Infection control is concerned with preventing the spread of infection inhealthcare institutions. It is the practical subdivision of hospital epidemiology which is practiced within any healthcare system rather than directed to the community^[1]. Radiology staff in hospitals manage different patients daily. Some of them might have different infections which could be serious and might even lead to death^[2]. Those patients who have infections can put the radiology staff at risk when they visit the department. Furthermore, they can also be a source of contamination to the radiology area such as surfaces, instruments, and machines^[3]. Therefore, radiology staff should be knowledgeable and up-to-date to deal with such patients^[4]. Moreover, they should be skilled in basic infection prevention measures in order to protect themselves and other patients from the risk of infection^[5].

  According to the Saudi National Council of Statistics, Al Baha area which is located in the south west part of the Kingdom of Saudi Arabia (KSA) has a population of 411,888 people. The health system in Al Baha area is managed by the Ministry of Health and has 10 hospitals with different bed capacities ranging from 30 to 350 beds. However, only five of these hospitals have radiology services. Thus, the purpose of this study is to evaluate the knowledge and attitudes of radiology staff in Al Baha hospitals towardsroutine infection prevention measures when dealing with patients.

Methods

  A descriptive qualitative survey was carried out among all workers in the radiology departments in the five hospitals which provide radiology services in Al Baha. A structured questionnaire (Figure 1) was distributed between the radiology staff and filled out by 73% study participants (82/112). This research was approved by the Ethical Research Committee of the Faculty of Medicine at Al Baha University. All the questionnaires were then entered and analyzed using the Statistical Package for Social Sciences (SPSS) version 16.0. Chi-square (χ²) test and Fishers exact tests were used to test for the differences between categorical data. The results were collected and analyzed using the 0.05 significance level.

Figure 1: Questionnaire to detect the knowledge and Attitude of Infection Prevention Measures among Radiology Staff

Results

  This study was conducted on 82 employees in the radiology departments in Al Baha hospitals with 73% response rate. The study group was categorized according to occupation, experience, and infection control background. The results show that 58.5% of the study group had no previous training in infection prevention precautions (Table 1). Application and practice of standard precautions of infection control at the radiological departments by the study group were generally accepted (Table 2 and 3).

Table 1: General characteristics of the study group.

Table 2: Application of infection prevention precautionsof in the radiology departments.

Table 3: Practice of infection prevention precautions in the radiology departments.

  There was an insignificant relationship between staff occupation and the application of infection prevention precautions in the radiological departments (p-value > 0.05) (Table 4). Practices of precautions of infection control in the radiological departmentsfor all staff members regardless of their occupation were applied onlywhen they knew patientshadan airborne infection (p-value < 0.05) (Table 5).

Table 4: The relation between occupation and the application of infection prevention precautions in the radiology departments.

Table 5: The relation between occupation and the practice of infection prevention precautions of the radiology staff.

  Application and practice of infection prevention precautions in the radiological departments in relation to the experience in years was insignificant (p-value > 0.05), except when it comes to the cleaning and decontamination of equipment and surfaces in the department (p-value < 0.05) (Table 6 and 7). The relation between previous infection control training and the application of cleaning and decontamination of equipment and surfaces in the radiological departments by the study group was highly significant (p-value < 0.01) (Table 8). Table 9 shows that there is a correlation between practices of infection prevention precautionsin the Radiology departments (airborne, droplet, or contact precautions) and previous infection control training (p-value < 0.05).

Table 6: The relation between occupational experience and the application of infection prevention precautions of the radiology staff.

Cleaning and decontamination of equipment and surfaces at the department preformed

Table 7: The relation between occupational experience and the practice of infection prevention precautions of the radiology staff.

Gloves should be changed between patientsAfter exposure to patient during examination you should

Table 8: The relation between previous infection control training and the application of infection prevention precautions of the radiology staff.

Table 9: The relation between previous infection control training and the practice of infection prevention precautions in the radiology department.

Discussion

  Employees in radiology departments are exposed to many risks during their work especially respiratory infection^[3,6]. In some hospitals, this risk may rise with the increase in patient numbers. It was also noticed that the time spent between radiology staff and the patients increase according to the type of procedure they go through. It must be remembered however that some patients might have other infectious diseases other than airborne infections, which can also be another risk to radiology staff. Such patients should be considered as well and radiology staff should be trained or at least aware of them^[7,8,9].

  The study had a 73% response rate with the participants categorized as: technicians 72%, nurses 13.4%, radiologists 7.3%, and others 7.3%. It is a widely held view that infection control involves knowledge, measures, and practice of guidelines adopted to protect healthcare providers and patients^[9]. Thus, standard precautions of infection control are the main plan for the prevention of healthcare related infections, and are applied to all patients at any times regardless of their diagnosis. Elements of these precautions include hand hygiene and the use of appropriate personal protective equipment during contact with a patient and his products. Another problem that radiology staff may face is when a procedure is interventional nature. This might increase the risk of exposure^[10]. Despite the fact that in this study around 76.8% of radiology workers had work experience < 10 years, and just 34 workers (41.5%) had previous training in infection control, their application of infection prevention precautions was fairly accepted. Although, the type and duration of training in Al Baha can be regarding as basic and less frequent in comparison to their counterparts elsewhere in the world, their compliance can be considered acceptable. Lack of infection prevention training among radiology staff in many centers worldwide was reported before in different studies and this deficiency increases the risk of exposure to infection^{[3,8,9,10,11]}.

  Although this study foundthat many radiology staff had positive attitudes when dealing with patients who need respiratory precautions, some staff do not show this kind of behavior. This however should be changed and standard precautions should be applied at all times with all patients; those with or without infection^[12]. Furthermore, radiology staff should inform patients about any precautions and why they must be applied^[10]. This is done for their own safety, the safety of the patient, and for the safety of future patients.

  Each radiology staff, according to their occupational category, have their own way of dealing with patients complaining of airborne symptoms. These results are similar to other studies^[8,9]. All employees in radiology departments should be aware of hygiene requirements during daily routine procedures. Reluctance in infection prevention precautions may lead to bacterial contamination of different surfaces in the department, exposing both staff and patients to the possibility of infection^[3]. Radiology workers are in direct contact with suspected or probable cases of respiratory diseases or other infectious diseases while conducting chest X-ray examinations^[2,13].

  The infection control experience of the department staff could play an important role in prevention of infection. Many surfaces and equipment present in radiology departments can present great challenges for effective disinfection^[14]. The disinfection practices are effective in reducing or eliminating pathogens. Radiology workers should be aware of the value of disinfecting contact surfaces between patients to prevent infection transmission^[4]. This study clearly found that the work experience in years was significantly related with the cleaning and decontamination of equipment and surfaces in the department. In a similar study, the more experience a radiology staff had, the better they are regarding knowledge about infection prevention^[1].

  With regards to the correlation between infection control training and the application of cleaning and decontamination of equipment and surfaces in the radiological department, the study found it was highly significant. Moreover, practices of infection control precautions according to the previous infection control training were significant when performed for patients with airborne, droplet, or contact precautions. Similarly, it is a finding that has also been identified in the literature. Infection control training such as hand hygiene induced significant improvement in awareness and practices among radiographers and healthcare assistants^[5]. Therefore, continuing training is compulsory. On a similar note, it was reported that 94% of surveyed radiology workers needed training in the use of infection control guidelines^[1]. In the Kingdom of Saudi Arabia, infection control is a rapidly growing issue so the infrastructure of this discipline is still under establishment and trying to improve^[15,16].

Conclusion

  This study found that the knowledge and attitude of staff working in Al Baha Radiology departments towards the application of standard precautions of infection prevention was acceptable. However, the results clearly illustrate the need for more continuous training in order to increase awareness of standard precautions and thus minimize infection exposure.

References