Interventional News: Safety First
By Raymond F. Vennare
Radiology Today
Vol. 25 No. 2 P. 8
When the World Health Organization reiterates its call for the acceleration of “innovative approaches to improve health,” one must take seriously their inherently well-informed perspective and implied importance of continuous improvement and innovation for the health and safety of clinicians. When it comes to health care–associated injuries (HCAIs), the CDC estimated the total costs of treating HCAIs and related disabilities to be in excess of $28.4 billion in the United States alone.
Interestingly enough, the very field of IR was created specifically to “revolutionize the practice of medicine to guide the real-time treatment of disease,” according to Stanley Baum, MD, FACR, the father of IR and the late chairman of the radiology department at the University of Pennsylvania’s Perelman School of Medicine.
From new techniques to breakthrough technologies, innovation is at the heart of IR. It should serve as the driving force behind bringing forward the best safety practices for the health and well-being of IR staff, especially when it comes to reducing the risk of exposure in two key areas: potentially infectious bodily fluids and radiation.
Assessing Risk
By definition, the very practice of, and procedures for, IR occur in a high-risk environment. Given that environment, the improper or unsafe handling of liquid medical waste can be dangerous and costly for health care workers and the facilities in which they practice. This exposure not only increases the risk of infection for staff but also can lead to fines, penalties, and contingent liabilities incurred for the treatment and care of those employees or patients.
The statistics are alarming: There are approximately 26 types of infections that can be transmitted through medical waste. Nearly 15% of that medical waste is hazardous, 10% of which is infectious. As many as 26% of hospital staff may not wear a gown or facial protection during disposal of that medical waste, which puts both staff and patients at serious risk of exposure to airborne contaminants, splashes, or spills.
Moreover, according to the National Institutes of Health, the risk of HCAIs has risen in the radiology department in the last three decades. This, in large part, can be attributed to an uptick in the number of patients visiting the department and the proportional increase in the utilization of imaging modalities and interventional procedures.
As a result, radiologists, technologists, and other support staff may be unprepared, if not totally unaware, of potentially infectious diseases carried by patients under their care and supervision on a daily basis. From needlestick injuries to accidental exposure to infectious pathogens, the dangers of possible transmission can include life-altering diseases like HIV and hepatitis B and C.
Fortunately, however, the World Health Organization has also acknowledged that good infection prevention and control programs can reduce health care infections by 70%. If this statistic is correct, then hospitals and medical centers must remain vigilant about improving, identifying, and implementing new techniques and technologies to mitigate risk and reduce their exposure to harmful contaminants and other dangers during IR procedures.
The key questions to ask are both obvious and beneficial: What can be done to measurably reduce risk and ensure the health and safety of staff members on a regular and sustained basis? How do we dissuade the use of substandard equipment, complacency, and repetitive procedures and improve turnaround time without sacrificing staff and patient safety?
Safety Solutions
The CDC, the Environmental Protection Agency, and the Association of Perioperative Nurses have independently recommended that all contaminated body fluids be disposed of directly into a sanitary sewer. Knowing that the management of infectious fluid waste totals 75% of disposal costs and the risk of exposure is high, a virtual hands-free fluid management system is an important consideration.
The International Society of Oncology Pharmacy Practitioners has proposed strict infection prevention protocols in their Standards of Practice, which strongly recommend that the collection and drainage of body fluids should be managed in a closed system and disposed of intact and undisturbed. Canisters, evac bottles, and moving equipment through rooms, corridors, and common areas within hospitals and treatment facilities all pose high levels of risk. We must bring innovations into the IR suite to ensure the safety of staff members as well.
Similarly, but one step closer to shielding personnel entirely from physically disposing of medical waste is a direct-to-drain solution which, as the name suggests, moves fluid directly from the patient to the drain.
Christopher Piunti, lead sonographer at Edward-Elmhurst Hospital, is part of a team that prioritizes the health and safety of the nearly 45 ultrasound staff members there. To help mitigate the risk of body fluid/biohazard exposure, they have installed an automatic direct-to-drain fluid removal system for paracentesis procedures in their interventional ultrasound suites.
“We found a direct-to-drain system to be very clean, safe and a seamless process for all involved,” Piunti says. “Most important is that it helps prevent our staff from coming into contact with potentially infectious bodily fluids.”
An equally concerning risk related to IR is the proximity to the very radiation that makes these procedures possible. The use of robotics to reduce the potentially harmful effects of cumulative exposure to radiation over time. While carefully regulated attention is given to instituting good radiation protection habits, robotics offers a revolutionary solution to minimize the long-term effects of radio contamination.
According to Shen Ning, an MD/ PhD candidate at Boston University Chobanian and Avedisian School of Medicine and cofounder and CEO of INIA Biosciences, “Robotics in the interventional suite has the immense potential to increase procedural efficiency and reduce occupational hazards, including radiation exposure and accumulated musculoskeletal disorders from lead aprons.” Inevitably, Shen believes, the development and use of telerobotics would enable physicians to perform these procedures remotely, both providing care to more patients and improving safety for technologists, clinicians, and physicians.
Echoing the potential benefits of robotic intervention, Alessandro Posa, from the department of diagnostic imaging, oncologic radiotherapy and hematology at A. Gemelli University Hospital Foundation in Rome, Italy, stresses the importance of considering robotics in the IR suite. “Routinary use of robotics can lead to the reduction of radiation exposure to operators and can increase procedure accuracy in the near future,” notes Posa in the National Institutes of Health article, “Technological Advancements in Interventional Oncology.”
Innovation Is Key
Whether implementing new policies and procedures, adopting hands-free fluid management systems, or installing direct-to-drain or robotic treatment solutions, hospitals, medical centers, and treatment facilities need to embrace innovation in the service of patient satisfaction, mitigation of institutional risk, and the safety and protection of all professionals dedicating their careers to IR.
— Raymond F. Vennare is the founder of numerous companies that provide services from diagnostics and therapeutics to bioinformatics and medical devices. Vennare is currently the CEO of Predictive Oncology, Inc, the parent company of Skyline Medical.
