Can you tell us about your cath lab at Silver Cross Hospital?
We try to run our procedure rooms with as much flexibility as possible. We have interventional radiologists, neuro radiologists, cardiologists, electrophysiologists, and vascular surgeons who use our labs for treating patients. I do have one dedicated room with fixed electrophysiology (EP) equipment, where we do ablations five days a week. There is also one biplane lab, which is where we do all of our neuro interventions, as well as procedures like kyphoplasty. But we try to have as much flexibility as possible; most of our staff are cross trained in the various specialties. We have a number of cardiology groups on staff and two different radiology groups. So rather than just having cardiac in one wing of the hospital and EP in another, and yet another area for IR, we have combined many different disciplines under one roof. I do like it that way, because it makes things more interesting and there is more variety, but it is harder to train staff because there is so much ground to cover.
Can you tell us about your patient prep?
Immediately adjacent to our interventional labs is what we call IPPR, Interventional Pre/Post Recovery. It is a trained group of staff that focuses on the pre and post care of our patients. Outpatients will come to our IPPR area, with a CNA that floats and supports throughout all rooms, and then the nurses split up into teams to start the day, taking care of 3 to 4 patients. Their teams will vary throughout the course of the day. We use the same approach and process for our outpatients, obviously dependent on the procedure. If we are doing a pacemaker, we are going to prep the chest. If it’s just a left heart cath, we are prepping the groin. If it is a radial, we will prep the wrist, and so on. Inpatients are prepped at the bedside in the inpatient’s unit, and sometimes my staff will have to take the prep a bit further, because we are particular about how we like it. But for our outpatients, prep is always consistent, because we have an exclusive, dedicated group that does the same work, day in and day out. Processes are hardwired and standard work is in place. We use the ClipVac™ (BD) on nearly all of our patients, especially for things like pacemakers. We tell our patients to use an antibacterial wash the night before they come in. We will use the ClipVac and prep the skin with ChloraPrep, whether it is a groin, chest, etc. We will do prep in the pre/post area, but then once the patient gets to the table and we are starting to drape, a sterile prep is done in the procedure room. We avoid shaving in the procedure rooms as much as possible, as it makes preparing a sterile field more challenging.
Are you prepping the groin if a radial is being planned?
We do, and we always have to explain to patients why we are doing that. Thankfully, we have a really low conversion rate from radial to femoral. It’s extremely rare, but we do it just in case. We’re still seeing most of our volume through the femoral artery, but we do have physicians on staff that are comfortable with all treatments via the radial artery, including atherectomy and some acute cases as well. It’s the comfort level of the physicians. We are seeing a trend upwards in radial cases, which I think is consistent with trends at community hospitals throughout the country.
Before the ClipVac was implemented, what were the issues you faced with hair removal?
One issue was the quality of the prep site. The nurses would use a Tegaderm or a sticky pad to try and remove as much hair as they could, but it was never 100% effective. Some of our physicians — and I don’t think we are unique — are really particular, so some would call me into the room, because they could see hair clippings remaining in the vicinity of where they were going to be working. We would try to clean up as best we could, but it was never very effective, so that was concern #1. Concern #2 was the quality of the prep from an infection control perspective. If we are cleaning the site, then taking sticky tape to it, there is always the concern about leaving any residual material or adhesive on that area, and we want to be mindful about infection control and mitigate that risk whenever we can. The problem was twofold, and it was on every patient.
Did you have to change sheets after clipping?
When we prep a patient in an outpatient area, they will be on a cart. We will transfer that cart into the procedure area and will put the patient on the procedural table from there, which will have a clean sheet on it. So changing sheets wasn’t an issue, but we already duplicate linen, because we are putting them from one clean sheet onto another clean sheet. It’s a customer service aspect as well.
When did you first start using the ClipVac?
We put the ClipVac (BD) in place over a year ago. Our department is laid out so that we are immediately adjacent to the operating rooms, and there are a number of shared resources between our departments and the OR. It was actually our OR nurse educator that first approached me about the ClipVac. It was something the surgical department was implementing from an infection control perspective.
Can you describe the ClipVac?
This is one of those things where you say, why didn’t I think of this? It’s simple. Picture your typical clipper. The ClipVac has a low-profile attachment that is connected via tubing to a vacuum. When activated, ClipVac will efficiently suck up any hair as it is clipped from any area of the body. It is easy to use, and is not large or obtrusive. The actual vacuum unit is smaller than a shoebox. We bring it into the room and connect it to the clippers. Training took about as long as it’s taking me to explain this to you. It has worked out well.
Is there any time difference between the original method and use of the ClipVac?
It is quicker, because there is not the cleanup afterwards. You have already removed that hair.
Is it easier for the patient?
It is more of a privacy issue for the patient. They feel less violated. There is less time spent going near the groin area, because you don’t have to clean them up as much. There is definitely a comfort and privacy benefit for the patients.
From an infection standpoint, is there less risk for infection because you are having less contact with the site?
Absolutely. The ClipVac was used in our operating rooms first, and obviously there is a strong focus on preventing infections in an operative setting, although we have that concern as well in the interventional suites. We use it on thousands of patients a year, and believe it contributes toward our efforts to reduce infection risk. Our infection and quality control people were very supportive of the ClipVac.
Was it trialed prior to use?
Yes, the OR did a trial and then they thought of us, so we did a trial as well. We brought it in for outpatients, trained the staff on how to use it, and implemented it right away with the support of a local representative that was here to help us. We did have a simulation of surface skin with hair on it, so you could train before using it on a human being, but it was pretty simple to go live. We used it on every patient for a couple of days. Groin patients going to the cath lab, chest patients needing pacemakers, things like that. The feedback from staff was really good. The basic conclusion was, how soon can we get this?
How do you get started with use of the ClipVac?
It is plug and play. There is a proprietary clipper with the unit.
BD will provide ClipVac units at no charge, so long as you are using the disposables?
Yes. We committed to a number of the disposable products, which is not an uncommon relationship — we have similar scenarios with a number of pieces of equipment.
Has ClipVac become part of your protocols?
Yes. Since we have a small group of staff, particularly in the outpatient area, ensuring compliance is simple. We have 5 or 6 nurses and one CNA, and she does the bulk of the prep, so the continuity is there. It was easy to get the ClipVac onboard, and they liked it, too, so it was one of our easier implementations.
Was there any resistance or concerns about moving away from adhesive?
No. From a patient perspective, this was seen as more respectful of the patient’s privacy and less invasive. There is less cleanup for the staff. It was a win-win.
What about maintenance?
We do a wipe down between patients. We have never had an issue with the existing unit. Our biomed department tests out every piece of equipment to make sure that it is safe, and it tested out fine.
Do you have advice for other cath labs that might consider ClipVac?
With any product, you have to look at it from a business perspective, as well as from a clinical perspective. From a business perspective, this was an additional cost for us, so we had to justify it. What you can do is give our patients a more comfortable, less invasive, and more private experience, and that is important. I know if I was a patient, I would appreciate that. We look at infection prevention and we felt that this was an improvement over our previous processes. It’s hard to put a dollar amount to something like that; thankfully, I can’t recall the last time we had an infection in our labs. I know from the operating rooms, if you put a knee implant in and have an infection, you have to take it out. The same applies in the cath lab; explanting a pacemaker because of an infected pocket creates a hugely dissatisfying, and potentially dangerous situation for the patient, and a large cost to write off for the hospital. So if you can justify the ClipVac by looking at it as risk reduction, then it makes sense financially. It was a patient satisfier and our staff like it. Yes, there was a small additional cost, but we feel it was worth it. Everyone is going to have to make those decisions unique to their own setting.
Any final thoughts?
Silver Cross Hospital is a standalone hospital; we are not part of a system, so we are a little more nimble and a little more agile when it comes to implementing new processes and protocols, as well as new equipment. We have a good crew and a good department, and have grown quite a bit. Silver Cross Hospital is a 120-year-old organization, but we moved into a brand-new hospital 5 years ago, and have seen significant volume growths since opening our new facility. In our interventional suites, we’ve seen growth in cardiac volumes, as well as growth in our advanced IR cases. We have an ambitious and independent medical staff that we’ve partnered well with to bring great care to our community. Adding efficiencies with products like the ClipVac has been instrumental in meeting the needs of our medical staff and growing volumes, while still maintaining high-quality patient care.
Brendan Casey can be contacted at email@example.com.