Friday, August 18, 2006

Sterile Technique in the Cath Lab

A New York Times article today discusses high rates of coronary stenting noted in doctors in Elyria, Ohio realative to the rest of the US. What was more interesting to me was the article's picture: a cardiologist performing a heart catheterization procedure without a hat or mask, while the radiographic technologist at least has a protective face shield. While I am aware of the low incidence of infection from these procedures, potential risk to the operator and patient still exists. Universal Precautions to eliminate infections to the operator from blood borne pathogens are needed, especially in bloody procedures like this. Also, I remain concerned about the potential for infection risk to our patients with indwelling prosthetic valves or who receive implanted devices like stents, vascular closure plugs, and PFO closure devices. Policy is clear on this:
Since the incidence of infections related to procedures in the cardiac catheterization laboratories is low, it is unlikely an adequately powered randomized study of caps and masks will ever be performed. However, the consequences from such infections are significant while the risk of using these precautions is nonexistent. Therefore, it is the recommendation of these guidelines that the use by the operator(s) of a cap, mask, and eye protection be strongly considered, if not mandatory, for all procedures performed in the cardiac catheterization laboratory for the protection of the operator.

If an operator does not use a cap and mask routinely, they should at least be used for procedures in patients who are at increased risk for both an infection as well as for a serious complication, should one develop. Such patients include those with native valve disease or intracardiac prostheses, arterial access performed through a femoral arterial graft, prolonged catheter or procedure times, prolonged use of an in-dwelling sheath following the procedure, intra-aortic balloon pump insertion, per-Infection Control Guidelines cutaneous valvular procedures, and the use of implantable devices such as stents, septal closure devices, and/or VCDs. It may not always be known at the start of the procedure if one of these higher-risk situations will occur. Accordingly, each facility should consider the best policy for their laboratory, with patient safety given the highest priority.
Issues related to blood-borne pathogens are real, especially in today's highly-interventional cath labs, and proper sterile technique improves safety for the patient AND cardiologist. After all, most of our technicians follow the physicians' lead.

--Wes

4 comments:

Cathy said...

Hello,

Interesting Blog.

I plan to read alot of what you have written. I was drawn to your blog, first of all, by your name. My dad was also named Wes. It isn't really unique but there are not many of you around. When I hear of one, I like to check him out. Second, you are from the same city and state as another physician blogger who has a wonderful blog. Third, you are very close to my most favorite city. Lots of good times I've had in Chicago.

I'm going to add you to my blog list so I can come back and read often. if that is not ok please let me know.

DrWes said...

Thanks, Cathy. Feel free to add me to your list. I appreciate your comments and completely share your enthusiasm for the great city of Chicago!

--Wes

Jenn O said...

Dr Wes -

I read this blog entry with great interest. A question for you...

My dad had two cardiac cath lab trips this week, after "failing" a stress test. They needed to place two stents and were concerned about "too much dye" to do both at the same time.

He was supposed to be released today, but has developed an as yet to be identified infection. They're treating him with vancomycin.

I'm a paramedic - so I know just enough to get myself in trouble; but unfortunately I live 2000 miles from my dad. Should I be concerned?

If you have time to answer this post, I sure appreciate it!

jenn o.

DrWes said...

10/12/08 @ 11:10 CST

jenn o.-

Developing a systemic infection this fast after stenting, while not unheard of, would be unusual. Certainly, it sounds like his doctors are concerned enough to cover your father with an antibiotic that covers skin organisms, perhaps because they may feel that's the most likely source for his fever. Any hospital-acquired infection is serious and it would be wise to communicate directly with your father (if possible) to see if he would permit you to contact his doctor directly to discuss the situation.