Antibiotic resistant MRSA
MRIs Are a Breeding Ground for Super Bugs Like MRSA
October 22, 2008
by Lynn Shapiro, Writer
The Joint Commission--the agency that certifies hospitals--is extremely concerned about super bugs like Methicillin Resistant Staphylococcus Aureus (MRSA) and is evaluating control procedures for every department in hospitals including the MRI suite, says Peter Rothschild, M.D., a radiologist and MRI expert who authored the landmark paper "Preventing Infection in MRI: Best Practices."
But efforts to address the problem are falling woefully short in hospitals, and are completely absent in free-standing imaging centers, according to experts.
Dr. Rothschild tells DOTmed News, "When you go to a restaurant, you know the health department has looked at it. Even the trashiest restaurant. But there's no one watching these outpatient imaging centers--no requirement that anyone comes in there and certifies them as clean and safe."
Furthermore, there's a Catch 22 with MRIs in all settings, Dr. Rothschild says. "The magnets and the pads on the table can harbor MRSA and need to be cleaned. But cleaning crews are not permitted to go into the imaging room unless technologists supervise them at all times. Since the cleaning crew usually comes late at night after the technologists have gone home, the MRI rooms are rarely if ever cleaned," Dr. Rothschild says.
"If the cleaning crew is not properly supervised, they could be injured or killed," the doctor says. "For example, if they bring in anything metal (like a screw driver) it will be drawn into the magnet at over 60 miles an hour." He mentioned the infamous case of the young boy in New York who was killed when a non-MRI-compatible oxygen tank was brought into the suite by mistake. It was sucked into the magnet, crushing the patient.
"Also if a new cleaning person has a pacemaker or aneurysm clip and enters the room he could be killed," Dr. Rothschild says.
What's more, the magnets don't come with cleaning instructions so there is great concern over using harsh cleaning solutions on the coils and magnet, which are very expensive and can be damaged, he says.
Pads Harbor Germs
"Worst are the pads. They come in close contact with the patient and are often torn and frayed -- the perfect breeding ground for bacteria. With a black light, you can see the biological materials left on these pads where bacteria can grow. The technologist's answer to torn and frayed pads is often to puts a clean sheet over these contaminated pads, which is of no help.
"The pillows are another example of lack of infection control. They are bought at the store and are used for years before being discarded and never properly cleaned," Dr. Rothschild says. He advises that "pillowcases do not protect patients against aggressive staph infections like MRSA. The centers need to change their pillows and use pillows designed for medical use, not ones bought at Wal-Mart."
Deaths Are Staggering
He says that deaths from MRSA have been staggering, with more people dying in the U.S. this year from the super bug than from AIDS. The mutated bacteria still respond to some antibiotics but treatment is extremely difficult. Some antibiotics are successful in some people but others don't respond. What's more, the newer antibiotics are very expensive and may have serious side effects. The usual way to spread MRSA is through surface to skin contact, but sometimes it is airborne.
"We must focus on prevention," Dr. Rothschild says.
He advises that the most important procedure to stop MRSA is hand washing. However, what's unbelievable, Dr. Rothschild says, is that he has never seen a sink in any MRI rooms he's visited in over 25 years. (We welcome DOTmed users' expert views on the challenge of running pipes and plumbing into the MR suite!)
"Mobile MRIs don't even have running water and technologists rarely wash their hands between patients. They keep spreading these bacteria. They're often too busy and infection control gets overlooked. The price of an MRI is coming down so they need to scan more patients in less time, leaving no time for proper infection control. Technologists feel they could be fired if they are too slow at turning around the MRI room for the next patient," Dr. Rothschild says.
Use Written Protocols
He adds, MRI centers must install written protocols. Centers must insist that technologists wash their hands and clean the pads. Also if pads are torn and frayed, even if patients don't see them because a sheet is placed over the pads, they must be replaced.
One technologist told Dr. Rothschild that the pad she used was so bad it smelled. She used air fresheners to cover up the stench.
Malpractice Suits
Centers need to take MRSA seriously, if only because they might be facing medical malpractice suits, Dr. Rothschild warns. For example, if patients get MRSA after having an MRI, the plaintiff's attorney can subpoena the pads and obtain cultures to determine if the bug came from the same colony living on the pads or in the magnet, using DNA-type testing. Additionally Dr. Rothschild has shown MRSA can live on the pads for over eight weeks.
He adds that "the best way I have found for patients to protect themselves is to ask to see the center's written infection control policies before their scans. If that center does not follow the cleaning procedures, I would look for another MRI center where infection control is a priority."
11 Steps for Preventing Super Bug Infections in MRI
In his paper, "Preventing Infection in MRI," Rothschild says that "the cleanliness of free-standing imaging centers and hospital radiology departments is crucial for reducing the spread of MRSA and other acquired infections." Following are 11 simple procedures that can prevent the spread of these infections.
1. Have a written infection control policy to include MRI cleaning procedures as well as the cleaning schedule and have it posted throughout the center.
2. Implement a mandatory hand washing/hand sanitizing procedure between patient exams for technologists and any others who come into contact with patients.
3. Clean the MRI tables, inside the bore of the magnet, and any other items that come into contact with a patient. Infection control experts recommend this be done between each patient.
4. Clean all pads and positioners with an approved disinfectant. Infection control experts recommend cleaning after each patient.
5. Periodically inspect the pads with a magnifying glass, particularly at the seams, to identify fraying or tearing. If present, the pads should be replaced.
6. Regularly check all padding material with an ultraviolet ("black") light and make sure that any biological material detected on the pads can be removed.
7. Replace damaged or contaminated pads with new pads incorporating permanent antimicrobial agents.
8. Use pillows with a waterproof covering that is designed to be surface wiped. Replace pillows when their barrier is compromised.
9. Promptly remove body fluids and then surface disinfect all contaminated areas.
10. If a patient has an open wound or any history of MRSA or another infection:
a. All staff coming in contact with the patient should wear gloves and gowns. These barriers must be removed before touching other areas not coming in contact with the patient: door knobs, scanner console, computer terminals. etc.
b. The table and all the pads should be completely cleaned with disinfectant before the next patient is scanned, if it is not already being performed between every patient. For patients with any known infectious process, add 10-15 minutes onto the scheduled time to assure there is enough time to thoroughly clean the room and all the pads.
11. All furniture should be periodically cleaned. Ideal surfaces are: those that are waterproof and wipeable. Infection control experts recommend this be done between each patient.
About Peter Rothschild, MD
Dr. Rothschild, a radiologist, is one of the foremost Open MRI experts. He served as Medical Director of the research laboratory at the University of California, San Francisco, where he helped develop the first Open MRI scanner. He is the editor of the first textbook on Open MRI and has written papers on the topic. A popular lecturer, he speaks on MRI and its future. He is founder and president of Patient Comfort Systems Inc., a company devoted to patient comfort and safety.
Video Links
A video on infection control and MRI prepared by Rothschild and colleagues is available at http://www.patientcomfortsystems.com/
He also recommends these videos showing "flesh eating" MRSA bugs:
http://www.youtube.com/watch?v=HK8caVCrLBg
http://www.youtube.com/watch?v=p31y6p_Fc9g
But efforts to address the problem are falling woefully short in hospitals, and are completely absent in free-standing imaging centers, according to experts.
Dr. Rothschild tells DOTmed News, "When you go to a restaurant, you know the health department has looked at it. Even the trashiest restaurant. But there's no one watching these outpatient imaging centers--no requirement that anyone comes in there and certifies them as clean and safe."
Furthermore, there's a Catch 22 with MRIs in all settings, Dr. Rothschild says. "The magnets and the pads on the table can harbor MRSA and need to be cleaned. But cleaning crews are not permitted to go into the imaging room unless technologists supervise them at all times. Since the cleaning crew usually comes late at night after the technologists have gone home, the MRI rooms are rarely if ever cleaned," Dr. Rothschild says.
"If the cleaning crew is not properly supervised, they could be injured or killed," the doctor says. "For example, if they bring in anything metal (like a screw driver) it will be drawn into the magnet at over 60 miles an hour." He mentioned the infamous case of the young boy in New York who was killed when a non-MRI-compatible oxygen tank was brought into the suite by mistake. It was sucked into the magnet, crushing the patient.
"Also if a new cleaning person has a pacemaker or aneurysm clip and enters the room he could be killed," Dr. Rothschild says.
What's more, the magnets don't come with cleaning instructions so there is great concern over using harsh cleaning solutions on the coils and magnet, which are very expensive and can be damaged, he says.
Pads Harbor Germs
"Worst are the pads. They come in close contact with the patient and are often torn and frayed -- the perfect breeding ground for bacteria. With a black light, you can see the biological materials left on these pads where bacteria can grow. The technologist's answer to torn and frayed pads is often to puts a clean sheet over these contaminated pads, which is of no help.
Torn and frayed pads
are a biohazard
and must be replaced
are a biohazard
and must be replaced
"The pillows are another example of lack of infection control. They are bought at the store and are used for years before being discarded and never properly cleaned," Dr. Rothschild says. He advises that "pillowcases do not protect patients against aggressive staph infections like MRSA. The centers need to change their pillows and use pillows designed for medical use, not ones bought at Wal-Mart."
Deaths Are Staggering
He says that deaths from MRSA have been staggering, with more people dying in the U.S. this year from the super bug than from AIDS. The mutated bacteria still respond to some antibiotics but treatment is extremely difficult. Some antibiotics are successful in some people but others don't respond. What's more, the newer antibiotics are very expensive and may have serious side effects. The usual way to spread MRSA is through surface to skin contact, but sometimes it is airborne.
"We must focus on prevention," Dr. Rothschild says.
He advises that the most important procedure to stop MRSA is hand washing. However, what's unbelievable, Dr. Rothschild says, is that he has never seen a sink in any MRI rooms he's visited in over 25 years. (We welcome DOTmed users' expert views on the challenge of running pipes and plumbing into the MR suite!)
"Mobile MRIs don't even have running water and technologists rarely wash their hands between patients. They keep spreading these bacteria. They're often too busy and infection control gets overlooked. The price of an MRI is coming down so they need to scan more patients in less time, leaving no time for proper infection control. Technologists feel they could be fired if they are too slow at turning around the MRI room for the next patient," Dr. Rothschild says.
Use Written Protocols
He adds, MRI centers must install written protocols. Centers must insist that technologists wash their hands and clean the pads. Also if pads are torn and frayed, even if patients don't see them because a sheet is placed over the pads, they must be replaced.
One technologist told Dr. Rothschild that the pad she used was so bad it smelled. She used air fresheners to cover up the stench.
Malpractice Suits
Centers need to take MRSA seriously, if only because they might be facing medical malpractice suits, Dr. Rothschild warns. For example, if patients get MRSA after having an MRI, the plaintiff's attorney can subpoena the pads and obtain cultures to determine if the bug came from the same colony living on the pads or in the magnet, using DNA-type testing. Additionally Dr. Rothschild has shown MRSA can live on the pads for over eight weeks.
He adds that "the best way I have found for patients to protect themselves is to ask to see the center's written infection control policies before their scans. If that center does not follow the cleaning procedures, I would look for another MRI center where infection control is a priority."
11 Steps for Preventing Super Bug Infections in MRI
In his paper, "Preventing Infection in MRI," Rothschild says that "the cleanliness of free-standing imaging centers and hospital radiology departments is crucial for reducing the spread of MRSA and other acquired infections." Following are 11 simple procedures that can prevent the spread of these infections.
1. Have a written infection control policy to include MRI cleaning procedures as well as the cleaning schedule and have it posted throughout the center.
2. Implement a mandatory hand washing/hand sanitizing procedure between patient exams for technologists and any others who come into contact with patients.
3. Clean the MRI tables, inside the bore of the magnet, and any other items that come into contact with a patient. Infection control experts recommend this be done between each patient.
4. Clean all pads and positioners with an approved disinfectant. Infection control experts recommend cleaning after each patient.
5. Periodically inspect the pads with a magnifying glass, particularly at the seams, to identify fraying or tearing. If present, the pads should be replaced.
6. Regularly check all padding material with an ultraviolet ("black") light and make sure that any biological material detected on the pads can be removed.
7. Replace damaged or contaminated pads with new pads incorporating permanent antimicrobial agents.
8. Use pillows with a waterproof covering that is designed to be surface wiped. Replace pillows when their barrier is compromised.
9. Promptly remove body fluids and then surface disinfect all contaminated areas.
10. If a patient has an open wound or any history of MRSA or another infection:
a. All staff coming in contact with the patient should wear gloves and gowns. These barriers must be removed before touching other areas not coming in contact with the patient: door knobs, scanner console, computer terminals. etc.
b. The table and all the pads should be completely cleaned with disinfectant before the next patient is scanned, if it is not already being performed between every patient. For patients with any known infectious process, add 10-15 minutes onto the scheduled time to assure there is enough time to thoroughly clean the room and all the pads.
11. All furniture should be periodically cleaned. Ideal surfaces are: those that are waterproof and wipeable. Infection control experts recommend this be done between each patient.
About Peter Rothschild, MD
Dr. Rothschild, a radiologist, is one of the foremost Open MRI experts. He served as Medical Director of the research laboratory at the University of California, San Francisco, where he helped develop the first Open MRI scanner. He is the editor of the first textbook on Open MRI and has written papers on the topic. A popular lecturer, he speaks on MRI and its future. He is founder and president of Patient Comfort Systems Inc., a company devoted to patient comfort and safety.
Video Links
A video on infection control and MRI prepared by Rothschild and colleagues is available at http://www.patientcomfortsystems.com/
He also recommends these videos showing "flesh eating" MRSA bugs:
http://www.youtube.com/watch?v=HK8caVCrLBg
http://www.youtube.com/watch?v=p31y6p_Fc9g