One of many factors affecting the decision to stop using contrast in glass bottles is the risk of cuts. At Raritan Bay Medical Center, Perth Amboy, NJ, we first needed to assess that risk. We were looking specifically at the metal ring that is crimped around the stopper of a traditional glass contrast bottle. There had been informal reports that some of the staff were having trouble with it, and that there had been cuts as a result.
With the employee health nurse, we reviewed all incident reports. Next, interviews were conducted with staff members throughout the medical center (including employees working in diagnostic imaging, cardiac catheterization, and the operating room) to collect information regarding their use of glass bottles with stoppers surrounded by aluminum rings.
Raritan Bay Medical Center, Perth Amboy, NJ is a 450-bed community hospital situated on two campuses. Each year, we perform about 10,000 procedures that require contrast injections. Based upon the sheer volume of cases that we see in our medical center, when the new polymer packaging for contrast media was introduced to us, we thought that it was very important to explore its use.
A formal procedure, with an interdisciplinary approach, is used to determine whether or not we will make any kind of change in our medical center. To begin the process, the information was presented in monthly Diagnostic Imaging Quality Action Committee meetings. The committee is composed of the quality standards coordinator, the director of the radiology department, the chair of the radiology department, a radiology nurse, and a representative from the quality assurance department of the medical center.
The committee decided that more information was needed and requested a formal presentation from the contrast company’s representative. This presentation reinforced our interest in the use of polymer bottles for contrast packaging.
Next, we presented information on the new contrast media polymer packaging at a meeting of our product-evaluation committee. This committee is similar to the radiology quality committee, but has additional representatives from materials management, biomedical engineering, and nursing. Changing the facility’s contrast media strictly to nonionic contrast was being considered simultaneously with the change from glass to polymer packaging. Such changes affect the entire hospital because contrast media are also used outside of the radiology department, such as in cardiac catheterization, in other departments in the hospital, and in the operating room.
At this point, all recommendations concerning contrast packaging were brought to the environmental care committee, which was previously known as the safety committee. This committee includes representatives from the employee-health and risk-management departments. This was their first introduction to the potential change in contrast packaging, and the environmental-care committee members were involved in our decision making from that time forward.
–Stephen M. Deutsch, RT(R), (CT)
We found that no one had filed an incident report after being cut by a glass bottle or its ring during the previous 2 years. This was surprising because nearly all staff members who had been interviewed had stated that they had cut themselves opening the glass contrast bottles. In many cases, the bottles’ metal rings had failed to disengage properly, so the employees had resorted to the use of hemostats or scissors to pry off the rings. Naturally, these attempts increased the risk of cuts.
When asked why they had not filed incident reports, many interviewees replied that they had been too busy to complete a report. They had simply bandaged their cuts, worn gloves, and proceeded to their next cases. When informed, the employee health nurse was astounded that no one had taken the time to report a cut, especially given the risk of blood-borne pathogens in hospitals. Although many employees considered the cuts that they experienced while handling glass bottles of contrast to be clean (because the bottles had not been in contact with patients), they ignored the fact that subsequent patients might be exposed to the staff member’s blood. They also failed to consider the fact that their hands were very likely to be in infected fields during the course of their work. Because the cuts associated with glass contrast bottles had been unreported, the risks inherent in their use had simply been invisible until we investigated the situation.
Although the glass contrast bottles were soon to be eliminated as a source of cuts, we conducted staff education and had posters made emphasizing that every injury, no matter how minor, is very important. All injuries must be reported to the medical center, to risk management, and to employee health.
Once the information on contrast media glass bottle-related cuts was compiled, it was presented at an environmental care meeting, which made it part of the record reviewed by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The environmental-care guidelines used by JCAHO require the institution to reduce and control environmental hazards and risks, to prevent injuries, to maintain safe conditions for the staff, and to minimize environmental stressors for the staff.
Based on further discussions, a meeting was held with all concerned parties to explain that we were not receiving incident reports for contrast-bottle related cuts, but we knew that the risk was there. This presented an opportunity to recommend to our administration the need to adopt a polymer packaging system for contrast media that has the potential to prevent such injuries (see Change Engineering).
The change was approved, and the staff’s acceptance of the new system has been tremendous. Staff satisfaction has improved because they recognize that their concerns will be addressed, even though they did not make formal reports of the problem. Because incident reporting is cumbersome in many organizations, and because radiology staff is typically very busy, failure to file incident reports is probably widespread. Fortunately, the hazards involved in using glass bottles for contrast media can now be addressed.
Stephen M. Deutsch, RT(R), (CT), is quality standards coordinator, Diagnostic Imaging, Raritan Bay Medical Center, Perth Amboy, NJ. This article has been adapted from Advantages of +PlusPak: Reduction in Risk of Cuts, which he presented to the Polymer Bottle Safety Focus Group on September 10, 2004, in Las Vegas.