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Chen J, Tu J, Huang S, Zhu Z, Tu Y. Is It Appropriate to Completely Eliminate Contact Shielding during CT Examination? A Discourse Based on Experimental Findings. HEALTH PHYSICS 2024; 126:46-55. [PMID: 37792391 DOI: 10.1097/hp.0000000000001742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
OBJECTIVE Through the integration of experimental data and literature, this study examines whether complete elimination of contact shielding during CT examination is warranted, with a particular focus on potential impacts to children's thyroid and pregnant women, as well as limitations associated with contact shielding. Methods: The thermoluminescent dosimeter (TLD) tablets were inserted into the phantom's five organs and tissues. Select fixed exposure, automatic exposure control (AEC), and use contact shielding combined into four experimental modes, with scanning of the phantom's four parts. Obtain the absorbed dose measurements within or outside the FOV. Statistical analysis was conducted using SPSS software. Results: (1) The AEC significantly reduces dose within and outside the FOV, with a dose reduction of 40%-60%. (2) The application of contact shielding outside the FOV significantly reduced the dose adjoin the FOV. (3) Both the use of AEC mode and contact shielding can effectively minimize the dose, with a reduction of 50-80%. (4) The shielding within the FOV may introduce image artifacts or interfere with AEC, the implementation of contact shielding outside FOV provides little reduction in radiation exposure risk through previous literature. (5) Contact shielding exhibits certain drawbacks in all aspects. Conclusion: The utilization of AEC mode in clinical CT should be widely adopted to minimize patient radiation exposure. In general, contact shielding both inside and outside the FOV should be avoided during exposure. However for children under 12 years old with thyroid gland examination, contact shielding could maximally reduce external radiation and may be appropriate. Pregnant women require careful evaluation when considering the use of contact shielding. Contact shielding should not be entirely abandoned.
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Affiliation(s)
- Jiwei Chen
- Department of Medical Engineering, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, Jiangsu 215300, P.R. China
| | - Jianchun Tu
- Department of Radiology, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, Jiangsu 215300, P.R. China
| | - Shengyan Huang
- Department of Nursing, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, Jiangsu 215300, P.R. China
| | - Zhenhua Zhu
- Department of Medical Engineering, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, Jiangsu 215300, P.R. China
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Yoon J, Nwadike BA, Bijanki VN, Kaar SG. Cleanliness of Lead Garments in the Operating Room. Am J Med Qual 2023; 38:107-109. [PMID: 36762853 DOI: 10.1097/jmq.0000000000000103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Jane Yoon
- Department of Orthopaedic Surgery, Saint Louis University School of Medicine, Saint Louis, MO
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Samara ET, Saltybaeva N, Sans Merce M, Gianolini S, Ith M. Systematic literature review on the benefit of patient protection shielding during medical X-ray imaging: Towards a discontinuation of the current practice. Phys Med 2022; 94:102-109. [PMID: 35030383 DOI: 10.1016/j.ejmp.2021.12.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/15/2021] [Accepted: 12/28/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Patient shielding during medical X-ray imaging has been increasingly criticized in the last years due to growing evidence that it often provides minimal benefit and may even compromise image quality. In Europe, and as also shown in a short assessment in Switzerland, the use of patient shielding is inhomogeneous. The aim of this study was to systematically review recent literature in order to assess benefits and appraise disadvantages related to the routine use of patient shielding. METHODS To evaluate benefits and disadvantages related to the application of patient shielding in radiological procedures, a systematic literature review was performed for CT, radiography, mammography and fluoroscopy-guided medical X-ray imaging. In addition, reports from medical physics societies and authorities of different countries were considered in the evaluation. RESULTS The literature review revealed 479 papers and reports on the topic, from which 87 qualified for closer analysis. The review considered in- and out-of-plane patient shielding as well as shielding for pregnant and pediatric patients. Dose savings and other dose and non-dose related effects of patient shielding were considered in the evaluation. CONCLUSIONS Although patient shielding has been used in radiological practice for many years, its use is no longer undisputed. The evaluation of the systematic literature review of recent studies and reports shows that dose savings are rather minimal while significant dose- and non-dose-related detrimental effects are present. Consequently, the routine usage of patient protection shielding in medical X-ray imaging can be safely discontinued for all modalities and patient groups.
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Affiliation(s)
- Eleni Theano Samara
- Radiation Protection Unit, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Natalia Saltybaeva
- Radiation Protection Unit, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marta Sans Merce
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
| | | | - Michael Ith
- Department of Diagnostic, Interventional and Pediatric Radiology (DIPR), Inselspital, Bern University Hospital, University of Bern, Switzerland
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Balter S, Rodriguez MA, Pike JA, Kleiman NJ. Microbial Contamination Risk and Disinfection of Radiation Protective Garments. HEALTH PHYSICS 2021; 120:123-130. [PMID: 33369969 PMCID: PMC7872069 DOI: 10.1097/hp.0000000000001387] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
ABSTRACT Healthcare-associated infections are a major public health concern for both patients and medical personnel. This has taken on greater urgency during the current COVID-19 pandemic. Radiation Personal Protective Equipment (RPPE) may contribute to risks of microbial contamination. This possibility was tested in 61 personal or shared-use lead aprons and thyroid collars at Columbia Presbyterian Irving Medical Center. Fifty percent tested positive for either bacterial or fungal contamination, mostly around the neckline of lead vests and thyroid collars. Repeated testing of garments some weeks to months later confirmed continued presence of microbial contamination. The possibility that hospital-approved disinfection agents could degrade the radio-protective features of these garments was also examined. Samples of identical construction to garments in regular use were subjected to either daily or weekly wipes with hypochlorite or alcohol-based hospital-approved cleaning agents for 6 mo. A third group of samples was maintained in contact with the cleaning agents for 6 mo. All samples were fluoroscoped four times during the study. None demonstrated any degradation in radioprotection. All samples were photographed monthly. Physical degradation of the outer plastic covering by concentrated hypochlorite and limited mechanical damage around stitched seams of the samples cleaned daily with alcohol was noted. Based on the high prevalence of microbial contamination, regular cleaning and disinfection protocols should be implemented. Regular cleaning with medical-facility-approved cleaning and disinfecting agents is likely to be effective at reducing the microbial load and unlikely to result in significant reduction in radioprotective properties of these garments.
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Affiliation(s)
- Stephen Balter
- Departments of Radiology and Medicine College of Physicians and Surgeons Columbia University, New York, NY 10032
| | - Michelle A. Rodriguez
- City University of New York (CUNY) Graduate School of Public Health and Health Policy New York, NY 10027
| | - Janett A. Pike
- Infection Prevention & Control New York-Presbyterian Hospital New York, NY 10032
| | - Norman J. Kleiman
- Department of Environmental Health Sciences Mailman School of Public Health Columbia University, New York, NY 10032
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A novel disinfection protocol using ATP testing for lead garments in the electrophysiology lab. J Interv Card Electrophysiol 2021; 62:565-568. [PMID: 33421019 PMCID: PMC7794636 DOI: 10.1007/s10840-020-00936-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/28/2020] [Indexed: 11/20/2022]
Abstract
Purpose Electrophysiology procedures pose infection risk and require surgical room sterility. Currently, there is no universally approved protocol for disinfecting lead garments in the electrophysiology laboratory. This study explores the feasibility of using ATP testing to assess the microbial burden of lead aprons and evaluates the impact of a sanitary intervention. Methods Adenosine triphosphate (ATP) testing is a well-established hospital standard to quantify biological matter on a surface and, by proxy, the microbial burden. It is measured in RLU (relative light units). Pre-intervention ATP testing was performed on 34 lead garments after use for electrophysiology procedures. The thyroid collar, mid-chest vest, and left axillary areas of the garments were swabbed using a Hygiena SystemSure II luminometer with ATP swabs (Hygiena, Camarillo, CA). These sites were then disinfected with disinfectant wipes (PDI Super Sani-cloth Germicidal Disposable Wipe) and ATP testing was repeated. Results The mean duration of garment wear was 213 min. The thyroid collars had the highest mean RLU before intervention, followed by the mid-chest vest and the left axillary areas. The intervention was found to significantly decrease ATP readings for all three sites (p = 0.0002, p = 0.0001, p = 0.0002 respectively). Linear regression modeling to assess the impact of intervention showed a significant correlation with pre-intervention ATP values for all three sites but no correlation with fluoroscopy time, fluoroscopy dose, or total time spent within the procedure. Conclusions Lead garments harbor microbial contamination after use according to ATP testing. A sanitary intervention can decontaminate lead garments and potentially reduce rates of hospital infection.
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Gilat R, Mitchnik I, Beit Ner E, Shohat N, Tamir E, Weil YA, Lazarovitch T, Agar G. Bacterial contamination of protective lead garments in an operating room setting. J Infect Prev 2020; 21:234-240. [PMID: 33408761 DOI: 10.1177/1757177420947466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 07/12/2020] [Indexed: 01/08/2023] Open
Abstract
Background Protective lead garments (PLG) worn in the operating room are a potential source for bacterial colonisation and thus may increase the risk of intraoperative infection. The clinical significance of such bacterial contamination has yet been established. Although disinfection protocols have been employed, their effectiveness is also unknown. Objective We sought to describe and compare the bacterial profile of PLGs with a focus on common pathogens involved in surgical site infections (SSI) and prosthetic joint infections (PJI). Methods We studied body aprons and neck-thyroid protective shields. We sampled 20 body aprons and 21 neck PLGs, swabbing the inside and outside of the PLGs. Swabs were cultured on different media and the results were assessed and compared. Results Of PLGs, 87.8% were contaminated. The neck-thyroid shield PLGs was generally more contaminated than body apron PLGs and exhibited significantly higher loads of Staphylococcus epidermidis (P = 0.048). Other pathogen cultured were Micrococcus spp., Acinetobacter lwoffii (A. lwoffii), Bacillus species (Bacillus spp.), Moraxella osloensis (M. osloensis) and Pseudomonas stutzeri (P. stutzeri). No other common pathogens associated with SSI or PJI were detected. Conclusions PLGs are heavily contaminated despite regular cleaning protocols. Neck PLGs are highly contaminated with potentially infectious agents. As neck PLGs are often directly exposed above the surgical sterile gown and the surgical field, measures should be undertaken to reduce their exposure and bacterial load, perhaps by suggesting users consider avoiding the use of intraoperative fluoroscopy when possible or alternatively supporting the use of body exhaust suits when PLGs are needed.
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Affiliation(s)
- Ron Gilat
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, USA.,Department of Orthopedic Surgery, Yitzhak Shamir Medical Center, Zerifin, Israel.,Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ilan Mitchnik
- Department of Orthopedic Surgery, Yitzhak Shamir Medical Center, Zerifin, Israel.,Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eran Beit Ner
- Department of Orthopedic Surgery, Yitzhak Shamir Medical Center, Zerifin, Israel.,Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Noam Shohat
- Department of Orthopedic Surgery, Yitzhak Shamir Medical Center, Zerifin, Israel.,Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eran Tamir
- Department of Orthopedic Surgery, Yitzhak Shamir Medical Center, Zerifin, Israel.,Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yoram A Weil
- Hadassah Medical Center, Jerusalem, Israel.,Affiliated to the Hebrew University, Jerusalem, Israel
| | - Tsilia Lazarovitch
- Department of Orthopedic Surgery, Yitzhak Shamir Medical Center, Zerifin, Israel.,Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gabriel Agar
- Department of Orthopedic Surgery, Yitzhak Shamir Medical Center, Zerifin, Israel.,Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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McAleese T, Broderick JM, Stanley E, Curran R. Thyroid radiation shields: A potential source of intraoperative infection. J Orthop 2020; 22:300-303. [PMID: 32616992 PMCID: PMC7322090 DOI: 10.1016/j.jor.2020.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/06/2020] [Indexed: 11/15/2022] Open
Abstract
Introduction Thyroid radiation shields are often uncovered by the surgical gown and may represent a preventable source of wound contamination. The aims of this study are to define the common pathogens found on thyroid radiation shields and evaluate the effectiveness of a simple cleaning method. Methods Samples were obtained from 29 community thyroid shields collected from the operating theatres of 3 teaching hospitals. Each shield was swabbed under strict sterile technique using a separate swab for each of 4 designated zones. After sampling, shields were cleaned with a readily available disinfectant and sampling was repeated after 5 min. All swabs were cultured in ambient air at 37 °C on 5% sheeps blood agar for 48 hrs and subsequent growth was identified by a MALDI-TOF Walkaway mass spectrometer. Results Before cleaning, 100% of thyroid shields (29/29) and 68% of shield zones (79/116) grew at least 1 type of bacteria. Coagulase negative staphylococci, including S. epidermidis, S. capitis, S. cohnii, S. haemolyticus and S. hominis, were most commonly isolated. Enterobacteriaceae and S. aureus were also cultured. After cleaning, culturable contamination was reduced by 86.3% and 64.5%, respectively (p < 0.001). Conclusion The most common pathogens associated with SSIs can be isolated on thyroid radiation shields. Appropriate cleaning of thyroid shields with readily available disinfectant can significantly reduce the bacterial burden as detectable by culture. Hospitals should facilitate staff education and reinforce their policies on cleaning these shields which may often be overlooked.
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Affiliation(s)
| | - J M Broderick
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - E Stanley
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - R Curran
- Our Lady of Lourdes Hospital, Drogheda, Ireland
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Jain S, Rajfer RA, Melton-Kreft R, Nistico L, Miller MC, Stoodley P, Altman DT, Altman GT. Evaluation of bacterial presence on lead X-ray aprons utilised in the operating room via IBIS and standard culture methods. J Infect Prev 2019; 20:191-196. [PMID: 31428200 DOI: 10.1177/1757177419833163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 11/04/2018] [Indexed: 11/17/2022] Open
Abstract
Background Despite precautions, surgical procedures carry risk of infection. Radiation-protective lead aprons worn by operating personnel are a potential source of bacterial contamination and have not been fully evaluated. Aim/objective To evaluate lead aprons as a source of bacterial contamination, identify organisms most commonly found on this source, and devise a method with which to lower the risk of contamination. Methods In this basic science study, 20 randomly selected lead X-ray aprons were swabbed at three time points. The experimental treatment was with a hospital-grade disinfectant wipe. The samples were assessed for bacterial growth via traditional plating methods and mass spectrometry. Plates were graded on a scale of 0 to 4+ based on the number of quadrants with growth. Growth on one quadrant or more was considered contaminated. Findings/results Bacteria were initially detected via IBIS on a majority of the aprons (32/40), most commonly Staphylococcus epidermidis and Propionibacterium acnes. Virulent organisms cultured were Methicillin-resistant Staphylococcus epidermidis (MRSE), Neisseria, Streptococcus viridans and pseudomonas. MRSE were detected on 5/20 of the samples. Immediately after treatment, the majority of aprons showed less bacterial contamination (0/20 standard culture positive; 13/20 IBIS positive) with some recurrence at the 6-h time point (2/20 standard culture positive, 16/20 IBIS positive). All MRSE detected initially was eradicated. Discussion Lead X-ray aprons worn in the operating room harbour bacteria. Disinfecting before use may prevent the introduction of virulent organisms to patients. Our proposed method of sanitising with a disinfectant wipe is quick and effective.
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Affiliation(s)
- Sameer Jain
- Department of Orthopaedic Surgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA
| | - Rebecca A Rajfer
- Department of Orthopaedic Surgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA
| | - Rachel Melton-Kreft
- Center of Excellence in Biofilm Research, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA
| | - Laura Nistico
- Center of Excellence in Biofilm Research, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA
| | - Mark C Miller
- Biomechanics Laboratory, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA
| | - Paul Stoodley
- Departments of Microbial Infection and Immunity and Orthopaedics, Infectious Diseases Institute, Ohio State University, Columbus, OH, USA.,National Centre for Advanced Tribology at Southampton (nCATS), Department of Mechanical Engineering, University of Southampton, Southampton, UK
| | - Daniel T Altman
- Department of Orthopaedic Surgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA
| | - Gregory T Altman
- Department of Orthopaedic Surgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA
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Honigsberg H, Speroni KG, Fishback A, Stafford A. Health Care Workers' Use and Cleaning of X-Ray Aprons and Thyroid Shields. AORN J 2018; 106:534-546. [PMID: 29173378 DOI: 10.1016/j.aorn.2017.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 05/24/2017] [Accepted: 10/05/2017] [Indexed: 11/28/2022]
Abstract
We evaluated the use and cleaning of x-ray aprons and thyroid shields by surveying rural hospital system health care workers who wear x-ray aprons and thyroid shields. One hundred fifty-five of the 173 respondents were RNs (89.6%), and 94 respondents were from inpatient or outpatient surgical settings (54.3%). One hundred thirty-five respondents (78.0%) reported soiled x-ray aprons or thyroid shields, and 52 (30.1%) reported shield odors. Eighty-three participants (48.0%) indicated they never spot cleaned. Standard department cleaning never occurred for 37 x-ray aprons or thyroid shields (21.4%); and 114 x-ray aprons or thyroid shields (65.9%) contacted a patient or patient item 1 to 10 times per shift. Twenty-six participants (15%) specified there were policies and procedures for cleaning x-ray aprons and thyroid shields. Use of evidence-based cleaning guidelines and manufacturer's requirements for effective spot and standard cleaning of the protective aprons and thyroid shields are warranted.
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Phelps AS, Gould RG, Courtier JL, Marcovici PA, Salani C, MacKenzie JD. How Much Does Lead Shielding during Fluoroscopy Reduce Radiation Dose to Out-of-Field Body Parts? J Med Imaging Radiat Sci 2016; 47:171-177. [DOI: 10.1016/j.jmir.2015.12.082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/03/2015] [Accepted: 12/16/2015] [Indexed: 11/30/2022]
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Yun HC, Kreft RE, Castillo MA, Ehrlich GD, Guymon CH, Crouch HK, Chung KK, Wenke JC, Hsu JR, Spirk TL, Costerton JW, Mende K, Murray CK. Comparison of PCR/electron spray ionization-time-of-flight-mass spectrometry versus traditional clinical microbiology for active surveillance of organisms contaminating high-use surfaces in a burn intensive care unit, an orthopedic ward and healthcare workers. BMC Infect Dis 2012; 12:252. [PMID: 23050585 PMCID: PMC3526496 DOI: 10.1186/1471-2334-12-252] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 09/20/2012] [Indexed: 11/24/2022] Open
Abstract
Background Understanding nosocomial pathogen transmission is restricted by culture limitations. Novel platforms, such as PCR-based electron spray ionization-time-of-flight-mass spectrometry (ESI-TOF-MS), may be useful as investigational tools. Methods Traditional clinical microbiology (TCM) and PCR/ESI-TOF-MS were used to recover and detect microorganisms from the hands and personal protective equipment of 10 burn intensive care unit (ICU) healthcare workers providing clinical care at a tertiary care military referral hospital. High-use environmental surfaces were assessed in 9 burn ICU and 10 orthopedic patient rooms. Clinical cultures during the study period were reviewed for pathogen comparison with investigational molecular diagnostic methods. Results From 158 samples, 142 organisms were identified by TCM and 718 by PCR/ESI-TOF-MS. The molecular diagnostic method detected more organisms (4.5 ± 2.1 vs. 0.9 ± 0.8, p < 0.01) from 99% vs. 67% of samples (p < 0.01). TCM detected S. aureus in 13 samples vs. 21 by PCR/ESI-TOF-MS. Gram-negative organisms were less commonly identified than gram-positive by both methods; especially by TCM. Among all detected bacterial species, similar percentages were typical nosocomial pathogens (18-19%) for TCM vs. PCR/ESI-TOF-MS. PCR/ESI-TOF-MS also detected mecA in 112 samples, vanA in 13, and KPC-3 in 2. MecA was associated (p < 0.01) with codetection of coagulase negative staphylococci but not S. aureus. No vanA was codetected with enterococci; one KPC-3 was detected without Klebsiella spp. Conclusions In this pilot study, PCR/ESI-TOF-MS detected more organisms, especially gram-negatives, compared to TCM, but the current assay format is limited by the number of antibiotic resistance determinants it covers. Further large-scale assessments of PCR/ESI-TOF-MS for hospital surveillance are warranted.
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Affiliation(s)
- Heather C Yun
- San Antonio Military Medical Center, San Antonio, TX, USA.
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