Radiology’s Role in Limiting Health Care–acquired Infections

In a session at this month’s meeting of AHRA: The Association for Medical Imaging Management in Las Vegas, Nevada, Lyn M. Mehlberg, BS, CNMT, FSNMTS, a self-described regulations junkie, predicted that regulators—including the Joint Commission, CDC, OSHA, and CMS—are poised to come down hard on radiology on the issue of infection control in radiology departments and imaging centers. Mehlberg, quality and safety specialist for cardiovascular, diagnostic, and radiation oncology services, Aurora BayCare Medical Center, Green Bay, Wisconsin, pointed out the fault lines and advised attendees on how to develop a sound infection-control policy in her talk, “The Next Big Thing: Infection Prevention and Control in the Imaging Department.”

“Up to 10% of all patients come down with HAIs, and 2 million are reported annually, accounting for 100,000 deaths and costing the health care system $5 billion a year. As a result, the Joint Commission has made reducing HAIs a 2009 National Provider Standard Goal.”

Lyn Mehlberg When Mehlberg asked the audience how many were up to speed on quality and infection control and were prepared for the next Joint Commission inspection, not one hand was raised. “Infection control has been an afterthought in health care, especially in areas outside surgery, ICU patient units, and interventional radiology,” she says. “Interventional radiology does a great job, but how many of you have transferred those same infection-control measures into MRI and CT biopsies? Some of these things should be applied in opening percutaneous intravascular central catheter lines.” Most of the standards have been written for general nursing or general surgery, Mehlberg explains, but need to be translated for the imaging department. While everything, from the phone to the glove box to the keyboard, is teeming with pathogens, the good news is that, for the most part, the cure is as low-tech as soap and water. Mehlberg cites studies that show that most dedicated health care professionals spend only 5 seconds washing their hands, although hands must be washed for 15 seconds (and the washing must involve rapid hand motion with soap) for pathogen removal through washing to be effective. “The Joint Commission is coming out with stopwatches and timing how long your staff members are washing their hands,” she warns. Why Now? Statistics suggest that regulators are targeting infection control because of the impact that health care–acquired infections (HAIs) have on patients and hospital systems. Up to 10% of all patients come down with HAIs, and 2 million are reported annually, accounting for 100,000 deaths and costing the health care system $5 billion a year. As a result, the Joint Commission has made reducing HAIs a 2009 National Provider Standard Goal, and is asking that hospitals enact the following preventive measures:

• institute guidelines for hand hygiene,
• report sentinel events involving infections,
• prevent multidrug-resistant organisms, and
• prevent central-line infections.

“This will be a big push for the next five years,” Mehlberg predicts. She reports that violations in the following three categories were found during recent visits to imaging departments/centers. First, lack of USP gap analysis: USP is not a regulator, but the federal government has charged it with setting practices for the pharmacy world. The Joint Commission is recognizing that there are no exemptions for any specialties, and it is going to start asking how hospital staff are preventing sterility breeches anywhere that pharmaceuticals and radiopharmaceuticals are used—including the radiology, nuclear medicine, and cardiology departments. Second, poor hand hygiene: In once instance, staff members were cited for not using disinfectant hand gel each time they had touched equipment or patients, and one surveyor wanted to see more hand-gel stations. Two hospitals were cited because staff members did not use paper towels to turn off faucets, and a lack of formal hand-hygiene monitoring was also noted. Third, equipment violations: These included a staff failure to clean equipment surfaces between patients; with the rise in public infectious outbreaks, radiology departments need to recognize the importance of cleaning the inside of the bore. Other violations included failures to clean lead aprons, lead pigs, or syringe shields. The Joint Commission is asking how often facilities are cleaning these items and what is done if blood gets on them. Tears, holes, and lack of protective covers on positioning aids, were also noted as issues, along with unsecured sharps containers. Addressing the Problem How can you bring your department up to speed? At the very least, Mehlberg recommends that facilities develop a medications-management policy. Access the American Society of Health-system Pharmacists’ discussion guide http://www.ashp.org/s_ashp/docs/files/HACC_797guide.pdf and get together with your staff to think about whether there is anything else that can be done to make medication processes safer for patients. Take a close look at the nuclear-medicine department. Until 1991, radiation hazards took precedence over the biohazard component of regulation, but OSHA came up with guidelines for occupational exposure to blood-borne pathogens in October 2001, creating a de facto federal mandate: every facility must come up with a blood-borne–pathogen policy. Facilities should ensure that the nuclear-medicine department is included in their blood-borne pathogen plans. Mehlberg advises replacing outdated needle-assist systems that force a spray to remove that risk in the hot laboratory. She also suggests inviting the pharmacy director to the department to ensure compliance. Many states fall under federal OSHA jurisdiction, so find out if your state is one of them. Comply with the CDC’s 2007 guidelines for performing lumbar punctures. Everyone performing a lumbar puncture must wear a face mask to prevent patient exposure to oropharyngeal flora. When these get in the spinal column, they bypass the immune system and can cause bacterial meningitis, Mehlberg explains. This guideline affects myelograms, spinal and epidural anesthesia, and intrathecal chemotherapy. Be sure that staff members are in compliance with CDC fingernail recommendations: nails must be clean and no more than 0.25 inch in length. Artificial nails, long nails, and chipped polish harbor and support bacteria. Develop a formal hand-hygiene program and monitor it. Always remove gloves when using a common work station, and remember that the glove box is a source of germs. Have solid procedures for cleaning between patients. Door handles, sink faucets, and wheelchairs are all sources of human pathogens. Limit/control foods and beverages in the department. Discard ripped positioning aids. Appoint an infection-control liaison; find a technologist who will be vigilant on the issue. “In summary, the rampant spread of infection is seriously burdening our health care system,” Mehlberg concludes, adding that there is also a major new financial incentive to be compliant: CMS is no longer paying for care associated with certain HAIs.Cheryl Proval is vice president, publishing, The Imaging Center Institute, Tustin, California.