Is Portable X-ray Equipment Spreading Resistant Bacteria in Your Unit?
Is Portable X-ray Equipment Spreading Resistant Bacteria in Your Unit?
Abstract & Commentary
By David J. Pierson, MD, Editor, Professor, Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, is Editor for Critical Care Alert.
Synopsis: An initial survey demonstrated poor infection-control technique by radiology technicians in the ICU and frequent contamination of X-ray machines by resistant bacteria. Technique improved and contamination decreased with an educational and monitoring intervention, although the improvements diminished after several months.
Source: Levin PD, et al. Contamination of portable X-ray equipment with resistant bacteria in the ICU. Chest 2009 Apr 17; Epub ahead of print.
Levin and colleagues at Hebrew University-Hadassah Medical School in Jerusalem carried out a 4-phase study to clarify the role of radiology technicians and portable X-ray equipment as potential vectors for the spread of infection in their 20-bed ICU, as well as to determine whether an intervention designed to diminish this role would be effective. The first phase consisted of covert observation of the performance of routine daily chest X-rays in the unit, to determine such things as whether the technician used established hand-hygiene measures before and after each exam, and whether the film cassettes were handled in a manner consistent with good infection control. In the second phase, surface cultures were taken from the X-ray machine once all the morning films in the unit had been taken. The third phase consisted of an educational intervention with the radiology technicians on proper infection-control measures related to obtaining the daily X-rays, plus continued culture surveillance and non-covert observation of the technicians on their rounds. Finally, in the fourth phase, an additional month of technician observation and machine cultures was undertaken 5 months after the intervention phase.
During the observation, intervention, and follow-up phases of the study, 173, 113, and 120 chest X-rays were taken, respectively. In only 1% (2/173) of the observation-period X-rays were adequate infection-control measures followed. During the intervention period this increased to 42% (48/113), but it fell to only 10% (12/120) of X-rays in the follow-up period (P < 0.001, follow-up vs intervention and observation periods). X-ray machine surface cultures yielded resistant Gram-negative bacteria on 39% (12/30), 0% (0/29), and 50% (7/14) of occasions, respectively, for the 3 periods (P < 0.001). The authors conclude that multiresistant bacteria are frequently transferred from patients to the X-ray machine in the presence of poor technician infection-control practices, and that these could be a source of cross infection among patients. They further conclude that improved infection-control practices can decrease this transfer, and that radiology technicians should be included in ICU infection-control measures.
Commentary
As pointed out by the authors, nosocomial infections caused by highly resistant bacteria currently affect about 20% of ICU patients, and a substantial proportion of these infections are thought to originate with inadequate hand hygiene and other infection-control lapses by members of the ICU team, leading to patient-to-patient transmission. This study demonstrates that radiology technicians should be included in the term "ICU team," and that portable X-ray machines may be important vectors for the spread of bacteria among ICU patients. Its findings also suggest that, while educational interventions can be effective in achieving infection-control compliance and reducing bacterial contamination of X-ray machines, the benefits of such interventions are unlikely to be sustained without some sort of ongoing program to encourage and monitor the use of appropriate infection-control measures.
Levin and colleagues at Hebrew University-Hadassah Medical School in Jerusalem carried out a 4-phase study to clarify the role of radiology technicians and portable X-ray equipment as potential vectors for the spread of infection in their 20-bed ICU, as well as to determine whether an intervention designed to diminish this role would be effective.Subscribe Now for Access
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