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11 Steps For Preventing Superbug Infections In MRI
AS PUBLISHED BY PETER ROTHSCHILD, MD

Suggestions for infection control procedures for free-standing imaging centers and hospital radiology departments.

The cleanliness of free-standing imaging centers and hospital radiology departments is crucial for reducing the spread of MRSA and other acquired infections. The following are 11 simple procedures to implement that can prevent the spread of these infections.

1. Have a written infectious control policy to include MRI cleaning procedures as well as the cleaning schedule and have it posted throughout the center.
2. Implement a mandatory hand washing / hand sanitizing procedure between patient exams for technologists and any others who come into contact with patients.
3. Clean the MRI tables, inside the bore of the magnet and any other items that come into contact with a patient. Infection control experts recommend this be done between each patient.
4. Clean all pads and positioners with an approved disinfectant. Infection control experts recommend cleaning after each patient.
   
5. Periodically inspect the pads with a magnifying glass, particularly at the seams, to identify fraying or tearing. If present, the pads should be replaced.
   
6. Regularly check all padding material with an ultraviolet (black) light and make sure that any biological material detected on the pads can be removed.
   
7. Replace damaged or contaminated pads with new pads incorporating permanent antimicrobial agents.
   
8. Use pillows with a waterproof covering that is designed to be surface wiped. Replace pillows when their barrier is compromised.
   
9. Promptly remove body fluids, and then surface disinfect all contaminated areas.
   
10. If a patient has an open wound or any history of MRSA/other infection:
    a. Gloves and gowns should be worn by all staff coming in contact with the patient. These barriers must be removed before touching other areas not coming in contact with the patient, i.e. door knobs, scanner console, computer terminals, etc.
    b. The table and all the pads should be completely cleaned with disinfectant before the next patient is scanned, if it is not already being performed between every patient. For patients with any known infectious process add 10-15 minutes onto the scheduled scan time to assure there is enough time to thoroughly clean the room and all the pads.
11. All furniture should be periodically cleaned. Ideal surfaces are those that are waterproof and wipeable. Infection control experts recommend this be done between each patient.
    

Contrast Administration

The ICAMRL Standards require a policy for the administration of contrast agents, medication and/or sedation. The administration must be performed by licensed or qualified, trained personnel, under the direct supervision of a licensed physician and in compliance with federal, state or local laws.

Careful screening of patients that may have decreased renal function is imperative to avoid risks of developing Nephrogenic Systemic Fibrosis (NSF). Although the cause of (NSF) is not fully understood by the medical community, it has been associated with the contrast agent, gadolinium. NSF is caused by increased deposition of collagen, or fibrous tissue, in the dermal layer of the skin as well as in other organs. It is a painful, often progressive disease and has been reported in patients on hemodialysis, peritoneal dialysis, in renal transplant and liver transplant recipients, in patients with end stage renal disease and in those with acute renal failure not requiring dialysis. The FDA first notified health care professionals and the public about the potential gadolinium-related risks for NSF in June and December 2006. The FDA notification requires vendors of MR contrast agents to post a warning label on their product stating that patients with severe kidney insufficiency potential or post liver transplantation, and with chronic liver disease, are at risk for developing NSF. There are five gadolinium-based contrast agents approved for use in the United States, however whether the potential risks for developing NSF are the same for all agents has not been concluded. For patients with normal kidney function or those with mild-to-moderate kidney insufficiency, there have been not reported incidents of NSF.

In conclusion, all laboratories, regardless of their participation in the accreditation process, are under an obligation to employ the available resources related to safety to ensure that they are providing an environment that ensures quality patient care.

***

REFERENCES

“Joint Commission Alert Shines Light on Preventing MRI Accidents, Injuries,” The Joint Commission.

Kohl, Doug. “Patients Develop Superbug MRSA Infections After Undergoing MRI Scanning,” Emax Health. November 2008.

“Preventing accidents and injuries in the MRI suite,” The Joint Commission, Issue 38. February 2008.

REFERENCES AND MR SAFETY RESOURCES

MRI Safety — sample screening form, implant list, and much more information

The Institute for Magnetic Resonance Safety, Education, and Research (IMRSER) — free safety video

MRI Suite Safety Calculator — from mri.planning.com

ACR Guidance Document for Safe MR Practices 2007

http://www.ashp.org/import/News/HealthSystemPharmacyNews/newsarticle.aspx?id=2400

http://www.auntminnie.com/index.asp?Sec=sup&Sub=mri&Pag=dis&ItemId=81666

http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Disinfection_Nov_2008.pdf

http://www.fda.gov/cder/drug/advisory/gadolinium_agents.htm

http://www.medicalnewstoday.com/articles/123142.php

http://www.mrisafety.com/safety_article.asp?subject=204

http://www.nsfhelpcenter.com/

Dr. Rothchild’s video on MRI infection control

Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008. William A. Rutala, Ph.D., M.P.H.1,2, David J. Weber, M.D.

Sadowski, EA, Bennett, LK, Chan, MR, et al. Nephrogenic systemic fibrosis: risk factors and incidence estimation. Radiology 2007; 243:148.