You
begin by taking the chest image with Mrs. Schanck still on the gurney. After this image,
you decide to move her to the table for the kidney, ureter, bladder, and the decubitus
views. As you move the gurney over to the radiographic table and prepare for the move,
you determine that Mrs. Schanck will be unable to move on her own.
QUESTIONS
1. What is the first assessment that must be made?
2. Once this assessment is made, what is the best way to move the patient to the
radiographic table?
3. For the remainder of the procedure, what is the best way to make sure that the
patient remains safe while in your care?
CHAPTER 4 REVIEW QUESTIONS
1.
a.
b.
c.
2.
a.
b.
c.
d.
3.
a.
b.
c.
d.
4.
a.
b.
c.
d.
5.
a.
b.
c.
d.
6.
a.
b.
c.
d.
a.
b.
c.
d.
8.
9.
When admitting a patient to the diagnostic imaging department, what should be done? (Circle
all that apply)
Take the patient to the dressing area and explain in some detail how he or she should
dress for the procedure.
Give the patient directions concerning how to care for valuables brought to the
department.
Assist any patient who appears to need assistance with preparation for an examination.
The most effective means of reducing friction when moving a patient is by:
Placing the patient’s arms across the chest and using a pull sheet.
Pushing rather than pulling the patient.
Rolling the patient to a prone position.
Asking the patient to cooperate.
When transporting a patient back to the hospital room, some safety measures to be used are:
(Circle all that apply)
Place the side rails up, the bed in “low” position, and the call bell at hand.
Inform the nurse in charge of the patient that the patient has been returned to the room.
Give the patient something to eat or drink.
Be sure that the TV is in place for the patient’s viewing.
Contributing factors to create skin breakdown are: (Circle all that apply)
Turning the patient every 1 to 2 hours.
Friction and pressure.
Frequent diagnostic imaging procedures.
A wet environment.
If a patient who has a cast in place complains of pain that is sudden in onset and increases in
intensity when the affected limb is moved, what should be done? (Circle all that apply)
Complete the procedure and discharge the patient.
Elevate the affected limb.
Notify a physician immediately.
Find a nurse to administer pain medication.
When caring for a patient who has a new cast applied to an extremity, what must be
remembered? (Circle all that apply)
Hold the cast firmly at a position between the joints when moving it.
Observe for signs of impaired circulation.
Support the cast with bolsters and sandbags where needed.
The extremity is now almost impervious to pain and can be twisted as needed for the
image.
7. When caring for a patient who is disabled and is difficult to move, it is best to:
Keep the patient as quiet as possible.
Work quickly.
Obtain as much help as necessary to avoid injury to the patient and to the radiographer.
Move the patient by gurney.
When moving a heavy object from one place to another, you should ___________ the weight,
not ______________ it. Doing so allows for the use of the correct arm muscles.
Patients most prone to falls are: (Circle all that apply)
a.
b.
c.
d.
10.
a.
b.
c.
11.
i.
ii.
iii.
iv.
v.
a.
b.
c.
d.
e.
12.
13.
14.
15.
16.
a.
b.
c.
d.
The frail elderly.
The person who is confused.
Persons who have been given a psychoactive drug.
Persons with sensory deficits.
When moving a patient into an unnatural position for a radiographic examination, the patient
should maintain that position:
Until he asks to be moved.
Until the radiograph has been processed and approved by the radiologist.
Only for the time it takes to make the exposure.
Match the following:
Patient on side with
forward arm flexed
and top knee flexed.
Semi-sitting position
with head raised
45° to 60°.
Patient lying flat
on back.
extremities.
Patient on back with
head raised 15° to 30°.
Fowler position
Supine position
Semi-Fowler
position
Trendelenburg
position
Sims position
Name the two convenient and safe methods of moving a patient from a radiographic table to a
gurney.
Describe three legitimate reasons for application of immobilizers to an adult patient.
List four signs of circulatory impairment if a patient is wearing a cast.
What are three methods of reducing a patient’s exposure to ionizing radiation?
The leading cause of work-related injuries in the field of health care is:
Bumping into misplaced equipment.
Overexposure to radiation.
Infection owing to poor handwashing techniques.
Abuse of the spine when moving and lifting patients
BJECTIVES

After studying this chapter, the student will be able to:

Define the basic terminology used in the practice of infection control.

List and describe the known microorganisms that may cause infection.

Explain the rise in antibiotic-resistant diseases and the emergence of previously

unknown or unrecognized diseases.

Describe and demonstrate the methods of controlling infection in health care settings.

Discuss the modes of transmission of HIV, all forms of viral hepatitis, methicillin-

resistant Staphylococcus aureus, vancomycin-resistant S. aureus, vancomycin-

resistant Enterococcus, multiple drug-resistant organisms, Clostridium difficile,

extended-spectrum b-lactamase, and tuberculosis, and the methods of preventing

their spread in health care settings.

List the regulatory agencies that set and maintain the guidelines for safety in health

care and the community at large.

substances or other potentially infectious material, or if a sharp injury occurs in the

course of work.

KEY TERMS

Antibiotics: Soluble substances derived from a mold or bacterium that kills or inhibits

growth of other microorganisms

Antifungal: Kills or inhibits fungi or their growth or reproduction

Antimicrobial drugs: Drugs that tend to destroy microbes or prevent their multiplication

Attenuated vaccine: A weakened or dilute solution of microbes

Bacteria: Colorless, minute, one-celled organisms with a typical nucleus

Broad-spectrum antimicrobial drug: A drug effective against a wide variety of

microorganisms

Carrier: A person or an animal that harbors a particular infectious agent and does not have

clinical disease but is able to transmit the disease to others

Cilia: Mobile extensions of a cell surface

Cytomegalovirus infections: A group of viruses in the Herpesviridae family

Encephalopathy: A disorder of the brain

Enterotoxigenic: Referring to an organism that produces toxins specific for cells in the

intestinal tract

Eucarya or Eukaryote: A cell containing a membrane-bound nucleus and chromosomes of

DNA, RNA, and proteins

Fecal-oral route: Disease passed from one person who has poor handwashing hygiene to

another person through food touched by the former following stool elimination

Fungi: Cells that require an oxygenated environment to live; may be either yeasts or molds

Genetic predisposition: Inherited potential through the genetic transmission for a

particular illness or characteristic

Helminths: Parasitic worms that may live in the human intestinal tract for long periods if not
treated

Immune: Free from acquiring a particular infectious disease

Immunosuppressed: Persons whose immunity is prohibited for physiologic reasons

Infectious disease: A disease capable of being passed from one person to another

Nucleoid: A part of a nucleolus (a nuclear inclusion body)

Parasite: An organism that lives in or on another and draws its nourishment from that on

which it lives

Pathogenicity: The ability to cause disease

Percutaneous injection: Passage through the skin by needle puncture, including

introduction of wires and catheters

Personal protective equipment (PPE): A variety of barriers used alone or in combination

to protect mucous membranes, skin, and clothing from contact with infectious agents

Prion: An infectious particle of non–nucleic acid composition; must mutate to become

infectious

Prokaryotes: An organism consisting of a single cell

Pseudomembranous colitis: (SYN pseudomembranous enterocolitis) formation and

passage of pseudomembranous material due to infection by Clostridium difficile

Retention urinary catheters: Tubes that are placed in the urinary bladder and fixed in

place for a period of time

Sepsis: The presence of pus-forming and other pathogenic organisms

Standard Precaution: A group of infection prevention practices that apply to all patients,

regardless of suspected or confirmed diagnosis

Sterile: Free of all living microorganisms

Vascular access devices: Catheters or needles that are able to enter the blood vessels

Virulent: Extremely toxic

Viruses: Minute microbes that cannot be visualized under an ordinary microscope; the

smallest microorganism known to produce disease

control to protect themselves and others from acquiring infectious diseases.

The practice of infection control measures is a necessity for all who are

working in, being treated in, or visiting health care settings.

The radiographer must understand the methods of isolating body

substances (called Standard Precautions) and be able to correctly perform

all transmission-based precautions as he or she works with patients. Correct

cleaning of equipment, correct hand hygiene, and correct disposal of

contaminated waste must be part of every procedure in imaging to guard

against the spread of infection.

NOSOCOMIAL INFECTIONS

Despite increasing use of infection control measures and the control or

elimination of many diseases, infections in patients while they are receiving

health care have increased. This is the result of the increase in organisms

becoming resistant to anti-infective drugs. Anti-infective drugs include

antimicrobial, antibiotic, and antifungal drugs. Infections acquired in the

course of medical care are called nosocomial infections. This term is most

often applied to infections contracted in an acute care hospital; however, it

also applies to infections patients receive while in extended care facilities,

outpatient clinics, and behavioral health institutions. Infections contracted

at birth by infants of infected mothers are also classified as nosocomial. A

nosocomial infection that results from a particular treatment or therapeutic

procedure is called an iatrogenic infection. Although a patient acquires a

particular infection while in a health care unit, he or she may not develop

symptoms of the illness until leaving the health care environment. This is

still considered to be a nosocomial infection. A person who enters a health

care facility with an infection is said to have a community-acquired

Everyone has microorganisms in their body at all times. These

microorganisms are called normal flora. Infections that are caused by

microorganisms that are not normal flora are called exogenous infections.

When a person acquires an infection in the health care setting as a result of

an overgrowth of normal flora, it is called an endogenous nosocomial

infection.

Endogenous infections are often the result of the alteration in the

number of normal flora present in the body or the alteration in placement of

normal flora into another body cavity. Endogenous infections may also be

the result of treatment with a broad-spectrum antimicrobial drug that

alters the number of normal flora. Many factors in health care facilities

encourage nosocomial infections. Display 5-1 lists these factors.

Factors That Increase the Patient’s Potential for

Nosocomial Infection

There are individuals who present themselves for health care come from

many social and economic environments. A variety of factors in the social

and economic environment may render a person more susceptible to

acquiring a nosocomial infection. Display 5-2 describes some of these

factors.

The bloodstream and the urinary tract are common sites of nosocomial

infections. These are often the result of long-term use of vascular access

devices (VADs) and retention urinary catheters. Infections in wounds

following surgical procedures and respiratory tract infections also occur

frequently. Early removal of urinary catheters, intravenous catheters, and

other types of invasive treatment devices is recommended whenever

possible to reduce the incidents of nosocomial infections. Meticulous care

importance, and will be discussed later in Chapter 11.

MICROORGANISMS

Viruses cause many disease, and are discussed in this chapter.

Infectious diseases are caused by both eukaryotic and prokaryotic

microorganisms. Microorganisms known to produce diseases are bacteria,

fungi, viruses, and prions. If a microorganism is known to produce