Contamination of Interventional Radiology Lead Aprons by Nosocomial Pathogens
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2017, Vol 1, Issue 2
Abstract
Lead radiation protection aprons and neck/thyroid shields are used by hospital personnel in rooms where ionizing radiation is present. These methods of radiation protection are used in the catheter lab by personnel such as interventional radiologists and interventional cardiologists who often perform procedures upon immunocompromised patients who are at increased risk for acquiring hospital acquired infections (HAI). In the United Kingdom, HAI constitute a substantial financial burden up to 1000 million euro per year [1]. Patients with HAI remain in the hospital 2.5 times longer and incur higher personal costs than patients without [2]. Since these radiation protective aprons are cleaned infrequently, they serve as a possible source of HAI [3,4]. Studies have shown that white coats and ties [3-6] are a reservoir for colonies of pathogens to grow and spread nosocomial infections. However, no study has been done to show whether lead shields that are worn by hospital personal, especially ones in the IR catheter labs, can be a source of nosocomial infection to their daily contacted patients and to themselves. Our study will address what types of pathogens grow on protective lead aprons and collars. Potential implications of this study include whether or not a policy should be proposed regarding protective lead maintenance and disinfection. Methods Twenty-five subjects, (radiology technologists, nurses, physicians, and physician assistants) were provided with a questionnaire detailing the amount of use and frequency of laundering. The study was conducted in a university hospital interventional radiology department. Two locations (Figures 1A & 1B) with potential patient contact were sampled: outer thyroid and chest shield and two locations with self body contact: inner thyroid and chest shield. The internal and external 25 cm2 surface of both the thyroid shield and shoulder of lead apron were sampled with a sterile swab and inoculated on sheep blood with novobiocin, bile esculin azide, eosin methylene blue (EMB), and sabouraud dextrose agar. These agars were specific for the identification of Staphlococcus Aureus (Staph. A), Methicillin Resistant Staphlococcus Aureus (MRSA), Escherichia Col (E. coli) and Tinea species. Studies have demonstrated that these organisms are associated with health care apparel contamination [3-5]. A CFU of 1 was considered a significant source of infection and was regarded as positive in this study. An expert microbiologist and a medical technologist were consulted with microbe interpretation. The data was analyzed using descriptive statistics methods. (Tables 1 & 2) The results of the survey questionnaire revealed that none of the medical staff cleaned their protective lead. Furthermore, in the last 10 years, none of the aprons were replaced. The majority of subjects wore the lead for at least 4-5 hours per day during procedures (Figure 2). Skin flora, (CoNS) were found on all lead aprons and thyroid shields, with (28%) having more than 20 CFUs. Colonies of Staph A was found on the lead aprons and thyroid shields of 21 subjects (84%); three of the isolates were resistant to methicillin (MRSA). Staph A was found on the outer protective lead of 12 subjects (48%) and interior of 11 subjects (44%). Tinea (Figure 3) species were also found on 21 lead aprons (84%). Tinea was found on the outer protective lead of 20 subjects (80%) and interior of 18 subjects (72%). E. coli and VRE were not detected on any protective lead aprons. There was no statistically significant association with the time spent wearing protective lead and the presence of Staph A (Table 1) (Chi-Square=5.19, DF=5, p-value=.393). However, there was a statistically significant association between medical staff’s time spent wearing protective lead and the presence of Tinea species (Table 2) (Chi-Square=14.435, DF=5, p-value=.0131). Increase in Tinea colonies was related to time spent wearing protective lead aprons (Figure 2). The fellows had the highest amount of Tinea growth; 88% of sampled thyroid and lead shields showed fungal colonization, likely related to greater time of apron use. The lowest growth was found on physicians and physician assistants, both having 25% of their lead protection contaminated with Tinea species. For Staph A and Tinea species, there were no statistically significant difference between locations sampled on the thyroid and lead apron.
Authors and Affiliations
Mohamed M Jaber, Edward Qiao, Monte L Harvill, Farah A Nasser
Keywords
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- EP ID EP567414
- DOI 10.26717/BJSTR.2017.01.000203
- Views 153
- Downloads 0
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