Current status quo on COVID-19 including chest imaging

Table 4 Precautions to be adopted by the radiologists, radiology staff, and trainees at the workplace and the various disinfection procedures that should be followed

Precautions to be adopted by the radiologists, radiology staff, and trainees at the workplace and the various disinfection procedures that should be followed
As a standard practice with any major public health emergencies from infectious diseases, any patient or personnel entering the health care facility should be screened by infrared temperature detector which measures the individual’s head temperature and displayed on the device
Mandatory wearing of surgical masks by all patients and staff prior to entering the hospital and at all times within the hospital premises
Isolating of symptomatic workers and social distancing to the risk of transmission from asymptomatic careers
Separating workstations by at least 6 feet
Reducing one-on-one consultations and conferences
Rotating the radiologists and staffs within the department in to 2-3 teams, off and on service together to limit the chance of spread of infection within small teams e.g., instituting a 1-week-on, 1-week-off work schedule so an adequate reserve capacity is maintained in case one group has to be quarantined
While continuing to provide emergency and oncology services, non-urgent outpatient visits, imaging studies and interventional procedures should be rescheduled or postponed after discussing with the patient’s referring physician/surgeon. These steps not only allow to free limited resources for the COVID-19 patients, but also allows to maintain safe distance among patients in the waiting, thereby, reducing the risk of transmission of the disease
Enabling teleradiology services, so that radiologists can interpret images remotely from home
Access to PPE especially to those directly dealing with confirmed and suspected COVID-19 cases (including nurses, trainees, technicians and radiologists). It is imperative to practise sterile donning and doffing of PPE in advance, and training should be provided including for safe disposal. A PPE equipment comprises of-medical protective clothing (non-sterile waterproof gown and sterile surgical gown), surgical cap, N95 mask or Ffp2/3 mask, double sterile gloves, face shields and goggles or adhering mask which also provides eye protection
Wide implementation of supportive protection: By using disposable medical caps, medical protective face masks (antifog type or N95 respirators, disposable latex gloves (double layered) and strictly implementing good hand hygiene with alcohol-based rub containing at least 60%-95% alcohol or by washing hands with soap and water for at least 20 s
Mandatory wearing of surgical masks by all patients prior to undergoing imaging
When transporting the patient for any imaging or to IR section, identify the lowest traffic/risk path, including avoiding areas with critically ill patients, if possible
Maintain spatial distance of at least 1 meter whenever possible between patient and staff during transfer
If possible, divide the radiology department into 4 zones: (1) Contaminated zone: Connected to the fever clinic, fever access way, the CT and DR examination rooms; (2) Semi-contaminated: Includes the fever-CT and fever DR control rooms and other patient examination access areas; (3) Buffer zone: Access areas for medical personnel ad a dressing area for technologists; and (4) Clean zones: Includes administrative office and the diagnostic room (rooms containing the work stations and storage rooms for medical supplies). Patients are strictly forbidden from entering the clean zones
No observers, students or unauthorized personnel should be allowed to enter the radiology department
Warning signs should be hung on the doors to the entrance of his hospital as well as the radiology department reminding the mandatory use of face masks as well as maintaining a safe distance
In hospital with more than one CT and one DR systems, one CT scanner and one DR system closest to the emergency department can be exclusively designated for confirmed and suspected COVID-19 patients
Disposable sheets should be used for every CT examination, which should be changed after each study
For ultrasound studies or USG guided procedures: Use single-use sterile gel, and the USG machine and transducer should have an extra-long cord and covered in a double bag
Equipment and environment sterilization procedures: (1) Object surface sterilization: Object surface is cleaned with 1000 mg/L chlorine containing disinfectant, wiped twice with 75% ethanol for non-corrosion resistance, once every 4 h; (2) Equipment sterilization: Cleaned with 2000 mg/L chlorine containing disinfectant. The DR detector and CT gantry in the affected area should be disinfected after each examination, using solutions suggested by the manufacturer/ vendor or wiped with 75% alcohol solution; (3) Equipment located in the buffer zone: Are wiped with 500-1000 mg/L chlorinated disinfectant or alcohol-containing disposable disinfectant wipes twice a day; (4) Sterilization of the air: All central air conditioners should be turned off to prevent air contamination with each other. In the contaminated area: The door is opened for ventilation, each time more than 30 min, once every 4 h. The air sterilizer is continuously sterilized or the ultraviolet ray is continuously used in the unmanned state for 1 h, four times a day. During disinfection the inner shielding should be closed. Other ambient air is sprayed with 1000 mg/L chlorinated disinfectant and ventilated twice a day; (5) Floor disinfection: The floors are wiped with 1000 mg/L chlorinated disinfectant; and (6) Disinfection of the bed: Both the bed and floors are wiped with 2000 mg/L chlorine-containing disinfectant. Visible contamination: Disposable absorbents should be used initially, to completely remove the pollutants, following which a cloth soaked with 2000 mg/L chlorine-containing disinfectant should be used for 30 min before wiping
Additional guidelines for IR staff & procedures: (1) If possible, perform IR procedures at the patient’s bedside to minimize transfer, at the discretion of the interventional radiologist; (2) Identify a procedure room with adequate ventilation/air-exchange (ideally a negative pressure room), with a minimum of 6 air changes per hour; (3) Minimize the number of healthcare professionals/support staff involved in the care of the COVID-19 patients whenever possible; (4) Ensure proper disinfection of re-usable eye protection (e.g., leaded glasses) and lead aprons, and for proper cleaning of the room and equipment; (5) Place appropriate signs indicating the presence of a COVID-19 patient (e.g., “COVID-19 patient: DO NOT ENTER”) on the room entrance; and (6) For AGP, such as gastrostomy/gastrojejunostomy/jejunostomy feeding tube insertion, chest tube insertion, lung/mediastinal biopsy, bronchial artery embolization, etc.; the staff and physicians should wear the following PPE: Gowns, gloves, N95 or equivalent respirator and eye protection (goggles or face shield)

COVID-19: Coronavirus disease 2019; CT: Computed tomography; PPE: Personal protective equipment; IR: Interventional radiology; AGP: Aerosol generating procedures; DR: Digital radiography; USG: Ultrasonography.