SAFETY TRAINING

Revised January 2021

RADNET SAFETY MANUALS

The RadNet Safety Manual and Radiation Safety Manualare maintained in the online Document Library at

http://Applications.RadNet.Com

They contain policies about:• Injury & illness prevention• Exposure to bloodborne pathogens• Ergonomics• Chemical handling• Personal protection• Radiation exposure• Emergency response• And more

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COVID-19 Prevention3

• Do your part to help keep those around you safe.

• Stay home when you are sick.

• Keep your mask on.

• Wear eye protection as appropriate for patient interactions.

• Wash hands often with soap & water for at least 20 seconds.

• Cover your cough or sneeze with a tissue!

Hand Hygiene

Handwashing – The single most important thing you can doto prevent the spread of germs, viruses, and bacteria.

• Wet hands and apply soap• Rub hands palm to palm• Wash the back of each hand• Wash fingers and finger tips• Wash your wrists• Wash under your nails• Rinse with running water

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Threatening Behaviors include:• Verbal Abuse• Direct Threats• Indirect Threats• Nonverbal Threats• Violent Actions

IS DEDICATED TO PROVIDING AVIOLENCE-FREE WORKPLACE

If you encounter an aggressive person:• Get your manager involved • Remain calm & keep an even tone of voice• Maintain eye contact and a safe distance• Determine an escape route• Report all threats, violent behavior or

suspicious acts of crime to your manager as soon as they happen

GENERAL SECURITY MEASURES6

• Keep all doors except the front entrance closed and locked from the outside at all times, including during business hours.

• Have all visitors and vendors sign the Visitor/Vendor Sign In Log.

• Report burned out or inadequate lighting, inside and outside.

• If you arrive to work and notice signs of a break-in, do not enter the building to investigate. Leave immediately and call the police and your manager.

• Take precautions when working alone or in the evening.

• Park in well lit areas if you work at night or very early morning.

• Leave the building with someone else after dark.

ACTIVE SHOOTER7

• Have a plan in mind before a tragedy strikes.There are 3 things you could do that make a difference:

1. RUN: Get out if you can and leave your belongs behind. o Get out of harm’s way and prevent others from entering.

2. HIDE: If you can’t get out safely, find a place to hide. o Act quickly and quietly and lock the door. o Turn off the lights and silence your cell phone.

3. FIGHT: Asalast resort when your life is in imminentdanger.Whether alone or working together as a group, fight!o Attempt to incapacitate the shooter with physical aggression.o Improvise weapons and commit to taking the shooter down.

Be Sure to Know:• More than one way out of the building.• Where your fire alarm pull stations are located.

Evacuation Plan for Dangerous Situations In the Building:• Check all rooms so everyone gets out and assist patients/visitors.• Employees are not required to fight fires. Doing so is voluntary.• Go to the Outside Designated Meeting Area where your manager

will take a head count to ensure everyone is out of the building.

Shelter-in-Place Plan for Dangerous Situation Outside:• Go to the designated Shelter-in-Place location, which is as an inside

room with no windows, outside doors, or outside walls. • Lock all doors and close curtains/blinds. Stay away from windows.• If sheltering for an outside chemical release, seal gaps under doors

and turn off the HVAC. Cover your nose/mouth with a damp rag.

EVACUATING AND SHELTERING8

FIRST AID9

• It is RadNet policy to contact local emergency medical services for any significant injury or illness. They are considered to be our primary source of first aid.

• Document the victim’s vital signs such as pulse, blood pressure and breathing.

• Always document first-aid treatment in the Incident Report. What may appear minor now could turn worse after the injured person leaves our facility.

• Every employee should know where the First Aid Kit, Oxygen Tanks and Emergency Crash Cart / Drug Box are located.

PREVENTING SLIPS AND FALLS10

Slips and falls are a common incident in RadNet centers.• Eliminate potential trip hazards.• Wear slip-resistant shoes to work.• Pay attention to where you are walking.• Slow down at corners and stay to the right.• Clean up spills and wet spots immediately.• Assist unstable patients through the facility. • Use mats at all outside entrances to wipe wet shoes.• Eliminate step stools when exam beds are adjustable.• Stay with patients as they get on and off of exam beds.• Offer a wheelchair if patients are unsteady on their feet.• Offer patients chairs and stools without wheels to sit on.

• Inspect your equipment regularly and report any damage.• Use only power-strip extension cords and never connect

multiple cords together.• If you feel a shock or tingling from any equipment, report it

immediately and take it out of use until it is serviced.• Circuit breakers must be accessible. Never store items in

front of them. Do not store anything in electrical closets.• Space heaters are a fire hazard and must be approved by your

manager, have safety shut-off if tipped, and be plugged directly into a wall outlet. Never plug them into an extension cord or cubicle outlet.

• Electrical equipment produces heat. • Never block ventilation slots on your equipment.

ELECTRICAL SAFETY11

Document incidents at http://applications.RadNet.com.

Incident Reports should tell us:• WHO was involved?.. witnessed it?.. documented it?• WHAT happened?.. caused it?.. was said?• WHEN did it happen?.. was it reported? • WHERE did it occur?.. did they get medical treatment?• HOW did it happen?.. did we assist the injured person?

Determine Why the incident occurred. Develop a Corrective Action Plan to prevent it from recurring.Document the Corrective Action Plan in the incident report.

REPORT & DOCUMENT RIGHT AWAY12

ERGONOMICS 10113 vs.

Ergonomic Stressors can make you uncomfortable.• Repetitive Activity • Using Force or Strength

• Static Position • Awkward Positions • Pressure Points

You CAN reduce the amount of stress they cause by changing the way you do your job.

• Adjust your workstation • Improve your work habits • Use the proper tools • Rearrange what you use often• Store heavy items between shoulder and knee height• Use a cart or dolly • Get help to move heavy items• Make yourself comfortable • Get help when lifting patients• Adjust exam bed to your hip level when helping patients sit up• Use positioning bolsters for easier reach across patients

GOOD SEATED POSTURE14

• Head facing straight forward.• Knees bent 90 degrees.• Feet flat on the floor or footstool.• Wrists in line with forearms.• Shoulders relaxed.• Elbows close to the side.Check your position right now to see if you need to adjust your workstation.

AVOID DISCOMFORT15

• Utilize occasional micro-breaks (10-60 seconds) to break up repetitive tasks or static postures.

• Shift positions often.

• Take quick stretch breaks throughout the workday.

• Stand up every hour if you sit for long periods.

• Sit down occasionally if you are on your feet for long periods.

It isn’t always about expensive chairs and fancy gadgets.

Change your work habits to make yourself more comfortable.

Micro-break periodically to avoid getting uncomfortable.

MAGNETIC FIELD DANGER16

• MRI exam rooms must have a “DANGER” sign posted at the entrance to warn everyone of the dangerous magnetic field.

• Magnetic fields are invisible.

• Metallic objects can reach speeds of 45 miles per hour as they fly through the room toward the bore (tube) of the scanner.

• Patients can be seriously injured and even killed in MRI accidents.

• The MRI exam room is a restricted area. Never enter unless you have been screened by the MR technologist.

• Remember that even when the department is closed at the end of the workday, the scanner is always magnetic.

RADIATION PROTECTION17

Time, Distance and Shieldingare the best protection from radiation exposure.

• The less Time you spend in the radiation area,• The more Distance between you and the radiation source,• The more Shielding used between you and the source, • The less exposure you will receive.

A three-blade symbol is used todesignate a radiation area or package containing radioactive materials.

RADIATION MONITORING18

• Radiation workers must be issued a separate radiation monitor for each imaging center they work at and must wear them.

• Administrative employees are not monitored because they are not exposed to radiation above allowable public exposure limits.

• Store monitors in a radiation free area at the imaging center. • Never take radiation monitors out of the office. • Per the Nuclear Regulatory Commission (NRC), a radiation worker

may receive 5,000 millirems of exposure in a 12-month period. • Exceeding Trigger Limits warrants written Notification.

Monthly Trigger Limits Quarterly Trigger LimitsNuclear Medicine / PET Technologists> 120 mrem body badge > 1200 mrem ring badge> For I-131 exposures: 0.133 uCi/Bioassay

Other Modality Technologists / Radiologists> 40 mrem body badge

Nuclear Medicine / PET TechnologistsN/A – Monthly Monitoring Only

All Other Technologists/Radiologists> 120 mrem body badge

EMPLOYEE PREGNANCY19

Special considerations are given to pregnant radiation workers who notify their employer in writing of their pregnancy.

To help protect the fetus from radiation, the mother is:• Assigned a fetal monitor to wear at the abdomen.• Allowed 1/10 of the normal exposure limit

(maximum of 50 mrem/month and 500 mrem/pregnancy)

Once a Pregnancy Declaration is submitted, the lower dose limits will be applied; And RadNet will implement certain restrictions whenever possible, realizing that a pregnant radiation worker may have to continue to perform her normal duties.

PATIENT PREGNANCY SCREENING20

• Patients scheduled for radiation procedures must be screened to ensure they are not pregnant.

• The patient must verify in writing that she is not pregnant.• The technologist must verbally verify that the patient is not

pregnant and document this, such as on the history form.

FETAL EXPOSURE ESTIMATE• Sometimes we don’t know a patient was pregnant until after the

exam. When this happens, your Health Physicist can calculate a “Fetal Exposure Estimate”.

• Fetal Exposure Worksheets are available in the Document Library. • Complete the worksheet and fax it to your Health Physicist to have

the calculation made.

DIAGNOSTIC IMAGING21

Read Orders Carefully Before Performing Each Exam!!!With the exception of screening mammograms, exams involving ionizing radiation cannot be performed without a written, electronic or documented verbal order from the referring physician.

SHIELDINGTechnologists must wear and use appropriate protection devices, such as lead aprons, lead blocks and lead shields.

Gonadal shielding MUST be provided to all patients of reproductive age when it will not interfere with the diagnostic procedure.

No x-ray worker shall be required to hold patients unless they volunteer to do so and no person shall regularly hold patients.

HAZARD COMMUNICATION• Each facility’s Chemical

Information List describes the hazardous chemical products in your workplace.

• Each product has a Safety Data Sheet that tells you important hazard information.

• There are 2 signal words: Warning – a less serious

potential hazard Danger – a more serious

potential hazard

• Hazardous chemical labels display pictograms.

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EYEWASH STATIONS23

• RadNet imaging centers are equipped with faucet-mounted eyewash stations. Learn where yours is located.

• To activate, turn on the water supply and push the button to divert the flow of water to the spray heads.

• Use only cool or tepid water to flush your eyes.

CHEMICAL SPILLS• Isolate the area and wear protection: Read the label or Safety Data

Sheet for the right glove.• Contain & Absorb: Spill kits provide absorbent pads suitable for

large spills. Place soaked pads in the spill kit container for disposal.• Dispose in accordance to state regulations: Contact your

biohazardous waste carrier to see if they handle chemical disposal.

CHEMICAL EXPOSURE24

Read the label or Safety Data SheetMany chemicals are skin irritants, so it’s important to know if you need to wear gloves or other protective equipment.

Symptoms of chemical exposure can include: Dizziness - Nausea - Headache - Rash - Burn - Pain

EYES: Flush with water for 15 minutesSKIN: Wash with soap and waterINHALATION: Move to fresh airINGESTION / SWALLOWING: Read the label or Safety Data Sheet to determine if you should induce vomiting

If medical assistance is necessary, bring a copy of the label or SDS to the treating physician.

TB INFECTION VS. DISEASE25

Tuberculosis /TB is caused by Mycobacterium Tuberculosis bacteria.

TB Infection is not contagious. • The germs remain alive inside the body, but are inactive.• A person with TB Infection has no symptoms. • They should see a physician to discuss treatment options.

TB Disease is active and contagious.• Some people develop TB Disease soon after infection, while

others may get sick later or not at all.• Symptoms include: bad cough lasting longer than 2 weeks,

coughing blood, weakness/fatigue, loss of appetite, fever and night sweats.

RESPIRATORY SAFETY26

Promptly Identify and Isolate patients who are:

• Known to have Active TB• Have an order to Rule Out TB• Have a +PPD with a productive cough• Have a persistent cough >2 weeks with 2 or more other symptoms Bloody Sputum Weakness or Fatigue Weight Loss / No Appetite Night Sweats Fever

PATIENT ISOLATION & TB EXPOSURE27

Patients known to have or suspected to have Active TB Disease should be isolated and asked to wear a surgical mask.

Staff must wear an N95 respirator and post this sign outside of the room used to isolate a known or suspected TB patient.

No admittancewithout a typeN95 or more

protectiverespirator

If you are exposed to a patient with Active TB:• You will be screened immediately & again 10 weeks after exposure

to determine if you were infected.• Employees who convert to PPD+ should be medically evaluated,

receive a chest radiograph, counseling and be advised of treatment options. Employees with Active TB may not return to work until they are no longer infectious.

PERSONAL PROTECTION28

• RadNet policy requires you to wear Personal Protective Equipment (PPE) when there is potential to be exposed to a hazard.− Hazardous Chemicals - Radioactive Materials− Blood and Body Fluids - Infectious Diseases

• PPE is provided by your employer at no cost to you.REMEMBER: It can’t protect you if you’re not wearing it.• Always inspect your PPE before you use it and immediately discard

PPE that is damaged and compromises your safety.• Discard PPE as follows:

PPE lightly contaminated with blood or body fluids or with no visible contamination is to be disposed into a regular trash can.PPE saturated with blood or body fluids is to be disposed into red bag waste.

PPE - GLOVES29

• Latex & latex-free exam gloves protect hands from exposure to blood and body fluids and are for one-time use.

• Inspect before and after applying for punctures, tears, discoloration, other physical defects. Discard if any defect exists.

• Peel inside out to remove, making sure not to touch the outer surfaces.

• Exam gloves do not prevent cuts or punctures.

• Unless heavily soiled with blood or body fluids, exam gloves can be disposed in regular trash.

• Rubber gloves are for chemical exposure and general cleaning.

• They can be cleaned and reused multiple times, but must be replaced when damaged.

• Rubber gloves are not appropriate protection against blood and body fluid exposures.

PPE - EYE PROTECTION30

• Safety goggles and safety glasses protect your eyes from splash or spray of chemicals and body fluids.

• Goggles provide protection across the front, top, bottom and sides.

• Glasses with side extension provideprotection from the front and sides.

• Both can be cleaned and reused, but must be replaced when damaged.

• See your manager if you need special eye protection for wearing over regular prescription glasses.

PPE–SMOCKS, HAIR & FOOT COVERS31

• Fluid resistant smocks or aprons protect you and your clothing from splash or spray of chemicals or body fluids. Sleeves should be tucked into your gloves.

• Hair and foot covers should be worn any time you anticipate a potential splash or spray toward your body.

• We provide disposable ones that are for one-time use.

• Lab coats must be worn when handling radioactive materials.− Nuclear Medicine Technologists must wear long-sleeved

lab coats when handling radioactive isotopes.− Lab coat contaminated with radioactive material must be

removed and stored until the radiation decays to background level.

PPE – LEAD SHIELDING32

• Lead aprons protect the body from ionizing radiation and come in half aprons, full body aprons, thyroid shields, lead gloves & lead glasses.

• Use lead aprons to protect both employees & patients.

• Clean with a damp cloth or disinfectant wipe.

• Replace them when damaged.

• Hang or lay flat when not in use.

Never fold or crumple a lead shields.

• X-ray them annually to examine their integrity.

PPE – MASKS & RESPIRATORS33

• Surgical masks protect your nose and mouth from body fluid exposure.

• Wear when you anticipate potential splash or spray of body fluids to the face.

• They are for one-time use.• Surgical masks will not

protect you from airborne diseases, such as tuberculosis or measles.

• N95 Respirators provide protection from airborne diseases, such as tuberculosis or measles.

• They fit snugly and create a seal around the edges.

• They are typically for one-time use, but can be reused in times of critical supply shortages.

• N95 users must be fit-tested to determine the correct size and demonstrate they can put it on properly.

TRANSMISSION OF PATHOGENS34

Bloodborne Pathogens are germs, bacteria and viruses that can be transmitted through infectious body fluids.

Diseases can be transmitted through mucous membranes (eyes/nose/mouth), wounds in your skin (cut/scratch/sore), and punctures with contaminated needles or sharps.

Don’t let it happen to you:• Use Universal Precautions at all times.• Understand potential exposures at work.• Disinfect equipment and work surfaces properly. • Dispose medical waste into appropriate containers.• Protect your skin and mucous membranes with PPE.

CLEANING AND DISINFECTING35

• Follow the directions on disinfectant labels to effectively kill viruses and bacteria.

• Disinfectants must stay wet on the surface for the recommended amount of time before wiping them off.

• Wipe products must air dry to be effective.

• Soaking products have minimum soak times to effectively kill viruses and bacteria.

• Disinfectants are skin irritants. Wear gloves to protect your hands from the chemicals and from the germs you are cleaning.

DISEASES FOUND IN BLOOD36

• HIV can cause AIDS. It depletes the immune system. HIV does not survive well outside of the body. There is currently no vaccine to prevent HIV infection.

• Hepatitis B may lead to chronic liver disease, liver cancer and death. HBV can survive 1 week in dried blood. Symptoms: fatigue, jaundice, abdominal pain, nausea, vomiting. A vaccine is available.

• Hepatitis C is the most common chronic bloodborne infection in the U.S. Symptoms are the same as HBV. HCV may lead to chronic liver disease and death.

DISEASES FOUND IN SALIVAShingles, Meningitis, Herpes Simplex, Pneumonia, Chicken Pox, Conjunctivitis, Flu, and Acute Viral Rhinitis (common cold). The flu virus can live on surfaces for 48 hours after contamination.

SHARPS SAFETY37

1. Place the cap of the needle into the recapping device.

2. Using one hand, slide the needle into the cap.

3. Twist the cap to release it from the device.

• Use safety needles & safety scalpels whenever possible.• Dispose sharps immediately in puncture proof containers.• Keep containers close to where you perform injections.• Use a dustpan and brush to clean up broken glass.• Do not allow patients to walk around without their shoes.• If you must recap a contaminated needle, use the one-handed

scoop method or a recapping device.

BIOHAZARDOUS WASTE CONTAINERS38

Biohazardous Waste: • Items saturated with blood or body fluids where it would flake off

or release in liquid form if the item were compressed.- IV tubing with blood, BE tubing, TV Ultrasound probe covers, biopsy gauze

NOT Biohazardous Waste: • Items with small amounts of blood or body fluids where the blood

or body fluids would be released in liquid form if compressed. - Band-Aid or gauze with a small amount of blood- Exam glove or exam table paper with a small smear of blood or body fluids

• Use lids to prevent spills and close containers/bags at ¾ full.• Display the Biohazard symbol on the outside of the container.• Must be puncture proof for needles and sharps.• Do not eat, drink or apply cosmetics in a biohazard area.• Store “Dirty” waste and laundry separately from clean supplies.

MEDICAL WASTE GUIDELINES

SHARPS CONTAINER• Needles, disposable scalpels, broken glass• No medical supply wrappers or packaging

RED BAG• SATURATED gloves, bandages, gauze, exam table paper• VISIBLY CONTAMINATED plastic tubing and disinfectant wipes• Heavily soiled dried-blood-caked items• Blood, body fluids, body tissues

REGULAR TRASH• Medical supply wrappers• Cups and straws• LIGHTLY CONTAMINATED gloves, PPE, bandages, gauze,

exam table paper• Non-sharp items with NO VISIBLE CONTAMINATION

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IF YOU ARE EXPOSED40

Follow these RadNet guidelines if you are exposed:• Report blood or body fluid exposures to your Manager immediately.

• A confidential post-exposure medical evaluation will be offered and a workers’ compensation claim will be filed to pay for your evaluation, blood tests and treatment.

• We will attempt to identify the source individual and request he/she be tested at the Company’s expense.

• If he/she agrees to testing, the results will be provided to the exposed team member and his/her treating physician.

CONTROLLED SUBSTANCE WASTE

NOTE: Controlled substances (anxiolysis and sedation meds) should not be disposed in biohazardous waste containers.There are 3 Ways to Dispose of Unused Controlled Substances:• RX Destroyer - For disposal of dropped Class III, IV and V

tablets and liquid controlled substances that were drawn up during a procedure and not used (ie: the extra waste that is still in the syringe).

• MEDflats Box - For disposal of expired Class III, IV and V controlled substances (anxiolysis meds) to a reverse distributor.

• Disposal Safe - For disposal of expired Class II controlled substances (interventional tablet & liquid pain meds) to a reverse distributor.

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HEPATITIS B VACCINATION42

Imaging center employees at risk of blood exposure are offered the Hepatitis B Vaccination at no cost to themselves.It is your voluntary choice whether or not to receive it.

Hep B Vaccination requires 3 shots given over 6 months.It is followed by a blood test to ensure it was successful.

At-risk employees must either:• Receive the vaccination series,• Provide proof of previous vaccination, or• Sign a Declination Statement indicating you do not want to be

vaccinated, but may change your mind at a later date.

DRUG REACTIONS43

• Respond immediately if your patient experiences a drug reaction.

• Alert the Radiologist and get the crash cart/drug box ready.

• It may be necessary to administer medication if your patient is experiencing hives, but remember that you can only administer drugs under a doctor’s order.

• Drug reactions must be documented as an incident.

• The patient is to be given a copy of the signed Contrast/Medication Reaction Discharge Instructions and this should be documented in the incident report.

IF YOU HAVE QUESTIONS

• If you have questions after reviewing this training module, please talk to your facility manager or their designated representative.

• If you need further assistance, please contact RadNet’s Quality Assurance Department.

West Coast: Claudia Hernandez (310) 514-6743Alycce Holt (626) 644-2362Carol Meena (909) 322-1237

East Coast: Monique Mansoura (917) 657-3710Heather Roach (301) 310-3728April Dickerson (443) 801-3020

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TEST YOUR SAFETY KNOWLEDGE

Complete the corresponding quiz• There are 20 questions• You must get 17 or more correct to Pass (85%)• If you do not Pass, review your Quiz before retaking it

− Click the My Quizzes tab in the header bar − Click the View Quiz icon.

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Copyright and Trade Secret Warning – All Rights Reserved

This training presentation contains confidential and proprietary trade secrets of andcopyrights belonging to RadNet Management, Inc., its subsidiaries, and/or affiliates(collectively, "RadNet").

This training presentation may only be used by a RadNet Center, RadNet'srepresentatives or upon the express written permission of RadNet, and may not bereproduced in any media, either in whole or in part. Any reproduction of thesedocuments, in whole or in part, or any use of these documents, other than as directed oragreed upon in writing by RadNet, is strictly prohibited and constitutes a violation of law.