Clinical Value

The Joint Commission, which provides standards for safe and high quality health care, continuously reviews organizations activities in response to sentinel events.

These events are unexpected occurrence involving death or serious physical or psychological injury or “the risk thereof.” In order to implement and assure that hospitals comply to these rules, The Commission has come out with a series of rules and guide lines that hospitals must follow. Report of these incidence, “sentinel events ” has generated a task force.

The phrase, “the risk thereof ” includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome, such as: medical errors, hospital acquired infections, tubing misconnections, and persistent and potentially deadly occurrence and lines disconnection.

The ECT Patient Gown was designed to meet the increasing demand of our health care system and meets the needs of an increasingly complex patient population during hospitalization. The features we have designed are not present in current standard gowns. Our advantages are in the details.

Central line slits:

Minimize the stress on the insertion site. Help maintain the intended occlusive dressing as per policy. Lessens the chance of the line or dressing becoming dislodged. Provides good visualization .

Telemetry pockets:

Holds patient telemetry box, which is used to transmit a patient heart rhythm. Allows Patients to ambulate freely and helps to evaluate the heart function during activities.

Gastrostomy slits:

Anatomically placed, provides better visualization of the connection to the feeding tube source, assuring that the feeding is infusing as intended. Allows easy access to the tube for administration of medication and water flushes, which are all part of routine tube care.

Drainage slits with accompanying pockets:

Placed on either side of the gown, they allow various tubes or drainage apparatus, such as Jackson-Pratt’s, Hemovacs, J-vacs…to be conveniently thread through allowing these various drainage apparatus to be secured in large pockets, thus the advantages of:

• Replaces Safety pins which have typically been used for securement.
• Facilitates early ambulation.
• Lower risks of stress to the incision site thus decreased risk of infection caused by stress to the incision site.
• Improvement in patient comfort.
• Reduction of patients length of stay in the hospital setting.

The ECT Patient Gown was also intended to address this very important concept of safety, as expressed in goal #7 and goal #13 of the 2008 Joint Commission National Patients Safety Goals which encompass safety, visualization, and patient involvement in their own care. The ECT Patient Gown addresses this very important concept of SAFETY. Through the slits, lines and drains are exposed, thus helping to minimize the risk of Nosocomial infections or hospital acquired infection.

By having the lines readily exposed, nurses will be able to provide care with less manipulation of the patients, thus helping to reduce the risk of physical transfer of micro-organisms seen in Direct-contact transmission and Indirect-contact transmission.

It has been estimated that one out of ten patient acquires nosocomial infections. An estimated 2 millions per year.
Medical staff move from patient to patient, providing a way for pathogens to spread.
Medical staff wear their scrubs to and from work thus the risks of community acquired infections are greater
Ms magazine reports that as many as 92 percent of deaths from hospital could be prevented.
Wide spread use of anti-microbial agents creates the emergence of resistant strains.
The patient length of stay end up increasing 4 to 5 days extra costing Medicare, Medicaid and other insurance company an estimated $4.5 to $11 billions and up per year.

As of October 2008 Medicare and Medicaid stop paying for hospital acquired infections. And most likely private insurance companies will be following their path. Preventable incidents and sentinel events might, in the near future, fall in the same categories.

Visualization and Patient involvement in their own care!

Lines misconnections:
To date, nine cases involving lines misconnections have been reported to the Commission’s sentinel event database. These resulted in eight deaths and one instance of permanent loss of function. By having the slits anatomically placed, the chances of these incidence occurring are largely minimized. (ref. issue #36 April 3, 2006 of the JCAHO sentinel event alert).

Lines disconnections:
All though not as highly reported, these are frequent occurrences in a hospital setting. Feeding tubes, central lines and J-Pratts often become disconnected under the standard gown and the non conscious patient is at risk of many adverse effects; hypoglycemia and hemorrhage. Again, by having the lines exposed, patient and family will be involved in their care by alerting the hospital personnel when these events occur.

Most of these factors and much more have been addressed in the concept of The ECT Patient Gown. It will help hospitals to join this new culture of patients safety and help meet The Commission’s high performance standard.

Q&A…

Q—“They had problems with the slits for tubes, etc. They thought that the tubes would be pulled out as the gown was slid around, pulled, or as the patient rolled over.”

A—ECT Gown Central line slits

Central lines, with needleless injection sites / blood sampling ports (lumens) firmly attached, are sutured to the patient’s skin. If not sutured, the central lines are anchored onto the skin with a device that holds them in place. With the traditional IV gown, the lumens rest directly on the patient’s chest and tends to flap around underneath the gown. This causes the dressing placed over the central line to be displaced, necessitating a change in the dressing earlier than the 7 days recommended by the Center for Disease Control (CDC). The central line slits on the ECT Gown were expressly designed to expose the lumens, thus providing easy access for the care giver to administer medication, draw blood and perform other procedures. Lumens connected to an IV and/or other medical devices will be thread through the IV sleeves of the ECT Gown, therefore eliminating the possibility of IV line being ‘pulled out’ through the slits. Indeed, with this feature the lumens are more apt to stay in place, even when the patient moves. The concern raised that the central line can be ‘pulled out’ can be dispelled since: (1) the line is sutured into the patient’s skin; (2) removal requires the use of a central line removal kit; and (3) the lumens cannot be pulled from the central line as it is securely fixed to the catheter juncture hub.

Of course, if the bedside care provider determines that the patient is confused or agitated, and may grab at the exposed lumens, then the central line slits should not be used (to expose the lumens) and the ECT Gown can simply be worn (and utilized) as a standard IV gown.

ECT Gown PEG tube slits (Percutaneous Endoscopic Gastrostomy Tubes)

“The PEG tubes are inserted through a small incision only slightly larger than the tube itself in the abdominal wall. With the traditional IV gown, the PEG tube is covered, whereas the ECT Gown features a slit designed to expose the tube for easier access and improved nursing care efficiency. The tube is secured in the abdomen by one of several methods: (1) some PEG tube brands have a small wire inserted inside the tube and after insertion the wire is pulled from the exterior end of the tubing causing the other end of the wire to curl up or ‘pigtail’ thus preventing it from being pulled out from the abdomen; and (2) other systems employ a very small balloon at the end of the tube which is inflated in the stomach after insertion, serving the same purpose. Removal of the PEG tube involves either cutting the pigtail wire or deflating the balloon, allowing the tube to slip easily from the stomach”.

The risk of dislodgment of the PEG tube with the ECT Gown exists only if the patient (or someone else) were to forcefully pull the tube from his/her body.

Again, if the bedside care provider determines that the patient is confused or agitated, and may grab at the exposed PEG tube, then the PEG slits should not be used and the ECT Gown can simply be worn (and utilized) as a standard IV gown

Q—“They thought it would be an infection control risk to put lines through the slits because the lines would need to be disconnected to do so.”

A—As explained above, IV tubings are thread through the IV sleeves (secured by snaps) and not through the central line slits. Only needleless injection sites / blood sampling ports (lumens) are thread through the central line slits.

As for the PEG tubes, with the traditional IV gowns the tube is hidden under the gown. If an accidental disconnection occurs, it will only be detected by the healthcare provider when she/he assesses the patient. Whereas with the ECT Gown, because the tube is exposed over the gown any accidental disconnection is immediately visible and can be promptly corrected without putting the patient’s health in jeopardy.

Q—“We had an Infection Control Practitioner in the room as well. She did not believe the claims of reduced infections. She wondered if there were any independent clinical trials to verify those claims.”.

A—It has been demonstrated in past studies that the chest and groin areas of the human body are the areas with the highest colonization of bacteria. This is due to patient activity; perspiration; staphylococcus bacteria on the skin itself. We have designed the ECT Gowns with the specially featured slits that serve as a barrier/shield between the needleless ports and chest area, helping minimize the risk of blood stream infection.

Q—The doubling up of the fabric in back – they didn’t think it would be good for patients to lie on the seams and ties.

A—The basic structure of the ECT Gown is modeled on the traditional IV gown. The only additional features are the central line slits, gastrosomy slits and utility pockets. The comparable seams in many traditional IV gowns have not been proven to create any skin break down. They are tied at the same level in the back. If the patient is bedridden there is no need to fasten the bottom tie, as this will give the nurse easier access to the patient. Keep in mind that patients, upon ambulation, are now wearing two gowns in order to protect their privacy. Patients wearing two gowns inhibits the care giver’s access. Because of greater coverage in the rear, the ECT Gown eliminates the need for double gowning, enhance patient satisfaction and reduces costs.

References:

1) McBryde E et al. ” An investigation of contract transmission of methicillin-resistant Staphylococcus aureus.” Journal of Hospital Infection 2004; 58:104-108.

2) Ricks, delthia. “Germ Warfare.” ms. Magazine. Spring 2007. pp 43-45.

3) Klevens, RM et al. “Estimating health care-associated infections and deaths in U.S. hospitals, 2002″ Public Health Reports 2007; 22: 160-66.

4) Read article from the news observer:

http://www.newsobserver.com/news/story/1491527.html?story_link=email_msg#none

5) Read article featured on The Wall Street Journals front page dated 5/11/09.

http://online.wsj.com/article/SB124199135515304615.html#articleTabs=article

6) NSW Health. 2005. Infection Control Program Quality Monitoring Indicators. Version 2 User’s Manual. NSW Health.

7) O’Grady, N.P. and M. Alexander, et al. 2002. Guidelines for the prevention of intravascular catheter –related infections. Infection Control and Hospital Epidemiology 23 (12): 759-769.

Oral Cancer Foundation. http://www.oralcancerfoundation.org/dental/tube_feeding.htm