Adams School of Dentistry: Infection Control Manual - Chapter 13: Radiology Infection Control Policies

It is the responsibility of all individuals to apply clinical radiation safety and infection control practices involved with diagnostic radiology including faculty, students, staff, and any other individuals who are responsible for the proper use and maintenance of radiological equipment and/or materials. Whenever a piece of equipment is suspect of malfunction, DISCONTINUE use immediately and consult with either an instructor or peer to review potential issue.

Operators should not assume that the radiology operatory is cleaned and disinfected and verify that the operatory has not been used previously. Before patients are escorted to a radiology operatory, all surfaces that could potentially be touched must be cleaned and disinfected including but not limited to patient chair, entire tube head, and counter surfaces.

Review the policy of “Standard Regarding Use of Ionizing Radiation,” for minimum requirements, radiation safety, operator obligations, and general radiology exposure guidelines. Additional policy on Pregnant Students and Radiation may also be reviewed and provide further information.

Radiology PPE Guidelines

Appropriate clinical attire and Personal Protective Equipment (PPE) are required when rendering patient care in the Radiology Clinic AND whenever radiological procedures or examinations are performed. All discarded materials are to be disposed of in appropriately identified Biohazard receptacles. Appropriate attire and PPE are outlined below:

1. Disposable treatment gloves
2. Face shield / Eye protection
3. Mask, ASTM Level 3 or N95
4. Disposable / Reusable gown

Radiology Operatory - Initial Cleaning Procedure

1. Clean and disinfect (wipe/discard/wipe) the following with appropriate intermediate-level disinfectant:
2. Patient chair and armrests
3. X-ray Unit
   • Arm and head
   • Exposure switch panel
4. Work Area
   • Countertops
5. Depending on the type of imaging device utilized, complete the following:

• Digital Sensor
  • Clean and disinfect (wipe/discard/wipe) entire sensor unit with appropriate intermediate-level disinfectant; OR
  • Place in UV sanitation unit and follow manufacturer instructions.
• Digital Sensor Holder
  • Clean and disinfect (wipe/discard/wipe) holder, inside and out, with intermediate-level disinfectant
• Phosphor Storage Plates (PSP)
  • NOTE: Students are to request attending or radiology staff to assist in cleaning and disinfecting PSP units as these units require special care.
  • Clean and disinfect (wipe/discard/wipe) according to manufacturer instructions; OR
  • Place in UV sanitation unit and follow manufacturer instructions

Radiology Operatory - Setup Procedure

1. Perform hand hygiene and put on appropriate PPE. Standard eye protection may be worn under face shield of operator.
2. Login to EPIC and locate the patient’s chart
   1. Power on radiology unit
   2. Set exposure time based on receptor type (Sensor or Phosphor Storage Plate (PSP))
3. Match exposure to anticipated image location
4. Refer to posted technique charts for appropriate exposure times
5. Attach rectangular collimator (not circular) and cover with barrier
6. Select the appropriate type of imaging device and follow the instructions below for setup:

Sensors

1. Open MiPACS desktop and choose the appropriate template for the images ordered.
2. Verify sensor is connected properly and ready for an exposure.
3. Place barrier over sensor wall holder and on sensor. Be sure  to not allow the sensor to drop on the floor as this can damage them.

PSP

1. With clean hands, retrieve PSP’s and a denture cup for exposed/contaminated PSP packets.
2. Place a paper towel on work area for wiping PSP packets.
3. If available and/or applicable, place barrier on counter with printed FMX sheet to keep track of progress.

Setup Procedure - Continued

7. Depending on clinical area, a designated area or container may be present to contain paperwork. If not, designate a “clean area” that only paperwork and other material may temporarily be placed, to ensure cross-contamination does not occur.
8. Retrieve any additional anticipated disposable items that might be needed during the procedure (i.e., cotton rolls, bitewing tabs, additional barrier bags, and so forth).
9. With clean hands, gather sterilized and appropriate XCP instruments (ring, arm, blue, yellow, and red bite blocks) for radiographs, depending on utilization of senor of PSP.

Radiographic Examination

1. Pull up patient’s electronic chart
2. With full PPE, but without gloves, call patient from waiting room and escort the patient from the waiting room to the radiography operatory. Do NOT wear PPE outside of clinical area and into waiting room.
3. Depending on clinical area, place paper charts, orders, and other paperwork in either the appropriate location or designated area.
   • Student Radiology: Place patient paper chart in the bin on operatory wall, not on the workspace with clean and/or contaminated materials
4. Pre-procedure rinse should be given to patient before imaging occurs
5. Place lead apron on patient after seating and BEFORE putting on gloves
6. Adjust patient headrest for support and optimal angle for exposure
7. Imaging Devices

• Direct Digital Sensor
  • After each exposure, verify that image was taken
  • When not in use, return to sensor holder to prevent from accidentally dropping
• PSP Receptor
  • After each exposure, wipe saliva off packet with paper towel
  • Place packet in denture cup

Radiology Operatory - Breakdown Procedure

1. Remove lead apron and place it on the lead apron racks.
2. Remove gloves, perform appropriate hand hygiene, and escort patient back out.
3. Perform appropriate hand hygiene and put on gloves. Remember to wear PPE during operatory breakdown.
4. Remove soiled chair barrier and invert, then fill with all disposable items, dispose of in biohazard receptacle, remove gloves, and perform hand hygiene.
5. Clean and disinfect (wipe/discard/wipe) radiology cubicle surfaces mentioned earlier. If a sensor was utilized, disinfect with one of the appropriate options. Direct sensor (CMOS) holder must be cleaned and disinfected (wipe/discard/wipe).
6. Contaminated instruments are taken apart and rinsed under water and placed in designated sterilization bag in hallway with GLOVES (rinsing of instruments is only necessary if this is not done in Central Sterilization).
7. Once all barriers and trash are removed, wipe each item/surface (countertop, digital sensor, lead apron, black box, exposure button, etc.) once with appropriate intermediate-level disinfectant. Remove gloves, perform appropriate hand hygiene, put on new gloves, and wipe each item/surface again to disinfect. Ensure that all items/surfaces are visibly wet and follow manufacturer instructions for contact time.
8. Remove gloves and perform appropriate hand hygiene.
9. Fold extension arm against wall with PID pointing towards floor.
10. At end of the day, return imaging device(s) to appropriate area, log-off computer, and turn off x-ray unit.

Processing PSP Receptor Procedure

1. Position black box, or appropriate light-proof container, on a clean counter surface, with clean and ungloved hands.
2. Put on gloves, open PSP packet with gloved hands, and allow the PSP receptor to fall untouched into top slit of black box.
3. Once all PSP receptors are in the black box, remove gloves and perform hand hygiene.
4. Verify that MiPACS is closed in operatory and transport black box to clean scanning room. EPIC may remain active but failure to close MiPACS in operatory will result in error of images being scanned.
5. Once the scanner indicates it is ready with green lights, place each PSP receptor into a slot, with the blue side (phosphor)facing the scanner and text facing operator.
6. Wait until all PSP receptors have been scanned before mounting images. Failure to do so may negatively impact images.
7. Retrieve scanned PSP receptor with gloved hand from scanner tray and either place in designated bin or disinfect with one of the appropriate options. Be sure to not dispose of the re-useable PSP receptor.
   • Do not bring PSP receptors back to the operatory or place on any contaminated surface
   • If additional images are required, obtain new PSP receptor.

PSP Disinfection - Staff/Faculty Only

1. Care of PSP receptors require special care and should only be completed by appropriately trained Adams School of Dentistry (ASOD) Staff or Faculty.
2. Put on full PPE, if not already completed, and with gloves, gather receptors for disinfection
3. Transport receptors to designated area for disinfection
4. Wipe each receptor with a PSP cleaning wipe, then place clean receptors in designated clean area.
5. Remove gloves, perform hand hygiene, and put on new gloves.
6. Package each individual receptor in a clean barrier envelope, position the DOT at the open end of the envelope, and seal the package. Ensure that each package is completely sealed to prevent cross contamination.
7. Place sealed envelopes in peel pouch and send to the Central Sterilization Unit for sterilization.

Direct Digital Sensor Disinfection

1. Completing the steps below can be completed by all appropriately trained ASOD Personnel.
2. Put on full PPE, if not already completed, and with gloved hands, remove and dispose the contaminated plastic sleeve from the sensor and the sensor holder.
3. Clean and disinfect (wipe/discard/wipe) the sensor, core, and sensor holder with an US Environmental Protection Agency (EPA)-registered hospital disinfectant (intermediate-level).

Extraoral Radiographic Procedure - Panoramic Units

All areas of potential contamination are to be barriered when using a panoramic unit, with minimal amount of adjustment to this procedure allowed. Adhere to the same guidelines for cleaning and disinfection (wipe/discard/wipe) of radiology operatories. Barriers should be placed over the following areas:

1. Bite block
2. Chin rest
3. Hand rests
4. Control panel
5. Exposure button

Bite blocks should ideally be  sterilized or high-level disinfected between patients. Clean and disinfect (wipe/discard/wipe) all surface areas including chairs, handgrips, bite guides/blocks, head positioning device, remote switch, and control panel. Adhere to the tenants outlined in “Radiology Operatory - Breakdown Procedure” for applying appropriate cleaning and disinfection procedures.

Extraoral Radiographic Procedure - Portable Units

Due to the nature of portable units, no set standard will be applicable across the clinical areas of ASOD. Didactic course/exam and training is required before handling portable units and, at a minimum, each unit should be cleaned and disinfected following the wipe/discard/wipe technique, with an EPA-registered hospital disinfectant (intermediate-level) . Combination of the information from the course and appropriate aseptic techniques from both clinical and radiology operatory procedures should be implemented. Specific questions can be sent to the Infection Control Committee for review with operators utilizing their best judgement in the meantime.

Back to Chapter 12

Proceed to Chapter 14