The Joint Commission Expresses Concern Over Poor Infection Control in MRIs

HAYWARD, CA (March 4, 2009)—In its February 2009 newsletter, “Environments of Care News,” the Joint Commission, the main entity that accredits hospitals in the United States, has published an article titled “Preventing Infections in the MRI Suite: Magnetic Environment Poses Strong Challenges.”

This landmark article quotes Peter Rothschild, M.D., author of the groundbreaking paper “Preventing Infections in MRI: Best Practices” and founder of Patient Comfort Systems. The recommendations in Dr. Rothschild’s paper resulted from his close work with the infection control arm of the Joint Commission. Now, following the publication of Dr. Rothschild’s paper, the Joint Commission, realizing the critical importance and risk to the patient from the lack of infection control in MRIs, is alerting hospitals and imaging centers, in no uncertain terms, about the importance of infection control in MRI facilities.

Dr. Rothschild explains, “The Joint Commission is clearly concerned over the lack of infection control in the MRI suite. They will, in the future, closely examine this area, and properly train their inspectors to physically enter MRI rooms for a more definitive inspections. The areas under greatest scrutiny will be: 1) existence of an infection control policy; 2) how and when the MRI was cleaned; 3) who are the individuals performing this cleaning and what is their safety training; 4) examining all the table pads and positioners to see if they are torn or frayed. Inspection may even include a black light to reveal biological material embedded in the pads, on the table or within the MRI bore itself.”

“The Joint Commission clearly cannot assure the public that an accredited hospital is safe without thoroughly evaluating the MRI suite. The lack of even basic infection control, such as hand washing or cleaning between patients, is well known by technologists operating the MRI and radiologists reading the MRIs,” adds Dr. Rothschild, who also has published an 11-step infection control policy designed for the MRI center. As Dr. Rothschild explains, “An MRI is a very complex and dangerous area to clean. It is unreasonable to think it can be cleaned safely and effectively by untrained personnel.”

Dr. Richard Nolan, M.D., a well-respected orthopedic surgeon in the San Francisco Bay Area, states, “The MRIs I have seen in the hospitals and especially outpatient facilities have basically no effective infection control. It is all adhoc by whomever the technologist is running the MRI at the time. I have been disgusted by the total lack of cleanliness in these facilities. Rarely do I ever see a technologist even wash his/her hands between patients much less make sure that the pads are not torn and that they are cleaned properly between patients. It has always been unclear to me how a hospital could pass a Joint Commission inspection year in and year out with such a lack of infection control and in clear violation of the Center for Disease Control guidelines. Clearly the Joint Commission inspectors in the past have not looked in the MRI suite. This is unfortunate since my patients think that if a hospital is certified by the Joint Commission, the MRI is clean and safe. In the past there has been nothing farther from the truth. This is why I congratulate the Joint Commission for taking on this important health issue.”

The Joint Commission has made it clear that they are following the CDC guidelines on infection control. These guidelines specifically state that a clean sheet is not a barrier to infectious agents. However, this is usually the only thing used by imaging centers to protect their patients. The CDC guidelines also make clear that the pads on the table as well as the coils must be cleaned between patients, not merely covered with a sheet. Most importantly, the CDC states that if table positioners or pads are torn or frayed they must be replaced. Therefore, the common practice of simply placing a clean sheet over torn, contaminated pads and covering up the smell with air freshener is a clear breach of basic infection control. Another common violation of CDC standards at outpatient MRI centers is the incredibly dangerous practice of having employees take contaminated laundry home to wash in their own household washing machines in order to save money. Not only can this further the spread of infectious agents throughout the community, but since their washing machines often lack any special sanitizing capabilities, these employees risk contaminating their own family’s clothing and thus even further spreading diseases.

“This is one of the many practices that show the total lack of understanding of infection control at MRI centers, putting not only their patients at risk but also their employees, their families and ultimately the entire community. These are just a few of the reasons the Joint Commission is so concerned about lack of infection control in these MRI facilities,” explains Dr Rothschild.

Antonio Bayon, President of MagnaWand, echoes Dr. Rothschild’s concerns while focusing on the cleanliness of the MRI bore itself. “I have been involved in the MRI business for more than 20 years, half of those years as an MRI service engineer. During my years as a service engineer, I saw all kinds of biological contaminants inside the bore of the magnet. It was common to see blood, urine, and other patient’s fluids in the tube, where the patient is placed for their MRI. I have even seen vomit dripping down the insides of the bore. I can assure you that this critical area where there is very close patient contact is not being cleaned. In the only study ever to look for the superbug MRSA in an MRI, it was found colonized in the bore of the MRI.”

Dr. Rothschild adds, “I am most disappointed by the total lack of concern by the radiology community to address this clear and present danger to our patients. I hope that the Joint Commission’s new direction will encourage administrators as well as risk management departments to take this issue seriously and adopt procedures designed to protect the patients. Until this is uniformly applied, the patients and referring doctors are basically on their own to determine if an MRI center is safe. This is most concerning for patients who are immunosuppressed or have a poorly developed immune system as their risk of a Superbug infection is often life threatening.”

Louise Kuhny, RN, Senior Associate Director of Standards and Interpretation Group at the Joint Commission, has stated in the article that the Joint Commission’s infection prevention standard underscores the need for a clean MRI suite, and that every accredited organization must have a specialized infection prevention plan. She further states the need for procedures concerning the proper removal of body fluids and disinfection of contaminated areas between patients. Most importantly, Ms. Kuhny discusses that the Joint Commission inspectors expect to see compliance such as mandatory hand washing by providers between every patients.

Louise Kuhny, RN, assures that “the Joint Commission surveys include all areas of an accredited facility in this survey activity including the MRI suite.”

As emphasized by Dr. Nolan, “A hospital’s overall infection control policy can only be as strong as its weakest link. This weakest link has clearly been demonstrated to be in the MRI suite. Immediate urgent attention by the risk management department and the administration of these hospitals and clinics is needed to address this serious public health risk. The 11-step procedure for infection control in MRI, developed with the help of infection control experts at the Joint Commission, is an important first step for hospitals and imaging centers to come into compliance with infection control standards that are used throughout the health care industry.”

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