The Radiographers profession

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Sweden

Hygiene

Basic hygiene routines should be applied by all healthcare professionals during examination and treatment or other direct contact with a person receiving care. This is to prevent the spread of bacteria and viruses that can cause diseases (SOSFS 2015:10). The healthcare in Sweden is governed by various laws and regulations. The Health Care Act calls for all patients to receive good care. This means that the care should be of good quality and with a good hygienic standard to take into account the patient’s safety and security (SFS 1982:763). There is also a law governing the quality of care, which has the objective of protecting the population from infectious diseases. The act means that healthcare professionals must have the knowledge and experience needed to counteract infection spread (SFS 2004: 168).
Good healthcare in Sweden means following the basic hygiene routines. Meaning that healthcare professionals should wear short-sleeved upper parts for examination, care and treatment. The work clothes are only used in the workplace, should be replaced daily or as soon as they become dirty (Vårdhandboken, 2017a). Plastic apron should be used to protect the work clothes from getting dirty in close contact with patients (Vårdhandboken, 2017b). The hands and arms should be free from jewelry. The nails should be kept short cut without nail polish. If the healthcare professionals has long hair or beard that can get in the way, it should be attached (Vårdhandboken 2017a). Hand desinfection should be used before and after patientcontact. In case of suspicion that the patient has vomiting or diarrhea, wash hands thoroughly with soap and water before hand disinfection and gloves are used. Protective gloves are for single use and should be exchanged between different work and patient.
According to an articel from Hong Kong, gloves are the most common personal protective equipment and it is important that the gloves are changed between every patitent since they can spread infections to material, environmental surfaces and other people (Chau, J P-C., Thompson, D R., Twinn, S., et.al. 2011) The purpose of basic hygiene routines and clothing rules is to prevent possible transmission of infection in the healthcare, both among patients and healthcare professionals (Vårdhandboken, 2017b).

Education

During the education in Sweden to become radiographer, knowledge is the basis for a safe patient care. Already in the first cours students learn about hygiene aspects. In practical terms, students will assess how they work according to basic hygine routine before they go to their first practical placement. The education should also provide the theoretical knowledge of nursing that is required to establish and maintain a nursing relationship before, during and after an radiology examination or treatment. In addition to this, education includes learning about laws and regulations governing healthcare in Sweden (Jönköping University, 2015; Jönköping University, 2016). A certified radiographer should be able to account for healthcare measures, spread of infection, common bacteria and viruses. As well as comprehensive account of antibiotics and antibiotic resistance (The Swedish Society of Radiographers, 2011).

Vietnam

Country

Vietnam is located in southeast Asia with a population of approximately 95 million people. The capital, Hanoi, has about 7.5 million inhabitans. Besides tourism, the country’s main source of income comes from industries. The currency is Vietnamese dong (VND) and 1 Swedish crown corresponds to around VND 2000. The languages spoken are Vietnamese as well as many minority languages. Religions are mainly Buddhism and Catholicism but also many indigenous religions are found (Central Intelligence Agency, 2017).
Vietnam used to be a very poor country, but since the 80’s the number of people living below the poverty line has decreased with 50% of the population who lived in poverty in 2015 according to the United Nations Development Program, (UNDP:s) estimate. Vietnam has developed in several areas over the last 30 years, and today the country has generally good healthcare. Maternal and child mortality has decreased significantly and the average life expectancy is 71 years for men and 76 for women. The development of the current healthcare system is a significant improvement in Vietnam (Central Intelligence Agency, 2017).
The health status in Vietnam has improved considerably in recent years. Healthcare in Vietnam has become better than its neighbouring developing countries. However, there are still inequalities in health between different groups in society. The people living in the poor areas do not have the same access to healthcare as those living in better-placed areas (World Health Organization, 2015).

Hygiene

According to the ministry of justice (MOJ) in Vietnam are there laws and regulations regarding hygiene in healthcare. In the Law on Medical Examination and Treatment there are measures to control bacterial spreading in medical examinations. Some of these actions are personal hygiene and protection. The healthcare professionals should use protective clothing and have a good personal hygiene to reduce the risk of spread bacteria (Ministry Of Justice, 2009). The Ministry of Health (MOH) are responsible for the guidance of healthcare and health industry in Vietnam (Ministry Of Health, 2013). MOH also get support from WHO in the work for better hygiene in healthcare (World Health Organization, 2015). WHO have developed several guidelines regarding good hygiene in healthcare. One of the guidelines is how to work for and have a good hand hygiene by disinfect hands before, during and after patient contact, wear gloves when it is needed and also wash hands (World Health Organization, 2009).

Education

The education to become radiographer in Vietnam are four years. The importance of the program is placed primarily on technology and diagnostic imaging. There is not much teaching about hygiene and nursing because the technical parts are in focus throughout the education. In the second year, students receive an hour’s hygiene lecture that includes hand hygiene according to the curriculum. They use WHO and MOH as sources and retrieve information from their websites (D. Doan, personal communication, 2 April, 2018).

Radiography

In the education to become a radiographer, the main field is radiography. Radiography is interdisciplinary and involves four different areas. Nursing, medicine, radiation physics and imaging- and functional medicine. Knowledge is gathered from these areas and radiography is based on evidence and also science. The education in radiography shall provide knowledge of nursing. It is required to establish and maintain a nursing relationship with the patient before, during and after an examination or treatment. It should also provide the knowledge that is required necessary for the implementation of imaging morphological and functional methods for treatment and diagnosis (The Swedish Society of Radiographers, 2011).

The Radiographers profession

In the work as a radiographer is it important to have a professional conduct. Sweden have therefore developed both a professional code so radiographers can find ethical guidelines and support and also a competency standard for registered radiographers. In the Swedish compentency standars for Registrered Radiographers (The Swedish Society of Radiographers, 2011) are the four basic ethical principles: respect for selfe-determination (autonomy), nonmaleficence, beneficence and justice. All these principles are important for the radiographers to follow both among patients and fellow healthcare professionals. The professional ethical code for radiographers is formed by the radiographers own professional liability and main area, radiography. The ethical code has also four main areas, radiographer and the: patient, profession, society and professionals in caring. These have been evolved to give support in the daily work as a radiographer (The Swedish Society of Radiographers, 2008).
Because the radiographer has daily meetings with several patients is it important with good hygiene. All staff at radiology departments, including radiograpers, need good knowledge of contagious spread and measures to protect patients and healthcare staff according to a study from America (Sobia, K,. Mirza, MD,. Tyson, R, et.al. 2015).

Rationale

Studies have shown that the best way to prevent spread of healthcare-associated infections like MRSA is good basic hygiene routines and knowledge. In developing countries there is a major spread of MRSA and studies have shown that there is a tendency for it to also increase in Sweden. The authors will therefore identify how this can be prevented in the future work as radiographers because it is a profession that daily meets a substantial number of patients. The problem about HCAI is global and will become more complex so it is really important in our future profession to be aware of it and daily prevent it. It is important that students learn both practical and theoretical about hygiene so that they can work independently and consciously in their future profession as radiographer.
Studies of this specific topic performed in Vietnam were not found. Hence, we would like to perform a study regarding knowledge of hygiene among radiographer students in Sweden and Vietnam. The comparison is expected to bring more knowledge so that both Vietnam and Sweden can learn from this and improve the knowledge ahead of our forthcoming work as radiographers.

Purpose

The purpose is to compare how the radiographer students in Sweden and Vietnam use the knowledge they have learn during the education about hygiene aspects and routines associated with patient-related work. Also see how they put this knowledge in to practice.

Materials and metods

This thesis has a quantitative design with descriptive statistics and comparative design. The study was conducted with a survey and an observation study. The material was collected through questionnaires (appendix 1 and 2) both among radiographer students from three different schools in Sweden and Da Nang University of Medical Technology and Pharmacy. The survey was designed in the survey program from Jönköping University, in Pingpong. The study also including observations from Vietnam.
Data collection was implemented in both countries using paper questionnaires the students had to fill in with pen. The inclusion criteria for participating in the study were that the students studying to become radiographers. The exclusion criteria were if they were not students because we had no specific requirements otherwise. The questionnaires were handed out to a number of 50 students in Sweden. Because of the small classes we have in Sweden the questionnaires were handed out to students from three different schools in year two and three. The surveys were first handed out to year two and three at one school. Since we wanted 50 participants the survey was then handed out to two other schools. No selection was made on the first school because the surveys were handed out to all the students in year two and three. At the other schools the survey was handed out to a few because we only wanted 50 participants. The selection of these students were randomly. In Vietnam, we handed out 50 questionnaires at one school and those were handed out to students in the third year, since the third year in Vietnam has the equivalent practice as student in year two in Sweden. The education differs between the countries. The selection of these students were random since the whole class could not participate because they were more than 50 in the class. The survey was handed out from the front of the classroom and backwards until all questionnaires were distributed. The participants were also able to indicate gender and age. The observations were performed for two days in one of the hospitals that the University cooperates with. This gave us the opportunity to observe how the students worked there and see how they worked hygienically.
The study was based on questionnaires and observations. Information was collected in a relatively easy way from a variety of individuals. The questionnaires includeed questions regarding alcohol-based handrub, use of the gloves and protective aprons among others. The survey was designed with five different answer options in the ordernal scale. In Sweden the questionnaire was in Swedish and in Vietnam both in English and Vietnamese so all the students who participated could understand all the information and provide a more reliable result. Before the trip to Vietnam, the data collection and the compilation of the results from the students in Sweden was completed in order to begin comparing the result as soon as the data collection in Vietnam was done. At the beginning of our stay in Vietnam we handed out the survey and after that we conducted the observations, to see how the outcome of the survey corresponds to clinical practice. We also took notes meanwhile. For the observations, we had developed a protocol (appendix 3) that was used. After the observations data was analyzed and compiled in a table.
Besides that, we could discuss what we saw and take out from that differences and similarities, good and less good things we saw. The things that was observe are how they were dressed, when they use alcohol-based handrub, gloves and so other. The protocol (appendix 3) for the observations were designed based on the questions in the survey, so that we observed were the same things that the students had answered in the questionnaire. Beside the survey and the observation, facts were gathered through scientific articles. The articles were collected from PubMed and Medline from the University Library at Jönköping University. The articles should be published between 2008 and 2018. The requirement was also that they should be Peer-Review, available in English and have a free full text.
The statistics program SPSS version 25.0 was used for data analysis. The collected data from the surveys was transferred to SPSS and the results are presented in tables and current text. Measurements that have been used in the analysis are median, percentage (%) and p-value. Chi-square have been conducted to calculate numeric values and variations between variants. In order to strengthen the credibility of the correlations, the limit for significant relationships has been set to p-value < 0.05 (5%). SPSS was also used for the analyz of the observations. All data from the protocols was transferred in to SPSS and then statistics were counted. The results were then compiled in tables and text. The tables were made in Excel.

Ethics

The basic individual protection requirement can be embodied in four general key requirements for research. These requirements are the information requirement, the consent requirement, the confidentiality requirement and the utility requirement. The information requirement means that all participants in the study were informed that it was voluntary to participate, what conditions they had and their roles in the task. The consent requirement means that individuals were entitled to participate in the questionnaire voluntarily and that consent was given before participarion. Information was given in written and oral about the questionaries and the study. Those who participated were allowed to discontinue their participation at any time during the survey, without consequences. The confidentiality requirement includes the protection and preservation of personal data so that no unauthorized persons gained access to them and could not identify the participants in the study. Ethically sensitive data was handled with confidentiality. The utility requirement means that the information and data collected were used solely as the basis for the essay (Vetenskapsrådet, 2002). When we are done with our thesis, Da Nang University of Medical Technology and Pharmacy will get access to it. The result will be presented in a way that no person can be identified and all papers both for surveys and the observations have been destroyed.

Content
Sammanfattning
Summary
Content
Introduction
Background
Healthcare
Sweden
Hygiene
Education
Vietnam
Country
Hygiene
Education
Radiography
The Radiographers profession
Rationale
Purpose
Materials and metods
Ethics
Results
Survey
Observations
Discussion
Result discussion
Method discussion
Clinical implications
Future research
Conclusion
References
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A study of radiographer student´s knowledge about hygiene aspects A comparative study in Vietnam and Sweden