OR Today - April 2014 by MD Publishing

INDUSTRY INSIGHTS

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Or PrOcessiNg ‘B17 Phase’

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CONTENTS

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OR TODAY | April 2014

54 CORPORATE PROFILE

Sage Services Group offers solutions for improving Quality of Care, Reducing the Risk of Healthcare-Acquired Infections, and Saving Money

INFECTION PREVENTION PERSIST

Details about healthcare-associated infections have resulted increased awareness on prevention with organizations and facilities promoting education and hand hygiene compliance as well as new high-tech solutions.

SPOTLIGHT ON

Staff at Children’s Healthcare of Atlanta go above and beyond the call of duty when winter storm causes chaos in Georgia’s largest city.

OR Today (Vol. 14, Issue #3) April 2014 is published monthly by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 302691530. POSTMASTER: Send address changes to OR Today at 18 Eastbrook Bend, Peachtree City, GA 30269-1530. For subscription information visit www.ortoday.com. The information and opinions expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher. Reproduction in whole or in part without written permission is prohibited. © 2014

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April 2014 | OR TODAY

contents

departments

Publisher

John M. Krieg | john@mdpublishing.com

vice president

Kristin Leavoy | kristin@mdpublishing.com

EDITOR

John Wallace | jwallace@mdpublishing.com

art department Jonathan Riley Yareia Frazier Jessica Laurain

account executives

Sharon Farley | sharon@mdpublishing.com Warren Kaufman | warren@mdpublishing.com

INDUSTRY INSIGHTS

11 News & Notes 14 AAAHC Update 16 ASC Update 26 OR Processing’s ‘B-17 Phase’

Jayme McKelvey | jayme@mdpublishing.com

Circulation Bethany Williams

accounting Sue Cinq-Mars

web Services Nam Bui Taylor Martin Michelle McMonigle

company showcase 22 Clorox Healthcare

iN THE OR 30 33 34 42

Suite Talk Market Analysis Product Showroom CE Article

OUT OF THE OR 74 Health 76 Fitness 80 Nutrition 82 Recipe 86 Pinboard

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industry insights news & notes

STAFF REPORTS

Kimberly-Clark Awarded Contract for Hand Hygiene Products Kimberly-Clark and Novation has announced that for the first time in the history of the Kleenex brand, Kimberly-Clark is offering its complete line of hand-hygiene products via an exclusive contract through NOVAPLUS. The new five-year agreement represents the first NOVAPLUS contract for hand-hygiene products. Through the agreement, Kleenex and Scott antimicrobial hand soap and washes, instant hand sanitizers, dispensers, and hand lotion will be sold and supported through the program. This provides savings of up to 20 percent to the more than 100,000 hospitals and affiliates that Novation serves, including members of VHA, UHC, Children’s Hospital Association and Provista. The effort is designed to help healthcare organizations — as well as educational institutions — lower costs and increase the quality of care and experience in the

critical areas of hygiene compliance and infection prevention. Through the agreement, Kleenex hand hygiene products will be sold and marketed using the recognition and support of the highly recognized

NOVAPLUS private-label program, which delivers the best financial value on the products and services that hospitals use most frequently.

MEDLINE ACQUIRES PROFESSIONAL HOSPITAL SUPPLY Medline Industries Inc. has announced that it has acquired Professional Hospital Supply and all related facilities to complement its highly successful and fast-growing business. PHS is a privately held distributor of medical and surgical supplies, including sterile procedure trays, and will continue to operate in Temecula, Calif. under the PHS name as a Medline subsidiary. The companies are not disclosing financial terms of the agreement. “PHS is a successful business with talented employees which, like us, is family owned, privately held and shares a passion for customer satisfaction,” said Charlie Mills, chief executive officer of Medline. “Combining Medline’s strong and growing portfolio of products and distribution network with PHS’ superior customer relationships allows us to establish a new industry benchmark for superior quality, service and value.” With the acquisition, the combined companies will have more than 12,000 employees worldwide, 1,200 sales representatives, 40 distribution centers, 19 manufacturing facilities and 350,000 medical and surgical products. Combined sales of the two companies in 2013 exceeded $6.6 billion.

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April 2014 | OR TODAY

INDUSTRY INSIGHTS NEWS & NOTES

MEGADYNE UNVEILS NEW E-Z CLEAN PRECISION BLADE Megadyne Medical Products has unveiled new E-Z Clean Precision blade electrodes. The design features a smaller blade width than standard electrosurgical tips allowing for reduced power settings and increased control to maneuver in small spaces, with minimal risk of collateral tissue damage. The EZ-Clean Precision Blades expand Megadyne’s offering of specialty electrodes for precise cases. The non-stick PTFE coating decreases eschar build-up, reducing smoke and allowing surgeons to achieve consistent cutting and coagulation. Additionally, the product can remove a potentially dangerous sharp needle from the surgical field.

ECOLAB LAUNCHES NEXA HAND HYGIENE PLATFORM

Ecolab introduces Nexa, a new hand hygiene dispensing platform that makes it easier to promote good hand-washing practices and reduce the spread of infectious diseases in healthcare facilities. According to the Centers for Disease Control and Prevention, an estimated 80 percent of all infections are transmitted by hands, and hand washing is the single most effective way to reduce the spread of infectious diseases. Failing to sufficiently wash one’s hands significantly contributes to the spread of foodborne illness outbreaks and also to the 1.7 million healthcare-acquired infections that occur in the U.S. each year. The Nexa platform can dispense an array of Ecolab hand hygiene products, including liquid and foam hand soaps, lotions, hand sanitizers and body shampoos, all from the same unit, making changing of products easy. Depending upon the product used, Nexa dispensers can be installed near commercial kitchen sinks, in restrooms and public spaces of commercial buildings, and at nurses’ stations, in patient rooms and in public areas of healthcare facilities. Nexa’s simple design meets ADA guidelines and offers many benefits. FOR MORE INFORMATION about Nexa, visit www.ecolab.com/handhygiene.

OR TODAY | April 2014

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A Comprehensive Approach to Environmental Hygiene in the O.R. Ecolab’s EnCompass® Environmental Hygiene Program with CleanOp® Room Turnover Kits takes a focused approach to O.R. cleaning and turnover that provides healthcare facilities with a complete program designed to improve cleaning outcomes in the O.R. \ Improve O.R. turnover time with streamlined cleaning procedures and tools \ Customize solutions with Mojave® super-absorbent linens and disposable microfiber cloths and mops \ Provide training to help staff efficiently turn the O.R. \ Comply with AORN, OSHA and Joint Commission guidelines \ Objectively monitor cleaning outcomes with the EnCompass® Monitoring Program featuring DAZO® Fluorescent Marking Gel and real time reporting For more information: 800 824 307 or www.ecolab.com/healthcare

industry insights AAAHC UPDATE

by Geoffrey Charlton-Perrin

You have an excellent ASC. Who knows that besides you?

ou have some of the most experienced surgeons, caring nurses, and helpful administrative staff, working in your well-run, well-equipped surgery center. So what else could you possibly need? The patients will come in droves, right? Well, possibly. If they do, you’ll sleep soundly at night knowing that you are providing quality care and a vital service to the community. But what if you’re newly established? Or hidden away in some corner of a commercial park, where most of the traffic is 18-wheelers and pizza delivery trucks. How do you make your presence known to people in need of surgery? If you have an affiliation with a primary care organization, you will most likely benefit from referrals. In which case, no problem. But if you don’t, what then? Marketing. Marketing!? Isn’t that like those telemarketers who call as you’re sitting down to dinner? Well, yes, that is a kind of marketing. But marketing can take many forms – it’s not always the work of the devil. Marketing can help get food to starving nations or vital supplies to earthquake victims, or help deserving professionals like you, just as often as interrupting you at mealtimes or when you’re in the shower. 14 OR TODAY | April 2014

It’s also the most effective way to get your story out to hundreds of potential patients you’ve never met. Think of both marketing and advertising as communications, then maybe your stomach won’t churn so much. Now, if you happen to be a new facility of a large ASC group, your headquarters may already be advertising on billboards, with radio commercials, or by placing advertisements in local publications so you will benefit along with your sister locations. But if you’re a single location, and only recently opened, advertising may be out of reach. Fear not. There are other ways you can reach out to the public. Let’s start by getting the word out. Write an announcement letter to send to third-party payers, business and community leaders, local government agencies, local medical societies, professional organizations and current patients. It

should be signed by a senior person in your organization. Send a news release and deliver it to your local newspaper. If you’re a new facility, that itself is worthy of mention in the local paper. If you have been around a while, you may have to create a special event an open house, for instance. Send a news release to the local newspaper to announce this event. If you’re particularly enterprising, you may be able to get the newspaper to cover it as a news event. If you’re located in a small town, invite the mayor and other community leaders or local officials. During the event, make sure you have designated someone to take plenty of photographs to send to the newspaper. Try to make the shots as interesting as possible – preferably no pictures of four people standing side by side holding plates of egg rolls. (Oh yes, did I mention that it would be nice to provide hors d’oeuvres for the visitors?) Is there a writer in the house? If one of your staff harbors secret desires to be a latter-day Hemingway, they might write a health-oriented article for the health section of your local newspaper or submit it to WWW.ORTODAY.COM

AAAHC Update

a medical publication geared to a surgical readership. Just make sure it is relevant to the magazine’s audience; and – very important – that the writer’s connection with your ASC is clearly noted. Of course, there is no better advertising than word of mouth; if you regularly achieve successful outcomes, you may create a torrent of satisfied patients who extol your capabilities to friends and neighbors. And that’s great. But one-on-one advertising can take quite a long time. Getting coverage in the media can work quicker if you’re prepared to put in the time. Making yourself available for public speaking – at a local library, association or at medical conferences and meetings – can also help spread your facility’s reputation. It takes commitment and determination to promote your ASC. But it can be done. Who knows? You may end up with more patients and a new-found admiration for marketing! About the Author Geoffrey Charlton-Perrin is director of marketing and communications for AAAHC, the nation’s largest ambulatory healthcare accrediting organization. Previously, he was director of marketing for the Chicago Convention and Tourism Bureau, and before that president of a major Chicago advertising agency.

WWW.ORTODAY.COM

Guidelines for Preparing a Professional News Release By now, you may be thinking: “How on earth do I write a news release?” Well, it’s not as hard as you might think. For starters, there are many how-to websites that can help. They may also include a template that you can tailor to your particular organization. Here are a few specifics to bear in mind as you sit down to prepare a news release for local newspapers, professional publications and newsletters, or radio and television stations, to promote your facility:

Identify a contact for your organization. This individual will receive calls from the media when a recipient of your release wants more information. Include your contact’s name, telephone number and email address in the upper righthand corner of the first page of the release.

2 3

A quote from your chief medical officer, administrator or other senior staff member always helps.

you’ve been around a while; or how you came to be formed if you’re new to the area.

4 5

Include the words “For Immediate Release” and the date in the first line of copy.

For any release longer than one page, put the word “more” at the bottom center of the first page and repeat the first few words of the headline at the top of the second page. Use two sheets of paper; don’t send a two-sided copy. For a release of any length, indicate the end of the release with three pound signs (###).

Send the release directly to the editor/producer in charge of healthcare news. Some organizations have found that hand delivering a release gets good results.

Include a photo or a note at the end of the release that a photo is available on request.

Include information about your organization’s history within the community if

April 2014 | OR TODAY

industry insights ASC update

by William Prentice

Medicare Needs to Protect the Original Goals of Its ASC Quality Reporting Program

ata collection for a national ASC quality reporting program tied to the services that ASCs provide to Medicare beneficiaries and coordinated by the Centers for Medicare and Medicaid Services (CMS) began in 2012. Believing that a national ASC quality reporting program managed by CMS would allow ASCs to demonstrate the high quality of care that they provide and provide lasting benefits for patients, the ASC community had long advocated for a program of this kind. To support the program’s development, representatives of the ASC community worked with the National Quality Forum (NQF) to identify measures that would be both meaningful and appropriate for the ASC setting. Early in the program, CMS asked ASCs to report on five measures backed by both the ASC community and NQF. Four of the measures involved the reporting of adverse events, such as patient falls and wrong-site surgery, and one targeted the timing of the delivery of prophylactic IV antibiotics before surgery. ASCs embraced the new program, and more than 98 percent of eligible centers complied with

16 OR TODAY | April 2014

the reporting requirements in the program’s first year. From the beginning, CMS indicated that ASCs would be asked to report on additional quality measures in the future. Two of those measures that CMS identified early on were the use of a safe surgery checklist and influenza vaccinations among healthcare professionals who work in ASCs. Beginning in 2013, CMS also asked ASCs to begin

reporting surgical volume for certain procedures performed in the previous calendar year. Although those reports did not pertain directly to quality of care, ASCs worked to comply. Despite some difficulties that ASCs encountered in determining how to report the original five measures on their Medicare claim forms and gaining access to the CMS QualityNet website that they use to report the other data, the program appeared to be heading in a good direction and the ASC community looked forward to seeing the results of the data collection. In the middle of last year, however, CMS issued its proposed 2014 Medicare ASC payment rule. In that proposed rule, CMS identified four new measures that the agency planned to ask ASCs to report: • Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures WWW.ORTODAY.COM

asc update

• Endoscopy/Poly Surveillance: Appropriate follow-up interval for normal colonoscopy in average risk patients • Endoscopy/Poly Surveillance: Colonoscopy Interval for Patients with a History of Adenomatous Polyps — Avoidance of Inappropriate Use • Cataracts — Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery ASCA and many others in the healthcare community immediately objected to all four measures, noting that they do not reflect the quality of care an ASC provides and do not address operational areas under the control of an ASC. Instead, they are measures that physicians monitor and are already being reported in the Physician Quality Reporting System (PQRS). Because ASCs do not manage or maintain all of the records where this information could be found, collecting the necessary data to submit these reports is likely to involve a time-consuming and cumbersome process that would be redundant with work others are already doing and reports already being filed elsewhere. ASCA and others submitted comments on the proposed rule, reiterating the ASC community’s support for the national quality reporting program but registering objection to the new measures. In response, CMS removed “Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures” but kept WWW.ORTODAY.COM

Believing that a national ASC quality reporting program managed by CMS would allow ASCs to demonstrate the high quality of care that they provide and provide lasting benefits for patients, the ASC community had long advocated for a program of this kind. the other three measures in the final 2014 ASC payment rule that it issued late last year. As a result, ASCs are preparing to begin collecting data as early as April 1, 2014, to be able to meet the program’s reporting deadlines. Since CMS adopted the three measures contained in its final ASC payment rule for 2014, ASCA and others have been talking with CMS officials and members of Congress about ways of minimizing the burdens that the new measures might place on ASCs. In early February, ASCA joined the American Society for Gastrointestinal Endoscopy (ASGE), the American Gastroenterological Association (AGA) and the American College of Gastroenterology (ACG) in a meeting with CMS staff to discuss the two gastrointestinal (GI) measures. Later in the month, ASCA, the Outpatient Ophthalmic Surgery Society, the Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery met with CMS staff to discuss the measure involving cataract surgery. ASCA and the GI and ophthalmology communities have also requested that CMS continue to work with the ASC community to minimize the reporting burden and redundant reporting efforts that the newly

adopted measures create and seek consensus on future additions to the program. Suggestions for areas that new measures might address include equipment processing, sedation safety, patient experience/satisfaction and post-discharge emergency department visit within 72 hours of an ASC procedure. To learn more about any progress that we make in this area, please check the “Latest News” section on the home page of ASCA’s website (www.ascassociation.org) regularly. If you would like to be involved in ASCA’s efforts related to this issue, please contact Kara Newbury at knewbury@ascassociation.org. Failure to address the concerns that ASCA and others have raised regarding these new quality reporting measures will undermine the national ASC quality reporting program that CMS has established, reduce the value of the program to Medicare and its beneficiaries and place unreasonable burdens on ASCs that will not contribute to improved quality in the ASC setting in any way. William Prentice is the chief executive officer of the Ambulatory Surgery Center Association.

April 2014 | OR TODAY

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company showcase Clorox Healthcare

Clorox

Healthcare

lorox is synonymous with disinfection and its healthcare products live up to the high standards that customers have come to expect when they see the company’s name.

The Clorox Healthcare® Facility in Pleasanton, California

The company was born just over a century ago. It provided products to businesses in the San Francisco Bay Area and from its humble beginnings grew to include many different products for various industries, including healthcare. “The Clorox Company was originally founded in 1913 as The Electro-Alkaline Company,” explains Matt Laszlo, Vice President and General Manager, Clorox 22 OR TODAY | April 2014

Professional Products Company. “The company produced liquid bleach at its first plant in Oakland, California, and sold it to industrial customers in the San Francisco Bay Area. Today, the company offers a diverse portfolio of products which includes products specially formulated for healthcare facilities.” Clorox’s solid reputation in the retail market meant high expectations from customers when Clorox entered the healthcare sector and the company did not disappoint. “When Clorox entered the healthcare market, we tried to raise the bar on how disinfectants should be thought about. We brought more focus to clinical data and to the science that helps healthcare providers reduce HAIs,” Laszlo says. “At Clorox we are always striving for better patient outcomes which aligns us well with the goals of healthcare facilities.” Not only does Clorox strive for better patient outcomes, but it also looks to create solutions to help customers do their jobs more effectively and efficiently. “While liquid bleach has been used in hospitals for decades to disinfect, we saw an opportunity to transform this product into a more effective, user-friendly form to offer customers a facility-wide disinfecting solution,” Laszlo

explains. “We launched our Clorox Healthcare® Bleach Germicidal Wipes into the marketplace about eight years ago and saw a tremendous increase in our healthcare business. We invest significantly in research and development to deliver innovative disinfecting solutions specifically designed for healthcare facilities.” Clorox doesn’t just sell products though. The company partners with its customers in their infection prevention journey. Laszlo says, “Clorox Healthcare has a large team of account managers that are prepared to provide facility assessments to identify areas of concerns and recommendations for standardization and greater compliance. We offer in-service training and product education any time the customer requests it. It’s important that we work with our customers to help them achieve better outcomes in their facilities. “In addition to in-service training, we also invest significantly in educational resources and tools,” he adds. “We create and sponsor webinars and whitepapers to provide education on emerging topics such as the importance of killing germs on soft surfaces. We also create infection prevention toolkits for C. difficile, norovirus and influenza as well as provide relevant pathogen education. Finally, we work WWW.ORTODAY.COM

SPECIAL ADVERTISING SECTION

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Aplicare® 4% CHG Skin Cleansing Kit

with key opinion leaders to ensure that customers are getting the clinical data they need to make the right decisions for their facilities.” After almost a decade serving the healthcare industry the company is looking forward to the future and continuing to support this very important sector that impacts lives on a daily basis. “Surface disinfection is a core competency and has been for over 100 years. What excites us about the future is extending that clinical and technical expertise into other areas of infection control like skin antisepsis,” Laszlo says. “We truly feel that we have the technological capability to win in this space. We have best-inclass scientists that work tirelessly to develop solutions that will help our customers fight the spread of HAIs.” The company is expanding both its disinfection and its skin antisepsis product portfolios. One new venture has been the introduction of disinfectants that can play a significant role in the operating room. “We recently launched a new line of disinfectants that are hydrogen peroxide-based. Hydrogen peroxide has allowed us to deliver fast disinfecting kill times in a non-bleach form. We believe this product is a great solution for the operating room where fast turnover times in between surgeries are critical,” Laszlo says. In April, we will introduce the new Aplicare® 2-in-1 CHG Skin Cleansing Kit. The kit has a unique design that promotes compliance with AORN recommendations for 2 CHG cleanses prior to surgery,” he adds. “The kit removes barriers to patient compliWWW.ORTODAY.COM

ance by giving patients everything they need in one convenient, easy-touse package, including a bilingual, waterproof instruction card that can be taken into the shower for easy reference and access to instructional videos on Aplicare’s website. It’s a great example of where we’ve listened to issues of OR staff and developed a solution to address that need. These new products are just the beginning. “We have a strong focus on innovation and we have big plans to take surface disinfection and skin antisepsis to the next level over the next few years,” Laszlo says. “We will achieve this through our own technology development as well as partnerships and acquisitions with companies that align well with our strategies.” An example of this partnership strategy is the recent venture between Clorox Healthcare and Ultraviolet Devices, Inc. (UVDI) to introduce the Clorox HealthcareTM Optimum-UVTM System. For the first time ever, the two companies will team up to combine the power of manual surface disinfection with advanced ultraviolet (UV) technology to deliver an even more comprehensive surface disinfection solution. “This partnership signifies the importance of and the need for a bundling of environmental surface solutions, so hospitals can take a more comprehensive approach to reduce the threat of infections among patients, staff and visitors. With the Clorox Healthcare™ Optimum-UV™ System, there is now a solution that works hand-in-hand with routine manual cleaning and

Aplicare® Skin Antisepsis Solutions

disinfecting procedures to reduce the threat of infection” Laszlo says. Laszlo is quick to point out that the success of Clorox Healthcare is a direct result of its employees and their hard work. “Clorox’s greatest asset is its people. Within Clorox Healthcare, many of the team-members have a personal mission to improve patient outcomes because their personal lives have been impacted by HAIs,” he explains. “This personal commitment results in creating leaders that can make an impact both at Clorox and in the healthcare community.” The employees’ focus goes well with the Clorox Healthcare mission statement and together they provide a recipe that produces great results. “The mission statement for our healthcare business is to ‘save lives by delivering comprehensive solutions that help eliminate healthcare-acquired infections.’ Everything we do has the patient and healthcare provider in mind and inspires us to deliver high-performing, effective solutions,” Laszlo says. fOr MOre iNfOrMaTiON about Clorox Healthcare, visit www.cloroxhealthcare.com April 2014 | OR TODAY

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industry insights By J. Darrel Hicks, BA, REH, CHESP

OR Processing’s ‘B-17 Phase’

Using Checklists to Ensure a 24/7 Safer Operating Room Environment

he original checklists used by pilots and co-pilots were developed to make sure that everything was done, and that nothing was overlooked or forgotten – to eliminate accidents and incidents. Similarly, new “best-practice” checklists developed specifically for OR processing are paving the way to a safer operating room environment, especially in those scenarios involving several infection prevention modes of practice.

In his pioneering book, “The Checklist Manifesto: How to Get Things Right,” surgeon and writer Atul Gawande makes clear the reasons why checklists are an absolute necessity in life if we are to get things done right. Gawande cites architects and pilots – and physicians and surgeons – among the professionals who recognize that checklists are essential if they are to succeed and perform safely. I would argue that Gawande might say that processing the operating room today has entered its “B-17 phase.” That is to say, in today’s environment, the checklist should soon become a mandatory tool for ensuring the quality of cleaning and disinfection of the OR in the same way the checklist was first developed in the 1930s for the new and complicated B-17 aircraft: 26 OR TODAY | April 2014

To make sure in complex situations that everything is done, that nothing is overlooked or forgotten; to eliminate accidents and incidents. Fortunately, new checklists that are focused specifically on OR processing best practices are now available and are being embraced by those clinicians who have recognized their value to ensuring patient safety. These new checklists come at a critical time. Patients must be provided a clean, safe environment. Healthcare-associated infections (HAIs) have been linked to external sources, which can include environmental surfaces. The risk of infection from pathogenic organisms on environmental surfaces is due not only to their presence but to their ability to survive on and be transferred to many surfaces.

In order to prevent surgical wound infections, a multimodal approach is necessary. There are many disciplines involved in protecting the health and safety of surgical patients and staff. Here is an essential inventory of some of the key infection prevention modes of practice: • Employee health • Surgical draping • Surgical environments – floors, walls, ceilings and the absence of floor drains; all vinyl coverings on mattresses, stools, chair arms, etc. should be free of tears and splits; • Temperature and humidity • Airborne contamination and ventilation systems • Traffic control • Handling of infectious waste, linen and sharps • Intra-operative infection control responsibilities of both the circulator and scrub tech • Housekeeping requirements Sanitation protocols for cleaning and disinfection are required before, during and after each procedure. Environmental cleaning is the framework and basis for all aseptic practices. This is why I believe the WWW.ORTODAY.COM

OR Processing ‘B17 Phase’

time has come for a checklist that covers the 24/7 clean-and-ready condition of the surgical suite. This checklist will aid those who are responsible for processing the OR on a regular basis. (The term “process” as used includes cleaning and disinfecting an item or area using a clean micro-denier cloth or flat mop, as appropriate and an EPA-registered disinfectant.) In one instance of the kind of checklist I’m talking about, the Association of periOperative Registered Nurses (AORN) recently awarded its AORN Seal of Recognition™ to the PerfectCLEAN® Operating Room program developed by UMF Corp., a manufacturer and innovator of infection prevention products. UMF Corp. broke down the processing of the surgical suite into the same four segments identified in the “Recommended practices for environmental cleaning in the perioperative setting. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2013:243-254.” Those segments (and the four separate checklists) are: • OR 24-Hour Idle Processing Unused rooms should be

processed once every 24 hours to ensure their readiness for surgery in an emergency situation where the room is needed immediately.

• OR Pre-First Procedure Processing Includes removing unnecessary

equipment based upon direction of the charge nurse and arranges remaining equipment as directed; process overhead surgical lights,

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all horizontal (upward facing) surfaces including tables, counter tops, equipment and floors. • OR Between Procedure Processing Due to the heavy surgical

schedule, room turnover has to be performed by several people working in concert. Once nursing and the anesthesia techs have performed their necessary duties, the room must be processed by the cleaning staff all within a 10- to 15-minute window (some processing may take up to an hour depending on the size of the room, the amount of equipment to be processed and the excessive soiling of the area). This is truly “team cleaning.”

• OR Terminal (End-of-the-Day) Processing

This is performed in each individual operating room when the last case of the day is finished; is usually done only once in a 24-hour period. The decontamination process begins at the highest level (light tracks, ceiling fixtures) and progresses downward (floors and baseboards) with an eye for blood or other potentially infectious material (e.g., flesh, bone, etc.). Using a clean micro-denier cloth and appropriate disinfectant, thoroughly wipe down all furniture and furnishing paying particular attention to the surgical table and the area/equipment within 5 feet of the table. There may be items that the anesthesia tech or OR orderly is responsible for cleaning and disinfecting; make sure they are using a micro-denier cloth and appropriate disinfectant when

performing these tasks. Wet scrub the entire floor, wall-to-wall, moving and replacing furniture as you go.

Each of these four newly available checklists is laminated. These “best-practice” checklists provide the “cleaning task description” with separate boxes for the cleaner’s initials and the inspector’s initials and is able to be wet cleaned and disinfected. Realizing that wall space is a precious commodity in the OR, one should have a prominent and consistent spot where these checklists are displayed. The checklists provide a visible reminder of processing tasks and hold the appropriate staff member responsible and accountable for performing them. Just like the checklists used by B-17 pilots and co-pilots that prevented loss of life and valuable military assets, the implementation of these four checklists helps ensure that patients are provided a safe and clean surgical environment. After all, the sanitation of the surgical theatre is among the key approaches to the prevention of surgical site infections. J. Darrel Hicks has more than 30 years of experience providing safe and clean hospital ORs.

April 2014 | OR TODAY

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OR TODAY | April 2014

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April 2014 | OR TODA TODAY

In The OR suite talk

Suite Talk

Conversations from the OR Nation’s Listserv

Post-case transportation to decontamination room I was wondering what others are doing to cover the back table during transport to the decontamination room? I manage a small OR department where decontamination and CS are within the department and about a two-minute walk from the OR. We just had a mock Joint Commission survey and they said that covering the back table with an impervious disposable drape no longer meets requirements. So, I was wondering what should we use? A: We have always covered it with a sheet after all fluids have been emptied or sucked up in the room. A: We have a closed case cart system from Metro. Our bags of trash and linens are closed and placed on top of the case cart. The instruments and basins (without fluids) are placed within the case cart and the doors are closed before exiting the room to be moved to the soiled utility room for trash drop off and then to the decontamination area for CSS. A: Everything that is not thrown in the trash or the biohazard containers needs to be transported to the decontamination room in closed containers. We purchased some Rubbermaid containers with lids to transport instruments, etc., to decontamination. A: That is correct, we were told the same thing and now transport all in a case cart. A: I agree that items to be transported to the decontamination room must be in closed containers. The facilities I have worked in use stainless steel container systems that can be put through the washer/sanitizer after each use. Is this how you wash and sanitize your Rubbermaid containers? A: Is there a Joint Commission point regarding closed containers? Many smaller facilities don’t have the case cart washing systems and are using impervious drapes to cover the table, but we’ll need to rethink this process if the Joint Commission no longer allows it. A: We don’t have a case cart washing system as we are also a small facility. We have been using the impervious drapes as well to cover the table, but it sounds like this will not fly with the Joint Commission. A: Yes, we did put our containers through the washer/sanitizer. We now have closed metal case carts that require hand washing and they are sprayed with disinfectant.

30 OR TODAY | April 2014

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suite talk

old school protocol Am I turning into the “mean old OR nurse?” Remember your first day in the OR? Frightening, huh? Standing up against the wall, and being told not to touch anything blue, hoping no one asked you for anything. Flirting with surgeons and participating in jokes was not an option. Some younger/greener staff do not take their job seriously. When putting a patient under, keep quiet, don’t talk about other patients, and turn the music down. Sometimes it seems like I am at home with my kids. Being friendly with surgeons, participating in interesting conversation, and being professional is all good and well. But, there is a time and a place for this. How come some people don’t know the difference? A: It is very frustrating for us old school nurses! A: I agree, but the surgeons and anesthesia have also changed over the years and are part of the problem. A: You are not turning into the old mean nurse. There was a time when nursing in general was more professional – not just in the OR. I can recall having to give up my chair when physicians came to the nursing unit. Times have changed, for sure. I agree there is a time and a place for everything. Loud music, flirting and inappropriate jokes should not take place in the operating room. Seasoned, professional OR nurses should continue to expect a standard of professional behaviors in the OR. If we lower the standards, what will be expected of future generations? Friendly, yet professional, interactions with surgeons and participation in interesting conversations is what we should expect now and in the future. It is up to us to help future generations understand the difference. A: Remind the younger generation the reason we are all here and that is the patient! Let them know! It may help for a while, until you have to do it again. A: Amen to that! A: Thank you, I agree. I, too, remember giving up my chair as a student. Thankfully, this has changed for the better. However, the patient still comes first above all else. We should continue to expect a good rapport with our peers and impart this to our nursing students who visit occasionally.

These posts are from OR Nation’s Listserv For more information or to join the conversation, visit www.theornation.com.

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April 2014 | OR TODAY

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In The OR market analysis

by JOhn Wallace

market analysis

Disinfectants market expected to reach $2.9B by 2017

ealthcare-associated infections (HAIs) are a growing concern and more emphasis is being placed on eliminating potentially deadly episodes.

The Centers for Disease Control and Prevention (CDC) define HAIs as “infections that patients acquire during the course of receiving healthcare treatment for other conditions.” The CDC reports that medical care-related infections can be devastating and even deadly. They can also be costly for healthcare providers. A 2009 study published by the CDC estimates that the annual direct hospital cost of treating HAIs in the United States is in the billions. “Applying two different Consumer Price Index (CPI) adjustments to account for the rate of inflation in hospital resource prices, the overall annual direct medical costs of HAI to U.S. hospitals ranges from $28.4 to $33.8 billion (after adjusting to 2007 dollars using the CPI for all urban consumers) and $35.7 billion to $45 billion (after adjusting to 2007 dollars using the CPI for inpatient hospital services),” according to the CDC study. “After adjusting for the range of effectiveness of possible infection control interventions, the benefits of prevention range from a low of $5.7 to $6.8 billion (20 percent WWW.ORTODAY.COM

of infections preventable, CPI for all urban consumers) to a high of $25.0 to $31.5 billion (70 percent of infections preventable, CPI for inpatient hospital services).” These factors help account for the growth of the global disinfectants market. According to a report from Global Industry Analysts Inc., the market is also driven by an increased focus on hygiene and growing concerns over the spread of infectious diseases both at home and in public places. Rising demands in the food and healthcare industries will continue to drive the market. In those industries, cleaning and sanitation are vital for safety. Disinfectant chemicals are also becoming more common as an ingredient in various conventional and industrial cleaning products. The GIA report indicated “that outbreaks of infectious diseases and epidemics, such as, Swine Flu (H1N1), Avian Influenza (Bird Flu), Pertussis, Common Flu, Cholera, and West Nile Virus Infection, among others, have made spending on cleaning and disinfectant products

less discretionary and more indispensable. The role played by cleaning and disinfectant products in addressing key society and social issues related to health and well being makes the market for the same resilient to recessionary forces.” The report says that the global disinfectants market will remain strong because sanitation and hygiene are essential. GIA says the global market will reach $2.9 billion by 2017. Aerosol and liquid products are the most commonly used surface disinfectants, though a growing number of hospitals and healthcare facilities are implementing ultraviolet (UV) disinfection systems as an additional measure. Promotional campaigns and a demand from developing markets, especially the Asia-Pacific region, will also help push the market to new heights. The GIA report indicates that major players in the global disinfectants marketplace include 3M Company, Ecolab Inc., Henkel KGaA, Kao Corporation, Prestige Brands Inc., Procter & Gamble Co., Reckitt Benckiser Plc, SC Johnson & Son Inc., Sealed Air Corporation, Diversey Inc., The Clorox Company, Unilever Plc, and Zep Inc. April 2014 | OR TODAY

In The OR product showroom

Ruhof Biocide® Detergent Disinfectant Pump Spray Ruhof Biocide® Detergent Disinfectant Pump Spray is a quaternary germicide for cleaning, disinfecting and deodorizing any hard, non-porous surface. Ruhof Biocide® is bactericidal, virucidal, fungicidal, tuberculocidal and non-corrosive. It is ideal for use on all hard, non-porous inanimate environmental surfaces including floors, walls, metal surfaces, stainless steel surfaces, bathrooms, shower stalls, bathtubs, cabinets, and more. In addition, this product deodorizes smelly areas such as garbage storage areas, basements, restrooms and other places that are prone to odors caused by microorganisms. Ruhof Biocide® is also effective against Mycobacterium tuberculosis (BCG) at 20 degrees C, Staphylococcus aureus, Salmonella choleraesuis, Pseudomonas aeruginosa, Clostridium difficile vegetative form (C.diff), Escherichia coli 0157:H7, Methicillin resistant Staphylococcus aureus (MRSA), Vancomycin intermediate resistant Staphylococcus aureus (VISA), Vancomycin resistant Enterococcus faecalis (VRE), HIV-1 virus (associated with AIDS), Polio virus Type 1, Hepatitis B virus (HBV), Tricophyton mentagrophytes (athlete’s foot fungus), mold and mildew.

34 OR TODAY | April 2014

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Product Showroom

Clorox Healthcare™ Optimum-UV™ System Clorox Healthcare, known for its line of innovative hospital disinfectants, is now partnering with Ultraviolet Devices Inc. (UVDI) to introduce the Clorox Healthcare™ Optimum-UV™ System. For the first time ever, the two companies are teaming up to combine the power of manual surface disinfection with advanced ultraviolet (UV) technology to deliver an even more comprehensive surface disinfection solution. The Optimum-UV™ System utilizes UV-C technology to inactivate pathogens, achieving 99.992 percent C. difficile reduction in five minutes at eight feet. The partnership with UVDI reinforces Clorox Healthcare’s commitment to helping healthcare professionals stop the spread of infections. For more information, visit www.CloroxHealthcare.com/UV.

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April 2014 | OR TODAY

In The OR product focus

TRU-D SmartUVC™ Lumalier’s TRU-D SmartUVC™ is a smart UVC disinfection device. TRU-D sees and measures its surroundings with intuitive Sensor360™ technology, which ensures precise and accurate delivery of UV light energy for complete terminal disinfection of healthcare environments, making them safer for patients and improving patient outcomes. TRU-D automatically calculates the pathogen-lethal UV dose required for each room, dynamically compensating for room size, shape and other dosealtering variables such as the position of contents, windows, blinds and doors. Tru-D is safe to use in rooms with glass windows and doors. UVC is not transmitted through glass windows.

36 OR TODAY | April 2014

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Product Showroom

STERIS PATHOGONâ&#x201E;˘ UV Disinfection System Independent studies prove PATHOGON UV Disinfection System is effective against pathogens that can cause HAIs. The system is designed for use as part of a complete cleaning and disinfection program. Automated cycle times range from four to 25 minutes, depending on the targeted organism and the size of the space being treated. The process produces no ozone or secondary contaminants, and rooms can be re-occupied immediately after treatment. PATHOGON UV Disinfection System kills 99.999 percent of MRSA and VRE, 99.99 percent of C. diff. spores and eliminates 99.999 percent of viruses.

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February 2013 | OR TODAY

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OR TODAY | April 2014

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In 1979 the Steelers won the Super Bowl. Saturday Night Fever was the album of the year. And AAAHC began accrediting ambulatory health care organizations.

YEARS STRONG

Weâ&#x20AC;&#x2122;ve been raising the bar on ambulatory care through accreditation for 35 years. The secret of our success? Our peer review. AAAHC surveyors are physicians, nurses, anesthesiologists, medical directors and administrators. Which is why organizations routinely heap praise on us for our consultative and educational survey process. And why we are the leader in ambulatory accreditation.

If you would like to know more about AAAHC accreditation, call us at 847-853-6060. Or email us at info@aaahc.org. Or you can visit our web site at www.aaahc.org. Improving Health Care Quality through Accreditation

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April 2014 | OR TODAY

Some people just look at the surface. We go right to the core.

Introducing the 3M SpotOn Temperature Monitoring System ™

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From the makers of 3M™ Bair Hugger™ therapy and the 3M™ Bair Paws™ system comes an amazingly simple, accurate and non-invasive way to monitor core body temperature throughout the perioperative process. To learn more about this ingenious technology, visit spotontemperature.com.

In The OR continuing education 435C

by Cynthia K. Halvorson, RN, MSN, CNOR, and Nancymarie Phillips, RN, PhD, RNFA, CNOR

continuing education 435C

Safe Labeling Helps Prevent OR Errors The goal of this program is to provide perioperative nurses, surgical technologists and pharmacists with information about the challenges of and effective strategies for medication and solution labeling in the perioperative setting. After studying the information presented here, you will be able to: • Discuss the intent of The Joint Commission’s National Patient Safety Goal NPSG.03.04.01 (formerly 3D), involving labeling medications and solutions on and off the sterile field • Identify the challenges for safe medication administration unique to the perioperative environment • Describe strategies for effective medication and solution labeling on and off the sterile field

Gannett Education guarantees this educational activity is free from bias. The planners and authors have declared no real or perceived conflicts of interest that relate to this educational activity. See page 51 to learn how to earn CE credit for this module.

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veryone is familiar with the adage “What you see is what you get.” But can healthcare professionals rely on it when it comes to safe medication administration in the perioperative setting — or should “Looks are deceiving” be their motto? This module explores patient safety goals and strategies for effective medication and solution labeling on and off the sterile field in the perioperative environment. Perioperative healthcare professionals and pharmacists must be knowledgeable about these concepts so they can promote patient safety and desirable outcomes. Play It Safe Safe and effective patient care is the very core of perioperative practice. The Association of periOperative Registered Nurses (AORN), the professional organization of perioperative RNs, published Perioperative Patient Focused Model, which recognizes that “there is nothing more important to the practicing perioperative nurse than his or her patient.”1 Publications such as the AORN Standards, Recommended

Practices and Guidelines, articles in peer-reviewed journals, research, safe practice guidelines, and tool kits are valuable resources for safe patient care; however, failures in patient care processes and systems still occur and can result in errors in patient care. These occurrences and “near misses” can harm patients. When the error is detected before the care or treatment is administered (a “good catch”), patient harm is avoided. Sometimes, the care is administered but does not appear to cause patient harm. Unfortunately, sometimes the care, treatment or medication is administered erroneously, resulting in temporary or even long-term harm to the patient. These negative outcomes, including medication errors, receive national attention when they become sentinel events.2 April 2014 | OR TODAY

In The OR continuing education 435C

This attention, in particular in the Institute of Medicine’s 1999 report on medical errors, To Err Is Human: Building a Safer Health System, has made patient safety initiatives a priority for healthcare organizations and government agencies.3 In 2002, AORN launched the Patient Safety First campaign to reduce errors in surgical settings and create resources to help perioperative clinicians provide safe patient care. Specific practices include correct patient and surgical site verification and surgical counts, as well as medication safety, which can be found in the AORN Standards and Recommended Practices. The Joint Commission established its National Patient Safety Goals (NPSGs) in 2003, which continue to influence patient care in 2013. Goal 3 (improve the safety of using medications) addresses safe medication and solution administration. Perioperative care areas must meet the three requirements of Goal 3, plus a retired requirement, 3A. NPSG.03.04.01 (formerly 3D) involves the labeling of medications and solutions on and off the sterile field and the improvement of patient safety during the intraoperative phase. Other organizations with a focus on safe medication administration include the Institute for Safe Medication Practice, United States Pharmacopeia and the American Society of Health-System Pharmacists. As defined by the national Coordinating Council for Medication Error Reporting and Prevention (which the United States Pharmacopeia formed in 1995), a medication error is a preventable event that may cause or lead to inappropriate medication use and harm while the medication is in the control of the healthcare professional, patient or consumer.4 Factors 44 OR TODAY | April 2014

related to errors include professional practice; healthcare products; procedures and systems (including prescribing and order communication); labeling, packaging and nomenclature; compounding; dispensing; administration; education; monitoring and use. The outcome of medication errors can be minimal — no risk to the patient — to life-threatening. The Patient Safety Advisory Group (formerly the Sentinel Event Advisory Group), appointed by the Joint Commission in 2002, reviews and documents reported medication error and investigates sentinel events by performing root cause analyses.5 Four of the first seven sentinel event categories in The Joint Commission’s Top 20 sentinel events occur in the perioperative arena, with medication errors as the fifth most reported event.6,7

The Joint Commission’s Top Seven Sentinel Events Wrong site surgery (perioperative setting) Patient suicide Operative/postoperative complications Delay in treatment Medication errors Patient falls Unintended retention of foreign object

NPSG.03.04.01 The NPSGs are intended to develop standards and directions for practice to create a national movement for patient safety. NPSG.03.04.01, the first to specifically address intraoperative practice, recognizes a risk point in the safe administration of medications in the perioperative period.8 It requires clear labeling for medications and solutions that have been removed from their original containers or packaging and transferred to other containers for use on and off the sterile field by a person other than the preparer. This requirement applies to the pre-, intra- and postoperative and procedural components of any patient care setting in which operative or invasive procedures are performed, including medications used by anesthesia providers.5,9 Patient preparation areas, preoperative holding and PACU areas, radiology and imaging services, endoscopy units, and patient care units where “bedside procedures” are performed must meet these implementation expectations.9,10 Characteristics of Perioperative Settings A healthcare facility is a complex environment with many departments and patient care units. In general, facilities are similar in their management of patient care; however, the OR is a different and separate entity with unique nuances and distinct management processes and methods of delivering patient care. In many organizations, the perioperative continuum of care is the most involved, with many critical factors, steps and processes influencing patient outcomes. Several departments and caregivers hand off the WWW.ORTODAY.COM

continuing education 435C

perioperative patient in a short period of time. Generally, the medication process in the OR involves a triad of the prescribing physician, the preparing and dispensing pharmacy, and the circulating nurse and the scrub person, who are the final check before medication administration from the sterile field.11 Characteristics of the perioperative setting create concerns about the safe administration of medication. Multiple healthcare providers provide care simultaneously. Multiple people handle medications dispensed to the sterile field before the surgeon administers them. Unique to the OR is the additional team member, the scrub person (who may be an RN). The scrub person is an intermediary between the medication preparation and dispensing pharmacy and/or the circulating nurse and the surgeon as the final administrator of the medication or solution to the patient. The pharmacist, surgeon and circulating nurse have unique and complementary roles. As licensed professionals, they have primary accountability for their respective responsibilities in the medication administration process as compared to an unlicensed scrub person.5 (The scrub person is often an unlicensed surgical technologist with limited pharmacology knowledge.) Medication Orders The medication process involves the following steps: • Prescribing (a physician’s order) • Processing the order (transcribing and documenting) • Preparing the medication or solution WWW.ORTODAY.COM

• Dispensing • Administering the medication to the patient • Monitoring and documenting the effect of the medication In the OR, the preference card has long been viewed as the primary source for the physician’s written medication orders and as “standing orders.” However, a study evaluating the relationship of preference cards to medication errors found that relying on preference cards may provide a false sense of security.12 The study found major concerns involving information on preference cards, including outdated, incomplete or inaccurate information; revisions that are not reviewed or approved by the surgeon; inconsistent nomenclature (generic vs. brand name); abbreviations that don’t comply to best practices or the facility or Joint Commission’s standards; and unclear and nonnumeric instructions for dosage and concentration calculations. In addition, medications are sometimes listed with options: If local, use medication “A”; if general, use medication “B.” It is particularly frustrating when there isn’t a preference card specific to the operating surgeon or scheduled procedure, making it necessary to use a “similar” procedure card. Since the medications listed on the substitute preference card may not be what the surgeon intends to use, the required medications and solutions must be reviewed and confirmed with the surgeon before the procedure.5 Medication orders may be given verbally in a variety of scenarios: in the preoperative holding area, in the break area or during an OR procedure. All have the potential for errors, particularly medication

orders given verbally in the OR. Masks can muffle speech, several conversations are under way at the same time, and the circulating nurse is juggling priorities. Verbal orders should be repeated back and written down as soon as possible, with the physician signing the order. This can be a problem if the surgeon is scrubbed at the time the order is given. The surgeon must sign the medication order after the surgical procedure is completed. Medication Preparation One surgical procedure can require the preparation and mixing of several medications and solutions. Clear, complete and accurate instructions and conversion charts for the dosage and concentration calculations (including age-specific information) are critical.5,13,14 Satellite pharmacies are the best model for preparing medications and solutions. However, the circulating nurse is responsible for this step when the OR is not supported by a satellite pharmacy and when additional medications and solutions are ordered during the case. Typical practice also includes preparing medications and solutions for the following case during the current case or during room turnover and case setup. Sometimes medications must be prepared on the sterile field. The challenge is to maintain one’s focus despite multiple activities and distractions. Medication Dispensing Using a medication or solution within the sterile field requires removing it from its original container and aseptically transferring it to the sterile field. Sterile dose packaging is not available for many medicaApril 2014 | OR TODAY

Clinical Vignette The relief team for the primary ophthalmology group arrives as the surgery concludes, and the eye patch is placed on the surgical patient. The relief team asks the primary team to immediately take its break since they have a full relief schedule. The relief RN transfers the patient to the PACU and then completes the next case setup for cataract extraction with lens implantation and trabeculectomy with the relief scrub person. Expected case setup time is seven minutes; the case will take roughly 20 minutes to complete. The medications are prepared and transferred to the sterile field using needle gauge and syringe size combination for identification of the medications and solutions. The balanced saline solution (BSS), an isotonic irrigating solution to maintain pupil dilation and keep the eye moist, is hung on the phacoemulsification unit. Several milliliters of the BSS are flushed through the phacoemulsifier tubing and the hand piece into a glass medicine cup to prime the unit and hand piece. The relief circulating nurse pours 500 mg of vancomycin (Vancocin) in 10 mg of normal sterile saline into a second glass medicine cup while the scrub person prepares the Mayo stand instrumentation. The relief scrub person prepares the medications and solutions, matching syringe size and needle gauge for identification, including a 3-cc syringe filled with BSS from the glass medicine cup to avoid opening another BSS sterile dose bottle (15 mL) at the end of the procedure. This syringe is placed between the medicine cups on the back table. The relief scrub person places the glaucoma drainage device implant into the vancomycin mixture in the second medicine glass until the surgeon is ready to implant the device. The primary team returns from break as the surgical prep is completed. Since the primary team and surgeon have a longterm working relationship, the surgeon rarely needs to ask for the next instrument, medication or solution during procedures. At the end of the cataract procedure, the surgeon seals the surgical wound and injects the incision with BSS from the 3-cc syringe prepared during the case setup. As the surgeon returns the syringe to the Mayo stand, the primary scrub person realizes it is unclear whether the syringe was filled from the medicine glass containing BSS or the one containing vancomycin. Since antibiotics are toxic when injected into the eye — and vancomycin has a long half life in normal eyes — a retinal ophthalmologist is called to the OR to perform emergency management with aggressive BSS lavage. The trabeculectomy procedure is not performed because of the emergency situation. Since the patient is at risk for a loss of visual acuity and even blindness, additional postoperative follow-up is required. In addition, the patient requires continued medical management of the glaucoma until it is appropriate to reschedule the trabeculectomy.

Which is a contributing factor in this medication error? a. Lack of labeling of medications transferred from the original container to syringes on the sterile field b. Long-term specialty team working with the surgeon c. Verbal confirmation of medications as passed to the surgeon d. Appropriate handoff between the two OR teams

Medication errors during surgery resulting from unlabeled secondary containers and syringes on the sterile field are significant for: a. Obligating any future surgical procedures for the patient to be on an inpatient basis b. Causing potentially long-term harm to the patient c. Managing interventions by the anesthesia provider d. They have no significance beyond the immediate surgical procedure

To avoid future medication errors, the ophthalmology service should implement which strategy? a. Taking breaks when there is a delay or at the end of the case schedule b. Denying operating privileges for the surgeon involved c. Viewing the incidence as a statistical inevitability d. Labeling syringes and other containers on the sterile field and conducting a handoff review of medications and amounts given

3. Correct Answer: D — The labeling of all medications and handoff review between relief staff improves safe patient care and reduces medication errors. 2. Correct Answer: B — The range of the effect of medication errors can be from little impact to significant and long-term harm to the patient. 1. Correct Answer: A — Although a routine practice, a lack of labeling the medications transferred to the sterile field created a point of risk in the administration of the medications. 46 OR TODAY | April 2014

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continuing education 435C

tions and mixtures used intraoperatively. NPSG.03.04.01 requires that two qualified practitioners verbally and visually confirm medications transferred to the sterile field. Medication Administration Another unique characteristic of the perioperative medication process is that two or three practitioners prepare and dispense a medication or solution before the surgeon administers it. The pharmacist or circulating nurse prepares and dispenses the medication. The scrub person — with his or her often limited pharmacology knowledge — receives and transfers the medication to the surgeon. The circulating nurse oversees the scrub person labeling the container on the sterile field and the delivery device being handed to the surgeon.5 The surgeon usually does not see the original container or the preparation of the medication. Medication Intensive The OR is medication intensive. Several medications are used for one surgical procedure. One study showed that preference cards listed on average 4.93 medications.11 One procedure may require several categories of medications — topical and local anesthetics, contrast media, dyes, gases, antibiotics, anticoagulants — and solutions (plain or with additives) administered by various routes (topical, injection, infusion or irrigation). In addition, high-alert medications, such as heparin and epinephrine, are common in the OR. Researchers found that 14% of preference cards included three high-alert medications.12 Once on the sterile field, “look-alike” concerns WWW.ORTODAY.COM

extend beyond similarities in medications’ names. Many medications and solutions are clear and look similar, such as fluids and local anesthetics, whether plain or with additives. NPSG.03.04.01 mandates labeling of the container and the delivery device even when there is only one medication or solution on the field. Complex Procedures With advanced technology and ever-expanding surgical techniques, surgical procedures are increasingly complex. A multitude of equipment, such as infusion pumps and ultrasonic irrigation and aspirators, delivers solutions to the sterile field. Multiple procedures and specialty teams, including the surgeon, scrub person and circulating nurse, can be part of the care of one surgical patient. Patient Population OR patient populations span the age continuum, from neonates to geriatric patients. It is common to care for pediatric and adult patients in one day, whether within one or several surgical specialties. Age-specific medication information and guidelines should be readily available.5,9,14 OR Conditions Many surgical procedures require that room lights be dimmed or turned off. The X-ray view box, a lamp on the anesthesia cart, surgical spotlights or a lighted workspace provides alternative or indirect “lighting.” Visibility is compromised, especially for reading medication labels and preparing and managing medications and solutions within the sterile field. The workspace in the circulating nurse’s area can be small

and cluttered with equipment and retrofitted computers and keyboards. From “patient-in” to “patient-out,” the OR is a busy area. Conversations take place between team members. Distractions and interruptions are common. During the surgical procedure, the circulating nurse manages multiple priorities of the patient, anesthesia provider, surgeon and scrub person. Staffing Adequate staffing with the appropriate skill mix and assignments is important for safe patient care. The current realities of short staffing, temporary and contract staff, and novice team members create challenges. Complex or multiple specialty procedures requiring additional staff create further demands. Time as a Quality Indicator Time is an important indicator when evaluating performance and productivity in the OR. Shorter procedure times, quicker turnover, increased case volume and total procedure minutes are monitored. A sense of “faster, faster, faster!” exists. Some procedures, such as D&C and arthroscopies, can leave the team with the feeling the case is over before it starts. It is an environment of rapid interventions. Safety Goals Perioperative nurses assume the role of the patient’s advocate during the perioperative experience. A primary focus of perioperative practice is patient safety. One researcher identifies several safety goals for perioperative nurses to use in concert with the NPSG.8 As the patient’s advocate, the perioperative nurse is many times the most April 2014 | OR TODAY

In The OR continuing education 435C

significant barrier to adverse events. With patient safety as the priority, the RN critically assesses every activity and intervention as safe practice. Professional responsibilities require the RN to know and use best practices and to be aware of changes in practice, as well as knowing the patient safety initiatives of the organization. Patient safety goals provide the RN an opportunity to be a patient safety leader. Administrative Support Essential to quality or process improvement is the support and ongoing follow-up from an organization’s leadership. Managers provide leadership for a collaborative, multidisciplinary systems approach to improve processes. They also play an important role in establishing safe practice protocols and identifying necessary core competencies to create highly reliable patient care. This collaborative teamwork fosters mutual respect, with each practitioner knowing his or her role, understanding the roles of fellow caregivers, and having a sense of responsibility and accountability to teammates.15 Leadership must provide the resources that staff needs to ensure this culture of safety. These resources include: • Staffing that provides the appropriate number, skill mix and assignments • Time for education and training, case setup and medication preparation • A safe work environment with reduced distractions and interruptions, as well as appropriate lighting and work areas • A nonpunitive culture in which reporting of errors is a routine professional responsibility 48 OR TODAY | April 2014

• Information for increased awareness, quality data and education and training • Tools and supplies that support safe practice and adherence to policies, including labels and markers, and alternative lighting for work areas on and off the sterile field15 Label Information Unlabeled medications are unidentifiable. Transferring medications to the sterile field without labeling is an unsafe practice that neglects basic principles of safe medication management.11 NPSG.03.04.01 mandates labeling for medications on and off the sterile field. Label information must include a medication’s name and strength — and amount when medications are mixed, as with antibiotic irrigations, tumescent and heparin solutions and epinephrine. The unit of measure — percent, grams, milliliters or units — must be recorded along with the date the medication is prepared. An expiration date is applicable when the medication is not used within 24 hours of opening the container or if a specific time limit after reconstitution exists. Original containers and delivery devices must be kept in the OR for verification until the procedure is completed. Medications in unlabeled containers must be disposed of immediately. The only exception to labeling is when the medication is immediately (no intervening steps or functions before administration) used or disposed of. Basic to any treatment, the adage “if it isn’t written, it isn’t given” applies to medication labeling. Label Quality Labels are placed on containers,

including syringes, medicine cups, pitchers, bulb syringes and solution bags made of metal, glass and plastic. The labels are subjected to a wet field for several hours; therefore, labels should be evaluated for the following: • Adhesive durability • Ink that resists smudging when wet or handled often • Adequate size to allow all required information to be legible and clearly visible • Adaptability to fit on a variety of shapes and sizes of containers • Cost-effectiveness and availability Several labeling systems are available. Kits and custom packs include pens with permanent ink and labels that are color coded, preprinted or custom printed to meet a hospital’s needs. Transferring to a Sterile Field When two or more people are preparing and administering medications and solutions in the intraoperative setting, they must communicate clearly when transferring medications and solutions to the sterile field.11,15 Two qualified people must communicate to verbally and visually confirm the information on the medication label. To maintain consistency with counting policies, some hospitals require that an RN be one of the people involved. When one person both prepares and administers the medication, the two-person verification is not required. If the medication is prepared but not given immediately, labeling is required. Labeling Medications must be labeled as they are received on the sterile field, WWW.ORTODAY.COM

continuing education 435C

The Seven Rights of Perioperative Medication Administration5

labeling one medication at a time to prevent mislabeling. Even if only one medication or solution is on the sterile setup, it must be labeled. An effective strategy is the use of preprinted labels, which can be included in the supply pack as well as in separate sterile packaging. Prelabeled containers, such as bowls, basins and syringes, are not acceptable since the risk exists for a different medication or solution to be transferred to the container.5,11,14 Consistent labeling protocols must be practiced throughout the department in all specialty services. NPSG.03.04.01 focuses on medications that are removed from their original containers, that are both on and off the sterile field and that are intended to be administered to the patient during the procedure. Solutions with additives, such as electrolytes, antibiotics and epinephrine, which are delivered from the original container by a device such as an irrigation pump, must also be clearly labeled. Labeling is required for “one-person scenarios” (i.e., when one person prepares the medication or solution but does not administer it immediately). Verification on the Field When passing a medication or solution to the surgeon, the scrub person must say the medication or solution name and strength out loud. Many times, the surgeon cannot take his or her focus from the immediate surgical field, has asked for several items at a time or may be continuing a discussion with other team members. The surgeon must confirm the name and strength of the medication or solution as well.14 Communication Another unique aspect of patient care in the OR is that the primary scrub person and circulating nurse can WWW.ORTODAY.COM

Right Patient “Time out” for patient identification, allergy confirmation and surgical procedure verification Use of two patient identifiers, such as full name and birthdate Right Medication • Orders: Verify preference card (“written orders”) information with surgeon; “read back” of verbal orders with surgeon signoff when written • Dispensing: satellite pharmacy, controlled access dispensing systems, open access storage areas • Labeling: All medications removed from original container and transferred to secondary containers on and off the sterile field • Verification: • Visual and verbal by two qualified people, one of which must be an RN, when transferring • Verbal verification of name and strength by scrub person when handing to surgeon • Review during breaks, change of shift and specialty handoffs

Right Dose • Satellite pharmacy mixing/preparation • Age-specific dosage and concentration calculation charts • Verbal and visual verification by two people

Right Route • Topical, injection, irrigation, infusion, flush • Competency using delivery equipment (irrigation pumps, specialty syringes, ultrasonic suction, irrigator, aspirators)

Right Time • Medication or solution prepared and transferred to sterile field at the right stage of procedure • Expiration time or date for time limits after reconstitution or if not used within 24 hours

Right Reason • Appropriate antibiotic/antimicrobial for known infectious after culture and sensitivity confirmation • Experimental drugs used only with appropriate process and informed consent

Right Documentation • Signature affirmation by surgeon for drugs ordered in the perioperative setting • Delivered dose recorded April 2014 | OR TODAY

In The OR continuing education 435C

transfer responsibilities of direct and indirect patient care activities. Procedures and protocols must be established for communication of medication information during temporary relief for turnover, case setup and breaks, and during permanent relief for patient handoffs at change of shift and to specialty teams. Information discussed by the entering and exiting team members must include the medication or solution name, strength, concentration and amount administered.5,11 Staffing Additional staffing is beneficial during complex or multiple specialty procedures with extensive setup and during the initial patient positioning, prepping and incision time. Typically, these procedures have several priorities for the patient, anesthesiology provider and surgeon. A second circulating nurse can work exclusively with the scrub person to dispense and label the medication or solution. The work schedule should be managed to avoid extended work hours since fatigue contributes to medical errors. The perioperative setting is medication intensive. NPSG.03.04.01 provides a focus for safe medication administration in intraoperative practice. A review of the facilityâ&#x20AC;&#x2122;s medication administration process will determine revisions and resources required for safe practice protocols and policies. Having the perioperative team use consistent medication labeling and verification processes, as the standard of practice helps reduce medication errors.5,11,15 Cynthia K. Halvorson, RN, MSN, CNOR, is a perioperative clinical specialist and educator in Zurich, 50 OR TODAY | April 2014

Switzerland. She has 30 years of experience in perioperative patient care as a staff nurse, clinical specialist, specialty service manager and outcomes manager in community and academic centers in the United States.

ber 30, 2010. http://www.jointcommission. org/assets/1/18/Stats_with_all_fields_hidden30September2010_%282%29.pdf. Accessed January 28, 2013. 8. Hicks RW, Wanzer L, Goecker B. Perioperative pharmacology: A framework for

Nancymarie Phillips, RN, PhD, RNFA, CNOR, is a tenured professor and the head of the perioperative education department at Lakeland Community College in Kirtland, Ohio. Her curriculum includes perioperative nursing, registered nurse first assistants and surgical technology.

perioperative medication safety. AORN J

References

J 2011; 94(3):217-218.

1. Perioperative patient-focused model. In:

11. Brown-Brumfield D, DeLeon A. Adher-

Standards, Recommended Practices, and

ence to a medication safety protocol: cur-

Guidelines. Denver, CO: AORN; 2012.

rent practice for labeling medications and

2. Barnsteiner J, Disch J. A just culture

solutions on the sterile field. AORN J 2010;

for nurses and nursing students. Nurs Clin

91(5):610-617.

North Am. 2012;47(3)407-416.

12. Dawson A, Orsini MF, Cooper MR, Wol-

3. Kohn LT, Corrigan JM, Donaldson MS,

lenburg K. Medication safety: reliability of

eds. To Err Is Human: Building a Safer

preference cards. AORN J. 2005;82:399-

Health System. Washington, DC: National

414.

Academy Press; 2000.

13. Shin AY, Longhurst C, Sharek PJ.

4. About medication errors: what is a

Reducing mortality related to adverse

medication error? National Coordinating

events in children. Pediatr Clin North Am.

Council for Medication Error Reporting

2012;59(6):1293-1306.

and Prevention Web site. http://www.nc-

14. Recommended practices for medica-

cmerp.org/aboutMedErrors.html. Accessed

tion safety. AORN Standards and Rec-

January 28, 2013.

ommended Practices for Inpatient and

5. Phillips NM: Berry and Kohnâ&#x20AC;&#x2122;s Operating

Ambulatory settings. Denver, CO: AORN;

Technique. 12th ed. St. Louis. MO: Elsevier;

2012: 251-300.

2012.

15. Treiber LA, Jones J. Medication er-

6. Sentinel event. Joint Commission Web

rors, routines, and differences between

site. http://www.jointcommission.org/sen-

perioperative and nonperioperative nurses.

tinel_event.aspx. Published January 2011.

AORN J 2012; 96(3):285-294.

2011; 93(1):136-145. 9. Hanna GM. Medication safety in the perioperative setting. Anesthesiol Clin. 2011;29(1):135-144. 10. Herlehy AM. Influencing safe perioperative practice through collaboration. AORN

Accessed January 28, 2013. 7. Sentinel event statistics as of Septem-

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continuing education 435C

How to Earn Continuing Education Credit 1. 2.

Read the Continuing Education article. Go online to ce.nurse.com to take the test for $10. If you are an Unlimited CE subscriber, you can take this test at no additional charge. You can sign up for an Unlimited CE membership at www.nurse.com/unlimitedCE for $44.95 per year.

Deadline Courses must be completed by February 28, 2015 3. If the course you have chosen to take includes a clinical vignette, you will be asked to review the vignette and answer 3 or 4 questions. You must answer all questions correctly to proceed. If you answer a question incorrectly, we will provide a clue to the correct answer. 4. Once you successfully complete the short test associated with the clinical vignette (if there is one), proceed to the course posttest. To earn contact hours, you must achieve a score of 75%. You may retake the test as many times as necessary to pass the test. 5.

All users must complete the check out process to complete the process. You will be able to view a certificate on screen and print or save it for your records.

Accredited Gannett Education is accredited as a provider of continuing nursing education by the American Nurses Credentialing Centerâ&#x20AC;&#x2122;s Commission on Accreditation. Accredited status does not imply endorsement by the provider or ANCC of any commercial products displayed in conjunction with this activity. Gannett Education is also accredited by the Florida Board of Nursing (provider no. FBN 50-1489) and the California Board of Registered Nursing (provider no. CEP13213).

ONLINE Nurse.com/CE You can take this test online or select from the list of courses available. Prices subject to change.

Questions Questions or for a complete listing of our courses Phone: 800-866-0919 Email: ce@gannetthg.com

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April 2014 | OR TODAY

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GENIUS IN YOUR O.R. INSPIRED REVOLUTIONS IN SURGICAL GLOVE TECHNOLOGY. The surgeon saw the obstructed artery and instantly knew — this procedure was crucial. Every second of the four-hour operation mattered. And each piece of surgical equipment could make a difference. GAMMEX Non-Latex Sensitive surgical gloves, featuring the innovative SENSOPRENE formulation, were developed specifically for moments like these. • Superior sensitivity while maintaining glove strength • Chemical accelerator-free formulation delivers comprehensive allergy protection • The fit, donning properties and grip you expect • Exceptional value in synthetic category For additional information or to request a sample, call Ansell today at (855) 868-5540 or visit us at www.ansellinfo.com/sort

® and ™ are trademarks owned by Ansell Limited or one of its affiliates. ©2014 Ansell Limited. All Rights Reserved. Story is provided solely for illustrative purposes and does not describe any actual surgeon, procedure or patient.

CORPORATE PROFILE

SERVICES GROUP

iMPrOviNg QualiTy Of care, reduciNg The risK Of healThcare-acQuired iNfecTiONs, aNd saviNg MONey

s recently as 2010, the CDC estimated that there were roughly 1.7 million healthcare-acquired infections (HAIs). This led to nearly 100,000 deaths in the U.S. The prevention of HAIs is a priority for every hospital in the country. Each institution finds ways to reduce risks and Sage Services Group is a leader when it comes to preventing these sometimes deadly infections.

Joe Harper, President of Sage Services Group, is excited about its new complete line of disposable products that are compatible with most vital sign monitors. It is this line of products that Sage Services Group believes will provide increased patient safety and diminish the instance of healthcare-associated infections (HAIs). “We can 54

OR TODAY | April 2014

provide products for all of the major manufacturers like Philips, GE, Spacelabs, Datascope and Welch Allyn. This, again, allows us to be a fullservice provider where a customer has to make only one phone call.” In 2004, research conducted at the University of Wisconsin Hospital and Clinics in Madison,

Wis., identified that over 75 percent of ECG leads were contaminated with one or more antibiotic-resistant nosocomial pathogens. The study concluded “the attachment of contaminated lead wires to a new patient can result in colonization and ultimately in invasive infection by multi-resistant nosocomial microorganisms.” Risk of colonization is more likely when you include WWW.ORTODAY.COM

SPECIAL ADVERTISING SECTION

“These cost-saving, single-use products have been proven to reduce the risk of cross contamination, lowering healthcare-associated infections.” - Joe Harper Sp02 sensors along with reusable Blood Pressure Cuffs. “These cost-saving, single-use products have been proven to reduce the risk of cross contamination, lowering healthcare-associated infections,” Harper says. Cross-colonization can easily be seen in the day-to-day operation of a healthcare facility. The effectiveness of Sage Services Group’s innovative products are illustrated by the following example: A patient was recently admitted for a total knee replacement. She was the second patient on the OR schedule. Before the pre-operative process was completed, a nursing home patient is rushed in for an exploratory procedure associated with a GI bleed. The elderly patient has a documented MRSA infection from the past. The surgery goes well and she is taken to the ICU for post-op monitoring. Back in the OR, standard room turnover procedures take place. Now, the total knee patient moves into the room and patient monitoring begins immediately. The same reusable chest leads are attached and the Sp02 finger clip is placed on the patient’s recently manicured finger. Now the reusable Blood Pressure Cuff is inflated just above the operative site. Each of these devices had direct contact with the previous patient who had a MRSA. This presents a number of real concerns for the Infectious Disease staff at our hospital. • What happens to patients treated in the OR going forward? Real world data suggests that over 75 percent of the ECG leads may be harboring bacteria. This data doesn’t include the additional risk of Sp02 finger clips that are WWW.ORTODAY.COM

difficult to clean. The Blood Pressure Cuff on the operative side with hook and loop fastener and a ribbon strap is impossible to clean. • What happens to the next patient who enters the Icu room after our GI bleed patient? Our GI patient was moved to a step down floor, but that night a patient with open wounds from a motor vehicle accident was in the same ICU room. • What happens to the facility’s reimbursement if any of these patients are readmitted for treatment of a healthcare- acquired infection? Suddenly, the costs become quite high. • are there infection risks for the staff? Yes

SOLUTIONS A new line of products from Sage Services Group can minimize these risks and save the hospital money.

DISPOSABLE ECG LEAD WIRES Disposable ECG lead wires are becoming more and more popular across the U.S. in hospitals and surgery centers. These products are being introduced into many departments within the hospital, including the ICU, ER, Telemetry and the OR. Hospital clinicians see these products as a necessary part of their infection control program to combat healthcareacquired infections. “With the cost to treat patients with HAI’s being so high,” says Harper, “it’s logical to look at any product that could help reduce the risk of infection.” The company’s single-use leads are fully compatible with every major

manufacturer’s patient monitoring systems including Philips, GE, Spacelabs, Datascope, Mindray, Drager, Datex-Ohmeda and Nihon Kohden. Clinicians have applauded the fact that our leads require no adapters, simply “Plug and Play.” The single-use leads are fully shielded and meet performance requirements set in the ANSI/AAMI standards for ECG lead wires and cables. We offer the leads in 3-, 5-, 6- and 12-lead configurations with either a snap/ lock connection or grabber/pinch. As a patient moves through the departments of the hospital, disposable ECG leads remain with him making transport seamless. The leads are easy to use with the ribbon style cable construction that allows the clinician to peel the leads apart creating a customized fit for each patient. Single-use leads are white in color so they are easily identified as a disposable rather than a reusable item. Finally, the patient-friendly connectors are clearly color coded and labeled to aid in lead placement ultimately reducing clinical errors.

April 2014 | OR TODAY

corporate

profile

Disposable SpO2 Sensors Disposable SpO2 sensors are frequently used in many healthcare environments to measure a patient’s blood-oxygen saturation. Blood-oxygen levels are extremely important to clinicians in assessing the overall condition of a patient. The use of a single-use sensor is another tool to help reduce cross contamination from one patient to another patient. The sensor is applied to the patient during admission, stays on the patient their whole length of stay, and is discarded when the patient is discharged. Sage Services Group is concerned about infection prevention and overall patient safety. Their line of Disposable SpO2 products are designed to assist in providing the best possible patient care. Single-use sensors come in a wide range of sizes including Adult, Pediatric, Infant and Neonate. The lightweight construction of the sensors aids in patient comfort making them almost unnoticeable. Sage Services Group offers the products in three types of latex-free material to accommodate for different patients. The material includes: 3M Fiber Adhesive, 3M White Adhesive Foam and Blue Non-Adhesive Foam style sensors. All of the sensors are durable and are designed to last the full stay of the patient.

Disposable Blood Pressure Cuffs Disposable Blood Pressure Cuffs have become the standard of care for many infectioncontrol conscious hospitals throughout the Unites States. Like other patient monitoring items, Blood Pressure Cuffs may become contaminated with bacteria during a patient’s stay at the hospital. If the cuff isn’t properly disinfected there could be cross contamination from patient to patient. To eliminate this risk, hospitals have transitioned to a disposable cuff approach where each

56 OR TODAY | April 2014

patient receives a single-use cuff upon admission. These disposable cuffs come in a variety of sizes and configurations dependent on the patient and the type of equipment being used. The cuffs are latex free and come in single or double hose depending on customer preference. To eliminate errors and increase efficiency, the cuffs are labeled with patient size and range. They are designed to keep patient comfort a priority with a soft woven fabric and rounded corners.

Disposable One Piece ECG Cable A truly unique item in the line of products offered by Sage Services Group is the Disposable One Piece ECG Cable. This product provides the option of having one complete disposable cable that connects the patient to the monitoring equipment. The thought behind this product is that it eliminates the need for a reusable ECG trunk cable that connects to the disposable ECG lead wire. In highrisk patients, this cable offers a single-use option from top to bottom. CONCLUSION Documented potential for cross contamination has led many hospitals to evaluate infection controls for their patient monitoring equipment. HAIs can have a significant impact on any institution: patient health, quality of care, staff safety, accreditation and reimbursement. A complete line of disposable products from Sage Services Group benefits patients, staff members, and healthcare facilities. These products can improve outcomes and help staff in the prevention of HAIs. Having one company that can reach across all brands will simplify and reduce the risk of hospital acquired infections at your institution. Sage Services Group, based in Charleston, S.C., has a focused approach on servicing healthcare facilities’ patient monitoring systems.

3 4

For more information please call 877-281-7243 or visit www.sageservicesgroup.com

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Easy-to-Use Disinfectants Palmero’s infection control line helps streamline operating room turnover We carry several types of disinfectants As a medical sales professional, what are the key talking points I should know about Palmero’s DisCide line? Available as a spray, foam, aerosol or towelette, and our DisCide Ultra liquid comes in Gallon refills. Palmero’s DisCide disinfectants offer your clients ready-to-use, fast-acting, hospital-quality products that are designed to expedite operating room turnover. Each of these products is ideal for use in the central sterilization room and office areas, as well.

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So what’s the final takeaway? Palmero’s DisCide line offers a choice of ready-to-use, hospital-quality disinfectants that are easy to use. Products that are ideal for hospitals and medical offices. From fast-acting DisCide ULTRA to clinicians will find these products to be economical and effective choices to meet all of their infection-control needs. REFERENCE * Kills tuberculosis (Mycobacterium bovis or TB), methicillin-resistant Staphylococcus aureus (MRSA), HIV-1, AIDS

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INFECTION PREVENTION

PERSIST

HAIs STILL PROBLEMATIC DESPITE SURGICAL ADVANCES by don sadler

any advances that have been made in surgery and healthcare in recent years are truly astounding, which makes it ironic that thousands of patients still die every year from a relatively simple cause â&#x20AC;&#x201D; healthcare-associated infections (HAIs).

The statistics with regard to HAIs are sobering: At least two million patients become infected with bacteria that are resistant to antibiotics each year, according to the Centers for Disease Control and Prevention (CDC), and HAIs occur in 5 to 10 percent of all hospitalized patients. Worse yet, HAIs are the fourth leading cause of death in the U.S., with 278 people losing their lives every day from an infection they acquired during their hospital stay.

INCREASED AWARENESS OF HAIS If there is any good news in this, it’s that such sobering statistics have resulted in an increased level of awareness about the risks and dangers of HAIs among healthcare professionals. “There is certainly no lack of awareness about the dangers of HAIs,” says Dr. Wallace Puckett, Vice President & General Manager, Healthcare Consumables, with STERIS. “But a hospital, by definition, is a place that will be filled with pathogens because it is filled with sick people. Despite our best efforts, infections find their way into post-op, ICU and the surgical suite.” Most HAIs, such as surgical wound infections and urinary tract infections, are caused by bacteria normally carried harmlessly on a patient’s own skin, such as Staphylococcus aureus, or intestine, such as E. coli, says Deborah Gardner, MSPAS, OPA-C, CIC, an international scientific affairs and education manager at 3M’s Infection Prevention Division. “For patients with severely weakened immune systems or in intensive care, infections can come from microorganisms present in the environment, whether inside or outside the hospital,” Gardener says. “Antibiotic-resistant microorganisms like MRSA and ESBL producers are likely to have come from another infected or colonized patient, either via the hands of a healthcare worker or through a contaminated hospital environment where an infected patient has been cared for. These can cause a range of infections.” Terri Link MPH, BSN, CNOR, CIC, Ambulatory Education Specialist 62

OR TODAY | April 2014

with the Association of periOperative Registered Nurses (AORN), adds that pathogenic microorganisms are becoming more resistant to antibiotics as a result of the inappropriate use of antibiotics. “The role of the environment in the transmission of pathogenic organisms has been studied extensively,” Link says. “In order for environmental cleaning to be effective, the correct product must be used in the correct way according to manufacturer’s recommendations.”

often prevents them from performing a simple but highly critical task in the prevention of HAIs.” “The first line of defense should be as simple as good hand hygiene compliance,” adds Garder. “Incorporating bundles of care can also help lower the risk of infections. For example, one commonly known practice bundle for the OR is CATS: Clipping (vs. shaving); Antibiotics (appropriate administration); Temperature (normothermia); and Sugar (glucose control).”

healthcare professionals are nearly unanimous in their views about the best way to prevent hais: good hand hygiene compliance.

GOOD HAND HYGIENE COMPLIANCE Healthcare professionals are nearly unanimous in their views about the best way to prevent HAIs: good hand hygiene compliance. “Unfortunately, appropriate hand hygiene remains a struggle for healthcare workers,” explains Link. “And this is not limited to one discipline — breaches occur on all levels.” According to the World Health Organization, compliance with hand hygiene standards realizes a 65 percent compliance rate globally. “So there remains a big opportunity for improvement,” says Gardner. “Hand washing is the number one and easiest way to prevent HAIs,” says Nancy E. Fellows, MPA, MSN, RN, CNOR, Senior Clinical Education Consultant with Advanced Sterilization Products (ASP). “But with all of the resources available to healthcare workers, being too busy or just simply not thinking about it

Environmentally proper surface cleaning and disinfecting can eliminate residual bacteria being transferred from one patient to another, says Fellows. “Those who perform environmental service tasks may feel that their contribution to preventing HAIs is minuscule,” says Fellows. “On the contrary, their knowledge and the proper use of the resources used to clean and disinfect patient areas will provide a safer environment for the patient.” Gardner says that 3M launched an initiative called OneTogether last year that is aimed at improving patient safety by reducing HAIs. “OneTogether aims to engage a network of professional associations and industry partners with the goal of driving individual small actions to collectively generate a significant impact on the incidence of HAIs. Supporting associations include AORN, IAHCSMM, SIS and Practice WWW.ORTODAY.COM

Greenhealth.” Individuals can learn more about the initiative online at JoinOneTogether.org. EDUCATION IS THE KEY Fellows believes that HAI prevention starts with education. “Every member of a healthcare system has a responsibility and should be held accountable for patient safety,” she says. “When individuals are not aware that they are doing something that could have an adverse effect on a patient’s safety, the probability of acquiring an HAI is elevated. Providing the correct tools and resources to identify breaches in practice and how to improve upon these practices is critical.” “Time would be well-spent talking to frontline healthcare providers about what are the barriers to compliance with well-known, standardized behaviors and techniques that we know help prevent HAIs,” says Lena Fogle, Surgical Solutions PeriOperative Consultant with STERIS. “This will help get everyone on the same page.” According to Fellows, healthcare workers are more likely to comply with HAI prevention behaviors and techniques when they are being observed by a supervisor. “But infection control practitioners can’t be everywhere at all times,” Fellows says. Puckett echoed Fellows’ observations. “We have used direct observation — sometimes referred to as secret shopper — for many years, and we’ve discovered that this helps reduce HAIs. But it’s hard to keep this up, and HAI rates eventually bounce right back,” Puckett says. WWW.ORTODAY.COM

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Link recommends environmental surveillance to ensure that surfaces are cleaned appropriately and gaps in cleaning do not occur. “AORN Recommended Practices for Environmental Cleaning are an excellent tool to use in helping to make sure that environmental cleaning is appropriate and effective in the operating room. The CDC Toolkit on environmental cleaning is another excellent resource for conducting surveillance on environmental cleaning,” Link says. In addition to good hand hygiene practices and environmental cleaning, the following are measures that may also help prevent surgical site infections: • Appropriate antibiotic use; • Perioperative glycemic control; • Maintaining perioperative normothermia; • Optimizing tissue oxygenation; • Showering or bathing with soap preoperatively; and • Preoperative patient skin antisepsis. NEW TECHNOLOGY SOLUTIONS As awareness about the risks and dangers of HAIs has risen, new prevention techniques and

technologies have been introduced to help reduce HAIs. These include automated room disinfection systems, hand hygiene compliance monitoring systems and new features on medical device sterilization systems like the STERRAD® 100NX® System. “But reducing HAIs requires a multi-pronged approach,” says Puckett. “Handy hygiene is just part of it. We’re convinced that healthcare workers want to do the right things when it comes to HAI prevention, but workflow systems need to be created and good habits reinforced to help make it happen.” Focusing on the fundamentals can play a big role in preventing HAIs. “Getting back to the basics of hand hygiene and cleaning of the environment in healthcare facilities are the two most important and effective ways to decrease HAIs,” says Link. Puckett notes that there has been a move toward “getting to zero” when it comes to HAIs. “I don’t think anyone is sure that we can actually get to zero,” Puckett says. “But we can significantly decrease the number and severity of HAIs if we do the right things.” April 2014 | OR TODAY

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CODE WHITE: Spotlight On Nursing Staff

at Children’s Healthcare of Atlanta By Matt Skoufalos

“R

ain in Atlanta is not good for traffic,” said Steven Wagner, Chief Development Officer for Children’s Healthcare of Atlanta (CHOA).

Which explains, somewhat, how fewer than three inches of snow could have been responsible for thousands of stranded schoolchildren, hundreds of vehicle accidents, and a panic that locked down the major metro area for a harrowing two-day period at the end of January.

Atlanta doesn’t have a strong infrastructure to deal with the accumulation of either ice or snow, Wagner said, and when local school districts elected to hold classes as normal on January 28, a die was cast that eventually led to one of the biggest logistical nightmares the city had seen in years.

Those same nurses are having to scramble to get coverage for their families, get coverage for their units, [and] get coverage for the kids in their care.

By 11 a.m., the public schools saw the writing on the wall, as the roadways were icing up and the accumulation continued to mount, and “all at the same time, decided that they had to send the kids home early,” Wagner said When that announcement broke, he said, “every single parent that works in Atlanta jumped in their cars at the same time” and headed out on the roads — ahead of the salt and plow trucks. “If somebody could get in their car and drive, they did,” Wagner said. “And on top of that, people started panicking. Then everything was blocked. So you now have a snow and ice problem and a traffic problem. “The result of all of that globally was people spent hours to go two miles.” The scenario was an exercise in how the best of intentions nonetheless resulted in widespread panic, Wagner said. He recounted story after story of the travel woes of colleagues who spent literally a full day traveling to go fewer than 30 miles. People abandoned their cars on the Interstate. Students bunkered down in their schools; others were eventually sent home on buses that either hit the same travel snags or broke down on the ice. Wagner’s wife spent 10 hours collecting their three school-aged children, a feat in which she was assisted by friends, neighbors, and some helpful high-schoolers who were ferrying stranded passengers on four-wheeled ATVs. At Children’s Healthcare of Atlanta, however, a “Code White” emergency was in effect, meaning staff were under special orders due 70

OR TODAY | April 2014

After 10 hours of standstill traffic, a woman went into premature labor on GA-400. Chuck, Eva and Rico from our ground transport team fought their way to her, administered fluids and helped prevent a premature delivery.

to the weather. Non-essential personnel were dismissed, off to join the press of humanity on the highways, while staffers scheduled to arrive later were ordered to report immediately in support of those who remained to care for the vulnerable patients at one of the busiest pediatric facilities in the nation. Just as the travel plans for those parents collecting their children were harrowing, Wagner “heard story after story of people doing whatever it took” to get in to work at

CHOA. Nurses parked on side streets and walked two or more miles to reach the facility; one called four different family members to get her where she had to go in stages. At the same time, Wagner said, hospital staff made similar preparations as their homebound counterparts, arranging caregivers for children and pets for a minimum of two nights. “Internally, they’re taking care of patients,” he said; “they’re dealing with the stress of a pediatric hospital, and they’re taking time to make WWW.ORTODAY.COM

Wearing a backpack filled with homemade bread and sandwiches, Catherine, a pharmacist, walked more than five miles to Scottish Rite. She arrived to a standing ovation from her team.

those four or five different phone calls. All the stress that they were feeling, they’re feeling on top of the obligation that they have to the kids at the hospital. Those same nurses are having to scramble to get coverage for their families, get coverage for their units, [and] get coverage for the kids in their care.” The nurses at CHOA live by a “how-do-we-get-it-done, what-dowe-need-to-do attitude” that describes their level of dedication to the children in their care, their colleagues at the facility, and the people who are depending on them at home as well, Wagner said. The staff who were called in to relieve their counterparts were no less deserving of acclaim, he said, because in addition to meeting their obligations at home, they “really took some risks to see about getting down there.” “They’re really dedicated to the mission of what we do,” Wagner said. Inside the facility, nursing and hospital staff were transforming the building into an emergency shelter. Although a majority of the patient rooms are designed to be private, so that families can stay with their children, he said, there were no such accommodations made for the staff who would be bedding down for the night there. Environmental services WWW.ORTODAY.COM

A makeshift bedroom for staff at Egleston.

workers started rolling out cots, creating sleep spaces in conference rooms and offices. “Any non-patient area they could find that was dark and fairly quiet became bedrooms,” Wagner said. “Then people are going to have to eat, so meals for people who aren’t generally at the hospital are going to have to be prepared. “It went from being a hospital to a complex hospital that was acting as a hotel.” Meanwhile, Wagner said, the needs of the patients at the facility had in no way diminished. At census meetings, floor managers congregated to take stock of the resources needed for their operations. The campus where Wagner works, Children’s at Egleston, has the highest acuity rating of any pediatric healthcare system in the country, he said, meaning that, even in the face of considerable confusion, their patients could ill afford any drop in the quality of care provided there. “We have the highest patient volume and we also take care of the sickest,” Wagner said. “I literally was up for about 36 straight hours because I felt a need to just help however I could.” Although it was largely a symbolic gesture, Wagner joined up with a representative from human resources,

A snowy garden provided the perfect background for a quick break.

and toured the facility, handing out stuffed dolls of the hospital mascots, Hope and Will, at every nurse’s station he could find. “I loaded them up in a trash bag and just handed them out to staff to say, ‘Here, I hope this puts a smile on your face,’ ” Wagner said. “Give it to a kid on your unit, give it to your kid; it was just something to help.” Despite the myriad pressures of the day, Wagner did recall a moment of respite among the exhausted staff at the facility: once they knew their patients were being cared for, nursing staff changed into their pajamas and played in the courtyard garden at the hospital. They were building snowmen, making snow angels, getting into snowball fights; setting the scene that should have been for so many more children in the Atlanta metro area during the day of emergency. April 2014 | OR TODAY

out of the or health

by MARILYNN PRESTON

The Art of Making Change: Part One

t the start of the new year, my friend Diana did what millions of Americans do: She made a resolution to exercise more.

“You’re too young to be this out of shape,” her doctor told her. Diana had a gym in her building, and a husband who would cover for the kids, and she certainly had the clothes. Diana set her alarm for 6 a.m. every morning for the first week. She crept out of bed and was on the treadmill by 6:10. Thirty minutes of walking (and checking her mail), followed by a few stretches and some weights, and by 7 a.m., she was back in her apartment, showering for work, fighting off the urge to drink a Diet Pepsi for breakfast. By the middle of week two, Diana was shutting off the alarm and snuggling up with her husband. No more early morning workouts, and her promises to hit the gym after work withered and died as well. Yesterday, she told me she’s given up and feels like a failure. Yes, she’s a failure. And there are millions of you out there struggling with the same issue as you watch your New Year’s resolve melt away, like the extra cheese on the beef nacho chips you just polished off without thinking: What’s the best way to make change happen? I’ve been a student of behavior change – and a practicing life coach – for years, and as the year unfolds and Resolution Interruptus sets in, I want to assure you it’s not too late to reset your intention and experience success. 74 OR TODAY | April 2014

But you need to understand how change happens, and how to make it happen for you. It’s a big subject. Expect two columns on this, starting with my current list of keys to success, subject to change, just like everything else in life: YOU HAVE TO WANT IT. Your doctor may be pushing you to exercise, or your girlfriend nagging you to quit fried foods, but if you don’t want it for yourself, it’s not going to happen. Here’s the most important truth to emerge from all the research: You can’t change to please someone else. Well, you can, but it won’t last. Lasting lifestyle change – moving more, eating smarter, balancing play and work – happens when you are ready, when you are deeply committed, when you decide to take charge of your own health and wellness. Call it your aha! moment, and let’s hope it happens before a heart attack or a scary diagnosis. LESS IS MORE. It may feel good – in

the moment – to resolve to lose 30 pounds in six weeks, but it’s a crazy and counterproductive goal. A pound a week, maybe two, is plenty to shoot for. Same with athletic pursuits. Be realistic. Better to succeed at running one 10k race than dream of a marathon with no plan or real intention of following through. Small victories fuel big changes. If you are going to set one intention for 2014, choose one you are certain you can achieve.

REWARD YOURSELF. Once you set a

Write it down in your journal. For example: After five workouts in a row, I will treat myself to a massage ... or a margarita. There are apps and websites for this, too, www.StickK. com being one of the best known. You can also place big bets with friends, but it has to be for serious cash so you’re highly motivated not to give in. GET SUPPORT. You are more likely to stick to your goals if you play with others on a similar path. That could mean joining a running club or Weight Watchers, or finding a training partner. Misery loves company, but so does success. LET FAILURE INSPIRE YOU. See failure as feedback. Take it in stride, and don’t let it deter you from moving forward – again! – toward your goal. Resiliency is required, so learn to stand up and fall down with grace and courage. Change is hard work, but it doesn’t feel like work when you’re living the life you want to live. That’s what authenticity feels like. And it’s authenticity – being true to your highest values – that makes lasting change more likely. Next Month: It’s OK to tear up your old resolutions. Marilynn Preston is the creator of Energy Express, the longest-running syndicated fitness column in the country. She has a website, marilynnpreston. com, and welcomes reader questions, which can be sent to MyEnergyExpress@aol.com.

realistic goal, attach a reward to it.

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OUT OF THE OR FITNESS

OVERCOMING IRRITATION IN YOUR RUNNING ROUTINE

any men run to stay in shape or alleviate stress, but running can come with its own set of physical and mental irritations. To show all men that they can eliminate these everyday irritations, Dove Men+Care Deodorant and John McEnroe teamed up to help a group of men run the 2013 ING New York City Marathon without irritation. As the team prepared for the race, New York Road Runner’s running coach John Honerkamp gave pointers on what it takes to reach the finish line, while “anti-irritation coach,” John McEnroe, armed them with tips derived from his own personal triumph over irritation. Whether you are training for a marathon or just enjoy getting out on the track occasionally, incorporating a few tips from these experts can help you navigate your running routine without any interference:

Hydrate early. Dehydration takes a

toll on your physical performance, causing nagging muscle cramps, dry mouth and fatigue. Honerkamp recommends drinking eight to 10 glasses of water every day to ensure you are comfortable and well-hydrat-

OR TODAY | April 2014

ed throughout your workout. In addition to water, your body needs electrolytes to retain fluids, so Honerkamp suggests having a sport drink close by. “If you are doing endurance activities, make sure you are properly fueling your body.”

people know that basic headphones constantly fall out while you are on the move and can be incredibly frustrating. Instead of buying a new pair, try wrapping the cord around the top of your ear instead of letting it fall straight down.

Prepare-for any type of weather.

While you strive towards your fitness goal, do not let the weather stand in your way. Make sure you check the hourly forecast before your daily workout and carefully plan your wardrobe to account for any fluctuating temperatures or weather patterns. “As long as you are equipped with the proper clothing, even rainy day runs can be a lot of fun,” Honerkamp says. You should also keep in mind that your body temperature will change throughout your workout and ensure you layer with clothing that keeps you comfortable before, during and after your training.

Eliminate distractions. McEnroe, an athlete whose history of irritation is well-documented, believes many everyday irritants are preventable. There are a lot of potential irritations on any given day, and you have to minimize these distractions. For example, many

Make stretching routine. It is

critical to take care of your muscles, before and after exercise, to avoid injuries and excessive soreness. When properly incorporated into a fitness regimen, stretching can also prove to improve muscle activity and help your body recover more quickly. Honerkamp also recommends icing muscles to reduce inflammation after particularly vigorous workouts.

Chart your progress. McEnroe believes setting goals is important to staying motivated. Decide what to focus on during training each week and evaluate your progress along the way. When you see how much you improve and how good you feel over time, you will want to continue the regimen to stay in great shape.

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OUT OF THE OR NUTRITION

BY LORI ZANTESON

RAISIN’ THE BAR ON NUTRITION

They may be ugly, but raisins have some beautiful health benefits

aisins have been revered since ancient times. Grapes were dried into tiny wrinkled gems as early as 2,000 BC, when they were eaten and used as decorations during feasts and religious ceremonies, as well as utilized for barter currency and prizes during sporting events by the Romans. Produced worldwide today, California is the largest producer, tracing back to 1873 when a determined grape grower took his crop, which had been “destroyed” by a heat wave, to market and met instant success. The rest is, indeed, history. THE FACTS Unlike most dried fruits, and perhaps a tribute to their popularity, dried grapes are uniquely named raisins. Grapes and raisins share the scientific name, Vitus vinifera, though the contrast between the shrunken, wrinkly pellets surrounding their sweet, chewy flesh, are quite the contrast to their plump, juicy counterpart. Grape varieties, such as Thompson seedless, Muscat, Sultana, and Malaga are the most popular to dehydrate, whether by sun or oven drying. A one-quarter cup serving of raisins delivers 6 percent Daily Value (DV, based on 2,000 calories per day) of satiating dietary fiber, 9 percent DV of heart-healthy potassium, and a dose of health protecting antioxidants, though, because

OR TODAY | April 2014

most raisins are made from white grapes, they do not contain a significant amount of resveratrol, as do red grapes. THE FINDINGS The health benefits of eating raisins are many. Several new studies on raisins and health were published in the June 2013 Journal of Food Science. One such study shows that raisins and grapes eaten as an afternoon snack led to a lower overall food intake among children, compared to eating other common snacks, like chips or cookies. Not only did raisins give a feeling of fullness, they also provided important nutrients, such as potassium and iron. Another study, a scientific review of almost 80 studies, also published in the journal, shows that raisins have the potential to reduce the risk of diabetes and heart disease, and that raisin consumption contributes to improved blood glucose control for diabetics, and also can be helpful for weight loss and management.

THE FINER POINTS Raisins are readily available yearround, both in bulk and small packages. Choose richly colored, moist raisins when you can hand select or see them through the packaging. Store them in an airtight container, and refrigerate or freeze for longest life — up to six months. Pour a little hot water over raisins to “plump” them before use. They are especially delicious in baked scones, quick breads and muffins. Raisins are also easily tossed onto hot or cold cereals, yogurts and salads, as well as added to pilafs and stuffing, trail mix, or eaten straight out of hand. NOTABLE NUTRIENTS SEEDED RAISINS (1 OUNCE) calories: 83 dietary fiber: 2 g (8 percent recommended Daily Value) Potassium: 231 mg (7 percent DV) copper: 0.1 mg (7 percent DV) iron: 7 mg (4 percent DV) Manganese: 0.1 mg (6 percent DV) Reprinted with permission from Environmental Nutrition, a monthly publication of Belvoir Media Group, LLC. 800-829-5384. www.EnvironmentalNutrition.com.

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NUTRITION

RAISIN SCONES INGREDIENTS: 2 1/3 cups prepared whole grain coarsely chopped biscuit mix 3 tablespoons sugar 1 egg, beaten 1/2 cup milk 3/4 cup raisins • Milk and sugar for topping Preheat oven to 450° F Stir together biscuit mix, sugar and raisins. Blend egg and milk; add to dry mixture, stirring thoroughly. Turn out onto lightly floured board. Pat and roll into an oblong about 1/2-inch thick. Cut in diamonds by making diagonal cuts with a knife. Prick tops with fork; brush with milk and sprinkle with sugar. Bake on greased baking sheet for 10-12 minutes. Makes 12 scones.

NUTRITION INFORMATION per serving: 130 calories, 3.5 grams fat, 23 grams carbohydrate, 3 grams protein, 4 grams dietary fiber, 230 mg sodium. Recipe adapted courtesy of

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out of the or recipe

by Nealey Dozier

Chicken & Mushroom Lasagna C hicken and mushroom lasagna has been a favorite in our house for a number of years. Its hearty layers of cheesy goodness always warm me up on cold nights, and itâ&#x20AC;&#x2122;s one of the few leftovers that I actually look forward to more than the main event.

82 OR TODAY | April 2014

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recipe

This lasagna is a simple enough dish to wow your family on a weeknight, but it’s also special enough to impress at a dinner party for your foodiest friends. (Just ask my father-in-law, who years after tasting it still brings it up!) It’s great for a group because it doesn’t need much

to pull it all together – just a lightly dressed green salad and a bottle of good wine. You even get bonus points if you assemble it a day before. One of the best things about this lasagna is that it’s incredibly forgiving. If you want to, say, throw in a few handfuls of spinach or swap out

a different type of cheese, I don’t think anyone will complain. And even if you are just cooking for two, it’s worth making a whole batch and freezing half for a later day. Some busy day, you’ll thank yourself that a hot, satisfying meal is only an oven away.

Chicken & Mushroom Lasagna (Serves 8 to 10) INGREDIENTS 6 tablespoons unsalted

butter, divided 1 pound baby bella mushrooms, trimmed and sliced 1 small onion, diced 2 - 3 large cloves garlic, minced 1/2 cup dry white wine 3 cups cooked and shredded chicken 1/2 cup plus 2 tablespoons all-purpose flour 4 cups warmed milk, preferably whole milk 1 cup chicken stock 2 tsp salt 1/4 tsp dry mustard powder 1 tsp dry sherry or Marsala (optional) • Freshly ground black pepper 1 cup grated Parmesan, divided 16 lasagna noodles (from a 1 pound box) 2 cups shredded mozzarella cheese 2 cups grated Gruyere cheese

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Preheat the oven to 350° F. Lightly grease a large, rectangular casserole dish or lasagna pan. Bring a large pot of heavily salted water to a boil. In a large Dutch oven or heavy pot, melt 2 tablespoons of butter on medium-high heat. Add the mushrooms and sauté until they start sweating liquid, about 4 minutes. Add the onion, garlic and a pinch of salt. Continue cooking, stirring often, until onions are translucent, about 8 minutes. Add the wine and bring to a boil; continue cooking until most of the liquid has evaporated. Transfer the mushroom mixture to a separate bowl along with the shredded chicken. To make the bechamel (white sauce), add the remaining 4 tablespoons of butter to the pot and melt over medium heat. Stir in the flour until a thick paste forms; continue cooking to remove the “raw” taste, about 1 minute. Pour in the milk and chicken stock, and

cook, whisking often, until the mixture is thickened, 10 to 15 minutes. Whisk in the salt, mustard powder, sherry and a generous amount of freshly ground black pepper, followed by 1/4 cup grated Parmesan. While the bechamel is thickening, prepare the noodles. Add the noodles to the boiling water and cook, stirring occasionally, until al dente, 7 to 8 minutes. Drain and arrange on a lightly greased sheet pan to prevent sticking. Fold the chicken and mushroom mixture into the bechamel. Taste and adjust seasoning. (Be liberal with salt and pepper.) In a separate bowl, combine mozzarella, Gruyere, remaining 3/4 cup Parmesan cheese. Spread 1 cup of the chicken mixture into the bottom of the prepared baking dish. Arrange 4 noodles on top of the chicken, overlapping if necessary. Spread about 1 cup of chicken mixture over the noodles followed by 1 cup of cheese. Repeat

layers, ending with the remaining cheese on top. Bake, uncovered, until the lasagna is hot and bubbly, about 45 minutes. Allow to cool for 10 to 15 minutes before serving. The lasagna can be assembled and refrigerated up to 24 hours in advance; just add 15 minutes to the cooking time when ready to bake. It can also be frozen for up to three months; wrap the lasagna pan in foil and freeze until solid. To cook, bake the frozen lasagna, covered, for 1 hour and 15 minutes, and then uncover and bake another 30 to 45 minutes until cooked through. Nealey Dozier is a writer for TheKitchn.com, a nationally known blog for people who love food and home cooking. Submit any comments or questions to kitchn@apartmenttherapy.com. © 2014, Apartment Therapy. Distriibuted By Tribune Content Agency Llc.

April 2014 | OR TODAY

84 OR TODAY | April 2014

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OUT OF THE OR PINBOARD

PINBOARD

The News and Photos That Caught Our Eye This Month

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TIPS TO REDUCE BELCHING Belching is a natural, normal way to relieve built-up pressure. But some people — or their partners — might wish this release didn’t occur quite so often. A recent issue of Mayo Clinic Health Letter offers tips to minimize belches.

eat and drink slowly — Typically, less air is swallowed when eating and drinking more slowly. It may also help to avoid talking while eating.

drink fewer carbonated beverages — Soft drinks and beer release carbon dioxide gas, increasing the volume of air in the digestive system.

3 4 5 6

avoid gum and hard candy — Swallowing air increases when chewing gum or sucking on hard candy. skip the straw — Sipping from a glass reduces air swallowed compared to using a straw.

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MORE INFORMATION can be found

don’t smoke — Air is swallowed when inhaling tobacco products.

check dentures — When dentures are loose, excess air is swallowed when eating and drinking.

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April 2014 | OR TODAY

Fluid Warming Streamlined • Increase regulatory compliance: • Display actual temperature of every bag • Records the shelf life of every bag • Improve processes: • Efficiently warm patients from admission to discharge • Save space and footsteps by warming fluids at the point of use • Save money: • Reduce disposable costs while warming 20-140 liters of fluid over 12 hours • Increase reimbursements: • Reduce SSIs and time spent in the PACU • Increase patient satisfaction surveys & clinical outcomes

just how See www.ivnow.com to see quickly ivNow can pay for itself.

ivNow-3 pedestalmounted counter top module with tilt kit

ivNow-1 counter top module

Warming patients inside and out Blanket & Fluid Warmers | ISO 13485:2003 Certified | www.enthermics.com

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Wheel obstructions

Great for total joints, spine, neuro, craniotomies, endo, ...or any large case.

Maximize Space With our two-tier back table and drape, create one sterile field with multiple levels to increase your usable work space.

Drape Create a sterile field with our standard or heavy-duty one-piece patented drape. Clear plastic window in rear allows for light penetration and improved visibility. Protected by U.S. Patent No. 6,019,102

Visibility Arrange and organize trays easily - without the need for stacking.

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April 2014 | OR TODAY

REVOLUTIONIZING TODAY’S SURGICAL SUITES Designed for safety, comfort and efficiency.

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ABSORBENT PADS

Super absorbent, economical disposable floor pads which eliminate expensive laundry costs.

SAFE CORD

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Safe Cord™ is a durable, disposable safety strip designed to cover cables and cords on the OR floors thereby reducing the risk of staff tripping hazards and injuries.

www.flagshipsurgical.com 888.633.5843 Products Patented & Patent Pending

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April 2014 | OR TODAY

index alphabetical 3M Healthcare………………………………………………… 6, 41 AAAHC……………………………………………………………… 39 AIV Inc.…………………………………………………………………81 Alcon Laboratories, Inc.……………………………………19 American Surgical Professionals…………………… 85 Ansell Healthcare Inc.……………………………………… 53 Arthro Plastics Inc.…………………………………………… 38 ASC Association…………………………………………………18 BEMIS Healthcare…………………………………………… 65 BOSS Instruments…………………………………………… 73 Bryton Corporation…………………………………………… 9 C Change Surgical……………………………………………… 4 Cactus………………………………………………………………… 64 Cardinal Health………………………………………………… 72 Checklist Boards Corp.………………………………………81 Cincinnati Sub-Zero………………………………………… 94 Clorox Healthcare………………………………… 21-23, 25 Cygnus Medical………………………………………………… 75

Dan Allen Surgical…………………………………………… 40 Didage Sales Company, Inc.…………………………… 77 Ecolab Inc., Professional Products Div.……………15 EIZO Nanao Technologies……………………………… 67 Encompass Group, LLC…………………………………… 38 Enthermics Medical Systems………………………… 88 Flagship Surgical……………………………………………… 90 GelPro……………………………………………………………………18 Government Liquidation…………………………………IBC Healthmark Industries…………………………………… 66 Innovative Medical Products, Inc………………… BC Innovative Research Labs, Inc.……………………… 89 Jet Medical Electronics…………………………………… 78 Lumalier Corporation………………………………………… 5 McGan Technologies……………………………………… 78 MD Technologies…………………………………………………91 MedWrench……………………………………………………… 93 Mobile Instrument Service & Repair…………… 29

OR Specific……………………………………………………… 89 Palmero Health Care……………………………………… 59 Piedmont Medical, Inc………………………………………91 Polar Products………………………………………………… 38 Ruhof Corporation…………………………………………… 2-3 Sage Services…………………………………………28, 54-57 Select Surgical Technologies………………………… 10 SMD Wynne Corp.…………………………………………… 84 Spectrum Surgical Instruments Corp.………… 52 STERIS Corp.…………………………………………………… 32 Stryker Sustainability Solutions…………………… 24 Surface Medical………………………………………………… 84 Surgical Power………………………………………………… 39 SurgiDat Corp…………………………………………………… 77 TBJ, Inc.……………………………………………………………… 58 TeleTracking Technologies Inc.……………………… 20 Tenacore Holdings, Inc.…………………………………… 79 umf Corporation……………………………………………… 28

ACCREDITATION AAAHC……………………………………………………………… 39

education Spectrum Surgical Instruments Corp.………… 52

ANESTHESIA Cactus………………………………………………………………… 64 Checklist Boards Corp.………………………………………81 Innovative Research Labs, Inc.……………………… 89 SMD Wynne Corp.…………………………………………… 84

ENDOSCOPY Cactus………………………………………………………………… 64 Ecolab Inc., Professional Products Div.……………15 Government Liquidation…………………………………IBC Innovative Research Labs, Inc.……………………… 89 MD Technologies…………………………………………………91 Mobile Instrument Service & Repair…………… 29 OR Specific……………………………………………………… 89 Ruhof Corporation…………………………………………… 2-3 Spectrum Surgical Instruments Corp.………… 52 TBJ, Inc.……………………………………………………………… 58 Tenacore Holdings, Inc.…………………………………… 79

Palmero Health Care……………………………………… 59 Ruhof Corporation…………………………………………… 2-3 SMD Wynne Corp.…………………………………………… 84 Spectrum Surgical Instruments Corp.………… 52 umf Corporation……………………………………………… 28

index categorical

APPAREL Healthmark Industries…………………………………… 66 arthroscopic surgery Arthro Plastics Inc.…………………………………………… 38 ASSOCIATIONS AAAHC……………………………………………………………… 39 ASC Association…………………………………………………18 AUCTIONS Government Liquidation…………………………………IBC BEDS Innovative Medical Products, Inc………………… BC Piedmont Medical, Inc………………………………………91 Surface Medical………………………………………………… 84 BIOMEDICAL Cactus………………………………………………………………… 64 Innovative Research Labs, Inc.……………………… 89 Surface Medical………………………………………………… 84 CARDIAC SURGERY C Change Surgical……………………………………………… 4 Cables/Leads Sage Services…………………………………………28, 54-57 CLEANING SUPPLIES Encompass Group, LLC…………………………………… 38 Ruhof Corporation…………………………………………… 2-3 Clamps Innovative Medical Products, Inc………………… BC CS Spectrum Surgical Instruments Corp.………… 52 DISPOSABLES Flagship Surgical……………………………………………… 90 Government Liquidation…………………………………IBC Sage Services…………………………………………28, 54-57

92 OR TODAY | April 2014

INFUSION PUMPS AIV Inc.…………………………………………………………………81 INSTRUMENTS Government Liquidation…………………………………IBC Spectrum Surgical Instruments Corp.………… 52 internet resources MedWrench……………………………………………………… 93

Fall Preventiom Encompass Group, LLC…………………………………… 38

Knee Systems Innovative Medical Products, Inc………………… BC

fluid control Arthro Plastics Inc.…………………………………………… 38

Laser Checklist Boards Corp.………………………………………81

GEL PADS Innovative Medical Products, Inc………………… BC

latex free Ansell Healthcare Inc.……………………………………… 53

GENERAL Cactus………………………………………………………………… 64 Checklist Boards Corp.………………………………………81 Didage Sales Company, Inc.…………………………… 77 GelPro……………………………………………………………………18 Government Liquidation…………………………………IBC Innovative Research Labs, Inc.……………………… 89 Lumalier Corporation………………………………………… 5 Select Surgical Technologies………………………… 10 Surgical Power………………………………………………… 39

Leg Positioners Innovative Medical Products, Inc………………… BC

Hand/Arm Positioners Innovative Medical Products, Inc………………… BC HEALTHCARE STAFFING/Management American Surgical Professionals…………………… 85 SurgiDat Corp…………………………………………………… 77

Ophthalmics Alcon Laboratories, Inc.……………………………………19 Ecolab Inc., Professional Products Div.……………15 OR Table Accessories Bryton Corporation…………………………………………… 9 Innovative Medical Products, Inc………………… BC ORTHOPEDIC OR Specific……………………………………………………… 76 Surgical Power………………………………………………… 39 OTHER Select Surgical Technologies………………………… 10

Hip Systems Innovative Medical Products, Inc………………… BC

Patient Aids Innovative Medical Products, Inc………………… BC

INFECTION CONTROL/PREVENTION 3M Healthcare………………………………………………… 6, 41 BEMIS Healthcare…………………………………………… 65 Clorox Healthcare………………………………… 21-23, 25 Ecolab Inc., Professional Products Div.……………15 Encompass Group, LLC…………………………………… 38 Government Liquidation…………………………………IBC

Patient MONITORs EIZO Nanao Technologies……………………………… 67 Jet Medical Electronics…………………………………… 78 Patient Warming Encompass Group, LLC…………………………………… 38

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INDEX CATEGORICAL POSITIONING AIDS Innovative Medical Products, Inc ……………… BC

STERILE PROCESSING TBJ, Inc. …………………………………………………………… 58

SURGICAL GLOVES Ansell Healthcare Inc. …………………………………… 53

POSITIONERS/IMMOBILIZERS Innovative Medical Products, Inc ……………… BC

STERILIZATION Clorox Healthcare ……………………………… 21-23, 25 Lumalier Corporation ……………………………………… 5 Spectrum Surgical Instruments Corp. ……… 52 STERIS Corp. ………………………………………………… 32

SURGICAL GRAFTS Select Surgical Technologies ……………………… 10

STRETCHERS Piedmont Medical, Inc ……………………………………91

SURGICAL SUPPLIES Cincinnati Sub-Zero ……………………………………… 94 Cygnus Medical ……………………………………………… 75 Government Liquidation ………………………………IBC Ruhof Corporation ………………………………………… 2-3

REFURBISHED EQUIPMENT Piedmont Medical, Inc ……………………………………91

SUCTION MATS Arthro Plastics Inc. ………………………………………… 38

SURPLUS MEDICAL Government Liquidation ………………………………IBC

REPAIR/SERVICE AIV Inc. ………………………………………………………………81 Piedmont Medical, Inc ……………………………………91 Spectrum Surgical Instruments Corp. ……… 52

SURGEON COOLING Polar Products ……………………………………………… 38

SUPPORTS Innovative Medical Products, Inc ……………… BC

SURGICAL AAAHC …………………………………………………………… 39 Arthro Plastics Inc. ………………………………………… 38 BOSS Instruments ………………………………………… 73 Cactus ……………………………………………………………… 64 Cardinal Health ……………………………………………… 72 Checklist Boards Corp. ……………………………………81 Clorox Healthcare ……………………………… 21-23, 25 Dan Allen Surgical ………………………………………… 40 Ecolab Inc., Professional Products Div.…………15 EIZO Nanao Technologies …………………………… 67 Flagship Surgical …………………………………………… 90 Lumalier Corporation ……………………………………… 5 MD Technologies ………………………………………………91 Select Surgical Technologies ……………………… 10 SMD Wynne Corp. ………………………………………… 84 Stryker Sustainability Solutions ………………… 24 Surgical Power ……………………………………………… 39

TEMPERATURE MANAGEMENT C Change Surgical …………………………………………… 4

RADIOLOGY Cactus ……………………………………………………………… 64 Checklist Boards Corp. ……………………………………81 Ecolab Inc., Professional Products Div.…………15 EIZO Nanao Technologies …………………………… 67

REPLACEMENT PARTS Surface Medical ……………………………………………… 84 REAL-TIME LOCATION SYSTEM (RTLS) TeleTracking Technologies Inc. …………………… 20 SHOULDER RECONSTRUCTION Innovative Medical Products, Inc ……………… BC SIDE RAIL SOCKETS Innovative Medical Products, Inc ……………… BC SOFTWARE SurgiDat Corp ………………………………………………… 77 TeleTracking Technologies Inc. …………………… 20 SPINE OR Specific …………………………………………………… 89

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SURGICAL EQUIPMENT Arthro Plastics Inc. ………………………………………… 38

TEST INSTRUMENTS McGan Technologies …………………………………… 78 ULTRASOUND AIV Inc. ………………………………………………………………81 Ecolab Inc., Professional Products Div.…………15 Tenacore Holdings, Inc. ………………………………… 79 VIDEO Ecolab Inc., Professional Products Div.…………15 EIZO Nanao Technologies …………………………… 67 WASTE MANAGEMENT BEMIS Healthcare ………………………………………… 65 WARMERS Enthermics Medical Systems ……………………… 88

April 2014 | OR TODAY

c i n c i n n a t i

s u b - z e r o

Gelli-Roll® & Norm-O-Temp® The Norm-O-Temp® and Gelli-Roll® combined offer a whole body warming system that can be used in pre-op, the Operating Room, recovery, or the Emergency Department for conductive warming. The Gelli-Roll® is a reusable water blanket that provides patient warming and comfort. It allows for the caregiver to have complete access and is easy to clean with disinfectants.

“Gel pad water blanket warming was more effective in maintaining normothermia after cardiac anesthesia compared with convective warming. This can be considered an advantage as the gel pad system is easy to use and quiet. Gel pad warming has replaced underbody convective warming during cardiac anesthesia at our institution.” — Charles E. Smith M.D., MetroHealth Medical Center ASA Poster, November 2009

www.cszmedical.com Phone: 513-772-8810 Toll Free: 800-989-7373 Fax: 513-772-9119

Enhanced Humbles LapWrap Positioning Pad ®

Now even more secure with two-way performance! Anesthesiologist Frank Humbles, M.D. knows the importance of patient positioning. The Enhanced Humbles LapWrap®. • Positions patients arms while allowing easy access for leads and IV’s • Secures patient to OR table • Is dual sided for increased flexibility • Optional extensions can be attached for the extremely obese

Designed to meet

The operative word in patient positioning.

AORN

recommendations

www.impmedical.com

Now you can secure your patient in place. Loop the LapWrap® tab around the side rail of the OR table.

Bariatric Patients are no problem. The LapWrap’s® tab configuration also makes positioning bariatric patients easier.

Keep arms securely positioned. Designed to prevent tissue injury. Arms stay where you put them during the procedure.

Adaptable to all size patients. Use the optional extensions to secure the extremely obese.

The LapWrap® was designed to meet AORN recommendations in “Recommended practices for positioning the patient in the perioperative practice setting” to prevent tissue injury and ischemia that may be caused by tucking a patient’s arms at his or her side.

For more info or to order call 1-800-467-4944 US Patent No. 8,001,635