**1. Introduction**

Medical imaging professionals, such as radiologists, radiologic technologists, and other imaging specialists, may have some knowledge of healthcare-associated infections (HAIs). However, their level of knowledge may vary depending on their specific area of expertise and their exposure to patients with HAIs. HAIs are infections that patients

**Citation:** Sukumar, S.; Saha, S.; Dkhar, W.; Panakkal, N.C.; Nair, V.T.; Bommasamudram, T.; Vaishali, K.; Nagaraja, R.; Ravichandran, S.; Kadavigere, R. Knowledge of Medical Imaging Professionals on Healthcare-Associated Infections: A Systematic Review and Meta-Analysis. *Int. J. Environ. Res. Public Health* **2023**, *20*, 4326. https:// doi.org/10.3390/ijerph20054326

Academic Editor: Delfina G. Ramos

Received: 12 January 2023 Revised: 25 February 2023 Accepted: 27 February 2023 Published: 28 February 2023

**Copyright:** © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

acquire while receiving medical care, and they can occur in any healthcare setting, including hospitals, outpatient clinics, and long-term care facilities. HAIs are a significant public health concern, and healthcare professionals across all specialties are responsible for preventing and controlling these infections. Medical imaging professionals may have some knowledge of HAIs because they work closely with patients and often come into contact with contaminated equipment and surfaces. They may be trained in infection control measures, such as proper hand hygiene, cleaning and disinfection of equipment, and the use of personal protective equipment (PPE) to reduce the risk of transmission. In addition, medical imaging professionals may be involved in the diagnosis and treatment of patients with HAIs, particularly those that affect the respiratory system, such as tuberculosis or pneumonia. They may use imaging techniques such as chest X-rays, computed tomography (CT), or magnetic resonance imaging (MRI) to detect and monitor the progression of these infections. Overall, medical imaging professionals are an essential part of the healthcare team and play a critical role in preventing and controlling HAIs. While their specific knowledge of HAIs may vary, they should receive ongoing education and training on infection control measures to ensure the safety of both patients and healthcare workers.

The pandemic outbreak of Zoonotic viral diseases such as Corona, Nipah, and Ebola has resulted in a public health emergency with months of lockdown and financial loss to major tax-collecting departments such as tourism, aviation, and import–export. Further, the Zoonotic viral diseases have threatened the world economy with the loss of manpower, funds rerouting to the healthcare sector and vaccine research, and the health of human beings, leading to mass deaths and hospitalizations [1]

The World Health Organization (WHO) notified COVID-19 as a pandemic disease on 11 March 2020, and the global containment and quarantine efforts contamination incidents continue to increase post-haste. In developing countries such as India, there is a noticeable increase in the in-flow of infected patients to the hospital due to the recent and past outbreaks of pandemic Zoonotic viral diseases. The chances of cross infections increase with more immunocompromised patients visiting the hospital for other underlying cases. Still, they become infected with nosocomial infections, creating the need to assess cross-infection locations.

The infected patients with Zoonotic viral diseases primarily presented with dyspnoea, fever, and dry cough [2]. Further, these patients are highly contagious, and the infection is transmitted between people through droplets, close contact, and fomite [3,4]. The virus-like COVID-19 remains viable for 72 h on plastic and stainless steel and up to 3 h in aerosols [5]. The estimated half-life of the virus in the aerosol ranged from 1.1 to 2.1 h. Metals such as stainless steel have a half-life of 5.5 h, and the half-life of the plastic is 6.8 h [6]. The presence of bioaerosol in the surrounding air has profoundly influenced the health of humans, animals, and plant life. Further, both the viable and nonviable pathogens such as bacteria, fungi, and viruses present in the surrounding environmental air may also influence health [7,8].

Colonized and highly contagious infected patients visiting the hospital for different treatments may increase the chance of HCAI for patients and healthcare workers. Developing countries have a much higher risk of HCAI, with a radio of 20:1 as compared to developed countries [9]. In the past, HCAI was limited to inpatients. However, the recent pandemic virus outbreak resulted in increased HCAI in outpatients. Since the Department of Radiodiagnosis and Imaging plays a significant role in diagnosing different infectious diseases, there is a high probability of HCAI among radiology staff and patients [10]. Equipment such as radiography, magnetic resonance imaging, computed tomography, fluoroscopy, ultrasound, echocardiography and positron emission tomography used for diagnostic and therapeutic examinations were more prone to infection, resulting in healthcare-associated infections (HCAI). The other infected equipment in the Radiology Department (RD) including the imaging tables, keyboard, touchscreen, computer mouse, lead apron, radiographic markers, and transferring table are also more prone to the HCAIs [11–18].

However, despite the improvement in the practices, HCAI is still prevalent in the healthcare facilities affecting patients worldwide each year. In the recent outbreak, HCAI has reported that 3.8% of the total infections are related to COVID-19 [19]. To overcome the challenges of HCAIs, the knowledge and precautionary standards regarding HCPs must improve [20]. The HCPs such as Medical Imaging Professionals (MIP) working in the radiology equipment should know standardized operating protocols to minimize the spread of HCAIs via the radiology equipment [21,22].

Since there is limited research regarding the knowledge of the HCAI among the HCPs reported in the literature, the awareness of MIPs on the HCAI has also been underexplored.

The purpose of this study is to interpret research reports pertaining to knowledge and precaution standards among MIPs.

#### **2. Materials and Methods**

This systematic review was performed to identify MIPs' knowledge and precautionary standards regarding HCAIs in the radiology department. PRISMA-reporting guidelines were followed in this study [23].
