*4.2. Knowledge of Hand and Machine Hygiene in RD*

Olu O. et al. [37] reported 95% of healthcare professionals acquired the HCAI during the outbreak of Ebola in 2014. Therefore, the HCAI in the Healthcare Professional (HCP) may accelerate the transmission and result in mortality [5]. However, if healthcare professionals adhere to the guidelines and protocol of disinfection and isolation, the risk of HCAI may drop to 10.7% [37]. The HCAI can be overcome by hand hygiene and sanitation practices, which may lower the incidence of the disease, as opposed to treating the disease [38].

The microbial growth on an MIP's hand can be effectively overcome by sterilization of the hand. The alcohol-based hand sanitisers were most commonly used for the sterilization of hand fields [13]. Further, proper sterilization of the imaging equipment can prevent one-third of the HCIAs [36]. Carling et al. reported that 88% of MIPs were aware that the primary reason for the contamination of the radiology equipment is due to the inadequate disinfection procedures followed in the department [39]. Cleaning the equipment and cassette between the patient's examinations using the alcohol wipe and chlorhexidine-based detergents is effective, and they are recommended as compared to soap and water [40,41]. The alcohol gel, disinfecting wipes, and the standard hand wash are recommended to disinfect the radiographer's markers during the procedure [40]. However, special consideration is required for the ribbon markers [42].

The American Institute of USG in medicine recommended using water and soap or quaternary ammonium disinfectant spray for the USG [40]. The MRI machine's disinfection is difficult compared to the other imaging equipment in the RD [41]. However, it is recommended to use the solution of 1000 parts of hypochlorite with a million parts of chloride to disinfect the MRI machine [11]. Abdel-Hady El-Gilany et al. reported that the MIPs have inadequate knowledge about sanitation practices as compared to the other HCPs [24].

During the portable examination of the infected patients, especially EBOLA and COVID-19 patients, specific emphasis on hand hygiene is necessary [35]. Further, additional precaution measures include the proper use of gloves while performing and handling highrisk patients. The gloves are also recommended when there is a risk of MIPs in contact with blood during the procedure [11]. However, it is not recommended to use gloves for every radiological procedure [25]. In the present review, the MIPs show poor knowledge of the glove's recommendation, with a pooled effect size of 0.41 (0.17, 0.65).

#### *4.3. Recommendations of Precaution Standards to Protect the Patients and HCP*

The MIPs can break the chain of HCAIs from other HCPs through proper education, hand hygiene surveillance, vaccination against preventable disease, and prevention of needle-struck injury. Abdel-Hady El-Gilany et al. reported that the MIPs have inadequate knowledge about needle-struck injury as compared to the other HCPs [24].

Training the MIPs with high-quality education can break the spread of the HCAIs in the radiology department [22]. Bello et al. reported that only half of the MIPs have intermediate knowledge of infection control measures [43]. However, in the present study, the MIPs show poor knowledge about the "Precaution standards recommendations to protect the patients and the healthcare workers" with a pooled effect size of 0.87 (0.77, 0.97).
