Assessment of hygiene practices related to radiopharmacy shielded workstations

Objective
Most of scintigraphy examinations require injection of radiopharmaceuticals (RP). RP are prepared in an automated dispenser (AD) for positon emission tomography radiotracers and in a low-energy shielded workstation (LEW) for low-energy emitters, with aseptic conditions. The aim was to assess hygiene practices of pharmacy technicians (PT) and electro-radiology technicians (ERT). This audit was part of continuous improvement of produced injectable preparations’ quality and safety.

Methods
An analysis of one-year results of surfaces and gloves’ microbiological controls highlighted critical points. An evaluation grid was drafted from this analysis and hygiene procedures in force: 25 items for PT (working only on LEW) and 45 for ERT; microbiological controls were still assessed during the audit. It was conducted by a pharmacy resident who evaluated each technician, integrated data into Excel® and analyzed results.

Results
During 3 months, 18/22 technicians were evaluated. Professionals’ clothing was consistent at 89%. However, only 17% of technicians washed their hands when entering the unit. Concerning LEW, only 18% of them carried out gloves and surfaces disinfection before starting activity, whereas non-sterile devices were correctly biodecontaminated at 82%. For daily cleaning, all steps were carried out according to existing procedures, but cleaning from the back to the front was not followed at 36%. Concerning AD, daily cleaning steps were consistent at 93%, in contrary to weekly cleaning for which only 80% of technicians cleaned the entire interior surface and 20% disinfected gloves. Finally, all professionals knew different cleaning products but their use wasn’t uniform. Microbiological controls weren’t improved (gloves: 26% non-compliance in first quarter 2019 versus 32% in first quarter 2020 and surfaces: 8.5% versus 7%).

Discussion-conclusion
As microbiological controls weren’t improved, we can think that audit didn’t affect technicians’ behavior. This assessment highlighted practices deviances and inhomogeneity, particularly on cleaning products’ use. It also allowed us to understand that hygiene procedures were too complex. Hygiene procedures were reviewed to harmonize practices. Cleaning products’ use was defined, particularly for isopropyl alcohol and detergent-disinfectant. Moreover, results showed major microbiological contamination of gloves; however they are not changed regularly. A corrective action for gloves is planned: implement an annually turn-over. Audit results presentation and new hygiene procedures information to the staff were organized for continuing professional development. Finally, pedagogic flyer on microbiological results will be shown monthly.

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