HospitalInspections.org

Based on observation of 1 of 1 sampled patients during a heart catheterization procedure (Patient 11), and review of facility policy for dress code in the Cardiac Catheterization Laboratory, the facility failed to ensure staff working in close proximity to the sterile field had on proper surgical attire to prevent potential infection risk to the patient. The facility census was 72. The total sample was 46. Findings are:

A. Observation of a heart catheterization procedure on 5/7/13 performed on Patient 11 from arrival in the Cardiac Catheterization Lab at 7:30 AM until the procedure ended at 8:25 AM revealed the Scrub/Radiology Technician and the Cardiologist wore full sterile surgical attire. The circulating Registered Nurse (RN) wore surgical scrubs without hair covering or mask. On 2 occasions during the procedure the RN came within 3 feet of the sterile field to reposition the patient's right arm. The right radial (wrist) artery was used for the introduction of the heart catheter/introducer.

B. Staff interview with the facility Infection Control Practitioner on 5/7/13 at 9:30 AM confirmed the circulating RN in the Cardiac Catheterization Laboratory "needs hair covering and mask on if within 3 feet of the catheter insertion site."

C. Record review of facility policy titled "Dress Code in the Cardiac Cath [Catheterization] Lab [Laboratory]" effective date of 6/10 and last reviewed date of 3/13 revealed the following:
Under section titled "Purpose" the policy states "Surgical attire provides a barrier between personnel and patient and between patient and personnel through which contamination may pass and also provides protection against exposure to infectious microorganisms and hazardous materials."
Under section titled "Policy" notes ancillary personnel entering the semi-restricted and restricted area of the Lab are to wear surgical attire consisting of scrub top and pants. The policy states "It is recommended that the procedure-performing physician wear surgical clothes, surgical hat or hood, mask and shoe covers if it is anticipated that splashes or spills will occur during the procedure. The current policy only requires ancillary personnel who are scrubbed in to wear surgical hats to cover hair and masks.

D. Interview with the Operations Director for Diagnostic Services on 5/7/13 at 9:00 AM related the facility has drafted a new policy titled "Imaging Guidelines for Collaboration with SSI [Surgical Site Infection] Bundle". The SSI bundle is a group of best practices implemented to prevent surgical site infections. The new policy requires staff "working within 3 feet of the sterile table or field" to wear "hat, mask, sterile gloves and gown" for "Moderately Invasive Procedures." The policy requires "All staff to wear green scrubs, hat and mask." The policy identifies Heart Catheterization with or without stent placement a moderately invasive procedure.

E. Review of the "2010 Perioperative Standards and Recommended Practices" for Aseptic Practice recommends "Personnel should cover head and facial hair, including sideburns and necklines, when in the semi restricted and restricted areas of the surgical suite." The standards also state "All individuals entering restricted areas of the OR suite should wear a mask when open sterile items and equipment are present." During the heart catheterization procedure a sterile table is set up and sterile drapes are used just as in the operating room. The facility infection control staff failed to ensure infection control practices were implemented in the Cardiac Catheterization Laboratory to protect patients from potential infection.