**4. Discussion**

This systematic review was aimed at investigating the knowledge of the MIPs on the HCAIs. The literature search resulted in five articles, of which three articles were considered for the meta-analysis.

#### *4.1. The Spread of Infection*

The RD plays a vital role in the diagnosis and treating of the patient's disease using X-ray, CT scanner, MRI Scanner, interventional radiology, and ultrasound (USG). The probability of the HCAIs may increase due to the colonized and infected patients waiting for the diagnostic procedure [13]. Further, the contaminated hand is considered to be one of the primary sources of transferring the HCAIs. The contaminated hand of the MIPs and the other HCPs, including nurses, practitioners, and attendees, can lead to the transfer of the infection pathogens from one person to another person, adjacent surface, and equipment [35]. Nyirenda et al. reported that 98% of Malawi MIPs have good knowledge about the primary source and spread of infection [30]. However, in the present review, the MIPs reported that the environment was a major source of multi-resistant bacterial transmission, with a pooled effect size of 0.18 (0.08, 0.28). Giacometti et al. reported that 41.7% of the X-ray tube, 91.7% of control panels and imaging plates, and 8% of the X-ray cassettes were contaminated, which may transmit the HCAIs [36]. Therefore, faculty working in the RD should have updated knowledge and standard operating procedure to reduce the HCAIs spread via radiology equipment or the HCP in the RD.
