Cath Lab Digest - January 2008 - (Page 14)

14 CATH LAB STAFF HEALTH JANUARY 2008 Figure 3. An ergonomically incorrect way to hold pressure. both physiology and technique, for the recovery of access sites.6-8 Dr. David Allie, an endovascular surgeon, interventional cardiologist, scientist and educator to physicians and staff alike, has explored similar questions as to whether manual compression should still be the gold standard for achieving hemostasis, as Dr Seldinger stated in 1952.9 Is it the standard because of the safety to the patient and access site? I am also concerned that there is no mention of the hands that hold that manual pressure. Where is that safety standard? We are taught that we have to choose between safe practice for the patient and ergonomic safety for the staff recovering that patient, but these two sides do not need to be diametrically opposed. We just need to evaluate the task and look for ways to reduce the risk of injury. After collecting the survey data, I went back to asking questions and looking for answers. I contacted NIOSH, the National Institute of Occupational Safety and Health, a branch of the Centers for Disease Control, looking at tools available to collect objective data evaluating the actual stress and force delivered to the body as we do tasks at work. This agency actually has the scientists and tools to evaluate the tasks we do at work. The best part of such objective data collecting is that it is a free service provided by the U.S. Department of Health and Human Services. The way to get this agency to come to your institution is simply to write or call, and invite them to come. The tool they offer is called the Health Hazard Evaluation Program (www. cdc.gov/niosh). The next step is to identify an institution where these scientists can come and evaluate the tasks (interested facilities can contact me at marshasicp@aol.com). Hospitals in the U.S. and in the United Kingdom (which has identified holding pressure as high on the list of causes of repetitive stress injury) have also identified the number of times a person can do this task in a given day. In the U.K., the Occupational Health Department helped set those times. (I have asked the staff “across the pond” to share their standards with us, as part of the work to find solutions. I will be returning as a speaker at EuroPCR 2008 and hope to see some of the written guidelines at that time.) We also have the strength of a multi-disciplinary committee, the Occupational Health Committee, chaired by Dr. James Goldstein at the Society for Cardiovascular Angiography and Interventions (SCAI). This committee, of which I am a member, is in the process of evaluating the impact of our injuries to our healthcare workers. Committee work is currently in progress, and it is exciting as well as troubling as the numbers and patterns of injuries are being revealed. We have healthcare workers, government agencies, industry professionals, medical societies and professional societies all working to identify the risks and injury patterns of our healthcare workers. Why? Well, it is a nice thing to do, but more than that, it is a mandated nice thing to do (by the U.S. Department of Health and Human Resources). health professional, their employers, educators, their work environment, as well as the manufacturers of the equipment used in invasive cardiology and medical imaging suites. All who care for our patients are involved, and the creation of standards will ultimately benefit not only us, but our patients. ■ Acknowledgments: The author wishes to send her heartfelt thanks and acknowledgments to Tommy Maloney, Chuck Williams and Rebecca Kapur for their editorial help. It is wonderful to have people who help others make their points clear and easier to read. Marsha Holton can be contacted at marshasicp@aol.com References 1. Wiatrowski W. Occupations with the Most Injuries and Illnesses with Days Away from Work, 2002. U.S. Department of Labor, Bureau of Labor Statistics. Compensation and Working Conditions. Available online at http://www.bls.gov/ opub/cwc/sh20040525ch01.htm. Accessed December 18, 2007. 2. Holton, M. Ergonomics in the Cath Lab (or how to save staff backs, necks, wrists…) Cath Lab Digest 2003;11(5):114. Accessed December 13, 2007. Available online at: http://cathlabdigest. com/article/1637 3. Lecture Orr G. An Overview of Ergonomics. Orr Consulting. ergotonic@ aol.com 4. As calculated in 2005 by Magnolia Outpatient Rehabilitation Facility, 2205 5th Street North, Columbus, MS 39705. Tel. (662) 243-1097. 5. Balance Systems, Inc. Advanced Research in Rehabilitation Technology. National & International Statistics for Carpal Tunnel Syndrome and Other Associated Repetitive Strain Injuries of the Upper Extremity. Available at: http://www.repetitive-strain.com/national.html. Accessed December 17, 2007. 6. Powell D. Understanding Hemostasis. CME offering 2004-2006: www.naccme. com. No longer available. 7. Guiry M. Removal of the Femoral Arterial Sheath, The Medicines Company. 8. Achieving Successful Hemostasis: Prevent RSI Through Mechanical Compression. A North American Center for Continuing Medical Education (NACCME) CME/ CEU Educational Program. Accessed December 13, 2007. Available at: http:// www.naccme.com/webcasts/170_index.cfm 9. Allie D, Herbert CJ, Walker CM. Vascular Access Site Hemostasis: “An Endovascular Surgeon’s Perspective” Manual Compression May Not Be Benign Part 1. Cath Lab Digest Sept 2004:12(9):1,6–14. Accessed December 13, 2007. Available online at: http:// cathlabdigest.com/article/3143 10. Society of Cardiovascular Angiography & Interventions. Press Room: 11/22/2004. “Survey Finds Interventional Cardiologists Suffer High Rate of Orthopedic Injuries.” Accessed December 13, 2007. Available at: http://www.scai. org/pr.aspx?PAGE_ID=3727 11. Holton M. Erogonomics Revisited: Carpal Tunnel Syndrome. Cath Lab Digest 2005 Mar;13(3):48–53. Conclusions The data we have collected thus far supports the hypothesis that musculoskeletal repetitive stress injury patterns do exist in the cath lab. The survey results support the efforts and development of a multidisciplinary approach to further study these serious health risks to our practitioners. When this data was compiled, it revealed that those who reported injuries did consider them work-related (86%). The survey showed that only 54% of those hurt and who sought medical treatment felt it worked. That is just over half. One out of two cath lab professionals who are hurt still suffer after treatment. The numbers also showed 75% of those responding held manual pressure to recover their patients’ access sites. I surmise that Dr. Seldinger’s “gold standard” is still in practice. The mean holding time of 19 minutes is a long time to hold force against a pressure. Or, to put it in ergonomic risk terms, duration, force, and position. Holding pressure for 19 minutes, in the same position, with the hands in an unnatural position, will increase the risk of carpal tunnel strain and injury. The survey results are not only another piece in the puzzle, but a call to action. We need to develop a standard to reduce workplace injuries for our invasive laboratories. These standards must address the roles of the Table 4. Survey results: injury locations. For more information on injury patterns, see References. (results tabulated by RADI Medical Systems, Inc.) http://www.bls.gov/opub/cwc/sh20040525ch01.htm http://www.bls.gov/opub/cwc/sh20040525ch01.htm http://www.cdc.gov/niosh http://www.cdc.gov/niosh http://cathlabdigest.com/article/1637 http://cathlabdigest.com/article/1637 http://www.repetitive-strain.com/national.html http://www.repetitive-strain.com/national.html http://www.naccme.com http://www.naccme.com http://www.naccme.com/webcasts/170_index.cfm http://www.naccme.com/webcasts/170_index.cfm http://cathlabdigest.com/article/3143 http://cathlabdigest.com/article/3143 http://www.scai.org/pr.aspx?PAGE_ID=3727 http://www.scai.org/pr.aspx?PAGE_ID=3727

Table of Contents Feed for the Digital Edition of Cath Lab Digest - January 2008

Cath Lab Digest - January 2008 Central Baptist Hospital Contrast Media Use in High-Risk Patients An Ergonomic Survey of Cath Lab Repetitive Stress Injuries Contents Clinical Editor’s Corner Takotsubo Cardiomyopathy, a.k.a., Transient Left Ventricular Apical Ballooning Syndrome: An Acute Coronary Syndrome Imposter Searching for the Key to D2B STEMI Intervention News STEMI Interventions: Commentary The Massachusetts Stent Study The Value of Educating Staff Ask the Clinical Instructor: A Q&A Column for Those New to the Cath Lab SICP* Chapter Updates The Society of Invasive Cardiovascular Professionals Holds an RCIS Review Course at New Cardiovascular Horizons 18:20 To Denver — One Student’s First Clinical Experience CEU Education Center Meetings Calendar What Do You Think? Clinical & Industry News Classifieds The Ten-Minute Interview with…Heather Vardon, RN Advertisers Index

Cath Lab Digest - January 2008

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