Experts Call for Standardized Cleaning of Reusable Lead Aprons

Could reusable lead aprons be one of health care's most overlooked infection prevention risks? According to experts participating in a recent Infection Control Today roundtable, the answer may be yes.

Although lead aprons and thyroid collars are routinely worn in operating rooms, catheterization laboratories, interventional radiology suites, and emergency departments to protect clinicians from radiation exposure, panelists said these garments often fall outside formal cleaning and disinfection protocols.

"We have to do better," said Peter Graves, BSN, RN, CNOR, CEO of Clinical Solution, LLC. "Everything's supposed to be clean. And if it's not, we have to do better."

Graves challenged the common belief that lead garments pose little infection risk because they remain outside the sterile field.

"I would argue they do on every single case," he said. "The only thing is that we sequester them behind a sterile gown."

Justin McKay, cofounder of RadCare Services, said contamination of reusable lead garments is more common than many clinicians realize. He cited environmental testing that found bacterial contamination on many garments and described what his technicians routinely encounter during servicing.

"The gross factor is real," McKay said. "Some of our technicians...have a dry-heave counter on their whiteboard because of what they see and smell coming off the garments."

The panel agreed that one of the biggest obstacles is the lack of standardized guidance. Jill Holdsworth, MS, CIC, FAPIC, AL-CIP, noted that while hospitals often document that lead aprons have been cleaned, the methods used may vary widely.

Panelists also highlighted ATP testing as an effective way to demonstrate contamination and encourage leadership support. McKay recalled testing lead garments in an operating room and finding contamination levels significantly higher than those on a gas pump handle.

"When infection prevention sees the data, they say, 'We cannot ignore this,'" he said.

Brenna Doran, PhD, MA, ACC, CIC, AL-CIP, emphasized that solving the problem requires collaboration among infection preventionists, perioperative teams, radiology departments, environmental services, and hospital leadership.

Ultimately, the experts agreed that reusable lead garments deserve the same attention given to other reusable equipment. Developing standardized cleaning protocols and improving environmental hygiene may help reduce contamination while strengthening patient and staff safety.