MANAGING NEW CHALLENGES IN SERVICE DELIVERY WITH COVID-19: RADIOGRAPHERS’ EXPERIENCE

COVID-19

COVID-19 pandemic is something that many did not “see it coming”. Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus.

The COVID-19 virus spreads primarily through droplets of saliva or discharge from the nose when an infected person coughs or sneezes. Therefore, it is important to practice respiratory etiquette (e.g. coughing into a flexed elbow). Most people infected with the COVID-19 virus will experience mild to moderate respiratory illness and recover without requiring special treatment.

Older people, and those with underlying medical problems like cardiovascular disease, diabetes, chronic respiratory disease, and cancer are more likely to develop serious illness. The best way to prevent and reduce transmission is to be well informed about the COVID-19 virus, the causes of the disease and the mode of spread.

IN PREPARATION OF COVID-19 PANDEMIC

In the Department of Biomedical Imaging, University of Malaya Medical Centre, Kuala Lumpur, a Task Force COVID-19 team was formed to plan, prepare and manage the new challenges and to ensure smooth delivery of imaging services.

The staff were divided into two teams in anticipation of accidental exposures to COVID-19 patients. This was necessary to ensure the service delivery was not interrupted, should the need arise for staff to undergo quarantine process.

As one of the front liner team, the Radiographers are required to screen and scan body temperature of each patients prior to imaging examinations such as X-Ray, CT Scan, MRI and other examinations.

Radiographers carrying out mobile radiography play an important role in performing bedside imaging (e.g. chest X-Ray) at the designated wards and emergency areas. The request for mobile radiography increased during the pandemic as to avoid risk exposure to staff during patient transfer to the imaging department.

Prior to the mobile examination, the equipment (tube head and arm only) is covered with plastic, especially when handling patient on high flow mask / intubated / nebulizer. The image receptor (e.g. Imaging Plate (IP) / digital detector) will be wrapped with zip lock plastic and into another plastic bag to ensure double protection. The equipment is then cleaned using disinfectant.

Should the COVID-19 patient have other diseases, such as Diabetes Mellitus and cardiovascular disease, they are most likely to develop other complications that may require CT Scan or MRI imaging for diagnosis and treatment purposes.

Therefore, several stimulation sessions on donning and doffing Personal Protective Equipment (PPE) and handling of COVID-19 patients were conducted in clinical areas so that staff are aware and well informed in managing the new challenges.

PERSONAL PROTECTIVE EQUIPMENT (PPE)

Generally, when handling routine patients, donning personal protective equipment (PPE) such as surgical face mask, disposable glove (when handling bodily fluid) and practising hand hygiene based on the opportunities and indications should be suffice.

When performing imaging examination for patient under surveillance (PUS), PPE such as, surgical face mask / N95 [for aerosols generating procedure (AGP)], face shield / eye protection, isolation gown (fluid-repellent long-sleeved gown) and non-sterile gloves are donned.

When handling patient under investigation (PUI) or COVID-19 patient, full PPE (listed as for PUS patients with additional PPE such as head cover, shoe cover and scrub suit for AGP patients) are donned.

Surgical face mask is replaced with N95 mask if patient is unable to wear mask, coughing, requires oxygen support or ventilated. Therefore, it is paramount to be aware and be informed of the patient’s condition so that radiographers can protect themselves when performing their duties.

STANDARD OPERATING PROCEDURE (SOP)

It is essential for radiographers to adhere to the new Standard Operating Procedure (SOP) to avoid accidental exposures. After handling COVID-19 patients, the radiographer will perform disinfectant cleaning (on the equipment used) and shower. The room will be decontaminated (by external providers) before proceeding with the next patient for examination.

With the additional requirements, ensuring adequate staffing is important to ensure smooth flow of the imaging services rendered and this was ensured by the Task Force COVID-19 team.

THE IMPORTANCE OF HANDWASHING AND COMPLIANCE TO HAND HYGIENE

We would like to emphasize the important of handwashing and / or hand rub technique. Protect yourself and others from infection by practising proper hand washing with soap and water / using alcohol-based hand rub frequently and avoid touching your face.

THE NEW NORMAL

New protocol, New strategy, Handling Patients, New Guidelines and Teamwork (e.g. Radiologist, Radiographer, Nurses, Attendants and other staff). Together we perform our roles and responsibilities efficiently to face this new challenge, COVID-19.

We are happy to see all staff of UMMC and community in their relentless fight against COVID-19!

Together,

We can Win the Fight Against COVID-19!

#KitaTeguhKitaMenang #KitaJagaKita #MalaysiaPrihatin #StayAtHome #StayHealth #StaySafe #StayCare

The New Normal!

3Cs: Avoid Crowds | Contact | Confined Spaces

3Ws: Wear Masks | Wash Hands and Sanitize | Warn Others to Practise SOP

ACKNOWLEDGEMENT

We would like to thank and appreciate donations of essential items from all generous contributors to the department and University of Malaya Medical Centre (UMMC) in support of the challenging situation. #KitaJagaKita