Local, State, Federal

Infection Control in the MR Suite

In April 2006, 15-year-old Nile Moss died from a methicillin-resistant Staphylococcus aureus (MRSA) infection after an MRI study. Since that time, there appear to be no other infamous cases linked to the MRI suite and no available data to tell how often patients are infected or succumb to such infections directly acquired in MR suites. A spokesman for The Joint Commission (JC), Oakbrook Terrace, Ill, said that the JC does not have data about infection control and MRI suites, but that it does include measures to evaluate and address MRSA and other multidrug-resistant organisms as part of its facility accreditation process.

Louise M. Kuhny, RN, MPH, MBA, CIC, senior associate director, Standards Interpretation Group at the JC, noted that the JC devotes an entire chapter for accreditation to infection control. However, there is no section specifically for MR suites, but rather for the entire facility.

Kuhny said, “There are two real pillars or main foci for the infection control chapter. Those are a four-step risk-based infection control process, and use of relevant scientific guidelines.” Those guidelines, she noted, are from the Centers for Disease Control and Prevention (CDC) recommendations and procedures.

The first step, risk assessment, examines what types of patients are being served, the types of services being provided at the facility, and the general infectious disease issues in the community. Second, based on that risk assessment, goals are formulated for the organization. These goals need to be specific and measurable. Third, interventions are designed and implemented based on relevant scientific guidelines. Finally, the fourth step after intervention is an annual re-evaluation.

In terms of the MRI suite, Kuhny refers to the specific environmental guidelines from the CDC, which generally discuss cleaning practices, disinfectants, methods for cleaning, and how often cleaning disposables should be changed. However, Kuhny said there is nothing in the CDC guidelines that she is aware of specific to the MRI suite.

At the same time, Kuhny does say that the JC has found infection control problems in MRI areas and that it has issued what are called “requirements for improvement” to these institutions. However, she could not provide specific data about these circumstances.

She said, “We definitely do write requirements for improvement for MRI areas, which is the same way we do for any other area in a facility. However, we don’t really have a mechanism to break out that data from the rest of the infection prevention data. But I can tell you that it’s definitely an area that we do evaluate in organizations and that we do write requirements for improvements related to them.”

She added, however, “There’s certainly a risk of MRSA and other multidrug-resistant organisms across an organization. I’m not sure that we would have the data to characterize that as being a higher risk in the MRI suite than it is in other areas of the organization. But it is a concern.”

Peter Rothschild, MD, a radiologist and researcher, has written a number of articles and white papers expressing the need for more MRI infection control standards.

Rothschild is now the president of Patient Comfort Systems, Newark, Calif, which manufactures MRI pads, a potential source of infection. In terms of infection control and MRI pads, he recommends the pads be cleaned after each patient, inspected with an ultraviolet light, and changed when contaminated, frayed, or damaged.

However, Rothschild’s white paper recommendations go far beyond pads. He is concerned about throughput pressures on technicians and cleaning staff having improper infection control training—or skipping the MRI suite entirely due to administrator fears that a metal object may accidentally be brought into the suite and damage the MR bore. (Rothschild’s white papers are available at the company’s patientcomfortsystems.com Web site.)

While the JC is clearly concerned about infection control throughout institutions, it does not have the data to confirm the severity of the problem in MRI suites.

In addition, Kuhny pointed to the JC’s new national patient safety goal focused on multidrug-resistant organisms (MDROs), including MRSA, vancomycin-resistant enterococci (VRE), Clostridium difficile infections (C-DIFF), and multiresistant gram-negative bacteria.

Because this is a new goal, the compliance has a phase-in period. Currently, organizations must be working on an action and implementation plan. By October 1, 2009, they are required to have a pilot testing, and by January 1, 2010, full implementation of a specific plan must be in place to reduce the MDROs in the organization. Contact the JC for more information about this program.

—Tor Valenza