Hygiene at CT and MRI

Abstract: Background: Preventing the spread of infections is a constant battle against microorganisms. Hospital-acquired infections (HAIs) with multidrug-resistant (MDR) bacteria are a global problem today and causes suffering for patients and have high costs for society. In a hospital environment, patients with various illnesses and injuries meet, a large proportion of these people will also pass the radiology department, which places high demands on good hygienic standards to avoid HAIs. Although much research has been conducted on hygiene routines and the spread of infection in healthcare, most of the research has not focused on the radiology department. Aims: The overall goal of this thesis was to study hygiene in public and private radiology departments’ CT and MRI facilities with a focus on bacterial growth and the attitude of staff and managers to hygiene guidelines. The purpose of Study I was to identify selected hand-touched surfaces inside and outside the CT and MRI examination rooms that are prone to contamination and might represent a risk for transmission of HAI pathogens. We also aimed to examine if there were differences in bacterial contamination between public and private radiology departments. The purpose of Study II was to investigate the compliance with basic hygiene guidelines among the staff working with CT and MRI and the managers' approaches to basic hygiene routines. Finally, we aimed to examine differences in adherence to hygiene guidelines among staff employees within public and private radiology departments. Material and Methods: The same radiology departments participated in Study I and II (six public and four private radiology departments). For Study I, bacterial samples were taken from selected hand-touched surfaces inside and outside CT and MRI examination rooms. Sampling was carried out between patients after standard cleaning procedure, using flocked nylon swabs. The swab was applied over a 100 cm2 surface, and after cultivation the number of, bacterial colony forming units (CFU) per cm2 was calculated, with values >2.5 CFU/cm2 being indicative of contamination. Study II was based on a survey data. One questionnaire was distributed to the staff working with CT and MRI with questions about basic hygiene guidelines. The second questionnaire was distributed to managers, also with questions about basic hygiene guidelines. A total of 250 surveys (210 for CT- and MRI staff and 40 for managers) were distributed in paper format at the radiology departments during the autumn of 2016. Closed questions were summarised in frequency tables, and comparisons between groups regarding categorical data were analysed using Fisher ́s exact test, and t-test was carried out to compare continuous variables. The open questions were analysed with inspiration from manifest qualitative and quantitative content analysis. Results: The results of Study I did not show any growth of MDR bacteria, however surfaces were found where the number of CFU exceeded the limit value of 2.5 2 CFU/cm . Keyboards, chairs in the patient changing rooms, headphones, and the alarm control/buzzer were found to be the most contaminated surfaces. The least contaminated surfaces were the medicine trolley and the sides of the MRI tunnel. There was no significant difference between public and private radiology departments. The results of Study II showed that the main reasons why staff working with CT and MRI did not follow basic hygiene guidelines were stress, lack of time, and the occurrence of emergency situations. The managers also believed that stress and lack of time were strong reasons for why staff did not follow the basic hygiene guidelines. Most staff working with CT and MRI in both public and private radiology departments reported adequate hygiene knowledge. Among the variances that emerged between staff working in public and private radiology departments, there, was a significant difference (p = 0.007) regarding the compliance with not wearing rings, bracelets or nail polish while performing patient- related work. There was also a significant difference (p < 0.001) regarding the use of plastic aprons when there was a risk of contaminating the work clothes. There was also a significant difference (p = 0.003) between how the staff of public and private CT and MRI facilities cleaned the examination tables between each patient. Conclusion: Identified areas within CT and MRI in both public and private radiology departments, that need more disinfection are keyboards, chairs in the patient changing rooms, headphones, and the alarm control/buzzer. No MDR indicator microorganisms were found in the study, and there were no significant differences between public and private radiology departments. The main reasons why the staff both in public and private CT and MRI did not follow the hygiene guidelines were stress, lack of time, and emergency situations. Among the significant differences that emerged between staff working in public and private radiology departments were wearing bracelets, rings and nail polish in patient- related work, and the use of plastic aprons, and disinfection of the examination table between patients.