An audit of lead aprons used in operating theatres at three academic hospitals in Johannesburg

Abstract

Background: Occupational radiation exposure to anaesthetists is increasing as a growing number of procedures requiring anaesthetic care are performed using radiological imaging. The primary modality of protection during these procedures are lead aprons. The aprons used in the three hospitals audited in this study were anecdotally thought to be in poor condition, with accompanying serious effects for the wearers. In a review of the literature no studies could be identified which measured the radiation exposure to anaesthetists in South Africa, nor to assess the adequacy of the protective garments worn in South African operating theatres. Although radiation exposure to anaesthetists has been described as low in the international literature, this assumes functional protective shielding. Objectives: The objectives of this study were to identify and describe pre-existing apron maintenance protocols, describe the apron populations in terms of demographic data (age, lead equivalence, manufacturer, design) and describe the aprons’ physical condition (cleanliness, holes, fasteners). The aprons’ internal, radiation attenuating structure was assessed by X-ray and additional radiation transmitted as a result of defects was calculated. The aprons were then assessed for adequacy in terms of national guidelines and international literature. Methods: The research design was that of a descriptive, prospective, contextual study, assessing the adequacy of lead aprons used in operating theatres at three hospitals affiliated with the University of the Witwatersrand in Johannesburg. Descriptive data was collected by the researcher. The aprons were X-rayed by qualified radiographers under standard conditions and the resulting images were assessed by a qualified radiologist. The additional radiation exposure was then calculated by the researcher using Microsoft ExcelTM 2013. At each hospital, every apron identified as being used in the main operating theatre complex was included in this study. Results: A total of 87 aprons were investigated across the three hospitals. Of these 45/87 (52%) were found to be unsafe for use in operating theatres due to inadequate lead equivalence as defined by South African law. A subset of 18/87 (21%) aprons had defects identified by X-ray severe enough to render them inadequate for use. Conclusion: The majority of aprons investigated were inadequate for use by anaesthetists in operating theatres. Insufficient quality control, poor handling by the wearers and vague government guidelines were all implicated as causative for the high failure rate.