While in New Orleans last month for the 2026 AORN Global Surgical Conference and Expo, I attended a session called, “Is It Really Clean? ATP (Adenosine Triphosphate) Contamination Monitoring.” The discussion got into the nitty gritty of rapid measurement of cleanliness: what ATP testing is, where it is used inside a hospital, and the surfaces that fail testing most consistently. The real gem of the presentation was the list of examples. The speaker had tested scopes, door handles, toilet flushers, a lot of stuff. So I asked, “Have you ever ATP-tested a lead apron?”

“No?” was the sheepish answer.

I wasn’t surprised. In my 10 years of running a lead apron service company, that’s normally the answer I hear. Radiology directors, operating room managers, infection preventionists, and, now in a conference room in the Big Easy, a researcher who tests for contamination for a living, all have admitted they largely ignore the personal protective equipment (PPE) that drapes across clinicians and patients.

This deficit comes despite clear data showing the infection risk lead aprons present. Here is a short review of some of the literature:

• Researchers at Wayne State tested 25 interventional radiology aprons and found 84 percent positive for S. aureus, and 12 percent carried MRSA outright.
• Researchers at the University of Messina sampled 88 garments across surgical departments and found 80.7 percent bacterial contamination. Meanwhile, only two-thirds of the surveyed departments had any cleaning protocol at all on the books.
• A 2019 study at Allegheny General detected bacteria on 80 percent of OR apron swabs. They watched 80 percent of contamination recur within six hours of a disinfectant wipe-down.

The data is shocking, but makes perfect sense when you think about it. Lead aprons regularly collect blood, bodily fluid, skin flora, sweat, makeup, splatter, and surgical debris. A surface wipe just is not enough, and the literature has said so for decades.

This conclusion should not have been breaking news, especially at AORN. That’s because, in 2017, AORN published a survey of 173 health care workers showing:

• 78 percent had worn visibly soiled X-ray aprons or thyroid shields.
• 48 percent had never spot-cleaned the garment’s core material.
• 21.4 percent reported their aprons had never undergone any departmental cleaning at all.
• Only 15 percent worked at facilities with a written policy on the topic.

AORN’s research is incredibly compelling and concerning, but you wouldn’t be able to tell from the conversations my colleagues and I had at our booth in New Orleans. Sterile processing professionals stopped by, looked at the photos we were running on a loop, and nearly unanimously remarked that they had never thought of lead aprons as potential infection vectors.

Once we went into the data, the people we talked to wanted to know more, and more. An AORN staff member spent 20 minutes with me reviewing the 2017 journal article alongside images. Her response? “This is eye-opening.”

It should be, and the awakening should be a call to action to address the structural problems that have left lead apron cleaning overlooked. In most hospitals, lead aprons sit on the wrong side of an organizational fence, falling outside the scheduled workflows that handle every other reusable item in the operating room. As a result, this vital piece of PPE often ends up sitting in closets or in hallways between procedures rather than being cleaned and properly stored.

There is another problem too. Surgical volume has been migrating to ambulatory settings for the better part of two decades, and the lead aprons used to shield staff and patients during fluoroscopy-guided cases are migrating with it. Outpatient centers are subject to infection control requirements, but may have fewer dedicated resources than a hospital, particularly when it comes to logistics concerning staffing and designated decontamination space.

After a week on the floor in New Orleans, what sits with me is the consistency of the reaction I saw, from the presenter, from hospital execs, from sterile processing professionals, from the senior AORN staffer with whom I raised this issue. Years of literature is clear, but still the most common response when I ask about lead aprons and infection was, “I didn’t know.”

A year from now, at the 2027 AORN Conference and Expo in Philadelphia, this problem deserves a spot on the mainstage. Studies have confirmed that lead aprons are quietly carrying microorganisms, Staph aureus, MRSA, and ringworm, and AORN confirms these garments are coming into contact with patients each shift.

In the meantime, action is necessary. The perioperative profession has never waited for the program committee to define what clean means, and it should not start now. Practitioners should be pulling the garments out of closets and off the racks, looking at them honestly, and asking their infection control and sterile processing leads how they can do better.

Using wipes alone doesn’t cut it. AORN positions that you can’t disinfect a contaminated surface. 100,000 patients die every year from hospital-associated infections. It’s time to level up and develop some best practices in the name of patient and staff safety.

Justin McKay is a radiation safety expert and health care executive.