Skin care

1. Patient Care and Management
Semi-Final
Topic 1
SKIN CARE
 The radiographer is responsible for the care of the patient’s skin or integumentary
system while in the diagnostic imaging department.
 Skin breakdown can occur in a brief period of time (1 to 2 hours) and result in a
decubitus ulcer that may take weeks or months to heal.
 A subcutaneous fat layer cushions the skin of young persons, but this underlying
padding decreases with age and may be nonexistent in the elderly.
 When the subcutaneous fat layer is lost, any shear pressure can cause the skin to tear
and bleed.
Factors that contribute to skin breakdown
 Creating pressure on the skin
 Immobilizing a patient in one position for an extended period of time
creates pressure on the skin that bears the patient’s weight.
 Creating a shearing force
 Moving a patient to or from a diagnostic imaging table too rapidly or
without adequately protecting the patient’s skin may damage the
external skin or underlying tissues as they are pulled over each other
creating a shearing force.
 Creating friction
 caused by movement back and forth on a rough or uneven surface such
as a wrinkled bed sheet.
 Allowing a patient to lie on a damp sheet or remain in a wet gown may
lead to skin damage. Similarly, urine and fecal material that remain on
the skin act as an irritant and are damaging to the skin.

2.  tissue necrosis
- death of body tissue, it occurs when too little
blood flows to the tissue.
 Early signs that indicate imminent skin
breakdown are blanching and a feeling of
coldness over pressure areas. This
condition is called ischemia.
 Ischemia is followed by heat and redness in the area as the blood rushes to the
traumatized spot in an attempt to provide nourishment to the skin. This process is called
reactive hyperemia.
 If, at the time of reactive hyperemia, the pressure on the threatened area is not relieved,
the tissues begin to necrose, and a small ulceration soon becomes visible.
Decubitus Ulcer

3.  The areas most susceptible to
decubitus ulcers are the scapulae,
the sacrum, the trochanters, the
knees, and the heels of the feet.
 The patient who is on the imaging
table for a long period of time
should be allowed to change
position occasionally to keep
pressure off the hips, knees, and
heels.
 Place a pillow or soft blanket under the patient or by turning him or her to a different
position whenever possible. This is done in the usual hospital situation every 2 hours.
 If the patient is lying on a hard surface, such as the radiographic table, it should be done
every 30 minutes.
 If a patient is perspiring profusely or is incontinent of urine or feces, make certain that
he or she is kept clean and dry, and take precautions when moving the patient to prevent
skin abrasions.
 Persons who are most prone to skin breakdown are the malnourished, the elderly, and
the chronically ill.
 They may have:
 dehydrated skin
 an accumulation of fluid in the tissues (edema)
 increased or decreased skin temperature
 a loss of subcutaneous fat that acts to protect the skin
CAST CARE AND TRACTION
 Radiographic exposures of
fractures that have been casted are
often needed to determine correct
positioning of musculoskeletal
tissues.
 Casts may be made of plaster,
fiberglass, plastic, or cast-tape
materials. The material used
depends on the type of injury, the
length of time needed for immobilization, and the
physician’s preference.
 The radiographer will often care for the patient who has a
newly applied cast. Some of the materials used, particularly
plaster, contain water and can accidentally be compressed.
 Compression of a cast may produce pressure on the patient’s
skin under the cast, and this, in turn, may lead to the
formation of a decubitus ulcer at the site of cast
compression.
 A cast that becomes too tight may cause circulatory
impairment or nerve compression.
 When moving a patient who is wearing a cast, slide an
opened, flattened hand under the cast.

4.  Avoid grasping the cast with fingers, since this may cause indentations if the cast
material is still damp.
 A cast must be supported at the joints when it is moved.
 A casted extremity must be moved as a unit with flat hands supporting it at the joints.
 When moving a patient who has an abduction bar placed between the legs of a spica
cast, it is imperative that the abduction bar not be used as a moving or turning device.
 To position a patient who is in a cast, positioning sponges or sandbags must be on hand
so that the cast can be well supported.
 A recently casted limb usually should be kept elevated.
 If a cast is allowed to put pressure on the skin in any area, it may impaired circulation
or damage underlying nerves.
Signs of impaired circulation or nerve compression
 Pain
 Sudden pain or pain that increases with passive motion may indicate nerve
damage.
 Coldness
 Fingers or toes distal to a cast should feel warm.
 Numbness
 A cast that is too tight may cause numbness, another sign of nerve damage.
 Burning or tingling of fingers or toes
 These symptoms may indicate circulatory impairment.
 Swelling
 Indicative of edema, swelling may result in circulatory impairment or nerve
compression.
 Skin color changes (to a pale or bluish color)
 Skin should remain pink and warm. In darkskinned persons, temperature and
comparison with the normal extremity are evaluated.
 Inability to move fingers or toes
 All fingers and toes should be able to be moved and fully extended and flexed.
 Decrease in or absence of pulses
 These changes may indicate circulatory impairment
 If the last three changes are observed, the physician should be notified and an
attempt to relieve the pressure must be made.
 If the patient in a body cast or a spica cast reports difficult respirations or nausea or is
vomiting, notify the physician because this may indicate abdominal distress that
requires immediate treatment.
 Radiographic images of patients who are in traction will require the use of the portable
unit.
 When working with a patient in a traction device, the traction apparatus must never be
removed or pulled on. To do so may cause a reduced fracture to become misaligned.

5. Topic 2
MEDICALASEPSIS
• deals with reducing the probability of infectious organisms being transmitted to a
susceptible individual.
• the state of being free from disease-causing microorganisms.
Microorganisms
• living organisms that are too small to be seen with the naked eye.
• They include bacteria, viruses, protozoa, prions, and fungi
• normal flora
– microorganisms that live on or inside the body without causing infections or
diseases
• pathogens
– Microorganisms that cause infections and diseases.
• nosocomial infections - acquired in the course of medical care.
– infections contracted in an acute care hospital
– infections patients receive while in extended care facilities, outpatient clinics,
and behavioral health institutions.
– Infections contracted at birth by infants of infected mothers
– iatrogenic infection - a nosocomial infection that results from a particular
treatment or therapeutic procedure
– occupationally acquired - when the infection contracted by health care workers

6. CYCLE OF INFECTION
Elements Needed to Transmit Infection
1. pathogenic or infectious agent (may be a bacterium, a fungus, a virus, a prion, or a parasite)

7. 2. reservoir or environment in which the pathogenic microbes can live and multiply
-a human being, an animal, a plant, water, food, earth, or any combination of organic materials
that support the life of a particular pathogen
- might be a patient with hepatitis, a radiographer with an upper respiratory infection, or a
visitor with staphylococcal boil.
3. A portal of exit from the reservoir
- may be any route through which blood, body fluids, excretions, or secretions leave the body.
- examples include the respiratory, urinary, and gastrointestinal tracts; an infected wound; and
the bloodstream.
4. A portal of entry into a new host
- is the route by which microorganisms gain access into the susceptible host.
5. A means of transmission
• Direct contact
– when a person or an animal with a disease or his blood or body fluids are
touched. This contact can be by touching with the hands, by kissing, by
percutaneous injection, or by sexual intercourse.
• Indirect contact
– involve transport of organisms by way of fomites, vectors, vehicles, airborne,
and droplet contamination.
Indirect contact
• fomite - an object that has been in contact with pathogenic organisms
– fomites in the radiology department might include the x-ray table, vertical
bucky, image receptors, positioning sponges contaminated with infectious body
fluids, or perhaps your contaminated gloves.
• Vectors - insect or animal carriers of disease. They deposit the diseased microbes by
stinging or biting the human host.
– examples of vectors are mosquitoes that transmit malaria or dengue fever
• vehicle - any medium that transports microorganisms.
– Examples include contaminated food, water, drugs, or blood.
• airborne contamination - occurs either by dust that contains spores or by droplet
nuclei, which are particles of evaporated droplets measuring 5 microns or smaller
containing microorganisms that remain suspended in the air for long periods
– examples are M. tuberculosis, rubeola, and the varicella viruses
• Droplet contamination - occurs when an infectious individual coughs, sneezes,
speaks, or sings in the vicinity of a susceptible host.
– involves contact of the mucous membranes of the eyes, nose, or mouth of a
susceptible person with large droplets
– Examples are Influenza, meningitis, diphtheria, pertussis, and streptococcal
pneumonia
– The process of reducing the total number of organisms is called microbial
dilution and can be accomplished at several levels.

8. • The process of reducing the total number of organisms is called microbial dilution and
can be accomplished at several levels.
Levels of Microbial Dilution
• First level
– simple cleanliness measures that can reduce the transmission of
microorganisms, such as the ff:
– proper cleaning
– dusting
– linen handling
– hand hygiene techniques,
• Second level
• disinfection
• involves the destruction of pathogens by using chemical materials.
– use of alcohol
• Third level
• surgical asepsis or sterilization.
• This involves treating items with heat, gas, or chemicals to make them germ-free. The
sterile items are then stored in a manner that prevents contamination.

9. How can you fight the spread of infection?
• Stay home when you are ill if possible. If you must work, avoid contact with
immunocompromised patients.
• Use a tissue to cover your mouth when you sneeze or cough.
• Wear a clean uniform or hospital scrubs daily, and remove them before leaving the
hospital or clinic.
• The best option is to wear hospital scrubs so that they can be laundered by the hospital.
• Perform hand hygiene frequently.
• Use established precautions when handling patients, linens, or items contaminated with
body substances.
• Change or remove contaminated gloves after handling a patient or before touching other
objects or equipment in the room.
• Practice good housekeeping techniques in your work area.
• When in doubt about the cleanliness of any object, do not use it.
• Dispose immediately of linens, instruments, or other items that touch the floor.
• The floor is always considered contaminated.
• Ask patients who are coughing or sneezing to cover mouth and nose with tissues.
Hand Hygiene
• Microbes are most commonly spread from one person
to another by human hands.
• It follows that the best means of preventing the spread
of microorganisms continues to be hand hygiene.
• Correct hand-washing procedure before and after handling supplies used for patient
care and before and after each patient contact is required.
• Hand hygiene is required even if gloves have been worn for a procedure as there may
be small punctures in the gloves.
• Treat all blood and body substances as if they contain disease-producing
microorganisms and dispose of them correctly. Then wash your hands.
• Approach the sink and turn on the tap.
• Do not allow your uniform to touch the sink.
• Apply soap. Clean your hands and knuckles and the areas between your fingers with a
firm, rubbing motion.
• Clean your fingernails with running water to flush away dirt and microorganisms.
• Clean your wrists and forearms with a firm, circular motion.
• Because of the high degree of
non-compliance with
handwashing before and after
each patient contact, waterless
alcohol-based hand rubs are
now used effectively in place of
many handwashing situations.
• If hands have been heavily
contaminated, hands must first
be washed as described earlier
and then the antiseptic rub
used.

10. Housekeeping
• Good housekeeping in the workplace reduces the incidence of airborne infections and
the transfer of pathogens by fomites.
• A clean, dry environment discourages the growth of all microorganisms.
• Much of the cleaning in the radiology department may be done at night by the
housekeeping staff, but the radiographer is responsible for inspecting the work area
regularly and maintaining high standards of medical asepsis.
Several general principles apply whenever cleaning is required:
• Always clean from the least contaminated area toward the more contaminated area and
from the top down.
• Avoid raising dust.
• Do not contaminate yourself or clean areas.
• Clean all equipment that comes in contact with patients after each use. Use a cloth
moistened with disinfectant.
• The CDC recommends sodium hypochlorite bleach (Clorox) as an
inexpensive, effective disinfectant for preventing the spread of HIV.
• Mix bleach in a 1:10 solution daily, because its effectiveness declines
rapidly when diluted.
Handling and Disposal of Contaminated Items and Waste
Handling Linens
• Objects or linens soiled with body secretions or excretions are considered contaminated
and may serve as fomites even when no stains are apparent.
• Any linen used by patients should be handled as little as possible.
• To prevent airborne contamination, fold the edges of linens to the middle without
shaking or flapping, and immediately place loosely balled linens in the hamper.
• Never use any linen for more than one patient.
• Most institutions today handle all linen the same way, regardless of the degree of
contamination.
• The linen is placed in plastic bags, and laundry handlers follow established precautions
to prevent infection transmission.
Disposal of Contaminated Waste
• A modern hospital uses many disposable items, from simple objects such as paper cups
and tissues to more complex items such as catheterization sets.
• Disposable items are designed to be used only once and then discarded.
• The only exception to this rule involves the immediate reuse of an unsterile item (for
example, emesis basin) by the same patient.
• Each hospital has a protocol for discarding disposable items. Some separate glass,
plastic, and paper into covered containers, while others place everything together.

11. • Follow the procedure for your institution. Regulations demand that objects
contaminated with blood or body fluids be discarded in a suitable container and marked
with the biohazard symbol .
• Used needles and syringes are placed in special containers designed to receive the
syringe without recapping it.
• Contaminated bandages and dressings are handled with gloves and placed directly into
red plastic biohazard bags, which are sealed and discarded.
• Before sending specimens to the laboratory, place them in clean containers with secure
caps and slip them inside a plastic bag labeled with a biohazard Symbol.
Topic 3
• Standard Precautions are designed to reduce the risk of transmission of unrecognized
sources of bloodborne and other pathogens in health care institutions.
• Standard Precautions apply to:
– Blood
– All body fluids
– Secretions and excretions (except sweat), regardless of whether they contain
visible blood
– Nonintact skin
– Mucous membranes
• Remember that the key to effective protection is using a consistent approach to all
contact with all body substances of all patients at all times.
• In 2005 the CDC published revised guidelines for infection control for all persons
working in health care settings.
• Atwo-tier system was established to be applied as prescribed for patients with particular
diagnoses.
• STANDARD PRECAUTIONS (TIER 1)
– to be used at all times when any health care worker is caring for a patient.
• TRANSMISSION-BASED PRECAUTIONS (TIER 2)
– designed to place a barrier to the spread of highly infectious diseases between
persons with such diseases and the persons caring for them.
STANDARD PRECAUTIONS (TIER 1)
• minimum infection prevention practices that apply to all patient care, regardless of
suspected or confirmed infection status of the patient, in any setting where health care
is delivered.
• Hand hygiene.
• Use of personal protective equipment (e.g., gloves, masks, eyewear).
• Respiratory hygiene / cough etiquette.
• Sharps safety (engineering and work practice controls).
• Safe injection practices (i.e., aseptic technique for parenteral medications).
• Sterile instruments and devices.
• Clean and disinfected environmental surfaces.

13. TRANSMISSION-BASED PRECAUTIONS (TIER 2)
• designed to reduce the risk of airborne, droplet, and contact transmission.
• They may be used separately or in combination for diseases with multiple routes of
transmission and must be used with Standard Precautions.
• Isolation precautions are meant to separate the patient who has a contagious illness
from other hospitalized patients and from the health care workers.
• If a disease can be transmitted only by direct contact, the reliable patient may remain
in a ward or a room with another patient.
• If the disease is spread by airborne route, a private room is necessary; however, two
patients who have the same disease may share a room.
Airborne Isolation
• This method of transmission occurs when microbes are spread on evaporated droplets
that remain suspended in air or are carried on dust particles in the air and may be inhaled
by persons in that room or air space.
Diseases that are spread by airborne route are:
• sudden acute respiratory
• syndrome (SARS)
• smallpox
• tuberculosis
• varicella “chicken pox”
• rubeola
• When diseases require this type of isolation, the
following precautions are required.
– A private room, negative air-pressure
ventilation, and an N95 respirator mask for
health care workers a surgical mask for visitors;
door closed.
– Standard Precautions
– A surgical mask for a patient to be transferred
within the hospital
Droplet Isolation
• Transmission by droplets occurs when droplets
contaminated with pathogenic microorganisms are
placed in the air from a person infected with a droplet-
borne infection.
• This happens when a patient sneezes, coughs, talks, or
deposits infection from his or her eyes, nose, or mouth
in other ways, and these droplets are inhaled or internalized in other ways to an
uninfected person.

14. Diseases spread by this route are:
• influenza,
• rubella
• mumps
• pertusis (whooping cough)
• most pneumonias,
• diptheria
• pharyngitis
• scarlet fever
• meningococcal meningitis.
• The following are requirements for
precautions for disease spread by droplet
transmission:
• A private room or a room with another person
infected with the same disease; door may be
left open.
• A mask for any procedure that requires less
than 3 feet in proximity to the infected patient.
• Standard Precautions
Contact Isolation
• There are two types of contact spread of infection,
1. Direct contact - Direct contact occurs when a susceptible person actually touches an infected
or colonized person’s body surface in an area where infectious microbes are present.
– Colonization is defined as the presence of microorganisms on the skin or body
surface of an individual who has no symptoms of the disease.
2. Indirect contact occurs when a susceptible person touches or comes into contact with an
object that has been contaminated with infectious microorganisms.
• These contaminated objects are called fomites.
– A fomite can be a soiled instrument, a used syringe, a food or beverage
container, or contaminated hands.
The following are precautions to prevent disease spread by contact:
• A private room or a room with another person infected with the same disease if the
patient cannot be relied on to maintain adequate precautions or is too young to do so
• Gloves to be worn by health care workers before entering the patient’s room and
removed before leaving it
• Wearing a gown if there is a possibility of touching the patient or items in the room or
if the patient is incontinent or has diarrhea, an ileostomy, a colostomy, or a draining
wound that does not have a barrier dressing in place
• Careful handling of any dressing materials,linens, clothing to prevent cross
contamination
• Visitors must wash hands before and after entering

15. Radiography of Isolation Patients
• Patients placed in isolation often tend to feel rejected and "untouchable." You can help
alleviate these feelings by expressing a friendly interest in the patient and by avoiding
any display of fear or revulsion as you perform your duties.
Radiography of the isolation patient requires two people:
• (1) the "clean radiographer" positions the x-ray equipment
• (2) the "dirty radiographer" places the covered image receptor and positions the
infectious patient.
• Cross contamination is minimized when both radiographers remember their roles and
also minimizes contamination of x-ray equipment, which is difficult to disinfect
completely.
• Both radiographers don the attire necessary to enter the isolation room and perform the
exam.

16. • Upon completion of the exam, the radiographers carefully remove the contaminated
isolation attire, disinfect the equipment and imaging receptor, and perform hand
hygiene.

18. • Isolation patients may need to be transported to the radiology department for imaging
studies.
• This will also require a minimum of two radiographers who don the protective attire
and work as a team to complete the exam.
– one to position the patient and the other to position the equipment and controls.
• The stretcher or wheelchair must be covered with a sheet and disinfected after transport
of the patient.
• The x-ray room must also be disinfected; and linen and contaminated wet and dry waste
should be disposed of appropriately.
Surgical Asepsis
• Surgical asepsis is the complete destruction of all organisms and spores from equipment
used to perform patient care or procedures.
– often associated with the surgical suite, but it is also used whenever performing
any invasive procedure, such as a lumbar puncture or urinary catheterization.
– establishing a sterile field, performing a surgical scrub, and donning sterile attire
to assist with an invasive procedure, such as an angiogram, are all examples of
practicing surgical asepsis.
• Sterile items used in the radiology department are usually obtained from central sterile
supply. Most disposable items, such as small syringes, intravenous sets, and
catheterization sets, are sterile when purchased and are protected by a paper or plastic
wrap. Reusable items, such as instruments and glass syringes, are wrapped, sterilized,
and reissued by central sterile supply.
• Although the radiographer is seldom directly involved in the process of sterilization, it
is helpful to understand the methods that may be involved.

19. Methods of Sterilization
• Chemical sterilization
• involves the immersion and soaking of clean objects in a bath of germicidal solution
followed by a sterile water rinse. The effectiveness of this process depends on solution
strength and temperature and the immersion time, all of which are difficult to control
accurately.
• Dry heat
• such as that in an oven, is required to sterilize some sharp instruments, certain powders,
and greasy substances. The amount of time needed for this type of sterilization varies
from 1 to 6 hours at a temperature range of 329°F to 338°F (165"-170°C).
• Conventional gas sterilization
• Items that would be damaged by high temperatures are usually sterilized with a mixture
of gases (freon and ethylene oxide) heated to 135°F (57°C). Gas sterilization is used
primarily for electrical, plastic, and rubber items, and for optical ware.
• Telephones, stethoscopes, blood pressure cuffs, and other equipment used in
isolation rooms may be sterilized in this manner.
• This treatment is very effective but has one drawback. The gases used are
poisonous, so they must be dissipated by means of aeration in a controlled
environment.
• Gas plasma technology
• Items are cleaned, wrapped, and placed in a compact mobile unit where low-
temperature hydrogen peroxide gas plasma diffuses through the wrapped instruments
and effectively kills both microorganisms and spores. Gas plasma is formed within this
sterilizing unit when vaporized hydrogen peroxide is subjected to radiofrequency
energy, changing the vapor into a low temperature plasma. The plasma then breaks
down into free radicals (atoms with unpaired electrons in outer shells). These free
radicals destroy the microorganisms by stripping their atoms of electrons. Upon
completion of the sterilization cycle the remaining free radicals are converted into
nontoxic byproducts, primarily water and oxygen.
• Autoclaving
• An autoclave is a device that provides steam sterilization under pressure, the most
commonly used sterilization method. It is also the quickest and most convenient means
of sterilization for items that can withstand heat and moisture. High temperatures (250"-
275°F [121°-135"CI) can be achieved under pressure, making this an extremely
effective method.

20. establishing a sterile field, performing a surgical scrub, and donning sterile attire to assist with
an invasive procedure, such as an angiogram, are all examples of practicing surgical asepsis.