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Contaminated medical lead clothes in an orthopedic specialist hospital: The potential for infection

Published:February 04, 2016DOI:https://doi.org/10.1016/j.ajic.2015.10.045
      To the Editor:
      We read with great interest the article, “Contamination of dental goggles and effectiveness of 3 disinfectants in a stomatology hospital,” by Yang et al.
      • Yang D.
      • Zhou F.
      • Hu M.
      • Lai L.
      • Yang J.
      • Xiao J.
      • et al.
      Contamination of dental goggles and effectiveness of 3 disinfectants in a stomatology hospital.
      The study highlighted the fact that goggles in dental practice can increase cross-contamination and infection risk. This article gave us a great deal of inspiration. I am a hospital infection preventionist working in an orthopedic hospital that has 18 laminar flow operating rooms, 3 emergency operating rooms, and performs approximately 13,200 operations per year. Patients admitted to this hospital are typically experiencing musculoskeletal disorders caused by traffic or work-related accidents and various musculoskeletal degenerative diseases such as hyperosteogeny, osteoarthritis, spinal stenosis, and intervertebral disc herniation. Nearly 90% of inpatients are treated with surgery. Mini-C-arm fluoroscopy and radiograph apparatus are often used during orthopedic procedures. These instruments emit a large amount of x-rays, which can bring about significant harm to the body and health of surgical staff.
      • Giordano B.D.
      • Baumhauer J.F.
      • Morgan T.L.
      • Rechtine G.R.
      Patient and surgeon radiation exposure: comparison of standard and mini-C-arm fluoroscopy.
      Therefore, medical lead clothes are frequently used as a physical barrier to avoid x-rays. However, as with dental goggles, medical lead clothes could be potential reservoirs of nosocomial pathogens.
      The shortage of medical lead clothes in our facility leads to repeated use, and most medical lead clothes are not cleaned or disinfected after each use. In addition, during the course of orthopedic surgical procedures, blood splashes occur frequently, contaminating the medical lead clothes. If the medical lead clothes are not cleaned or disinfected in a timely and effective manner after use, they could become reservoirs of nosocomial pathogens—not only bacteria, but also viruses such as HIV and hepatitis B and C viruses—that can survive in dry blood for up to 5 weeks and possibly longer.
      • Cattaneo C.
      • Nuttall P.A.
      • Sokol R.J.
      Detection of HIV, hepatitis B and hepatitis C markers in discarded syringes and bloodstains.
      Besides, due to the particularity of the material, medical lead clothes cannot be disinfected with a germicidal wipe containing alcohol or chlorine-containing disinfectants, making it difficult to disinfect the surface of medical lead clothes.
      • Eder H.
      • Schlattl H.
      • Hoeschen C.
      X-ray protective clothing: does DIN 6857-1 allow an objective comparison between lead-free and lead-composite materials? Rofo.
      We conducted a study to observe the use of medical lead clothes in our operating rooms. There were 76 pieces of medical lead clothes of the same type that were being used in our operating rooms for surgery that involved use of radiograph apparatus. Each item of lead clothing was disinfected with a germicidal wipe containing quaternary ammonium salt at the end of an operative day. No item of medical lead clothing was sterilized between uses during the day. We found 39 pieces of medical lead clothes were used more than once; some were used 3 or 4 times. Secondly, there were 27 pieces of medical lead clothes with visible blood at the end of the day, which had the potential to transmit bacteria or viral infections to patients as well as wearers and cleaners. Thirdly, the presence of bacteria was detected. Before the disinfection of medical lead clothes, swabs that had an area of 25 cm2 at the 5 diagonal points were sampled. Each sample was placed in a tube and inoculated on a general nutrient agar plate, and then incubated for 48 hours at 37°C. The MicroScan WalkAway 96 PLUS instrument (Siemens, Dade Behring, Deerfield, IL) was used for the identification of the bacteria. Staphylococcus aureus, epidermal S aureus, Pseudomonas aeruginosa, Escherichia coli, Acinetobacter, and methicillin-resistant S aureus were all isolated.
      We concluded that medical lead clothes should be cleaned after each use and that medical lead clothes contaminated by blood should be promptly decontaminated. Ideally, medical lead clothes should be washed in commercially available purpose-built automatic washing machines. The covers of medical lead clothes, which not only can be detachable but also have a moisture-resistant coating, are a useful alternative. Medical lead clothes with antimicrobial material or components may assist in cross-contamination and infection prevention.

      References

        • Yang D.
        • Zhou F.
        • Hu M.
        • Lai L.
        • Yang J.
        • Xiao J.
        • et al.
        Contamination of dental goggles and effectiveness of 3 disinfectants in a stomatology hospital.
        Am J Infect Control. 2015; 43: 1003-1005
        • Giordano B.D.
        • Baumhauer J.F.
        • Morgan T.L.
        • Rechtine G.R.
        Patient and surgeon radiation exposure: comparison of standard and mini-C-arm fluoroscopy.
        J Bone Joint Surg Am. 2009; 91: 297-304
        • Cattaneo C.
        • Nuttall P.A.
        • Sokol R.J.
        Detection of HIV, hepatitis B and hepatitis C markers in discarded syringes and bloodstains.
        Sci Justice. 1996; 36: 271-274
        • Eder H.
        • Schlattl H.
        • Hoeschen C.
        X-ray protective clothing: does DIN 6857-1 allow an objective comparison between lead-free and lead-composite materials? Rofo.
        Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 2010; 182: 422-428