Could Outsourcing Lead Garment Management Improve Infection Prevention?

Reusable lead aprons and thyroid collars have long been treated as necessary equipment that hospitals must purchase, store, inspect, repair, and clean. During a recent Infection Control Today^® (ICT^®) roundtable, produced in collaboration with Diagnostic Imaging^® (DI^®), infection prevention and perioperative experts questioned whether that traditional ownership model still makes sense.

Peter Graves, BSN, RN, CNOR, said the evidence surrounding contamination on lead garments creates a clear responsibility for hospitals to act.

“There’s a boatload of studies out there that talk about this,” Graves said, pointing to research identifying bacterial contamination on lead aprons used in operating rooms. “If you’re armed with that knowledge, and you have documentation that shows that we’ve known about this for years and years, it’s indefensible at that point.”

For Graves, the issue comes down to the fundamental patient safety principle of doing no harm.

“We want to make sure that we give that patient the best opportunity,” he said. “Yes, there’s a problem. I don’t think anybody would say that there’s not.”

He emphasized that lead garment hygiene must become a team priority, including for clinicians who personally own their equipment.

“I don’t care how good they are,” Graves said. “They can cause infections just like a junior surgeon can. So again, make this personal, make it a priority, make it a team event.”

Justin McKay, cofounder of RadCare Services, proposed a more radical solution: hospitals may not need to own lead garments at all.

“Why do hospitals want to own and manage lead garments?” McKay asked. “Why do they want that liability on their hands?”

He compared the concept with linen and scrub rental programs, in which outside vendors supply clean products, remove used items, and replace damaged or improperly fitting equipment. Under a similar model, hospitals could exchange garments when staffing needs or sizes change rather than purchasing another set.

“Half of it doesn’t fit. Half of it you don’t use. Someone’s left, and you still have it,” McKay said. “You’re passing it around. No one cleans it. It doesn’t get repaired. You don’t know what to do with it. It’s a hassle.”

Panelists acknowledged that changing this model would require more than demonstrating cost savings. Brenna Doran, PhD, MA, ACC, CIC, AL-CIP, noted that clinicians may interpret standardization as another loss of personal choice.

“These kinds of cultural shifts take time,” Doran said. “From a provider’s perspective, they might be thinking, ‘This is just one more thing that I have to give up in order for you to save a dollar.’”

She said leaders must communicate the safety and operational value of any new program without making clinicians feel that something is simply being taken away.

The panel also called for more research connecting contaminated lead garments with specific health care-associated infections. Graves suggested that hospitals experiencing clusters of infections, such as Staphylococcus epidermidis following total joint procedures, consider culturing the lead garments used in those rooms.

“See if you can trace it,” he said. “Because the lead is in another closet somewhere, we don’t look at it. We don’t see it. Out of sight, out of mind, so therefore it’s not a problem. But we need to do that full 360.”

Until regulations become more prescriptive, Graves recommended cleaning garments after use, documenting that work, including lead aprons in routine rounds, and establishing close partnerships between infection prevention and perioperative teams.

“If you’re not partnering closely with your OR and IP people, that’s a problem,” he said. “Get out of your office. Get together. Have coffee. Round. Work together on a daily or weekly basis.”