OR Today - October 2015 by MD Publishing

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TAKE GOOD CARE

NURSES • SURGICAL TECHS • NURSE MANAGERS

SPOTLIGHT ON

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OCTOBER 2015

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ROBOTS in the workplace Robotic Surgery & Patient Satisfaction

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CONTENTS

features

OR TODAY | October 2015

ROBOTS IN THE WORKPLACE: ROBOTIC SURGERY AND PATIENT SATISFACTION

Robotic surgery continues to become more and more popular in today’s advanced health care environment. The number of surgical procedures has expanded in recent years to include prostate, hernia, gall bladder, colon and hysterectomy surgeries, among others. Patient satisfaction is one of the driving factors for this sustained growth.

CORPORATE PROFILE: SUMMIT MEDICAL

Summit Medical’s success and growth over the past 30-plus years can be attributed to its innovative approach and dedication to quality. The company’s mission statement says it best: “At Summit Medical we develop products not just for our customers, but with our customers. Our collaborative approach cultivates innovative medical solutions for the global health care industry. Through excellence in design, supplychain management, manufacturing and customer service we put quality at the forefront in all aspects of our business.

SPOTLIGHT ON: FORMER TREE CLIMBER REACHES NEW HIEGHTS AS A NURSE

Ask most nurses what got them into the profession, and “the treeclimbing business” is not usually a response you’ll hear. But for John Steinmacher the leap to a new profession has helped him put down roots and stand tall.

OR Today (Vol. 15, Issue #8) October 2015 is published monthly by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 30269-1530. 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. © 2015

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October 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

26 INDUSTRY INSIGHTS 10 News & Notes 16 AAAHC Update 20 OR Today Live! Recap

Andrew Parker | andrew@mdpublishing.com

ACCOUNTING Kim Callahan

WEB SERVICES Betsy Popinga Taylor Martin

IN THE OR 22 25 26 34

Suite Talk Market Analysis Product Showroom CE Article

OUT OF THE OR 58 60 62 64 68

Health Fitness Nutrition Recipe Pinboard

70 Index

OR TODAY | October 2015

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INDUSTRY INSIGHTS NEWS & NOTES

STAFF REPORTS

AORN TO ACQUIRE PFIEDLER ENTERPRISES The Association of periOperative Registered Nurses (AORN) has announced an agreement to acquire Pfiedler Enterprises, a provider of continuing medical and nursing education. The planned acquisition, with an expected Sept. 30 closing, represents AORN’s commitment to providing evidence-based health care education resources that are easily accessible to nurses and other perioperative professionals. AORN represents the interests of more than 160,000 perioperative nurses by providing nursing education, standards, and practice resources – including the peerreviewed, monthly publication AORN Journal – to enable optimal outcomes for patients undergoing operative and other invasive procedures. AORN’s 41,000

registered nurse members manage, teach, and practice perioperative nursing, are enrolled in nursing education or are engaged in perioperative research. Pfiedler Enterprises was founded as Education Design in 1981 to meet the learning needs of surgeons and perioperative nurses. As the surgical practice advanced, the organization’s founders, Judith I. Pfister, RN, BSN, MBA, and Julia A. Kneedler, RN, MS, EdD, developed live symposia with traditional lectures and panel discussions, intensive hands-on workshops, web-based and self-directed learning activities so that new knowledge and competency can be integrated into clinical practice and thereby improve patient care. Today, Pfiedler Enterprises pro-

vides more than 100 online courses for nurses to more than 300,000 online users. The organization has been accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education (CME) to physicians since 2002. “Our two organizations have enjoyed many successful collaborations over the years as we created and delivered education resources to advance evidence-based practice,” said AORN’s Executive Director/CEO Linda Groah, MSN, RN, CNOR, NEA-BC FAAN. “This acquisition will position us to create more content and become even more efficient in the delivery of education resources to support safe patient care.” •

DIVERSEY CARE SOLUTIONS NOMINATED FOR INNOVATION AWARDS Sealed Air’s Diversey Care division has announced that four of its innovations have been nominated for ISSA 2015 Innovation Awards. The awards, which recognize groundbreaking products and services in the cleaning and sanitation industry, will be announced during the ISSA/INTERCLEAN show taking place Oct. 21-23 in Las Vegas. Diversey Care’s nominated products include the StandOut Durable Floor Finish, Pro Series chemical concentrates, TASKI swingo 2100 micro-rider and the TASKI Intellibot SwingoBot 755. To vote, visit www.issa.com/vote through Oct. 16. ISSA members can vote once per day per category. The nominated innovations will be showcased at the Diversey Care booth, 1811, and the TASKI Intellibot booth, 3349, during the ISSA/INTERCLEAN show. •

OR TODAY | October 2015

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NEWS & NOTES

IMP INTRODUCES UNIVERSAL STERIBUMP FOR STERILE EXTREMITY POSITIONING

The Universal SteriBump, from Innovative Medical Products Inc., provides sterile extremity positioning. Its contour design cradles the patient’s extremities in the sterile field in a secure, safe, elevated position, reducing the possible occurrence of healthcare-associated infections. Because the lint- and latex-free Universal SteriBump positioner is designed for single use, there is no possibility of cross contamination. Its guaranteed sterility also frees up operating room scrub techs, nurses, or physician assistants from having to hold a limb during certain surgical procedures or having to bundle together sterile towels and other cloths to create a makeshift limb support. The IMP solution also lets OR personnel select multiple positioning heights or angles. The sterile IMP foam support is ideal for multiple procedures including arthroscopy, total hip and total knee surgery, as well as trauma procedures. •

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SKYTRON ADDS TO PROCESS SOLUTIONS PRODUCTS Skytron LLC has signed a definitive agreement with Mobile Aspects Inc. for the distribution of Mobile Aspects’ iRISupply, iRIScope and iRISecure product lines. The Mobile Aspects products are the latest addition to the Skytron Process Solutions product category designed to increase clinical efficiencies in perioperative and procedural workspaces. Mobile Aspects’ iRIS suite of solutions helps health care facilities increase revenue reimbursement and improve process and workflow efficiencies, while helping them to comply with The Joint Commission and other regulatory agency guidelines. “Skytron is focused on improving efficiencies within the clinical environment to include a focus not only on cost reductions and regulatory compliance, but revenue enhancement as well,” said David Mehney, Chief Executive Officer at Skytron. “Mobile Aspects is a leader in innovation, and its line of products to track high-value surgical supplies, flexible endoscopes, tissue and implants is ideally suited to complement our portfolio of clinical solutions.” Mobile Aspects products and services have been implemented and are currently in use at many of the nation’s leading teaching hospitals and health care facilities. The Mobile Aspects suite of solutions represents only three of several new products launched by Skytron in recent months aimed at improving efficiency in health care environments. Other product launches include Aurora Four surgical lights, Ergon 3 booms and the 1602 Essentia surgical table. • FOR MORE ABOUT Skytron, visit www.skytron.us.

October 2015 | OR TODAY

INDUSTRY INSIGHTS NEWS & NOTES

MEDROBOTICS RECEIVES FDA CLEARANCE TO MARKET FLEX ROBOTIC SYSTEM

Medrobotics Corp. has received FDA clearance to market the Flex Robotic System and is initiating commercial launch in U.S. hospitals. It received European CE mark clearance in March 2014. “The Flex Robotic System is the first and only robot-assisted surgical platform with a flexible scope cleared by FDA for use during transoral procedures,” said Samuel Straface, Ph.D., president and CEO of Medrobotics. “The minimally invasive system enables surgical access and visualization in hard-toreach locations through a single site. 12

OR TODAY | October 2015

Doctors can then complete procedures that might otherwise be difficult, or even impossible, to perform due to inability to visualize or access the site.” The Flex Robotic System employs a flexible robotic scope that moves through the body’s natural twists and turns. Once the surgeon reaches the desired vantage point, the scope becomes rigid to form a stable surgical platform. The onboard, high-definition vision system makes it possible to see and operate with a range of flexible surgical instruments. The unique

“wristed” 3mm Flex Instruments allow the surgeon to operate precisely in confined spaces. Minimally invasive surgery has demonstrated advantages for patients and providers compared to traditional open procedures, decreasing hospital stays and recovery times. The Flex Robotic System was designed to provide an affordable, easy-to-use robot-assisted surgical platform for hospitals and surgeons seeking to provide minimally invasive treatment options to the broadest number of patients possible. • WWW.ORTODAY.COM

THE JOINT COMMISSION OFFERS INTEGRATED CARE CERTIFICATION A new certification option from The Joint Commission is focused on helping health care organizations improve care coordination across the continuum of care, beginning with hospital and ambulatory care settings. The new Integrated Care Certification option assesses how well a health care organization integrates information sharing, transitions of care, hand-off communications and other key activities as a patient moves between the hospital and outpatient care settings. With a focus on leadership, clinical integration, patient and family engagement and other areas, this new certification is the starting point for improving patient outcomes with better-coordinated care. The standards are designed to be flexible to accommodate different system types, from large hospital systems with multiple campuses to small independent hospitals and from small primary care practices to large multispecialty groups. The Integrated

Care Certification requirements will help organizations develop a foundation for using data to identify their risk points and then determine ways to better manage those risks. The goal of the certification is to improve transitions in care and management of complex conditions, such as cancer, that require integration of inpatient and ambulatory care. “This certification solidifies the links between health care settings and provides a pathway for leaders to improve patient satisfaction, decrease readmissions and reduce emergency department use,” said David W. Baker, MD, MPH, FACP, executive vice president, Division of Health Care Quality Evaluation, The Joint Commission. In order to be eligible for the certification, at least one component of the health care system, such as the ambulatory care or hospital services, must be accredited by The Joint Commission. The certification period

NEWS & NOTES

is for three years, and organizations are evaluated by reviewers who specialize in integrated care. This certification is separate from the accreditation process and does not affect the accreditation status of an organization. The goal is to eventually develop the Integrated Care Certification program to assess organizations as a full delivery system and evaluate the integration of care across the care continuum beyond ambulatory to include settings such as skilled nursing facilities, home care, longterm care, and behavioral health care. The new certification standards for Integrated Care are available in E-dition format on a complimentary trial basis for organizations that are considering applying for certification. • FOR INFORMATION or to request a copy of the trial standards, email qualityhospitals@jointcommission.org.

VIEW MEDICAL INC., ENGINEERED MEDICAL SOLUTIONS ANNOUNCE PARTNERSHIP View Medical Inc. has announced a strategic partnership with Engineered Medical Solutions Company LLC (eMedsco), a manufacturer and distributor of LED cordless surgical lighting. As a result of the agreement, eMedsco will design, manufacture, and distribute View Medical’s novel SurgiLight product line. “We are excited about the potential of this partnership. Our primary objective is to provide surgeons with a highly focused, yet flexible and adjustable LED lighting solution without the constraints of surgical headlights,” said Troy D. Drewry, chief executive officer of VMI. “eMedsco is the ideal partner to make this goal a reality. Their knowledge and experience in the design, manufacturing and distribution of LED medical lighting will allow us to significantly reduce our time to market and provide surgeons with our innovative lighting technologies.” The SurgiLight by View Medical is a surgical lighting system that aims to provide surgeons with a safe and practical illumination device to focus on minute target areas. It connects to overhead surgical light handles, and features a long, flexible shaft that allows the user to direct the light onto the incision from any desired angle. The LED bulb provides a bright and localized light without the burden of heavy headlamps and wired systems. The attached battery pack delivers a long functional life, and eliminates the dangers and difficulties of existing lighting systems. “This strategic alliance is mutually beneficial. The SurgiLight technology nicely complements our existing product portfolio,” said Dan Coppersmith, manager of eMedsco. “The SurgiLight product will benefit from our vast expertise in the medical lighting field. The SurgiLight will also provide our established distribution channels with another innovative lighting solution for customers.” • WWW.ORTODAY.COM

October 2015 | OR TODAY

INDUSTRY INSIGHTS NEWS & NOTES

REDUCING COLORECTAL SURGICAL SITE INFECTIONS Surgical site infections (SSI) continue to remain a national health care issue, raising costs due to prolonged hospitalization, additional diagnostic tests, treatment, and sometimes additional surgery. In fact, research suggests that SSIs can extend hospitals stays by 7-10 days and cost $27,402 per incident, accounting for up to $10 billion annually in health care spending. Medline is working in partnership with the Joint Commission Center for Transforming Healthcare and Cleveland Clinic to share the latest SSI findings with health care leaders and medical device and clinical solution developers. The goal: uncover some of today’s real problems and barriers to spark serious dialogue and solutions. “At Medline, we’re committed to developing and improving medical devices and clinical solutions that advance health care,” says Sue MacInnes, chief market solutions officer at Medline and a member of the Joint Commission’s Leadership Advisory Council. “We work side-by-side with health care’s greatest thought leaders to help solve problems – it’s our strength to collaborate, innovate and create solutions. We are honored to have this opportunity to work with the Joint Commission and Cleveland Clinic to uncover new ways to reduce SSIs.”

Coleen Smith, director of high reliability initiatives for the Joint Commission Center for Transforming Healthcare, and Brad Schwartz, senior project manager of quality improvement for the Cleveland Clinic’s Quality and Patient Safety Institute, presented findings from The Reducing Colorectal Surgical Site Infections (SSI) project. After two-and-a-half years, participating hospitals in the Reducing Colorectal Surgical Site Infections project experienced the following results: • 45 percent reduction in superficial incisional SSIs • 32 percent reduction in colorectal SSIs • Estimated cost savings of more than $3.7 million for the 135 estimated colorectal SSIs avoided during the project period. • The average length of stay for hospital patients with any type of colorectal SSI decreased from an average of 15 days to 13 days. • LEARN MORE about the latest findings at http://bit.ly/1KcG1Y4.

CARDINAL HEALTH INVENTORY MANAGEMENT SOLUTIONS INTRODUCES WORKFLOW MODULES To help eliminate the more than $5 billion in waste each year in the U.S., Cardinal Health Inventory Management Solutions announced the launch of automated, cloud-based workflow modules for biological implants, sutures, and trauma and spine implants to help manage complicated operating room inventory, eliminate waste and remove cost from the operating room (OR) supply chain. The new modules can help hospital supply chain and clinical executives manage device and implantable inventory and workflows. These complex and expensive challenges can cause billions of dollars to be wasted annually 14

OR TODAY | October 2015

through expiration, loss or uncaptured charges. The new Cardinal Health solutions can help increase visibility to product demand and consumption and reduce waste incurred during manual processes. “Adding to our existing automated, cloud-based analytics platform, the operating room workflow solutions provide a comprehensive, scalable operating room solution that can help hospitals take costs out of their operating room supply chain,” said Jean-Claude Saghbini, vice president and general manager of Cardinal Health Inventory Management Solutions. The new Cardinal Health Inventory Management Solutions OR

workflow modules help hospitals maintain chain of custody documentation, identify unused inventory for returns, and avoid product expiration. The solution integrates with electronic medical records and other hospital IT systems for more accurate charge capture and interoperability. Through the use of RFID tagging and barcode, the modules provide full visibility for day-to-day management and enable long-term inventory planning. MORE INFORMATION about Cardinal Health Inventory Management Solutions can be found at www.cardinalhealth. com/CIMS. WWW.ORTODAY.COM

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INDUSTRY INSIGHTS AAAHC UPDATE

BY MARY SIBULSKY, RN

READY FOR YOUR SURVEY? HOW ABOUT INFECTION PREVENTION?

o you’re ready for your survey. Got the policies and procedures down pat. Know the accreditation handbook inside and out – paying special attention to administration, governance and quality improvement. Checked that all your providers are appropriately credentialed and privileged for your center. Studied the list of approved procedures. Yep. You’ve got all those accreditation standards reviewed and you’re ready to go. But wait a second. How about infection prevention? As a surveyor, what I often see topping the list of deficiencies are the ones that impact infection prevention. Here are some questions that you should ask yourself prior to the survey: How is the IV start technique in the pre-op or OR area? Does the staff pay attention to washing hands before and after; and are the items that need to be aseptic maintained as such? Does everyone swab the port with alcohol before accessing the IV system? (This simple step is so frequently skipped!) Does your OR follow standards set by AORN for the attire policy? (And does the whole team follow this?) Which disinfectant solutions are used to clean surfaces and floors, and is the staff using them aware of the kill time or “wet time?” (One way to ensure this is to mark your wipe containers or spray bottles in bold with the number of minutes that the surface needs to remain wet.) Does the

OR TODAY | October 2015

turnaround time designated for your ORs confirm that the kill times are being respected? Check your techs in the reprocessing area – do they know how to handle and clean all the various instruments and devices? The infection preventionist nurse should be doing periodic checks to verify that items are being cleaned correctly and that the staff follows the manufacturer’s guidelines for processing. A large binder with all the IFU (instructions for use) should be accessible in each processing area. Verify that the biological and chemical indicators you run have the results documented accurately. Make sure that dates and times are correctly noted. Can the surveyor easily track which instrument set was used and see evidence in the sterilization logs documenting when and how it was processed? Everyone knows – or should know – what to do if a biological indicator fails or the autoclave fails. But is

MARY SIBULSKY, NURSE MANAGER OF AN OPHTHALMIC ASC

there a written policy telling staff exactly how to respond? Just documenting the failure isn’t enough. What happens next and who should be notified? Are patient contact items disinfected according to manufacturer IFUs? Are the current recommendations being followed for things like BP cuffs, thermometers, laser lenses, monitoring equipment? Does the time out review infection risks such as immunocompromised state, previous blood borne pathogen, or MDRO infection status? Is the WWW.ORTODAY.COM

AAAHC UPDATE

If you’ve done a thorough job of preparing for your accreditation survey – and paid extra attention to the infection prevention part of the survey – you will come through with ﬂying colors.

implant in the OR, and is it verified by the surgeon prior to the start of the case? Can its sterility be assured by package integrity or confirmed by a negative biological indicator result prior to use? Is the antibiotic pre-op administration verified? All staff should have documented education in infection prevention performed at least annually. Can you supply evidence of this education for the surgeons and anesthesia providers as well? Have they been updated on the changes in infection prevention, sharps safety, or any other relevant policy changes? Most importantly, how can you work with your surveyor to make the entire survey process educational and helpful? Remember the handbook we talked about earlier? Know it so thoroughly that you can easily discuss the standards if a question comes up. Make use of available resources such as the checklists in the handbook, CMS infection control survey sheets and other online resources and surveillance tools. Express your concerns directly with the surveyor when you don’t understand. Don’t be afraid to say things like, “Can you show me where I would find that reference?” or “Which standard does that apply to?” or even “Help me understand how we can better meet that standard.” Lastly, motivate your staff to be involved in the survey process by keeping them educated. Use various members of the team to complete surveillance. Quality improvement (QI) studies are one form of survey prep that can help your team be more confident that they know what to do – not just when the surveyor is watching, but in their everyday work. Surveyors can usually tell WWW.ORTODAY.COM

when the OR team “gets it” and really owns the processes they follow for patient safety. Undergoing a surveyor’s rigorous inspection in the surgery center can be a daunting experience for even the most seasoned and professional team. There is just something a little unnerving about having a person watch your every move, knowing you will be assessed on every action. But if you’ve done a thorough job of preparing for your accreditation survey – and paid extra attention to the infection prevention part of the survey – you will come through with flying colors. When that happens, make sure you celebrate with the

staff. Throw a “We did it party” and don’t forget to continue to reaffirm your efforts throughout the year. MARY SIBULSKY is nurse manager of an ophthalmic ASC in North Idaho and has been a nurse since 1975. She is a proud member of her local APIC Chapter #102 conference committee and board. She has presented at national APIC as well as at regional APIC meetings on infection prevention and the survey process and infection prevention in underdeveloped countries. She has worked as an ASC Surveyor for AAAHC since 2007.

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October 2015 | OR TODAY

INDUSTRY INSIGHTS NEWS & NOTES

STAFF REPORTS

SURGICAL CONFERENCE

‘ONE OF THE BEST’

he inaugural OR Today Live! Surgical Conference attracted more than 150 perioperative and health care professionals to Las Vegas for toptier educational opportunities, a sold out exhibit hall filled with the latest products and services and unique networking events designed to connect and empower. The conference brought OR Today magazine to life creating a dynamic event that fostered solutions for the ongoing challenges, regulations and shifting landscape impacting the surgical suite and health care professionals. MD Publishing President and Founder John Krieg said he is excited about the future of OR Today Live! following the success of the first-ever conference. “This is a phenomenal beginning to an annual event,” Krieg said. “Attendees are thrilled with the educational offerings; the speakers; the laid-back, intimate atmosphere. They are able to connect with their peers from around the country and share information and relax in a professional environment.” MD Publishing Vice President Kristin Leavoy agreed. “The inaugural OR Today Live! far exceeded our expectations for a first-year show. The energy of the attendees was incredible,” Leavoy said. “Repeatedly I heard feedback from attendees and exhibitors alike that the close-knit, intimate setting allowed for meaningful conversations and connections to take place.”

OR TODAY | October 2015

“Attendees in the educational sessions and the exhibit hall were abuzz with take-aways from the show which they could share with their departments and ultimately improve patient care and safety,” Leavoy said. “It was truly heartwarming.” The Competency & Credentialing Institute (CCI) partnered with OR Today magazine to kick off the conference with a Surgical Services Management Certificate of Mastery workshop. Participants learned the essentials of surgical services management from industry leaders, earning a Certificate of Mastery and 26 contact hours upon successful completion of the program. Jim Stobinski with CCI said OR Today Live! is “one of the best” conferences he has ever attended. “The first day our room was packed,” Stobinski said. “We were really impressed on a number of fronts. On the first front, we were impressed with the quality of the setting. It was just first-class all the way.” “We do a lot of these trade shows and … it ran flawlessly,” he said about OR Today Live!. “We are very pleased with the attendance. Everyone was very

engaged. I would love to come back (next year).” The Poolside Welcome Reception in Cherry Lounge sponsored by AIV Inc capped off the first day. Attendees, exhibitors and educators enjoyed great food, beverages and intimate networking in a luxurious and relaxed setting. The “Las Vegas Name” game served as a great conversation starter and as a catalyst for interaction. The Welcome Reception set the tone for the next day. Attendees started Day 2 early with a continental breakfast at 7 a.m. followed by top-quality educational seminars, an insightful keynote address from Lisa Waldowski from The Joint Commission, the exhibit hall grand opening luncheon and another great networking event – Cocktails and Cash in the Exhibit Hall. Elvis was in the building for lunch on the final day of the conference. After a nutritious breakfast and two educational seminars everyone gathered for the Exhibit Hall Luncheon and Door Prizes with WWW.ORTODAY.COM

NEWS & NOTES

“ This has been an outstanding show. [...] individuals have been very engaged in the content that has been offered. There is a lot of excitement about what OR Today is doing regarding this content. I am happy to be a part of this event.” -R. Clinton Crews

Elvis. After two more educational seminars, the conference came to a close at the Red Rock Lanes Bowling Party where peers exchanged ideas and solutions as they kicked back and relaxed after a busy conference. WWW.ORTODAY.COM

Attendees praised the conference and commented on the exceptional education and unique, intimate atmosphere that sets OR Today Live! apart from all the other conferences. “This has been an outstanding show,” R. Clinton Crews, Director of the Surgical Assistant Program at Eastern Virginia Medical School said. “These past couple of days, individuals have been very engaged in the content that has been offered. There is a lot of excitement about what OR Today is doing regarding this content. I am happy to be a part of this event.” “I enjoyed the culmination of the information. The presentations and the speakers were awesome,” said Christine Mariner, Director Perioperative Services at CHI St. Luke’s Memorial Lufkin. “(I enjoyed) the exhibits and the networking. It was in a venue nice

enough that we could reach out to everybody.” Planning is already underway for 2016 and the second annual OR Today Live! Surgical Conference. “We have taken a phenomenal first step and the first brick has been laid to build upon something for the industry,” Krieg said about the first-ever OR Today Live! Surgical Conference. “OR Today Live! intends to use this year’s show as a springboard for making 2016’s show even better,” Leavoy said. SEE MORE PHOTOS from the OR Today Live! Surgical Conference at www.ORTodayLive.com.

October 2015 | OR TODAY

IN THE OR SUITE TALK

SUITE TALK

Conversations from the OR Nation’s Listserv

POST-OP CALLS How long post-op should a nurse be calling a patient? What is the recommended protocol for when a patient cannot be reached? A: We call the next day after discharge for out patient. We keep attempting the call until we reach the patient. A: We make three attempts and then fax a letter to the surgeon’s office to notify them if we don’t reach the patient after the three attempts. We changed our policy when we started doing pain management as many of the pain patients ignored our calls and got frustrated with us when we kept calling. •

JOINT COMMISSION

Does anyone know if it is a requirement to have tissue and implants tracked electronically? Presently we do it manually. A: Manual is fine. Electronic is usually easier but is not required. A: We just underwent our JCAHO survey in February and our tracking system is manual and the surveyor was even “impressed” with our degree of detail and the accuracy of our tracking. Electronic tracking is not mandatory. A: Would you be able to share your document. The Joint Commission liked ours but this was the New York

OR TODAY | October 2015

State Department of Health. Why, oh why, can’t they be on the same page with the same standards? A: If you have had you JCAHO visit already, can you share if they were looking for specific deficiencies this time around? A: We just finished ours as well. The requirement isn’t electronic. It is that you must be able to track when the tissue was received, the packaging was intact, the temperature was adhered to (ie: frozen), and when it is

implanted – who received it, that the lot number of the reconstituting solution is recorded along with the expiration date. If the tissue is discarded due to expired, temperature changed, etc. the record must demonstrate the reason and the disposition of it along with the date. These records must be kept for a minimum of 10 years. After implantation – then the expectation is that for 20 years post implantation you will be able to find the information. I too was complimented on my totally manual system. • WWW.ORTODAY.COM

SUITE TALK

PEDIATRIC PATIENTS There are a number of ways to decrease pediatric patient anxiety. One anesthesiologist used his cellphone to show pediatric patients videos. The patients would tell him which cartoon they liked best like â&#x20AC;&#x153;SpongeBobâ&#x20AC;? or something, and he would download it on his phone and let the child hold it while they rode back to the OR on the stretcher. Many of the kiddos would get into the video and the amount of anxiety caused by separation from the parents was significantly decreased. This is a wonderful distraction. Please share any of your ideas that have worked to decrease anxiety in pediatric patients. A: Several months ago, we started allowing pediatric patients the ability to draw on their sheets with washable markers. After a trial with our laundry department, we starting to provide patients under 10 a box of washable markers. They color on their sheets and the sheets are then washed as normal. The idea was generated from our staff members who were researching ways to reduce anxiety. A: That is amazing! Love that idea!

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October 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.

OR TODAY | October 2015

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IN THE OR MARKET ANALYSIS

STAFF REPORT

MARKET ANALYSIS

Wound Management Market Climbing

ound care is an important part of health care and is becoming more important with an emphasis being placed on patient safety and patient satisfaction. Wound pain and infections can be bad news for health care facilities and lead to a decrease in reimbursements. A growing number of older patients is another factor creating growth in the wound management market as more surgeries are being performed and more wounds are being treated. Advances in wound care are also impacting the market. “Advanced wound care and closure products are emerging as a standard solution for treating chronic wounds. Traditional wound care and closure products are being increasingly substituted with advanced wound care and closure products due to their efficacy and effectiveness in managing wounds by enabling faster healing,” a recent report from Allied Market Research states. “Attempts to reduce the duration of hospital stays in order to limit surgical health care costs, and the rising inclination towards products that enhance therapeutic outcomes are driving the demand for advanced wound care and closure products,” the report continues. “The risks associated with ineffective wound healing promote the demand for combination dressings, which is a modern trend in the market that is

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replacing traditional wound dressing methods.” A report from BCC Research forecasts a market set to exceed $11 billion in just three years. “The global market for advanced wound management totaled $8.6 billion in 2013, up from 2011’s value of $7.9 billion,” according to BCC Research. “By 2018, this market is likely to reach $11.3 billion, a compound annual growth rate of 5.6 percent.” Negative pressure wound therapy is another growing segment of the wound care market. Negative pressure wound therapy is a leading wound care therapy that applies negative or sub-atmospheric pressure on a wound in a closed drainage system. Negative pressure wound therapy aides wound healing by stimulating the granulation tissue, by lowering edema, and increasing blood circulation. Negative pressure wound therapy systems can be utilized for treating traumatic wounds, surgical wounds, pressure sores, and chronic wounds such as

venous stasis ulcers and diabetic foot ulcers. A report from Transparency Market Research states that the global negative pressure wound therapy market was estimated at $1.5 billion in 2013 and is growing at a compound annual growth rate of 10.2 percent from 2014 to 2020. The single-use negative pressure wound therapy market is also growing rapidly. “As per this report, in terms of product segments, conventional negative pressure wound therapy systems constituted the biggest market segment, but the single use NPWT systems market segment is expanding at a higher CAGR – of about 17 percent – during the forecast horizon between 2014 and 2020,” according to Transparency Market Research. “The negative pressure wound therapy market is experiencing a conspicuous shift from utilization of conventional NPWT systems to single-use. This shift in inclination is majorly due to the higher convenience offered by single use NPWT systems to patients, as well as their cost advantage over conventional systems and higher portability.” Transparency Market Research predicts that the global negative pressure wound therapy market will reach $2.9 billion in 2020. October 2015 | OR TODAY

IN THE OR PRODUCT SHOWROOM

3M STERI-STRIP™ ANTIMICROBIAL SKIN CLOSURE The 3M™ Steri-Strip™ Antimicrobial Skin Closure is a small but effective solution for reducing the risk of surgical site infections (SSIs), the second most common hospital-acquired infection. The adhesive skin closure product has broad-spectrum activity against the pathogens most commonly causing SSIs and it is the only adhesive skin closure product on the market with antimicrobial properties. Numerous clinical studies have shown that wounds treated with Steri-Strip™ Skin Closures exhibit lower infection rates than those closed with invasive sutures or staples. Studies have also shown better cosmetic results than sutures or staples.•

OR TODAY | October 2015

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PRODUCT PRODUCT SHOWROOM FOCUS

ALLOSOURCE ALLOSKIN™ AC AlloSkin™ AC is a meshed, dermis-only human skin graft providing off-the-shelf convenience in regenerative technology. Through AlloSource’s proprietary process, the graft is decellularized while preserving the natural biologic components and structure of the dermal matrix. AlloSkin AC is especially suited for OR use as it is designed for a single application, and ideal for acute and chronic wound therapy. The meshed format also encourages fluid drainage from the wound. AlloSkin AC provides a favorable microenvironment for bio-ingrowth to begin revascularization and cellular repopulation. This sterile product is available room temperature, ready-to-use and is pliable to contour to wound topography. • FOR MORE INFORMATION, visit allosource.org.

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October 2015 | OR TODAY

IN THE OR PRODUCT SHOWROOM

ANSELL GAMMEX® BURN-WOUND TREATMENT SOLUTIONS Ansell is changing the dressing treatment paradigm with novel, fully customizable solutions for the hard to dress areas in burn and wound. The company is now launching foot/ankle and mask products to its line of glove and finger dressings. GAMMEX® Outer Dressings advanced technology use a custom blended fabric that provides superior wicking, stretch, and 2x absorption than gauze for better fluid management resulting in fewer dressing changes, better range of motion, and improved patient comfort. GAMMEX® Outer dressings are compatible with any contact dressing, including creams. They replace traditional wraps with form fitting garments for fast, easy, and reliable dressing placement across all provider levels. GAMMEX® Silver Barrier dressings feature the first fully-customizable solutions with Velcro™ closures for adjustable compression and localized wound evaluation. The unique design of each dressing provides better patient comfort, easier application, enhanced mobility, and a cost competitive alternative to other Silver dressings. The launch includes four products compatible across treatments: GAMMEX® Silver Barrier Foot, Silver Barrier Mask, Outer Foot Dressing, and Outer Mask Dressings. •

OR TODAY | October 2015

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PRODUCT PRODUCT SHOWROOM FOCUS

KCI V.A.C.ULTA™ The V.A.C.Ulta™ Negative Wound Pressure Therapy System is an integrated wound management system that delivers proven V.A.C.® Negative Pressure Wound Therapy and V.A.C. VeraFlo™ Instillation Therapy, which consists of V.A.C.® Therapy coupled with automated, controlled delivery and removal of topical wound solutions. V.A.C.® Therapy, in the absence of instillation, is intended to create an environment that promotes wound healing by secondary or tertiary (delayed primary) intention by preparing the wound bed for closure, reducing edema, promoting granulation tissue formation and perfusion, and by removing exudate and infectious material. • FOR MORE INFORMATION, visit www.vaculta.com.

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October 2015 | OR TODAY

IN THE OR PRODUCT SHOWROOM

CARDINAL HEALTHTM NPWT PRO FAMILY OF DEVICES Cardinal HealthTM has developed a NPWT device portfolio specifically targeted to the needs of the different care settings. Cardinal Healthâ&#x201E;˘ NPWT PRO is designed for the acute and skilled nursing care settings, PRO to GO is designed for transition or discharge care, and PRO at HOME is designed for home use. Each device has a similar design and user interface helping to provide a consistent experience across the continuum of care for both caregiver and patient. In addition the PRO family of devices are lightweight (0.9 lb.), easy to use, portable and use the same foam dressings across all devices. â&#x20AC;˘

OR TODAY | October 2015

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PRODUCT PRODUCT SHOWROOM FOCUS

SMITH & NEPHEW PICOTM

PICOTM represents a unique way of treating patients who would benefit from the application of single-use negative pressure wound therapy. PICOTM has been shown to provide positive patient outcomes when applied to open wounds, closed surgical incisions and skin grafts. The PICOTM system is canister-free which means the pump is small enough to fit in the palm of your hand. The PICOTM pump generates an effective negative pressure of -80mmHg5 and provides therapy for up to 7 days. Provided together as a convenient all-in-one-system, canister-free PICOTM supports patients in maintaining their daily activities. Patients may be safely discharged with PICOTM in place, the size and simplicity gives confidence that they can manage the system at home. â&#x20AC;˘ WWW.ORTODAY.COM

October 2015 | OR TODAY

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October 2015 | OR TODAY

IN THE OR CONTINUING EDUCATION 152-60G

OR TODAY | October 2015

BY SARA A. LOWE, RN, MSN, CPNP, APNP, AE-C

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CONTINUING EDUCATION 152-60G

LATEX

ALLERGY ALERT

atural rubber latex (NRL) is found in many products in modern society. It’s used in rubber-based products including balls, erasers, spatulas and mattresses. Reports about the prevalence of latex allergy vary greatly, probably due to different levels of latex exposure, sensitivity of testing and varying methods for estimating prevalence. Many studies have tried to determine the prevalence of latex sensitization in healthcare workers and the general population. Three studies have suggested sensitization among healthcare workers was between 5% and 12%,1-3 while reactivity in the general population was between 0.5% and 5%.1

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 41 to learn how to earn CE credit for this module.

The goal of this latex allergy continuing education program is to update nurses’ knowledge about latex allergy. After studying the information presented here, you will be able to: • Differentiate between type 1 and type 4 allergic responses to latex • Identify two sources of potential latex exposure • List four measures for reducing risk to latex-allergic individuals in healthcare facilities

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People with congenital conditions requiring multiple surgeries (e.g., spina bifida) are among the highest at-risk populations for latex allergy. A 2009 study showed the prevalence of latex sensitization in children with spina bifida to be 31%.4 However, the Spina Bifida Association states that up to 73% of children and adolescents with spina bifida may be latex sensitive.5 Latex hypersensitivity was first recognized in 1979, with increasing frequency in the 1980s and 1990s.6 The U.S. Food and Drug Administration declared it a serious concern after 15 latex-related deaths occurred between 1988 and 1992, and after reports of more than 1,000 systemic allergic reactions were received.7 Increased recognition of latex allergy at many work sites, including healthcare facilities, dental offices, hair salons and law enforcement agencies, led the National Centers for Disease Control and Prevention (CDC) and the National Institute for Occupational Safety and Health (NIOSH), to issue the following warning in June 1997: “Workers exposed to latex gloves and other products containing natural

rubber latex may develop allergic reactions such as skin rashes; hives; nasal, eye or sinus symptoms; asthma and (rarely) shock.”8 UNDERSTANDING THE SOURCE NRL originates as a milky fluid produced by Hevea brasiliensis trees, sometimes called “rubber trees.” Two methods are used to process NRL into more than 40,000 products. More than 85% of the world’s harvested latex is processed using dry rubber sheets and acid coagulation, making products such as rubber balls or tires. These are unlikely to cause an immediate type (IgE-mediated) allergic reaction. The remaining harvested latex is processed to make flexible rubber products via centrifugation, dipping a mold into liquid latex, heating (vulcanization), drying to retain shape and coating to prevent sticking to one another. Talc and cornstarch have been used in the past but caused a contact rash or increased the allergenicity of the product. Now latex-dipped products are coated in a synthetic polymer to prevent them from sticking to one another.9 October 2015 | OR TODAY

IN THE OR CONTINUING EDUCATION 152-60G Dipped latex products, especially gloves, balloons and condoms, have primarily caused allergic reactions. Items composed of crepe rubber, such as the soles of shoes, are less likely to cause reactions. Latex paints are not a problem, because they contain a nonallergenic synthetic latex and not NRL.10 LEARNING FROM THE PAST The increase in latex allergy prevalence was related to the rising use of and demand for latex products. In 1987, the CDC introduced universal precuations as a result of the AIDS epidemic. These precautions called for donning latex gloves before any contact with a patient or with bodily fluids of a patient, regardless of the anticipated level or duration of contact. The increased use of latex gloves fueled greater demand and led to faster manufacturing methods, which is hypothesized to contribute to increased intact allergenic latex proteins on the finished gloves and may have contributed to the rise in latex allergy.1,11,12 In 1998, the CDC and NIOSH issued the document “Latex Allergy: A Prevention Guide” to provide information on susceptibility, prevention, screening and management of latex allergy responses.13 In 2008, the Occupational Safety and Health Administration issued the safety and health information bulletin titled “Potential for Sensitization and Possible Allergic Reaction to Natural Rubber Latex Gloves and other Natural Rubber Products.”14 EXPOSURE Latex sensitivity is a type 1, IgE-mediated response involving the formation of systemic antibodies to the proteins in NRL.9 Many people believe the powder on latex gloves is the culprit in latex allergy. Although powder is involved, 36

OR TODAY | October 2015

the allergic response is induced by naturally occurring latex proteins.9 NRL contains more than 200 different polypeptides; 14 proteins found in NRL have been accepted by the Allergen Nomenclature Subcommittee of the International Union of Immunological Societies as latex allergens.15 Powder plays a role in NRL protein exposure. Starch or talc was previously added to latex gloves to prevent them from sticking together and make them easier to put on. The powder binds with naturally occurring latex proteins in the gloves. When the powder is dispersed during glove donning or removal, the latex molecules become airborne and may be inhaled or come in contact with exposed skin.3 Healthcare facilities have been encouraged to use powder-free latex gloves and nonlatex gloves as much as possible. Latex-sensitized people may react to different proteins based on how they were exposed. For example, a healthcare worker exposed through frequent skin contact with latex gloves may react to different polypeptides than a person with spina bifida exposed through frequent bladder catheterizations and surgeries.9 This creates difficulty in developing a method for desensitization similar to immunotherapy injections used routinely for treatment of environmental allergies (e.g., ragweed, cat, dust mite). Patients can absorb latex proteins through the skin, mucous membranes or the respiratory system and may absorb latex molecules directly into the circulatory system during invasive procedures.9 For example, the necessity for surgical repair exposes infants with spina bifida to NRL in the gloves worn by surgical personnel; the more surgeries, the more likely repeat exposure is to prompt an IgE (allergic) response. For those who wear latex gloves, such as healthcare professionals, any

breach in the skin provides an avenue for latex protein molecules to enter the bloodstream, sensitizing the individual and prompting an IgE response that may manifest in a variety of symptoms.7,9 Any person who frequently wears latex gloves is at risk, including beauticians, police officers, auto mechanics, gardeners, food service workers, day care employees, plumbers and tollbooth workers. Latex gloves are inexpensive and can be bought in any discount store. Many consumers aren’t aware of their risk for latex allergy, so they continue to choose latex gloves for everyday chores. REACTIONS — WHAT TO LOOK FOR Healthcare providers should be able to recognize the major allergic reactions to latex. Clinical manifestations range from a local inflammatory response, such as edema, itching, redness and papules, to potentially life-threatening systemic reactions, such as anaphylaxis. Skin, mucous membrane, respiratory or intravascular exposure to latex allergens can trigger a reaction.9 Reaction to latex exposure may range from itchy, watery eyes and rhinorrhea to pharyngeal edema and asthma-like bronchoconstriction. All reactions are immediate but can be delayed. Irritant contact dermatitis, the most common reaction, results from contact with gloves, glove powder or another substance that physically or chemically harms the skin. It causes dryness, chapping or split skin.14 Irritant reactions are not immunologically mediated responses but may play a role in immune responses because the skin’s integrity is interrupted, allowing latex proteins and other chemicals used in latex manufacturing to enter the body. Delayed reactions (i.e., type 4), known as allergic contact dermatitis, WWW.ORTODAY.COM

CONTINUING EDUCATION 152-60G

are most often confined to the area of the body directly exposed to the allergen. This can occur 24 to 72 hours after contact. The ensuing erythema, cracking, crusting, vesicles and oozing lesions may last for days. Chemicals used in latex glove processing or other glove materials are the primary culprit in these reactions. NRL is rarely the cause of these reactions.14 People who have experienced this reaction have complained of oral swelling and itching after dental exams during which latex products were used or erythema of the skin touched by latex-containing elastic. Healthcare providers may notice excoriated areas on their hands after using gloves. Multiple incidents may occur before a person begins to suspect latex sensitivity because of the delayed nature of these reactions.14 Immediate reactions (i.e., type 1) are mediated via an antibody response to latex proteins. This is an IgE/histamine-mediated allergic reaction. Repeated exposure to latex proteins through the respiratory tract, skin or mucosal membranes increases the body’s production of allergenspecific antibodies. After initial antibody production, a secondary minimal exposure induces a histamine cascade, and a reaction ensues within minutes. No way exists to determine when or whether a person will convert from a type 4 to a type 1 reaction. Type 1 symptoms can range from local complaints (at the site of contact) such as urticaria, rhinitis, pruritus or angioedema, to generalized (systemic) with severe hypotension, shock and death.9,13,14 IgE-mediated reactions may occur within minutes or up to one hour after exposure and can progress rapidly.14 WHO’S AT RISK? Risk factors for developing an allergy to latex may include the following: • A history of recurrent surgical or WWW.ORTODAY.COM

medical procedures, especially early in life. Examples include people with a diagnosis of spina bifida, urological or neurological defects, congenital cardiac or orthopedic anomalies or severe burns.9,14 • Daily use of latex gloves; for example, healthcare professionals.10,14 • Occupational exposure to latex or latex particles; for example, latex manufacturing workers.14 • A history of allergic rhinitis, asthma or eczema (atopic disease).14 • A history of allergies to foods such as bananas, avocado, kiwi, mango, chestnut, papaya and stone fruits (i.e., cherries, peaches), especially if progressive in scope or severity in a person who has ongoing exposure to latex.9,14 DIAGNOSIS OF NRL ALLERGY Diagnosis of latex allergy is based on history, including risk factor analysis and an accurate allergy evaluation. For example, patients with latex allergy may have had adverse reactions during medical or surgical procedures, which were believed initially to be the result of anesthetics or other drugs.16 Research has shown that latex glove powder can be left on food surfaces and may cause allergic reactions in latex-allergic people who eat the contaminated food.9 People with primary food allergy to cross-reacting foods (listed above) have rarely had clinical reactions to latex.9 If latex allergy is suspected, the patient should be referred to an allergist for specific testing and diagnosis. Skin testing via percutaneous prick or intradermal is the most common in vivo method for the diagnosis of environmental or food IgE-mediated allergies.17 A standardized latex allergen solution for percutaneous skin testing was used in clinical investigations of latex allergy. It was found to be reliable for

the diagnosis of latex allergy and was identified as the gold standard in the experimental setting. But the FDA did not approve the solution for clinical use.18,19 In vitro (serum) testing for latex allergy is the primary method used to identify specific IgE antibodies to latex.9 Several in vitro tests are available to detect IgE antibodies associated with a type 1 reaction to NRL. There are three FDA-cleared assays (Radioallergosorbent Test [RAST], AlaSTAT and Hycor HYTEC) and one non-FDA-cleared assay (enzyme-linked immunosorbent assay [ELISA]).9,19-21 In a study of 117 participants reactive to latex and 195 participants not allergic to latex, the RAST and AlaSTAT assays rendered false negative results in 25% of patients with known latex allergy; the HYTEC identified 27% false positive results.22,23 Due to the high rate of false results, routine screening for latex allergy without a history suspect for latex sensitization is not recommended. The high rate of false-negative testing suggests multiple serologic tests for latex sensitization may be helpful in the evaluation of patients with a history highly suggestive of latex sensitivity.19 MANAGING THE LATEXSENSITIVE PATIENT Immunotherapy is the most effective treatment of environmental allergies. However, the FDA has not approved an allergen extract for immunotherapy for latex allergy.9 Limited trials related to latex allergy treatment are being performed, but no specific treatment has been approved by the FDA. The primary management method for latex allergy is prevention — avoidance of products that contain NRL — and, when needed, medication therapy for latex-induced allergic responses. Avoiding exposure is difficult for patients and sensitized healthcare October 2015 | OR TODAY

IN THE OR CONTINUING EDUCATION 152-60G

SAMPLE OF NATURAL RUBBER LATEX PRODUCTS AND SUGGESTED SUBSTITUTES NRL Products

Suggested Substitutes

Infants Bath toys

Plastic, cloth

Pacifiers, feeding nipples

Silicone products

Crib mattress pads

Cotton pads

Diapers

Cotton

Toys and Sports Equipment Balloons

Mylar balloons

Balls (Koosh, soccer, volleyballs)

Leather balls

Swim fins and goggles

Clear plastic

Racquet and golf club handles

Leather

Home/School/Office Cleaning gloves

Nitrile, neoprene, vinyl, copolymer gloves

Erasers, craft supplies

Vinyl or silicone

Costume masks Telephone cords

Vinyl or silicone

Telephone cords

Clear cords

Mats, carpet backing

Polyurethane foam

Clothing Shoes (sneakers, rubber soled)

Leather

Elastic fabric, underwear

Spandex, Lycra

Thong sandals

Leather

Raincoats/slickers

Nylon or synthetic

Health/Medical Products Condoms, diaphragms

Synthetic rubber/natural membrane condoms

Adhesive tape, bandages

Paper tape, brands without natural rubber

Urinary catheters

latex Silicone catheters

OR TODAY | October 2015

workers, who frequently encounter latex-containing devices during caregiving. People who have significant latex sensitivity must be informed about non-latex alternatives and the need to communicate their sensitivity to others. Also, healthcare facilities have the responsibility to minimize exposure for patients and healthcare personnel to reduce the risk of exposure and subsequent reaction.3 People with latex allergy should do the following: • Wear a medical alert/condition bracelet identifying specific allergies, such as latex or cross-reactive foods. • Speak with their allergist or primary care provider about carrying self-injectable epinephrine (i.e., an epinephrine autoinjector), which is the first-line treatment for severe allergic reactions. • Inform all necessary individuals (family, friends and healthcare personnel) about the hypersensitivity to latex and what to do in case of an emergency. • Carry and refer to a list of latexcontaining products and safe, non-latex alternatives (see Sample of NRL Products and Suggested Substitutes sidebar). Supportive medical therapy is the same as for any severe allergy, including antihistamines, corticosteroids and bronchodilators. For severe responses, epinephrine and IV access for support medications may be necessary while also maintaining a sufficient airway.14 PROVIDING A SAFE ENVIRONMENT Employee and provider education on how to recognize and treat patients and staff who are latex-allergic is vital to maintain patient safety. A 2010 survey about the knowledge regarding NRL allergy in 156 healthcare workers in the United Kingdom found more than 50% could not recognize a type 1 allergy to NRL and 84% felt WWW.ORTODAY.COM

CONTINUING EDUCATION 152-60G

they would benefit from training regarding NRL.24 The topic of latex allergy should be added to new employees’ orientation and annual mandatory education. Creating “latex-free” environments or healthcare facilities is nearly impossible. However, recent evidence shows a “latex-safe” environment is ideal, safe, and practical for patients, providers, and healthcare facilities.9 To develop a “latex-safe” healthcare facility, a multidisciplinary task force is necessary to evaluate the current state and develop plans for change. This should include allergy specialists, anesthesiologists, respiratory therapists, materials management staff, occupational health, food services, housekeeping and representatives from patient care units and risk management. Begin by identifying all latex-containing products in the facility and work to identify suitable latex-free alternatives. Effective since 1998, the FDA’s medical device labeling regulations require all medical products be labeled with their latex content.25 This has not been extended to include consumer products. The American Latex Allergy Association has a listing of latex-free alternative medical and consumer products. Systems that use color-coding to identify latex-allergic individuals and latex-free products for their use can enhance institution-wide recognition and promote safety. A large warning label can be placed on appropriate patients’ charts, and signs should be posted near their rooms, requiring visitors and healthcare providers to seek instructions from the nurse before contact with the patient. A latex-free product cart should be placed outside latex-allergic patients’ rooms; at a minimum, this cart should contain latex-free gloves, stethoscope, blood pressure cuff, tape and IV supplies. Latex-free urinary catheters, ECG monitoring electrodes and emergency airway equipment are also desirable. A WWW.ORTODAY.COM

process must be developed that alerts all departments about patients who are allergic to latex so that food handling, diagnostic tests and transport are safe for them. Each unit may need its own policy for the treatment of latex-allergic individuals. Additional measures that may help reduce the presence of latex and its consequences for allergic individuals include the following: • Ensure that NRL is not used on, near or around latex-allergic patients. Items that come in contact with the mucous membranes must be latex-free, and a protective barrier, such as a stockinette, should be used between skin and latex articles if they must be used. • Contact product manufacturers for written documentation of latex content to ensure adequate protection for the allergic patient. Do not make assumptions about which objects contain latex. For example, some black rubber resuscitator bags appear to be made of latex, but are not. • Remember to involve the dietary department in latex precautions. The use of latex gloves during food preparation has been linked to allergic reactions..9 • Ban NRL balloons, which can be a dangerous source of exposure. Mylar balloons are an acceptable, risk-free substitute. • Notify emergency medical system personnel about any precautions or changes that have been made in the delivery of care; for example, the added screening for latex allergy in the admissions procedure. • Encourage latex-allergic individuals to obtain a medical identification bracelet or necklace, to notify family and friends about their allergy and to have a plan for emergencies. • Promote the use of powder-free gloves. This reduces the risk of sensitization and reaction to NRL

by eliminating exposure to latex particles bound to the powder that is dispersed when gloves are donned.5,9 Research has shown that type 1 latex-sensitized individuals may be able to work in a healthcare setting if powder-free gloves are used by coworkers and if sensitized workers use synthetic gloves.3 The clinician’s first goal in protecting latex-allergic patients is to minimize exposure in the healthcare environment. Before the latex-sensitive individual undergoes surgical, diagnostic or therapeutic procedures, the nurse must collaborate with the individual’s primary care provider or allergist to initiate precautions against latex exposure and provide supportive therapy, if necessary. The second goal should be to prevent the new sensitization of other individuals, especially fellow healthcare providers, by following institutional protocols and policies and staying abreast of new information through in-service education. A stepwise approach to prevention, as it relates to diagnosing and managing a coworker’s suspected latex allergy, will help to determine whether an employee may return to work.9 With healthcare professionals advocating prevention and protection as part of their daily routine in the workplace, the rate of latex sensitization or allergic reactions can be minimized. LATEX ALLERGY RESOURCES • American Academy of Allergy, Asthma & Immunology • American Association of Nurse Anesthetists • American College of Allergy, Asthma & Immunology • American Latex Allergy Association • Canadian Allergy, Asthma and Immunology Foundation • UCL Institute of Child Health • World Allergy Organization

October 2015 | OR TODAY

IN THE OR

CLINICAL VIGNETTE

Elaine Murphy is a 53-year-old dental hygienist with a history of delayed rashes on her hands after wearing natural rubber latex (NRL) gloves. Today, a coworker brought Ms. Murphy to the ED after she experienced facial swelling, shortness of breath and dizziness while at work. She states that the dentist with whom she works was standing next to her when he snapped his gloves while removing them. Ms. Murphy’s vital signs on presentation to the ED are BP 94/50; T 97; HR 88; RR 32. She still has observable angioedema and difficulty breathing.

Ms. Murphy’s new symptoms upon exposure to NRL are due to progression in her allergic reactions from: A. Type 1 to type 4 B. Contact dermatitis to type 1 C. Type 4 to type 1 D. Type 1 to contact dermatitis In the ED, Ms. Murphy is given epinephrine, diphenhydramine and prednisone. Her angioedema begins to resolve, and her respiratory distress improves. Which of the following teaching points should be emphasized? A. She should speak with her allergist or primary care provider about carrying self-injectable epinephrine. B. She should avoid wearing rubber-soled tennis shoes. C. She must quit her job immediately. D. She should carry diphenhydramine (Benadryl) at all times to treat any future anaphylactic reactions.

Ms. Murphy’s lung sounds should be auscultated as part of the respiratory assessment, but none of the available stethoscopes can be verified as latex free. Which of the following is the appropriate action? A. Skip this part of the respiratory assessment. B. Cover the stethoscope tubing with a stockinette. C. Cover the stethoscope tubing with foam rubber. D. Use any available stethoscope and try not to touch the tubing against Ms. Murphy’s skin.

Ms. Murphy has blood drawn to test for latex allergy. Which test may be negative even though she has had positive symptoms? A. Patch test B. Hycor HYTECH test C. Skin prick test D. RAST test

1. Correct answer: C — Localized, delayed rashes indicate a type 4 reaction. Continued exposure to NRL increases the body’s production of antibodies, eventually causing an immediate type 1 reaction, such as angioedema or anaphylaxis.

2. Correct answer: A — Self-injectable epinephrine (autoinjectable epinephrine) is the first-line treatment for anaphylaxis. Only epinephrine quickly reverses such allergic reactions as airway constriction, facial swelling and hypotension.

3. Correct answer: B — As long as no skin comes in contact with the tubing, any stethoscope may be used. The best way to ensure this is to cover the tubing with a stockinette.

4. Correct answer: D — The RAST test has been found to render false negative results in 25% of patients with a known latex allergy.

40 OR TODAY | October 2015

EDITOR’S NOTE: Susan McGann, RN, BSN, CEN, was the original author of this educational activity, but has not had an opportunity to influence the content of this current version. Abby Plambeck, RN, BSN, and Judith B. Paquet, RN, were past authors of this educational activity, but have not had an opportunity to influence the content of this current version. SARA A. LOWE, RN, MSN, CPNP, APNP, AE-C, works in the asthma and allergy clinic at Children’s Hospital of Wisconsin, which is part of the division of asthma/ allergy and clinical immunology at the Medical College of Wisconsin in Milwaukee. The author has declared no relevant conflict of interest that relates to this educational activity. REFERENCES

1. Charous BL, Blanco C, Tarlo S, et al. Natural rubber latex allergy after 12 years: recommendations and perspectives. J Allergy Clin Immunol. 2002;109(1):31-34. 2. Turjanmaa K. Incidence of immediate allergy to latex gloves in hospital personnel. Contact Dermatitis. 1987;17(5):270-275. 3. Kelly KJ, Wang ML, Klancnik M, Petsonk EP. Prevention of IgE mediated sensitization to latex in health care workers after reduction of antigen exposures. J Occup Environ Med. 2011;53:934-940. 4. Majed M, Nejat F, Khashab ME, et al. Risk factors for latex sensitization in young children with myelomeningocele. J Neurosurg Pediatr. 2009;4(3):285-288. 5. Natural rubber latex allergy in spina bifida. Spina Bifida Association Web site. http://www.spinabifidaassociation.org/site/c.evKRI7OXIoJ8H/ b.8277195/k.12A8/Natural_Rubber_ Latex_Allergy_in_Spina_Bifida. htm. Accessed May 8, 2014. 6. Nutter AF. Contact urticaria to rubber. Br J Dermatol. 1979;101(5):597-598. 7. Sussman GL, Beezhold DH. Allergy to latex rubber. Ann Intern Med. 1995;122(1):43-46. 8. Preventing allergic reactions to natural rubber latex in the workplace. Centers for Disease Control and Prevention Web site. http://

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cdc.gov/niosh/docs/97-135. Published June 1997. Accessed May 8, 2014. 9. Kelly KJ. Latex Allergy. In: Pediatric Allergy: Principles and Practice. 2nd ed. Philadelphia, PA: Elsevier; 2010. 10. Latex allergy: tips to remember: American Academy of Allergy, Asthma and Immunology Web site. http://www. aaaai.org/conditions-and-treatments/Library/At-a-Glance/ Latex-Allergy.aspx. Accessed May 8, 2014. 11. Ownby DR. A history of latex allergy. J Allergy Clin Immunol. 2002;110(2 Suppl):S27-S32. 12. Centers for Disease Control and Prevention. Recommendations for prevention of HIV transmission in healthcare settings. MMWR Morb Mortal Wkly Rep. 1987;36(Suppl 2):1S-18S. http://www.cdc.gov/mmwr/preview/mmwrhtml/00023587.htm. Accessed May 8, 2014. 13. NIOSH publications and products: latex allergy: a prevention guide. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/niosh/docs/98-113. Published 1998. Accessed May 8, 2014. 14. Occupational Safety and Health Administration. Potential for sensitization and possible allergic reaction to natural rubber latex gloves and other natural rubber products. United States Department of Labor Web site. http://www. osha.gov/dts/shib/shib012808.html. Published January 28, 2008. Accessed May 8, 2014. 15. IUIS Allergen Nomenclature Sub-Committee. Allergen nomenclature. Allergen.org Web site. http://www.allergen. org/search.php?allergensource=Hevea+brasiliensis. Accessed May 8, 2014. 16. Hebl JR, Hall BA, Sprung J. Prolonged cardiovascular collapse due to unrecognized latex anaphylaxis. Anesth Analg. 2004;98(4):1124-1126. 17. Demoly P, Bousquet J, Romano A. In vivo methods for the study of allergy. In: Adkinson NF Jr, Bochner BS, Busse WW, Holgate ST, Lemansky RF Jr, Simons FE, eds. Middletonâ&#x20AC;&#x2122;s Allergy Principles and Practice. 7th ed. Philadelphia, PA: Elsevier; 2009:1267. 18. Kelly KJ, Kurup V, Zacharisen M, Resnick A, Fink JN. Skin and serologic testing in the diagnosis of latex allergy. J Allergy Clin Immunol. 1993;91(6):1140-1145. 19. Pedersen DJA, Klancnik M, Elms N, et al. Analysis of available diagnostic tests for latex sensitization in an at-risk population. Ann Allergy Asthma Immunol. 2012;108(2):94-97. 20. Kurup VP, Kelly KJ, Resnick A, Bansal NK, Fink JN. Characterization of latex antigen and demonstration of latex-specific antibodies by enzyme-linked immunosorbent assay in patients with latex hypersensitivity. Allergy Proc. 1992;13(6):329-334. 21. Kurup VP, Kelly KJ, Turjanmaa K, et al. Immunoglobulin E reactivity to latex antigens in the sera of patients from Finland and the United States. J Allergy Clin Immunol. 1993;91(6):1128-1134. 22. Hamilton RG, Biagini RE, Krieg EF. Diagnostic performance of Food and Drug Administration-cleared serologic assays for natural rubber latex-specific IgE antibody. The Multi-Center Latex Skin Testing Study Task Force. J Allergy Clin Immunol. 1999;103(5 Pt 1):925-930. 23. Biagini RE, Krieg EF, Pinkerton LE, Hamilton RG. Receiver operating characteristics analyses of Food and Drug Administration-cleared serological assays for natural rubber latex-specific immunoglobulin E antibody. Clin Diagn Lab Immunol. 2001;8(6):1145-1149. 24. Al-Niaimi F, Chiang YZ, Chiang YN, Williams J. Latex allergy: assessment of knowledge, appropriate use of gloves and prevention practice among hospital healthcare workers. Clin Exp Dermatol. 2013;38(1):77-80. 25. Latex labeling required for medical devices. U.S. Food and Drug Administration Web site. http://www.fda.gov/ ForConsumers/ByAudience/ForPatientAdvocates/HIVandAIDSActivities/ucm126385.htm. Updated March 31, 2009. Accessed May 8, 2014.

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SUMMIT MEDICAL Q+A with Marcus Super Director of InstruSafe Sales and Marketing

ummit Medical Inc., based in St. Paul, Minnesota, was founded in 1982 and has grown substantially since its humble beginnings. The company’s success and growth over the past 30-plus years can be attributed to its innovative approach and dedication to quality.

MISSION STATEMENT:

At Summit Medical we develop products not just for our customers, but with our customers ... The company’s mission statement says it best: At Summit Medical we develop products not just for our customers, but with our customers. Our collaborative approach cultivates innovative medical solutions for the global health care industry. Through excellence in design, supply-chain management, manufacturing and customer service we put quality at the forefront in all aspects of our business. OR Today recently quizzed Marcus Super, Director of InstruSafe Sales & Marketing, about the company and found out more about Summit Medical’s unique business style. 44

OR TODAY | October 2015

Q Please share a

little bit about your company’s history and how you achieved success. A: Our Company was founded as a microsurgery medical device manufacturer. Shortly thereafter the wherewithal of an ENT scrub nurse brought to the Company’s attention the need for quality instrument protection, and InstruSafe was born. Under our previous company name we found success in collaborating and developing products with health care professionals and customers both inside and outside of our key markets. This created our formula for

success as the company grew and eventually was spun-off as Summit Medical Inc. Staying with this formula; we have continued to develop products that impact the customers we serve and the global health care community.

Q What are some

advantages that your company has over the competition? A: As a small but growing company, we have amazing flexibility. This allows us to work directly with our customers on product innovation and improvement. We are also afforded shorter project lead times

and above industry manufacturing timelines as a direct impact of our flexibility and as we grow, maintaining that flexibility will be vital to our success. One of the InstruSafe team’s greatest advantages is our combined 25 years of hands-on, industry experience in the markets we serve, helping us empathize on basic needs and manifests our compassion for health care. This gives us the unique perspective to truly understand the real world needs of our customers and reinforces our compassion for health care.

Q What are some

challenges that your company faced

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We are immensely excited about what InstruSafe offers to device reprocessing. Our instrument protection and organization trays have an impact on the entire use cycle of surgical instrument sets.

InstruSafe® Instrument Protection Trays are 510(k) cleared for a variety of sterilization cycles.

Visit instrusafe.com for full list

last year? How were you able to overcome them? A: Summit Medical being only five years in business has navigated typical small company obstacles. With growth comes many challenges, but it has been our flexibility and the ability of our employees to adapt, that has contributed to our successful reaction to rapid growth. We have an amazing team of talented employees who show tremendous dedication. Everyone here is known for wearing multiple hats. This helps us stay focused on our strategy for growth and has rewarded us – specifically with a FAST 50 award as one of the 50 fastest-growing private Minnesota companies according to the Minneapolis-St. Paul Business Journal.

Q Please explain

your company’s core competencies and unique selling points.

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A: Our team excels because we are an innovative and analytical team with strong customer support. We also have great flexibility with an eye on product development, design, engineering, quality, regulatory and manufacturing.

Q What product or service that your company oﬀers are you most excited about right now? A: We are immensely excited about what InstruSafe offers to device reprocessing. Our instrument protection and organization trays have an impact on the entire use cycle of surgical instrument sets. This starts in the operating room and continues through sterilization. We understand that instruments are expensive and delicate, so the primary function of the product is to extend reusable device life and ensure instruments arrive in the operating room ready for use and in

the condition surgeons deserve to perform safe and effective surgical procedures. Our trays are FDA 510(k) cleared for a variety of sterilization cycles providing flexibility for our customers. With our unique design we are confident that instrument repair and replacement can be reduced, allowing health care facilities to better utilize that budget on the patient care experience.

Q What is on the

horizon for your company? How will it evolve in the coming years? A: Growth is definitely on the horizon for Summit Medical and the InstruSafe brand. We are implementing strategies that will make InstruSafe the premier brand for instru-

SPECIAL ADVERTISING SECTION

ment organization and protection. Our evolution will continue through the development of novel sterile processing products and collaboration with our customers. We strive to become an industry leader for the sterilization, protection and organization of surgical instrumentation.

Q Please share some

company success stories with our readers – one time that you “saved the day” for a customer. A: Recently we collaborated with a facility and manufacturer’s sales representative here in the Midwest to consolidate orthopedic instrument sets from 10 trays to 3. This was a large project that required custom tray designs to accommodate

InstruSafe Team (L to R):

Corey Ganley, Specialty Sales Representative Marcus Super, Director InstruSafe Sales + Marketing Michael Morehouse Strategic Account Administrator

October 2015 | OR TODAY

instruments the facility determined were necessary for the procedure. By defining this, the facility was able to eliminate the need to sterilize unutilized instruments and reduce the cost per case. To be honest, we have success stories frequently with InstruSafe. It is not uncommon for customers to have recently purchased a robotic surgery system and have completely forgotten to purchase sterilization trays to protect this highly expensive equipment. In these circumstances, we are capable of providing same-day shipping so the customer can get their equipment prepared for use and launch a successful new surgery program.

Summit Medical operates out of a 20,000-square-foot facility in St. Paul, Minnesota.

Q Please describe your companyâ&#x20AC;&#x2122;s facility. A: We currently operate in a 20,000-square-foot facility located in Minnesota. This is the home of our entire team of engi-

neering, manufacturing, quality and regulatory, accounting, sales and marketing. Our manufacturing and warehouse facilities make up more than two-thirds of our overall footprint.

Q Please highlight

any recent changes to your company, inventory, services, etc. A: In February, we were acquired by Shore Capital Partners. The acquisition has created an exciting time for Summit Medical. We share a unified interest in the growth of our business and this provides us with new resources to achieve our future goals.

Q Please tell me

about your employees.

Engineer: Mark Hagerty shown 3D modeling an InstruSafe Tray design.

OR TODAY | October 2015

A: We have been fortunate to have great leadership from our president Kevin McIntosh. He has created a very motivated and bal-

anced culture for our small but growing company, as a result we have fostered a team atmosphere. Without every single one of our employeesâ&#x20AC;&#x2122; daily contributions we would not have achieved our current level of success and we will need them to achieve our goals for the future.

Q Is there anything

else you want OR Today readers to know about your company? A: Our Company thrives on customer input. We want everyone to know that the products we make are for the benefit and improvement of the health care community we all serve. We look forward to this collaboration and encourage customers to visit with us at trade shows, provide feedback through our website, or give us a call and learn firsthand that Minnesotans truly are nice.

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Specific patient benefits of robotic-assisted aparoscopic prostatectomy compared to traditional open surgery: • Shorter surgery times • No transfusion or bleeding • No incision • Less patient pain and faster recovery time • Faster removal of catheter • Higher rates of regained urinary control and sexual potency

ROBOTS in the workplace Robotic Surgery & Patient Satisfaction By Don Sadler

n only about 15 years,

There are several

robotic surgery has

different reasons for

become increasingly

the growing popu-

common for many differ-

larity of robotic

ent types of surgical proce-

surgery, but the

dures. These include pros-

main one is simple:

tate, hernia, gall bladder,

It usually results in

colon and hysterectomy

higher levels of

surgeries, among others.

patient satisfaction.

ROBOTS in the workplace Robotic Surgery & Patient Satisfaction

IMPROVING PATIENT OUTCOMES “It’s all about improving patient outcomes,” says Dr. David B. Samadi, M.D., the Chairman of Urology and Chief of Robotic Surgery at Lenox Hill Hospital in New York, New York. “And robotic-assisted surgeries result in better patient outcomes in the vast majority of cases.” Samadi was one of the pioneers in performing roboticassisted laparoscopic prostatectomy (or RALP) in the U.S. nearly 15 years ago. Since then, he has performed about 6,500 of the procedures and devised his own custom RALP: the Samadi Modified Advanced Robotic Technique, or SMART. Using the SMART technique, Samadi has achieved a 90 percent patient satisfaction rate with their prostate cancer treatment decision more than a year after surgery. Ninetysix percent of his patients regain urinary control in two to three months and 85 percent regain sexual potency within 12 to 24 months. “With this procedure, it’s about much more than just a surgery – we’re talking about quality of life,” he says. “Urinary control and sexual potency are a huge part of being a man.” The SMART technique avoids mobilizing and moving the nerves before removing the prostate, Samadi says. “The less you have to touch or move the nerves, the less chance there is of damaging them and causing incontinence or impotence. The result is a higher post-treatment quality of life,” he explains. According to Samadi, the majority of robotic surgeries 50

OR TODAY | October 2015

today occur in urology, and about 90 percent of these are prostate surgeries. “The prostate is the deepest organ in the body and it’s surrounded by sensitive nerves so robotics are a perfect fit,” he says. “If the surgeon is experienced in robotics, there is no longer any reason not to perform the surgery robotically,” Samadi adds. “I believe that the era of open prostate surgery has ended.”

“

weeks or longer • Higher rates of regained urinary control and sexual potency by patients Dr. Chad Engan, M.D., FACS, the Director of Robotic Surgery at Benefis Health System in Great Falls, Montana, has performed about 250 robotically assisted inguinal hernia repairs over the past three years.

It’s all about improving patient outcomes,” says Dr. David B. Samadi, M.D., the Chairman of Urology and Chief of Robotic Surgery at Lenox Hill Hospital in New York, New York. “And robotic-assisted surgeries result in better patient outcomes in the vast majority of cases.”

WHAT EXACTLY IS ROBOTIC SURGERY? The term “robotic surgery” often conjures up images of robots in the OR performing surgeries, but this isn’t the case. Surgeons still do the procedures, but they use robotic arms to control miniaturized instruments that are inserted into tiny incisions like with other minimally invasive techniques. Samadi lists a number of specific patient benefits of RALF compared to traditional open surgery: • Shorter surgery times – about an hour to an hour and a half versus three to four hours • No transfusion or bleeding • No incision versus a six- to eight-inch incision • Less patient pain and faster recovery time • Faster removal of catheter – one week versus two

“Robotics provide all the benefits of any minimally invasive surgical technique,” he says. “In hernia repair, these are mainly less pain neuralgia and faster recovery time.” “Robotics are a tool that helps me do what I do better,” he adds. According to Engan, a recently published study concluded that robotically assisted single-site transabdominal preperitoneal (RASSTAPP) inguinal hernia repair is both safe and effective. “The absence of clinical evidence of recurrence or neuralgia is extremely encouraging,” he says. Last summer, Sharon L. Morris, BSN, RN, CNOR, Surgical Services, North Valley Hospital in Whitefish, Montana, attended a presentation by Engan where he shared the results of this study. “I have to say I was a little skeptical at first,” she says. “We WWW.ORTODAY.COM

“

Robotics provide all the benefits of any minimally invasive surgical technique [...] Robotics are a tool that helps me do what I do better”

have been doing hernias open and laparoscopic for a long time.” “However, when he shared his research on the decrease of post-op pain and zero recurrence rate my ears perked up,” Morris continues. “The number one complaint of patients who undergo hernia surgery is post-op pain.” Robotic surgery is not just beneficial to patients – it’s also beneficial to surgeons. “For example, there are ergonomic benefits for surgeons,” says Engan. “We are sitting in a console operating the instruments instead of standing over the patient for hours with our arms extended.” “And the instrumentation allows 540 degrees of wristed articulation versus 270 degrees with the human wrist,” Engan adds. “Also, the optics and three-dimensional clarity are far superior, and the software eliminates surgeon tremor for smoother and more efficient manipulation of tissue.” “The main benefit for surgeons is better visualization,” adds Samadi. “This can mean the difference between removing all of the cancer and leaving some of the cancer behind.” MORE ROBOTIC SUCCESSES One of the most recent robotic surgery success stories was reported from California, where the thoracic surgery team at John Muir Health’s Concord medical center used a robotic-assisted device in a lobectomy procedure. The team has successfully WWW.ORTODAY.COM

completed more than a dozen of these procedures robotically using the da Vinci surgical system. In a traditional open chest cavity surgery, surgeons must cut between the ribs, and sometimes even spread the ribs, to access the lung. This leaves patients with a large incision on the side of the chest and results in a longer and more painful postoperative recovery. But when performed robotically, the incision is no more than one centimeter in length, which results in decreased pain levels and a shorter recovery time. Dr. Wilson Tsai, co-medical director of the thoracic program at John Muir Health, points out that recent studies indicate that roboticassisted lung surgery can deliver equal or better results compared to open chest cavity surgery. For example, one study recently published in The Annals of Thoracic Surgery concluded that robotic-assisted thoracoscopic surgery was safe and effective in various settings by delivering outcomes better than open thoracotomy and equal to video-assisted thoracic surgery (VATS). The robotic-assisted surgery resulted in two to four fewer days spent in the hospital, fewer blood transfusions, shorter usage of a chest tube by at least one day, and fewer air leaks lasting more than five days. “Surgical applications with advanced robotics expand treatment options and offer outcomes comparable to other minimally invasive approaches, especially for patients with more

complex cases,” says Tsai. “Patients appreciate the shorter recovery time that allows them to go home and get back to their normal lives quicker.” OR TEAM EXPERIENCE IS ESSENTIAL Engan stresses the importance of training and experience in robotic surgical equipment and techniques for OR team members. “Having an experienced and well-trained team of perioperative nurses and technicians is critical to making robotic surgery a success,” he says. Robotic surgery places unique challenges on perioperative nurse managers and directors, adds Ramona Conner, MSN, RN, CNOR, editor-in-chief, Guidelines for Perioperative Practice for the Association of perioperative Registered Nurses (AORN). “In particular, they face challenges in coordinating multiple demands for the equipment by an increasing number of surgeons,” says Conner. “They also have to provide specialized training and competency verification for personnel and coordinate staffing schedules to provide competent OR personnel for every roboticassisted procedure.” Ultimately, robotics is just a tool, Samadi stresses. “It’s a piece of equipment,” he says. “But in the hands of a skilled and experienced surgeon, robotics can result in extremely high levels of patient satisfaction.”

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FORMER TREE CLIMBER REACHES NEW HEIGHTS AS A NURSE By Matth ew N. Sk oufalos HT ON: SPOTLIGER, RN, BSN INMACH JOHN STE

sk most nurses what got them into the profession, and “the tree-climbing business” is not usually a response you’ll hear. But for a decade before John Steinmacher was at his patients’ bedsides, he was swinging from branches in homeowners’ backyards, several stories in the air, as a climber for hire.

“Mostly we deconstructed big trees in backyards,” he said. “It was a lot of labor, a lot of climbing. I realized at some point that I’d probably want to do something that had a living wage and that I could do up to retirement; something that my body could take.” As much fun as it was, Steinmacher said that the tree business provided all the motivation he needed to “do something better.” “You always need that hard labor job to realize that you need to go upward in life,” he said. “I started feeling like I was playing hooky on my life career.” Steinmacher started exploring the medical field. Ophthalmic technology seemed to have too low of an earnings ceiling for him; pharmacy school and the requisite Ph.D. program seemed too ambitious for his age. He considered becoming a physician’s assistant, until he learned that many of them begin their careers as nurses. “It looked more like something I could do and be happy with,” Steinmacher said. “I realized how many different places nursing can take you, how many different kinds of nursing there are, and the core value of helping people, helping others.”

SPOTLIGHT ON JOHN STEINMACHER, TEINMACHER, RN, BSN

Steinmacher, who already had a bachelor’s degree in German studies from the University of Pennsylvania, began his prerequisites at Camden County College in New Jersey, and eventually enrolled in an accelerated, one-year bachelor’s degree program at nearby Thomas Jefferson University in Philadelphia. He passed his NCLEX in accelerated fashion, too, wrapping up the examination in 75 questions. Shortly after graduation, he began his first job in the field, working as a three-quartertime floor nurse at a continuing care retirement community in Moorestown, New Jersey.

John Steinmacher’s typical day as a climber included great views like this one. This photo was taken from a tulip tree in Kennett Square, Pennsylvania.

At Collingswood Manor, a 60-bed residential facility where Steinmacher currently serves as the Evening Coordinator of health care nurses, he enjoys a supervisory role in which he assesses residents, administers medications, and helps his charges in their daily activities. Best of all, the job is located in his hometown. His commute is only a few blocks by foot, and the

YOU GET TO BE A PART OF A TEAM THAT’S REALLY DOING SOMETHING POSITIVE, WHETHER YOU’RE IN HOSPITAL, HOSPICE, OR LONG-TERM CARE. “The first nursing job is hard to land unless you have connections, and I didn’t have any connections to health care,” Steinmacher said. “I was hired by Christopher Kenneally, the Director of Nursing. I worked there for two years before I got an offer for a better position at Collingswood Manor by the Director of Nursing there — who was Christopher Kenneally.” 56

OR TODAY | October 2015

noon-to-8 p.m. shift allows him to span the day and evening work, the better to coordinate workflow and a continuity of care at the facility. “The doctors will seek the advice of their eyes and ears, the nurses, and their other specialists,” Steinmacher said. “A nurse works an eight-hour shift three or four days in a row, and then they’re not there. The next nurse

in gets a report, but it’s a five-minute report on 20 people. So there will be somebody in who the next nurse in can ask questions of and get information from.” A major aspect of Steinmacher’s responsibilities includes maintaining positive morale among the staff under his charge while driving a resident-directed model of care, which he said represents a departure from the traditional approach. Resident-directed care helps to resolve some of “the classic problems that nursing homes have,” Steinmacher said — namely compliance with medication regimens, doctor’s orders, and dietary and exercise routines — while reducing negative behaviors that can affect the community. “If you assess a person’s likes and dislikes, and then pay attention to those and honor those preferences, the resident is much easier to care for,” he said. Migrating to “a much more home-like model,” with flexible dining and waking times, and working to incorporate the on-campus apartments into a “home on a street” atmosphere improves the quality of patients’ WWW.ORTODAY.COM

John enjoyed tree climbing but wanted to do something better.”

John Steinmacher left his tree climbing job to become a nurse.

lives, which also makes the facility operate more smoothly, and helps retain clients, Steinmacher said. “These people have choices, and the hospitals in the area need to compete — and so do the long-term care facilities — for residents,” he said. “People usually have two and three choices; they have preferences, and they can talk to other people who are already there. They can tour the facilities. If they went there for rehab, they can choose to come back or they can be somewhere else.” “If the residents are doing better, then the nurses are doing better, and the management is doing better,” Steinmacher said. “As management and a person who hopes for the best in general, part of [my job] is to facilitate that WWW.ORTODAY.COM

John Steinmacher is seen with family and friends after graduating from nursing school. Pictured, from left, are his wife Natasha, daughter Katherine, John Steinmacher, his father John J. Steinmacher, Sr., and former tree climbing business partner Robert Bennett.

positive outlook. When there’s negative vibes going around and there’s change, I keep it on the positive to keep the morale up.” As the patient-directed care model evolves, it will change Steinmacher’s role in the facility as well: his responsibilities will lie more in providing mentorship to the staff underneath him while also reducing his direct resident caseload by as much as two-thirds. Steinmacher said that should allow him to reach patients one-on-one, the aspect of his job that he finds the most gratifying. “It’s a needy population,” he said.

“It’s gratifying to get the thanks you get several times a day from helping people. Feeling appreciated is a reward. It’s a very valuable benefit.” It’s certainly not the only advantage to working in the field — as opposed to working in a tree — that he touts. “You have job security,” Steinmacher said. “You get to be a part of a team that’s really doing something positive, whether you’re in hospital, hospice, or long-term care.” “There’s almost no limit for upward mobility,” he said.

October 2015 | OR TODAY

OUT OF THE OR HEALTH

ASHLEY COLPAART, M.S., R.D. ENVIRONMENTAL NUTRITION

CHRONIC FATIGUE SYNDROME NOT JUST IN YOUR HEAD R esearchers at the Center for Infection and Immunity at Columbia University’s Mailman School of Public Health have identified distinct immune changes in patients diagnosed with chronic fatigue syndrome, known medically as myalgic encephalomyelitis (ME/CFS) or systemic exertion intolerance disease. The findings could help improve diagnosis and identify treatment options for the disabling disorder, in which symptoms range from extreme fatigue and difficulty concentrating to headaches and muscle pain. These immune signatures represent the first robust physical evidence that ME/CFS is a biological illness as opposed to a psychological disorder, as well as the first evidence that the disease has distinct stages. Results appear online in the new American Association for the Advancement of Science journal, Science Advances. With funding to support studies of immune and infectious mechanisms of disease from the Chronic Fatigue Initiative of the Hutchins Family Foundation, the researchers used 58

OR TODAY | October 2015

immunoassay testing methods to determine the levels of 51 immune biomarkers in blood plasma samples collected through two multicenter studies that represented a total of 298 ME/CFS patients and 348 healthy controls. They found specific patterns in patients who’d had the disease for three years or less that were not present in controls or in patients who’d had CFS for more than three years. Short-duration patients had increased amounts of many different types of immune molecules called cytokines. The association was unusually strong with a cytokine called interferon gamma that’s been linked to the fatigue that follows infection with many viruses, including the EpsteinBarr virus (the cause of infectious

mononucleosis). Cytokine levels were not explained by symptom severity. “We now have evidence confirming what millions of people with this disease already know – that ME/CFS isn’t psychological,” says lead author Dr. Mady Hornig, M.D., director of translational research at the Center for Infection and Immunity and associate professor of epidemiology at Columbia’s Mailman School. “Our results should accelerate the process of establishing the diagnosis after individuals first fall ill, as well as discovery of new treatment strategies focusing on these early blood markers.” There are already human monoclonal antibodies on the market that can dampen levels of a cytokine called interleukin-17A, which is among those the study shows were elevated in early-stage patients. Before any drugs can be tested in a clinical trial, Hornig and colleagues hope to replicate the current, cross-sectional results in a longitudinal study that follows patients for a year to see how cytokine levels, including interleukin-17A, differ WWW.ORTODAY.COM

HEALTH

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“This study delivers what has eluded us for so long: unequivocal evidence of immunological dysfunction in ME/ CFS and diagnostic biomarkers for disease.” — Dr. Lipkin within individual patients over time, depending on how long they have had the disease. STUCK IN HIGH GEAR The study supports the idea that ME/CFS may reflect an infectious “hit-and-run” event. Patients often report getting sick, sometimes from something as common as infectious mononucleosis (Epstein-Barr virus), and never fully recovering. The current research suggests that these infections throw a wrench in the immune system’s ability to quiet itself after the acute infection, to return to a homeostatic balance; the immune response becomes like a car stuck in high gear. “It appears that ME/CFS patients are flush with cytokines until around the three-year mark, at which point the immune system shows evidence of exhaustion and cytokine levels drop,” says Hornig. “Early diagnosis may provide unique opportunities for treatment that likely differ from those that would be appropriate in later phases of the illness.” The investigators went to great lengths to carefully screen participants to make sure they had the disease. The researchers also recruited greater numbers of patients whose diagnosis was of relatively recent onset. Patients’ stress levels were standardized; before each blood draw, patients were asked to complete standardized paperwork, in part to engender fatigue.

The scientists also controlled for factors known to affect the immune system, including the time of day, season, and geographic location where the samples were taken, as well as age, sex, and ethnicity/race. In 2012, W. Ian Lipkin, M.D., director of the Center for Infection and Immunity, and colleagues reported the results of a multicenter study that definitively ruled out two viruses thought to be implicated in ME/CFS: XMRV (xenotropic murine leukemia virus) and murine retrovirus-like sequences (designated pMLV: polytropic MLV). Hornig and Lipkin expect to report the results soon for a second study of cerebrospinal fluid from ME/CFS patients. In separate ongoing studies, they’re looking for “molecular footprints” of the specific agents behind the disease – be they viral, bacterial, or fungal – as well as the longitudinal look at how plasma cytokine patterns change within ME/CFS patients and controls across a one-year period, as noted above. “This study delivers what has eluded us for so long: unequivocal evidence of immunological dysfunction in ME/CFS and diagnostic biomarkers for disease,” says Dr. Lipkin, senior author of the current study and the John Snow Professor of Epidemiology at Columbia’s Mailman School. “The question we are trying to address in a parallel microbiome project is what triggers this dysfunction.”

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October 2015 | OR TODAY 1510_MW_tpv.indd 1

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OUT OF THE OR FITNESS

WEARABLE FITNESS TRACKER CAN BUILD YOUR MOTIVATION TO EXERCISE

ou see them clamped to the wrists of people everywhere: restaurant servers, office colleagues, fellow gym rats, the teenager next door. Fitness trackers seem to have become required accessories among the fitness conscious. They’re becoming so popular that companies are even producing ones that look more like fashion jewelry than fitness monitors. As with many trends, it can be hard to tell whether this is just a passing one, or the start of something more. Jackie Kuta Bangsberg, a clinical exercise physiologist and University of Wisconsin Health Fitness Center manager, has also noted the increasing trend of fitness trackers among the center’s members. And, she thinks, they offer a lot of great potential if they are actually used. “A lot of people who currently use trackers are already fit. They love technology, love being able to track and download their workouts,” she notes. “Trackers can be really beneficial, but only if you use them consistently. And for those who don’t want to or can’t join a class, the wearable devices may be a 60 OR TODAY | October 2015

great way to stay motivated.” WILL YOU ACTUALLY WEAR A TRACKER? If you’re considering buying a device, Kuta Bangsberg recommends asking yourself, “Am I someone who is going to actually wear and use this, or is it just a novelty?” She also suggests talking with others who actually use trackers to find out what they think. Mary Werner, a lifeguard at the University of Wisconsin Health Fitness Center, began wearing a tracker thanks to her mom. “My mom really liked the one she wore, so she got me one for Christmas,” said Werner. “It’s a great subtle reminder to myself to try to incorporate more

activity into my day and to reach my daily goal of 10,000 steps. I would highly recommend getting a device.” Kuta Bangsberg says that’s one of the nice things about trackers: You can see your progress, which can help maintain momentum when positive changes aren’t always obvious. “We know it takes about six weeks of maintaining a behavior change for it to actually stick. If we can help people reach that point, then they actually start to miss the behavior when they don’t do it,” explains Kuta Bangsberg. “With the trackers, we can see those changes quickly – more steps than the previous day, or consistently reaching those steps each day – that can be the positive feedback people need to keep going.” Werner’s device syncs with an app on her phone. She can receive weekly emails with a summary of activities including information like calories burned and how much time she spent being active. She can even compete with others who have similar devices. “I’m a competitive person, so if I’m in a competition with someone I have more WWW.ORTODAY.COM

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incentive to try and go above and beyond my step goals,” comments Werner.

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THE BENEFITS OF CONSISTENCY A common complaint about trackers is that they’re not always accurate in recording activity. Kuta Bangsberg points out that the benefit they offer is consistency. Using the device daily offers an opportunity to see the trends over time. So focus less on specific details and more on the bigger picture. And, as companies continue to refine the accuracy of the devices, trackers may offer benefits we haven’t even discovered yet. “As the technology continues to evolve, they could offer significant advantages in helping people not only maintain healthy habits, but actually identify health concerns,” says Kuta Bangsberg. “It’s exciting to think of the possibilities.”

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HAVE PATIENCE Even with the additional motivation of competing against others, research shows that approximately 50 percent of those who start wearing a tracker stop within a year. It’s difficult to turn external motivations – like competing against others – into internal motivators. That’s why Kuta Bangsberg encourages wearers to be patient. “If you get a tracker, give yourself at least eight weeks and watch yourself. If nothing else, you’re going to learn something about yourself in that time. And it’s important to be realistic about your goals. You’re not going to go from a sedentary lifestyle to walking 10,000 steps in a single day,” she says. After putting the device on, Kuta Bangsberg recommends having a few “normal” days so you can establish what a typical day for you is like. Then slowly, over the course of time, challenge yourself. Try for 100 more steps the next day. If you don’t make it, aim for 50 more steps. Or, see if you can do the same number of steps at least five days in a row. Over time, she notes, you’ll eventually have made progress because you’re doing more than you would have otherwise done in a normal day. And she points out that setbacks are

common, and make it easy to think we’re off track. But we’re often not as off track as we think we are. “We are impatient by nature and want to see change quickly. And we get easily distracted. But, if we plan for setbacks and realize we’re still making progress, we can continue to find a positive way to move forward. Behavior patterns are so ingrained, it’s really challenging to establish new ones,” says Kuta Bangsberg.

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October 2015 | OR TODAY

OUT OF THE OR NUTRITION

BY MATTHEW KADEY, MSC, RD

SEEDS OF CHANGE

eeds are proof that Mother Nature works in remarkable ways. The bearers of life from the ground up, seeds contain all the makings for an entire plant. And in turn, these little powerhouses are packed with nutritional treasures. “As a group, seeds offer healthy doses of fiber, protein, beneficial fats, and minerals, and are extremely versatile in the kitchen, which makes it easy to enjoy them every day,” says Wendy Bazilian, DrPH, MA, RD, author of “The SuperFoodsRx Diet” (Rodale Books 2007).

Soup topped with toasted pumpkin seeds

HERE ARE SIX STAND-OUTS TO SPRINKLE INTO YOUR DIET MORE OFTEN.

Chia seeds: For better or worse, these tiny seeds from Central America were made famous by the Chia Pet, along with the catchphrase “Ch-chch-chia!” But chia (Salvia hispanica) has experienced a renaissance as a nutritious food. On top of providing a payload of dietary fiber – 10 grams in a one-ounce serving – chia delivers omega-3 fatty acids, as well as the bone-strengthening minerals calcium and phosphorus. Recent research shows that chia also possesses strong antioxidant activity, which could confer protection from diseases like cancer. Sneak more in: The soluble fiber in chia swells in liquid and takes on a tapioca-like consistency, which can be harnessed to make healthier fruit spreads and puddings. Sprinkle the mild-tasting seeds on fruit salads, yogurt and oatmeal. You can work chia powder into pancakes and baked goods by finely grinding up the seeds.

OR TODAY | October 2015

Pumpkin seeds: Also known as pepitas, these olive-green seeds can up the health ante of your diet. Much more than just jack-o-lantern cast-offs, shelled pumpkin seeds are a top-notch source of magnesium, linked with lower diabetes risk and more. An American Journal of Clinical Nutrition study found higher intakes of magnesium reduce the risk of heart disease by 30 percent. Grab a handful and you’ll also benefit from a healthy dose of phosphorus, iron and vitamin K. Sneak more in: Toast pumpkin seeds until they begin to pop and use to garnish soups, stir-fries and salads. Add seeds to granola and trail mix, and use finely chopped seeds to coat chicken, fish or tofu.

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NUTRITION

5 3

Hemp seeds: Hemp seeds are blessed with a flavor reminiscent of pine nuts and sunflower seeds. A 3-tablespoon serving delivers 10g of high-quality protein. Hemp protein also has been associated with lowering blood pressure levels. The mineral windfall of hemp includes magnesium, iron, phosphorus and zinc. And don’t overlook hemp’s omega fats for better heart health. Some seeds are sold with the hull still intact, but these can be hazardous to your dental work and are less versatile in cooking. Sneak more in: Blend hemp seeds into smoothies and salad dressings, or toss them onto yogurt, roasted vegetables, soups, green salads or cereal.

Flax seeds: Nutty tasting flax is derived from the linseed plant and contains a trifecta of heart-healthy properties: soluble fiber, omega-3 fatty acids and lignans. Lignans are a plant compound shown to help improve cholesterol and lower inflammation. Flax seeds possess a hard outer shell, so they need to be ground for their nutrients to be properly absorbed. Sneak more in: Stir ground flax into cereals, blend into smoothies or mix into homemade energy bars.

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Sunflower seeds: The kernels of the sun-loving yellow flower are brimming with vitamin E – each ounce provides about half the daily quota. Acting as an antioxidant, vitamin E protects against cell-damaging free radicals that roam the body. Other nutritional perks from these seeds include B vitamins, magnesium and selenium. Sneak more in: Toss shelled sunflower seeds into salads, pasta and grain dishes such as pilafs. Blend into dips and incorporate into DIY granola.

Sesame seeds: More proof that great things come in small packages, the seeds of the Sesamum indicum plant provide a dairy-free source of calcium, good for bone health, as well as proper muscle function. They’re also rich in copper, a mineral essential for numerous enzymatic reactions in the body, including those involved in energy production and nervous system functioning. So, indeed, it’s time to say, “Open sesame.” Sneak more in: A showering of sesame seeds can elevate all sorts of Asian-inspired dishes, from noodle salads to teriyaki salmon. They also can add great texture to homemade breads, crackers and energy bars.

Salad Toppers

A showering elevate all so of sesame seeds can rts of Asianinspired dishes

POWER SEED SPRINKLE

SERVES 6 1/4 1/4 2 3 2 •

cup unsalted pumpkin see ds, shelled cup unsalted sunﬂower see ds, shelled tablespoons sesame seeds tablespoons hemp seeds or chia seeds tablespoons agave syrup or maple syrup Pinch salt

Heat skillet over medium-low heat. Add pumpkin seeds and sunﬂowe r seeds; heat for 4 minutes, shaking the pan often, until seeds are lightly golden. Add sesame seeds, stirring often, and heat until they are toasted, about 1 minute. Stir in hemp or chia seeds, syrup and add a pinch of salt; heat 1 minute more. Allow to cool and store in air-tight container. Serv e over yogurt, ice cream and salads. NUTRITION INFORMATI ON

PER SERVING:

113 calories, 8g fat, 7g carbohyd rates, 5g protein, 1g fiber, 50mg sodiu m.

– Environmental Nutrition

October 2015 | OR TODAY

OUT OF THE OR RECIPE

OR TODAY | October 2015

BY DIANE ROSSEN WORTHINGTON

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RECIPE

THE PERFECT SALAD FOR ANY TIME OF DAY

ruit salad is often the answer to what to serve on the hottest days, but it is also a great treat while tailgating. It is also ideal for a light lunch or mid-day snack. It is one of the few dishes appropriate for breakfast, brunch, lunch and dinner, not to mention dessert. The everyday way to make fruit salad is to mix peak-of-season fruits in a large bowl and toss them together with a little lemon juice to preserve their color.

This recipe is one of my favorite fruit salads. Tropical fruits are mixed together with a sprinkling of toasted coconut. You can serve this alone or with a big dollop of your favorite yogurt. You could also serve this salad with a scoop of coconut sorbet for a refreshing dessert. HERE ARE A FEW MORE CREATIVE COMBINATIONS: Using a melon baller, make melon balls from watermelon (red and yellow, if possible), Crenshaw melons and orange honeydew melons. Flavoring the mixed melon salad with a passion fruit liqueur is especially good. Serve the salad in a big glass bowl decorated with mint sprigs. A good creamy dressing to serve on the side is plain

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yogurt blended with crème fraîche and flavored with a few drops of the same liqueur.

Slice peeled Babcock peaches in half and remove the pit. The flesh of this delicious peach is creamy white with red streaks running through it. Fill the centers of the peaches with raspberries and finish with a dollop of crème fraîche and a sprig of mint.

Combine peeled and diced papaya with diced avocado, and dress with lemon juice. In the Caribbean, the papaya seeds are served with the papaya and much enjoyed for their peppery taste. Add them to the mixture for an interesting change.

TROPICAL FRUIT SALAD WITH TOASTED COCONUT Serves 6 1/2 cup shredded sweetened coconut 1 ripe pineapple, peeled and cut into 1-inch chunks 1 ripe papaya, peeled, seeded and cut into 1-inch chunks 1 ripe cantaloupe, peeled, seeded and cut into 1-inch chunks 1 ripe mango, peeled, pitted and cut into 1 inch chunks • Juice of 1 lime • Fresh mint leaves, for garnish 1. Preheat the oven to 350 F. Place the coconut on a baking pan and toast for about 5 minutes, or until golden but not burnt. Cool. 2. Place cut fruit into a large bowl. Add the lime and mix to combine. Sprinkle the toasted coconut over the fruit just before serving. Garnish with mint and serve in small plates or bowls.

Diane Rossen Worthington is the author of 18 cookbooks, including “Seriously Simple Parties,” and a James Beard Award-winning radio show host. You can contact her at seriouslysimple.com. October 2015 | OR TODAY

OR TODAY | October 2015

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KILLS SUPER BUGS

Pathogenic Bacteria: Acinetobacter baumannii Carbapenem Resistant E. coli (CRE) Clostridium difficile (including spores) Escherichia coli Methicillin Resistant Staphylococcus aureus (MRSA) Proteus mirabilis Pseudomonas aeruginosa Serratia marcescens

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OUT OF THE OR PINBOARD

PINBOARD

The News and Photos That Caught Our Eye This Month

OR TODAY

CONTESTS • OCTOBER • October means Halloween and scary tales. Many scary stories talk about a full moon and we want to hear yours. Tell us about the most unusual event that has happened during your shift when a full moon was high in the night sky. Each person who sends in an entry will receive a $5 gift card. One lucky person will win a $50 pizza gift card to buy lunch for their department. Email your brief story to Social@MDPublishing.com. •

THE WINNER GETS A $50 PIZZA GIFT CARD

CONTEST

WINNER

{ JULY/AUGUST }

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EACH SUBMISSION WINS AN OR TODAY PRIZE PACK

OR TODAY

Ciao from Italy!

Win Lunch! 68

OR TODAY | October 2015

Lori Mozenter, RN, BSN, RNFA, enjoyed reading OR Today while on vacation in Sorrento, Italy!

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PIN BOARD

Fresh Produce

FARMERS MARKET:

FAMILY FUN AND HEALTHY FOOD It’s well accepted that fresh vegetables and fruit are welcome additions to your plate. For those without a backyard garden or who simply would like to bring a little variety to the shopping experience, visit a local farmers market. Megan Stinchfield, RD, MSH and nutrition program director, Life Time Foundation offers tips to make the farmers market an entertaining outing for the entire family: • Know what’s in season. When you arrive, take a lap around the market to try samples and scope out the best prices and bestlooking produce. • Support local farmers. Shopping at farmers markets supports your local farmers and promotes small businesses. Use this opportunity to create relationships with farmers in your area. Ask them about their farming practices and how they like to prepare their produce. Encourage your children to ask farmers questions as well to help them learn how their food gets from the farm to your kitchen table. • Educate your kids. Farmers markets are a great opportunity to educate your children on how to eat healthy by introducing them to local farmers and have them try both familiar and new foods. • Engage kids in the process. Give them a small budget so that they can purchase a bit of their own produce. Play a farmers market treasure hunt game and have your child pick out their favorite fruits and vegetables or a fruit or vegetable from each color of the rainbow. • TO FIND A FARMERS MARKET near you visit www.localharvest.org or

www.usdalocalfooddirectories.com.

Chef Inspired The Lean Cuisine brand reintroduces itself as a modern eating brand and ally for women’s wellness. No longer focused on diet, the Lean Cuisine brand relied on insights from hundreds of women as it evolved to reflect a shift in the way Americans – primarily women – are eating and shopping. Women want chefinspired, ethnic dishes that offer a variety of attributes and bold yet simple packaging that stands out in the aisles, and the Lean Cuisine brand is meeting that challenge. Lean Cuisine is introducing 10 new recipes, including Pomegranate Chicken, Sweet Sriracha Braised Beef, Sesame Stir Fry with Chicken and Roasted Chicken and Garden Vegetables.

FOR MORE INFORMATION and product availability, visit www.leancuisine.com.

“ Our job as nurses is to cushion the sorrow and celebrate the joy, everyday, while we are ‘just doing our jobs.’ ” – Christine Belle, RN, BSN WWW.ORTODAY.COM

October 2015 | OR TODAY

INDEX ALPHABETICAL wAIV ………………………………………………………… 17 Anacapa ……………………………………………… 67 Bryton Coproation ………………………………… 5 C Change Surgical ………………………………… 9 Cardinal Health ……………………………… 33, 42 Cincinnati Sub-Zero ……………………………IBC Dabir Surfaces……………………………………… 23 D. A. Surgical ……………………………………… 32 Enthermics Medical Systems, Inc. ……… 15

GelPro ………………………………………………………18 Healthmark Industries………………………… 43 Innovative Medical Products, Inc …… BC Jet Medical Electronics ……………………… 33 Kapp Surgical Instrument, Inc. ……………18 MD Technologies ………………………………… 52 MedWrench ………………………………………… 59 Pacific Medical LLC ……………………………… 6 Palmero Health Care ……………………………61

Paragon Service ………………………………… 53 Ruhof Corporation ……………………………… 2-3 Sage Services …………………………………………19 Summit Medical Inc. ……………………… 44-47 Surgical Power …………………………………… 42 TBJ, Inc. ………………………………………………… 24 Tru-D ………………………………………………………… 4

HAND/ARM POSITIONERS Innovative Medical Products, Inc ……………… BC

REPAIR SERVICES Pacific Medical LLC ………………………………………… 6

HIP SYSTEMS Innovative Medical Products, Inc ……………… BC

SHOULDER RECONSTRUCTION Innovative Medical Products, Inc ……………… BC SIDE RAIL SOCKETS Innovative Medical Products, Inc ……………… BC

INDEX CATEGORICAL ACCREDITATION AAAHC ………………………………………………………………19 ANESTHESIA Paragon Service …………………………………………… 53 APPAREL Healthmark Industries…………………………………… 43 ASSOCIATIONS AAAHC ………………………………………………………………19

INFECTION CONTROL/PREVENTION Palmero Health Care ………………………………………61 Ruhof Corporation ………………………………………… 2-3 Tru-D …………………………………………………………………… 4

AUCTIONS MedWrench …………………………………………………… 59

INTERNET RESOURCES MedWrench …………………………………………………… 59

BEDS Innovative Medical Products, Inc ……………… BC

KNEE SYSTEMS Innovative Medical Products, Inc ……………… BC

CARDIAC SURGERY C Change Surgical …………………………………………… 9

LABORATORY TBJ, Inc. …………………………………………………………… 24

CABLES/LEADS Sage Services ……………………………………………………19

LEG POSITIONERS Innovative Medical Products, Inc ……………… BC

CLEANING SUPPLIES Ruhof Corporation ………………………………………… 2-3

MONITORS Jet Medical Electronics ………………………………… 33

CLAMPS Innovative Medical Products, Inc ……………… BC

OTHER AIV ………………………………………………………………………17

DISPOSABLES Kapp Surgical Instrument, Inc. ………………………18 Sage Services ……………………………………………………19 ENDOSCOPY Kapp Surgical Instrument, Inc. ………………………18 MD Technologies …………………………………………… 52 Ruhof Corporation ………………………………………… 2-3 Summit Medical Inc. ………………………………… 44-47 TBJ, Inc. …………………………………………………………… 24 GEL PADS Innovative Medical Products, Inc ……………… BC GENERAL AIV ………………………………………………………………………17 GelPro …………………………………………………………………18 MedWrench …………………………………………………… 59 Summit Medical Inc. ………………………………… 44-47 Surgical Power ……………………………………………… 42

OR TODAY | October 2015

SOCIAL MEDIA MedWrench …………………………………………………… 59 STERILIZATION Summit Medical Inc. ………………………………… 44-47 TBJ, Inc. …………………………………………………………… 24 Tru-D …………………………………………………………………… 4 SURGICAL AAAHC ………………………………………………………………19 Cardinal Health ………………………………………… 33, 42 D. A. Surgical ………………………………………………… 32 MD Technologies …………………………………………… 52 Summit Medical Inc. ………………………………… 44-47 Surgical Power ……………………………………………… 42 SURGICAL SUPPLIES Cincinnati Sub-Zero ………………………………………IBC Ruhof Corporation ………………………………………… 2-3

TBJ, Inc. ………………………………………………… 24

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

OR TABLES/ ACCESSORIES Bryton Coproation …………………………………………… 5 Dabir Surfaces………………………………………………… 23 Innovative Medical Products, Inc ……………… BC

TEMPERATURE MANAGEMENT C Change Surgical …………………………………………… 9

ORTHOPEDIC Surgical Power ……………………………………………… 42 PATIENT AIDS Innovative Medical Products, Inc ……………… BC

WARMERS Enthermics Medical Systems, Inc. …………………15 WOUND MANAGEMENT Anacapa ………………………………………………………… 67

PATIENT MONITORING Pacific Medical LLC ………………………………………… 6 POSITIONING AIDS Innovative Medical Products, Inc ……………… BC POSITIONERS/IMMOBILIZERS Innovative Medical Products, Inc ……………… BC

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c i n c i n n a t i

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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

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October 2015 | OR TODAY

Enhanced Humbles LapWrap Positioning Pad ®

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

Designed to meet

The operative word in patient positioning.

AORN

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

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

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

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

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

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

. AORN is a registered trademark of AORN, Inc. AORN does not endorse any commercial company’s products or services.