Electrophysiology Procedures & Cardiac Rhythm Management —
Training activity: 2

Details

Maintain sterile field during CRM cath lab procedures

Type

Entrustable training activity (ETA)

Evidence requirements

Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion. ​

Reflection at multiple timepoints on the trainee learning journey for this activity.

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

What does success look like?

• Identify what are the expectations for maintaining a sterile field during CRM cath lab procedures.
• Consider how the relevant learning outcomes apply, specifically concerning infection control and patient safety principles.
• Discuss with your training officer to gain clarity on expectations for maintaining sterility within the dynamic procedural environment, for example, during equipment transfer or patient draping.

What is your prior experience of this activity?

• Think about what you already know about maintaining sterile fields.
• Consider possible challenges that might arise during a CRM procedure that could impact sterility, such as a break in technique during cable management or device handling, and think about how you might handle them.
• Recognise the scope of your own practice for this activity, i.e., know when you will need to seek advice or help concerning sterility issues, and from whom.
• Acknowledge how you feel about maintaining sterile field during the cath lab procedures.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop related to proactively observing and correcting potential breaches of sterility.
• Identify specific insights you hope to gain regarding sterile practice in the context of device implantation.

What additional considerations do you need to make?

• Consult actions identified from previous experiences with maintaining sterile fields.
• Identify any important information you need to consider about the specific procedure or environment beforehand, such as the flow and specific needs of the procedure.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst moving within the sterile area or handling equipment?
• Are you encountering situations such as:
  • Noticing a near miss or an actual breach of the sterile field, such as accidental contact with a non-sterile item or person?
  • Complex manoeuvres or unexpected movements near the sterile field that require immediate concentration to avoid contamination?

How are you reacting to the unexpected development?

• How is this impacting your actions? For example, are you responding to the situation appropriately? Are you deciding when to alert someone to a potential breach?
• Consider the steps you are taking in the moment, such as:
  • Actively positioning yourself to minimise risk during complex interactions near the sterile field?
  • Seeking immediate clarification from a senior colleague or the scrub nurse/physician if you are unsure if a breach has occurred?
• How are you feeling in that moment? For instance, are you finding it difficult to maintain awareness of sterile boundaries? Is it affecting your confidence in complex manoeuvres near the sterile field?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are your actions focused on maintaining the sterile field appropriate for your role in assisting the procedure?
• What are you learning as a result of the unexpected development? For example, are you gaining a better sense of common risks to the sterile field in this environment?

On action

What happened?

• Begin by summarising the key points of the experience of maintaining the sterile field.
• Consider specific events, actions, or interactions which felt important, such as challenges in the environment or interactions with other team members regarding sterility. Describe the steps you took to maintain the sterile field and note any near misses.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately adapting your movement to avoid contact with a non-sterile surface or cable during equipment transfer. How did you feel during this experience?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding sterile technique. What strengths did you demonstrate (e.g., vigilance)? What skills and/or knowledge gaps were evident, such as identifying personal habits or environmental factors that pose risks to sterility?
• How does this activity reinforce the importance of sterility in preventing infection?
• Identify any challenges you experienced, and how you reacted to these.

What will you take from the experience moving forward?

• Identify the actions or ‘next steps’ you will now take, including incorporating any feedback you have received with regards to maintaining sterility.
• Identify specific practices you will adopt or reinforce to improve your maintenance of the sterile field in future procedures. Has anything changed in terms of what you would do if you were faced with a similar situation again?
• Do you need to practise any aspect of the activity further, such as reviewing draping protocols?

Beyond action

Have you revisited the experiences?

• Have you reviewed your actions from your previous reflections for this activity? What specific points of vulnerability or techniques for ensuring sterility did you previously identify as challenging or requiring more attention? Have you completed these previously identified actions? For example, if you planned to review the standard operating procedure for device handling within the sterile environment, how did completing this action impact your subsequent effectiveness in maintaining the sterile field?
• Engage in professional storytelling with peers, near peers, or colleagues about sterile technique best practices or near-miss incidents, such as anticipating movement that might lead to a breach. How has discussing these conversations reinforced critical principles or highlighted nuances you hadn’t considered?

How have these experiences impacted upon current practice?

• Consider how the accumulated learning from performing or reflecting on sterile field maintenance will support you in preparing for observed ‘in-person’ assessments for the module, such as a Direct Observation of Practical Skills (DOPS) that assesses your conduct during a device implant.
• How has your practice in awareness of potential contamination points and prevention improved over time? For example, how does this developing skill contribute to patient safety during other invasive procedures like electrophysiology (EP) studies or lead extractions?
• What transferable skills e.g., procedural vigilance or contamination control did you develop through this activity, and how will this understanding help you contribute to safety during other surgical or interventional procedures?

Relevant learning outcomes

#	Outcome
# 1	Outcome Demonstrate effective physiological and scientific support for complex CIED implant, providing technical expertise, ensuring patient safety and appropriate procedural documentation.