Portland Community College | Portland, Oregon

Medical Imaging: Health and safety

Health and safety

As future professionals in the healthcare and emergency services industry, students are expected to not only thoroughly learn and comply with the safety standards of their program of study, but also serve as role models. In settings in which the focus is on the patient¡¯s health and care, it is critical that all safety protocols are followed. The safety of students, faculty, patients, and program animals is of the utmost importance.

Refer to the safety topics in the section for one¡¯s program of study. Review the college¡¯s Health & Safety Manual and in particular, Chapter 4 for the Bloodborne Pathogen (BBP) Exposure Control Plan. Programs may have specific procedures relevant to their site, program of study, and facilities. The following are other college health and safety resources to be mindful of.

• PCC¡¯s Public Safety department offers a variety of services to ensure the safety of the students
• Public Safety emergency preparedness and response and emergency procedures pages.
• Healthy campus ¨C provides guidelines to help keep PCC¡¯s campuses healthy.

Health profession student clinical training administrative requirements

In order for students to complete the required clinical training, PCC requires all students to meet the Oregon Administrative Rule (OAR) Chapter 409 ¨C Division 30 for students in clinical training prior to clinical placement. Students are to meet any requirements mandated by their clinical site as well. A detailed description of these requirements are listed in Requirements for Clinical & Field Education. They include:

• Successfully pass a criminal background check
• Successfully pass a ten-panel drug screen
• Submit proof of current immunizations
• CPR certification: Students are required to obtain and maintain current certification in BLS (CPR) for Healthcare Providers by the American Heart Association.
• Complete Health Insurance Portability and Accountability Act (HIPAA) and OSHA Bloodborne Pathogen compliance training modules.

Insurance

Portland Community College provides Workers¡¯ Compensation coverage for registered students working at external non-paid training and practice sites such as clinical, externship, and co-operative education sites. Students in co-operative education courses must follow the guidelines on the insurance coverage webpage to be eligible for Workers¡¯ compensation coverage. For more information, see the US Department of Labor Workers¡¯ Compensation website.

Portland Community College does not carry primary health insurance coverage (sometimes referred as illness, injury, and accident coverage) for students. Students are encouraged (but not required) to acquire comprehensive health and accident insurance that will provide continuous coverage during their time at the college. Students are responsible for their own health needs, health care costs, and health insurance coverage. The online Healthcare Marketplace is a good resource for finding health insurance.

Injury reporting

In the event of an injury on PCC property or at an external practice site (i.e. clinical, externship, and co-operative education sites), students should follow these steps:

1. Seek medical help.
2. Immediately inform the site supervisor (instructor, clinical instructor, nursing supervisor, charge nurse, preceptor) and the PCC course instructor of the incident.
3. Work with the faculty department chair or program director to complete necessary forms and obtain follow-up instructions.
4. If the injury occurred at an external practice site, follow-up with the site supervisor to complete additional incident reports/paperwork that may be required by the clinical site.

Specific requirements for bloodborne pathogen exposure

Follow these steps:

1. Provide immediate care for the wound/exposure site:
   • For emergency needlestick or other sharp medical device with human blood or other infectious bodily fluids:
     • Wash needlestick site and/or potential exposure site with soap and water
   • Flush splashes to the nose, mouth, or skin with water
     • Irrigate eyes with clean water, saline or sterile irrigates
2. Immediately inform the site supervisor (instructor, clinical instructor, nursing supervisor, charge nurse, preceptor) and the PCC course instructor of the incident.
3. Seek medical help at the nearest emergency department and inform them of the bloodborne exposure and obtain a baseline blood draw.
4. Inform faculty department chair or program director what emergency department was used.
5. Work with the faculty department chair or program director to complete necessary forms and obtain follow-up instructions.
6. If the injury occurred at an external practice site, follow-up with the site supervisor to complete additional incident reports/paperwork that may be required by the clinical site.

For more information, see Chapter 4, Bloodborne Pathogen (BBP) Exposure Control Plan of the college¡¯s Health & Safety Manual.

Timeline for all injury reporting, including bloodborne pathogen exposure

• Seek medical care immediately.
• All injuries, illnesses, property damage, motor vehicle collisions, or other incidents that occur at the college, or in the course of college business if not at the college, should be reported within 24 hours of having knowledge of the incident.
• For Workers¡¯ Compensation claims, the law requires that a form must be filed within 5 days of notice of knowledge of a claim.

Pregnancy guidelines ¨C voluntary declaration

Portland Community College does not discriminate against any student on the basis of pregnancy or related conditions. Absences due to medical conditions relating to pregnancy and maternity leave will be excused for as long as deemed medically necessary by a student’s doctor and students will be given the opportunity to make up missed work. Students needing assistance can seek accommodations from Accessible Ed & Disability Resources located on all campuses.

Since ionizing radiation has been determined to be harmful to the developing embryo/fetus, the following compliance is required to protect the health of the student and child. The recommendations of the National Council on Radiation Protection Report #116 states that a dose to the fetus from occupational exposure of the pregnant mother shall not exceed .5 rem (5 mSv) for the entire pregnancy, not to exceed .05 rem (.5 mSv) per month.

The options for declared and undeclared pregnant students are outlined here.

The pregnant student may elect to notify the program director, faculty department chair, and/or clinical coordinator of the pregnancy. Once the pregnancy is declared in writing, a conference will be held with the program director, faculty department chair, and/or clinical coordinator to review radiation risks, dose limit guidelines, and the cardinal principles of radiation protection. The student must present a written statement from their physician indicating the expected date of delivery and the student¡¯s fitness for clinical education. The declared pregnant student will be administered a fetal badge to be worn at the waist, inside any protective lead apparel. Declared pregnant students may:

1. Continue the program without pregnancy modifications:
   • The student may elect to continue in the radiography program, fulfilling all program requirements as contained within the curriculum, without modification and adhere to all radiation protection guidelines and recommendations as follows:
   • The student will be provided an additional radiation dose monitoring device to monitor exposure to the fetus.
   • The student will be required to adhere to the principle of As Low As Reasonably Achievable (ALARA).
   • The program will provide the student with monthly fetal dosimeter monitoring. The recommendations of the National Council on Radiation Protection Report #116 states that a dose to the fetus from occupational exposure of the pregnant mother shall not exceed .5 rem (5 mSv) for the entire pregnancy, not to exceed .05 rem (.5 mSv) per month.
2. Request a leave of absence (LOA):
   • The student may request a leave of absence when they, the physician, or the program director or faculty department chair believes that it is no longer viable for the student to function in a manner conducive to learning. The return of the student must be approved by their physician along with a written release that the student may return to their clinical assignment with no restrictions.

Radiography program requirements for the declared pregnant student

All missed coursework and clinical hours due to the pregnancy must be completed. The student will receive an “I” (Incomplete) for any course or clinical grade in which hours or material were missed. These missed hours must be made up upon the student’s return and within one year in order to convert the “I” to a letter grade. The make up of all missed clinical hours is required for program completion. No program requirements are waived for pregnant students. Please refer to the Attendance section.

The student may withdraw, in writing, the declaration of pregnancy at any time. Retraction of the pregnancy declaration requires the student to abide by the general guidelines for radiation workers. Therefore, after a pregnancy declaration retraction, the student will be monitored according to general guidelines for radiation workers as described by the National Council on Radiation Protection Report #116 and state laws (a separate fetal dosimeter is not required to be provided).

A pregnancy declaration is voluntary. The student may choose not to declare the pregnancy to the program.

The program will not be responsible for any injuries to the embryo/fetus should the student decide to remain in the program during the entire gestational period.

Radiation safety ¨C general guidelines

Students are expected to learn, regularly practice, and demonstrate proficient use of radiation protection procedures in the lab and clinical settings. As such, students will:

• Collimate (limit radiation exposure field) to include only the required anatomy of interest and to achieve images of optimal diagnostic quality
• Observe from the control booth (protected area) or from behind a lead protective screen, or if the student must remain in the radiographic room they will wear a lead apron at all times with a radiation badge worn outside the apron at collar level
• Utilize proper technical factors for all radiographic exposures, assessing exposure/deviation index values and adjusting techniques accordingly
• Educate patients and others regarding radiation safety procedures as appropriate to maintain safe radiation practices.

When working in surgical areas and during fluoroscopic or portable procedures in rooms occupied by patients, students will:

• Wear proper attire
• Wear a lead apron with radiation badge at collar level outside lead apron
• Stand as far from patient and x-ray tube as is practical
• Observe all regulations which apply to the particular area
• Protect hospital personnel, other patients, and visitors whenever possible from direct or indirect radiation exposure

During an exposure procedure, (radiographic/fluoroscopic) students will not:

• Be in the direct line of the x-ray beam (primary beam) even when wearing a lead apron
• Hold or support a patient or image receptor during the exposure
• Under any circumstances allow themselves, fellow students or any other human being to be exposed for tests or experimentation

Radiation monitoring (dosimeter requirements)

Each radiography student is subject to the occupational exposure limits and the requirements for the determination of the doses which are stated in the National Council on Radiation Protection and Measurements Report #116 and the Oregon Health Authority Standards for Protection Against Radiation 333-120-0100. The program will provide students with their dosimeters (personal radiation monitoring devices) at the start of fall term prior to labs and clinical rotations.

While attending clinical rotations and during energized lab activities at the college, students are required to wear their radiation monitoring devices at all times. When a lead apron is being worn, the monitoring device shall be worn on the collar outside of the apron. When not in a fluoroscopy room, the device may be worn on the front of the student at collar level.

Failure to bring the dosimeter to either lab or clinic will result in an absence from that activity/rotation. Students arriving to lab or clinic without their dosimeter must leave and return only when they have their dosimeter. Absences from lab or clinic must be made up.

If a student loses their badge, they may have a spare badge assigned to them if available, or a new badge will be ordered. Any lab/clinic time lost during this waiting period must be made up by the student. If a student loses their badge more than once, they will be counseled and a disciplinary review process will be considered.

Exposure of a personal monitoring device to deceptively indicate a dose delivered to an individual is prohibited. This act will prompt a disciplinary review process.

Dose reports will be provided to students and reviewed with faculty quarterly as dosimeters are processed and reports are received. Students must initial beside their name to acknowledge receipt and review of each reporting period. When a situation arises in which the dose report reaches alert levels described below, faculty will meet with the student for conference immediately. The conversation will include safety habits at clinic and possible reasons for the badge exposure. This will be documented and placed in the student¡¯s file for future reference. If a student receives a dose report which exceeds the thresholds set below, the following actions will occur:

• Less than 124 mrem ¨C no action taken
• Alert level 1, dose of 125 mrem (10% of quarterly limit) ¨C will be counseled in radiation protection within one school week
• Alert level 2, dose of 375 mrem or more ¨C will be immediately removed from clinical until the incident is investigated and a resolution is decided upon

Energized lab radiation safety requirements

1. At no time is the radiographic laboratory x-ray unit to be energized without permission and supervision of an instructor.
2. At no time shall the radiographic laboratory x-ray machine be used to x-ray human beings. Student experience in the laboratory requires a simulated patient (phantom) for use.
3. At no time shall a student hold a phantom during the radiographic exposure.
4. At no time shall a student hold an image receptor (IR) or quality control instrument during the radiographic exposure.
5. The energized room doors will be locked and/or machine circuit breaker is to be open when machine is not in use by the students or instructor who is supervising their work.
6. All laboratory activities are assigned to coincide with the instructor¡¯s schedule to ensure maximum supervision.
7. Formal classroom instruction shall be given to the student in the use of safety factors concerning the use of the x-ray unit.
8. The machine shall undergo periodic inspection by the State Inspection Committee on Radiation Safety and tube licenses with Oregon Radiation Protection Services will be kept current.
9. Any detected deficiencies shall be detailed in a written report and the program must correct all deficiencies so that the machine is safe for use.
10. At no time shall an exposure be made on the phantom or other types of apparatus when a person is in the laboratory exposure room.
11. All students are required to wear a radiation monitor (dosimeter badge) on their collar when working in the energized suite and during all labs which include an energized portion including open practice lab sessions. It is the student¡¯s responsibility to ensure they are wearing their dosimeter badge for all energized labs, and students will be spot-checked for badge compliance.
12. Failure to have a radiation monitor on the student¡¯s person will result in the student being dismissed from the lab until a monitor is worn. Make-up of the lab assignment is the responsibility of the student.

MRI safety

During the first introductory term, the program will provide students with information on magnetic resonance imaging/radiofrequency (MRI/RF) safety protocols as they pertain to the student clinical employee. Students are required to complete an MRI safety questionnaire that specifies the possible risk to an individual if they should enter an MRI environment. The completed questionnaire will be placed in the student¡¯s file and will also be shared with the clinical instructor in charge (CIIC) at the student¡¯s assigned clinical site and any special rotations. In addition, each student completes an MRI/RF safety check-off form during orientation at the clinical affiliate. Students are required to notify the program immediately in writing of any changes to their personal MRI safety status, including implanted medical devices or other potentially MRI-unsafe foreign bodies. If a student enters a positive result on the screening form, the program will follow up with additional screening and confirmation of MRI zone safety status. This information is kept on file at the college, and each clinic site also has students complete MRI safety screening forms on site as well.

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