“Nosocomial” means “hospital acquired” and few people believe you can get infected by bacteria lurking in a hospital.  We are often of the notion that hospitals and medical offices are always sanitary and cleaned every day.  Sometimes, though, other patients can infect us with their ills when we visit our doctors.  When your hospital makes you sicker, you have a nosocomial infection.

Dr. Peter Rothschild has written a scathing report about the unsanitary conditions infecting many MRI machines.  MRSA is one of the most dangerous and pernicious SuperBug infections.  30 years ago, MRSA  was responsible for only 2% of staph infections.

Today, that number has ballooned to 70%.  MRIs, one of the most ingenious medical devices ever invented for seeing into the body, are a safe haven for bacteria because the heavy-duty magnets in the machines make it a dangerous experience to clean on a regular basis.

Dr. Rothschild writes:

This author knows of no imaging center or hospital that pays their Level 2 MR personnel (i.e., the technologists) to wait around for the cleaning crews to come in and monitor them the entire time that they are cleaning the room. Therefore, the responsibility to clean the scan room is sometimes assigned to one of the MRI technologist or, more commonly, this responsibility is simply overlooked. However, the paradox is that the MRI technologist, who in almost all imaging centers is the Level 2 trained person, is rarely an experienced or even trained cleaning person with very limited time to clean.

This paradox is clear when asking the question, “Is the scan room being cleaned and if so by whom?” The answer that this author normally receives is “of course it’s being cleaned by the cleaning crews that come in at night after we leave.” It is crucial to ask the next question, “What Level 2 personnel are present to monitor the cleaning crew to make sure that it is done properly and safely?” This author knows of no cleaning crew that has the background training to be Level 2 personnel. Additionally, the cleaning crews contacted by this author have all stated that they been told or simply assume that they are not to go into the scan room. Cleaners often describe the MRI suite as the room with all the signs on the door warning them not to enter.

In addition to MRSA infections, there is risk of blood and bodily fluids cross-contamination:

Additionally, MRI technologists, especially those who trained in the 1970’s and 1980’s, had little training in infection control or proper cleaning procedures. An average MRI may scan 3,000 to 5,000 patients a year. CT scanners usually scan double or triple that number. The probability is that at least 50 – 100 of these patients are infected with MRSA or other HAI and many more are carriers.

Another area of potential exposure to infectious agents is the use of IV contrast material for both CT and MRI, which significantly increases the risk of blood contamination. The simple task of removing a needle from a patient’s arm and placing it into the sharps container has great risk. Blood can drip from the needle or from the puncture wound onto the pads, table and floor. This blood can often be unnoticed by a busy technologist or doctor performing the injection resulting in a contamination risk. It is not uncommon to find dried blood in an imaging suite which is an excellent culture medium for MRSA.

Contamination by forced air is another rising issue:

[MRI] Table pads inherently have air within them. When a patient lies down on the pads, this air is forced out through any hole or seam in the covering materials. This can cause the bacteria contaminating the central foam core to become ejected from the pad and aerosolize into the room environment. Of course the reverse air flow caused by the patient arising off the pads causes infectious materials to be drawn into the foam core from the surface, which is then re-ejected into the air when the next patient lies on the pad.

There have been numerous articles discussing the possibility of MRSA or other pathologic microorganisms becoming airborne during activities such as bed making and thus the possibility that MRSA can be transmitted among patients through the air (Shiomori.). There is also a suggestion that airborne MRSA may play a role in MRSA colonization of the nasal cavity or respiratory tract. Wilson showed that the presence of airborne MRSA in an area is strongly related to the presence and number of MRSA colonies and infected patients in that area. Shiomori states that measures should be taken to prevent the spread of airborne MRSA to control nosocomial MRSA infection.

On disinfecting the Magnet Bore:

An area of proven risk of MRSA is the inside of the MRI itself, often referred as the magnet bore or tunnel. The risk of MRSA transmission is increased in this area because the patient is often touching or in very close contact with the surface of the bore. It is obvious that cleaning inside the bore of an MRI unit is a difficult, dangerous and cumbersome task. The fact that most cleaning tools can not even be brought inside the MRI room, and especially into the bore, makes this task even more difficult.

The best possible way to clean the bore is to physically crawl inside to clean and disinfect the entire bore by hand. Unfortunately this also puts the technologist in very close contact with the contaminated surfaces and is yet another reason this is almost never done. In fact, the author, in over 25 years, has never seen a cleaning crew or technologist clean the inside of the MRI bore.

Dr. Rothschild provides this insight for the rise in MRSA infections during MRI scans:

The other practice that contributes to this situation is that MRI center often will overbook, that is put patients in time slots that are too short to perform a complete study, or add patients on to a full schedule. This is similar to the airlines overbooking, knowing that a number of patients will not show up for their appointment. Unless an MRI center overbooks patients, the “no shows” will have a disastrous effect on the bottom line since they take up time slots which cannot be charged for.

Merely two “no shows” a day, can mean up to $300,000 loss from the bottom line each year for an MRI center that may already be struggling. The profit of these imaging centers, which is a fixed cost business, is directly proportional to the number of scans completed in a day. The difference between scanning two patients an hour and three patients an hour can be significant, accounting for as much as an additional $1 – 2 million in annual revenue.

I urge you to read Dr. Rothschild’s entire report.

Dr. Rothschild’s conclusion includes 11 suggestions for infection control at free-standing imaging centers and hospital radiology departments — and it is your job, as the cogent and well-informed patient — to demand your right to be protected and defended against the infections of those scanned before you.

32 Comments

  1. Wow! It’s unbelievable that precautions for this haven’t been taken already. I’m certain that this is the case here as well. Scary!

    Like

  2. Interesting discovery David, makes me wonder whether one day we will be better off outside the hospitals etc. as all the germs and infections would be there inside?

    Like

  3. You should ask around, Dananjay! Find out what their “infectious disease policy” and if they don’t have one, run!
    How many doctors offices wipe down the exam table after each patient? They usually just cover the table in paper or cloth and consider that “cleaned” when it absolutely is not.

    Like

  4. There might well be a way to be healthier at home than in the hospital, Katha, especially with the rise of the SuperBug that cannot be killed and lives in hospitals and doctors offices.
    One way of saving time in MRI offices is to let the patients wear their street clothes in the machine instead of stripping them down to gowns. That saves time and laundering costs — but the backend is terrible for the patients because each person is re-contaminating an already contaminated MRI machine with all the crud and disease that is already on their bodies from the outside world! Dr. Rothschild addresses that in his article as well.
    Now we need to stay away from MDs with white coats:
    http://www.ncbi.nlm.nih.gov/pubmed/1773186
    It seems plain clothes for MDs are better than their “comforting” white coat uniforms that harbor all sorts of nasties!

    Like

  5. That’s true, Anne — hospitals are the best of us and the dirtiest of us. MRI machines are especially prone to this sort of filth because of the heavy magnets used and their danger to metal things and the people wearing and using them. You have to basically be certified or supervised by someone certified before you can even step into an MRI machine room.

    Like

  6. As David knows I caught MRSA after having life saving surgery 6 years ago.
    A large percentage of the population carry MRSA around with them every day and it does not cause them a problem. However a hospital environment can be and often is a MRSA cooker. Hospitals are often over heated – which helps MRSA multiply – with little or no fresh air – preferring to use closed air-con systems – they are also a feeding ground with plenty of raw material to feed on.
    Hospitals by their very existence are also full of vulnerable people, the young, the elderly and the sick whose immune systems are often already compromised.
    Dirty hospitals and machinery compound the risks to patients along with the lack of awareness about basic hygiene – ie people do not was their hands properly. Nurses and Doctors do not wash their hands in between patients or use the special gel provided – visitors do not wash their hands before visiting or use the gel provided.
    50 years ago nurses and doctors traveled to work in their own clothes and changed into their uniforms at the hospital. They changed out of them before leaving for home at the end of their shift. They were responsible for keeping the wards spotless themselves.
    I am horrified at the pictures you have shown here – especially as the MRI scanner that I was subjected to was spotless.
    I was given a disposable blanket/mat to lie on which was about an inch thick to absorb and body fluids/leakages and was placed straight into a specialized disposal unit when they were finished with me.
    I assume they have a specialized cleaning crew for the MRI unit – I am going to ask someone who will know.
    My personal situation with MRSA is that my status is flagged up on my medical records. MRSA means that when/if I get certain infections they will be resistant to most normal antibiotics and I will need specialized antibiotics. When/if I am ever hospitalized I will be subject to barrier nursing. I will have my own room – and extra precautions should be taken by the staff nursing me. It is an added risk factor to any surgery I might have or any hospitalization I may undergo.
    You asked in one of your other comments about how I deal with this in my work and my play environment.
    I risk assess everything I do both for the business and for my play.
    My good Doctor friend ( that I referred to above) is a Consultant Microbiologist has contributed to the stance that I take.
    Basically I assume that everyone has HIV and MRSA and prepare and deal accordingly.
    This means I use hospital standard antibacterial wipe down materials which are one use only before disposal in sealed unit which is then taken to local authority for disposal when full.
    It means that the dungeon and cottage are supplied with the same specialized antibacterial gel that is used in hospitals.
    It means I provide sharps boxes and anti bacterial wipes for needle play – it also means I provide several specialist bodily fluid kits – usually used for vomit but also can be used for bloodied materials or for semen.
    All the ropes get washed in sterilizing solution after use and are used in rotation.
    In my personal play – I have a bath first – it is part of the ritual. If I am doing needle play I clean my hands with specialized antibacterial gel, I cover the surface with a disposable mat, I use sealed sterilized needles and I clean the subjects skin with the specialized gel as well before starting.
    Once I have finished I recap the needles and dispose of in sharps box – use an alcohol swab to cleanse any blood on the victim (there is hardly any if you do it right). Then I clear away all materials into specialized container. Then I wipe the surface down with specialized cleaner.
    The dungeon will be given a thorough clean down before anyone else uses it.
    I am sorry for the essay – if anyone has any questions – please ask!

    Like

  7. I had so many questions for you, Nicola, but you pretty much pre-answered them all for me. Thank you!
    We should make it clear that you live in the UK and we should explain if your MRSA infection was nosocomial or not.
    I am especially pleased about your use of a sharps box. As you know, we are giving Jack the Cat fluids every day, and we have ultra-sharp needles that poke him — and us, by mistake. The Veterinarian’s office tells us just to “bring back the needles in a plastic bag” and I have to argue with them that they should provide a sharps box for us for the safe delivery of used needles! I don’t care if the needles have a cap or not, we get poked putting the cap back on the needles.
    I was able to buy a good sharps box on the internet for $4.00USD — you’d think the Vet’s office could provide them for us, charge $10 and make $6 on doing the right thing.
    What are your ropes made of? Do you wash them or steam clean them? Do you autoclave any of the metal rings or attachments?

    Like

  8. I can confirm it was/is nosocomial – ie I caught it in hospital.
    I must point out here that I consider myself to be very lucky to have escaped the more serious effects of MRSA – especially as bowel surgery patients are one of the higher risk categories as they are what is called *dirty surgery*.
    I am very surprised your vets do not supply sharps boxes – even more so given the mark up they could make on it.
    My ropes are marine ply and are a cotton/synthetic mix. After soaking in sterilizing solution they are washed in the washing machine at 30 degrees with antibacterial washing powder and then air dried. Never put rope containing cotton in a tumble dryer because it fluffs them up and you end up with fuzzy rope.
    The rope are provided without fixings – the metallic fixings and attachment points in the dungeon get wiped down with the same antibacterial cleaning agent as the rest of the fixtures and fittings.

    Like

  9. Fantastic, Nicola. All around wonderful and important information.
    Did you take any action against the hospital for your MRSA infection? Did they quickly discover it or did it take them awhile to diagnose?
    Nobody wants a fluffy rope! SMILE!
    I agree the Vets are doing a lousy job teaching people how to handle hazardous waste — especially when they implore you to “bring it back” for “proper disposal.” What about “proper delivery” between home and the Vet hospital?

    Like

  10. I did not take action against the hospital as they were quick to diagnose and treat before it became a real threat. I had everything explained to me by my personal doctor who also issued me with a checklist of warning signs to look for good advice to prevent a repeat – ie correct washing of hands, disposal of dressings and cleaning of the wound etc.
    I think the MRSA set back my healing by about 6 months to a year – not only physically but psychologically – it was ANOTHER thing that I had to deal with.
    Had the after effects of getting MRSA been significant for me I might have been tempted to sue the hospital – however I did not as they were not that significant and the hospital had saved my life and the fact that in a round about way I would be suing myself as I pay for the hospital through my taxes.
    If I had paid for a private treatment at a private hospital I would have done.
    I also get the silver lining of a private room for life if I ever have to go to hospital!
    I would be tempted to mail your vets concerning the handling of hazardous waste.

    Like

  11. It’s heartbreaking to learn of your nosocomial infection, Nicola! It enrages me!
    MRSA is a tough think to kill. We get reports of it taking over schools. One particular high school wrestling team was passing around to each other and then to every other school the team wrestled before they figured it out. They steam-cleaned the entire gym and locker room until they finally got a hold of the problem. Then, the next season, the infections started all over again. I think they way solved it was to kill the wrestling team and that was a demand of the local Public Health authority.
    I agree there is a distinct difference in the handling of human and animal hazardous waste — which fascinates me. I cannot buy a box of 100 18-gauge needles (“cat harpoons”) in NJ without a prescription from my Vet because there is a fear the junkies will somehow get a hold of them. I can’t even buy those needles over the internet and have them shipped to me in NJ with a prescription because of the fear the needles will end up in the wrong hands.
    The junkies go through the garbage of animal hospitals looking for any sharp delivery method, so I guess I need to understand and appreciate the hard line against needles, but Jack would certainly like the ultra-thin-walled Terumo needles instead of the monstrous Monojects.

    Like

  12. If I could have achieved some good by suing the hospital I would have done. I know from my stay there that they were doing everything they could to prevent such infections.
    Not every hospital is as on the ball as mine was and there have been needless deaths over the last few years in increasing numbers.
    I am not surprised that once the infection had taken hold in the gym that it was difficult to eradicate. Sweat is one of MRSA’s best environments to multiply in. They would just love a wrestling team!
    Your poor cat. I can understand your frustration with the needle supply regulations as well – I get mine mail order without a prescription and the local chemist/pharmacy takes the full sharps boxes for free safe disposal.

    Like

  13. I’m glad you don’t hold any hard feelings against your hospital, Nicola.
    Yes, Jack is having a hard time, but he’s stable now and on blood pressure medication as well. He’s very tough. We have “crazy cat friends” who are helping. It’s a good network to have. Our Vet is also taking up the cause and fighting the current policy of the animal hospital so they will begin to do “what’s best for the cat and not what’s more convenient for the management.”

    Like

  14. It is the second time I have stepped back from making a formal complaint/suing our medical service – I do not regret either of those decisions.
    I love the idea of crazy cat friends – everyone should have them!
    We need both human and animal hospitals to meet their patients needs and not their management needs.

    Like

  15. You’re a good person, Nicola. In the USA, you sue first and settle later. Not really a good system for getting good healthcare.
    Yes, our crazy cat friends are very smart and well-connected. They know where we’re going before we get there.
    I’m with you on taking better care of both animal and human patients!

    Like

  16. Update
    I said I would ask about cleaning procedures for MRI scanners in the UK. I have been told that all pieces of specialist equipment have written guidelines for cleaning and maintenance.
    My good friend is in the process of trying to get sight of the appropriate guidelines for MRI scanners.

    Like

  17. Thanks for the update, Nicola. The MRI machines in the USA all have written guidelines and procedures — but they are rarely carried out due to time/money concerns and safety matters of working so closely with the machine. Does the UK have a sustainable and verifiable way for consumers to actually know if their MRIs are actually being cleaned or not?

    Like

  18. Hopefully I will be able to answer that as well when I get the other information. I suspect there is a log that gets signed off each time it is cleaned/serviced/repaired and checked.

    Like

Share Your Thoughts:

Please log in using one of these methods to post your comment:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s