What Do You Think?

Compiled by CathLabDigest

Compiled by CathLabDigest

Answered!

Mask Wear?

We are trying to collect data from cath labs about requirements for the circulator and whether cath labs require the circulator to wear a mask during regular angiographic/interventional procedures, including pacemaker implants. Any help would be greatly appreciated.

Thank you!
Roger Sadberry
Director Cath Lab/Day Patient/GI Lab, Bakersfield Heart Hospital, Bakersfield, CA
Email: Roger.Sadberry@BakersfieldHeartHospital.com
Cc: Cathlabdigest@aol.com

Roger,
Under Joint Commission guidelines, all personnel who work in blood-borne environments such as cath labs are required to wear surgical head covers and masks to protect patients from unnecessary microorganisms. MRSA thrives in the nasal passages of healthcare professionals as well as patients.

In addition, the practice of not wearing appropriate apparel in a blood-borne environment is against CDC Standard Precautions Guidelines that were developed due to various viral diseases such as hepatitis A B, and C, HIV, AIDS, and many antibiotic-resistant bacterial microorganisms.

The Joint Commission has become adamant about NOT wearing hats and masks outside the procedural rooms unless the patient being transported is in an isolated environment. CDC precautions must be followed to reduce the high levels of infectious problems plaguing our patients in hospitals today.

In the past six months, I have lost several close friends to major antibiotic infections after they had minor and major surgical procedures. The majority of infections are being traced back to healthcare professionals (RNs, MDs, technologists), who never appropriately wash their hands under guidelines suggested by the CDC.

Infections are the reason Betadine is no longer used. The issues with Betadine occurred when so many cloned iodine-povidone cleaning solutions were being made after the patent expired on the original iodine-based compound. Most healthcare workers have never known that Betadine had to dry on the prepared areas of the skin before draping.

In addition to other issues, standard skin prepping and draping of patients for heart caths and PCIs is no longer appropriately done to lessen infectious problems.

These issues do not just occur in CCL or EP lab settings; they are occurring in our surgical suites.

I worked in a small hospital in Hawaii in early 2009. Eighty-five percent of their PPM/AICD patients developed major infections in the pockets. No one could solve the problem. The EP specialist tried everything. Nothing worked. The microorganisms causing the infections were coming out of the AC ducts next to the ceiling. The ducts ventilated the room with air blowing over the procedure table. They never checked the ducts for contaminants by culturing.

Rooms should be negatively charged if surgical procedures are done in procedural rooms. If most healthcare workers knew what was crossing the often unchanged AC/heat filters in hospitals, they would be alarmed.

Also, only one company in the United States manufactures the disposable trays we use in cath labs and EP suites in the United States. All the rest are off-shored. These trays are sterilized in the off-shored countries and shipped in cargo ships to the USA and elsewhere. Thousands of these trays are left in cargo containers on the docks where they are imported for shipment to hospitals across the USA. These cargo containers have no environmental controls whatsoever. I have seen dead insects in plastic bowls along with other debris that comes from poor QA of the facilities. I have spoken to hundreds and hundreds of peers over the years and they share the same experiences with me.

One of the worse systems used in procedural rooms today are the disposable femoral drapes, disposable surgical towels, and 4 x 4 gauze. The paper in the disposable drapes fragments with wetness. The gauze fragments. There is hair and hundreds of other types of debris in these trays. Where does this debris go? You got it. It is being instilled with flushing solutions into the circulatory systems of our patients.

As for patient care, our patients come first. Optimal patient care, optimal patient safety, and optimal continuity of patient care are the ultimate goals. We are required to not only protect the livelihood of our patients and their families, we are required to protect ourselves from their bodily contaminants so we do not pass the ever increasing “mortal-level” microorganisms to other patients who are placed on our tables after one patient is transferred off.

Have a great day.

Chuck Williams, BS, RRA, RCSA, RPA, RCIS, RT(R)(CV)(CI), CPFT, CCT, CTAE
Atlanta, GA

Suggested Reading

  1. Truscott W. Lint and particle contamination during diagnostic and interventional procedures in the cardiac catheterization lab. Cath Lab Digest 2006; 14: 10-19.  Available online at http://www.cathlabdigest.com/articles/Lint-and-Particle-Contamination-During-Diagnostic-and-Interventional-Procedures-Cardiac-Cat. Accessed February 13, 2012.

Re: Pre-labeling medication syringes

What are other labs doing in regards to pre-labeling medication syringes for emergent cases? We would like to be able to pre-label our standard medication syringes on our tables: heparin, saline syringes, lidocaine, and contrast syringes. We are being told that per the Joint Commission, it is not acceptable to pre-label any syringes in any situation.

We posted this question for Facebook readers at www.facebook.com/cathlabdigest. Here are some of the responses:

Patricia: We put lido, saline, nitro, etc., in our syringes, then label. Fill 1 syringe with lido, then put label on before we put it down on table. Fill syringe, then label. Funny that the rules have changed after all this time.

Cheryl: Same here. You can’t pre-label because you verify…draw up…or pour…then label!!

Mark: Same here. Fill syringe, then label, no pre-labeling allowed!

Barbara: No need to pre-label; label syringes as you fill them.

Roberta: Because we have to label every fluid on the table, the maker of our cardiac packs puts printed labels in them so we can stick them on our syringes, bowls. Labels are NTG, HEP, HEP Saline, NS, LIDO, and even blank labels to write whatever you want, like verapamil.

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New Questions

Re: Site Marking in Peripheral Procedures

We routinely do peripheral angiograms on lower extremities with stenting planned. The history states clearly that the plan is in regards specifically to the right or left, whichever extremity is affected. The cardiologist says it is not an OR case, so the rules do not apply to the cath lab. It is my understanding that no matter what the procedure is, if there is a laterality, the site must be marked. We are not talking about access points, which may or may not be predetermined, but specific stenting procedures. Thoughts?

Email: Shelley Lindsey at shelleylindsey1@gmail.com
Cc: cathlabdigest@aol.com

We posted this question for Facebook readers at www.facebook.com/cathlabdigest. Here are some of the responses:

Anna: We do not mark the site in our cath lab either, but the extremity is identified in a “time out” that we have been trained to do through CRM/Life Wings. Every team member must agree before we proceed.

Daven: We do not mark the site either, but the consent includes which extremity (left lower extremity or right lower extremity, etc.) and we also confirm the site during the timeout.

Nikki: We do not mark the site. We always look at both sides and fix accordingly. The consent is specific to both sides plus or minus intervention.

Re: Turnover rates?

I have read several articles relating to employee recruitment, retention, and turnover, with some claiming to have less and some more than the national average of employee turnover, without giving what exactly that rate is. I work in a lab that has an unusually high turnover rate (78 people in 11 yrs, 10 total staff members in lab). What exactly is the national average turnover rate, or do you have any resources where I may find this information? Thank you!

Email: cathlabdigest@aol.com