Tina Prestwood, Cardiac Cath Lab Manager, Royal Cornwall Hospital, TRURO, UK

What an interesting topic and one we have discussed numerous times in our Cath Lab here in Truro in Cornwall. When I started my job as CCL manager seven years ago all staff were wearing hats for all procedures and hats and masks for all pacing type procedures. Everyone had two pairs of shoes, blue shoes to wear outside the department and white shoes for inside the Cath Lab.

As I came from a Cath Lab that did not wear hats all day I wanted to make a change. I looked at a number of studies on the efficiency of hats and masks on the internet to ensure ‘evidence based practice’ and invited the views of our consultant cardiologists.

1. I found no evidence that the wearing of hats and masks reduced infection rates. However, every hospital has it’s own policies and our hospital policy clearly states that theatre staff should must wear the full kit.
   

2. All our consultants, except one, were in favour of not wearing hats routinely. They agreed to continue to wear hats and masks only for pacing procedures like ICD’s, PPM’s and Reveals.

3. We recently stopped the wearing of masks during pacing procedures for the ‘running’ staff. Only the operator and scrub nurse wear hat and mask.

4. We felt a CCL is not a ‘proper’ operating theatre and therefore we could make our own policy up.

5. Long hair has to be tied back and there have been no issues with staff not complying with this common sense rule. All staff are encouraged to wear a visor during angio and PCI procedures as protection from blood droplets.

6. We got rid of all the blue shoes. After all, patients arriving on beds that had been pushed on public hospital corridors went straight into the labs. Why fuss with in and out shoes? They did not make sense and our changing room is less cluttered.

7. Our infection rate is well below the national average, in fact I can’t remember an infected device in the past year.
   

Annie Williamson, Superintendent Radiographer, Guy's and St Thomas' Hospital, LONDON, UK

We only wear hats and masks during device implants/TAVI’s etc where there is an open wound (and when most procedures are carried out in a room with full positive pressure theatre ventilation). None of the staff wear hats and masks for interventional procedures but these are usually performed in Cath Labs with ‘treatment’ room ventilation.

We do not allow scrub staff to wear their scrubs (which are blue) outside the immediate Lab/department but running staff may move freely around whilst inside the hospital buildings wearing theirs (pink). No problem with infection rates.

Bryan Walker, Superintendent Radiographer, Manchester Heart Centre, MANCHESTER, UK

We are very consistent in wearing caps and masks with devices, but for very little else. For some congenital cases the operators do, but no one else in the room. The only regular exception is that anaesthetists appear not to adhere to this. I too wonder why.

Dennis Sandeman, Chest Pain Nurse Specialist, NHS Fife, Scotland, UK

At the Golden Jubilee Hospital in Glasgow they too do not wear hats or masks in the cath lab or EP labs unless a “device” is being implanted. Hats and masks as usual in theatre for PFO/ASD closure etc.