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Archive April 2020 XXI, No. 4

Infection Prevention: Don't Overlook This SSI Threat

Radiation protective gear needs a quick cleaning between procedures.

Angela Ellis

Angela Ellis, MSN, RN, CNOR


Cyndi MacDonald

Cyndi MacDonald, RN, CNOR


H. Lee Moffitt Cancer Center
PERSONAL PROTECTION Place garments on a table during cleaning to ensure all surface areas are wiped down.

The lead aprons, skirts and vests your staff wear to protect themselves from radiation exposure are an often-ignored aspect of infection prevention protocols. Following these steps will ensure your staff understands the importance of wiping pathogens off their surfaces after each use.

  • Identify the issue. To establish a cleanliness baseline, wipe a microbial swab across a few garments. You can also use fluorescent markers to test your staff's cleaning compliance. Without their knowledge, place a marker on each garment. A month later, use a black light to see if the markers are still there. If they are, staff weren't properly cleaning the garments.

We switch the locations of the invisible marks — under the right armpit area or by the base of the knee cover, for example. Our staff never knows where the mark will be, but they know we'll be monitoring how often they've been removed.

  • Create accountability. Survey your OR staffers about their garment cleaning practices. We found significant knowledge deficits. Some staffers cleaned the items between every case, others with varying frequency and about a quarter had never done it. The biggest barriers to compliance were short turnover times, staffing levels, availability of flat surfaces to lay the garments on to clean and It's not my job! mentalities. Bottom line: There was no accountability for cleaning the garments.

That problem was solved through staff education. We gathered our team during in-services to report our findings, and then educated them on proper cleaning practices with hands-on demonstrations.

  • Improve compliance. Thoroughly clean each garment with peroxide wipes — front, back and along all side seams — between every use. Be sure to follow the dry time recommended by the wipe's manufacturer.

You need a large flat surface to clean the garments, so your staff must find a table that isn't being used to get the job done.

By checking for the presence of the secret fluorescent markers and logging how many remain, you can monitor monthly cleaning compliance.

All our garments contain numbered tags that help us track individual items. We wipe each one down once a month by default, so we know they're being cleaned even if daily compliance lags. When a garment is confirmed clean, we affix a big green "Clean" label onto it.

  • Ensure proper storage. We noticed staff typically flung garments over storage racks instead of hanging them neatly. Folding these garments can result in breaches of integrity over time, increasing the risk of radiation exposure. If you're faced with the same issue, use your cellphone to snap a few pics of improperly stored garments and show them at your next staff meeting. The message will be obvious: Take the time to clean the shields, and then hang them up right.

Raising awareness

Only a thorough cleaning ensures the entire surface area of the shield is covered. This might not be top-of-mind for most staff members, but we hope our protocol can raise the profile of this important but often overlooked aspect of infection prevention. OSM

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