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Organizational and Nursing Management Factors Associated With Guideline‐Discordant Medical Radiation Protective Apparel Disinfection: A Multicenter Interpretable Machine Learning Study

Year: 2026

Type: article

Abstract: BACKGROUND: Effective management of Medical Radiation Protective Apparel (MRPA) is a global implementation challenge. In China, this is complicated by discordant guidance regarding MRPA disinfection, with some domestic specialty recommendations differing from manufacturer-aligned material-care guidance. AIM: To identify organizational and nursing management factors associated with guideline-discordant MRPA disinfection using an interpretable machine learning approach and to characterize their joint predictive patterns. PARTICIPANTS AND SETTINGS: A total of 123 public hospitals in two developed regions of eastern China (Shanghai and Zhejiang Province, China), including Tertiary A, Tertiary B, and Secondary A institutions. METHODS: In this cross-sectional study, a self-designed structured survey assessed MRPA management practices, with Critical Noncompliance (CNP)-a study-defined endpoint referring to reported use of alcohol- or chlorine-based disinfectants-as the primary outcome. This classification reflected discordance with manufacturer-aligned material-care recommendations rather than a formal regulatory designation. Data were analyzed using descriptive statistics and interpretable machine-learning models, with random forest selected as the final model and SHAP used for model interpretation. RESULTS: Guideline-discordant practices were common: alcohol- and chlorine-based disinfection was reported by 63.4% and 65.9% of institutions, and 67.5% used manual or partly manual traceability. Nursing personnel held 81.7% of management roles. In the independent test set, the random forest model achieved an AUROC of 0.849 (95% CI, 0.558-0.922). Random forest and SHAP identified Tertiary Grade A status, critical-area traceability, designated personnel, disinfection-personnel training, housekeeping/environmental-services execution, and third-party laundering as prominent contributors to CNP prediction. CONCLUSIONS: Guideline-discordant MRPA disinfection was associated with multiple organizational and workflow characteristics rather than a single professional role or management feature. The random forest-SHAP patterns are hypothesis-generating and identify organizational domains for prospective validation, particularly those involving guidance, training, traceability, and workflow design. IMPLICATION FOR NURSING MANAGEMENT: Nursing roles should be considered within the broader organizational systems in which responsibility, training, traceability, and workflow are structured. Future implementation studies should evaluate whether coordinated alignment of these components with evidence-based MRPA care improves guideline adherence, particularly in higher-tier hospitals.

Source: Journal of Nursing Management

DOI: 10.1155/jonm/2036458

Authors: Xing Xin, Suwen Li, Chenxin Ye, Luyin Cheng, Yuting Wu, Gendi Lu

Institutions: Shanghai University of Traditional Chinese Medicine, Shuguang Hospital

Language: English

Topic: Infection Control in Healthcare

Subfield: Infectious Diseases

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $2,700