4.1 Infection Prevention, Control & Sharps

4.1 Infection Prevention, Control & Sharps

Quick Answer: Every imaging encounter uses routine practices (hand hygiene, PPE based on risk, safe sharps, clean equipment). When a patient needs additional precautions—contact, droplet, or airborne—layer those controls on top without dropping the basics. Treat immunocompromised patients as high-risk for infection from the environment, and dispose of sharps and biohazardous waste at the point of use into approved containers. CAMRT Care Provider items (competency 4.4) almost always ask what you do in the suite or at the bedside, not to recite a pathogen list.

As a medical radiation technologist (MRT) writing the CAMRT Radiological Technology exam, infection prevention and control (IPAC) is a Care Provider expectation, not optional housekeeping. The National Competency Profile expects entry-level RTRs to apply routine practices and additional precautions, protect patients with compromised immunity, and manage sharps and biohazard disposal safely. Canadian framing follows Public Health Agency of Canada (PHAC) guidance and provincial/territorial IPAC standards adopted by health authorities—wording may vary slightly by province, but the hierarchy of controls is consistent.

The Care Provider block is 10–20% of the May 2024 Radiological Technology blueprint (about 19–37 of 185 questions). Infection-control scenarios sit alongside safety, assessment, and education items and are scored as application: choose the correct precaution level, PPE, sequence, or disposal action for a concrete case.

Routine Practices (Apply to Every Patient)

Routine practices (sometimes still called standard precautions in older materials) assume that any patient may carry blood-borne or other pathogens. They are not reserved for "known infectious" labels.

Core elements for the imaging department:

High-yield principle: Gloves do not replace hand hygiene. Remove gloves, perform hand hygiene, then move to the next clean task or patient.

Hand hygiene technique that exam scenarios assume

• Cover all surfaces of both hands; allow alcohol rub to dry completely before touching the patient or sterile field components.
• When soap and water are required (visible soil; Clostridioides difficile when policy specifies soap and water), wash for the full facility-recommended duration and dry with clean paper towels.
• Perform hand hygiene after removing PPE and before touching charts, keyboards, exposure panels, or your own face.

Additional Precautions: Contact, Droplet, Airborne

Additional precautions are added when routine practices alone are insufficient because of how the organism spreads. Always keep routine practices in place underneath.

Contact precautions

Used for organisms spread by direct or indirect contact (e.g., MRSA, VRE, many multi-drug-resistant organisms, and often C. difficile with enhanced cleaning).

Typical suite actions:

• Don gown and gloves before room entry (or before contact if the patient is ambulatory in a designated area).
• Dedicate or thoroughly clean equipment that touches the patient (cassettes/detectors, sponges, lead markers, step stools, portable unit handles).
• Limit shared equipment; if a detector must be used, cover per policy and disinfect after use.
• Doff PPE carefully at the doorway or designated area so contaminated outer surfaces do not touch clean zones; then hand hygiene.

Imaging scenario — MRSA outpatient wrist: Contact precautions still apply. Gown and gloves for positioning and for handling any dressing or skin contact. Clean the table, detector, and positioning aids after the exam. Do not place the patient's belongings on the clean detector bin without a barrier.

Imaging scenario — C. difficile inpatient: Contact (often "contact plus") with emphasis on soap-and-water hand hygiene when policy requires it (alcohol rub is less effective against spores). Use sporicidal disinfectant on surfaces per IPAC direction. Prefer single-room portable imaging when the patient cannot leave isolation safely; clean the portable thoroughly after the exam.

Droplet precautions

Used for pathogens spread by large respiratory droplets over short distances (e.g., influenza, many bacterial meningitides, some respiratory viruses).

Typical suite actions:

• Surgical/procedure mask within close range of the patient; eye protection if splash risk.
• Patient may wear a mask during transport if clinically able.
• Spatial separation; avoid crowded waiting areas when possible.

Imaging scenario — influenza-like illness for chest x-ray: Mask yourself for close contact; offer patient a mask for corridor travel; clean high-touch surfaces after the exam; hand hygiene before charting at the workstation.

Airborne precautions

Used for pathogens that remain infectious over longer distances in aerosols (classic exam example: tuberculosis active pulmonary disease; also measles, varicella when indicated).

Typical suite actions:

• Fit-tested N95 (or equivalent respirator) before room entry; remove only after leaving the room (or per local doffing sequence).
• Prefer negative-pressure airborne isolation room for stationary exams when available; for portable chest in isolation, complete the exam in the isolation room and do not bring the patient through clean corridors unless the clinical team has an approved transport plan.
• Keep the door closed; minimize staff in the room; schedule when possible to reduce exposure of other patients.
• Clean equipment after exit; do not hang the N95 around your neck or reuse against policy.

Imaging scenario — TB isolation portable chest: Read the isolation sign. Perform hand hygiene, don N95 (and other PPE as posted—often gown/gloves if contact elements coexist), enter with the portable already prepared, complete the exposure with efficient technique, exit, doff PPE in the correct order, hand hygiene, then clean the portable handles, detector, and any shared surfaces. Do not chart inside the isolation room on a "clean" workstation cart without barriers.

PPE donning and doffing (conceptual order)

Exact sequences follow employer IPAC posters; conceptually:

• Don (clean → room): hand hygiene → gown → mask/respirator → eye protection → gloves (over gown cuffs).
• Doff (room → clean): remove most contaminated items first (often gloves, then gown), hand hygiene as directed between steps, remove eye protection and mask/respirator last outside the room or at the threshold, then hand hygiene again.

Exam traps include putting on gloves first and forgetting the gown for contact precautions, or removing the N95 inside an airborne room while still exposed.

Patients with Compromised Immunity (4.4.2)

Immunocompromised patients (chemotherapy, transplant, severe neutropenia, high-dose steroids, advanced HIV, some hematologic malignancies) are at elevated risk of infection from staff, equipment, and other patients. Your role is protective, not only self-protective.

Practical expectations:

• Strict hand hygiene before any contact—even brief positioning adjustments.
• Minimize unnecessary staff and traffic in the room; avoid examining them immediately after a highly infectious isolation case without full equipment cleaning.
• Use clean technique for skin contact sites; do not place dirty cassettes, lead, or shared sponges against open ports or lines.
• Honour facility protective environment or reverse-isolation policies when posted (masking rules may differ from standard droplet precautions—follow the sign and nursing guidance).
• Coordinate timing so the patient is not held for long periods in crowded waiting rooms when scheduling flexibility exists.

Failure mode: "They look well, so I skipped the extra clean step." Appearance does not equal immune competence.

Sharps and Biohazard Disposal (4.4.3)

RTRs encounter sharps during contrast injection assistance, IV access collaboration, biopsy/fluoro rooms, and when handling broken glass or contaminated instruments.

Non-negotiables:

• Dispose of sharps immediately into an approved puncture-resistant sharps container at the point of use—not into a pocket, tray "for later," or soft garbage.
• Never recap needles using two hands; if a device must be recapped per rare policy exception, use a one-handed scoop only when that is the approved method—default is no recap.
• Do not overfill sharps containers; close and replace at the fill line.
• Report needlestick or mucous-membrane exposure immediately through occupational health / facility exposure protocol (first aid, report, risk assessment, follow-up). Do not wait until end of shift.
• Place blood-soaked materials and other regulated biomedical waste into designated biohazard bags or containers per provincial waste rules and facility colour-coding—not into regular recycling or open bins.

Imaging-suite link: After a contrast-related IV event or interventional case, survey the table and floor for sharps before moving the patient or bringing the next case into the room.

Putting It Together: Suite Workflow Checklist

1. Read requisition and isolation/IPAC flags before calling the patient.
2. Perform a point-of-care risk assessment; select routine practices ± additional precautions.
3. Gather dedicated or barrier-protected equipment; plan the shortest safe path for portables.
4. Hand hygiene and PPE before contact; efficient positioning to limit exposure time in airborne rooms.
5. Complete imaging; manage linens and waste correctly.
6. Doff PPE and hand hygiene; disinfect detectors, tables, handles, and markers; document any exposure or breach per policy.

Throughput pressure is not a valid reason to skip IPAC. On the CAMRT exam, the correct answer is almost always the action that protects the next patient and the team without abandoning diagnostic duty.

Exam Focus

Expect scenarios that mix modalities with precautions: portable chest on airborne isolation, contact precautions for MRSA in the general room, droplet precautions for a febrile outpatient, C. diff cleaning and hand hygiene, sharps disposal after injection support, and protecting a neutropenic patient from a contaminated detector. Match transmission route → precautions → PPE and cleaning, and keep routine practices underneath every choice.