February the month of Eros not Err Oh!: Preventing Infection in Cardiac Catheterization
Annually, there are more than 1 million cardiac catheterizations taking place in the United States, making it one of the most widely performed cardiac procedures within healthcare. Cardiac catheterization is a procedure where a physician inserts a catheter into a large blood vessel leading to the heart. It is performed for either diagnostic or therapeutic reasons using either a transfemoral (traditional) approach or a transradial (modern) approach. As with any invasive procedure, there are risks of complication or infections. Though each procedural approach has reported pros/cons of complications, healthcare-associated infections involving cardiac catheterizations are not typically a major problem for facilities; a large retrospective study involving over 22,000 cardiac procedures found a bloodstream infection rate of 0.11%. In spite of low rates, healthcare organizations must maintain adherence to recognized infection prevention practices to retain the overall low incidence as they promote heart health.
To err is human, to prevent divine
A layered comprehensive approach is ideal to effectively control infection risks in the cardiac cath lab. Best practice should include protocols for the environment, the patient, and the provider. When lapses occur within any of those domains, the risk of infection will increase.
- Environment: In addition to having a clean/disinfected environment prior to the procedure, it is important to maintain sterile fields, limit the flow of personnel into the cath lab, and ensure that appropriate level of air exchange is maintained during the procedure. Of course, disinfection of surfaces and equipment post procedure, with terminal cleaning at the end of day, is warranted. Enhanced disinfection with UV-C technology may also be included per facility protocol.
- Patient: Some patient risk factors cannot be readily adjusted (i.e. age, underlying disease state, etc.), however, mitigating for other factors such as decolonization of the skin/nares, clipping hair versus shaving (if needed), and ensuring patient is free of current infectious process can be performed.
- Provider: The provider and accompanying associates need to follow sterile technique during the procedure using full drape on the patient, wearing sterile PPE, and prepping the site with chlorhexidine/alcohol or other antiseptic if CHG allergic. Ensuring that the antiseptic scrub/dry times are followed is crucial in minimizing endogenous skin flora.
Maintaining a culture of patient safety is vital for all healthcare organizations. During this month of heart health awareness, let’s not underestimate infection risks associated with cardiac catheterizations. Support the interventional cardiology professionals at keeping infections low with a heart-felt message of thank you!
1Manda YR, Baradhi KM. Cardiac Catheterization Risks and Complications. [Updated 2020 Jun 22]. In: Stat Pearls [Internet]. Treasure Island (FL): Stat Pearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK531461/
2Muñoz P, Blanco JR, Rodríguez-Creixéms M et al. Bloodstream infections after invasive nonsurgical cardiologic procedures. Arch. Intern. Med. 161(17), 2110–2115 (2001).