OR Today - April 2015 by MD Publishing

CLOROX

EXPERT ADVICE PAGE 15

SPOTLIGHT ON

NUTRITION

CLIFF FAWCETT PAGE 60

TAKE GOOD CARE

NURSES • SURGICAL TECHS • NURSE MANAGERS

PESCETARIAN DIET PAGE 72

www.ortoday.com

APRIL 2015

REDUCING SURGICAL SITE INFECTIONS

‘Never Event’ Remains a Huge Problem For Providers and Patients

Address Service Requested MD Publishing 18 Eastbrook Bend Peachtree City, GA 30269

PRSRT STD U.S. Postage PAID MD Publishing WWW.ORTODAY.COM

READ OUR CORPORATE PROFILE ON PAGES 48-50

APRIL 2015 | OR TODAY

Ruhof’s new Endozime® Bio-Clean is the only enzymatic detergent that breaks through the extracellular polymeric layer that encases biofilm allowing for the complete elimination of all bioburden and biofilm by high-level disinfectants. PREPZYME®

Endozime® Bio-clean is also the only enzymatic detergent on the market

ENDOZIME® BIO-CLEAN

clinically tested to pass

PREPZYME® FOREVER WET ENDOZIME® SLR PHASE ONE Endoscopy Bedside Care Kit

ISO 15883 Annex F*. *ISO/TS 15883-5: 2006 - Washer-disinfectors - Part 5: Test soils and methods for demonstrating cleaning efficacy - Annex F (normative) Test soil and method for flexible endoscopes. (Test results available upon request)

ScopeValet™ ECO-BEDSIDE KIT (Eco-Bedside Kit’s tray and lid are 100% Biodegradable)

ENDOZIME® SPONGE

For More Information and GENEROUS FREE SAMPLES

1-800-537-8463 www.ruhof.com 2

OR TODAY | APRIL 2015

Prepzyme Forever Wet ®

Instrument Transport Humectant Spray The latest breakthrough in enzymatic pre-cleaning sprays, Prepzyme® Forever Wet’s unique humectant properties form a moist coating over the instruments that lasts for days. • The humectant formulation creates a moisture retention barrier which keeps soiled instruments and scopes moist for a prolonged period of time – unlike a GEL which HAS NO MOISTURE RETENTION properties • Operating room safe, non-aerosol, multi-tiered enzymatic spray helps prevent bio-burden from drying on the surface of soiled instruments and scopes • Ideal for transporting soiled instruments that may sit for an extended period of time • Reduces tray weight during transport compared to liquid presoaks • Soiled sharps are visible through humectant • Decreases spills and potential cross-contamination

Prepzyme® Forever Wet creates a long lasting moisture barrier. As seen here, instrument remains wet to the touch for days after application.

For More Information and GENEROUS FREE SAMPLES

1-800-537-8463 www.ruhof.com 393 Sagamore Avenue, Mineola, New York 11501 Tel: 516-294-5888 Fax: 516-248-6456 WWW.ORTODAY.COM

102114

OR TODAY | APRIL 2015

WWW.ORTODAY.COM

APRIL 2015 | 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 6

OR TODAY | APRIL 2015

WWW.ORTODAY.COM

CONTENTS

features

REDUCING SURGICAL SITE INFECTIONS

The technological advances that have been made in medicine and surgery in recent years are nothing short of astounding. Yet, even high-tech OR equipment and procedures donâ&#x20AC;&#x2122;t seem to be making a dent in the prevalence of health care-associated infections (HAIs), including surgical site infection (SSIs). We asked experts in the field to share tips on how to avoid HAIs and SSIs.

OR TODAY | April 2015

CURBELL MEDICAL

Patient safety is a constant concern in health care and new regulations emphasize the need to protect patients and medical professionals alike. Curbell Medical is aware of the increased demand to reduce HAIs and is ready to help with its wide-range of patient monitoring accessories, including a line of reusable and disposable ECG cables and lead wires

OR Today (Vol. 15, Issue #3) April 2015 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. ÂŠ 2015

WWW.ORTODAY.COM

APRIL 2015 | 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

Mike Venezia | mike@mdpublishing.com Jayme McKelvey | jayme@mdpublishing.com

28 INDUSTRY INSIGHTS 10 14 18 20 22

News & Notes Clorox Advice AAAHC Update OR Today Live! ASC Update

Andrew Parker | andrew@mdpublishing.com

CIRCULATION Bethany Williams

ACCOUNTING Sue Cinq-Mars

WEB SERVICES Betsy Popinga Taylor Martin

IN THE OR 24 27 28 36

Suite Talk Market Analysis Product Showroom CE Article

OUT OF THE OR 66 68 72 75 80

Health Fitness Nutrition Recipe Pinboard

MD PUBLISHING | OR TODAY MAGAZINE 18 Eastbrook Bend, Peachtree City, GA 30269 800.906.3373 | Fax: 770.632.9090 Email: info@mdpublishing.com www.mdpublishing.com

PROUD SUPPORTERS OF

85 Index

OR TODAY | APRIL 2015

WWW.ORTODAY.COM

APRIL 2015 | OR TODAY

INDUSTRY INSIGHTS NEWS & NOTES

STAFF REPORTS

MEDTRONIC’S PIPELINE FLEX EMBOLIZATION DEVICE RECEIVES FDA APPROVAL Medtronic plc has received U.S. Food and Drug Administration approval for its Pipeline Flex embolization device. Available through a limited U.S. launch, Medtronic’s latest-generation flow diversion device represents an advancement in large and giant brain aneurysm treatment. “Flow diversion has been a major breakthrough therapy for large or giant wide-necked brain aneurysms that are complex and have considerably higher risk of rupture and higher rates of complication with conventional treatment,” said Dr. Ricardo Hanel, Neurosurgeon, director of stroke and cerebrovascular center at Baptist Health in Jacksonville, Florida. “With thousands of patients successfully treated with Pipeline Embolization Device, the Pipeline Flex’s innovative delivery system will result in further advancing endovascular treatment and care.” Designed to divert blood flow away from an aneurysm, the Pipeline Flex embolization device features a braided cylindrical mesh tube that is implanted across the base or neck of the aneurysm. The device cuts off blood flow to the aneurysm, reconstructing the diseased section of the parent vessel. In the United States, the Pipeline Flex device is intended for use for

OR TODAY | APRIL 2015

the endovascular treatment of complex intracranial aneurysms that are not amenable to treatment with surgical clipping and are attached to parent vessels measuring between 2.5 and 5.0 mm in diameter.

The first-generation Pipeline embolization device has been used to treat patients in the United States since it was approved by the FDA in 2011. This product is part of the Neurovascular portfolio in Medtronic’s Restorative Therapies Group. •

WWW.ORTODAY.COM

NEWS & NOTES

AAAHC RAISES THE BAR ON QUALITY WITH NETWORK ACCREDITATION LAUNCH The Accreditation Association for Ambulatory Health Care (AAAHC) now offers a nationally recognized, comprehensive accreditation program specifically designed for health care organizations with multiple care sites. The new Network Accreditation Program provides larger organizations the option to undergo the collaborative, consultative and peer-reviewed accreditation process exclusive to AAAHC. “In today’s changing health care environment, it’s becoming more and more fiscally sound to acquire multiple health care sites, and these multi-site organizations are seeking ways to demonstrate that they, as a group, are delivering quality care,” said John Burke, PhD, president and CEO of AAAHC. “Our Network Accreditation responds to this trend and addresses this gap in the accreditation landscape; it sends a strong signal that an organization, along with all its clinical sites, provides a higher standard of patient care.” AAAHC Network Accreditation serves as a comprehensive evaluation that focuses on the overall capability of the corporate organization’s centralized administration to maintain its sites of care at nationally recognized standards. AAAHC grants Network Accreditation to the corporate organization as a whole, while each individual site of care included in the accreditation survey receives a certificate identifying that it is affiliated with a nationally accredited, quality organization. “Network Accreditation offers the same peer-based, consultative review that our industry has come to expect from AAAHC over 35 years,” added Burke. AAAHC Network Accreditation offers an exclusive focus on organizations with 10 or more health care sites, as well as the flexibility to allow for changes in sites of care during an accreditation term. Network surveyors are experienced health care professionals with a background in multi-site facilities. Ambulatory health care organizations seeking AAAHC accreditation undergo an extensive self-assessment and onsite surveys by AAAHC expert surveyors, including physicians, nurses and administrators who are actively involved in ambulatory health care. AAAHC accreditation indicates an organization participates in ongoing self-evaluation, peer review and education to continuously improve its care and services. To learn more about Network Accreditation from AAAHC, visit AAAHC online. • WWW.ORTODAY.COM

NONIN MEDICAL PARTNERS WITH WELCH ALLYN Welch Allyn has partnered with Nonin Medical, a designer and manufacturer of noninvasive medical monitoring solutions, to provide its clinically proven PureSAT SpO2 technology. The partnership allows Welch Allyn to offer technologies from three leading manufacturers as part of its next generation vital signs device that allows customizable vital signs capture, interval monitoring and wireless transfer of patient data to the electronic medical record (EMR). “Blood oxygen level (SpO2) is an important vital sign that provides feedback on a patient’s overall health status,” says Shawn St. Pierre, senior global category manager, vital signs, at Welch Allyn. “Clinicians see patients ranging from newborns through older adults, and require devices capable of providing accurate measurements across these populations and in the presence of varying medical conditions. With technologies constantly evolving, offering solutions from Masimo, Nonin Medical, and Covidien provides our customers with access to more innovations and the ability to select solutions that best match their performance needs.” Nonin Medical’s clinically proven PureSAT pulse oximetry technology delivers fast and reliable readings by utilizing intelligent pulse-bypulse filtering to provide precise oximetry measurements — even in the presence of motion, low perfusion or other challenging conditions. PureSAT signal processing pre-filters the pulse signals to remove undesirable signals and advanced algorithms then separate the pulse signals from artifact and interference. “Nonin Medical is excited to partner with Welch Allyn in providing pulse oximetry solutions that improve the quality of patient care while lowering the cost and improving the processes of care delivery,” said Mark VanderWerf, vice president of strategic relationships, OEM and mHealth for Nonin Medical. “Nonin and Welch Allyn share a Culture of Integrity — in terms of service, performance and value that customers can count on far beyond the sale. Working with Welch Allyn has been a pleasure and we look forward to a long-term, mutually beneficial relationship.” • APRIL 2015 | OR TODAY

INDUSTRY INSIGHTS NEWS & NOTES

STAFF REPORTS

BROWARD HEALTH IMPERIAL POINT RECEIVES NICHE “EXEMPLAR” STATUS

Broward Health Imperial Point has achieved “Exemplar” status for its Nurses Improving Care for Healthsystem Elders (NICHE) program, making it the first and only hospital in Broward County (Florida) to receive this distinction. The NICHE designation underscores BHIP’s commitment to excellence in the care of patients ages 65 and older. It also recognizes the hospital’s ongoing, high-level dedication to geriatric care and the implementation of high-quality, system-wide interventions and initiatives that demonstrate organizational commitment to the care of older adults. The “Exemplar” status — the highest of four possible pro12

OR TODAY | APRIL 2015

gram levels — was assigned following a program evaluation of the current state and future goals of BHIP’s NICHE program. The requirements include implementation of the NICHE Geriatric Resource Nurse model and evidencebased protocols on all applicable units, including specialty units; implementation of systemic aging-sensitive policies; inclusion of the input of patient, families, and community-based providers in planning and implementation of NICHE initiatives and assuming regional and national leadership roles. “The NICHE designation and the ‘Exemplar’ status signal our resolve to provide patient-cen-

tered care for older adults,” said Sandra Todd-Atkinson, the hospital’s chief nursing and operating officer. “Through our participation in the NICHE program, we are able to offer evidence-based, interdisciplinary approaches that promote better outcomes, positive experiences and improved care for our older patients. This leads to greater satisfaction rates for patients, their families and our staff.” The annual Program Evaluation is used to determine the level of their NICHE program. The evaluation benchmarks program progress year-to-year, targets future care initiatives and provides data to use in gaining and sustaining support from institution stakeholders. • WWW.ORTODAY.COM

NEWS & NOTES

C CHANGE SURGICAL INTRODUCES SURGICAL SLUSH SYSTEM C Change Surgical LLC has announced the full-market launch of Intelli-SLUSH re-usable slush containers for use with its SurgiSLUSH slush freezers to create the world’s first fully automated, re-usable slush system. The new slush system is designed to reduce direct costs and simplify the creation and usage of sterile slush. For over 20 years, competitive slush units have required expensive, single-use slush drapes for every procedure, costing hospital users tens of thousands of dollars over their lifetime. C Change Surgical’s Intelli-SLUSH re-usable slush containers eliminate the expense and risk associated with the use of disposable slush drapes in 400,000 annual U.S. procedures requiring sterile surgical slush. “Our extensive research clearly showed that material management and clinical personnel across the entire U.S. strongly desired a less costly, safer alternative in the sterile surgical slush market,” states Patrick Kammer, C Change Surgical president and managing director. “After a

highly successful initial market release, we are very optimistic about the full launch of the SurgiSLUSH with Intelli-SLUSH re-usable slush containers.” “Beside reducing costs, our system delivers another very significant advantage regarding the risk of unintended contamination. Clinicians across the U.S. have clearly expressed a desire to move away from disposable slush drapes that can tear or puncture during use. Reducing infection risk is a primary objective of all surgical teams,” Kammer reports. “SurgiSLUSH now uses secure, closed Intelli-SLUSH containers that eliminate procedure-long exposure to draped, open slush basins.” SurgiSLUSH with Intelli-SLUSH containers frees surgical teams from cumbersome intraoperative slush maintenance, allowing added focus on the surgeon and the patient. It saves valuable sterile field space because it creates slush where convenient, inside or outside of the O.R. This positioning flexibility reduces O.R. noise by eliminating the tedious agitating, mixing and

chopping of solidified slush in the sterile field. “With the push of a single button this system enables surgical teams to rapidly create and maintain perfectly smooth sterile slush, wherever and whenever convenient – even outside the O.R.,” states Kammer. “The system maintains perfectly smooth slush inside secure, re-usable containers for hours until needed.” SurgiSLUSH with the IntelliSLUSH bottle will be showcased at the upcoming 2015 AORN Conference and Expo. •

ATW COMPANIES SHOWCASES ENGINEERED METAL SOLUTIONS ATW Companies Inc. displayed its engineered metal solutions for medical devices at the MD&M West Exposition in February at the Anaheim Convention Center in Anaheim, California. The company displayed prototypes of unique suturing devices made using metal injection molding, manual surgical instruments for surgeon interactive technology, and an award-winning mechanical introducer device for obstetrical/gynecological surgery. New orthopedic curved needle suturing devices, featuring several small and intricate moving parts made using MIM at ATW’s MIM facilities in Rhode Island and California, were on display. These intricate devices will be combined with tube cannulas made at their tube fabrication facility in Pennsylvania. WWW.ORTODAY.COM

Prototypes of manual surgical instruments used in new surgeon-interactive hip and knee robotic arm technology were also displayed. The advanced technology offers a new level of precision and accuracy in aligning and placing implants, important factors that may improve surgical outcomes. Also exhibited was a mechanical introducer device used in minimally invasive obstetrical/gynecological surgery, for which ATW’s Parmatech subsidiary was awarded the grand prize in the medical/dental category of the 2012 Powder Metallurgy Design Excellence Awards Competition, sponsored by the Metal Powder Industries Federation (MPIF). Using the metal injection molding process provided a 70 percent cost savings over equivalent machined parts. APRIL 2015 | OR TODAY

Empower patient compliance TM with the Clorox Healthcare 4% CHG Skin Cleansing Kit. Provide patients with everything they need in one kit, and you’ve helped them enormously. And you’ve taken another important step in your SSI prevention strategy. 4 oz. 4% CHG Bottle: Evidenced-based literature shows 4% CHG bottles are equally effective for infection prevention as 2% CHG pre-saturated cloths – when patients receive standardized instructions.1

WAIT.

Are A Ar re yo you co onfi nfid den ent you ourr pa pati tien ti nts hav avee fo ollllow owed owed ow d your yo our ur preeop oper errat ativ tivve skkin n cle lean an nsiingg pro oto t co cols? lss?

*While supplies last. Limit one per customer. Business or institutional customers only. 1. Edmiston CE, Medical College of Wisconsin, Milwaukee, WI. “Evidence for using Chlorhexidine Gluconate Preoperative Cleansing to Reduce the Risk of Surgical Site Infection.” AORN Journal. Vol 92. No 5. (2010): 509-518. 2. Edmiston CE, et al. “Empowering the Surgical Patient: A Randomized, Prospective Analysis of an Innovative Strategy for Improving Patient Compliance to the Preadmission Showering Protocol.” Journal of the American College of Surgeons 219.2(2014): 256-264. 3. Hibbing, A., “A Picture Is Worth A Thousand Words,” The Reading Teacher; 2003. ©2015 Clorox Professional Products Company. 1221 Broadway, Oakland, CA 94612. NI-28111

OR TODAY | APRIL 2015

Patient Reminder Systems: Offer multiple contact points shown to enhance compliance for preoperative skin cleansing.2 Waterproof Instructions Card: Includes large text and visual icons, which studies show are effective for promoting understanding.3 Online Video Instructions: Easy to follow and drive correct product use.

Learn more and get a free sample* at www.CloroxHealthcare.com/CHGKit WWW.ORTODAY.COM

INDUSTRY INSIGHTS CLOROX ADVICE

BY ROSIE D. LYLES, MD, MHA, MSc

HIT THE SHOWERS: Patient Preoperative Skin Cleansing

he common idiom “April showers bring May flowers” may be on many people’s minds this month, but I’d like to focus on a different kind of shower – the preoperative variety. With many important surgical meetings happening this month such as the Surgical Infection Society’s 35th Annual Meeting (April 15-18) and the American Surgical Association Annual Meeting (April 23-25), April is the perfect time to review your facility’s process for patient preoperative skin cleansing and how proper skin cleansing can help reduce the risk of surgical site infections (SSIs).

different types of product forms (CHG presaturated cloths vs. CHG liquid soap). Despite these differences, evidence suggests that patients benefit from at least two CHG cleanses prior to surgery. Some of these findings include: • An infection risk 4.76 times higher among patients who did not receive a CHG cleansing prior to surgery compared to those who cleansed with CHG at least twice prior to surgery.1 • A study published in the Journal of Knee Surgery showed that “a statistically lower incidence of surgical site infections was found in patients using [CHG] cloths (0.6%) compared with patients undergoing in-hospital perioperative skin preparation only (2.2%).”2

ARE YOUR PATIENTS SHOWERING TOO MUCH OR NOT ENOUGH? Many outpatient and acute-care facilities ask patients to bathe using chlorhexidine gluconate (CHG) prior to surgery, but depending on the facility and the guidelines they follow, skin cleansing protocols can vary greatly. Different facilities encourage a different number of preoperative cleanses (one vs. two vs. three), types of cleansing products (CHG vs. soap and water) and

CHG concentrations on the skin’s surface accumulate with repetitive application, so a single cleanse may not be enough to reach the concentration needed to actually inhibit microorganisms on the patient’s skin. In their studies on the relative efficacy of two vs. one preoperative CHG cleanses, Dr. Charles Edmiston and colleagues have concluded that the accumulative effect of two cleanses offers significant benefits by increasing the concentration of CHG on the skin.3

WWW.ORTODAY.COM

ROSIE D. LYLES, MD, MHA, MSc, HEAD OF CLINICAL AFFAIRS

CHANGING INDUSTRY RECOMMENDATIONS In 2014, the Centers for Disease Control and Prevention (CDC) and the Association for PeriOperative Registered Nurses (AORN) issued drafts of their intended updates to their recommendations for preoperative patient skin antisepsis and SSI prevention that no longer specifically recommend the use of an antiseptic but rather allow for cleansing with either an antiseptic or soap and water. In addition, the AORN guidelines have gone from recommending two cleanses to one cleanse. APRIL 2015 | OR TODAY

CLOROX ADVICE

“CHG concentrations on the skin’s surface accumulate with repetitive application, so a single cleanse may not be enough to reach the concentration needed to actually inhibit microorganisms on the patient’s skin.”3

The proposed recommendation changes have the potential to cause confusion and jeopardize patient care by leaving preoperative bathing guidelines open to interpretation and expanding upon the variation of different skin cleansing protocols currently used by healthcare profes-

sionals. With SSIs affecting between 2% and 5% of inpatient surgery patients and resulting in death as often as 3% of the time,4 there is a need for greater clarity in preoperative skin cleansing recommendations.

TO LEARN MORE about this issue and specific steps to bolster SSI prevention strategies download a free copy of the whitepaper I recently co-authored, “An Evidence-Based Approach to Preoperative Skin Cleansing Focused on Patient Compliance” at www.CloroxHealthcare.com/CHGSkinPrep

[1] Dizer B, Hatipoglu S, Kaymakcioglu N, Tufan T, Yava A, Iyigun E, Senses Z. “The effect of nurse-performed preoperative skin preparation on postoperative surgical site infections in abdominal surgery.” Journal of Clinical Nursing 18.23(2009): 3325-3332. [2] Johnson AJ, et al. “Chlorhexidine reduces infections in knee arthroplasty.” Journal of Knee Surgery. 26(3):213-8 (2013): 213-8. [3] Edmiston CE, et al. “Empowering the Surgical Patient: A Randomized, Prospective Analysis of an Innovative Strategy for Improving Patient Compliance to the Preadmission Showering Protocol.” Journal of the American College of Surgeons 219.2(2014): 256-264. [4] Centers for Disease Control and Prevention. "Guideline for Prevention of Surgical Site Infection, 1999." Infection Control and Hospital Epidemiology 20. 4(1999): 247-278.

“

If the patient was your child, your spouse, you’d want the facility to be AAAHC accredited. Jack Egnatinsky, MD, Medical Director, AAAHC

”

Why more Health Care Professionals turn to AAAHC With Standards that are nationally recognized and annually reviewed, AAAHC accredits more than 6,000 health care facilities. Our surveys are conducted by experienced health care professionals, so they’re collaborative in nature and not just a check list.

For more information, Contact us: 847-853-6060 By email: info@aaahc.org Log on: www.aaahc.org

Improving Health Care Quality through Accreditation

OR TODAY | APRIL 2015

WWW.ORTODAY.COM

LOOKING TO CUT THE COST OF WASTE DISPOSAL?

A Means To Safe Liquid Waste Management Is your facility still pouring, using solidifiers, or putting full suction canisters into red-bag waste? Quick-Drain™ by Bemis puts liquid infectious waste where it belongs, the sanitary sewer system. Quick-Drain™ will dispose of fluid from Bemis suction canisters both quickly and safely. A single unit can service multiple ORs at a fraction of the cost of other complicated systems. It uses no electricity and minimal plumbing is needed.

Visit our website to learn more.

www.bemishealthcare.com 1.800.558.7651 HCG@bemismfg.com WWW.ORTODAY.COM

APRIL 2015 | OR TODAY

INDUSTRY INSIGHTS AAAHC UPDATE

BY SARAH MARTIN, MBA, RN, CASC

QUALITY

QUALITY OUTCOMES CAN EQUAL FINANCIAL SUCCESS IN YOUR ASC WHY QUALITY OUTCOMES ARE IN THE SPOTLIGHT In 2008, an outbreak of hepatitis C in patients treated at a GI center in Nevada placed infection control practices in ambulatory surgery centers (ASCs) in the national spotlight. The Centers for Medicare and Medicaid Services (CMS) revised the Conditions for Coverage for ASCs in 2009, placing the responsibility for patient rights and infection control squarely on the shoulders of a facilityâ&#x20AC;&#x2122;s governing body. This was the beginning of increased regulation on patient quality outcomes. Patient infections and deaths resulting from improper infection control measures at the New England Compounding Center (NECC) made national news in 2012-13 and again placed ASCs in the spotlight, as some of the compounded medications had been administered in ASCs across the United States. Most ASCs, particularly those with active accreditation status, were already meeting the bulk of the new CMS regulations pertaining to 18

OR TODAY | APRIL 2015

infection control. For facilities that were not accredited, but participating in Medicare programs, these changes required a significant revision to their practices and procedures. The importance of quality outcomes was further underscored with the implementation of the Ambulatory Surgical Center Quality Reporting (ASCQR) Program. The ASCQR is a pay-for-reporting, quality data program finalized by CMS requiring ASCs to report quality of care data for standardized measures in order to receive the full annual update to their ASC annual payment rate. This program started in October 2012 with the reporting of G-codes at the time of billing for procedures performed on patients with Medicare coverage. ASCs were now on the same playing field with hospital counterparts that had been providing quality data to CMS for years. QUALITY REPORTING OVERVIEW G-code reporting identified the frequency of events in ASCs related to

patient falls, burns, transfer, wrong site/side procedure, patient and/or implant and the timeliness of prophylactic IV antibiotic infusion. January 1, 2013, ushered in the requirement to verify use of a surgical safety checklist. Rounding out 2013 reporting requirements, ASCs reported on case volumes performed in 2012 on specific procedures which included ophthalmology, pain, GI, arthroscopic and others. The ASCQR program added new measures to report in 2014 and will continue to add new measures each calendar year. ASCs that do not meet the reporting requirements, including allowing the data to be publicly available, may incur a 2 percentage point reduction to any annual increase provided under the revised ASC payment system for that year. THE BIG PICTURE ON QUALITY With these new requirements to report quality data, there is now a direct impact on financial outcomes. Savvy consumers can now view quality data, and select facilities with WWW.ORTODAY.COM

AAAHC UPDATE

Quality is comprised of many moving pieces including: infection control, risk management, patient satisfaction, quality studies, peer review, credentialing, OSHA and compliance issues. high-quality outcomes. This visible data can now also be evaluated by managed care organizations in deciding whether to bring an ASC into their network. Hospitals are currently paid through value-based purchasing by CMS. For example, when a patient presents with a surgical site infection or a readmission for the same health diagnosis, the hospital is not reimbursed for the care provided. The CMS stated goal is “to promote higher quality, more efficient health care for Medicare beneficiaries through quality of care measurement,” and it is likely that in the near future ASCs will have payment tied to quality outcomes in addition to reporting on quality measures. There are other ways in which poor quality can negatively impact the financial well-being of ASCs. Accredited facilities seek to provide an even higher level of quality care, but failure to achieve the standards can result in financial losses. Should an immediate jeopardy situation arise during a survey, a facility may be closed until it can correct the cited issues. This same scenario can also occur when surveyed by the state health department. The loss of cases during the closure is an obvious financial blow, but the collateral damage from the subsequent negative publicity may impact case volumes for months or longer until the facility re-establishes its credibility. WWW.ORTODAY.COM

Quality is comprised of many moving pieces including: infection control, risk management, patient satisfaction, quality studies, peer review, credentialing, OSHA and compliance issues. Separating these pieces, or failure to recognize the linkage, can result in missed opportunities for improvement. Think of these elements as overlapping/linked puzzle pieces. The diagram below illustrates this interconnection. PROVIDING QUALITY CARE AND ACHIEVING POSITIVE FINANCIAL OUTCOMES These headline-grabbing negative outcomes can be averted. Using best practices can keep your facility finely tuned both in the quality and the financial areas; and meeting or exceeding quality requirements helps prevent the decrease of payments, facility closure or unwanted publicity from negative outcomes. A supportive governing body engaged in providing quality care lays the foundation for success. Facility management must stay informed of federal, state and accreditation standards, regulations and laws and maintain compliance at all times; and a thorough self-assessment of the facility’s operations can identify areas of non-compliance. The management team, in collaboration with the governing body, can then develop

action plans to implement changes to correct any deficiencies. Ongoing survey readiness is the key to ensuring quality and financial success in your ASC. There are many resources available, including accrediting organizations such as AAAHC, state ASC associations, and the Association for Ambulatory Surgery Centers (ASCA) to name a few. Frequently, publications provide information and sample documents on websites, often at no cost – and don’t overlook networking with peers to find solutions to problem areas. ASCs as a whole have consistently provided quality patient outcomes, and now these efforts are linked to reimbursement for services provided and will continue to evolve in the years ahead. ABOUT THE AUTHOR Sarah Martin has over 34 years of experience in health care, focusing on ambulatory services for the past 15 years. A registered nurse with an MBA, she holds the CASC credential and has served on the boards of ASCA, AAASC, Tennessee Ambulatory Surgery Center Association (TASCA), and the ASC Quality Collaboration. She is a frequent speaker at national ASC meetings; has held SVP and VP positions in both operational and clinical/quality roles with national ASC companies; and is a surveyor for AAAHC. APRIL 2015 | OR TODAY

INDUSTRY INSIGHTS OR TODAY LIVE!

BY JOHN WALLACE

SURGICAL CONFERENCE

ONE OF A KIND OR TODAY LIVE! ANNOUNCED FOR SUMMER 2015 Empowering the Surgical Services Community

erioperative leaders from throughout North America will flock to Las Vegas this summer for an exciting new conference that offers a unique blend of top-notch educational sessions and entertaining networking events.

The inaugural OR Today Live!, presented by OR Today magazine, is set for Aug. 30-Sept. 1 at the luxurious Red Rock Casino, Resort & Spa in Las Vegas. The resort is a recipient of the AAA Four Diamond Award and was named one of the world’s best new hotels by Conde Nast Traveler magazine. OR Today Live! presents a dynamic environment for perioperative professionals to engage with industry leaders, advance their education, further develop manage-

OR TODAY | APRIL 2015

ment skills, discover the latest services and products and ultimately deliver solutions to improve their health care facility’s performance. OR Today Live! will foster solutions for the prevailing challenges, regulations and culture changes facing the surgical suite and the professionals called on to manage the business decisions and patient care within the OR. John Krieg, president and owner of MD Publishing, said the new OR Today Live! Surgical Conference is an exciting venture that will benefit a variety of health care professionals. “OR Today Live! was created because of a need in the surgical services community for a smaller, more intimate conference,” Krieg explained. “Our experienced editorial board for OR Today brought to our attention that no such meeting existed.”

“What we are doing, essentially, is making the OR Today magazine live – thus the name,” Krieg added. “We are giving the attendees, our readers, an opportunity to engage with leaders at a three-day conference that is a gathering place and a community for the Surgical Services Professional.”

WWW.ORTODAY.COM

OR TODAY LIVE!

Benefits of attendance include networking with professionals in the industry and the opportunity to connect with members of the surgical services community who experience the same issues creating

Deborah A. Herdman, RN, BSHA, Director, PeriOperative Services, Trinity Health System; Susan Phillips, Vice President of Surgical Services, UNC Hospitals; Ren Scott Feagle, MSN/Ed, RN, CNOR,

The final day of the conference starts with breakfast at 8 a.m. followed by roundtable discussions from 9-10 a.m. Following a 30-minute break, the educational sessions begin at 10:30 a.m. followed by the

an atmosphere of collaboration for solving problems. Another feature is the ability to build relations with vendors who will showcase the latest technology, tools and product knowledge in the exhibit hall. Patient safety, always a priority, will be highlighted at OR Today Live! as attendees establish new management practices ensuring each patient has a positive experience by learning new ways to reduce errors and readmissions at their health care facilities. The OR Today Live! educational committee includes respected thought leaders representing different areas of the health care industry. Educational committee members are Sharon L. Morris, BSN, RN, CNOR, Surgical Services Staff Nurse North Valley Hospital;

Clinical Educator for Surgical Services, University Medical Center of Southern Nevada; and R. Clinton Crews, MPH, Director, Master of Surgical Assisting Program, Eastern Virginia Medical School. OR Today Live! will follow a three-day format beginning with workshops and a welcome reception on Sunday, Aug. 30. The second day of the conference will kick off with an informative keynote breakfast from 8-9:15 a.m. followed by educational sessions. The exhibit hall grand opening is scheduled for noon. The second round of educational sessions will kick off at 3 p.m. After a busy day of classes and networking in the exhibit hall, attendees are invited to attend the Red Rock Lanes Bowling Party from 6-8 p.m.

exhibit hall opening and complimentary lunch at 11:30 a.m. The conference concludes with a final round of educational sessions from 2-4 p.m. MD Publishing has more than a decade of experience with successful conferences, including the popular MD Expo. Find out more about OR Today Live! and register to attend online at ORTodayLive. com.

WWW.ORTODAY.COM

FOR INFORMATION P: 800.906.3373 â&#x20AC;˘ W: ORTodayLive.com

APRIL 2015 | OR TODAY

INDUSTRY INSIGHTS ASC UPDATE

CONTINUING DRUG SHORTAGES THREATEN PATIENT ACCESS TO CARE

s I write this message, ambulatory surgery centers (ASCs) across the country are grappling with yet another challenge to their ability to continue to deliver the top-quality, costeffective outpatient surgical care that they provide. The concern this time is a shortage of saline solution—a critical supply for ASCs and all those who provide surgery to those in need.

Almost weekly, and sometimes daily in the last year, ASCA hears the same question from our members: Where do I get the saline solution that I need to continue to meet the needs of our patients and physicians at a price I can afford? Meanwhile, media reports continue to focus on the continually escalating costs of this essential surgical supply while transactions in a gray market–a pseudo black market operated by third-party vendors–intensify and existing supplies often go to the highest bidder. Continuing consolidation in the supplier market also appears to be exacerbating the problem. The unfortunate truth behind the saline solution shortage is that this isn’t the first time that ASCs and other 22

OR TODAY | APRIL 2015

surgery providers have encountered a situation like this one. Recent shortages of versed, fentanyl, propofol and other drugs have also threatened patient access to surgical care. In fact, this problem is not unique to patients who require surgery. Many patients who seek care provided entirely outside the operating room have been forced to accept lesser quality care as a result of the drug shortages that have occurred in the U.S. in recent years. WHAT IS BEING DONE? After serious concerns about the effects that drug shortages were having on patient care were brought to the attention of Congress a few years back, Congress passed legislation known as the “Food and Drug Administration Safety and Innovation Act” (FDASIA). President Barack Obama signed the act into law on July 9, 2012. Title X of that law, addresses drug shortages by: • significantly expanding the drugs that are subject to drug shortage notification requirements; • requiring the manufacturer of a drug to notify the Food and Drug Administration (FDA) of discontinuance six months ahead of time and of an interruption or other hindrance as soon as is practicable;

• requiring the FDA to expedite the review of changes to the way in which critical drugs are manufactured; and • authorizing the FDA to publicly identify companies that fail to report shortages. The FDA is still in the process of implementing all of the requirements of the law, but you can track its progress at http://www.fda.gov/AboutFDA/ Transparency/track/ucm328907.htm. When the FDA learns that a drug is in short supply, it works to identify additional sources of supply or alternative manufacturers, consults with the manufacturers to identify ways to resolve any manufacturing or quality issues and may look at ways to help make new sources of the raw material needed to manufacture the drug available to the drug’s manufacturers. The agency may also begin looking at some longer term solutions, such as expediting new drug applications or beginning to import a foreign drug supply. WHAT IS ASCA DOING? The Ambulatory Surgery Center Association (ASCA) has participated in numerous conversations with members of Congress, FDA officials and others to raise awareness of the barriers that patients face in obtaining the care that WWW.ORTODAY.COM

ASC UPDATE

NO MORE

they need as a result of recent drug shortages. We continue to supply the information we collect to those with authority over this issue. To help keep all ASCs informed about the drug shortages that ASCs and others across the country are facing, ASCA has created a publicly accessible “Drug Shortages Information Center” on our web site available at www. ascassociation.org/drugshortages. There, you can find information about current shortages, news about temporary and long term solutions, additional detail about what the FDA is doing to address the shortages and more. You can also use some of the links that we have supplied there to report shortages and suspected price gouging to the FDA and the Federal Trade Commission.

Wheel obstructions

WHAT YOU CAN DO Since part of the FDA’s response plan relies on obtaining timely and accurate information about the shortages that occur from both those who use and those who manufacture the drugs, I encourage all ASC professionals to let ASCA know when you are experiencing problems. I also encourage you to use the links available in our online Drug Shortages Information Center to report shortages and suspected price gouging to the appropriate federal officials. To report shortages to ASCA, please contact Kristin Murphy at kmurphy@ ascassociation.org. For now, this situation remains frustrating, but ASCA will continue to advocate alongside others for a meaningful, long term resolution to this problem. Until one can be enacted, we will continue to contribute, whenever possible, to the temporary solutions that are posed along the way. We need the support of all ASC professionals to be as effective as possible in reaching these goals. WWW.ORTODAY.COM

APRIL 2015 | OR TODAY

IN THE OR SUITE TALK

SUITE TALK

Conversations from the OR Nationâ&#x20AC;&#x2122;s Listserv

ACLS FOR CONSCIOUS SEDATION Is it required at your facility that RNs have ACLS before they can administer drugs in conscious sedation procedures? If not, are there other requirements for RNs who push medication? A: They must have ACLS.

A: Yes, it is required at our facility.

A: ACLS is mandatory for all nurses working at our critical access hospital. In my opinion, it should be required for all nurses administering drugs.

A: Our facility and organization as a whole require ACLS for acute settings and especially moderate sedation.

A: Our facility requires ACLS before they can give conscious sedation.

A: We require ACLS along with procedural sedation course (with annual skills competency) for all RNs that administer drugs in procedural sedation.

LEAD APRONS How often should lead aprons be checked for integrity? When nurses are working while pregnant they are encouraged to wear lead aprons that protect the front and back. In order to ensure protection of the unborn child, the lead apron should be in ideal condition. Who is responsible for the aprons integrity? Is it the radiology department? A: Our radiology department takes care of cataloging and checking our lead. This is not a nursing responsibility. A: The radiology department checks ours annually.

OR TODAY | APRIL 2015

WWW.ORTODAY.COM

SUITE TALK

UTERINE MORCELLATORS Who all are still using uterine morcellators? What brand device are you using? I have a doctor wanting to use one, but I have no idea where to start looking for one. We had the Ethicon device which was removed by the company. A: I do not recommend using any of the morcelators at this time. Too many lawsuits and the risk of spreading cancer is too great.

A: After this item was pulled from market, our OB/GYN decided not to pursue this technique until further notice.

A: We use LiNA Medical USA Inc. They have a hand held morcellator that is really good.

A: I agree. We pulled all morcelators from use based on a review of documentation and a recommendation from our department of risk management.

A: The LiNA Xcise is still available and approved for use.

A: We are purchasing the TRUCLEAR System from Smith & Nephew, including the fluid management system. A: Intra-uterine morcellator only, not laparoscopic uterine morcellator. A: We removed our uterine morcellators due to the negative publications and studies.

SHELLAC NAILS Does your organization allow staff to wear shellac nail polish in the OR? I have asked for evidence based research, but our infection prevention nurses say there is nothing that clearly defines this and that no one has taken a firm stand. Some consider it nail polish so allow it, some consider it an enhancement like fake or gel nails and do not. If it is not allowed, is it just in the OR, or throughout your organization? A: We allow them as they are not fake, but nail polish that lasts longer and does not chip. A: We do, as long as it is not chipped or peeling. A: Ours does not allow it per policy. A: To keep it simple we do not allow it at our organization.

WWW.ORTODAY.COM

APRIL 2015 | OR TODAY

Power in the quality of our products! Active in our community! Loyal to our customers! Mindful of the dangers of micro-organisms Eager to help stop the spread of cross contamination Righteous in our testing Observant to the new dangers A name you can trust for over 50 Years! Look and see what the EPA had to say: As shown on the EPA’s list, Palmero Health Care’s DisCide Ultra Disinfecting Towelettes and DisCide Ultra Disinfecting Spray ACHIEVED the Agency’s stringent efficacy performance standards against Staphylococcus aureus, Pseudomonas aeruginosa, and Mycobacterium BCG (tuberculosis bacteria) and are confirmed as efficacious hospital disinfectants. HOW DID YOUR DISINFECTANT RATE? Visit EPA website for more info http://www.epa.gov/oppad001/atp-product-list.pdf In accordance to EPA’s guidelines: DisCide Ultra Liquids and Towelettes have been found effective against Ebola virus. For more information please go to: Registration Number 10492-4 and 10492-5. http://www.epa.gov/oppad001/list-l-ebola-virus.html

http://www.palmerohealth.com/requestSamples When requesting a free sample don’t forget to mention OrToday as how you heard about us.

OR TODAY | APRIL 2015

800-344-6424 WWW.ORTODAY.COM

IN THE OR MARKET ANALYSIS

MARKET ANALYSIS

Infection Prevention

nfection prevention continues to be a hot topic in health care as medical professionals stress patient safety. The number of health care-acquired infections and surgical site infections in recent years has brought an added focus to infection prevention, including new regulations and reimbursement policies.

The Centers for Disease Control and Prevention’s annual report on HAIs shows progress in the fight against these sometimes deadly incidents. However, it admits that the United States did not meet its 2013 goals set in 2009 by the U.S. Department of Health and Human Services. “Health care-associated infections (HAI) are a major, yet often preventable, threat to patient safety. The National and State Healthcare-Associated Infections Progress Report expands and provides an update on previous reports detailing progress toward the ultimate goal of eliminating HAIs. Infection data in this report includes central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), select surgical site infections (SSI), hospital-onset Clostridium difficile infections (C. difficile), and hospital-onset methicillin-resistant Staphylococcus aureus (MRSA) bacteremia (bloodstream infections),” according to the CDC website. “The HAI Progress Report describes significant reductions reported at the national level in 2013 for nearly all infections. CLABSI and SSI show the greatest WWW.ORTODAY.COM

BY JOHN WALLACE

reduction, with some progress shown in reducing hospital-onset MRSA bacteremia and hospitalonset C. difficile infections. The report shows an increase in CAUTI, signaling a strong need for additional prevention efforts.” On the national level, the progress report found: • A 46 percent decrease in CLABSI between 2008 and 2013 • A 19 percent decrease in SSIs related to the 10 select procedures tracked in the report between 2008 and 2013 • A 6 percent increase in CAUTI between 2009 and 2013; although initial data from 2014 seem to indicate that these infections have started to decrease • An 8 percent decrease in hospitalonset MRSA bacteremia between 2011 and 2013 • A 10 percent decrease in hospitalonset C. difficile infections between 2011 and 2013 The report helps measure progress toward the five-year HAI prevention goals outlined in the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination set in 2009 by the U.S. Depart-

ment of Health and Human Services. Progress is measured using the standardized infection ratio (SIR), a summary statistic used to track HAI prevention progress over time. “More action is needed at every level of public health and health care to improve patient safety and eliminate infections that commonly threaten hospital patients,” according to the CDC website. The infection prevention market is expected to continue to grow over the next few years with the overall global infection prevention market forecast to reach $14 billion by 2017, according to a recent report from MarketsAndMarkets.com. The report includes sterilization and disinfection practices. Some other tools that are a part of the fight against infections, including HAIs and SSIs, are surgical drapes, gloves, masks, air treatments, surface treatments, bathing solutions and antiseptics. Single-use products are also a weapon in the fight against infections, especially concerning cross-containination. Factors impacting the growth of the infection prevention market in the United States include health care reforms, regulations and a growing number of individuals who have access to health insurance. An aging global population and the spread of quality health care to developing nations is fueling the growth of the global infection prevention market. APRIL 2015 | OR TODAY

IN THE OR PRODUCT SHOWROOM

3M SKIN AND NASAL ANTISEPTIC 3MTM Skin and Nasal Antiseptic (Povidone-Iodine Solution 5 percent w/w [0.5 percent available iodine] USP) Patient Preoperative Skin Preparation is designed to work within the preoperative process to quickly and effectively reduce S. aureus colonization in the nares. Discover how easily it fits into your preoperative process. Visit 3M.com/ takecharge for a free trial. â&#x20AC;˘

OR TODAY | APRIL 2015

WWW.ORTODAY.COM

PRODUCT PRODUCT SHOWROOM FOCUS

CLOROX HEALTHCARE™ 4% CHG SKIN CLEANSING KIT The Clorox Healthcare™ 4% CHG Skin Cleansing Kit is an easy-to-use kit for pre-procedural skin cleansing designed to help improve patient compliance. Two packs, attached via a perforated seal, contain the essentials for two chlorhexidine gluconate (CHG) cleanses including a 4 ounce bottle of CHG, 3 cloths and a bilingual, waterproof instruction card. To help health care professionals deliver better patient outcomes, Clorox Healthcare has also issued a white paper that details the clinically proven benefits of multiple CHG skin applications as part of a strategy to reduce SSI risk. To download a copy of the white paper, visit www.CloroxHealthcare.com/CHGSkinPrep. •

WWW.ORTODAY.COM

APRIL 2015 | OR TODAY

IN THE OR PRODUCT SHOWROOM

ECOLAB

C9500H C-ARM DRAPE SYSTEM As hospitals seek to meet patient needs more efficiently, many have developed hybrid operating rooms that are set up to perform both open and minimally invasive procedures. To meet these evolving needs, manufacturers are designing new drapes for specific equipment with the hybrid OR in mind. Ecolab Healthcareâ&#x20AC;&#x2122;s C9-500H C-Arm Drape System is the first developed specifically for the Philips Allura Hybrid OR equipment. Philips is a leading innovator of this technology, and this drape system is designed to provide the required coverage for the sterile field and reduce infection-causing pathogens that may inadvertently spread by hard surfaces. â&#x20AC;˘ FOR MORE INFORMATION

visit http://www.ecolab. com/video/hybrid-orcarm-drape-set/.

OR TODAY | APRIL 2015

WWW.ORTODAY.COM

PRODUCT PRODUCT SHOWROOM FOCUS

SURGICUBE® UNIT The SurgiCube® Unit provides a localized, optimally filtered, sterile surgical environment to carry out high volume, low risk small surface surgeries and procedures. It supplies sterile air around the operating area using laminar down flow technique. All possible sources of contamination are sidelined, creating an optimal sterile field, thus reducing the risks for surgical site infections. The SurgiCube is location independent, cost effective and patient friendly. •

WWW.ORTODAY.COM

APRIL 2015 | OR TODAY

IN THE OR PRODUCT SHOWROOM

VESTAGEN

OR SCRUBS WITH VESTEX® PROTECTION Vestagen’s new operating room (OR) scrubs made with VESTEX active barrier technology provide OR staff an added layer of protection from unanticipated exposures while in- and outside of the surgical suite. VESTEX fabric protects surgical staff through embedded antimicrobial, fluid repellent and breathable properties and is the only fabric clinically proven to inhibit bacterial growth. The OR scrubs are also made from 100 percent polyester and wicking WarpDry Technology™ to provide the wearer comfort through the longest procedures. www.vestagen.com •

OR TODAY | APRIL 2015

WWW.ORTODAY.COM

PRODUCT PRODUCT SHOWROOM FOCUS

HALYARD HEALTH

AERO BLUE PERFORMANCE SURGICAL GOWNS

Halyard Healthâ&#x20AC;&#x2122;s new Aero Blue Performance Surgical Gown is a soft, lightweight gown that is four times more protective than other comparable surgical gowns while providing users with unsurpassed comfort. Aero Blue features a proprietary fabric with innovative Core technology that delivers the highest fluid protection available in a Level 3 surgical gown as defined by the Association for the Advancement of Medical Instrumentation (AAMI). Surgical attire that is resistant to penetration by blood and other fluids can help minimize risk of infection by preventing exposure. Aero Blue is available in a full range of sizes. FOR MORE INFORMATION,

visit www.aeroblue.info.

WWW.ORTODAY.COM

APRIL 2015 | OR TODAY

The only NO-SLIDE Trendelenburg Restraint TM

TrenGuard

. . .

Shown: 505 lb model in 40o Trendelenburg with PatientGuardTM 800 Stirrups, ArmGuardTM Arm Protector and TrenGuardTM 600 Trendelenburg Patient Restraint

ArmGuard

• • •

No shoulder braces. Lateral stabilizing pillows control body mass shift. Clinically proven “Speed Bump” bolster keeps patients of all sizes from sliding. System easily accomodates patients up to 550 lbs.

“TrenGuardTM is the ONLY safe restraint for extreme Trendelenburg without a single report of a patient sliding. There has never been a report of postoperative discomfort or patient injury.”

– Dan Allen

Exceeds AORN 2015 Guidelines “..patient’s arms should not be tucked at his or her sides when in the supine position.”*

CALL US

800.261.9953

EMAIL US

info@da-surgical.com

*Guideline for f positioning the ppatient. atient. In: Guidelines for f Perioperative P rio Pe riop iopera r tive ra v Pr ve PPractice. ractic ra tice tic ce. Denver,r,r CO: AORN, Inc; 2015:563-582. Emphasis added. AORN does not endorse any company’s products or services. AORN is a trademark of AORN, Inc.

FIND US ONLINE

ONE SOLUTION FOR ALL YOUR PATIENT MONITORING NEEDS

Have you Considered

Disposables?

Disposable items are a necessary component in Nashville the fight to reduce Hospital-Acquired Infections (HAI).

Visit us at Nashville • March 29-31, 2015 Nas

Booth #403 & #405 •

March 29-31, 2015

Pacific Medical Disposables are Offered in a Wide Variety of Cost Effective Options Single Use Kits are Custom Made to Order for your Department Disposable Products are Fully Compatible with All Manufactures Single Use Products Improve Efficiency, Enhance Comfort & Improve Quality of Care

DISPOSABLE NIBP CUFFS

DISPOSABLE SpO2 SENSORS

DISPOSABLE ECG LEADWIRES

Place Your Order Online or Call For More Details: info

(800) 449-5328

pacificmedicalsupply.com PACIFIC MEDICAL LLC

www.pacificmedicalsupply.com/disposable

32981 Calle Perfecto, San Juan Capistrano, CA 92675

Visit our Web Store to Order

IN THE OR CONTINUING EDUCATION 476D

OR TODAY | APRIL 2015

BY MAY MEI-SHENG RILEY, RN, MSN, MPH, ACNP, CCRN, CIC

WWW.ORTODAY.COM

CONTINUING EDUCATION 476D

A LURKING DANGER:

A ‘Bundle’ of Safety Measures Available to Fight Central Line-Associated Bloodstream Infections ContinuingEducation.com guarantees this educational activity is free from bias. The planners and authors have declared no relevant conflicts of interest that relate to this educational activity. See page 45 to learn how to earn CE credit for this module.

This module aims to inform nurses of the severity and causes of central lineassociated bloodstream infections and describe the central-line bundle, a group of evidence-based interventions. After studying the information presented here, you will be able to: • Describe the severity of CLABSIs • Explain the causes and risk factors of CLABSIs • Describe the five components of the central-line bundle WWW.ORTODAY.COM

silent killer lurks in every U.S. hospital: central lineassociated bloodstream infections. CLABSIs affect an estimated 80,000 patients in ICUs each year, and about 250,000 hospitalwide CLABSI are assessed.1 CLABSIs are associated with about 24,000 patient deaths each year.2 They are usually serious infections (e.g., sepsis) and lengthen hospital stay, inflate medical cost and increase the risk of mortality.2 The good news is that CLABSI is preventable,3 and nurses are empowered to reduce these troubling numbers. This module focuses on potentially deadly central venous catheter-associated bloodstream infections. Patients with CLABSI stay in the hospital about 12 days longer than patients without CLABSI.2 The average CLABSI case costs $18,000.2 One study shows that the estimates of attributable cost for CLABSI ranges from $5,734 to $22,939 per patient, based on the 2007 Consumer Price Index for urban consumers and inpatient hospital services.3 Given this data, efforts to reduce the rate of CLABSI are vital to improving healthcare quality and patient safety. The Institute for Healthcare Improvement recommends five key

measures based on best-practice guidelines to fight CLABSI:4 • Hand hygiene • Maximal barrier precautions upon insertion of the CVC • Chlorhexidine skin antisepsis • Optimal catheter site selection; subclavian vein is the preferred site for nontunneled catheters • Daily review of line necessity, with prompt removal of unnecessary lines Together, this group of evidencebased interventions is called the “central-line bundle.”4 The nurse’s understanding of CLABSI and evidenced-based bundle practice can significantly improve patient outcomes. APRIL 2015 | OR TODAY

IN THE OR CONTINUING EDUCATION 476D

A CVC, or intravascular catheter or central line, is a catheter that is surgically inserted into the great vessels in patients who require frequent or continuous injections of medications, fluids or nutritional support.5 It is an intravascular infusion device used for infusion, withdrawal of blood or hemodynamic monitoring whose tip terminates at or close to the heart or in one of the great vessels. For the purpose of surveillance reporting CLABSI and counting central-line days in the National Healthcare Safety Network (NHSN) system, the following are considered great vessels: the aorta, pulmonary artery, superior vena cava, inferior vena cava, brachiocephalic veins, internal jugular veins, subclavian vein, external iliac veins, common iliac veins, femoral veins and, in neonates, the umbilical artery and umbilical vein.5 CVCs are crucial to medicine, particularly in intensive care and during major surgery and resuscitation, providing secure vascular access and reliable hemodynamic measurement; however, central lines can cause complications such as local infections at the insertion site. Central lines can also cause systemic infections, such as CLABSI, septic thrombophlebitis and endocarditis, and metastatic infection, which includes lung abscess, brain abscess, osteomyelitis, endophthalmitis or septic arthritis. CLABSI is the most common of these infection-related complications. Clinicians should understand the difference between clinical and surveillance definitions of CLABSI. The clinical definition is physician driven and based on clinical signs 38

OR TODAY | APRIL 2015

and symptoms of bloodstream infection or sepsis, the blood culture laboratory results and the presence of a CVC. The surveillance definition of CLABSI is more specific and less subjective, and it relies on positive blood culture results and the presence of a CVC. The CLABSI definition in this module was developed by the CDC/NHSN and has been adopted by most healthcare facilities to generate facility-specific CLABSI rates. This definition lists essential criteria for surveillance of CLABSI and succinctly describes the methodology that should be used in CLABSI surveillance systems conducted by healthcare facilities. According to the CDC/NHSN, CLABSI is a laboratory-confirmed bloodstream infection, such as bacteremia/fungemia, in a patient with a CVC when no other secondary infection source with the same microorganism is found. If a patient develops a BSI within the period beginning two calendar days after insertion of a CVC and ending two calendar days after its removal, the BSI is said to be associated with the CVC.5 If more than two calendar days pass between CVC removal and the onset of infection, convincing evidence must exist before the infection can be classified as related to the central line.5 Two criteria must be met before a bloodstream infection is classified as CLABSI: The patient must have both a CVC and a laboratory-confirmed bloodstream infection. The signs, symptoms and blood culture laboratory results must not be related to an infection at another site. If the same organism is found at a site other than the bloodstream, it is a secondary

bloodstream infection rather than a primary bloodstream infection. For example, if both blood and wound culture results have shown Pseudomonas aeruginosa, the bloodstream infection is secondary since the microorganism may have migrated from the infected wound into the bloodstream.5 CDC SAYS ... Using the CDC/NHSN surveillance definitions, a laboratory-confirmed BSI (LCBSI) requires that one of the following three criteria be met:5 Criterion 1: A recognized pathogen in the blood is found from one or more blood cultures, and the pathogen is not related to an infection at another site. Criterion 2: The patient has at least one of the following signs or symptoms: fever (greater than 100.4 F [38 C]), chills or hypotension, and Signs, symptoms and positive laboratory results are not related to an infection at another site, and A common skin contaminant â&#x20AC;&#x201D; e.g., diphtheroids (Corynebacterium spp. not C. diphtheriae), Bacillus spp. (not B. anthracis), Propionibacterium spp., coagulasenegative staphylococci (including S. epidermidis), viridans group streptococci, Aerococcus spp., or Micrococcus spp. â&#x20AC;&#x201D; is identified in two or more blood cultures drawn on separate occasions, occurring within one calendar day of each other with the same skin contaminant found in both results. Criterion 3: A patient less than 1 year old has at least one of the following signs or symptoms: fever (greater than 100.4 F [38 C], core), hypothermia (less than 96.8 F [36 C], WWW.ORTODAY.COM

CONTINUING EDUCATION 476D

core), apnea or bradycardia, and Signs, symptoms and positive laboratory results are not related to an infection at another site and A common skin contaminant — e.g., diphtheroids (Corynebacterium spp. not C. diphtheriae), Bacillus (not B. anthracis), Propionibacterium spp., coagulase-negative staphylococci (including S. epidermidis), viridans group streptococci, Aerococcus spp., or Micrococcus spp. — is identified in two or more blood cultures drawn on separate occasions, occurring within one calendar day of each other with the same skin contaminant found in both results. A new criterion was added to the 2013 CDC/NHSN CLABSI module: mucosal barrier injury (MBI) LCBSI. This criterion is for patients with allogeneic hematopoietic stem cell transplant within a year or patients with neutropenia, defined as at least two separate days with values of absolute neutrophil count (ANC) or total white blood cell count <500 cells/mm3 on or within three calendar days before the date the positive blood culture was collected. The criterion also specifically defines the pathogens found in the blood culture.5 The CLABSI criteria do not include catheter tip culture or treatment with antibiotics; therapeutic options are clinical decisions made by healthcare providers. Blood cultures collected through CVCs can have a higher chance of contamination than blood specimens drawn through peripheral venipuncture. Therefore, cultures should ideally be collected through venipuncture from two to four blood WWW.ORTODAY.COM

draws from separate sites.5 However, this may be difficult in patients with very poor peripheral venous access. Hospital administrators should work to ensure best practice in specimen collection. Blood cultures obtained from any site (through existing intravascular catheters, arterial lines or venipuncture) must be considered in CLABSI surveillance. RATING THE RISKS Despite associated complications, CVCs remain necessary, especially for managing patients in critical condition. Therefore, clinicians must identify and modify the risk factors of CVC-associated infections.1 Multilumen CVCs are indispensable in managing patients requiring several IV medications, laboratory specimens, frequent blood product transfusions and fluid resuscitations; however, they may be related to a higher rate of CLABSIs than singlelumen CVCs.6 Multilumen catheters are manipulated more frequently, making colonization and bacterial growth at the tip more common. To prevent BSI, patients with multilumen catheters must be assessed daily to determine when to change to single-lumen or peripheral IV catheters.6 Femoral CVCs show increased incidence of deep vein thrombosis and catheter colonization. CLABSI due to gram-negative bacteria (e.g., E. coli and Enterobacter spp.) and yeasts is significantly higher in femoral CVC sites7 because of the proximity of the groin to the genital and perirectal area. The subclavian vein has the lowest rate of BSI, followed by the internal jugular vein. The femoral vein has the highest

CLABSI rate. Therefore, the subclavian vein is preferred for inserting nontunneled CVCs (percutaneously inserted into central veins [subclavian, internal jugular, or femoral]).1 Increased risk of CLABSI is seen in patients with femoral intravascular catheters who have a body mass index higher than 28.4.8 CVCs used to administer total parenteral nutrition or lipids and blood product transfusions are associated with increased incidence of BSI. Fungi and polymicrobial infections comprise a large proportion of BSIs in patients receiving long-term TPN. Microorganisms thrive in TPN and high-protein blood products.1 To protect patients, clinicians must use good antiseptic technique before accessing the CVC. Injection ports should be disinfected with an appropriate antiseptic (e.g., chlorhexidine, povidone iodine, an iodophor or 70% alcohol) before accessing the infusion system.1 Also, only sterile devices should be used to access the injection port.1 Injection ports should be allowed time to dry before the infusion system is accessed. Cap all stopcocks when the injection ports are not in use.1 After infusions of IV solutions that may enhance microbial growth, catheters should be flushed with sterile, preservative-free 0.9% sodium chloride according to organization policies and procedures and the manufacturer’s recommendations for the type of catheter. According to the CDC guideline, tubing used to deliver lipid emulsions, blood or blood products should be replaced within 24 hours of starting the infusion.1 APRIL 2015 | OR TODAY

IN THE OR CONTINUING EDUCATION 476D

The tubing used to administer propofol infusions should be replaced every six to 12 hours, when the propofol vial is changed, per the manufacturer’s instruction.1 Replace administration tubing sets not used for blood, blood products or lipids at intervals not longer than 96 hours.1,8 Other risk factors include prolonged hospitalization before CVC insertion, prolonged duration of catheterization, heavy microbial colonization at the insertion site, heavy microbial colonization of the catheter hub, certain patient populations, inexperience of the physician inserting the CVC and a low nurseto-patient ratio. Hospitals should keep nurse-to-patient ratios at least 2:1 in ICUs where nurses manage patients with CVCs and minimize the use of floating nurses in the ICU.8 Many groups of patients are vulnerable to BSI, including the elderly, neonates, critical patients, patients with severe medical conditions, burn patients, oncology patients, immunodeficient patients, neutropenia patients, organ transplant patients, immunocompromised patients and dialysis patients. GETTING ACCESS To cause catheter-related infection, microorganisms must access the bloodstream via the outside (extraluminal) or inside (intraluminal) surface of the catheter tube.9 After accessing the bloodstream, freefloating bacteria adhere to the catheter surface and form a microcolony. This leads to a biofilm, which allows sustained BSI and hematogenous dissemination (i.e., via the bloodstream). Microorganisms can enter by one of several 40

OR TODAY | APRIL 2015

mechanisms. Skin contaminants, likely aided by capillary action, enter through the skin during catheter insertion or in the days after insertion. Microorganisms can enter the catheter hub and lumen during catheter insertion over a percutaneous guidewire or during manipulation of the catheter. They can also be carried hematogenously to the implanted catheter from a distant local infection, such as pneumonia. The most common route of infection is migration of skin organisms at the insertion site into the cutaneous catheter tract with colonization of the catheter tip.1 COMPLEX INTERACTIONS The pathogenesis of the bloodstream comprises complex interactions between the invading microorganism and immune system defenses. When infectious agents spread to the bloodstream, the fever-producing substances secreted by phagocytes will “turn up” the body’s hypothalamic temperature regulator. Vasodilation substances released from the mediators of the inflammatory process in response to overwhelming BSI trigger widespread vasodilation and the reduction of total peripheral resistance. This causes reduced systemic vascular resistance and a decrease in mean arterial pressure. The heart rate is altered because of cardiac compensation. As a result, clinical presentation of BSI includes fever, chills, shaking, tachycardia and hypotension. The microbial profile of healthcare-associated infections, including BSI, has changed over the past decades. From 2009 to 2010, the species of bacteria most frequently

isolated from blood cultures were, in rank order, coagulase-negative staphylococci, Staphylococcus aureus, Enterococcus faecalis, Candida spp. or NOS, Klebsiella pneumoniae/oxytoca and Enterococcus faecium.10 Coagulase-negative staphylococci and Staphylococcus aureus were by far the most common, comprising 20.5% and 12.3% of CLABSIs, respectively.10 From 2009 to 2010, 54.6% of blood cultures testing positive for Staphylococcus aureus were found to be resistant to oxacillin/methicillin.10 In 1999, for the first time, more than half of all S. aureus infections in ICUs were resistant to oxacillin. When S. aureus resists oxacillin, it is classified as methicillin-resistant S. aureus, which has become endemic in many locations and often causes outbreaks. MRSA contributes significantly to increases in morbidity, mortality and healthcare costs.1,11 ALL TOGETHER NOW The central-line bundle correlates with the CDC’s BSI prevention guidelines.1,4,8 Used as a whole, the central-line bundle results in better outcomes than the five measures used individually. Use of the centralline bundle dramatically reduces the incidence of CLABSI, and the reduction is sustainable.12,13 The following is a description of the five key components in more detail. Hand hygiene: Good hand hygiene is the cornerstone of infection prevention. Wearing sterile gloves does not eliminate the need for hand hygiene. Cleaning hands before inserting or manipulating a CVC helps prevent contamination of central line sites WWW.ORTODAY.COM

CONTINUING EDUCATION 476D

and resultant BSIs. (Hands should be washed with antibacterial soap and water with adequate rinsing or cleaned with a waterless, alcohol-based hand sanitizer.) Hand hygiene has the lowest adherence rate of the five components of the central line bundle (62%).14 Every healthcare facility should develop strategies to improve hand hygiene. The World Health Organization’s key moments to perform hand hygiene:15 • Before touching a patient • Before clean/aseptic procedures • After body fluid exposure/risk of exposure (and after glove removal) • After touching a patient • After touching patient surroundings Maximal barrier precautions upon insertion: The operator inserting the CVC should wear a cap (with all hair tucked under the cap), mask, sterile gown and sterile gloves. The mouth and nose should be covered tightly by the mask. The patient should be covered from head to toe with a sterile drape. The adherence rate for sterile draping of patients is 85%.14 If a full-size drape is unavailable, use two small drapes to cover the patient. A sterile dressing must be applied to the insertion site before the sterile barriers are removed. Hand hygiene is also a part of maximal barrier precautions.4 Chlorhexidine skin antisepsis: Evidence suggests that antiseptic 2% chlorhexidine gluconate in 70% isopropyl alcohol provides better antisepsis than povidone-iodine.4 To prepare the site, press the applicator against the insertion site and apply the antiseptic solution using a WWW.ORTODAY.COM

back-and-forth friction scrub for at least 30 seconds. Allow the solution to air dry completely before CVC insertion (about two minutes). Never wipe or blot to dry.4 According to the CDC, no recommendation can be made for using chlorhexidinebased skin antisepsis on patients under 2 months of age.1 Optimal catheter site selection: A subclavian vein is preferred for nontunneled catheters.1 Subclavian venous access has a lower rate of CLABSI than internal jugular or femoral vein access. Subclavian placement may be associated with mechanical complications (e.g., pneumothorax). Patient-specific medical risk factors (e.g., subclavian vein stenosis, coagulopathy, anatomic deformity) should be carefully evaluated when the insertion site is selected.1,4 Daily review of line necessity with prompt removal of unnecessary lines: The risk of CLABSI is closely related to the length of time that a CVC is in place. When physicians and nurses conduct a daily review, unnecessary CVCs are more likely to be removed promptly. A daily review of CVC necessity can be incorporated into multidisciplinary rounds and daily goal reports.4 Ultrasound scanners (designed for guiding vascular access to reduce mechanical complications due to multiple sticks) are not a part of this bundle. BEYOND THE BUNDLE The central-line bundle focuses on the insertion of the catheter rather than later management of the catheter site. Following are

recommendations and guidelines for issues that emerge after the catheter is inserted. Guidewires: Replacing a malfunctioning catheter or exchanging a pulmonary artery catheter for a CVC over a guidewire has become common practice. According to the CDC, guidewires should not be used when replacing catheters in patients suspected of having an infection.1 The CDC does not recommend routinely replacing CVCs to reduce BSI.1 If no evidence of CLABSI is present, use a guidewire exchange to replace a malfunctioning nontunneled catheter as appropriate. Clinicians should wear sterile gloves before handling the new catheter.1 Maximal sterile barrier precautions (including a cap, mask, sterile gown, sterile gloves and a large sterile full-body drape) must be applied during guidewire exchanges for intravascular catheters.1 Pulmonary artery catheters: During insertion of a pulmonary artery catheter, use a sterile sleeve to protect the catheter. Sterile sleeves should be used for all pulmonary artery catheters.1 Prophylaxis: Do not routinely administer intranasal or systemic antimicrobial prophylaxis before or during an intravascular catheter insertion to prevent catheter colonization or development of BSI.1 Catheter and insertion-site care:1,16 • No recommendation can be made regarding the designation of a lumen to use for parenteral nutrition. • Apply sterile gauze or sterile, transparent, semipermeable dressing to cover the catheter insertion site. APRIL 2015 | OR TODAY

IN THE OR CONTINUING EDUCATION 476D

• If the patient is diaphoretic or if the site is bleeding or oozing, apply gauze dressing until this is resolved. • Immediately replace soiled, loosened or damp dressing. Replace dressing when inspecting the site. • Perform site care for nontunneled CVCs in adolescents and adults with a chlorhexidine-based solution, and replace gauze site dressings every two days (seven days for transparent dressings). For some pediatric patients, risk of dislodging the catheter may outweigh benefits associated with dressing changes. Institutional CVC site care policies should address frequency of dressing changes. • Until the insertion site has healed, replace dressings used on tunneled or implanted CVC sites no more than once per week. • Avoid the use of topical antibiotic creams or ointments on insertion sites other than for dialysis catheters; such creams and ointments may promote antimicrobial resistance and fungal infections. • Avoid submerging the catheter in water. Precautions should be taken to protect the catheter from the introduction of organisms during showering. • If the CLABSI rate remains higher than the institutional goal despite other strategies (e.g., education and the central-line bundle), use of antiseptic- or antibiotic-impregnated short-term CVCs and chlorhexidine-impregnated sponge dressings in patients older than 2 months is recommended. NURSES IN CHARGE Nurses should be trained on the 42

OR TODAY | APRIL 2015

indications of IV catheterization, proper insertion procedure, standardized care of CVCs based on institutional policy and the prevention of CLABSI. A hospital’s senior leadership is responsible for ensuring support for the nursing department and an infection prevention and control program that prevents CLABSI. Healthcare providers are responsible for ensuring that optimal CLABSI prevention practice is followed at all times.8 To implement the central-line bundle and ensure adherence, nurses should be empowered to supervise the insertion procedure. Nurses should have the authority to terminate procedures if they observe violations of hand hygiene, sterile technique or evidence-based guidelines for the prevention of intravascular catheter-related infections. Healthcare providers should be educated to increase their awareness of evidence-based infection prevention practice. Insertion kits, maximum barriers and 2% chlorhexidine gluconate in 70% isopropyl alcohol applicators should be kept in one location, such as on a single cart, so clinicians will be able to obtain all central-line insertion supplies easily. A CVC insertion checklist should be developed to document adherence, and data should be collected for benchmarking.8,16 Nursing administrators should provide feedback to the appropriate healthcare providers on unit trends in the incidence and prevalence of CLABSIs and on the strategies to prevent them. More and more patients are discharged with CVCs. Patients and families must be educated before discharge on caring for the catheter and preventing CLABSI. Providing written material can help the patient

retain information. The Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America collaborated with the CDC on a compendium of practice recommendations to prevent healthcare-associated infections, including CLABSIs. Clinicians can use this compendium as a reference.17 JOINING EFFORTS The Centers for Medicare & Medicaid Services no longer pay for the costs of treating CLABSI.18 In addition, hospitals accredited by The Joint Commission have to establish practices to prevent CLABSI.19 Prevention of CLABSI has become a national patient safety goal (NPSG) NPSG 07.04.01. Use proven guidelines to prevent infection of the blood from central lines. This Joint Commission requirement covers short- and long-term CVC and peripherally inserted central catheter lines.19 Hospital administrators and the public are more aware than ever of the need to prevent healthcareacquired infections. CLABSI is associated with increased medical expenses, morbidity and mortality. It is largely preventable with evidence-based guidelines and an increasing awareness of the role of nurse. A CLABSI rate of zero is the goal; patient safety is the No.1 priority. MAY MEI-SHENG RILEY, RN, MSN, MPH, ACNP, CCRN, CIC, is an infection prevention and control specialist at Packard Children’s Hospital at Stanford Medical Center and formerly clinical epidemiologist at University of California Los Angeles Medical Center. Riley holds two masters degrees, an MSN from the UCLA School of Nursing and WWW.ORTODAY.COM

CONTINUING EDUCATION 476D

an MPH from the UCLA School of Public Health. Her work in nursing has included medical/surgical, organ transplant and critical care nursing. Her experience in infection prevention/ hospital epidemiology includes work both with adult and pediatric patient populations. The author thanks David Pegues, MD, for allowing concepts from his physician’s CVC insertion training module to be used in the test for this module. Pegues was an infectious disease physician, the director of the epidemiology department at UCLA Medical Center and a clinical medicine professor of UCLA’s David Geffen School of Medicine. REFERENCES 1. O’Grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheter-related infections, 2011. Centers for Disease Control and Prevention Web site. http://www. cdc.gov/hicpac/pdf/guidelines/bsiguidelines-2011.pdf. Accessed December 27, 2013. 2. Perencevich EN, Pittet D. Preventing catheter-related bloodstream infections: thinking outside the checklist. JAMA. 2009;301(12):1285-1287. 3. Scott RD. The direct medical costs of healthcare-associated infections in U.S. hospitals and the benefits of prevention. Centers for Disease Control and Prevention Web site. http://www. cdc.gov/hai/pdfs/hai/scott_costpaper. pdf. Published March 2009. Accessed December 27, 2013. 4. Implement the central line bundle. Institute for Healthcare Improvement Web site. http://www.ihi.org/knowledge/Pages/Changes/ImplementtheCentralLineBundle.aspx. Updated August 2, 2011. Accessed December 27, 2013. 5. July 2013 CDC/NHSN protocol clarification. Central Line-Associated WWW.ORTODAY.COM

Bloodstream Infection Event. Updated July 2013. Centers for Disease Control and Prevention Web site. http://www. cdc.gov/nhsn/pdfs/pscmanual/4psc_ clabscurrent.pdf. Published July 2013. Accessed December 27, 2013. 6. Dezfulian C, Lavelle J, Nallamothu BK, Kaufman SR, Saint S. Rates of infection for single-lumen versus multilumen central venous catheters: a meta-analysis. Crit Care Med. 2003;31(9):23852390. 7. Lorente L, Jimenez A, Santana M, et al. Microorganisms responsible for intravascular catheter-related bloodstream infection according to the catheter site. Crit Care Med. 2007;35(10):2424-2427. 8. Marschall J, Mermel LA, Classen D, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008;29 Suppl 1:S2230. 9. Riley MMS. Mosby’s PDQ for Infection Control. St. Louis, MO: Mosby; 2009:7581. 10. Sievert DM, Ricks P, Edwards JR, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: Summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009-2010. Infect Control Hosp Epidemiol. 2013;34(1):1-14. 11. Karlowsky JA, Jones ME, Draghi DC, Thornsberry C, Sahm DF, Volturo GA. Prevalence and antimicrobial susceptibilities of bacteria isolated from blood culture of hospitalized patients in the United States in 2002. Ann Clin Microbiol Antimicrob. 2004;3:7. 12. Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006;355(26):2725-2732. 13. Warren DK, Yokoe DS, Climo MW, et al. Preventing catheter-associated bloodstream infections: a survey of

policies for insertion and care of central venous catheters from hospitals in the prevention epicenter program. Infect Control Hosp Epidemiol. 2006;27(1):813. 14. Berenholtz SM, Pronovost PJ, Lipsett PA, et al. Eliminating catheterrelated bloodstream infections in the intensive care unit. Crit Care Med. 2004;32(10):2014-2020. 15. Clean care is safer care. World Health Organization Web site. http:// www.who.int/gpsc/en. Accessed December 27, 2013. 16. Crnich CJ, Maki DG. Intravascular Device Infection. In: Carrico R. APIC Text of Infection Control and Epidemiology. 3rd ed. Washington DC: APIC; 2009. 17. SHEA-IDEA compendium of strategies to prevent healthcare-associated infections. Premier Web site. https:// www.premierinc.com/quality-safety/ tools-services/safety/topics/guidelines/ SHEA-IDSA-Compendium.jsp. Accessed December 27, 2013. 18. Hospital-acquired conditions. Centers for Medicare and Medicaid Services Web site. http://www.cms.gov/ Medicare/Medicare-Fee-for-ServicePayment/HospitalAcqCond/HospitalAcquired_Conditions.html. Updated September 20, 2012. Accessed December 27, 2013. 19. National Patient Safety Goals. Joint Commission Web site. http://www.jointcommission.org/standards_information/npsgs.aspx. Accessed December 27, 2013.

APRIL 2015 | OR TODAY

IN THE OR CONTINUING EDUCATION 476D

CLINICAL VIGNETTE Mr. Smith was admitted to the CCU two weeks ago for cardiomyopathy. A triple-lumen catheter was inserted in his left subclavian vein in the ED, and his condition has since stabilized. The physician had planned to transfer Mr. Smith to the med/surg floor, but his temperature rose to 101.6 F (38.3 C), and he exhibited hypotension and chills. Blood, urine and sputum cultures were obtained. The physician prescribed broad-septum antibiotics.

Can Mr. Smith be diagnosed with CLABSI if the blood culture shows P. aeruginosa isolated in one blood culture? A. No. P. aeruginosa appears in only one culture. B. Yes. He has laboratory confirmation and a CVC. C. Maybe, if signs and symptoms persist. D. Maybe, depending on when the culture specimen was obtained.

Can Mr. Smith be diagnosed with CLABSI if the blood culture result is coagulase-negative staphylococci (CNS) in blood culture and the same organism is found in another blood culture drawn 24 hours later? A. No. Since CNS appears in only one culture. B. Yes. A CVC and symptoms of infection are present. C. Yes. A CVC, a laboratory-confirmed BSI and symptoms of infection are present. D. No. Diagnostic studies are needed.

3. If blood culture results show CNS, which other criteria must be met before Mr. Smith can be diagnosed with CLABSI? A. He has fever, chills or hypotension. B. He has a CVC, and antibiotics are ordered. C. There is a positive sputum culture with the same organism. D. Symptoms of BSI are present, a CVC is in use and blood draws occurred within 48 hours of each other.

Mr. Smith’s sputum culture also shows P. aeruginosa. The chest X-ray showed infiltration and consolidation, which suggested pneumonia. Can he be diagnosed with primary CLABSI? A. Yes. The patient has positive blood culture and a CVC. B. No P. aeruginosa was also found in another site. C. Maybe, if the bacteria load is high. D. Maybe, depending on the physician’s diagnosis.

4. Correct answer: B — The same organism was found at a site other than the bloodstream. This is a secondary BSI. 3. Correct answer: D — If common skin contaminant is isolated from blood culture, other above criteria must be met. This organism also is not related to another infection site. 2. Correct answer: C — CLABSI can be diagnosed from a common skin contaminant isolated in one blood culture if the signs and symptoms of infection are present and the organism is not related to another infection site. 1. Correct answer: B — He has laboratory confirmation and a CVC. P. aeruginosa is a pathogen (not a skin contaminant). 44

OR TODAY | APRIL 2015

WWW.ORTODAY.COM

CONTINUING EDUCATION 476D

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 01/31/2016. 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.

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

ACCREDITED ContinuingEducation.com 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. ContinuingEducation.com 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@nurse.com

WWW.ORTODAY.COM

APRIL 2015 | OR TODAY

Operating Room Solutions

S58

Experience the Future of Operating Room Technology. The EIZO Large Display System is a complete turnkey solution that upgrades multiple standard size displays to one large format Quad HD 8MP display without obtrusive bezels. The Large Monitor Manager formats configurations from multiple video sources and displays them to a physicianâ&#x20AC;&#x2122;s preference. This solution maximizes the flexibility of image layouts and allows users better concentration on surgical and minimally invasive procedures. Be sure to ask about our full range of Multi-Modality displays available in 4MP, 6MP, and 8MP solutions, which integrate color and grayscale accurately on the same display.

800-800-5202 www.eizo.com

CORPORATE PROFILE

Innovators in Health Care Connectivity

atient safety is a constant concern in health care and new regulations emphasize the need to protect patients and medical professionals alike. Curbell Medical, well known in the medical community for decades of producing high-quality products, is aware of the increased demand to reduce health care-associated infections (HAIs) and is ready to help.

“Curbell is best known for our nurse call accessories but we supply a wide-range of patient monitoring accessories including a comprehensive line of both reusable and disposable ECG cables and lead wires,” says Theresa Hart, Product Manager. “We are most excited about our OnePatient® disposable ECG lead wires and the ability to address the risk associated with health care-associated infection with a flexible, financially viable approach. “We are enthusiastic about the opportunity to partner with customers to establish a flexible and scalable ECG connectivity solution with the use of OnePatient disposable ECG lead wires,” she adds. “Utilizing OnePatient is a simple way to reduce the complex cross-contamination issue, and reduce the risk of HAIs including surgical site infections (SSIs). Although there are 48

OR TODAY | APRIL 2015

many causes of HAIs, the use of disposable ECG lead wires can eliminate one source or pathway of contamination.” Numerous studies have demonstrated that reusable lead wires are contaminated with pathogens and are a potential path for infection. Since reusable ECG lead wires come into direct contact with a patient’s skin and are frequently in close proximity to incisions and catheters on the chest and abdomen, they are a potential source of cross contamination. Using disposable lead wires eliminates the potential for cross-contamination that has been associated with reusable lead wires, especially those that have not been properly cleaned between uses. The use of OnePatient disposable ECG lead wires, instead of reusable lead wires, is one simple step health care providers can take that will make a big difference in reducing the risk of infection and improving the quality of patient care. OnePatient disposable ECG lead wires connect directly into existing cables of the most popular patient monitors on the market today, including Philips IntelliVue, GE Multilink, Nihon Kohden, and Spacelabs TruLink. This direct connect design eliminates the needs for adapters that are often lost or accidentally disposed of after use. Additionally, the direct connection

enables seamless patient transfers and the ability to use one dedicated disposable ECG lead wires throughout a patient’s hospital stay. Medical professionals can select snap or pinch patient end connections. Also, the lead wires are fully shielded to reduce signal interference and they meet the ECG cable and lead wire requirements of ANSI/AAMI industry standards. These disposable lead wires provide a simplified and non-disruptive clinical workflow. Because they work just like reusable lead wires, the transition is seamless for health care professionals. They save time without the need to clean and disinfect between patients. The color-coded patient end connections enable quick lead placement and secure patient end connections assist in preventing accidental disengagement. “Curbell Inc. is a family-owned company with a 70-year history and an entrepreneurial spirit that guides our two core businesses – Curbell Plastics Inc. and Curbell Medical Products Inc.,” Don Gibson, VP of Marketing states. Headquartered in Orchard Park, New York, Curbell has a national presence. Primary manufacturing for Curbell Medical is located in Orchard Park, New York. All sales, service and research and development are in the U.S., as well. WWW.ORTODAY.COM

SPECIAL ADVERTISING SECTION

Curbell’s role in patient safety and patient satisfaction has been established with decades of experience in the medical field. The company began as a machine shop in the 1940s and is a leading medical device manufacturer that continues to stress quality, reliability and innovation. This dedication to high quality, innovative products is reflected in the work and attitudes of Curbell’s many employees. The medical business was formed in the 1960s when Curbell began manufacturing remote control units for health care grade televisions. A sense of pride in helping patients and meeting customers’ needs is obvious at Curbell and serves as a guiding force of the family-owned operation. “Curbell’s focus on customer needs and strategy of investing for the long term has led our organization’s growth into a leading medical device manufacturer,” Gibson shares. The company has advanced from its humble beginnings to be a strong player in the medical device industry and a trusted source for health care connectivity solutions. “Curbell enjoys a strong and growing market position in medical device accessories,” Gibson adds. “Quality, reliability and product innovation are our primary advantages. Throughout Curbell’s history, we have built a reputation as the vendor of WWW.ORTODAY.COM

choice in product applications that enhance patient care and the patient experience,” Gibson explains. “We are committed to providing customers with high quality products that enhance the reliability and performance of compatible equipment. All of our products are backed by our ISO 13485 quality system and by our commitment to GMP (Good Manufacturing Practices.)” “Most widely known for nurse call pillow speakers, we provide a comprehensive portfolio of costeffective connectivity solutions. Through the consistent delivery of value, service, performance and innovation, we have built a trusted brand, and trusted partnerships,” says Doug Rockwood, Executive VP of Sales and Customer Service. Curbell’s core competency is health care connectivity accessories and integration. “We understand that a device is only as strong as the connections, therefore we focus on accessories,” Rockwood states. “We care deeply about what happens between that piece of equipment and the patient. If there’s a loose connection, it doesn’t matter how good the device is. Our focus on accessories makes us uniquely positioned to meet the demands of patient monitoring accessories to improve the quality of care.”

Establishing a known and trusted brand in the health care field led Curbell to expand its offering, but not until after they met with health care providers to see what solutions were needed in the clinical setting. The Curbell approach is engineered to meet clinicians’ needs while also positively impacting the overall experience for patient and caregiver. “We are committed to offering our customers device-differentiating value through innovation. We look for advances that make a difference, whether it is a locking patient end connection to reduce alarm fatigue, or improved ergonomics to enhance usability,” Gibson says. “We seek direct input from clinicians as to what their pains are. We collect this input in a formalized way through market research to understand what hospitals want from accessories and what Curbell can do to increase caregiver efficiency and patient safety and satisfaction. We like to say that Curbell ‘Connects the Technical and the Practical’, with the Technical meaning what is required for a device to perform as intended. The practical means what we add to make the device perform optimally given our understanding of not only the product application, but also the clinical work environment.” APRIL 2015 | OR TODAY

Combining its knowledge of health care accessories, connectivity solutions and customer needs, Curbell expanded into the development and manufacturing of patient monitoring accessories. This expansion led to more innovation, specifically the OnePatient disposable ECG lead wires to simply address ways to improve patient safety without impacting clinical efficiencies. Healthcare-acquired infections (HAI) can have a significant patient safety, efficiency and financial impact on a hospital. OnePatient is a simple way to help reduce cross-contamination risks and enhance patient safety. New enterprise resource planning software has boosted the already efficient and well-run Curbell supply chain helping the company remain a crucial partner in the delivery of health care. “Recently we implemented SAP operating system. Our emphasis on strong supply chain management includes dedication to quality through ISO processes and procedures, and is backed by SAP technology,” Abdul Sarac, Curbell’s President explains. “We work to ensure that replacement cables and lead wires are in stock when our customers need them, thanks to Curbell’s procurement and logistic strengths.” “We understand that our success is dependent on our customers’ success,” Sarac adds. “Focused on customer service, we stay close to customers and address demand fluctuations with proven, flexible systems. Our software and technology allow us to manage 50

OR TODAY | APRIL 2015

demand and quickly respond to changing customer requirements and expectations, ensuring a reliable supply of product.” “Through continuous improvement and compliance with our quality management systems, including our ISO 13485 quality system and GMP (Good Manufacturing Practices); we deliver product quality, reliability, patient safety, and customer peace of mind that our products will meet their demanding performance and reliability expectations,” Sarac continues. “ECG accessories are one of the few products in the connectivity chain that actually touch the patient, and nurses touch lead wires every day, making them one of the most-used parts of the system – and, in turn, an area most subject to clinician scrutiny. Clinicians rely on Curbell to create and deliver reliable connectivity accessories that meet the critical and complex needs of patient monitoring.” Sarac points out that everybody at Curbell strives to meet the high expectations the company and its many customers have for every product. Every employee understands that the accessories they produce are life-sustaining and even life-saving devices. “Our people make the difference. We choose employees who thrive in a culture of innovation and demonstrate our core values of integrity, respect and learning,” he says. “We understand that it is our employees’ talents and collective contributions that are the key to our continued strength and success.”

“What is most important is the way that we do business leveraging our corporate values: Integrity, Learning and Respect,” Sarac says. “They guide how we operate; and are the foundation that characterizes our relationships, both internal and external.” Decades of experience in the medical industry means Curbell is prepared for the future thanks to forward-thinking employees at every level of the organization. Innovation, from within the company and collaboration with external partnerships fuels the company as it prepares for the future. “We see innovation on our horizon. And we recognize that innovation doesn’t happen in a vacuum within the walls of R&D labs,” Gibson says. “Therefore, we work with external partners to accelerate innovation. We go beyond obtaining Voice of Customer (VOC) in hospital and focus group environments. We take a multi-faceted approach to keep pace with the rapid changes in the market. We collaborate with universities, inventors, insurers, other manufacturers, and patients to elevate idea generation and development. They are major new market drivers reforming the way that health care is delivered and financed, and this approach helps us keep pace with market dynamics.” FOR MORE INFORMATION, visit Curbell Medical at www.curbellmedical.com.

WWW.ORTODAY.COM

TAKE CONTROL OF INFECTIONS AND YOUR BOTTOM LINE Interchangeable disposable lead wires let you decide how to manage HAIs, reduce complications, and avoid costly penalties. These days, with financial penalties based on HAIs and hospital cleanliness, you can’t afford not to use disposables. And OnePatient lead wires from Curbell are a scalable, cost-effective, disposable solution. Interchangeable design lets you balance cost vs. risk ' Use disposables on all patients, only within specific departments, or only on at-risk patients Disposable lead wires work with existing monitor ' cables, so you can choose to use a disposable or reusable based on individual patient need Eliminate cross-contamination ' Reusable ECG lead wires are a known risk factor for HAIs ' Helps you comply with recommended standards from the CDC and others* * Siegel, JD et al (20060). “Management of Multidrug-Resistant Organisms In Healthcare Settings”. Centers for Disease Control and Prevention; the Healthcare Infection Control Advisor Committee (HIPAC); 1-74

Call 1-888-501-4021 today to learn more about Curbell’s OnePatient solution. www.onepatientleadwires.com MAP1521A

REDUCING SURGICAL SITE INFECTIONS

‘Never Event’ Remains a Huge Problem For Providers and Patients

By Don Sadler

OR TODAY | APRIL 2015

WWW.ORTODAY.COM

he technological advances that have been made in medicine and surgery in recent years are nothing short of astounding. But even the most high-tech, whiz-bang OR equipment and procedures donâ&#x20AC;&#x2122;t seem to be making a dent in the prevalence of health care-associated infections (HAIs), including surgical site infection (SSIs).

According to the Centers for Disease Control and Prevention (CDC), between 5 and 10 percent of all hospital patients become infected with an HAI each year, or a total of about two million patients, and nearly 100,000 of them die as a result of the HAI. Meanwhile, about 400,000 surgical patients become infected with an SSI each year, so SSIs account for about 20 percent of all HAIs. SSIs are the second most common type of adverse event occurring in hospitalized patients, with between 2-5 percent of all surgical patients becoming infected with an SSI. It costs an extra $22,995 on average to care for a patient who contracts an SSI.

WWW.ORTODAY.COM

APRIL 2015 | OR TODAY

IMPORTANT BUT NOT URGENT An SSI occurs when micro-organisms from the skin or the environment enter the surgical incision. They can develop any time from between two to three days after surgery until the wound has completely healed, which is typically two to three weeks after the surgery. “SSIs are considered a ‘never event’ but they are obviously still a very big problem,” says Kaye Reiter, RN, MSN, the vice president of surgical services for Summa Health System in Akron, Ohio. “One patient infection is too many,” adds Amber Wood, MSN, RN, CNOR, CIC, Perioperative Nursing Specialist with the Association of periOperative Registered Nurses (AORN). “That’s why we are always striving to achieve zero HAIs and SSIs.” SSIs can lead to a wide range of patient problems. “Patients with SSIs face longer hospital stays, higher readmission rates and increased medical costs,” says Wood. “They also experience a higher degree of pain and suffering, and they are at higher risk for developing other medical complications, including higher mortality risk.” In addition, an infected wound can eviscerate and it takes longer to heal, Wood adds, and there may be complications if the wound doesn’t heal correctly. “The scar that is left from the infected wound may have to be revised at a later date, which means an additional surgical procedure,” Wood explains. “The bottom line is that recovering from an SSI can be a 54

OR TODAY | APRIL 2015

long and exhausting process for the patient,” Wood says. A TOP PRIORITY “SSIs can be devastating, which is why reducing SSIs is a top priority for most ORs today,” adds Sherry S. Hardee, MSN, RN, CNOR, NEABC, vice president, Catawba Valley Medical Center in Hickory, North Carolina. “When they do occur, we do a deep dive to look at every factor related to the patient’s care that could have been a contributing factor to the SSI. We want to look at all the pieces of the puzzle and address any contributing factors so they don’t happen again.” The most important key to preventing SSIs is strict adherence to sterile and aseptic technique. “There is a move now to go back to the basics of sterile technique,” says Hardee. “This includes following the Surgical Care Improvement Project (SCIP) guidelines.” Melissa Lingle, BSN, RN, CNOR, the unit director for the operating room at Summa Health System in Akron, Ohio, emphasizes the importance of choosing the right prep solutions and allowing them to dry appropriately. “Patient skin prep is key — using the right prep solutions the right way,” she says. During pre-admission prep, Lingle says that patients are given chlorhexidine wipes three days prior to surgery and told how to wipe and clean the surgical site before coming in to the hospital. “We also tell them to wear clean pajamas and sleep on clean bed sheets the night before surgery and to shower the morning before

“SSIs can be devastating, which is why reducing SSIs is a top priority for most ORs today, when they do occur, we do a deep dive to look at every factor related to the patient’s care that could have been a contributing factor to the SSI. We want to look at all the pieces of the puzzle and address any contributing factors so they don’t happen again.” – Sherry S. Hardee

WWW.ORTODAY.COM

“Patients with SSIs face longer hospital stays, higher readmission rates and increased medical costs,” says Wood. “They also experience a higher degree of pain and suffering, and they are at higher risk for developing other medical complications, including higher mortality risk.” – Amber Wood

surgery,” Lingle says. “The goal should be to educate and prep patients to prevent infection every step of the way, including before they come in to the hospital for surgery,” she says. Wood says that perioperative nurses can incorporate actions from evidence-based guidelines into their nursing practice to prevent SSIs. “For skin antisepsis, OR nurses should review the manufacturer’s instructions for use to ensure that they are using the product safely and effectively,” she says. “Allowing skin antiseptics to be in contact with the skin and dry for the recommended time will enable the antiseptic to work to its full potential.” THE IMPORTANCE OF HAND HYGIENE One of the simplest and most effective things that OR nurses and other perioperative team members can do to prevent SSIs, Wood stresses, is to frequently and thoroughly wash their hands, especially before beginning the preoperative skin antisepsis. WWW.ORTODAY.COM

“Also make sure all perioperative surfaces are clean before beginning the perioperative skin antisepsis,” she says. “It’s terrible to think we don’t have time to wash our hands, but that’s how it feels sometimes when we have so much to do,” Wood adds. “Unfortunately, the pressure to save time and increase efficiency will always be there. But we have to remember that the first and most important priority is keeping our patients safe.” “Every OR leader’s mantra should be: Yes, efficiency is important, but not at the cost of safety,” says Reiter. “We have a safety program in place that includes mandatory education for both nurses and physicians that’s designed to eliminate potential breakdowns in safety processes that could lead to HAIs and SSIs.” “No nurse would ever do anything to intentionally harm a patient,” adds Lingle. “But it’s kind of an unspoken rule in many ORs today that speed is important — you’ve got to get the patient on the operating table and get going. We need to make sure we slow down

enough to make sure patients’ skin is properly prepped and the prep has time to dry so it can do its job fighting bacteria.” These cost and efficiency pressures can be especially overwhelming for new nurses who are still trying to find their voice in the OR, says Hardee. “All OR nurses, regardless of their tenure, need to feel empowered to speak up for patient safety when they feel they need to,” she says. OR nurses can overcome pressures to increase efficiency possibly at the expense of safety by explaining their rationale to perioperative team members and providing supporting documentation, such as evidence-based guidelines and manufacturers instructions for use. “Leadership support is also vital to the bedside perioperative nurses’ success in making an impact on team members,” says Wood. AORN SSI GUIDELINES UPDATED According to Wood, AORN APRIL 2015 | OR TODAY

“We have a safety program in place that includes mandatory education for both nurses and physicians that’s designed to eliminate potential breakdowns in safety processes that could lead to HAIs and SSIs.” - Kaye Reiter

guidelines addressing SSIs were approved by the Guidelines Advisory Board as final and published in the 2015 AORN Guidelines for Perioperative Practice. She says the top changes for this year include recommendations that the patient should bathe or shower

ORT_Halfpg_Mar v2 OTL.indd 1

OR TODAY | APRIL 2015

before surgery with either a soap or an antiseptic, guidance for selecting safe and effective skin antiseptics at the facility level and for individual patients, and an emphasis on applying skin antiseptics in accordance with the manufacturer’s instructions for use. “The AORN Guidelines also

incorporate new guidance from the FDA that skin antiseptics must be stored in their original, single-use containers,” she says. When it comes to SSIs, “one patient infection is too many,” says Wood. “That’s why we are always striving to achieve zero SSIs.”

1/23/15 12:45 PM

WWW.ORTODAY.COM

Streamline Patient Warming from admission to discharge Warm fluids and blankets in bulk, then keep the fluids warm right in the OR with ivNow®

EC1730BL combination warmer DC400L fluid warmer

ivNow-3 warmer IV fluid

Improve processes: • Efficiently warm patients from admission to discharge • Warm fluids in a cabinet and keep them warm at the point of use with the space-saving ivNow warmer ivNow increases regulatory compliance: • Display actual temperature of every bag • Records the shelf life of every bag ivNow saves money: • Reduce disposable costs while warming 20-140 liters of fluid over 12 hours

Increase reimbursements: • Reduce SSIs and time spent in the PACU • Improve patient satisfaction surveys & clinical outcomes

WWW.ORTODAY.COM

Enthermics Medical Systems ISO 13485:2003 Certified | 1-800-862-9276 | www.enthermics.com

APRIL 2015 | OR TODAY

VBMĐDifficult Airway Management�

VBMĐ

An ultimate 2-Channel feature puts the fight to an end.� Endoscopy

astro- aryngeal ube

ask

with top opening for Endoscope

Endoscopy Mask:� for Diagnostic Airway Endoscopy / ibreoptic Intubation and astroenterology / EE rans Esophageal Echocardiography .

Channel 1 for Securing Airway

Channel 2 for Endoscope

Extraglottic Tube:� with two individual entilation and Endoscopy lumens for Control of Airway Patency during astrointestinal Endoscopic Procedures.

A Powerful achine with the Simplest ne-Dial- peration Design. Supplies the widest variety of cuffs disposable, reusable, autoclavable or in contour conical shaped that fully accommodates existing tourni uet systems.

Automatic Precision ourni uet Systems are easy to operate and offer tremendous flexibility. eatures one-dial operation, reducing errors and improving efficiency. 000 model the best ier s lock achine which powers two tourni uets at one time with special features, is ideal for double cuffing procedures ier s lock for I regional anesthesia or for bilateral surgeries.

ourni uet

achines and Cuffs are Compatible with All ourni uet Systems.

VBMĐMedical Inc.Đ call

00 5 0- 11 58

OR TODAY | APRIL 2015

visit www.vbm-medical.com

e -mail info

vbm-medical.com WWW.ORTODAY.COM

get your vascular bootie on the dance floor.

If your favorite move is the one where you hold the finest suture securely without damage, you wonâ&#x20AC;&#x2122;t miss a beat with Key Surgical Vascular Booties. They come packaged sterile in pairs of 2, 3 or 5 on groovy foam pads with adhesive backing. Choose red, yellow, blue or pink. And letâ&#x20AC;&#x2122;s boogie. Place your order today.

call WWW.ORTODAY.COM

800.541.7995

or visit keysurgical.com APRIL 2015 | OR TODAY

NURSE R, E N O I T I T C A PR EDUCATOR N REFLECTS O S EXPERIENCE koufalos By Matthew N. S

OR TODAY | APRIL 2015

WWW.ORTODAY.COM

LIFF FAWCETT SPOTLIGHT ON: C amily nurse pracf d e ifi rt e c dar Bo ett, MED, MSN, c aw F f lif C r ne titio to get right back took a long time ted: his alma mato where he star University in ter of Cedarville Cedarville, Ohio.

WWW.ORTODAY.COM

APRIL 2015 | OR TODAY

SPOTLIGHT ON: CLIFF FAWCETT

Fawcett’s father (and namesake) taught business management at Cedarville University for 25 years, starting when he was a freshman at Cedarville. His brother, Jeff, spent another 24 teaching business marketing at the university. Then, in 2010, Cliff joined the Cedarville faculty — just in time for his son, Andrew, to enter the school’s graphic design program. Four years later, Andrew is ready to graduate, and his younger brother, Ben, is a junior in the Cedarville University School of Business.

Cliff Fawcett, far right, is seen with his brother Jeff and father Cliff at his college graduation in 1988.

“Working with the Eagles, the casual fan is aware of the Donovan McNabbs and the Brian Westbrooks, Duce Staley, people like that, and we worked with those guys, but we saw a ton of players who most fans have never heard of.”

Currently, Cliff Fawcett heads the family nurse practitioner program at Cedarville. He describes the career he’s enjoyed in the years since as “very interesting and diverse.” He has earned two master’s degrees — one in sports medicine and one as a family nurse practitioner. He also has spent time working with one of the preeminent team doctors in Philadelphia, Arthur Bartolozzi. During Fawcett’s tenure with Bartolozzi, the physician was the team doctor for the Philadelphia Flyers and their minor league affiliate, the Phantoms; the Philadelphia Eagles, the Philadel62

OR TODAY | APRIL 2015

phia Kixx soccer team, the Camden River Sharks, the Philadelphia Rage of the women’s American Basketball League, and for athletics teams from Rowan and West Chester Universities. “Working with him — and we took care of all those teams — we were in the locker rooms, on the field, right in the thick of it all the time,” Fawcett said. Fawcett recalls spending weeks with players, evaluating them after game injuries, working them up in the locker room, staying with them through surgery if it was required, and getting them back on the field. He was with the

Phantoms during their 1998 American Hockey League Calder Cup victory, and along for the ride when many of the players from that junior team went on to NHL careers with the Flyers. He was also on hand for two years of the X Games in Philadelphia, where he remembers watching legendary skateboarder Tony Hawk land a 900-degree spin for the first time in competition — and riding in the ambulance with Carey Hart after Hart failed the first attempted backflip on a dirt bike. “[I saw] a lot of those significant historical events in action sports,” Fawcett recalls. “It’s surreal, really. And then I don’t think you realize it so much when it happens, but you watch for years, that replay on ESPN, and I saw it live.” “It’s not a place that a lot of people have access to, and I just felt really privileged to be there, and honestly, to help these guys,” he said. Fawcett said he “enjoyed figuring out the differences in personality between the different WWW.ORTODAY.COM

Cliff Fawcett, back row, second from right, is seen in Lincoln Financial Field in Philadelphia with the medical team he assembled for the 2003 Womenâ&#x20AC;&#x2122;s World Cup Soccer tournament.

Cliff Fawcett, left, is seen with Jackie Teagle, Dr. Art Bartolozzi and Damion Valleta in an operating room at Pennsylvania Hospital.

WWW.ORTODAY.COM

APRIL 2015 | OR TODAY

SPOTLIGHT ON: CLIFF FAWCETT

Cliff Fawett and his son Andrew are seen with the Philadelphia Phantoms mascot Phlex at a minor league hockey game.

teams” and had “so many memories of different players being injured,” including a number of borderline professional athletes who never made it past the practice squad yet needed professional care all the same." “Working with the Eagles, the casual fan is aware of the Donovan McNabbs and the Brian Westbrooks, Duce Staley, people like that, and we worked with those guys,” Fawcett said; “but we saw a ton of players who most fans have never heard of.” “There’s a lot of guys that are really, really talented,” he said. “They make it to that level, but they don’t succeed at that level like others. They have needs just as much as those big-name guys.” Fawcett said that many fans are enamored with the professional athletes, “and I felt like they got enough of that” from their supporters. Where he maintained his professionalism, it mattered to the players because “they needed someone to treat them like a human being,” Fawcett said. “They have a problem, it’s standing in the way of them making a living,” he said. “You’ve got a UPS driver with a bad back; he needs the right treatment to get back to work to make a living in the same way that a tight end with a bad back does.” That approach served Fawcett well after his time with Bartolozzi concluded. The doctor stopped working with the pro teams in 2003, and Fawcett stayed with his practice for another five years, working with the Philadelphia Kixx and the 64

OR TODAY | APRIL 2015

Cliff Fawcett is seen on the sidelines with Dr. Art Bartolozzi during a NFL football game. Fawcett helped Bartolozzi care for the members of the Philadelphia Eagles.

WWW.ORTODAY.COM

collegiate teams. Had it not been for his ability to distance himself from the profile of the work and his clientele, Fawcett said the letdown might have been very difficult to overcome. “I remember the day that Dr. Bartolozzi resigned from taking care of the Eagles and the Flyers,” Fawcett said. “I thought to myself, what am I going to do? I felt like that gave me credibility that I worked with those people.” But soon, Fawcett said, he realized that yes, he had done those things, and “no one can take that away from me.” “Second, I have credibility,” he said. “It’s not that I draw my credibility from the people that I work with.” “Looking back, my dad always used to say your career forms behind you,” Fawcett said. “Everything seems random, but you look back. You have to take the step that seems to make sense at the time.” “I think you sometimes put a lot of pressure on yourself to make the right choice,” he said. “It’s not that the choice doesn’t matter. I wouldn’t believe that I would have those opportunities, and I wouldn’t have believed that I would have moved on from those opportunities. It developed fluidly and I don’t regret any of it. It’s all good experience.”

Cliff Fawcett is seen with former Philadelphia eagles Head Coach Dick Vermeil. Fawcett worked with Dr. Art Bartolozzi to provide medical care and treatment to various professional and college sports teams in Philadelphia.

Professional Comfort for Surgeons, Nurses & Technicians

STAND IN COMFORT

MEDICAL ANTI-FATIGUE MATS

COMFORT CUSHION INSOLES

• Revolutionary gel + foam comfort • Reduce discomfort & fatigue • Compatible with hospitalgrade quaternary cleaners • Antimicrobial & antibacterial surfaces • NFPA 260 & CAL 117 compliant

• GelPro Comfort Cushion Insoles slip inside any standard shoe cover • Dramatically reduces fatigue from prolonged standing or walking • Provide the benefits of an anti-fatigue mat wherever you walk or stand • Can be used as long as 30 days before replacement is necessary *SHOES & SHOE COVERS ARE NOT INCLUDED

1/2” THICK CLOSED-CELL CUSHIONED FOAM

100% GELPRO GEL SUPPORTIVE FOAM

GelProMedical.com | WWW.ORTODAY.COM

Made in the USA

1.866.435.6287

Now accepting volume distributors

APRIL 2015 | OR TODAY

OUT OF THE OR HEALTH

STAFF REPORTS

LEARN HOW TO SPOT AND TREAT SINUSITIS A head full of congestion, post-nasal drip and a dull sense of smell and taste – these symptoms are common enough to be confused with allergies and colds. But such symptoms also could mean you have sinusitis, says Michael S. Benninger, M.D., Chairman of the Cleveland Clinic Head and Neck Institute.

Benninger offers the following tips about diagnosis and dealing with this common condition:

mentioned above, you may also have pain in your face and teeth and discolored drainage.

DON’T JUMP TO CONCLUSIONS: Because the symptoms of sinusitis overlap with other conditions, seeing a doctor will help narrow down a diagnosis. “The only way to truly determine what’s causing the symptoms is for a doctor to actually look inside the nose,” Benninger says.

WATCH YOUR SYMPTOMS: Acute sinusitis (rhinosinusitis) is inflammation of the tissue lining your nose and sinuses. It’s often caused by a virus or bacterial infection. On top of the stuffy head, sneezing and runny nose

OR TODAY | APRIL 2015

GIVE IT TIME, AND TREAT AS NEEDED: Acute sinusitis typically goes away on its own in seven to 10 days. If it lasts longer, your doctor may prescribe antibiotics. Chronic sinusitis is different. It lasts three months or longer, and treating it requires more time and patience. A combination of medications – including nasal steroid sprays, oral steroids, antibiotics and mucus-thinning drugs – may help ease symptoms.

USE OVER-THE-COUNTER DRUGS WITH CAUTION: Decongestant sprays and drops may relieve your symptoms for a short time, but use them sparingly or

avoid them altogether because of the danger of “rebound congestion,” says Benninger. That’s congestion that comes back after you stop taking them – leaving you with a new problem to treat.

SURGERY IS AN OPTION FOR SEVERE CASES: If the treatments above are not effective, or if nasal polyps develop and block sinus drainage, surgery may be necessary. The good news is that it’s usually an outpatient procedure. Surgery also may help hone a diagnosis in chronic cases.

YOU CAN TAKE STEPS TO PREVENT SINUSITIS: Wash your hands frequently to avoid the germs that lead to sinusitis. Eat well and exercise to boost your immune system. If you have allergies, treat them. You may also benefit from nasal irrigation (a Neti pot, for example), which rinses pollutants out of nasal tissue. These steps won’t “cure” sinusitis, but they can help you avoid it.

WWW.ORTODAY.COM

TRIM 3.25”

TRIM 4.5”

AD SIZE 1/4 Page Vertical

PUBLICATION MEDICAL DEALER BUYERS GUIDE

ORTODAY 1.888.828.2637

TECHNATION OTHER

NOTES www.bmesco.com

MONTH J

DESIGNER: JL

WWW.ORTODAY.COM

APRIL 2015 | OR TODAY

OUT OF THE OR FITNESS

HARVARD HEALTH LETTERS

CAN AN APP HELP YOU LOSE WEIGHT?

martphones and tablets combine an extraordinary amount of portable computing power with connectivity to the world via cellphone signal and WiFi. Many health entrepreneurs are trying to harness that power to help people to get healthier. According to one estimate, the number of health apps for phones may already top 40,000. Now the tough question: Do they actually work? A study published in November in the Annals of Internal Medicine on one popular weightloss app finds that the answer is “not so much.” Researchers at the University of California-Los Angeles put to scientific scrutiny a free app called MyFitnessPal. It’s based on research on how people make changes in their habits. The company claims it has more than 50 million registered users. MyFitnessPal is a web-connected food journal and weight loss coach. A user can access a database of more than 4 million foods, and add what he or she ate to a daily log. The app calculates the number of calories consumed and compares them to the daily calorie goal, which the app computes based on the user’s current weight, goal weight and desired rate of weight loss.

OR TODAY | APRIL 2015

The researchers randomly assigned more than 200 overweight middleaged women to one of two groups: One used MyFitnessPal as a weightloss aid, the other talked to a primary care doctor about weight issues but did not use MyFitnessPal. The women’s progress was assessed at three and six months – long enough to detect a significant difference in weight loss among these relatively motivated calorie counters. The app users lost an average of about 5 pounds – but so did the non-app users. That means, at least in this study, recommending a weight-loss app to people who want to lose weight isn’t much better than getting advice from a doctor. One reason may be that use of MyFitnessPal fell off quickly, from an average of five times a week at the start of the study to just over once a week by the second month.

DESIGNING EFFECTIVE HEALTH APPS Simply giving people an app to track their data is not enough to create positive health outcomes, says Dr. Kamal Jethwani, the head of research and innovation at the Center for Connected Health at Partners HealthCare (Boston, Mass.) and assistant professor of dermatology at Harvard Medical School. Many health apps still lack the built-in intelligence to figure out what particular mix of features – coaching, social connections, and financial or other incentives – can provide sufficient motivation to fuel real change. “There are many examples of apps that do one of the three right,” Jethwani says. “I have not seen one that does several things very well.” To help change that, Jethwani and his colleagues at the Center for Connected Health are developing a smarter app called Text 2 Move to spur healthier behaviors in people with diabetes. This dynamic phone messaging system tracks a user’s activity and location, and provides him or her with personalized, WWW.ORTODAY.COM

FITNESS

motivating messages and other feedback. Preliminary research suggests it increases average walking by a mile a day and improves blood sugar control. The next-generation version of the app will have multiple motivation modes – coaching, social, and gamification. It will analyze a user’s behavior for a short trial period and then “decide” which behavior it thinks will work best. “We would want to have an app that, within a couple of weeks, based on your data, decides what motivational style is going to work for you and offers you a host of options,” Jethwani says. This is more likely to

WWW.ORTODAY.COM

succeed than depending on stressed and overtaxed health care workers to figure out the best option and “prescribe” it for you. A HEALTH APP FOR YOU? In spite of the app’s poor showing in the UCLA trial, MyFitnessPal and other health apps can be useful tools for people who want to manage their weight and lifestyle. But it takes two things from the user – motivation to make a change and using the app enough to produce the desired effect. “Clinicians must become aware of these tools and support our patients in their use, since they are a great way to start moving the needle on

the awareness and education needed to produce lifestyle changes,” says Dr. Jethwani. “Motivated patients will achieve great results, while other patients may stop using them, but will definitely gain better insights into their lifestyles.” If you are interested in health apps, good information is available from a website called Wellocracy, which is run by the Center for Connected Health. It provides tools and information to help people find apps and personal fitness trackers that suit their personal needs and motivational style. Take a few for a test drive and see if you feel better.

APRIL 2015 | OR TODAY

OR TODAY | APRIL 2015

WWW.ORTODAY.COM

WE’VE GOT YOUR FLOOR COVERED! Safety, Comfort, Ergonomics.

APRIL 2015 | OR TODAY

OUT OF THE OR NUTRITION

ENVIRONMENTAL NUTRITION NEWSLETTER

PESCETARIAN DIET SWIMMING IN HEALTH BENEFITS

hink something’s fishy about a pescetarian diet? Think again! More people are interested in this style of eating, which may be one of the best things you can do for your health.

Pescetarians avoid red meat and poultry, yet eat all manner of seafood, including fish, shrimp and clams, along with dairy, eggs and an abundance of plant foods. Janis Jibrin, M.S., R.D., author of “The Pescetarian Plan,” says, “Following a pescetarian diet could potentially lower your risk of heart disease, type 2 diabetes, dementia, erectile dysfunction and depression.” Science backs a pescetarian eating style. Scientists have long observed that including fish in your diet is a healthful habit. Whether it’s the lack

OR TODAY | APRIL 2015

of saturated fat-laden red meat, high intake of fruits and vegetables, heart-healthy omega-3 fatty acids in fish, or abundance of minerals in shellfish, a pescetarian diet is a great way to keep your body healthy. A 2007 article in the American Heart Association journal reported that eating fish just once or twice a week was associated with a 42 to 50 percent reduction in the risk of sudden cardiac death in healthy adults. In two other studies, subjects who ate vegetarian diets, including pescetarian diets, had lower BMIs and a substantially lower risk of type 2 diabetes and death during a six-year study period than those who regularly ate meat and poultry. EATING THE PESCETARIAN WAY So how do you get started? Here are a few tips for implementing a wholesome pescetarian eating style:

WWW.ORTODAY.COM

1 2 3

MAKE AT LEAST 50 PERCENT OF YOUR MEAL VEGETABLES (or 50 percent fruit at breakfast).

ADD A LITTLE HEALTHY FAT, such as olive oil, nuts, or avocados, when sautéing vegetables or dressing salads.

FILL ONE-FOURTH OF YOUR PLATE WITH HIGH-QUALITY PROTEIN. While most experts recommend seafood 2-3 times per week, Jibrin suggests eating seafood once a day, along with other vegetarian choices, such as tofu, edamame, yogurt, cheese and eggs at other meals. Legumes, such as beans and lentils, also are good protein sources.

ENJOY ONE-HALF CUP OF WHOLE GRAINS AND/OR OTHER STARCHY FOODS (like sweet or white potatoes) four or five times a day. SHOPPING FOR SEAFOOD In order to make the most of your pescetarian diet, follow these shopping tips:

1 2

BUY SEAFOOD FROM A REPUTABLE STORE to ensure safety and freshness. ASK WHICH FISH ARE THE FRESHEST.

WWW.ORTODAY.COM

3 4

USE THE SNIFF TEST: Fresh fish doesn’t have a strong “fishy” smell.

LOOK BEFORE YOU BUY: The flesh of fillets should be shiny and smooth, and the eyes on whole fish should be clear and round. Mussels, clams and oysters should be tightly shut.

CHOOSE SUSTAINABLE SEAFOOD to safeguard the environment and avoid over-fished species. The National Smart Seafood Guide at foodandwaterwatch.org, or the Monterey Bay Aquarium Seafood Watch at seafoodwatch.org, can guide you. COOKING UP YOUR CATCH Don’t be intimidated; cooking fish is easier than cooking meat or poultry if you follow these tips:

1 2 3

GRILL, PAN-FRY, POACH, ROAST, OR STEAM fish and other seafood.

MEASURE THE THICKEST PART OF THE FISH. Cook 10 minutes per inch (fish thicker than 1/2 inch should be flipped over halfway through cooking time.)

DON’T OVERCOOK. Fish, shrimp and scallops are done when they’re still slightly translucent in the center (they’ll continue cooking after you remove them from the heat source.) Fish should feel firm, but still moist. It should be just ready to flake.

APRIL 2015 | OR TODAY

The premier meeting for the ASC industry Attend sessions to help you:

Network with colleagues and:

• Strategically position your ASC for optimal success

• Exchange best practices

• Protect your ASC from liability and financial penalties • Improve your clinical efficiency and patient care

• Discuss marketplace trends • Share real-world solutions • Advance your career

ASCA 2015 will feature the largest exhibit hall of the year and amenities including championship golf, award-winning restaurants and a rejuvenating full-service spa.

Learn more and register at www.ascassociation.org/ASCA2015

OR TODAY | APRIL 2015

WWW.ORTODAY.COM

OUT OF THE OR RECIPE

WWW.ORTODAY.COM

BY EMMA CHRISTENSEN

APRIL 2015 | OR TODAY

OUT OF THE OR RECIPE

HOW TO COOK TENDER & JUICY PORK CHOPS IN THE OVEN

hat if I told you that I could guarantee a method for cooking perfectly tender pork chops? Would you believe me? Or have too many dinners of overcooked shoe-leather pork chops turned you off from this easy addition to the weeknight meal rotation? Let me convince you to try them one more time. Let me convince you to try roasting your pork chops in the oven.

It’s not strictly necessary – you can still use this method to make great pork chops even without brining – but if you have some extra time, I recommend it. Brining actually changes the cell structure within the meat, resulting in a noticeably juicier chop. The salt brine also seasons the interior of the meat. It won’t taste “salty,” just well-seasoned. You can even add other seasonings like garlic, peppercorns, fresh herbs and lemon to the brine for more flavor. If you fear bland pork chops, definitely give brining a try. Pork chops are a tender, quick-cooking cut of meat – so quick-cooking, in fact, that they’re very easy to overcook. This is why I like to start the chops on

OR TODAY | APRIL 2015

the stovetop where they get a good sear and then transfer them to the oven to finish cooking. The gentle heat of the oven helps us to control the rate of cooking a little better and also prevents the outside from getting tough and dry before the middle has finished cooking. I encourage you to look for bone-in pork chops. They take a little longer to cook than boneless chops, but in my experience, they are another way of ensuring tender cooked pork chops. And by “a little longer to cook,” I’m really only talking about a few minutes. It won’t make a huge difference to your meal prep! You can also make this whole process of cooking

pork chops easier by using just one pan. Heat up the skillet in the oven while you get the rest of the meal prepped, then transfer it – carefully! – to a stove top burner to sear the pork chops. Once the chops are golden on the underside, you flip them and transfer the skillet back to the oven. The residual heat from the skillet will sear the other side of the pork chops while the heat of the oven cooks them through. The result is a perfectly cooked pork chop: one that’s golden and crusted on the outside and perfectly tender and juicy in the middle. Every time. Serve it with a simple side salad, roasted vegetables, or rice pilaf for an easy and quick weeknight meal.

WWW.ORTODAY.COM

RECIPE

HOW TO COOK TENDER & JUICY PORK CHOPS IN THE OVEN Makes 2 to 4 pork chops.

FOR THE BRINE (OPTIONAL): 3 cups cold water, divided 3 tablespoons coarse kosher salt (or 2 1/2 tablespoons table salt)

OPTIONAL FLAVORINGS: 2 smashed garlic cloves 1/2 teaspoon black peppercorns 1 bay leaf FOR THE PORK CHOPS: 2-4 pork chops – center cut, • • •

bone-on, 3/4-inch to 1-inch thick (about 1 pound each) olive oil salt pepper

Brine the pork chops (optional): If you have time, brining the pork for even a brief period adds flavor and ensures juiciness in the finished chop. Bring 1 cup of the water to a boil, add the salt and optional flavorings, and stir to dissolve the salt. Add 2 more cups of cold water to bring the temperature of the brine down to room temperature. Place the pork chops in a shallow dish and pour the brine over top. The brine should cover the chops – if not, add additional water and salt (1 cup water to 1 tablespoon salt) until the chops are submerged. Cover the dish and refrigerate for 30 minutes or up to 4 hours. Position a rack in the middle of the oven and preheat to 400 F. Place the skillet in the oven to preheat as well. While the oven heats, prepare the pork chops. Remove the chops from the brine; if you didn’t brine, remove the chops from their packaging. Pat dry with WWW.ORTODAY.COM

paper towels. Rub both sides with olive oil, then sprinkle with salt and pepper. Set the chops aside to warm while the oven finishes heating. Using oven mitts, carefully remove the hot skillet from the oven and set it over medium-high heat on the stovetop. Turn on a vent fan or open a window. Lay the pork chops in the hot skillet. You should hear them immediately begin to sizzle. Sear until the undersides of the chops are seared golden, 3 minutes. The chops may start to smoke a little – that’s OK. Turn down the heat if it becomes excessive. Use tongs to flip the pork chops to the other side. Using oven mitts immediately transfer the skillet to the oven. Roast until the pork chops are cooked through and register 140 F to 145 F in the thickest part of the meat with an instant-read thermometer. Cooking time will be 6 to 10 minutes depending on the thickness of the chops, how cool they were at the start of cooking, and whether they were brined. Start checking the chops at 6 minutes and continue checking every minute or two until the chops are cooked through. Transfer the cooked pork chops to a plate and pour any pan juices over the top (or reserve for making a pan sauce or gravy). Tent loosely with foil and let the chops rest for at least 5 minutes before serving. Emma Christensen is recipe editor at TheKitchn.com, a nationally known blog for people who love food and home cooking. Submit any comments or questions to kitchn@ apartmenttherapy.com.

SAVE THE DATE SURGICAL CONFERENCE

Empowering the Surgical Services Community

AUG 30 - SEPT 1 Red Rock Resort & Casino Las Vegas, NV ORTodayLive.com

APRIL 2015 | OR TODAY

Our Scope and Instrument Processing Sinks Elevate Your Work To New Heights TBJâ&#x20AC;&#x2122;s SPD Decontamination Work Stations Are Height Adjustable To Reduce Lower Back Injuries.

10% OFF FOR FIRST TIME CUSTOMERS

OR TODAY | APRIL 2015

WWW.ORTODAY.COM

TRIM 3.25”

WEAR CALZURO IN THE OR TRIM 4.5”

The 1.5” heel allows for hours of comfortable standing. Calzuro have slip-resistant soles and the side ventilation holes let your feet breath! Calzuro are machine washable and can be sterilized in the autoclave or bleached and come in a variety of different colors to personalize your scrubs.

800-257-9472

CALZURO.COM

e Th nal igi r O

PUBLICATION MEDICAL DEALER

TECHNATION

AD SIZE 1/4 Page Vertical

ORTODAY

MONTH J LatexFfree M A M J J A self adhesive back for attachment to the surgical field

Keeps sterile appliances from hitting the

NOTES S

Secure flexion & extension stabilization

Easy hook & loop adjustment

Visit us at AORN Show! Booth #3421

Economical - Saves pre-op time

Frees surgical practitioner’s hands to retract soft tissue

Several sizes and configurations - yellow or red iridescent for laser surgery

Sterile and disposable for single use

Sterile shelf life 2 years

Economical solution

DESIGNER: JL& loop closures floor with 4 hook

Call for FREE samples

Mitral Valve Repair or Replacement Surgery Exceptional Exposure for Right & Left Atrium

WWW.ORTODAY.COM

APRIL 2015 | OR TODAY

OUT OF THE OR PINBOARD

PINBOARD

The News and Photos That Caught Our Eye This Month

OR TODAY

CONTESTS • APRIL •

OR TODAY

CONTEST

WINNER { MARCH }

SHARING IS CARING

OR Today is great to share with co-workers. Snap a photo of a co-worker reading a copy of OR Today and you could win FREE lunch for your department. Email your photo along with your name, title and contact information to Social@MDPublishing.com. Every entry will win a $5 gift card, but remember that the most creative photo wins a pizza party!

THE WINNER GETS LUNCH FOR THE ENTIRE TEAM!

{

EACH SUBMISSION WINS AN OR TODAY PRIZE PACK

We love our pets

I’m Traci pictured here with my Jack Russell Terrier named Penny. I’ve been a Surgical Tech for 7 years. I love my little companion!

gift card! 80

OR TODAY | APRIL 2015

Win Lunch!

WWW.ORTODAY.COM

PIN BOARD

“Strive not to be a success, but rather to be of value.” –Albert Einstein

Your vacation awaits We all need a break from the stress and the hectic schedule we keep. The good news is that spring is a great time to take a vacation and recharge for the rest of the year. U.S. News recently listed the top 15 places to take a spring vacation. Here are some of the top U.S. destinations on the list: • U.S. Virgin Islands • Grand Canyon • San Diego • Washington, D.C. • Orlando-Walt Disney World • San Antonio • Charleston For the complete list, visit travel.usnews.com/ Rankings/Best_Spring_Vacations/.

“I wish I could put some people on mute.”

Join the community! WWW.ORTODAY.COM

Escape reality A NOVEL IDEA

Reading is a great escape and there is something special about finding a quiet spot and transporting yourself to a completely different world. OR Today looked around and found some works of fiction that feature medical professionals for you to check out: • “The English Patient”: We have all seen (or at least heard about the movie), but everybody knows the book is always better. Michael Ondaatje’s novel is worth a read. • “A Farewell to Arms”: This Ernest Hemingway classic is a must read! • “Shroud for a Nightingale”: Author P.D. James weaves a mysterious tale of unusual murders at a nursing school. • “No Other Medicine”: Gail Ghigna Hallas examines a fictitious world of health care corruption, but is it really that difficult to believe it could happen today. • “The Healer’s War”: A war nurse stationed at China Beach in Vietnam is the central figure in this tale by Elizabeth Ann Scarborough. • “Undercover Nurse”: A nurse becomes trapped in the dark world of drug trafficking and corruption. Can she survive? You will have to read this Jane Converse title to find out.

APRIL 2015 | OR TODAY

NEED MEDICAL EQUIPMENT, PARTS, OR SERVICE? Find it all in one place! MEDICAL EQUIPMENT, PARTS & SERVICE

AUGUST 2014 | WWW.MEDICALDEALER.COM

A look at trends in women’s health

TECHNOLOGY:

THE GREAT GENDER EQUALIZER

’S

RPO

R AT E PR O F

IL E

a sS rce

T HIS

FIND YOUR PREFERRED VENDOR:

VISION TO VALUE

P.68

p. 35 RADIOLOGY : p. 48 MED/SURG: PRODUCT FOCUS

PRODUCT FOCUS

Mammography

Temperature Management

free to subscribe at medicaldealer.com/subscribe

OR TODAY | APRIL 2015

WWW.ORTODAY.COM

APRIL 2015 | OR TODAY

OR TODAY | APRIL 2015

WWW.ORTODAY.COM

INDEX ALPHABETICAL AAAHC ………………………………………………………………16 Action Products Inc. ……………………………………… 70 ASC Association …………………………………………… 74 Bemis Health Care ……………………………………………17 Bio-Medical Equipment Service Co. ………… 67 Birkova Products …………………………………………… 79 Bryton Corporation ……………………………………… 56 C Change Surgical …………………………………………… 9 Censis Technologies, Inc. ……………………………… 70 Checklist Boards Corp. …………………………………… 4 Cincinnati Sub-Zero ………………………………………… 6 Clorox Professional Products ……………………14-16 Curbell Medical Products, Inc. ……………… 48-51

Dan Allen Surgical ………………………………………… 34 Eizo, Inc …………………………………………………………… 46 Encompass Group ………………………………………… 67 Enthermics Medical Systems, Inc. ……………… 57 Flagship Surgical, LLC ……………………………………71 GelPro ……………………………………………………………… 65 Government Liquidation ………………………………IBC Healthmark Industries…………………………………… 47 Innovative Medical Products, Inc ……………… BC Innovative Research Lab, Inc ……………………… 23 Jet Medical Electronics ………………………………… 82 Kapp Surgical Instrument, Inc. …………………… 79 Key Surgical, Inc. …………………………………………… 59

MAC Medical …………………………………………………… 84 MD Technologies …………………………………………… 67 MedWrench …………………………………………………… 82 Pacific Medical LLC ……………………………………… 35 Palmero Health Care …………………………………… 26 Ruhof Corporation ………………………………………… 2-3 Sage Services ………………………………………………… 74 Sealed Air ……………………………………………………… 86 SMD Wynne Corp. ………………………………………… 79 Surgical Power ……………………………………………… 69 TBJ, Inc. …………………………………………………………… 78 Tru-D …………………………………………………………………… 5 VBM Medical Inc. …………………………………………… 58

GENERAL GelPro ……………………………………………………………… 65 Government Liquidation ………………………………IBC Innovative Research Lab, Inc ……………………… 23 MedWrench …………………………………………………… 82 Surgical Power ……………………………………………… 69

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

INDEX CATEGORICAL ACCREDITATION AAAHC ………………………………………………………………16 ANESTHESIA Innovative Research Lab, Inc ……………………… 23 SMD Wynne Corp. ………………………………………… 79 VBM Medical Inc. …………………………………………… 58 APPAREL Healthmark Industries…………………………………… 47 ASSOCIATIONS AAAHC ………………………………………………………………16 ASC Association …………………………………………… 74 AUCTIONS Government Liquidation ………………………………IBC MedWrench …………………………………………………… 82 BIOMEDICAL Innovative Research Lab, Inc ……………………… 23 BEDS Innovative Medical Products, Inc ……………… BC CARDIAC SURGERY C Change Surgical …………………………………………… 9 CARTS Sealed Air ……………………………………………………… 86 CABLES/LEADS Sage Services ………………………………………………… 74 CLEANING SUPPLIES Ruhof Corporation ………………………………………… 2-3 CLAMPS Innovative Medical Products, Inc ……………… BC DISPOSABLES Curbell Medical Products, Inc. ……………… 48-51 Flagship Surgical, LLC ……………………………………71 Government Liquidation ………………………………IBC Kapp Surgical Instrument, Inc. …………………… 79 Pacific Medical LLC ……………………………………… 35 Sage Services ………………………………………………… 74 ENDOSCOPY Government Liquidation ………………………………IBC Innovative Research Lab, Inc ……………………… 23 Kapp Surgical Instrument, Inc. …………………… 79 MD Technologies …………………………………………… 67 Ruhof Corporation ………………………………………… 2-3 TBJ, Inc. …………………………………………………………… 78 VBM Medical Inc. …………………………………………… 58 FALL PREVENTION Encompass Group ………………………………………… 67 GEL PADS Innovative Medical Products, Inc ……………… BC MAC Medical …………………………………………………… 84

WWW.ORTODAY.COM

HAND/ARM POSITIONERS Innovative Medical Products, Inc ……………… BC HIP SYSTEMS Innovative Medical Products, Inc ……………… BC INFECTION CONTROL/PREVENTION Bemis Health Care ……………………………………………17 Clorox Professional Products ……………………14-16 Encompass Group ………………………………………… 67 Government Liquidation ………………………………IBC Palmero Health Care …………………………………… 26 Ruhof Corporation ………………………………………… 2-3 Sealed Air ……………………………………………………… 86 SMD Wynne Corp. ………………………………………… 79 INSTRUMENTS Government Liquidation ………………………………IBC INTERNET RESOURCES MedWrench …………………………………………………… 82 KNEE SYSTEMS Innovative Medical Products, Inc ……………… BC LAB TBJ, Inc. …………………………………………………………… 56 LEG POSITIONERS Innovative Medical Products, Inc ……………… BC MONITORS Eizo, Inc …………………………………………………………… 46 Jet Medical Electronics ………………………………… 82 OR TABLES/ ACCESSORIES Action Products Inc. ……………………………………… 70 Birkova Products …………………………………………… 79 Bryton Corporation ……………………………………… 56 Innovative Medical Products, Inc ……………… BC ORTHOPEDIC Surgical Power ……………………………………………… 69 VBM Medical Inc. …………………………………………… 58 PATIENT AIDS Action Products Inc. ……………………………………… 70 Innovative Medical Products, Inc ……………… BC PATIENT MONITORING Bio-Medical Equipment Service Co. ………… 67 Encompass Group ………………………………………… 67 Pacific Medical LLC ……………………………………… 35 POSITIONING AIDS Action Products Inc. ……………………………………… 70 Innovative Medical Products, Inc ……………… BC

PROCESSING TBJ, Inc. …………………………………………………………… 78 RADIOLOGY Eizo, Inc …………………………………………………………… 46 REPAIR SERVICES Bio-Medical Equipment Service Co. ………… 67 Pacific Medical LLC ……………………………………… 35 REPLACEMENT PARTS Birkova Products …………………………………………… 79 SHOULDER RECONSTRUCTION Innovative Medical Products, Inc ……………… BC SIDE RAIL SOCKETS Innovative Medical Products, Inc ……………… BC SOCIAL MEDIA MedWrench …………………………………………………… 82 STERILIZATION Clorox Professional Products ……………………14-16 Key Surgical, Inc. …………………………………………… 59 TBJ, Inc. …………………………………………………………… 78 SURGICAL AAAHC ………………………………………………………………16 Action Products Inc. ……………………………………… 70 Birkova Products …………………………………………… 79 Censis Technologies, Inc. ……………………………… 70 Clorox Professional Products ……………………14-16 Dan Allen Surgical ………………………………………… 34 Eizo, Inc …………………………………………………………… 46 Flagship Surgical, LLC ……………………………………71 Kapp Surgical Instrument, Inc. …………………… 79 MAC Medical …………………………………………………… 84 MD Technologies …………………………………………… 67 SMD Wynne Corp. ………………………………………… 79 Surgical Power ……………………………………………… 69 SURGICAL SUPPLIES Action Products Inc. ……………………………………… 70 Cincinnati Sub-Zero ………………………………………… 6 Government Liquidation ………………………………IBC Key Surgical, Inc. …………………………………………… 59 Ruhof Corporation ………………………………………… 2-3 SURPLUS MEDICAL Government Liquidation ………………………………IBC SUPPORTS Innovative Medical Products, Inc ……………… BC TEMPERATURE MANAGEMENT C Change Surgical …………………………………………… 9 TOURNIQUETS VBM Medical Inc. …………………………………………… 58

APRIL 2015 | OR TODAY

OR TODAY | APRIL 2015

WWW.ORTODAY.COM

APRIL 2015 | OR TODAY

Choose the hip positioner that works best for your patient and for you

Universal Lateral Positioner®: With 25 years of OR history, you can count on the ULP to deliver the most stable positioning available. It features three-point fixation and pivoting pad plates for secure placement. IMP’s exclusive Dual-Compression, Clip-On Patient Protective Pads and the ULP’s 25 year history without a patient incident set the industry standards.

De Mayo Hip Positioner®: Offering remarkable stability for your most challenging obese patients, the De Mayo Hip Positioner features two-point fixation. It sets up easily, as you “build” the positioner around your patient.

To see which hip positioners fit best with you and your patients, visit www.impmedical.com or call 800-467-4944 today. We’re the one source with all the choices you need for successful procedures on any size patient.

MorphBoard® Positioning System: For maximum versatility and ease of use, MorphBoard Systems establish position with the push of a peg.

IMP: The operative word in patient positioning.

OR TODAY | APRIL 2015