Radiology imaging equipment and accessories as possible fomites of nosocomial pathogens.

INTRODUCTION: Radiology is a technical service that provides medical imaging for all sectors of healthcare. Hospital-acquired infections (HAIs) is a major challenge in radiology and this is exacerbated in contexts where the healthcare system is unable to provide adequate funding and attention to effective infection control measures. The objectives of this study were to audit current cleaning procedures through the observation of practices in a radiology department, and to determine the types and numbers of nosocomial pathogens present on selected radiology imaging equipment and accessories before and after decontamination. METHODOLOGY: In phase one we observed seven radiographers to audit cleaning procedures and practices. In phase two we collected swab samples from selected radiology imaging equipment and accessories and then cultured them for identification of microbes. RESULTS: It was observed that radiographers partially practiced infection control measures. This was due to the absence of documented protocol for infection control procedures. Our results indicated that all the selected equipment and accessories were contaminated with microorganisms pre- and post-cleaning. The identified microbes were Staphylococcus aureus, Coagulase negative Staphylococci (CoNS), Bacillus species (spp.), Shigella spp., Shigella sonnei., Klebsiella spp., Salmonella paratyphi A (S. paratyphi A), Salmonella typhi (S. typhi), Providencia rettgeri, Enterobacter spp. and Citrobacter spp. and Methicillin resistant strains of Staphylococcus aureus (MRSA). CONCLUSIONS: The research concluded that the recommended cleaning agents did not effectively reduce the number of microorganisms making the selected equipment and accessories fomites for nosocomial pathogens.

Determining the Need for After-Hours Diagnostic Radiological Reporting in Emergency Departments at Public Hospitals in South Africa: Perceptions of Emergency Physicians in KwaZulu-Natal.

BACKGROUND: Emergency departments in South African public hospitals have a high patient load after hours, with inadequate numbers of health care professionals available to satisfy patient influx. In addition, there is often no provision of after-hours diagnostic reporting services in public hospitals, to an extent that the emergency physician is responsible for interpreting all radiographic images requested themseves. Emergency physicians, in this study, can be described as any medical doctor registered with the Health Professions Council of South Africa and working in the emergency department as a registrar or consultant physician because there were no physicians specialized in emergency medicine working at the hospitals selected for this study. AIM: The aim of this study was to determine the views of emergency physicians on whether there is a need for an after-hours diagnostic radiological reporting service in selected public hospitals in KwaZulu-Natal Province, South Africa. METHODS: A descriptive cross-sectional quantitative research design was utilized, through means of a survey, to assess the emergency physicians' perceptions regarding the need for after-hours diagnostic radiological reporting. In addition, the study used a descriptive quantitative research design to record the number of conventional diagnostic radiographic examinations performed at the selected hospitals, after hours, and the proportional number of these radiographic examinations that were reported on by radiologists during office hours, the following day. The distribution of questionnaires and data collection, with regard to the number of examinations reported on, and those not reported on, were carried out simultaneously during the execution of this study. The study was conducted over a three-month period in 2017, at four public hospitals in KwaZulu-Natal-one of the nine provinces of South Africa. RESULTS: This study found that, during the study period, between 0.1% and 0.6% of the conventional diagnostic radiographic examinations performed, after hours, were reported on by radiologists during office hours, the following day. The surveyed emergency physicians felt that the interpretation of diagnostic images took up valuable time that could be spent on patient management, and there was near-total agreement, whereby 92% (n = 36) of the physicians would have preferred after-hours reporting to be performed by a radiologist. Physicians agreed that having a radiologist or reporting radiographer to provide radiological reports would allow for more effective and efficient patient management. CONCLUSION: The results of this study indicated that there is a need for after-hours radiographic reporting at the selected public hospitals and for the further training of emergency physicians in radiographic image interpretation. Based on the findings of this study, it is recommended that after-hours radiological reporting services be considered for public hospitals and that courses be offered to emergency physicians on the interpretation of diagnostic radiographic images. A hospital policy review may therefore be needed to adjust the focus of hospitals toward reducing the workload of emergency physicians, wherever possible, such as by incorporating support services like radiographic reporting and by providing further training on the interpretation of diagnostic radiographic images, which will both act to reduce the potential risk of misdiagnosis.