We can thank the Coronavirus for making us rethink our hygiene and environment a little more than usual.  Have you given thought to how many germs are living in your department’s protective aprons and devices?  As a QM technologist for many years, I can tell you that if I didn’t clean the aprons, no one did.  Who is cleaning aprons and how often?  We decided to do a study of our customer base of technologists across the nation to see just who, what, when and how these devices get cleaned.

Surprisingly, a third of those responding said they cleaned their aprons after every use.  Another 12% said once a week and 8% said once a month.  That leaves at least 47% of the aprons out there, not getting cleaned ever or rarely.  I suspect the number of dirty aprons is much higher than that.

There’s no doubt, aprons and other protective devices harbor bacteria and viruses.   Aprons often travel from surgical suites to the ICU and back to the imaging department.  I did some research and I learned that there is a device called an ATP meter that measures the Adenosine Triphosphates (ATP) enzyme presence on surfaces (i.e. aprons).   The amount of ATP present is a quantitative measurement of biologic contamination, including organisms that can cause infection and disease.

Bacteria attaching to porous or textured surfaces, such as lead aprons, can form colonies of bacteria that form a biofilm.  Biofilms produce an extracellular polymeric substance (EPS) which is essentially a protective coating for the bacterial colony.  EPS consists of DNA, proteins, lipids and polysaccharides.  On an external surface EPS protects the bacteria from antimicrobial or antiseptic agents.  Biofilms are 10 – 1,000 times more resistant to antibiotics that the standalone bacteria.

These biofilms make aprons particularly difficult to clean due to their porous surface.  Effective cleaning requires soap, water, a soft bristle brush and scrubbing.  You should not immerse aprons in water, put them in a washing machine or dry clean them.  After aprons are scrubbed clean, they should be rinsed with a damp cloth and allowed to air dry.  After they dry, the next step in disinfecting them with either disinfectant wipes or sprays designed for lead aprons to kill remaining bacteria.  Then allow the apron to air dry again.  Bleach will damage lead aprons and is not recommended.  As time consuming as this process may be, it is the only way to remove biofilm from your aprons and protect yourself, other employees and patients.   THE CDC also states the best way to remove biofilm is to disrupt it physically with elbow grease.

The first step is to ensure you have a policy and procedures for cleaning all personal protective devices.  The procedures should include responsibility for cleaning, drying, and then disinfecting.  Frequency of cleaning needs to be specified to include additional instructions for when an apron comes in contact with infectious materials and biologic contamination.

AHEC’s survey of radiologic imaging professionals included the following responses from our readers (169).  How does your department compare with these responses?  It’s time to check your aprons!