Infection control practices and microbial load of imaging receptors used by a diagnostic imaging department at an academic hospital

Abstract

Introduction: Infection control protocols in health care settings vary across the world; however, a few key aspects are addressed in most countries’ protocols, such as hand hygiene and sterile procedures. Current infection control practices in South Africa and listed by the Department of Health include the hand hygiene steps of the World Health Organization (WHO), which provide information on pre- and post-patient contact, sterile practices and making use of personal protective equipment such like masks and gowns (Department of Health, 2017). Infection control protocols are important because of the consistent worldwide threat of contamination of patients and healthcare workers with nosocomial pathogens (Sukumar and Yadav, 2012). The effects of contamination can be devastating and, all over the world, researchers are searching for solutions to this problem. In the radiology setting, inanimate objects such as imaging receptors (IRs) have the ability to act as a fomite (Burbridge, 2012), which means infection/pathogens can be transmitted through equipment that comes in contact with patients. When IRs are not disinfected after patient contact, any possible infectious agent may be transmitted to another patient (susceptible host) (Ehrlich and Coakes, 2017). IRs travel through hospitals when equipment is used for mobile radiography and, thus, contribute to the risk of spreading infectious agents on the routes travelled through the hospital (Burbridge, 2012). Main research question: What are current infection control practices and microbial load on the surfaces of the IRs used in the diagnostic imaging department during mobile X-ray examinations at an academic hospital? Methods: The study sample involved all 12 available conventional 35 × 43 cm X-ray machine IRs and a digital X-ray machine detector (only the 35 × 43 cm digital detector was sampled, for the sake of consistency, in turn, the 24 × 30 cm digital detector was not sampled because it was not routinely used like the conventional IRs) used in the imaging department, as well as during mobile X-ray examinations at the participating academic hospital. The IRs were labelled to enable the researcher to keep track of the movement of each individual IR circulating through the hospital. Physical swabs were taken in the morning before the day shift started at 07:00 and again at 16:00 when the day shift ended. The swabs were taken individually for each IR pre- and post-disinfection with 70% ethanol. The sampled swabs were transferred to the laboratory for cultivation. Results: During the analysis of the data, it was found that infection control is not a priority for radiographers or student radiographers. Hand hygiene mostly had higher preference rates as a method of infection control, which is noteworthy. When the new digital X-ray machine with the antimicrobial layer was introduced, the study was changed; it is likely that antimicrobial layers will be the way forward and this possibility had to be investigated. In this study, no bacteria were detected at the end of a sampling day in which the digital X-ray machine was used, in comparison to the IRs, for which the participants had to take more care with cleaning and be aware of the placement of the IRs when travelling. The infection control practices in the department or on mobile X-ray examinations were not consistently applied, even though the Department of Health, Free State, as well as the researcher, have developed adequate infection control protocols. Covers for the IRs were used only twice throughout 86 trips. By failing to cover an IR, there will be a form of contact in a patient’s immediate area or bed. Any contact with a contaminated IR could lead to cross-contamination (Russotto et al., 2015; Wainwright, 2015). IRs move around frequently throughout the hospital for mobile radiography and the likelihood of exposure occurring is high, even if the participant takes along an extra IR to avoid walking back to the department when an extra mobile X-ray is requested. Significance: The importance of the study relates to evidence that many patients are infected with nosocomial pathogens, of which the source could be any number of items/people within the hospital setting (Jayasinghe and Weerakoon, 2014). By taking swab samples and observing if the infection control recommendations were followed, possible areas/actions that could cause contamination and colonisation could be identified in the implementation of current protocols.