key: cord-0889196-bwcy7k51
authors: Yan, Chenggong; Lin, Jie; Xu, Yikai
title: Recommendations for coronavirus disease (COVID-19) prevention and infection control in the radiology department: Chinese experience
date: 2020-07-01
journal: Clin Imaging
DOI: 10.1016/j.clinimag.2020.06.044
sha: 1105a76178e49575331aedd6209fa558b580fff5
doc_id: 889196
cord_uid: bwcy7k51

The coronavirus disease 19 (COVID-19) outbreak, first reported in Wuhan, China, is gradually spreading worldwide. For diagnosis, chest computed tomography is a conventional, noninvasive imaging modality that is very accurate for detection and evaluation of pneumonia and is an important adjunct to real-time reverse transcription polymerase chain reaction diagnosis of the virus. Previous studies have reported typical computed tomography imaging features indicative of COVID-19, such as multifocal ground-glass opacities with or without consolidation. With the sharply increasing demand for computed tomography examination during the outbreak, ensuring appropriate infection control in radiology departments is challenging. Thus, advanced training and education in standardized infection control and prevention practice are essential. The purpose of this brief review is to summarize such training and education for clinical management of this outbreak for radiology department personnel. We will describe standard transmission-based precautions, workflow for computed tomography examination of fever patients, and decontamination management of a radiology department.

J o u r n a l P r e -p r o o f

Coronavirus disease 2019 , caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported in Wuhan, China [1] . It is spreading fast with increasing numbers of infected patients worldwide. Currently, chest computed tomography (CT) is a conventional, non-invasive imaging modality with high accuracy and speed for early screening, primary diagnosis, and evaluation of disease severity [2] . Individuals with CT signs of pneumonia are recommended for quarantine while RT-PCR is performed in conjunction with a thorough medical evaluation to accurately diagnose COVID-19 [3] .With the sharply increasing demand for CT examination, radiology departments are at high risk site for cross infection with SARS-Cov-2. Therefore, implementation of standardized infection control and prevention practices in radiology departments is critically important [4] . This manuscript outlines recommendations for COVID-19 infection control and prevention pertinent to current radiology practice. Procedures are described for standard transmission-based precautions, appropriate use of personal protective equipment (PPE), CT examination workflow for fever patients, decontamination of reusable medical equipment, and decontamination of commonly exposed surfaces in our experience.

J o u r n a l P r e -p r o o f before and after the use of PPE.

Preventative measures, including general education and training, and proper decontamination of radiological equipment, should be taken. Personnel working within the contaminated zone are strictly prohibited from entrance into the potentially contaminated or clean zones. In addition, documentation (e.g. temperature measurement) indicating appropriate infection control practices and procedures should be made available to the radiographers to enforce implementation. With evidence of fever, cough, or other respiratory symptoms, radiographers should timely report to hospital infection control personnel.

Patient screening in fever clinics includes measurement of fever (temperature ≥ 37.2  C), travel, contact history, and symptoms. One important measure for prevention of SARS-Cov-2 transmission within the radiology department is to reduce the fever patient's stay within the department as much as possible. We recommend dedicated routes to transfer infectious patients in and out of radiology services. Patients with respiratory symptoms (e.g., fever, cough) must wear a surgical or N95 face mask during transportation and examination. If an isolation room is not available in the radiology department, suspected or confirmed COVID-19 patients should be separated from others by at least six feet in common waiting areas.

We recommend dedicated CT scanners for examination of patients suspected or confirmed to have SARS-CoV-2 infection. To assess COVID-19 pneumonia, two radiological J o u r n a l P r e -p r o o f technicians are desirable for CT scanning. Using PPE one technician prepares the patient on the CT imaging table, while the other technician operates the CT console. Workflow for chest CT examination is shown in Fig. 2. a. The fever clinic notifies technicians within the receiving department of the patient's arrival and necessary transmission-based precautions.

b. Radiology workers must don PPE that fully covers all body surfaces (Fig. 3A) and then prepare for operation of the imaging equipment. CT table tops, which come into direct contact with patients, must be covered with a replaceable sheet.

c. Once the patient is positioned by the clinician, the technician prepares the patient on the CT imaging table, following detailed protocols for CT scanning. The recommendation is to guide patients to the appropriate position on the examination bed by intercom (Fig. 3B) .

Artificial intelligence-assisted localization technologies for advanced imaging modalities can be used to avoid close contact with fever patients. f. Patients from different groups (e.g., inpatient, outpatient, emergency, and febrile) are segregated by place or time with minimal crossover. If there are several suspected or confirmed patients to be tested within the same period, it is recommended to CT scan suspected COVID-19 patients first and then confirmed patients.

g. When an asymptomatic infected patient with typical imaging features indicative of COVID-19 is identified in a non-febrile patient, radiology staff must immediately report this finding to the hospital. The suspected patient must be sent to the fever clinic for isolation and further investigation.

SARS-Cov-2 can be inactivated by ultraviolet light, high temperature (56C for 30 minutes), conventional disinfectants such as 75% alcohol, chlorine containing disinfectants, and peracetic acid [7] . a. Equipment surface cleaning: Our institution uses wipes saturated with 2,000 mg/L chlorine containing disinfectant or 75% alcohol to clean surfaces and equipment used in the care of COVID-19 patients. This cleaning is accomplished at least twice a day for a period of

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Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases

Health Care-Associated Infections and the Radiology Department

The Battle Against Coronavirus Disease 2019 (COVID-19): Emergency Management and Infection Control in a Radiology Department

Coronavirus 2019-nCoV: A brief perspective from the front line

Chiarello L; Health Care Infection Control Practices