Radiation Protection During Mobile Exams

Do you wear a lead apron during portable exams?

I have found in my years of experience as a radiologic technologist that practices vary from one radiologic technologist to the next.  Of course, we utilize some form of radiation protection when it comes to using a c-arm for mobile fluoroscopy in the operating room.  Fewer people wear lead when performing plain film images during surgical procedures.  And most don’t seem to worry about radiation protection during routine portable exams like chest x-rays and abdomen films.

Why is this?  

We learn in school that lead shielding is required when performing these exams.  For those of you who do not wear radiation protection for mobile exams, I am about to show you something which may cause you to change the way you prioritize wearing radiation protection apparel.

For some context, I want to step back in time, when Computed Radiography (CR) was first implemented at a hospital I was a clinical instructor for.  My job was to accompany student technologists while they performed their exams and to educate and evaluate.  Having never been to the operating room at that facility, I was given the opportunity to tag along with one of the staff techs who had been observing my student for the day.  They were assigned to perform a cross-table lateral lumbar spine image during a discectomy.

I watched as the staff technologist carefully walked around the table, being mindful of the sterile field, and positioned the draped image receptor next to the patient.  My student used the portable x-ray machine to align a horizontal beam to include the lumbar spine for the prone patient.  When they were finished setting up, they indicated to the O.R. staff in the room that they were ready to expose the image.  All of them, including the physician left the room while the three of us from the radiology department stayed to make the exposure.

We had taken two CR image plates into the room with us.  One was positioned next to the patient, and the other had been placed against the wall behind us.  The student made the exposure, extending the full length of the cable that attached the exposure switch to the portable x-ray machine, which was about 12 feet.  The staff technologist and I backed up to the wall behind us – I would guess an additional 3 feet behind the student technologist who exposed the image.  We all wore lead aprons.

Upon returning to the radiology department to develop the image, the student made a mistake that every technologist has done in their career.  He was carrying both the exposed image plate of the lumbar spine image as well as the unexposed image plate that had been resting against the wall behind us, and he forgot which one was the exposed plate.  The logical solution was to process both image plates under the “lateral lumbar spine” algorithm and discard the image that was not exposed.

The first image was not the lumbar spine image we had hoped it would be.  Instead, something peculiar appeared on the monitor in front of us as the scanner slowly revealed more and more of the image during processing.  Once the entire image had been scanned and the processing the algorithm was applied, it was clear that this was an image of a lower leg (a portion of the tibia and fibula).

Thinking we had come across someone else’s image plate that had been exposed for a different patient (and thankful we did not use that plate to image the lumbar spine), we began asking around the department to see if anyone was missing a tib-fib image from any of their exams.  No one was missing an image.  I decided to examine the image further on a PACS monitor for larger viewing.  The image quality was poor, and the resolution was horrible.  The exposure indicator proved that the image was slightly over-exposed.  I then realized what I was looking at.  This was the cassette that was leaning against the wall in the operating room approximately 15 feet from the patient that was x-rayed.  If you recall, the staff technologist and I had backed up against the wall prior to the exposure being made for the lumbar spine.  This was an image of the staff technologist’s leg, which was positioned just a few inches in front of the image plate during the lumbar spine exposure.  This was purely created by scatter radiation from the exposure we took in surgery.

Here are some examples of images created solely from scatter radiation in an experiment based off of lessons learned from this experience:

S# was 1190 at 8 foot distance from lateral lumbar spine phantom, which indicates about 1/4 the exposure required to produce a diagnostic hand x-ray

S# was 980 at a 6 foot distance from lateral lumbar spine phantom

I also decided to x-ray a chest phantom to simulate a portable chest x-ray using 120 kVp and 5 mAs. The following image was created from scatter radiation from about 10 feet away from the chest phantom.

S# was 2780

Though the last image produced from the chest phantom didn’t receive nearly the exposure as the one from the lumbar spine phantom, it is still obvious that there is enough radiation to penetrate the fingers from 10 feet away.  Now that you’ve read this and seen evidence of the radiation we work with every day as a radiologic technologist, are you going to change your practices?  If you already use radiation protection for your mobile exams, will you encourage your co-workers and student technologists to adopt these habits?

Registered radiologic technologists vow to keep radiation dose “As Low as Reasonably Achievable” (ALARA).  It is our duty not only to protect patients from the harm that can be caused by radiation, but to protect yourself and your co-workers from it as well.  Let us not forget the three basic principles of radiation protection; time, distance and shielding.  Keep the amount of time you are exposed to radiation low.  Keep as much distance from a radiation source as possible.  And finally, use shielding, including during mobile examinations.  Consistent application of all three of these basic principles of radiation protection will keep you, your patients and your co-workers as safe as possible.

About the Author 

Jeremy Enfinger is an experienced Radiologic Technologist, Radiography Program Instructor, and published author. He has served in leadership roles in hospital, outpatient and academic settings. His experience includes writing examination questions for the national ARRT Radiography Exam and multiple – modality training. He continues to pursue excellence in education and patient care. An avid blogger, Jeremy strives to promote standards of excellence in imaging through his online community with the sharing of veteran tips and techniques for high-quality imaging.

Additional Reading Written by Jeremy Enfinger via Topics in Radiography Blog

Experiments with Scatter Radiation (original post from 2009 – with updated images and technical factors)

Reducing Radiation Dose in Diagnostic Radiography

Podcast: How To Communicate Radiation Risks To Patients

What Everyone Should Know About Digital Radiography

Gold Standard Cleaning For X-Ray Aprons & Lead Wearables

What Does Gold Standard Cleaning Look Like For X-Ray Aprons And Lead Wearables?

Thus far in this lead apron based blog series, we have examined the infection issues and concerns associated with contaminated lead x-ray aprons and the science behind how staff members can easily test such surfaces for contamination using ATP testing.

This third blog entry will examine methodologies and practices utilized by clinical staff and facilities in the “cleaning” and maintenance of these protective lead wearables, and also explore what “cleaning” such a surface really entails. In discussing bioburden levels in the previous blog, we addressed how one cannot judge cleanliness on a surface by appearance alone.  Let’s take a deeper dive into what it means to truly clean and sanitize these protective, lead garments.

Survey Says…

In researching the topic, speaking with professionals at symposiums and inquiring with colleagues and peers, there is little consistency across the continuum of care with how these garments are cleaned and/or serviced. Shockingly, a number of Radiology, Cath Lab and Operating Room staff have lamented that such surfaces “never” get cleaned, while other staff and administrators have shared that such surfaces are sometimes cleaned, “when the case load is light on a Friday” or “on the midnight shift by the environmental services department.” Both patient and staff safety are at risk due to lack of staff compliance and clinical efficacy issues posed through improper cleaning practices.

Online research lead to a few administrators sharing that they ran these lead aprons through a cart washer, which lead manufacturing companies clearly advise not to do. Clinicians have also shared that they try to use products such as Lysol or Febreeze to “eliminate the odors” yet admit the lead wearables still aren’t “clean.” One of the more popular concepts considered in attempting to clean and service these wearables entails the discussion of “using sanitizing wipes” on such high-touch surfaces.  Unfortunately, the use of these wipes alone does not properly clean and sanitize the garments.

Pesky Directions

There are a number of sanitizing/disinfecting wipes on the market that some clinicians claim to use on lead aprons and wearables. When taking a closer look at the labels on these products, one may very well discover that most wipes are actually not recommended for use on lead wearables. Additionally, some wipes contain bleach and corrosive agents, which are both advised not to be used on aprons, according to the companies that manufacture them. A majority of the wipes on the market today are indicated for use on “non-porous” surfaces such as tables, bed rails, door handles, etc. rather than a porous surface such as a nylon covering of a lead wearable. Though the use of wipes might afford convenience to the user, the real issue with doing so lies in their clinical inefficiency in successfully cleaning the surface, not to mention completely removing any bioburden.

Wax Then Wash?

If your car had dirt, road tar and bird droppings on it, would you attempt to wax it in that condition?

For best outcomes, you would first clean and remove those elements before attempting to wax the car.  The same is true for other surfaces, including lead wearables.  Professionals who routinely assess bioburden understand the importance of a proper cleaning before sanitizing or disinfecting an item.  If an item is not properly cleaned and organic matter remains, nutrients also  remain to better foster the growth of surviving bacteria or future bacterial contamination.  This is by definition a risk factor for increased hospital associated infections.

All You Can Eat Buffet

In watching the news of late, one can gather that the world of microbiology is ever changing.  Bacteria are highly adept at persisting.  Through changes in their DNA they can gain antibiotic and/or antiseptic resistance, and these changes can happen through mutations or through integration of foreign DNA, but where would they find foreign DNA?  When bacteria die and the cells break open, then the DNA is accessible to the remaining bacteria.

The Problem with Sanitizing and Disinfecting Wipes

When facilities only use wipes on a surface and don’t completely remove the debris, they are in essence creating an “all you can eat buffet” for the surviving bacteria to thrive upon. If the dead bacteria had antibiotic or antiseptic resistance markers, now that DNA is fair game for susceptible bacteria to gain resistance!   In fact, numerous studies have shown that certain bacteria can pick up various genes from different species that makes them more pathogenic (either by making it antibiotic resistant, antiseptic resistant, or by allowing it to survive in a host better).

Layers Of Bacteria? Gross?

As if that wasn’t scary enough, what if I told you that some bacteria could gain antibiotic and antiseptic tolerance simply by growing?  (IT IS TRUE!)

Some bacteria can attach to a surface (particularly porous or textured surfaces such as lead wearables) and as they grow and form groups of bacteria (colonies) that can then form a biofilm.  Biofilms are clusters of bacteria that have attached and produced an extracellular polymeric substance (EPS) which are essentially a protective coating.

Extracellular Polymeric Substance (EPS)

EPS consists of DNA, proteins, lipids (fats) and polysaccharides (sugars).  This coating protects the bacteria inside the human body from cells that can either tag the bacteria for destruction or destroy the bacteria outright.  Externally (on a surface) it can protect the bacteria from anti-microbial drugs or antiseptic agents.  In fact, bacterial biofilms are 10 – 1,000 times more resistant to antibiotics than there standalone bacterial counterparts.  Their EPS is essentially a bacterial Teflon coating.  This Teflon coating only gets stronger when multiple species of bacteria co-inhabit the same biofilm, and if these attributes weren’t scary enough, bacteria in a biofilm can sense their microenvironment and may even produce toxins while in a biofilm that they wouldn’t normally produce.

Biofilm Life Cycle

Like all living things, biofilms have a life cycle, and a part of that life cycle involves dispersion of some bacteria that are then free to go and attach elsewhere, including in a human host. In 2007, the National Institutes of Health estimated that approximately 80% of chronic infections were biofilm related; thus, biofilms remain a serious problem in many facilities. When surfaces such as the nylon covering of a lead wearable are not cleaned properly, it allows different bacteria to begin to congregate.

Layers of Bacteria

Thinking this all sounds like something from a fictional book or movie, as if biofilms can only exist in some weird lab conditions or in some rare disease?  Nope!!!!

The most common example of a biofilm is one that everyone is probably familiar with, but may not realize is a biofilm, is dental plaque!  Biofilms are so hard to remove from surfaces that companies have spent millions of dollars trying to prevent their formation.  If you think about dental plaque, it makes sense.  We brush our teeth twice a day to best prevent plaque.  Unfortunately, when it comes to medical devices or any surface (particularly a porous or textured surface) in a medical treatment facility (such as lead wearables), biofilms can form once the surface is exposed to organic matter such as blood.  Now with the mental picture of layers of bacteria (such as plaque) on surfaces in medical treatment facilities, consider that some high-touch surfaces, such as radiological shields and aprons have not been properly cleaned for years (if ever!)

Elbow Grease Helps Break Up Biofilms

Biofilms are so tolerant of antimicrobials and antiseptics, that even the CDC positions the best way to remove a biofilm is to disrupt it physically, and they have included the ‘use of friction’ in their definition for proper cleaning.  Studies have been done that show that physically disrupting the biofilm by using friction is the primary means for destruction of the layers and thus removal of the biofilm.  (In the example of dental plaque, this would be equivalent of one going to the dentist and having them scrape the teeth in order to remove the plaque.)  The procedural process and outcomes are different when looking at the process of “cleaning” and “sanitizing” and it takes both of these separate processes to eradicate biofilms from porous, high touch surfaces. The surface on a lead wearable first needs to be cleaned before it can then be sanitized.

  • Cleaning – According to the CDC, cleaning entails the use of EPA registered products, coupled with the use of friction to physically remove dirt, microorganisms and bioburden and then removing/rinsing them away from the surface. Though a vast majority of the bioburden is removed during this process, the cleaning process does not always remove 100% of all bioburden & microorganisms.
  • Sanitizing – This process then “inactivates” 99.9% of all remaining microorganisms on environmental surfaces if allowed to sit visibly wet or “dwell” on the surface for the recommended amount of “dwell time” as per manufacturer instructions and guidelines.

Cleaning and Sanitizing really can’t be done in one-step, let alone with just a wipe. When you go to the dentist, the first step in the process is to scrape the plaque from the teeth before they are polished, just like your car needs to be adequately washed and dried, before it can be then waxed. Cleaning and sanitizing of a neglected surface such as a lead apron cannot be accomplished in one step either. In an effort to address such biofilms “head on” X-Ray apron servicing companies, such as Radiological Care Services (IN) are implementing multi-step, cleaning and sanitization programs for X-ray aprons and lead wearables. These programs are built in accordance with governing bodies, such as the CDC, JCAHO, AORN and HFAP, which position that surfaces should first be cleaned, before attempting to sanitize or disinfect them.

Stay Tuned For The Next Post

Stay tuned for the next follow up blog post, as we look specifically at what policies, regulations and expectations these governing bodies have of high touch surfaces, such as X-ray aprons and lead wearables. Between now and then, go brush your teeth and think about the layers of bacteria building up on lead wearables and aprons as they continue to invite bacteria to the biofilm party!

About The Author:

Kathleen R. Jones received her BS from Purdue University (West Lafayette) in Biology specializing in Genetics and Microbiology.   After working for five years in Quality Control she then completed her MS at Purdue University in Indianapolis.  Her growing interest in Infectious Diseases lead her to the Uniformed Services University of the Health Sciences where she obtained a Doctorate in Emerging Infectious Diseases.  Kathleen has a passion for progressive sciences and initiatives, and employs her keen understanding of the biofilm formation and elimination processes into her research and work.

Evaluating Microorganism Levels On X-Ray Aprons And Lead Wearables: The Science Of ATP Testing

How Have Microorganisms and Bioburden Been Measured?

In the previous blog post regarding X-Ray lead aprons, we explored the history of healthcare associated infections or HAIs, and how transmission risks are posed to patients and staff via contaminated “high touch, non-critical surfaces,” including X-Ray aprons and protective lead wearables.  In laying out the content of this blog, I was reminded of the phrases, “things aren’t always as they appear” and “don’t judge a book by its cover.” Is it possible that newer (clean looking) X-Ray aprons can carry a higher level of biological contamination when tested in comparison to older X-Ray aprons (which are dirty looking & smelling)? It is completely possible and plausible due to the concept of bioburden.

What is Bioburden?

Bioburden is defined in numerous medical dictionaries as the number of microorganisms contaminating an object.  So how does one assess for bioburden?  The gold standard for assessing for bacterial/fungal contamination has been to assess for colony forming units or CFUs.  A CFU equals one viable bacterium that has the ability to spread and replicate.

3 Main Ways to Measure CFUs: 

  1. A scientist could dilute the sample and count the bacteria by microscopic examination or through the use of a cell counter.  However, if bacteria are too small or clump together, then this method is problematic.  This method will yield total bacteria counts, both living and dead.
  2. A scientist could use Optical Density (OD) to estimate the number of viable bacteria in a sample.  This is where the scientist measures how cloudy a liquid culture of bacteria is.  While the bacteria are actively growing the liquid culture should continually become more and more cloudy.  Again, this method will yield total bacteria counts, both living and dead.
  3. A scientist could make serial dilutions of a liquid culture and plate out the bacteria in known dilutions until they can count single colonies and extrapolate back to figure out total CFU in a sample. This method only yields viable bacteria totals.

4 Challenges Associated with Bioburden Assessment

Assessing for bioburden (microorganisms) by calculating CFUs is not as easy or straight forward as one might imagine.

  1. The first challenge posed is that one needs to have a lab in which to grow bacteria, and depending on the bacteria one is dealing with there are different governmental regulations to follow.
  2. The second challenge presented is that of time, one needs to have the time and equipment to properly grow the bacteria/fungus.  Different species of bacteria or fungus grow at different rates, for example, culturing of bacteria on plates can take anywhere from overnight to multiple days.
  3. A third and very important challenge is posed by the bacteria and fungus themselves.  They are similar to people in the fact that not all of them grow and thrive under the same conditions.  In lab work, if only one kind of food source is used, one will only be able to assess for bacteria that grow on that particular food source.
  4. Finally, one needs to have a trained technician who knows how to assess which bacteria to grow under the correct conditions and then also how to properly count the bacteria.

While assessing for CFUs has traditionally been viewed as the gold standard for assessing bioburden, and it is vitally important for various microbial studies, it is not a good way to assess bioburden in real time.  It can be complicated.

What is ATP and How is it Evaluated?

What if there was an easier way to determine surface levels of biological contamination?

What if there was an easier way to assess for a molecule that is found only in living cells, both bacterial and human living cells?

There IS an easier way to evaluate for this molecule in real time (by using a simple swab and handheld reader), and it can be used by any hospital staff member as a surrogate for such complicated CFU work.  Let me introduce you to the molecule known as the “molecular workhorse,” called adenosine triphosphate (ATP).

Adenosine Triphosphate (ATP)

ATP is an energy molecule utilized by cells. It is present in humans, animals, plants and microbial cells.  ATP levels rise as a cell is undergoing apoptosis (programed cell death), but is generally consider to be completely degraded within 30 minutes of cell death (1).  This makes ATP a useful marker for the presence of unwanted biological contamination, including organisms that can cause infection and disease.

Okay – Get to the Point!

An increase in biological cells on a surface results in an increase in the amount of ATP present on that surface, thus making ATP an effective marker for the assessment of the hygienic status of an environmental surface. Simply stated, the amount of ATP present on a testing swab is a quantitative measurement of the cleanliness of the surface tested! In fact, ATP cell viability assays were determined to be the fastest, most sensitive, and least prone to artifacts, partially due to a lack of an incubation period (2).  The sensitivity of laboratory cell based ATP cell viability assays can detect fewer than 10 cells per well (2).  This technology has been modified to create a portable, ATP bioluminescence test, using a swab instead of plated cells.  This now allows for a real time assessment of bioburden on site.  These tests have been used to assess bioburden in many healthcare settings, including the ICU (3).  ATP measuring units, called luminometers, are handheld, user friendly, and display the results in seconds. (It doesn’t take a scientist to use an ATP luminometer!) The read out of an ATP bioluminescence test is not in CFUs, but is in relative light units or RLUs.  In the past, some scientists have questioned the validity of using a bioluminescence test instead of assaying for CFU.

Is There a Correlation Between CFUs & RLUs? 

Like most assessments, ATP bioluminescence assays also have limitations, but they are an excellent surrogate that allows the everyday staff member to assess bioburden in real time.  Those new to ATP bioluminescence testing often inquire about a correlation between CFUs and RLUs.  (Most laboratory microbiologists have the capability to perform CFU testing, and are not confined to real time assessment of bioburden.)  The most controlled way to achieve this is to look at different known amounts of CFUs and assess whether or not the RLUs increase accordingly.  That is exactly what Dr. Sciortino’s group did when they assessed three different portable ATP bioluminescence kits for their ability to detect various CFUs of two different HAI relevant bacteria (Staphylococcus aureus and Acinetobacter baumannii) and one strain of fungus (Candida albicans).

What they discovered was there was a linear relationship between bacterial CFUs and RLUs for all three luminescence kits, and for two of the three kits between fungal CFUs and RLUs (1).  Such research validates that the use of ATP luminometers can be used to assess for bioburden on surfaces in real time.  This research, plus Dr. Jaber’s study, in which 25 lead aprons were cultured for CFUs and showed that 21 were colonized with Tinea species (the family of fungus that causes ringworm) and 21 were colonized with Staphylococcus aureus, of which 3 aprons were colonized with MRSA (4), validates the ATP bioluminescence results for X-ray aprons and protective lead wearables.

In fact, these X-ray aprons and protective lead wearables, which are worn throughout many different areas within a healthcare system, including the operating rooms, cath labs, radiology/imaging areas, emergency rooms and beyond are regularly testing with RLU readings in the THOUSANDS to HUNDREDS OF THOUSANDS (5), which is scary. The bottom line is regardless if you are a classically trained microbiologist used to looking at CFUs or a hospital staffer looking at luminometer readouts in RLUs, when surfaces inside an OR or Cath Lab are testing in the hundreds of thousands range, it is a problem!

Is ATP Testing Growing in Use?

Through utilization of ATP luminometer testing systems, companies like Radiological Care Services (Indianapolis) are able to enter a facility’s Cath Lab, OR or Radiology Department and test lead apron inventories on site, providing real time numbers (bioburden levels) in a matter of seconds. An advocate for ATP luminometer testing, Dr. Sciortino even states, “ATP system monitoring may uncover the need for new disinfectant designs that adequately remove hospital surface biofilms, rendering used hospital equipment to its native state whereby a zero reading by ATP monitoring can be achieved” (1).  If you look back at the first blog post, “Contaminated X-Ray Aprons and The Risk of HAIs”, I positioned that “using wipes alone” was insufficient and through the use of ATP testing, Dr. Sciortino could be inferring a similar position.

Looking Ahead…

In the next blog post, we’ll specifically look at the science/methodology behind the use of sanitizing wipes and we’ll further explore the differences between true “cleaning” and “sanitization.” We’ll later examine what the governing bodies, such as AORN, CDC, HFAP and JCAHO state regarding their expectations of such surfaces within healthcare facilities. Understanding the science behind HAIs, testing for biological contaminants on surfaces, biofilms, and the difference between “cleaning” and “sanitization” will help us understand that current healthcare protocols in regards “non-critical, high touch surfaces” need to be changed in order to better protect hospital patients and staff.

About The Author:

Kathleen R. Jones received her BS from Purdue University (West Lafayette) in Biology specializing in Genetics and Microbiology.   After working for five years in Quality Control she then completed her MS at Purdue University in Indianapolis.  Her growing interest in Infectious Diseases lead her to the Uniformed Services University of the Health Sciences where she obtained a Doctorate in Emerging Infectious Diseases.  Kathleen has a passion for progressive sciences and initiatives, and employs her keen understanding of the biofilm formation and elimination processes into her research and work.

Sources:

  1. Sciortino, C. V. and R. A. Giles.  2012. Validation and comparison of three adenosine triphosphate luminometers for monitoring hospital surface sanitization: A Rosetta Stone for adenosine triphosphate testing.  AJIC.  40 (e233-9)
  2. Riss T.L., R.A. Moravec, A. L. Niles, H.A. Benink, T.J. Worzella, L. Minor. Minor, L, editor.  2013,  Cell Vialblity Assays. In: Sittampalam G.S., N.P. Coussens, H. Nelson, et al., editors. Assay Guidance Manual [Internet]. Bethesda (MD): Eli Lilly & Company and the National Center for Advancing Translational Sciences; 2004-. Available from: //www.ncbi.nlm.nih.gov/books/NBK144065/
  3. Moore, G., D. Smyth, J. Singleton, P. Wilson. 2010. The use of adenosine triphosphate bioluminescence to assess the efficacy of a modified cleaning program implemented within an intensive care setting.  AJIC. 38(8):617-622 DOI: //dx.doi.org/10.1016/j.ajic.2010.02.011
  4. Jaber, M., M. Harvill, E. Qiao.  2014.  Lead aprons worn by interventional radiologists contain pathogenic organisms including MRSA and tinea species.  Journal of Vascular and Interventional Radiology.  25:3:S99-S100.  DOI: //dx.doi.org/10.1016/j.jvir.2013.12.279
  5. “Outcomes: What do your numbers look like?” Radiological Care Services. Nov 20, 2014. //www.radcareservices.com/radiolgical-care-services-outcomes.html

Contaminated X-Ray Aprons And The Risk Of HAIs

Contaminated, Dangerous, and Unacceptable: The Impact of Contaminated X-Ray Aprons and the Risk of Health Care-Associated Infections (HAIs)

Infection Prevention checklists today include many new areas of concern such as contamination in lab coats, neckties, telephones, remote controls, privacy curtains and more. X-ray aprons and protective lead wearables are worn throughout many different areas within a healthcare system, including the operating rooms, cath labs, radiology/imaging areas, emergency rooms and beyond. Clinical studies have proven that X-ray aprons silently carry a number of microorganisms – Dr. Jaber (Wayne State) cultured 25 lead aprons to discover 21 were colonized with Tinea species (the family of fungus that causes ringworm) and 21 were colonized with Staphylococcus aureus, of which 3 aprons were colonized with MRSA (1).  

The Association of periOperative Registered Nurses (AORN) makes cleaning recommendations for items such as kick buckets, stools, patient restraints, keyboards, surgical lights and more; however, lead aprons which are routinely engulfed in sweat, blood, bodily discharge and surgical debris/residue have been consistently overlooked. Healthcare systems can no longer compromise both patient and staff safety through such perilous practices.  (Note – upcoming posts will further explore “current cleaning practices,” as well as cleaning recommendations and guidelines from National Governing Bodies such as the CDC/JCAHO/HFAP and AORN.)

Health Care-Associated Infections

HAIs are the 4th largest killer in the United States, claiming 100,000 American lives each year – more deaths than AIDS, breast cancer and auto accidents combined (2).

Hospitals are meant to be safe havens.  They are meant to be a place of refuge against disease, a place to heal and a place to recover from surgery or injury.  If that is the dream, then the nightmare would be a place in which you end up more ill than you were when you were first admitted!  Unfortunately, that nightmare becomes a reality for many unsuspecting patients and staff members today. One reason for this nightmare is the acquisition of a Health Care Associated-Infection or Hospital Acquired Infection (“nosocomial infection”).

The World Health Organization (WHO) uses a 1995 definition for a Hospital Acquired Infection (HAI):

An infection occurring in a patient in a hospital or other health facility in whom the infection was not present or incubating at the time of admission.  This includes infections acquired in the hospitals but appearing after discharge, and also occupational infections among staff of the facility (3).

HAIs in our Healthcare System

Think about it – it only makes sense that hospital acquired infections would be prevalent in our healthcare systems today.  Hospitals & medical facilities are places that people congregate when they are immunocompromised and/or are sick and in need of some type of care or treatment.

World Health Organization Study

In fact, a WHO study of various hospitals in 14 countries across Europe, Eastern Mediterranean, Southeast Asia and Western Pacific regions in the late 1980s concluded that 8.7% of patients had at least one Hospital Acquired Infection equaling 1.4 million afflicted people at any one time (4-5).

Centers for Disease Control and Prevention Estimate

In the United States alone, the CDC estimates roughly 1.7 million annual hospital-associated infections, from all types of microorganisms including bacteria combined, cause or contribute to 100,000 deaths each year (6). In fact, approximately 1 in 25 hospital patients has a hospital acquired infection at any one time (7). While these statistics are startling and horrifying, sadly they do not paint the complete picture. These statistics are patient specific and do not include the number of healthcare workers and hospital staff who have also acquired Hospital Acquired Infections.

Economic Impact of HAIs

Such infections lead to additional stress, longer hospital stays, lost wages for healthcare providers and higher morbidity and mortality rates overall.  HAIs also have a HUGE economic impact.  In addition to being the 4th largest killer in America, it is estimated Hospital Acquired Infections will cost the healthcare system an additional $30 Billion (2).

Why do HAIs Occur? 

We live in a medically advanced society, so why do Health Care Associated-Infections still run rampant, and what are we doing about them?  That is a good question, but the answer is multifaceted.  The first point to consider is that patients are usually immunocompromised when in need of healthcare services. They are either already ill or they have had a procedure that puts immense stress on their bodies, e.g., a joint replacement, major illness or other surgical procedure or treatment. 

As wonderful as modern medicine is, it is not without risks.  In fact, many diagnostic and/or therapeutic procedures involve the use of a medical device, e.g, catheters, intubation tubing, scopes, etc. These devices and even many “non-critical” surfaces and “high touch objects” such as X-ray aprons and lead wearables can become contaminated when not properly cleaned and sanitized.

Healthcare facilities are a place where sick and immunocompromised patients regularly navigate and patients are often transferred between units/floors.  This allows infectious agents to travel to different areas in a hospital and expose multiple people, including patients, family and staff members.

Infectious Agents

Infectious agents (bacteria, viruses, parasites, and fungi) present their own issues.  There are species that form spores that are resistant to most mechanisms of eradication. Kramer’s group recently performed a meta-analysis of the literature and summarized that most clinically relevant species of viruses could easily survive on dry, inanimate surfaces for between a few HOURS to DAYS and clinically relevant bacterial and fungal species could survive for DAYS to MONTHS (8).  The longer the infectious agent can be found in the environment the greater the chance that it can be passed to a new host.

The Need for New Policies/Protocols

Unfortunately, Health Care-Associated Infections (HAIs) are still a substantial source of morbidity and mortality throughout the healthcare continuum today.  While recent initiatives such as improved hand washing policies have helped that burden, there are additional new policies/protocols with regards to cleaning that need to be implemented in order to address other critical “high touch objects” such as X-ray aprons and lead wearables.

Education and Awareness

Through education and open-mindedness, we can bring awareness to the importance of following the cleaning recommendations of the governing bodies, such as the CDC/JCAHO/AORN and HFAP.  In knowing that infectious agents can still adapt to become drug resistant, antiseptic resistant, and increase their ability to survive in the environment, so, we too must adapt and be open minded to new concepts in our vigilant fight against hospital acquired infections.

Oft-Overlooked: X-Ray Aprons and Lead Wearables

X-ray aprons and lead wearables can no longer be overlooked, and they will need a renewed commitment to servicing. They need to be properly cleaned prior to sanitization efforts, in accordance with the guidelines of the CDC & JCAHO.  In my next blog entry, we’ll dive into the science behind testing X-ray aprons for the presence of microorganisms and examine how these surfaces are measured and evaluated.

SPOILER ALERT – If you think you have an idea of how contaminated such surfaces are inside of our healthcare systems, you will be in for a SURPRISE!

About The Author:

Kathleen R. Jones received her BS from Purdue University (West Lafayette) in Biology specializing in Genetics and Microbiology.   After working for five years in Quality Control she then completed her MS at Purdue University in Indianapolis.  Her growing interest in Infectious Diseases lead her to the Uniformed Services University of the Health Sciences where she obtained a Doctorate in Emerging Infectious Diseases.  Kathleen has a passion for progressive sciences and initiatives, and employs her keen understanding of the biofilm formation and elimination processes into her research and work.

Sources:

  1. Jaber, M., M. Harvill, E. Qiao.  2014.  Lead aprons worn by interventional radiologists contain pathogenic organisms including MRSA and tinea species.  Journal of Vascular and Interventional Radiology.  25:3:S99-S100.  DOI: //dx.doi.org/10.1016/j.jvir.2013.12.279
  2. “What is RID?” Committee to Reduce Infection Deaths.  n.p.  d.p.  Web.  Nov 7, 2014.  //www.hospitalinfection.org/objective.shtml
  3. Benenson, AS.  1995.  Control of communicable diseases manual.  16th edition.  Washington, American Public Health Association.
  4. Tikomirov, E.  1987. WHO Programme for the Control of Hospital Infections.  Chemiotherapia. 3:148-151.
  5. Mayon-White, RT, G.  Ducel, T. Kereselidze, E. Tikomirov.  1988.  An internal survey of the prevalence of hospital-acquired infection.  J. Hosp. Infect.  11 (SupplementA): 43-48
  6. Klevens, RM, JR Edwards, CL Richards, TC Horan, RP Gaynes, DA Pollock, DM Cardo.  2007.  Estimating health care-associated infections and deaths in U.S. hospitals, 2002.  Public Health Rep 122:160-166
  7. Magill, SS, JR Edwards, W Bamber, ZG Beldavs, G Dumyati, MA Kainer, R Lynfield, M Maloney, L McAllister-Hollod, J Nadle, SM Ray, DL Thompson, LE Wilson, SK Fridkin.  2014.  Multistate Point-Prevalence Survey of Health Care-Associated Infections.  N Engl J Med 370:1198-1208
  8. Kramer, A., I. Schwebke, and G. Kampf.  2006.  How long do nosocomial pathogens persist on inanimate surfaces? A Systemic Review. BMC Infectious Diseases.  6:130  Doi: 10.1186/1471-2334-6-130

What is FluoroSafety?

Identifying Important Risks Associated with FGI

In 1994 the FDA released a public health advisory warning of the potential for serious radiation-induced skin injuries to patients resulting from fluoroscopically guided interventions (FGI).  In the 20 years since this advisory, there have been hundreds of published cases of skin injury resulting from FGI, and the number is steadily increasing even today.  As the scope of disease that can be diagnosed and treated using FGI increases, so does the complexity of these procedures and the radiation doses to patients, physicians, and staff.  While these procedures provide an incredible benefit to the patient compared to open-surgical alternatives, there are important risks that must be understood by the performing physician.

The Need for Effective Training

In 2010, frustrated by the lack of user-friendly, accessible, and effective training focused on this topic, two diagnostic medical physicists started Fluoroscopic Safety, LLC [//www.fluorosafety.com]. Understanding the need for a balanced perspective and considering that radiation is not the only risk from FGI, they collaborated with an experienced board certified interventional radiologist well-known for his work in quality improvement.  Because of the multi-disciplinary M.D. and Ph.D. backgrounds of the authors of FluoroSafety courses, we understand that when a physician is performing an FGI, managing radiation dose is not the first thing on his mind.  Instead, practitioners are thinking about the patient-specific technical challenges associated with these procedures.  The training programs from FluoroSafety are developed with this in mind.  While our courses do provide instruction on the fundamental physics of fluoroscopy and radiation biology, we focus on simple methods for managing patient and staff radiation dose.  Using videos and animations, our courses provide an easy to remember and easy to execute set of practices which benefit both the physician and their patients.  This is one of the key features of our courses, designed by physicians and physicists together.

Fluoro CME Training and Education

The educational programs from FluoroSafety also help providers satisfy state regulatory requirements. Through a joint sponsorship with The University of Texas MD Anderson Cancer Center, our courses have been approved for up to 10.5 hours of AMA PRA Category 1 CreditTM.   Our programs meet the training requirements for practitioners who use fluoroscopy in Oregon, California, and Texas.  In addition, board certified providers who complete these courses are eligible to claim self assessment CME (SA-CME), as required for Maintenance of Certification (MOC) by members of the American Board of Medical Specialties (ABMS).

Interactive and Engaging Content

The educational programs from FluoroSafety are tailored to the needs of busy healthcare professionals and feature on-demand Flash-based learning rich in animations and videos.  Our courses also feature optional narration.  Course content can be accessed at the convenience of the physician from any computer, smartphone, or tablet with Internet access.

Meet State Requirements

Whether you are trying to meet state regulatory requirements or are simply interested in improving the care you provide to your patients, FluoroSafety has a course for you.  The most common feedback we have received from physicians who have taken our course is that they were surprised by how much they didn’t know about the safe use of fluoroscopy—you may be surprised too!

FluoroSafety.com

A. Kyle Jones, PhD

Alexander S. Pasciak, PhD

Joseph Steele, MD

Fluoroscopic Safety, LLC

Discover Gucci Radiation Resistant Glasses

Are you fashion savvy?

Have you been searching for a fashionable way to protect your eyes from the harmful effects of ionizing radiation?

Then look no further.

Gucci radiation resistant glasses have arrived. Gucci, a name synonymous with high-fashion and stylish sophistication is the latest addition to our radiation protection eyewear line.

Gucci’s styles for women range from the lightweight nylon frames of the Gucci GG 3547/S, to the bold, full-rimmed frame of the Gucci GG 3574/S.

For men, available styles include the classic Gucci GG1000/S full-rimmed acetate frame and the GG 1856/S ultra-sleek wrap frame.

Radiation resistant glasses never looked so good.

Women’s Radiation Resistant Glasses

Gucci GG 3547/S

The Gucci GG 3547/S (shown above) frames are made of lightweight, durable blended nylon for added comfort and flexibility. Unlike the brittle nylon eyeglass frames of the late 1940s, blended nylon frames are more resistant to breakage and are inherently stronger than their predecessor. Consequently, blended nylon frames are ideal for those looking for a high-quality, durable, and resilient frame.

The round shape of these frames subtly draws attention to the eyes and are well-suited for those with diamond-shaped faces. The ‘simultaneous contrast’ of the red and green temples, juxtaposing complementary colors, creates a stunning visual effect. The decorative, high-set temples are emblazoned with the iconic Gucci label (white lettering) on a bold red background. For those who have been seeking a distinctive and sophisticated pair of radiation resistant glasses, your journey finally may be nearing its end.

 

Gucci GG 3574/S

The epitome of Italian luxury, the Gucci GG 3574/S rectangular frame is bold and distinctive. The hypoallergenic black optyl frame is specially coated to resist sweat and cosmetics. These Gucci radiation resistant glasses seamlessly blend fashion, elegance, and sophistication into an integral piece of personal radiation protective equipment. A trendy frame for those who are unwilling to sacrifice style but understand the importance of properly protecting their eyes from the harmful effects of ionizing radiation.

Have you been searching for radiation eye protection that is functional, yet fashionable?

Your search is over.

These Gucci radiation resistant frames are the answer.

Offering the industry standard 0.75mm lead equivalency, the SCHOTT radiation resistant safety glass lenses will protect your eyes from the harmful effects of ionizing radiation.

According to the IAEA (International Atomic Energy Agency), “Many years or decades could pass before radiation-induced eye lens injuries become apparent. At relatively high exposures of a few Gy* , lens opacities may occur after many years¹.”

Ensure that your eyes are properly protected by wearing the appropriate radiation resistant glasses. In a 2010 study, Comparing Strategies For Operator Eye Protection In The Interventional Radiography Suite, “The use of leaded glasses alone reduced the lens dose rate by a factor of 5 to 10.” Reduce your risk of developing cataracts, while staying fashionable and safe with Gucci radiation resistant glasses.

Sources:

Thornton RH, Dauer LT, Altamirano JP, Alvardo KJ, St Germain J, Solomon SB. (2010) Comparing Strategies For Operator Eye Protection In The Interventional Radiography Suite.

//www.ncbi.nlm.nih.gov/pubmed/20920841

IAEA | Radiation Protection of Patients (RPOP) Radiation and cataract: Staff protection

//rpop.iaea.org/RPOP/RPoP/Content/InformationFor/HealthProfessionals/6_OtherClinicalSpecialities/radiation-cataract/Radiation-and_cataract.htm

Gray (Unit)

Wiki: //en.wikipedia.org/wiki/Gray_(unit)

*Gy = Gray, is a derived unit of ionizing radiation dose in the International System of Units (SI). It is a measure of the absorbed dose and is defined and is defined as the absorption of one joule of radiation energy by one kilogram of matter (0.01 Gy is equivalent to 1 rad).

What Is ALARA?

What is ALARA?

As Low As Reasonably Achievable (ALARA) is a buzzword commonly used in medical disciplines utilizing ionizing radiation for the diagnosis and treatment of disease. It is a phrase that should be considered whenever a patient, healthcare professional or a physician is in a situation where they might be exposed to radiation.  However, what does ALARA really mean in this context, where does it come from, and why is it used?  These questions will be addressed in this article from FluoroSafety and Universal Medical.

It’s all based on the LNT model

The linear-no-threshold (LNT) dose-response model describes the risk of stochastic effects following exposure to ionizing radiation, as a function of dose.  This model is based on available scientific data* from large exposed populations, such as Japanese atomic bomb survivors and is widely accepted by regulatory agencies and governments.  If the LNT model is correct, risk increases linearly with radiation dose, and there is no safe amount of radiation exposure where the increased risk is zero.  Because LNT suggests that there is no safe radiation dose, this motivates us to keep both our radiation dose, and the radiation dose that our patients receive very low.   More details on the LNT are available in the Advanced Training Program from FluoroSafety.

What is reasonable?

The use of ionizing radiation is necessary in many medical disciplines and while the LNT tells us that there is no safe level of radiation, we also understand that there are many cases where radiation must be used.  For example, before X-rays and CT scans, exploratory surgery was often utilized to diagnose unknown medical conditions.  Certainly, no patient would choose to receive exploratory surgery instead of a CT scan because they were concerned about radiation risk!  These risks must be put into perspective and the benefit weighed against the risk—for both patients and medical professionals who work around radiation.

For patients, the benefit of medical exposure to diagnose and treat disease is clear.  However, just because the patient receives a well-defined benefit, does not mean that radiation can be used indiscriminately.  The smallest amount of radiation that will allow the physician to diagnose or treat the suspected condition should be used—in other words, doses should be kept ALARA.  ALARA in diagnostic imaging may be as simple as using the lowest possible CT, X-ray or fluoroscopic technique factors.  It may also include protection devices such as lead aprons or gonadal shields to protect organs that do not need to be imaged.   Newer protection devices such as bismuth breast and eye shields can be useful for certain CT exams and can reduce dose to these sensitive tissues.

In occupationally exposed individuals, the benefit is entirely that of gainful employment.  There is no potential health benefit like there is for a patient receiving a chest X-ray to diagnose disease; therefore, risk/benefit must be adjusted accordingly.  The federal government strictly enforces dose limits for the occupationally exposed to protect this population which does not receive a well-defined benefit for their radiation exposure.  In practice, very few occupationally exposed individuals approach the federal dose limits, primarily due to their job function.  A CT technologist for instance, leaves the scanner room prior to starting the scan.  Lead shielding in the walls keeps the technologist’s dose ALARA.

However, technologists, nurses and physicians involved in fluoroscopic procedures often do not have the luxury of leaving the examination room while X-rays are being produced.  For these individuals, doses may be maintained ALARA by following the three cardinal rules of radiation protection, which are also discussed in detail in the Advanced Training Program from FluoroSafety.

Time, Distance and Shielding

In fluoroscopic procedures, occupational dose is proportional to the amount of time spent in the room when X-rays are being produced.  Staff dose can be reduced by keeping non-essential personnel out or by stepping outside when performing digital acquisition imaging or rotational CT angiography.  Power injectors are necessary in these cases and allow for both a reduction in staff dose as well is improved vascular contrast.

Another key component of keeping occupational doses ALARA is distance.   Often times the scattered radiation coming from a patient in a fluoroscopic, CT or X-ray procedure can be approximated as a point source; to this end the inverse square law applies.  Therefore, if one doubles their distance away from the source of radiation, the dose to that individual is decreased by a factor of four.  In fluoroscopy or CT procedures, it is often the case that taking one step back away from the patient will cut your dose in half.  Ancillary personnel who do not need to be near the patient can minimize their dose by maximizing their distance.

The final way to maintain doses ALARA is to use shielding whenever possible.  Personnel protective equipment consisting of lead or lead-free garments an integral component of proper radiation safety practice when working near fluoroscopy, CT or X-ray procedures.  Individuals in the room during fluoroscopy procedures should also wear protective thyroid collars and lead glasses to protect these sensitive organs.  For interventional fluoroscopy procedures, some operators find that sterile radiation reduction drapes can decrease their exposure to radiation.  Rolling and hanging glass shields provide superior protection compared to radiation reduction garments and should always be worn when commensurate with the goals of the procedure.

About the Author: 

Alexander S. Pasciak, PhD, DABR
Co-Founder, Fluoroscopic Safety, LLC
www.FluoroSafety.com
 
 Dr. Alexander Pasciak earned his B.S. in electrical engineering from the University of Washington and his M.Sc. in health physics and Ph.D. in nuclear engineering from Texas A&M University. Dr. Pasciak completed a two-year diagnostic medical physics residency program at MD Anderson Cancer Center in 2009.  For the past five years, Dr. Pasciak has worked as Diagnostic Medical Physicist at the University of Tennessee in Knoxville where he carries the rank of Associate Professor of Radiology.
 

Sources: 

*National Research Council. Health risks from exposure to low levels of ionizing radiation: BEIR VII—Phase 2. National Academies Press; Washington, DC: 2005.

 

3 Different Types Of Prescription Lead Glasses

For those who wear corrective lenses and need to protect their eyes from radiation, we offer three different prescription lens types for our lead glasses. After reading this post you will understand the different types of prescription lens types that we offer, eyeglass prescription terminology, and what prescription information is needed to properly place your order.

Before placing your order, it is important for you to understand the differences between the various corrective lenses before making your decision. Lead glasses provide you with the necessary eye protection to help reduce your risk of developing cataracts from prolonged exposure to ionizing radiation. In the past, those who wore corrective lenses would often be required to wear bulky radiation safety goggles or fit over lead glasses. However, a number of the lead glasses that we now offer are available with various types of prescription lens.

Prescription lens types:

  • Single vision prescription lenses
  • Lined bifocal prescription lenses
  • Progressive bifocal lenses

Single Vision

Single vision prescription lenses have the same magnification throughout and correct for only one distance. These lenses are designed to correct conditions such as myopia (nearsightedness¹), hyperopia (farsightedness), and astigmatism². Our single vision prescription radiation safety lenses offer the industry standard 0.75mm lead equivalency and are manufactured using SCHOTT SF-6 HT radiation resistant glass.

How do I know if I have a single vision prescription?

To illustrate, an example of a single vision prescription is shown below. While reviewing the sample prescription, you may notice several abbreviations, listed below are common terms found on eyeglass prescriptions. If your prescription doesn’t have any values or abbreviations in the ADD column, you have a single vision prescription.

 Single Vision Prescription Lenses
RxSPHERICALCYLINDRICALAXIS
O.D.-2.00-0.5040
O.S.-1.75
Pupillary Distance65

Prescription Abbreviations & Terminology 

  • OD – Oculus Dexter, from the Latin word dexter meaning “right”, means the right eye.
  • OS – Oculus Sinister, sinister which is derived from the Latin word sinistra meaning “left hand”, means the left eye.
  • SPH – Spherical, is the main strength of the lens prescription, and is written in 0.25 increments. It is also referred to as power and is abbreviated as PWR.
  • CYL – Cylinder, this will only appear on your prescription if you have an astigmatism, and is written in 0.25 increments. It is possible that this will only apply to one eye. If you don’t have an astigmatism, your doctor may leave this field blank, or they may choose to put ‘00’, ‘DS’, SPH’, or ‘Plano’ in this field. If the field has one of those abbreviations you will know that you don’t have an astigmatism correction in one or both eyes.
  • AX – Axis can be abbreviated as AX, or simply X. If the cylinder field is left blank or has any of the following abbreviations including ‘00’, ‘DS’, SPH’, or ‘Plano’, this field will be left blank or have an ‘0’.
  • PD – Pupillary distance or interpupillary distance (IPD) is the distance (industry standard is in millimeters) between your right pupil and left pupil. The PD is usually written in the lower row labeled P.D. on your prescription.

Single-Vision Pupillary Distance

  • Binocular P.D. – 65
  • Monocular P.D. – 30/30.5  (OS/OD)

Bifocal/Progressive Pupillary Distance Binocular

  • Near/Reading P.D. – 62
  • Distance P.D. – 65

The American Optometric Association states that Astigmatism is a vision condition that causes blurred vision due either to the irregular shape of the cornea, the clear front cover of the eye, or in other cases the curvature of the lens inside the eye. Astigmatism is a particularly common vision condition.

Lined Bifocal

Bifocal prescriptions are for patients who have difficulty seeing both far and near. They are commonly prescribed to individuals with presbyopia who also require a correction for myopia, hyperopia, and/or astigmatism. As their name suggests, lined bifocals offer distance correction on the upper portion of the lens, and near vision correction on the bottom portion of the lens. Lined bifocal lenses, provide two distinct optical powers with different focal lengths – one for distant vision and one for near vision. The near vision lens has a semicircle (bottom) that measures 28mm wide and has a flat-top (top). Traditional lined bifocal lenses are separated by a visible line.

Progressive Bifocal

Progressive bifocals, or simply progressive lenses, allow you to experience bifocal vision without the traditional bifocal lines. Progressive lenses provide you with a more natural way of seeing. Presbyopia³ is a common vision condition for those over the age of 40 where the eye has difficulty focusing on near-field objects. Individuals who have worn traditional bifocals in the past may have experienced “image jump”, this occurs when there is an abrupt break from distance to near-field vision. Progressive bifocal lenses provide  you with optimum vision and a seamless progression of lens strength.

How do I know if I have a bifocal prescription?

If you notice that there are numbers in the ADD column of your prescription, you have a bifocal prescription.

 Lined Bifocal/Progressive Bifocal Prescription Lenses
RxSPHERICALCYLINDRICALAXISADD
O.D.-2.00-0.5040+1.75
O.S.-1.75+2.00 PAL
Pupillary Distance65

ADD – ADD is the value commonly used for bifocal or progressive lenses. ADD indicates how much power is added to the distance prescription to create the reading-only prescription. ADD corrections will usually have the same value for both eyes. The abbreviation PAL may appear next to one of the numbers in the ADD field, or it may be written elsewhere on your prescription, this indicates that your doctor determined that you will need a different ADD correction for progressive lenses.

PAL– Progressive additive lens (ADD value specifically for progressive bifocal lenses).

Ordering Information

We hope that this post has provided you with helpful information that you will assist you during your research. To review, we covered the different types of prescription lead glasses that we offer, common terminology and abbreviations found on your prescription, and what prescription information we need to properly place your prescription lead glasses order. When ordering, please fax or email your prescription (Rx) including your pupillary distance (PD). For your convenience, prescription information can also be noted in the “Order Comments/Special Instructions” section under “Payment Information” while checking out.

Please note: Lens enhancements options are not available in combination with prescription lenses. 

Questions? Comments?

If you have any questions regarding the different types of prescription lead glasses that we offer, please feel free to contact us via live chat or simply leave a comment below.

Sources:

American Optometric Association – Eye & Vision Problems

 

How Do I Order Prescription Lead Glasses?

Question: How Do I Order Prescription Lead Glasses?

This is a frequently asked question that we receive from our new and existing customers. This post will walk you through the necessary steps to ensure that your order is processed in a timely manner. It is our goal to make your experience as painless as possible.

We currently offer over 75 different styles of lead glasses available with different types of enhancements. There are three prescription lens types available, including single vision, lined bifocal, and progressive bifocal (progressive lenses). Please note that the availability of Rx lenses will vary by frame type.

Step 1 – Find your pair of lead glasses

Step 2 – Determine prescription type

  • Single vision
  • Lined bifocal
  • Progressive bifocal (no-lines)

Step 3 – Choose Your Lens Style

Please note that options will vary by frame style and manufacturer. Due to the custom nature of prescription lead glasses they cannot be returned.

  • Standard
  • Anti-reflective (not available with prescription lens)
  • Fog free (not available with prescription lens)
  • Single vision Rx
  • Lined Bifocal Rx
  • Progressive bifocal Rx

Pricing adjusts in real-time as you add enhancements to the frames. The single vision, lined bifocal, and progressive bifocal prescription radiation safety lenses all offer the industry standard 0.75mm lead equivalency and are manufactured using SCHOTT SF-6 HT radiation resistant glass.

Step 4 – Choose frame color

Please note that color options will vary by frame style and manufacturer

Step 5 (Optional) – Add frame imprint text

  • Frames will be laser engraved
  • Imprint limit is 35 characters (may vary by model)
  • Engraved glasses are non-returnable

 Step 6 – Select desired quantity and click “add to cart”

Step 7 – Review your order

  • Review your order for accuracy

 

Step 8Proceed to checkout

  • Returning customers can sign in for faster checkout
  • New customers can create a personal account (Benefits of registering: quick checkout on future orders, easy order tracking, and special offers)

Step 9 – Enter billing and shipping information

  • Enter your billing information
  • Enter your shipping information
  • Choose your shipping method (Selecting Next Day or 2nd Day Air will only change the shipping transit time, as prescription lenses are made to order)
  • Enter payment information

Step 10 – Add Prescription Information

Please note that the manufacturer will contact us if they have any additional questions regarding the prescription after their initial review to ensure accuracy.

  • Add prescription information in the “Order Comments/Special Instructions” box
  • Include OD/OS values from prescription
  • Include Pupillary Distance (PD)
  • Prescriptions can be faxed to 1-800-535-6229
  • Prescriptions can be emailed to order@universalmedicalinc.com

Ordering Information

Prescription lead glasses normally take at least two weeks to produce (may vary depending on item availability). If you need prescription lenses before a certain date contact, please customer service for specific information regarding frame availability and production time. As mentioned above, selecting priority shipping will only expedite the transit time of the package. Since the prescription lenses are made for your unique eye prescription, production times will vary. In an upcoming post, we will discuss the different prescription lens types that we offer in more detail. If you’re curious as to how prescription lead glasses are made, you’ll want to make sure and check out our video.

Questions? Comments? 

Not sure what type of frame is right for you? Many of our lead glasses have product demonstration videos to help you find the right style. If you have any additional questions, please feel free to contact us or leave a comment in the box below.

Whiteboard Wednesday: Surgeon Cooling Systems

How Do Surgeons Stay Cool In The Operating Room?

Today on Whiteboard Wednesday we talk about how surgeons stay cool in the operating room. A major concern for medical staff working in the OR is fatigue caused by overheating.  Overheating is caused by the multiple layers surgeons and staff must wear for protection. During certain procedures the surgeon’s body heat is intensified, the CoolVest can help keep the surgeon more comfortable and alert.

What Is A Surgeon Cooling System?

The CoolVest System is a unique and innovative personal cooling system that is designed to keep surgeons cool and focused while performing surgery. The Single-Surgeon CoolVest System allows you to regulate your personal comfort so that you won’t perspire, suffer fatigue or lose concentration. The surgeon cooling system includes a lightweight vest that is constructed of hospital-grade ventilated nylon for maximum cooling, a variable flow control with quick-dry disconnect, wheeled cart with handle for convenient portability, and a UL listed cooler with variable flow 110V pump.

How Does The Surgeon Cooling System Work?  

The CoolVest is worn over scrubs and under surgical gowns. The tubing connection is located at the lower back of the garment to help keep the water supply tubing from interfering with the sterile field. Cooling tubes are located in the front and back of the garment for maximum cooling. The patented, thin-walled, non-kink tubing has been specifically designed for use under lead aprons.

Setup

  1. To begin, the cooling unit is filled with a mixture of approximately one gallon of water and ice (preferably block ice) or cube ice to the top of the unit.
  2. After the unit has been properly filled, you will want to attach the 8 foot insulated supply hose (quick disconnect) to the CoolVest.
  3. Apply the protective hose cover and then attach the other end of the insulated supply hose to the cooling unit.
  4. Listen for an audible click from both quick disconnect hose connections to ensure that they are properly connected.

Operation

  1. Once the supply hose has been properly protected and connected, you will want to plug the cooling unit’s electrical adapter into a grounded 110V outlet.
  2. Turn the unit on using the green On/Off power switch.
  3. Allow the unit to cycle until L.E.D indicator on Speed Control is activated (30 second pump start delay).
  4. Press “Ice Cube” on the Speed Control display on the lid of the system to start unit at desired level. L.E.D. on display will light from left to right for increased water flow. (e.g. 20-40-60-80-100% levels)
  5. To increase flow rate, press the “Ice Cube” button again, as needed, to adjust to the desired flow rate.
  6. To reset Speed Control setting: press “Ice Cube” until the surgeon cooling system stops; restart by pressing “Ice Cube” again until correct setting is indicated.

Relief From Heat While Performing Surgery

Surgeons have been impacted by excessive heat surrounding their bodies due to stress and other environmental factors. For example, neurosurgeons are required to wear appropriate radiation protective shielding (lead aprons, thyroid collars, lead glasses) while using imaging technology to protect them from the harmful effects of ionizing radiation. The use of these protective garments in addition to scrubs and surgical gowns can significantly increase the surgeon’s body temperature during surgical procedures. The increase in temperature can result in the surgeon becoming fatigued and perspiring during long surgeries which can reduce their focus and attention, resulting in a decrease in their ability to perform their tasks at the desired level.

Share Your Experiences

Have you experienced an increase in your body temperature while performing complicated surgeries? Interested in learning more? Make sure to check out our post on the Active Cooling Vest System For Surgeons In The OR!