Keeping Medicine Clean

I've been practising Advanced Pre-hospital Care for close to 30 yrs now and before I head off for other challenges i want to get a movement happening, or at least an awareness amongst practitioners that the things we know are just wrong don't have to be. Not all errors relate to funding. Some are just acceptance of mediocrity because that is how you were shown, it's normal procedure, or the boss said so. It doesn't have to be that way, nor should it. Lend your ear and keyboard and let's make some changes through awareness and publicity.

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http://www.youtube.com/watch?v=0hoF490xoJw check this Youtube link and see how the STAL Shield and Stand will revelutionize Infection Control and Occ Health practices from now on...

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"Making Good Better"

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Prodaptive Medical has taken a great step forwrd in the arena of infection control in emergency and acute care/urgent care medicine - see us here and send a note. Keeping medicine clean is what it's about. See us at the Jems-EMSToday 2011 Baltimore Conference.

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Bio-Contamination V - keeping the tools clean

 Al Wickheim - ALS Paramedic, CBRNE Tech.

   Last week I wrote about the introduction of contamination into the upper airways and onto the lungs surface by way of aspiration – vomitus and oral secretions, inhaled water, dirt or other debris.. I mentioned how much of this can be reasonably be managed with good technique but also referred to the ongoing problem, a dirty little secret amongst those who know, that the very instrument we use in many fields of medicine and pre-hospital care to clear this contaminant is in fact introducing other contaminants in the process. Yes, the Yankauer suction catheter that is drawing out the crud is in fact more than likely putting other crud back in.

     For the pre-hospital care paramedic this problem just seems to be a natural consequence of the procedure. Either the Yankauer falls to the floor dragged down by the weight of the tubing connected to it, physically knocked to the ground by a caregiver or there is just no place to put it. You are out in a barn working on the resuscitation of a farmer who has collapsed tending his cattle and at this point the only thing that is clean is the air. So where do you put your suction catheter before and between uses?

      Until now there has been no adequate solution.

A new product from Canada has finally overcome this problem. It is called the STAL Shield and Stand. Initially designed as a shield to block coughed, vomited and other orally ejected matter during oral suctioning the STAL has found multiple uses and applications in a variety of fields in and out of the hospital setting.

     In its role as a stand for the Yankauer the STAL supports the suction catheter’s working end up off the floor or other surface keeping it clean and uncontaminated. Not only does the Yankauer and the surface upon which it rests stay clean, the STAL supported catheter in its entirety stays off the floor making it easier to pick up and keeps the user’s fingers from contacting the floor.

     This simple and revolutionary device will change your practice from both a self satisfaction standpoint as well as from that immeasurable perspective of  “did we do harm?” See the STAL in action at www.prodaptivemedical.com, or on Youtube “STAL Shield and Stand. Video updates coming shortly.

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Bio-contamination - IV - Airway Involvement

       The Yankauer suction device is employed in a multitude of clinical situations, usually to clear the oral cavity and upper airway, above the vocal cords specifically. This activity can be part of an emergency life saving procedure, or of routine longterm care. Either way it is often critical to the management of the airway. The secretions and debris which may accumulate within these confined spaces impact vital functions. 

     By reducing  or totally obstructing the passage of inhaled air to the lungs one of the first rungs on the ladder of resuscitation is broken - air flow to the vital systems is stymied even before reaching it's initial pickup point in the body, the lungs. One "next step" in the above situations is that he air hungry patient works harder to inhale  and so has potential to breath whatever undesirable right into his lungs or temporarily blocked by the vocal cords themselves. Here the blockage of air passage can continue to be within the larger airways or be drawn deeper right into the lungs causing swelling, more fluid build up, literally coating the surfaces of the lungs with a layer of viscous mucous and harmful material.

     The prognosis here is grim but with rapid and effective intervention measures being taken the patient's odds for survival improve markedly. Unless those very efforts are being sabotaged by the unwittingly introduced health or life-threatening contamination to the  critical airways the practitioner was first trying to protect.

       After 50 yrs of tolerating and just accepting the problems of the Yankauer suction catheter finally a practical and effective tool to help control and reduce patient airway contamination is available. The STAL Shield and Stand addresses this and much more.

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bio-contamination 111

Hi, hoping you all have enjoyed a warm and happy holiday season. Last week I went on about the hazards inherent in the use of the Yankauer suction device. these are bone fide concerns that should be addressed from both the patient and health-care provider's standpoint. 

     Fifty years of bad practice with its use has led to just more bad practice. What has been needed, but just never devised is a way to effectively isolate the dirty end of the Yankauer from the rest of the environment.

Before and after it's first use, the packaging envelope works just fine. But after there is the slightest mess inside the envelope from the used Yankauer that option is done. It just doesn't work...sort of like trying to push on socks from the toe end. Think about a lightweight, transparent shield applied to the shaft of the suction wand, it securely fitting through a flexible central diaphragm in the shield. And think about the difference between a used Yankauer landing on the floor and a clean dry one. Where you going to wipe it? Then what? Think Stal Shield and Stand - Youtube it. later - a great New Year to all!

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Bio-hazard contamination 11

Last week I wrote about an issue that has somehow shamelessly been around the medical world for about 50 yrs. I know that many of you who read that probably had a number of issues in mind i had neveer thought of. What I am thinking of is the Yankauer Suction catheter. Used in dozens of medical arenas in and out of the institutional setting - in aircraft, surgical suites, pretty much anywhere a cardiac arrest happens or invasive airway management takes place. Which is pretty much anywhere. Think ditch, barn, restaurant, dyalisis clinic, pool change room or sidewalk. You name it.

     The yankauer arrives at the scene sterile, is removed from it's envelope and now is just clean. After it's first use an attempt is made to return it to it's envelope, sometimes successfully. After that it is anyone's guess where the yankauer will rest, but you can bet a clean area it will not be. a good option evolved years ago under the patients head or pillow. now the pillow is contaminated and the grit from the floor in the patients hair is on the yankauer. Which is blythly returned to the patients airway to re-suction. Which introduces the floor dirt from the patients hair into the patients mouth and airway. shortly after the practitioner passes a tube  through the mouth, down the airway and into the lungs. Which also picks up the contamination left byu the yankauer in the airway down into the lungs and the patient dies later in the ICU of some sort of respiratory ailment totally unrelated to their original sickness.

     A few years ago minds much greater than mine spent many hours developing a training program for Emergency and critical care health care practitioners specifically for managing the H1N1 pandemic. For all the dozens of new devices and protocols, procedures and standards redesigned and implemented not one addressed the Yankauer Sucton. This despite the the well establihed fact that many of todays known pathogens, H1N1, SARS and others are transmitted via droplet and aerosolized vectors from the coughing, vomitting, sneezing infected patient. And the patient who has any device introduced to his or her mouth and especially into their airways is a Pandoras Box of infection UNCONTROLLED. any thoughts, comments or similar problems encountered. See what Dr. Willms of Sharps Memorial hospital in San Diego has writen on this. We've come up with an answer...tune in next week.

Al

Prodaptive Medical Innovations

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WHERE WOULD YOU MOST LIKE TO VISIT ON YOUR PLANET?

tropics, no crowds, no tsunamis, good surf and fresh coconuts...you?

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Bio-hazard contamination

Hi there, my first official blog. You've all seen the stories in the news, - Dr. removes wrong kidney!, nurse administers wrong medication!, paramedic refuses transport for lack of payment! Horror stories all and rightly so. Sometimes bad judgment, sometimes bad information, sometimes just poor practice. And it is the poor practice I would like to touch on here.

     Everyone makes mistakes, I have, you have, they happen. To make the same mistake multiple times, knowingly, or someone in charge knowing and not rectifying the practice is the real wrong. In every aspect of medicine there are built in redundancies and protocols to ensure that the last mistake doesn't get repeated. Unfortunately some poor practices or techniques are so ingrained due to lack of oversight or lack of option that they become the norm.

     I'm quite familiar with one practice that has become that norm and is just plain wrong. And it has been going on for 50 plus years, across the board in many fields of medicine. And while training emphasizes it's prevention, lack of option forces its practice. Any guesses? I'll bet there are many thousands of you out there right now, medical types and others wondering, perhaps knowing and not aware of the fix. Send me a note relating your thoughts on just what this issue might be and lets see.  Here's a hint ...it goes inside your mouth and involves suction. And no it's not that! Cheers

Al

Prodaptive Medical Innovations Ltd.