Reopening Breast Screening Operations Amid COVID-19, Part 2
From the outset, the impact of the COVID-19 pandemic on breast imaging wasn't as great as on other areas of imaging, at least at our facility. Numbers dropped off initially, but not too significantly. For example, we still saw elderly patients who had been told by their referring physician that they absolutely must get their breast pain checked out, when instead they should have been self-isolating at the care home, where they live with other vulnerable individuals.
Much of the reduction in numbers was initiated internally, by the breast surgeons. They reduced the number of patients they were seeing to decrease the total number of people in the building at any one time. Another group of surgeons stopped practicing in the hospital and either saw patients in their rooms or did teleconsultations to pass on results.
Even with reduced numbers, however, we needed to implement additional hygiene practices to maintain a safe environment for patients and staff alike. These practices involved changes in three main areas: communicating and interacting with patients, cleaning the facility, and positioning patients during their examinations.
Communicating and interacting with patients
To reassure patients and referrers, the company put out videos on various social media platforms, explaining that we were still open for business and what measures we were taking to ensure everyone's safety. Similarly, an FAQ was added to the company website. The medical liaison officers contacted referring GPs to explain how we were now operating, including the use of online referrals.
At the height of the virus, some patients chose to wait outside until we were ready for them. When patients made their appointment, we screened them to identify risks such as recent travel and physical symptoms; upon their arrival at the reception desk, we asked again. We learned, of course, that no system is foolproof; we had a patient from another state who managed to be seen despite prohibitions on interstate travel.
Cleaning the facility
Initially, we were concerned about a lack of personal protective equipment (PPE), and the short supply of alcohol gel and cleaning wipes became an issue. I bought cleaning products for the mammography department so we could deep clean at the end of every session without using up our supply of sanitizing wipes.
Some staff started to bring in their own masks and chose to wear hospital scrubs. Then an email came out saying that mammographers and sonographers should wear a mask for all patients but keep the same mask all day. The waiting rooms were cleared of magazines, books, and toys. Where possible, chairs were removed to allow for physical distancing.
A similar approach was taken in the mammography rooms. All staff started to wear gloves, the machine was cleaned all over, and every surface touched by the patient or mammographer was cleaned, including the computer mouse, keyboard, and door handles. Magazines were removed from the cubicles and the chair was cleaned after each patient. Patients wore gowns only if they were having an ultrasound. Bed linen in the ultrasound rooms was removed and replaced with a couch cover, and between patients the couch was cleaned with sanitizing wipes.
Guidance was provided to radiographers on how to stay safe during a mammography exam. This included the following:
- For the CC view, move away from the patient’s face
- For the MLO view, have the patient look away from you
- Conduct interviews at a safe distance
- In general, be as efficient as possible when positioning to reduce the time spent in close proximity to patients
No one accompanied patients for ultrasound, apart from a translator on one occasion. The radiologists reduced the time they were in the rooms, didn't shake hands, and stood at the end of the bed. They also wore masks when performing any interventional procedures. On the whole, patients were happy with this arrangement and were just glad they could still get a mammogram during this time.
At the beginning of the pandemic, there was a lot of anxiety amongst staff members. It was not known if the measures put in place would be sufficient. Staff were concerned about their own safety and their proximity to patients, which seemed in conflict with the company’s goal to keep imaging as many patients as possible. Over time, though, regular updates from the CEO and our infection control team provided the required reassurance.
Morale has been ever changing, with individuals’ moods fluctuating as time passes. Those who were anxious at the start became calmer, whereas others who were initially complacent grew increasingly anxious. Hours were reduced in response to the drop-off in patient volume, creating another stress point.
Soon, however, it became apparent that South Australia (SA) was, in fact, doing really well and the number of COVID-19 cases was low with little community transmission. This didn't stop some patients from coming in wearing masks and wondering why we weren't physically distancing for the mammography and ultrasound appointments, which would be physically impossible.
As we go forward, staff are embracing a paperless system and hoping that it continues. Cleaning is still paramount, but physical distancing is becoming more erratic. That could be because we are in SA and there is an increased sense of security due to our low number of active cases. There is a sense that people are now seeking medical advice only when they genuinely need it, as opposed to taking the opportunity simply because it's there. As breast screening reopens, we expect an increase in volume when patients get their recalls for further assessment. It’s entirely possible, too, that we see an increase in cancers that have been diagnosed later due to a fear of going to the doctor during the worst of the virus.
About Dr Jones & Partners Medical Imaging
Dr Jones & Partners is a doctor-owned and -operated, Adelaide-based radiology practice offering a comprehensive range of diagnostic and interventional radiology services, including x-ray, CT, MRI, ultrasound, mammography, musculoskeletal interventional procedures, nuclear medicine, and PET. It has clinics in regional South Australia, the Adelaide CBD, and Alice Springs.
About the Author
Catherine Hill, BSc (Hons), currently serves as Chief of Modality – Mammography at Dr Jones & Partners Medical Imaging. It is her role to ensure that all mammography staff are up to date with current requirements pertaining to the ongoing COVID-19 situation while maintaining the best possible image quality and patient care.