Why ATP Testing Can Help Hospitals Improve Lead Garment Cleaning

Hospitals cannot improve lead apron hygiene without leadership support, clear cleaning protocols, and staff accountability, according to experts participating in a recent Infection Control Today roundtable. Panelists discussed the operational challenges surrounding reusable lead garments and offered practical strategies for moving the issue from an overlooked responsibility to an institutional priority.

Peter Graves, BSN, RN, CNOR, CEO of Clinical Solutions LLC, said ownership should never outweigh patient safety.

"I really don't care who owns the device. It's going into my patient room, and so that patient is a shared responsibility to everybody," Graves said. "As a nurse, as an advocate for patient safety, I'm always going to err on that side of safety."

Graves recommended that hospitals establish clearly defined policies outlining how lead garments should be cleaned, documented, and maintained while following manufacturers' instructions for use.

He also described assigning individual lead aprons to staff members during his time as an operating room director.

"I ordered them their own aprons, and they were all embroidered," Graves said. "I wanted them to have ownership, kind of like having a car. You want your car to look good."

Although that approach may not be practical in every department, Graves emphasized that contamination remains a concern wherever lead garments are used.

Justin McKay, cofounder of RadCare Services, said years of servicing thousands of lead garments have reinforced the need for routine cleaning.

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

He also challenged the assumption that newly purchased lead garments are clean.

"Garments aren't made in what you call a clean environment," McKay explained. "Ten people have touched it, and it shows up at your place...because it's assumed to be clean."

McKay said ATP testing frequently identifies contamination on both new and heavily used garments.

Jill Holdsworth, MS, CIC, FAPIC, AL-CIP, asked what message would resonate most with hospital leadership.

McKay pointed to the Association of periOperative Registered Nurses' recommendations for cleaning high-touch equipment and suggested that hospitals begin by implementing scheduled deep cleaning and routine wipe-downs of lead garments.

He said visual evidence and objective data often provide the strongest case for change.

"When a garment...ATP tests at 20,000 RLUs, and it comes back at zero after cleaning...the light bulb kind of goes off," McKay said. "There's probably a better way we could be doing this."

The panel agreed that improving lead garment hygiene begins with leadership engagement, standardized protocols, and practical implementation strategies that support both patient safety and environmental hygiene.