Noting recent double-digit increases in health-care associated infections (HAIs) and potential vulnerabilities in radiology departments, this author emphasizes proactive preventive measures to protect patients and staff.
Approximately, 1.7 million individuals develop health-care-associated infections (HAIs) every year, translating to a 4.5 percent prevalence rate in the United States.1 Health-care-associated infections are among the leading causes of death in the U.S as 90,000 to 99,000 die annually from HAIs, according to the National Institutes of Health (NIH).
It is not surprising that HAIs were on the rise during the COVID-19 pandemic. After all, hospitals were short staffed, workers were constantly dealing with emergencies, and there were numerous supply shortages.
However, the very recent news about the continued rise of HAIs is even more alarming. According to recently published statistics on hospital safety, the average risk of three HAIs— Methicillin-resistant Staphylococcus aureus (MRSA), central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI)—spiked to a 5-year high in hospitals during the COVID-19 pandemic and remain high today.2
A comparison of recent HAI data, covering late 2021 and 2022, to the period immediately prior to the COVID-19 outbreak, revealed the following increases in HAIs.
While the HIA increases varied by state, the data indicate that hospitals across the nation must recommit to patient safety to counteract the spread of HAIs. The good news is that a considerable proportion of HAIs are preventable through proper infection prevention and control (IPC) policy and planning.
With this in mind, let us take a closer look at vulnerabilities in the radiology department with HIAs and multiple ways imaging professionals can reduce HAI spread in the radiology department and throughout the institution.
Recognizing that Radiology Departments Can be Breeding Grounds for HIAs
Over the last three decades, the risk of HAIs has increased in the radiology department due to greater patient volume and an increase in the utilization of imaging modalities.3
In hospitals, radiology departments can be amajor reservoir for HAIs because they’re frequently utilized, shared locations for diverse patient populations—from children to the elderly to people with complex conditions and unknown diseases. Moreover, radiology departments have evolved from one-stop X-ray to multi-room facilities with an array of equipment and image-guided interventional treatments, increasing the chances for bacterial spread.
Given the large numbers of patients that pass through daily or have X-ray exams performed portably, contamination of radiographic equipment and accessories is unavoidable. Even with standard preventative measures, such as hand hygiene, use of protective barriers and antiseptic cleaning of surfaces, neither contact precautions nor antiseptic cleaning can eliminate all bacteria in the hospital.
Shared space—and shared equipment—can turn radiology departments into breeding grounds. Colonized and infected patients waiting for different radiological tests can increase the risk of HAI spread. In most cases, hospitals don't have dedicated equipment just for use on infectious patients.
Many reports have demonstrated deficiencies in disinfection and sterilization protocols within the radiology department.3 These include studies that illustrate the presence of microorganisms on medical equipment and radiology workstations.4,5 Furthermore, most EPA-approved disinfectants state that treated surfaces must remain visibly wet with the disinfectant for as much as two to four minutes to achieve maximum effectiveness as anything less diminishes effectiveness and increases risks. Yet, with high patient volumes, how many busy imaging facilities can be certain equipment stays wet that long?
Human contact poses yet another problem. Contaminated hands of health-care workers and/or patients can lead to transfer of infectious pathogens from one person to another and to adjacent surfaces and devices.
A wide range of microbial pathogens have been linked to different radiological devices and equipment.3 For example, portable imaging units come in close proximity to pathogen-laden surfaces in the intensive care unit (ICU) and the emergency department (ED). The detectors used in portable imaging routinely come in direct contact with the patient for just about every exam.
In addition, if a tech’s hands become contaminated when using a portable unit, it could result in the rapid spread of HAIs. That’s because portable X-rays are often utilized for multiple patients in a short amount of time, all while using just one detector across all patients and multiple departments.
Other modalities beyond digital X-ray pose unique challenges as well. In the case of MRI, the most common place for infection is the surface of the machine’s bore.3 However, since it is a difficult place to access, it may be overlooked during routine cleaning and disinfection.
The bottom line is that without proper infection controls, surfaces can breed hundreds of bacteria types and multiplication of bacteria into colonies. As radiology departments are particularly vulnerable to HAI spread, it’s imperative to establish and consistently use preventative strategies to keep patients and staff safe.
Essential Preventative Strategies to Help Safeguard Against HIAs
There are several measures radiology groups in hospitals and imaging facilities can take to prevent infections. The Centers for Disease Control (CDC), the NIH and many other experts have pointed to the following critical tactics.
Build a culture of safety. A commitment to safety starts at the top. STRIVE was a national initiative funded by the CDC and aimed at improving infection control.6 Some 400 hospitals nationwide completed a 12-month STRIVE intervention program. One key finding is that hospitals that are making real strides in infection control are those where leadership, starting with the CEO, is fully committed to infection prevention and control. They make infection prevention a chief business strategy, engage in developing and deploying best practices, provide incentives for achieving goals and follow the performance indicators.
That leadership commitment to infection control must permeate throughout an organization, reaching all departments and trickling down from managers to staffers. In the radiology department, staff should have an up-to-date knowledge and standardized operating procedures to minimize HAI spread via strict protocols, training, personnel, and radiology equipment. Cultivating a culture of safety in the organization and the department should be priority number one.
Reduce waiting time. Reducing the patient's stay in the waiting area is one of the most important factors in preventing the acquisition of HAIs in the radiology department. Prolonged exposure of patients to other patients and family members means the possibility of spreading HIAs from person to person. Moreover, “high touch” surfaces such as arms on chairs, tabletops, kiosk screens, and more in imaging waiting rooms can become contaminated.
Staggering appointments is one way to reduce wait times, but it’s not always realistic, especially in the hospital setting. Investing in speedy imaging equipment is another approach. It not only makes for faster patient throughput and less waiting room time, it also inherently enhances patient experiences.
Sterilize hospital equipment. Patients with bleeding wounds, surgical drains or draining abscesses may encounter the surfaces of imaging equipment leading to contamination. Other equipment including touch screens, keyboards, electrocardiogram leads, computer mice, patient transfer devices, and immobilization straps can all be infected. This emphasizes the need to develop and use an appropriate disinfection procedure before and after every patient visit to the radiology department.
Demand hand hygiene. Hand hygiene is a centuries-old concept, but still the primary strategy used around the world to prevent HAIs. The strict practice of hand hygiene reportedly reduces nosocomial infections by 40 to 70 percent. Even so, global studies have shown a lack of compliance on the part of health-care workers when it comes to hand hygiene. Researchers have suggested that regular hand hygiene is not practiced by more than 60 percent of healthcare workers.6
While alcohol sanitizers may be used, the use of alcohol is not very effective in enteric infections, particularly with Clostridioides difficle, and proper hand washing with soap and water is required. Special emphasis is required on hand hygiene while performing portable X-rays in the ED and other susceptible areas.
Additional routine precautionary measures include proper use of gloves, detector bags and disinfectant wipe downs after every exam and whenever entering a sterile field or coming into direct contact with patients.
Clean and disinfect radiology equipment. Here’s a critical fact every radiology professional should keep in mind: Up to one-third of HAIs can be prevented by proper cleaning of medical imaging equipment.7 In other words, a good deal of infection prevention is within your team’s control.
However, in a high-volume practice, ensuring that sanitary standards are met and maintained is no easy feat. One study reported that 88 percent of radiographers felt that lack of regular disinfection was a major contributing factor for contamination ofradiology equipment.8
Radiology managers must lead by example and require best practice protocols. These include ensuring all radiology surfaces including CT and MRI tabletops, and ultrasound tables, which come into direct contact with patients, are covered with a replaceable sheet, and replaced after every patient. Detectors should be bagged for all exams where it meets the patient and especially if there is a chance for body fluid contact. In addition, proper cleaning of imaging equipment with disinfectant solutions and or wipes must be performed between all exams.
Does Your Imaging Equipment Have Built-In Antibacterial Features?
Use antibacterial imaging equipment. Many hospitals choose digital radiography equipment that features built-in antibacterial protection as another added safety measure. For example, Fujifilm’s FDR D-EVO II and FDR D-EVO III detectors are made with a patented Hydro AG antibacterial coating. The company’s FDR AQRO portable X-ray system, the FDR Cross hybrid mobile C-arm and forthcoming models of MR and CT systems feature antibacterial coating on their high touch surfaces.
To help reduce the alarming rate of HAIs, Fujifilm has developed an exclusive antibacterial silver-ion coating, Hydro AG™, which provides an innovative layer of added protection to suppress growth of various types of bacteria, microorganisms, and mold on a portable or detector’s surfaces. This antibacterial coating uniquely regenerates its germ-killing silver ions to the surfaces when they are exposed to moisture, both ambient moisture in the air and moisture due to wipe downs.
Emphasizing The Use of Portable Imaging for Compromised Patients
Utilize portable devices for compromised patients. With compromised patients, isolation is the obvious first line of defense for avoiding HIA spread. However, these patients commonly require bedside imaging so ensuring the safety of the imaging equipment is imperative.
One solution for many hospitals is to use portable imaging equipment that is known for its antibacterial protection. For example, Fujifilm’s FDR AQRO Mini Mobile System is ideal for high-risk and sterile field areas such as the ICU, neonatal intensive care unit (NICU), operating room as well as isolation areas. Its cord-free design, smooth sealed surfaces and emphasis on infection control make it an ideal solution to serve as a device dedicated for infectious patients.
Outside of having dedicated portables just for compromised patients, thorough infection control protocols are always the utmost priority. Antibacterial coatings and dedicated systems are not a substitute for strict adherence to standard infection control protocols.
Be Part of the Solution
Data from the CDC data demonstrates that HAIs affect one out of every 31 patients and result in an overall economic burden to hospitals ranging from $28-45 billion, according to research from the NIH. The radiology department has an obligation to do its part to reduce HAIs, keep staff and patients safe, and save lives. Every radiology department has an opportunity to be part of the solution in reducing HAIs, ensuring patient and staff safety, and saving lives.
1. Haque M, McKimm J, Sartelli M, et al. Strategies to prevent healthcare-associated infections: a narrative overview. Risk Manag Healthc Policy. 2020;13:1765-1780. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532064/ . Published September 28, 2020. Accessed July 12, 2023.
2. The Leapfrog Group. New Leapfrog hospital safety grade reveals significant increase in healthcare-associated infections and worsening patient experiences during COVID-19 pandemic. Available at: https://www.leapfroggroup.org/news-events/new-leapfrog-hospital-safety-grade-reveals-significant-increase-healthcare-associated . Published May 3, 2023. Accessed July 12, 2023.
3. Llyas F, Burbridge B, Babyn P, Health care-associated infections and the radiology department. J Med Imaging Radiat Sci. 2019;50(4):596-606.e1.
4. Levin PD, Shatz O, Sviri S, et al. Contamination of portable radiograph equipment with resistant bacteria in the ICU. Chest. 2009;136(2):426-432.
5. Duszak Jr R, Lanier B, Tubbs JA, Ogilvie M, Thompson-Jaeger S. Bacterial contamination of radiologist workstations: results of a pilot study. J Am Coll Radiol. 2014;11(2):176-9.
6. AHA Center for Health Innovation. Getting hospitals to zero. Available at: https://www.aha.org/center/strive . Accessed July 12, 2023.
7. Giacometti M, Gualano MR, Bert F, et al. Microbiological contamination of radiological equipment. Acta Radiol. 2014;55(9):1099-1103.
8. Calfee DP, Salgado CD, Classen D, et al. Strategies to prevent transmission of methicillin-resistant Staphylococcus aureus in acute care hospitals. Infect Control Hosp Epidemiol. 2008;29 Suppl 1:S62-80.