Contamination of portable radiograph equipment with resistant bacteria in the ICU.
BACKGROUND
Approximately 15% of nosocomial infections in the ICU result from spread of bacteria on caregivers' hands. The routine chest radiograph provides an unexamined opportunity for bacterial spread: close contact with each patient and sequential examination of ICU patients. This study examined infection control procedures performed during routine chest radiographs, assessed whether resistant bacteria were transferred to the radiograph machine, and determined whether improved infection control practices by radiograph technicians could reduce bacterial transfer.


METHODS
Radiograph technicians were observed performing chest radiographs on all ICU patients. Culture specimens were taken from the radiograph machine. An educational intervention directed at technicians was instituted, and its effect on infection control and machine contamination was measured.


RESULTS
Surveillance of 173, 113, and 120 chest radiographs during observation, intervention, and follow-up periods was performed. Adequate infection control was practiced during the performance of 2 of 173 observation period radiographs (1%), 48 of 113 intervention period radiographs (42%; p < 0.001), and 12 of 120 follow-up period radiographs (10%; (p < 0.001) [follow-up vs intervention and observation periods]. Radiograph machine surface culture samples yielded resistant Gram-negative bacteria on 12 of 30 occasions (39%), 0 of 29 occasions, and 7 of 14 occasions (50%), respectively, for the observation, intervention, and follow-up periods (p < 0.001).


CONCLUSIONS
Multiresistant bacteria are frequently transferred from patients to the radiograph machine in the presence of poor infection control practices, and may be a source of cross-infection/colonization. Improved infection control practices decrease the occurrence of resistant organisms on the radiograph equipment. Radiograph technicians should be included in efforts to improve infection control measures.
Levin
Phillip D
PD
Departments of Anesthesiology and Critical Care Medicine, Jerusalem, Israel. Electronic address: phillipl@hadassah.org.il.
Shatz
Olga
O
Internal Medicine, Jerusalem, Israel.
Sviri
Sigal
S
Internal Medicine, Jerusalem, Israel.
Moriah
Dvora
D
Departments of Anesthesiology and Critical Care Medicine, Jerusalem, Israel.
Or-Barbash
Adi
A
Hebrew University-Hadassah Medical School, Jerusalem, Israel.
Sprung
Charles L
CL
Departments of Anesthesiology and Critical Care Medicine, Jerusalem, Israel.
Moses
Allon E
AE
Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
Block
Colin
C
Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
D000046:Academic Medical Centers; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control*; D004352:Drug Resistance, Microbial; D018432:Drug Resistance, Multiple; D004866:Equipment Contamination / Q000517:prevention & control* / Q000706:statistics & numerical data; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D008297:Male; D008826:Microbial Sensitivity Tests; D019095:Point-of-Care Systems; D011336:Probability; D013902:Radiography, Thoracic / Q000295:instrumentation*; D018570:Risk Assessment
D000900:Anti-Bacterial Agents