How Infection Preventionists Can Build the Case for Cleaner Lead Aprons Using ATP Data and Patient Safety

For infection preventionists (IPs), identifying a potential patient safety risk is only half the battle. Convincing hospital leaders to invest in solutions often proves far more difficult.

During a recent Infection Control Today^® and Diagnostic Imaging^® roundtable, experts discussed how infection prevention and control (IPC) professionals can overcome barriers to improving reusable lead garment hygiene. Their advice centered on one message: make the issue personal and support it with objective data.

The panel included

Peter Graves, BSN, RN, CNOR
Justin McKay
Jill Holdsworth, MS, CIC, FAPIC, AL-CIP
Tori Whitacre Martonicz, MA, moderator

Peter Graves, BSN, RN, CNOR, former operating room director and CEO of Clinical Solutions LLC, acknowledged the challenges IPC professionals face.

"You've got to make it personal," Graves said. "There are 100 competing issues for every OR leader every day. Now you're bringing something that's not on their radar, and you want to make this a number one priority."

Rather than relying solely on published research, Graves encouraged hospitals to investigate their own environment through quality improvement projects.

"We have cultures, we have ATP," he said. "Go and culture some of their lead. Do an internal investigation. You don't need an IRB if you're not going to publish it. You can determine how big the problem is."

For Graves, the issue became deeply personal after undergoing bilateral hip replacement surgery.

"The last thing I wanted...was some gross-looking lead separating me from the sterile field," he said. "I don't want that for my patients. I don't want that for my family members."

Justin McKay, cofounder of RadCare Services, agreed that objective evidence often changes minds faster than discussion alone. He frequently partners with infection preventionists to collect ATP data, photographs, and before-and-after comparisons that demonstrate contamination levels.

"What I love to do is work with infection prevention," McKay said. "Let us do the data. Let us take some photos. Let us ATP. Let us build you a before-and-after report."

McKay recalled an operating room director who questioned whether cleaning reusable lead garments was justified by the expense.

After ATP testing both a gas pump handle and a lead apron, the results surprised everyone.

"The lead was 9 times dirtier than the gas pump handle," McKay said. "When infection prevention sees the data, infection prevention says, 'We have to do something here.'"

The discussion also expanded beyond lead garments. Graves noted that contamination concerns extend to other reusable fabrics entering procedural environments.

"We don't think of lead in the Spalding classification whatsoever, and we should," he said. "It's entering a sterile environment, and we really need to change the whole paradigm around this topic."

The conversation became especially passionate when panelists discussed cost as a barrier to implementing better cleaning practices.

McKay said he understands hospitals face financial pressures but believes patient safety must remain the priority.

"When I hear someone say, 'We can't afford it,' it lights a fire in me," he said. "One hundred thousand patients die every year from health care-associated infections. I don't want to hear that we can't afford this. We can do better."

The panel agreed that successful change requires more than new policies. By combining compelling patient stories with environmental testing, ATP data, and practical quality improvement initiatives, infection preventionists can help move reusable lead garment hygiene from an overlooked concern to an institutional priority.