Tips on reducing MRSA and other healthcare-associated infections (HAIs)

Radiology departments are central hubs within hospitals, serving both infected and non-infected patients. This high traffic, combined with shared equipment and close patient contact, makes them potential hotspots for HAIs. Among the most concerning pathogens is methicillin-resistant Staphylococcus aureus (MRSA), which has been linked to increased mortality, prolonged hospital stays, and billions in excess healthcare costs. This whitepaper summarizes the risks of HAIs in radiology, highlights their relevance to surfaces and patient positioning devices, and provides practical measures for reducing infection transmission – pointing towards hygienic innovations that can substantially improve safety.

Contents

BACKGROUND – MRSA AND HAIs

RELEVANCE TO RADIOLOGY AND PATIENT POSITIONING

GUIDELINES FOR PREVENTING MRSA AND HAI IN RADIOLOGY

THE ISSUE OF WEAR AND TEAR

IMMOBILIZATION STRAPS USING VELCRO

HARD-TO-REACH SURFACES

CONCLUSION

SOURCES

BACKGROUND – MRSA AND HAIs

HAIs, also known as nosocomial or hospital-acquired infections, are transmissible diseases that appear at least 48 hours after hospital admission, within 3 days after discharge, or up to 30 days following medical treatment. Such infections can occur in any healthcare environment, including long-term care facilities, outpatient clinics, or during personal care (Alamer et al., 2022, p. 1). HAIs are among the most common complications of modern healthcare, affecting 5.9% of patients in Europe. In intensive care units, a concerning 19.2% had at least one HAI (Suetens et al., 2018).

MRSA is a multidrug-resistant organism that has spread worldwide, with prevalence ranging from below 1% in northern Europe to over 50% in parts of southern and eastern Europe (Palmqvist et al., 2019, p. 255). It is transmitted through direct contact, healthcare staff hands, or contaminated surfaces (Zhang & Burbridge, 2011, p. 1156). Despite some success in reducing bloodstream infections, antimicrobial resistance overall remains a major threat, causing more than 35,000 deaths annually in the EU/EEA (ECDC, 2024, p. 2).

RELEVANCE TO RADIOLOGY AND PATIENT POSITIONING

Radiology has evolved from a purely diagnostic service to a central, high-contact discipline with increasing interventional procedures. Imaging hubs handle millions of CT and MRI scans annually, often on patients who are immunocompromised, colonized, or acutely ill. As a result, radiology has been identified as a “high-risk area” for HAIs (Alamer et al., 2022, p. 2). Possible sources of contamination include:

• Hands – contaminated hands can transfer pathogens between persons and to surfaces and devices (Ilyas et al., 2019, p. 599)
• Imaging bed, immobilization straps – often overlooked during standard cleaning but frequently touched by patients (Ilyas et al., 2019, p. 600)
• Lead aprons, adhesive markers – have shown to be reservoirs for infection (Amer, 2021)
• Keyboards, chairs, headphones, alarm control/buzzer – a Swedish study found the most bacteria on these surfaces (Palmqvist et al., 2019)
• Side of the examination table – especially high concentrations of bacteria have been found here (Palmqvist et al., 2019, p. 256)
  

The challenge is compounded by increasing patient throughput, time pressure, and the immovability of imaging equipment, making strict adherence to hygiene protocols essential. Studies consistently highlight contamination risks in CT and MRI suites, where surfaces, coils, straps, and patient positioning devices can harbor pathogens (Ilyas et al., 2019). While routine disinfection can reduce microbial load, surface design and material properties often determine whether cleaning is effective (Amer, 2021; Hubble et al., 2016).

GUIDELINES FOR PREVENTING MRSA AND HAI IN RADIOLOGY

To prevent the spread of multidrug-resistant bacteria, it is essential that radiology departments take hygiene issues more seriously. These eleven steps provide an accurate and useful guide. While conceived against MRSA, the measures suit other HAIs as well (P. A. Rothschild, 2008):

1. Have a written infectious control policy to include MRI cleaning procedures as well as the cleaning schedule and have it posted throughout the center.
2. Implement a mandatory hand washing / hand disinfection procedure between patient exams for radiology staff and any others who come into contact with patients.
3. Clean the MRI tables, inside the bore of the magnet and any other items that come into contact with a patient. Infection control experts recommend this to be done between each patient.
4. Clean all pads and positioners with an approved disinfectant. Infection control experts recommend cleaning after each patient.
5. Periodically inspect the pads with a magnifying glass, particularly at the seams, to identify fraying or tearing. If present the pads should be replaced.
6. Regularly check all padding material with an ultraviolet (black) light and make sure that any biological material detected on the pads can be removed.
7. Replace damaged or contaminated pads with new pads incorporating permanent antimicrobial agents.
8. Use pillows with a waterproof covering that is designed to be surface wiped. Replace pillows when their barrier is compromised.
9. Promptly remove body fluids, and then surface disinfect all contaminated areas.
10. If a patient has an open wound or any history of MRSA or other infection:
    1. 1. Gloves and gowns should be worn by all staff coming in contact with the patient.
       2. Set aside more time for infected patients to assure there is enough time to thoroughly clean all the pads and the MRI table before the next patient is scanned.
11. All furniture should be periodically cleaned. Ideal surfaces are those that are waterproof and wipeable. Infection control experts recommend cleaning after each patient.

The Healthcare Infection Society (HIS) and the Infection Prevention Society (IPS) provide extensive guidelines for all healthcare facilities – they can be found under https://doi.org/10.1016/j.jhin.2021.09.022 (Coia et al., 2021). With regards to surfaces, recommendation 13.1 specifies to clean and disinfect shared pieces of equipment after each use, and according to specified protocol. With radiology equipment being among the most-shared equipment in healthcare, local protocol should be strictly followed. This has to be provided by the supplier of the equipment and will look approximately like this one by the company Pearl Technology.

THE ISSUE OF WEAR AND TEAR

Specifically, patient positioning devices are exposed to repeated use, constant cleaning, and the stress of heavy mechanical loads. This was especially pressing during the Covid-19 pandemic, when disinfection requirements were increased. Over time, many of these aids – particularly those made with conventional foam cores – develop cracks or tears in their surface coverings. Once the outer layer is damaged, porous inner materials are exposed. Besides the visual imperfection this represents a significant hygiene risk.

Figure 1: The coating on sponges quickly gets worn out, revealing porous foam

Porous materials provide an ideal environment for microbial growth. Oie et al. (2005) demonstrated that porous surfaces retain microorganisms even after standard cleaning procedures, making them a persistent source of contamination. In clinical practice, this means that positioning aids with torn coverings can become silent reservoirs for bacteria such as Staphylococcus aureus, including MRSA strains, and other healthcare-associated pathogens (Oie et al., 2005).

The magnitude of this problem is underscored by Hubble (2016), who found that 10 of 11 objects with porous surfaces in a radiology setting harbored an unacceptable number of bacteria. The authors concluded clearly: “These coverings should be removed immediately.” Such findings illustrate why continued use of damaged positioning devices directly undermines infection prevention measures in imaging departments (Hubble et al., 2016).

Video 1: Porous Materials like broken positioning wedges provide an ideal environment for pathogens (Video: Rothschild)

Rothschild (2008) highlighted that once the outer layer of positioning devices becomes cracked or porous, the exposed foam cannot be effectively disinfected. Such surfaces encourage biofilm formation and act as long-term reservoirs for bacteria. Given the high throughput in radiology departments and the vulnerability of many patients, this poses a serious risk of cross-contamination. Rothschild therefore argued for selecting materials that are resistant to wear and repeated disinfection (P. Rothschild, 2008). This aligns with the standards of the German Robert Koch Institute (RKI), which emphasize that materials in patient care must be resistant to mechanical stress (friction, cracks) as well as to the repeated application of disinfectants. Where coverings fail, areas that cannot be safely disinfected emerge, in which dirt and pathogens accumulate (Robert Koch Institut, 2022, p. 1099).

Figure 1: Positioning Wedges by the company Pearl Technology

Products by the company Pearl Technology are designed to eliminate this risk. By using durable, tear-resistant PU foil coverings, the positioning aids withstand both mechanical stress and chemical exposure. The foil has been engineered to remain intact under repeated use of disinfectants, even with alcohol concentrations up to 90% (Pearl Technology AG, 2025). This ensures that surfaces stay closed, smooth, and fully disinfectable – critical properties that guarantee long-term hygiene safety and compliance with RKI requirements (Robert Koch Institut, 2022). The material has grown in popularity especially during the pandemic, since it allowed radiology professionals to pass hygiene requirements.

Figure 2: Positioning wedges using tear-resistant PU foil (Product: ProFoam Wedge)

In summary, the exposure of porous materials in worn positioning devices is a well-documented infection risk. Evidence strongly supports replacing or avoiding such devices altogether. By investing in robust, PU-foil–covered positioning aids, radiology departments not only extend the lifespan of their equipment but also take an active step toward reducing infection transmission and safeguarding patient safety.

Figure 3: Cushions using smooth, tear-resistant PU-Foil stay hygienic for substantially longer (Product: PearlFit Cushions)

IMMOBILIZATION STRAPS USING VELCRO

Hubble (2016) highlights that immobilization straps and imaging bed pads often rely on hook-and-loop fasteners such as Velcro, which are characteristically difficult to disinfect thoroughly and can therefore harbor microbial contamination in radiology settings (Hubble et al., 2016). This is a serious concern because, as Ilyas et al. (2019) mention, immobilization straps themselves are potential infectious agents within the radiology department. Their frequent contact with patients and staff hands, combined with porous or fabric components, increases the likelihood of them serving as vectors for HAIs (Ilyas et al., 2019).

Figure 4: Immobilization straps are often left to be dirty

To address these challenges, the ProBelt patient positioning strap has been developed to avoid the use of Velcro, and even of fabric. By eliminating hook-and-loop fasteners, its design allows to reduce microbial retention and make routine cleaning in radiology environments more straightforward. Furthermore, the ProBelt system is made of a hard-wearing PU foil which allows cleaning even with 90% ethanol disinfection. Unlike conventional positioning aids, the surface of the material will not become brittle or porous, even at a high concentration of ethanol. Clinical feedback supports its hygienic efficacy. For instance, radiology leadership at DBK‑Neubrandenburg reported that, when using commercially available disinfectants, ProBelt allowed hygienically perfect and immediate reuse and effectively solved the hygiene problem associated with conventional fabric straps.

Figure 5: Immobilization straps using PU-buttons instead of Velcro are more easily kept clean (Product: ProBelt Straps)

HARD-TO-REACH SURFACES

Varying degrees of difficulty are associated with proper disinfection of imaging equipment, particularly because many systems have numerous crevices and openings that are hard to reach with manual cleaning. These areas can go uncleaned for long periods, becoming reservoirs for microorganisms and potential sources of infection for patients. Compounding this issue, disinfection is often carried out by external housekeeping staff who may not be familiar with the sensitive design of imaging equipment, which can reduce cleaning effectiveness (Hubble et al., 2016).

Figure 6: When a spill occurs, it is difficult to clean without a delay in patient throughput

Empirical evidence further highlights the risks. Palmqvist et al. (2019) found elevated bacterial contamination in CT and MRI examination rooms, with the highest colony counts reaching 20 CFU/cm² on the side of an examination table – well above the reasonable threshold. Concerningly, contamination can accumulate in patient-contact areas despite standard cleaning procedures (Palmqvist et al., 2019).

Specialized protective solutions can help address these vulnerabilities. For example, the CT Table Cover creates a hygienic barrier: its side flaps prevent patient contact with the table surface while blocking liquids, dust, and dirt from entering the table’s crevices.

Figure 7: Easy-to-clean table covers protect the table side and crevices from accumulating contaminants (Product: CT Table Cover)

Similarly, the CT Gantry Cover has been developed to address an area that is typically neglected in routine cleaning due to its inaccessibility. Since it can be quickly replaced after a messy examination, it saves valuable turnaround time while ensuring a hygienic surface, where otherwise manual disinfection would be challenging in the gantry’s intricate structures.

Figure 8: In case of a spill, the gantry cover can simply be exchanged before the next patient (Product: CT Gantry Cover)

CONCLUSION

Radiology departments face unique challenges in infection control due to their central role, high patient turnover, and equipment complexity. MRSA and other HAIs pose serious risks, with contaminated surfaces and worn positioning devices acting as hidden reservoirs. Effective hygiene requires both strict protocols and equipment designed to be disinfected reliably. Investing in hygienic patient positioning solutions is not only a compliance measure – it is a safeguard for patients, staff, and hospital reputation.

Sources

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Amer, F. (2021). Infection Prevention and Control in the Radiology Department/Service - ISID. ISID. https://isid.org/guide/hospital/infection-prevention-and-control-in-the-radiology-department-service/

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