It started with a rash.
Zachary Gerdts had never been a fan of the lead-coated garments he was expected to wear during certain surgeries in his job as a sales representative for an orthopedic device company. Required to guard against radiation exposure, the garments are worn by multiple people through multiple procedures, and at many hospitals are rarely, if ever, thoroughly cleaned and sanitized.
But after Gerdts developed that rash on his neck, after wearing a lead-lined collar to protect his thyroid, he knew he had to find a way for hospitals to regularly clean and sanitize their supply of lead-lined garments such as aprons, collars and caps.
After all, he knew he could often see dirt, such as dried blood or barium splashes on the aprons. But what germs lurked that he could not see?
Three years of research led Gerdts and a colleague to develop a multistep proprietary system for cleaning and sanitizing these garments. The company they started, Radiological Care Services, now services about 40 hospitals in Indiana and nearby states.
In its first year of operation, the company cleaned about 500 pieces. The following year, their inventory soared to just under 5,000. Last year, they hit about 25,000 from about 35 different hospitals, and this year they expect to double that. Eventually they hope to expand with satellite locations elsewhere.
Their selling point to hospitals is simple: No one wants to wear dirty garments, especially heavy aprons like these that the previous wearer may have sweated through in an operating room.
“These are supposed to protect your body. But they’re so disgusting it’s hard to make yourself want to put it against your skin,” Gerdts said. “If you go to the gym and sweat through your socks, you’re not going to hand them to your friend as they enter the gym.”
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That’s basically what happens at many health care facilities. Not only do workers hand them off to each other, but patients may also be expected to wear aprons that are not as clean as they might be.
Columbus Regional Health had a process for cleaning the aprons whenever they appeared to be dirty, and made sure to clean the ones used for patients with sanitary wipes in between each use.
Still, Bill Algee, the hospital’s director of imaging services, last year decided to sign a contract with RCS to have the hospital’s 200 or so lead-lined pieces used in the operating room, catherization lab and on patients cleaned twice a year.
“You’re never really sure if you have all the germs and stuff,” Algee said. “For me as a leader … it was not can we do it; it was how can we not do it. How can we not protect our patients, our ourselves better?”
The RCS process returns garments that look cleaner, smell cleaner and even feel cleaner, Algee said.
At least one small study suggests that such garments do collect their share of germs. A study of 25 lead aprons first presented at an infectious disease conference four years ago found that 21 of them, or 84 percent, had Staph and ringworm present.
A few staffers at Franciscan Health Indianapolis contracted ringworm from dirty lead wearables before the hospital signed up with Radiological Care Services, said Rhonda Anders, director of surgical services at the hospital.
So once she heard the RCS pitch, she was sold on the service. After all, she said, the hospital had set procedures for cleaning everything else in the room, just not the lead garments.
“We realized that our staff, our nurses and surgical technologists are exposed to all kinds of ick back in the OR,” she said. “I’m just going to be blunt: If a big sweaty man has been wearing that lead standing over OR lights for a few hours, you need to clean it.”
Before RCS began cleaning Franciscan’s lead aprons quarterly, Anders would have to pull some of the lead wearables in the worst shape out of service and try to restore them to a usable form. But since the service began, none has had had a buildup of “sweat and funk” sufficient enough to require retirement, she said.
It’s bad enough that hospital staff are exposed to these germs; patients may be as well, said Justin McKay, RCS’s co-founder and vice president.
Health care experts for the past decade have been striving to decrease the number of hospital acquired infections. The numbers have gone down, but a 2016 Centers for Disease Control and Prevention report found that on any given day, one out of 25 hospital patients contracts at least one preventable infection. Cleaning bacteria-infested garments can help ensure that these do not transfer bacteria from a provider to a patient.
Radiological Care Services starts by inspecting each garment. If there are any rips or tears, an upholsterer on staff repairs those. After cleaning the garments with its proprietary process, the company employs a device used on items such as the inside of meat grinders to look for a substance known as ATP, or adenosine triphosphate, which is the energy unit of all living cells. The presence of ATP on the garment signals that living organisms, likely some species of bacteria, still lurk.
One time McKay and Gerdts tested the ATP device on a gas pump handle. A few hours later, they ran it over some lead-lined garments in a hospital. The hospital reading came back nine times higher than the one at the gas station, McKay said.
Working out of a 15,000-square-foot space just south of I-70 on the east side, RCS has a staff of about 10, six of whom do the cleaning. The cleaning itself takes about 5 minutes, but drying can take as long as 12 hours. The company offers about a 48-hour turnaround for garments and will either clean a hospital’s supply in two batches or offer loaner garments for those who have smaller supplies.
Currently the company has about 500 loaner aprons with another 250 on the way.
A contract with RCS costs a hospital about $10,000 a year. Most hospitals clean the garments quarterly with RCS and do more perfunctory cleanings themselves in between, McKay said.
A former radiological technologist and manager who worked in Lafayette and at IU Health Methodist Hospital, Becky Apodaca said she could see the benefit of using a professional service such as the one that RCS offers.
“If you’re supposed to be doing it and it’s for the health of your staff and patients, and it can be outsourced effectively, great,” said Apodaca, now with the American Society of Radiologic Technologists, who spoke from her own perspective. “If you’re wearing them, those things can get hot. … You can have internal dirt and then external dirt. If you’re in trauma room, pretty soon you have blood, guts and puke all over.”
Often when McKay visits a hospital, he receives confirmation that the service his company offers is a needed one.
A few weeks ago, he stopped in a hospital cafeteria for a bite. A radiologic technologist came in for a cup of soda and stood at the drink machine wearing a lead apron with barium, contrast and other stains splattered all over it.
McKay struck up a conversation with her and she told him she had just finished a long case and needed a beverage break. Now, she said, she was headed straight to a patient’s room, in that same sullied apron, to perform a bedside X-ray.
Call IndyStar reporter Shari Rudavsky at (317) 444-6354. Follow her on Twitter and on Facebook.