Survey exposes infection-control procedures at MRI suites as poor

Findings from a survey of 100 imaging centers suggest that MRI scanning facilities, particularly those run independently from hospitals, lack basic infection-control procedures. Patients and staff could be at risk of contracting and spreading life-threatening diseases during MRI exams.

According to the paper, titled "Survey of infection control in the MRI environment," most imaging facilities appraised either lacked or failed to consistently follow infection-control protocols for their MRI suites. Findings also indicate that whenever infection-control procedures are in place, they're mostly left to the discretion of the personnel operating the scanners.

The survey was prompted after increasing concerns that lack of infection control at MRI centers might be leading to the spread of methicillin-resistant Staphylococcus aureus (MRSA) during MRI scanning. Apprehensions hit home after 15-year-old Nile Moss from Orange County, CA, died in 2006 from an MRSA-related infection after undergoing an MRI scan. Fear of a virulent MRSA strain spreading led to passage of the Medical Facility Infection Control and Prevention Act, signed into law by Governor Arnold Schwarzenegger in September 2008. The law became effective Jan. 1.

"Very few, if any, of these sites had any type of written infection-control procedures," said survey author Dr. Peter A. Rothschild, president of High Field & Open MRI of Louisville, KY.

In February, the Joint Commission, formerly the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), published an article devoted to preventing infections in the MRI suite. The piece alerted hospitals and imaging centers about the increasing risk to patients undergoing MRI exams from substandard infection controls. The article appeared in the February issue of the Joint Commission's newsletter Environment of Care News.

The Joint Commission article was preceded by a white paper on best practices to prevent MRI room infections, published by Rothschild in 2008. According to that paper, the managements of outpatient imaging centers and mobile MRI services often overlook basic infection-control procedures, such as hand washing or room cleaning between patients. It also noted that MRSA risk increases when torn or frayed pads used in many imaging procedures are not immediately replaced, and are left to become, literally, a hotbed for infectious bacteria.

The paper outlined 11 recommendations to prevent MRSA and other infections from gaining a hold, including having a written infection-control and MRI-cleaning policy in place, cleaning MRI tables and scan bores between patients, periodically inspecting padding material with ultraviolet light detectors for biological material, and replacing damaged or contaminated pads with new pads that carry antimicrobial agents.

Rothschild operates Patient Comfort Systems, a firm in Newark, CA, that sells MRI-related infection-control products.

According to Rothschild, the economic recession and a drop in reimbursement might contribute to infection-control problems. MRI technologists are under extreme pressure to turn around patients quickly. The Joint Commission currently performs unannounced spot inspections of hospitals and their associated medical facilities to enforce quality-assurance standards. Independent outpatient imaging centers, however, remain unregulated. The Joint Commission's overall concern about these shortcomings led to the survey. And its findings were shocking, Rothschild said.

"One technologist might clean the pad every third patient. Some technologists or operators don't clean the pad at all. Some change the sheets, some don't change the sheets," Rothschild told Diagnostic Imaging. "There is no consistency in what we saw."

Hospital administrators in general and radiologists in particular take the issue seriously, but most already have infection-prevention policies in place, and they follow them rigorously, said Dr. Chip Truwit, chair of the American College of Radiology Committee on MRI Accreditation.

Outliers always exist and many independent facilities do not follow Joint Commission standards. But most of them are regulated by individual states. For all others in the system, failing a Joint Commission inspection on infection-prevention grounds is simply not an option, Truwit said.

Satisfying the Joint Commission's standards is hard enough that those involved would be foolish not to take care of the easy stuff such as ensuring rooms and equipment are kept clean, Truwit said. Most MR facilities follow ACR quality-assurance guidelines on infection prevention. Superimposing yet another layer of preventive measures might be unnecessary, he said.

"I certainly don't want to minimize the problem. But this isn't something that people who run MRI centers just fell off the bus yesterday," Truwit said.