Litigation Risks & Liability Protections: Lead Aprons & Hospital PPE
Written By: Justin McKay
LAWSUIT - INDIANA (2017)
7 individuals in 5 years developed cancer while working in an Indiana hospital. Two of them, including a busy surgeon with a young family, have since passed away from brain cancer. As a result, the Healthcare Network was sued and recently settled the cases out of court with undisclosed terms.
What caused a surgeon to lead this lawsuit against the healthcare network?
BACKGROUND:
Protective X-Ray garments (lead aprons) are utilized all throughout various departments in our healthcare networks every day. (surgery, cath lab, radiology, endoscopy, pain management, etc.) These garments are worn by hospital personnel while performing fluoroscopy to protect themselves from scatter radiation, radiographic exposure to vital organs, etc. during surgical and radiological procedures.
THE LEGAL BRIEF:
Dr. Shinnerl stated, "The general condition of the lead PPE (personal protective equipment) provided to physicians and staff in the hospital OR at its main facility was decrepit" - "Namely, the leaded skirts, jackets, aprons, and thyroid shields were filthy, tattered and torn. There was no procedure for cleaning or assignment of them.” 1 Simply put, there was no system in place.
ARE X-RAY GARMENTS REALLY DIRTY?
Most networks have protocols in place for cleaning equipment, furniture, walls, floors, and ceilings. However, most facilities find it challenging to come up with the time, resources, and space to properly clean (in accordance with the manufacturers’ guidelines) the quantities of X-Ray garments they have in-house.
Research conducted at Wayne State University looked for pathogenic organisms on the lead aprons of interventional radiologists, when 25 garments were cultured at random. 21 of the 25 garments tested positive for Tinea (ringworm) and 21 of the 25 also were carrying Staph a – 3 of those were later confirmed to be MRSA. 2 In another study by Honigsberg et al, researchers cultured 109 lead garments and found bacterial contamination on 88 of them. 3
Many hospitals today may have a policy in place in which the garments are said to be wiped down or sprayed on a monthly basis. However, scientists and infection control directors agree that such measures are ineffective at truly cleaning these garments. In her post on proper garment cleaning techniques, Dr. Kathleen Jones states, “the use of wipes might afford convenience to the user, but the real issue with doing so lies in their clinical inefficiency in successfully cleaning the surface.” 4 With hospitals today being short-staffed and tight on time, garment cleaning and proper upkeep by staff generally take a back seat to other priorities.
DO WE HAVE TO X-RAY SCAN OUR HOSPITAL GARMENTS?
“Best Practice” healthcare networks do this on an annual basis. This is a labor and time-intensive task that most health networks dread and thus many opt out of doing citing that they will just “feel” the garment to check them for cracks and holes. The x-ray scanning process entails capturing a radiographic image of the x-ray garment to check the garment for holes, cracks, and tears. In essence, this process helps ensure that the hospital staff member that is wearing the garment every day is being properly protected.
GARMENT REPAIRS?
Hospital executives today are tasked with more on their to-do lists than ever before. Traditionally, there has not been a good solution for garment repair needs, other than to send the garment back to the manufacturing company. Consequently, the manufacturing company would either charge for needed repair work or simply suggest buying a replacement garment to the tune of several hundred dollars.
When damaged garments are ignored, hospital staff members often reach for items such as medical tape, binder clips, etc. in an attempt at fabricating a makeshift means to keep their garments in place and fit them properly. This presents concerns in terms of the X-Ray garment properly protecting the areas it is designed for on the body.
ARE X-RAY GARMENTS A SURVEY/AUDIT ITEM?
Yes. The accreditation teams from The Joint Commission, Healthcare Facilities Accreditation Program, DNV, State Board of Health, etc. do inquire about protocols and policies in place for the proper management of protective X-Ray garments. Hospital leadership is often asked about the proper hanging and storage of these garments, in addition to annual inspection records and cleaning policies. With hospitals having hundreds, if not thousands of these garments migrating around the facilities each day, this opens up a big hole in terms of liability protections being in place.
SUMMARY:
In a follow-up to that settlement, it was concluded that lead aprons and protective garments are effective when maintained properly. Flying under the liability radar for years, proper upkeep and documentation of lead aprons have traditionally been swept under the rug. Now is the time to create a better standard of care regarding these protective garments throughout the world of healthcare.
SHORT STAFFED & TIGHT ON TIME - HOW CAN WE BEST PROTECT OURSELVES?
There are garment solutions companies dedicated to the full service of your network’s complete garment inventory. These companies are equipped to clean, sanitize, repair, x-ray scan, inventory tag, and provide cloud-based, service documentation of each garment, from each department. Costing not even a fraction of a legal settlement like this one, outsourcing these services provides total liability protections for the network and implements “Best Practice Standards” for both patient and staff safety.
REFERENCES:
Wilson M. Lawsuit: Surgeon’s cancer caused by improper radiation safety at hospital. Courier & Press. https://www.courierpress.com/story/news/local/2017/05/24/lawsuit-surgeons-cancer-caused-improper-radiation-safety-hospital/102099200/
Jaber M, Harvill M, Qiao E. Lead Aprons worn by interventional radiologists contain pathogenic organisms including MRSA and Tinea species. J Vasc Intervention Radiology. 2014;25(3)S99-S100.
Honigsberg H, Speroni K, Fishback A, et al. Health care workers’ use and cleaning of x-ray aprons and thyroid shields. AORN J. 2017; 106(6):534-546.
Jones K. Gold Standard Cleaning For X-Ray Aprons & Lead Wearables. Universal Medical. https://blog.universalmedicalinc.com/gold-standard-cleaning-x-ray-aprons-lead-wearables/.
ABOUT THE AUTHOR:
Justin McKay has a Bachelor’s Degree from DePauw University and a Master’s Degree from Purdue University. He is a radiation safety expert, who has conducted extensive research on these topics and has presented nationally to several surgical and radiological professional organizations. He regularly consults with the healthcare network and IDN administration regarding implementing a total garment solutions platform for liability protection. Justin can be reached at jmckay@radcareservices.com.