OR Today - April 2016 by MD Publishing

CLOROX ADVICE

PRE-OPERATIVE PROTOCOLS PAGE 11

TAKE GOOD CARE

SPOTLIGHT ON

JOBY HYMAN PAGE 54

SAVE THE DATE

OR TODAY LIVE! PAGE 68

APRIL 2016

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CONTENTS

features

OR TODAY | April 2016

BULLYING IN THE WORKPLACE

CORPORATE PROFILE: HEALTHMARK

Healthmark Industries is looking forward to an exciting future with its continued expansion of staff and products. With almost 50 years of experience Healthmark continues to adapt to the business needs of their customers. The latest focus at Healthmark includes the expansion of products for managing the proper reprocessing of flexible endoscopes.

The topic of bullying has gotten a lot of attention in recent years as the negative effects of the bullying suffered by children have become more apparent. Unfortunately, children aren’t the only ones who are suffering at the hands of bullies. Bullying has long been an under-the-radar problem in the OR, but it is starting to attract more attention in the health care industry.

SPOTLIGHT ON: JOBY HYMAN

Joby Hyman has risen to become the Clinical Category Director of Supply Chain Management at St. Luke’s Health System in Boise, Idaho. For nurses interested in similarly advancing their careers, Hyman advocates parlaying a strong bedside manner and clinical routine into process improvement.

OR Today (Vol. 16, Issue #3) April 2016 is published monthly by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 302691530. POSTMASTER: Send address changes to OR Today at 18 Eastbrook Bend, Peachtree City, GA 30269-1530. For subscription information visit www.ortoday.com. The information and opinions expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher. Reproduction in whole or in part without written permission is prohibited. © 2016

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April 2016 | 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 Jessica Laurain Kara Pelley

ACCOUNT EXECUTIVES

Warren Kaufman | warren@mdpublishing.com Jayme McKelvey | jayme@mdpublishing.com Andrew Parker | andrew@mdpublishing.com

SURGICAL CONFERENCE

68 INDUSTRY INSIGHTS 11 14 16 20

Clorox Advice AAAHC Update News & Notes ASCA Update

ACCOUNTING Kim Callahan

WEB SERVICES Betsy Popinga Taylor Martin Adam Pickney

CIRCULATION Lisa Cover Laura Mullen

IN THE OR 22 24 27 28 34

Suite Talk Company Showcase: SurgiDat Market Analysis Product Showroom CE Article

OUT OF THE OR 58 60 62 64 66 68

Health Fitness Nutrition Recipe Pinboard OR Today Live! Preview

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

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INDUSTRY INSIGHTS CLOROX ADVICE

BY ROSIE D. LYLES, MD, MHA, MSC; HEAD OF CLINICAL AFFAIRS, CLOROX HEALTHCARE

NASAL DECOLONIZATION IN PRE-OPERATIVE PROTOCOLS AN ANTISEPTIC ALTERNATIVE TO ANTIBIOTICS THE BURDEN OF SURGICAL SITE INFECTION In today’s dynamic healthcare environment, preventing surgical site infections (SSIs) is one of the greatest challenges. SSIs continue to rank as one of the most common types of healthcare-associated infections1, and are associated with significant direct and indirect financial and emotional costs to healthcare facilities and to patients. The majority of SSIs are caused by Staphylococcus aureus (S. aureus),2 and patient colonization with S. aureus is a major risk factor for SSIs.2 DECOLONIZATION STRATEGIES TO REDUCE SSIS Patient decolonization prior to surgery may help to reduce the risk of SSIs. 3,4 Preadmission bathing or showering with chlorhexidine gluconate (CHG) is most commonly used to cleanse the skin. For nasal decolonizataion, the antibiotic mupirocin (brand name Bactroban) applied by the patient to the anterior nares twice daily for the five consecutive days prior to surgery has typically been used. However, concerns that resistance to mupirocin and low compliance may lead to decolonization failure has WWW.ORTODAY.COM

not decolonized.3 Universal decolonization with CHG and povidone iodine has also been shown to be as clinically effective but more cost effective than screening and decolonization with CHG and mupirocin.5 Studies have also shown that bacteria do not develop resistance to povidone iodine.6

ROSIE D. LYLES, MD, MHA, MSC; HEAD OF CLINICAL AFFAIRS, CLOROX HEALTHCARE

prompted the search for nonantibiotic alternatives. Povidone iodine can be an effective antiseptic alternative to mupirocin for nasal decolonization when used as part of preoperative bundle that includes CHG bathing. In patients undergoing orthopedic surgeries, povidone iodine is as effective as mupirocin for nasal decolonization,4 and a bundle including nasal decolonization with povidone iodine, CHG bathing and a CHG oral rinse resulted in lower rates of SSIs compared to patients

AN ANTISEPTIC ALTERNATIVE Clorox Healthcare™ Nasal Antiseptic Swabs are pre-saturated with a sterile povidone iodine gel and can be used for nasal decolonization. The swabs are applied by the healthcare provider one hour prior to surgery which can increase the likelihood of compliance. The gel reduces 99.4% of S. aureus at 1 hour and maintains persistence through 12 hours.7 In a safety and tolerance study, 96% of patients experienced no discomfort and were satisfied with the overall experience.8 An effective decolonization protocol that includes skin bathing and nasal decolonization has been demonstrated to be effective in reducing the risk of SSIs. Clorox Healthcare™ Nasal Antiseptic Swabs, are an antiseptic alternative for nasal decolonization that eliminates the risk and complexity of antibiotic usage. April 2016 | OR TODAY

CLOROX ADVICE

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Wheel obstructions FOR MORE INFORMATION about nasal decolonization, visit www.CloroxHealthcare.com/ NasalAntisepticSwabs REFERENCES 1 Sievert DM et al. Antimicrobial-resistant pathogens associated with healthcareassociated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009-2010. Infect Control Hosp Epidemiol. 2013 Jan;34(1):1-14. 2 Kalmeijer MD et al. Nasal carriage of Staphylococcus aureus: Is a major risk factor for surgical-site infections in orthopedic surgery. Infect Control Hosp Epidemiol. 2000;21:319-323. 3 Bode LG, Kluytmans JA,Wertheim HF, et al. Preventing surgicalsite infections in nasal carriers of Staphylococcus aureus. N Engl J Med 2010;362(1):9â&#x20AC;&#x201C;17. 4 Phillips M et al. Preventing surgical site infections: a randomized, open-label trial of nasal Mupirocin ointment and nasal povidone-iodine solution. Infect Control Hosp Epidemiol. 2014 Jul;35(7):826-32. 5 Torres EG et al. Is Preoperative Nasal Povidone-Iodine as Efficient and CostEffective as Standard Methicillin-Resistant Staphylococcus aureus Screening Protocol in Total Joint Arthroplasty? J Arthroplasty. 2016 Jan;31(1):215-8. 6 Lanker Klossner B et al. Nondevelopment of resistance by bacteria during hospital use of povidone-iodine. Dermatology. 1997;195 Suppl 2:10-3. 7 Clorox Study #9550-005 (in vitro) 8 The Clorox Services Company Study Number: 2015-002/2015-003. 12

OR TODAY | April 2016

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INDUSTRY INSIGHTS AAAHC UPDATE

BY JACK EGNATINSKY, MD

ARE YOU PREPARED FOR ADVANCED DIRECTIVES?

n 2014, CMS addressed Advanced Directives for ASCs in their interpretive guidelines this way:

“CMS has released revised interpretive guidelines to CMS state survey agencies and CMS regional offices. The new guidelines require ASC compliance with advance directives. While ASCs are still allowed to refuse to honor advance directives, the latest interpretive guidelines state: “A blanket statement of refusal by the ASC to comply with any patient advance directives is not permissible. However, if and to the extent permitted under State law, the ASC may decline to implement elements of an advance directive on the basis of conscience or any other reason permitted under State law, if it includes in the information concerning its advance directive policies a clear and precise statement of limitation.” CMS specifically states that an ASC’s notice of limitation could, if permitted by State law, indicate that it would always attempt to resuscitate a patient and transfer that patient to a hospital in the event of deterioration. When I’m on accreditation surveys, however, I still see statements like, “we do not honor advanced directives at our center.” 14

OR TODAY | April 2016

From what CMS has stated, this is no longer acceptable. You must give the patient a “clear and precise statement” of your policy. Your policy should include a rationale for why you choose not to honor advanced directives. Frequently, I see statements like, “it is very unlikely that you will experience an event that would require resuscitation while you are at our center. However, on the rare occasion that such an event occurs, we will make every effort to resuscitate you and transfer you to a hospital.” Is that enough? Do you ask patients on your pre-admission contact if they have an advanced directive? If they do, do you explain your policy? Do you ask them to bring a copy with them? Do you: • Explain to them that if you have to initiate resuscitation you would stabilize them for transfer to a hospital for more intensive care? • Let them know that you will send their advanced directive with them to the hospital? • Discuss with them that their named “surrogate” can ask that the resuscitative and continuing care efforts be stopped in the hospital if that is the patient’s wish, as expressed in their advanced directive? Check your state rules and regulations and your malpractice

insurance risk management department to determine the extent of your responsibilities. Make sure that your entire staff, from the receptionist to the patient care givers in each area of your center, clearly understands your policy. If you have a transfer agreement with a nearby hospital, discuss your policy with the hospital to make sure there will not be any issues when transfer is initiated. Hopefully, this is a situation that you will never encounter. But because it is so rare, it is crucial that you are fully prepared in the event that it happens. And should it happen, that’s when you will be immensely grateful that you had the foresight to educate and train your staff ahead of time. ABOUT THE AUTHOR Dr. Jack Egnatinsky is an anesthesiologist with extensive experience in the ambulatory surgery arena, both HOPD and ASC. He is a Past President of the Board of FASA, a predecessor to the ASC Association, and Past President of AAAHC. He is also the Board Chair of the Accreditation Association for Hospital and Health Systems (AAHHS) and is a representative of Acreditas Global, the international arm of AAAHC. He remains extremely active as a Medical Director for AAAHC, in addition to being a well-travelled AAAHC accreditation surveyor. WWW.ORTODAY.COM

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April 2016 | OR TODAY

INDUSTRY INSIGHTS NEWS & NOTES

STAFF REPORTS

RTLS TECHNOLOGY PUTS PEACE OF MIND IN THE PALM OF FAMILIES’ HANDS When a loved one is having surgery, being tied to the waiting room and wondering how things are going can be a time-consuming and stressful experience. Frequent questions at the front desk, while understandable, can be disruptive to workflow for desk staff and the charge nurses who have to continually check on patients. The Northwest Michigan Surgery Center in Traverse City, Michigan, provides a novel solution. Its iCare Patient Tracker app, available on computers and smartphones, puts peace of mind in the palm of a family member’s hand, allowing them to easily keep tabs on a patient’s progress. Since 2012, the surgery center has been showing the progress of patients through surgery on a large screen monitor in the waiting room. The new iCare app allows the same information to be viewed from anywhere with an Internet connection. On the day of surgery, patients and their families are given passwordprotected access to the iCare website. Like the display in the waiting room,

family members can see the HIPAAcompliant first name of each patient and whether they are in pre-op, surgery, post-op or ready to see family. Unlike similar progress indicators, iCare doesn’t rely on staff members to update the status of patients. Thanks to real-time locating system (RTLS) technology from Versus Technology, the patient’s status is automatically updated as soon as they move from one stage of care to the next, based on their actual location. This frees staff from unnecessary data entry, and ensures the information shown to family is always correct in real time. Versus also assists the surgery center to efficiently see 19,000 patients per year in their six ORs, four procedure rooms and 44 pre- and post-op beds. Versus Advantages OR patient flow software gives all staff visibility into patient, bed and OR status and intelligently cues staff when patients are ready for the next stage of care. In addition to Versus, two other companies helped develop the iCare app. SMB Group, a local technology

firm, provided programming expertise, and Flight Path Creative worked on design and development of the application. •

NEOSURGICAL BEGINS POSTMARKET SURVEILLANCE STUDY neoSurgical Inc. has begun a postmarket surveillance study of its FDA-cleared device, neoClose, at University of Texas Health Sciences Center at Houston. The randomized study will compare neoClose against the standard of care for closure in a bariatric surgery gastric bypass population of 70 adults aged 18-70 years with

OR TODAY | April 2016

BMI greater than 35. Principal investigators include: Erik B. Wilson, M.D., professor of surgery; Peter A. Walker, M.D., assistant professor of surgery; and, Shinil K. Shah, DO, assistant professor of surgery. “Surgeons in hospitals across the United States are rapidly adopting our neoClose device. This post-

market surveillance study is intended to build our clinical evidence behind neoClose and to begin to establish the superiority of neoClose versus the standard of care for closing port sites – a standard that absolutely must be improved to enhance patient outcomes and safety,” said Barry Russell, CEO of neoSurgical. •

WWW.ORTODAY.COM

NEWS & NOTES

STRYKER TO ACQUIRE SAGE PRODUCTS LLC Stryker Corp. has announced a definitive agreement to acquire Sage Products LLC from Madison Dearborn Partners in an all cash transaction for $2.775 billion. The transaction includes an anticipated future tax benefit that is expected to exceed $500 million and to positively impact cash flows over approximately 15 years. Sage develops, manufactures and distributes disposable products targeted at reducing “Never Events,” primarily in the intensive care unit and MedSurg hospital unit setting. Sage sales for fiscal 2015 totaled $430 million, up 13 percent over the prior year. “The company’s established leadership team and innovative products that help prevent hospital acquired conditions have driven consistent double-digit sales growth,” stated Kevin A. Lobo, chairman and chief executive officer. “This acquisition aligns with Stryker’s focus on offering products and services that support a mindset of prevention, specifically in the area of ‘Never

Events’ such as hospital acquired infections. Today, through our medical division, Stryker offers products that are complementary to those produced by Sage. Sage has a 45-year history of focus on patients and caregivers that is evident in their culture and fits well with our medical division. This business will also provide a consistent disposable revenue stream that will complement our capital equipment offerings. We look forward to welcoming the Sage team to Stryker.” Founded in 1971 and headquartered in Cary, Illinois, Sage is a developer of products and proprietary solutions designed to help improve outcomes for patients and clinicians, while maximizing efficiency and profitability for health care facilities. Sage’s products include solutions for oral care, skin preparation and protection, patient cleaning and hygiene, turning and positioning devices and heel care boots. •

ADVANCED COOLING THERAPY RECEIVES 510(K) CLEARANCE FOR SECOND DEVICE

Advanced Cooling Therapy has received 510(k) clearance from the U.S. Food and Drug Administration to market its second product, the Esophageal Cooling Device (ECD-02), in the United States. The Esophageal Cooling Device (ECD) technology platform, which includes ACT’s ECD-01 and ECD-02, is the only temperature modulation device available that uses the esophageal space to cool or warm patients. This new version of the ECD is designed for use with the Blanketrol II and III Hyper-Hypothermia systems made by Cincinnati Sub-Zero. The ECD-02, along with Advanced Cooling Therapy’s WWW.ORTODAY.COM

first product, the ECD-01, is designed to modulate and control patient temperature when clinically indicated through a single-use, fully enclosed triple lumen system that is inserted into the esophagus. Two lumens attach to existing temperature modulation equipment while a third lumen simultaneously allows gastric decompression and drainage. The ECD can be rapidly inserted by most trained health care professionals, in similar fashion to a standard gastric tube, and can be used to control patient temperature in the operating room, recovery room, emergency room or ICU. No other products on the market are approved to use the esophageal environment for whole-body temperature modulation. The ECD-01 received FDA de novo clearance in June of 2015 for use with the Medi-Therm III by Stryker. It also received its CE Mark in Europe in 2014, and is licensed for sale in Canada and Australia. • April 2016 | OR TODAY

INDUSTRY INSIGHTS NEWS & NOTES

INDUSTRY VETERAN JOINS LINET LINET has added Jeff Bell to its leadership team. Bell, who most recently served as chief sales officer for Amerinet, joins the LINET team as vice president of national accounts. In this role, Bell will be responsible for driving continued growth of LINET’s strategic customer base, including GPOs and IDNs. “LINET’s strong leadership and commitment to innovation were very important factors for me when deciding to join the team. It’s an honor to be part of a company who is truly revolutionizing safe patient handling and caregiver safety,” stated Bell. Bell is an accomplished health care executive with more than 25 years of senior level sales experience, having delivered double-digit sales growth in each of his previous roles. He also brings strong and extensive relationships with him as he joins the team. Bell is coming to LINET as the company continues to experience significant growth in the American market. •

LIFETHREADS LAUNCHES CONTEGO COLLECTION A second generation product line of medical apparel is being introduced by LifeThreads LLC. The new Contego Collection, which follows last year’s successful introduction of LifeThreads’ Classic Collection, is treated with an EPA-registered antimicrobial active ingredient that protects the fabric from harmful pathogens found within institutional medical environments. All LifeThreads garments are fluid resistant offering health care employees protection against blood, urine, vomit and other bodily fluids. Contego offers new styles with stretch tops, pants and cargo pants that are available in six colors – black, pewter, white, wine, royal blue and navy blue with three additional colors – ceil blue, hunter green and eggplant – debuting in March 2016. The premium quality stretch fabric 18

OR TODAY | April 2016

is made out of cotton (55 percent), polyester (41 percent) and spandex (4 percent) and provides an improved fit and greater comfort for health care professionals. Sizes range from XS to 3XL. Life Threads’ textiles are designed to prevent the spread of harmful bacteria in health care settings where patients are most vulnerable. “With the introduction of our new Contego Collection, we are challenging the status quo by offering a new line of highly-styled, comfort plus medical apparel with contemporary colors that medical professionals have been requesting for years,” said Karan Jhunjhunwala, founder and CEO of LifeThreads. “Our new wide range of garment colors supports coding schemes used increasingly in institutional settings to make it easier for patients to identify caregivers." • WWW.ORTODAY.COM

NEWS & NOTES

STUDY SHOWS UTILITY OF MASIMO RAINBOW ACOUSTIC MONITORING Masimo has announced that in a new study that compared acoustic respiration rate (RRa) from Masimo’s rainbow Acoustic Monitoring (RAM) to respiration rate from conventional capnography, researchers concluded that RAM was useful for monitoring dental patients under intravenous anesthesia. The Anesthesia Patient Safety Foundation (APSF) and The Joint Commission recommend continuous oxygenation and ventilation monitoring in all patients receiving opioidbased pain medications. RAM noninvasively and continuously measures respiration rate using an innovative adhesive sensor with an integrated acoustic transducer that is applied to the patient’s neck. The study, published in the Journal of Clinical Monitoring and Computing by Dr. Kentaro Ouchi and colleagues from Japan, compared the respiration rate measurements from RAM and capnography (Psychorich

IS nasal cannula and BP-608 Omron Colin monitor) in non-intubated patients with dental anxiety undergoing dental treatment. A total of 1,953 data points of respiratory rate were taken from the start to the end of anesthesia. Over the entire observation period, the results showed a significantly higher detection of respiratory rate by RAM (1,884 points, 96.5 percent) than by capnography (1,682 points, 86.1 percent) P < 0.0001. When comparing respiration rate from RAM and capnography during the induction, intraoperative, and emergence periods, the 95 percent limits of agreement (LOA) were -7.4 to 6.7 , -5.4 to 7.0, -3.9 to 5.3, respectively. The researchers commented that this study was only a comparison between two devices, since neither method could be considered a “corrective control,” or gold-standard reference. The authors concluded, “In comparison between capnography

using a nasal cannula for continuous monitoring for the respiratory rate, the acoustic method is useful during intravenous general anesthesia in unintubated spontaneously breathing patients undergoing dental procedures.” The authors note that the acoustic method might not accurately detect respiratory rate in cases in which a dental air turbine is used. For information on the RAM Acoustic Respiratory Rate Monitoring System, go to www.masimo.com. •

INAUGURAL WOUND HEALING EVENT A SUCCESS Wound Healing 2016 run by Euroscicon Ltd. was an open forum event that tackled the processes that are involved in wound healing. The event also discussed the related therapies to wound infection and healing. In addition to this, Wound Healing 2016 used an international setting, inter-specialty and multi-professional approach that offers huge numbers of opportunities for debate and discussion that is set in an informal atmosphere. According to researchers at the event, 40 million cases of non-healing chronic wounds are evident globally with 10 million reported in Europe. In Europe, wound management accounts for 2-4 percent of the health care budgets. Aside from this, the problematic biofilms in chronic wounds have been demonstrated to have a role to play in delaying wound healing and were also considered to increase the risk of a wound developing an infection. Dr. Narendra Kumar, associate professor of pharmaceutical sciences, at the Texas A&M Irma Lerma Rangel College of Pharmacy, proposed to develop new ways to completely protect and secure the gut lining from wounds. WWW.ORTODAY.COM

But, available options for the treatment of non-healing chronic wounds are limited when biofilms are evident, as biofilms are inherently recalcitrance to presently available antimicrobial interventions. Biofilms that are present in chronic wounds represent a serious clinical issue for the patient and a significant financial burden to health services worldwide. In conjunction with the need for new antibiotics, as highlighted by the chief medical officer of Cupron Inc. Professor Sally Davies, the development of innovative anti-biofilm agents is also urgently required. “New research findings were shared at Wound Healing 2016, which will further advance our fundamental understanding of this complicated and dynamic process,” according to professor Steven Percival from the University of Liverpool. The event also tackled that adding microscopic copper oxide particles in wound dressings enhances wound healing especially in hard to heal chronic wounds. The molecular mechanisms of the enhanced wound healing were also discussed. • April 2016 | OR TODAY

INDUSTRY INSIGHTS ASCA UPDATE

BY BILL PRENTICE

ASC ADVOCACY DOESN’T STOP IN THE VOTING BOOTH

n the last 40 years, millions of Americans have benefited from the high-quality, cost-effective surgical care that ASCs provide, yet there are still members of Congress and other policymakers who do not understand the services that ASCs offer or the ways that ASCs have transformed the surgical experience for patients and providers. ASCA continues to voice ASCs’ concerns and advocate for the ASC community in Washington, D.C., but its efforts are amplified many times over when individual ASC managers, owners, physicians and staff get involved.

To give ASCs the chance to be fully represented in the current national dialogue surrounding health care cost and quality, ASCA will host several events and provide a range of specialized services this year to help individual ASC leaders and advocates get involved. One of the most important events that ASCA will conduct this year is its Capitol Fly-In program. Through this program, we will help hundreds of ASCA members come to Washington, D.C., to meet face-to-face with their members of Congress this June and October. During these meetings, ASCA’s members will have important opportunities to discuss the cost-savings and quality care that ASCs provide. They will also have a chance to talk about some of the legislative initiatives pending in Congress that can help ASCs do even more for patients in need of outpatient surgical care. Another advocacy program that ASCA is supporting this year is National ASC Week. During the third week of August, ASCA is encouraging ASCs across the country to invite their

OR TODAY | April 2016

members of Congress into their facility to see, firsthand, what ASCs have to offer. ASCA has information that ASCs can use to prepare for these visits and staff that can help ASCs send invitations, conduct a facility tour and follow up with their legislators. One of the resources that ASCA makes available to help with facility tours and other ASC advocacy activities is its Campaign for Advancing Surgical Care website (www. ascassociation.org/advancingsurgicalcare). On that site, you can get copies of research studies that demonstrate the many advantages ASCs offer, view statistics about ASCs, find the ASCs in your local community and learn about federal legislation that the ASC community supports. New this year, you can also view a short video that answers the question “What is an ASC?” And, you don’t have to schedule an ASC facility tour before you can share the information on that website with your members of Congress or with your patients, community leaders and state officials. Just share the link provided above.

Another way that ASCA works on behalf of ASCs in Washington, D.C., is through our regulatory outreach. Every day, we work with national policy experts who set, approve and manage the regulatory requirements that apply to ASCs. Often, ASCs need additional information before they can comply with new requirements that are released. ASCA works to obtain clarification where it is needed and reform, and even repeal, when necessary. Individual ASC professionals can help support these efforts by providing data when ASCA requests it and information about the ways new regulations affect their facility. Comments about policy changes that are still needed to support ASCs in providing the services they already provide and expanding into new areas are always welcome. This November, when Americans go to the polls to elect the next president of the United States, we can expect that the future of our nation’s health care system will be one of the key issues that many voters will have in mind. If you work in or with an ASC, in addition to casting your vote this fall, I encourage you to make sure that you are a member of ASCA now and to make sure that you are involved in at least some of the advocacy and outreach opportunities ASCA offers this year. ASC professionals have a lot of work to do to make sure that ASCs are well-represented in the health policy decisions that will be made under our next president.

WWW.ORTODAY.COM

April 2016 | OR TODAY

IN THE OR SUITE TALK

SUITE TALK

Conversations from the OR Nation’s Listserv

WEARING MASKS We are considering a purchase of the Stryker Flyte helmets/hoods for use during total joint procedures. Do you require your team to wear a mask under this hood when it is not incorporated with the “toga” full body suit? A: No, the mask can be removed. A: We do not require masks to be worn with our Stryker hoods, only upon room entry when the mask is removed by a non-scrubbed staff member and the hood is donned.

Q Q

A: No requirement to wear a mask for us. Those that don’t wear a mask have an “adhesive” mask, with the strings cut off, stuck to their face. When the hood drape is placed over the head and before the gowning, the circulator reaches up under the hood and removes the mask.

CAUTERY AND JEWELRY

Is it still a concern to remove jewelry when using cautery? So many patients today are so reluctant to remove their jewelry that it has become a major concern. With the advances in EUS, have there been any recent burns around jewelry left in? A: Jewelry and body piercings are still a concern for burns. We ask all our patients to remove their jewelry and piercings. If they refuse, anesthesia and the surgeon have the right to refuse to do the procedure. If we proceed with the procedure, we have the patient sign a waiver that they were informed about the additional risks. A: With the REM technology, the risk for burn is not there as long as the jewelry is not “close” to the active cautery unit. More of a concern is jewelry that may become constrictive and cause a problem, specifically rings and necklaces. Another consideration is jewelry that may be compressed against the skin due to the positioning needs of a procedure. The final aspect of concern for burns is not to place the cautery pad over jewelry or over tattoos (which may have a metal based ink).

HCG REFUSAL

What is the protocol when a patient refuses a HCG morning of surgery? A: We chart that patient refused and let M.D. and anesthesia know (per preop nurse at our facility).

A: Yes, the employees and surgeon wear the mask while they scrub. When they get in the room and the circulator is present, she/he removes the mask for them as they don the rest of the Flyte system. Make sense?

OR TODAY | April 2016

A: I think that would be up to the surgeon/ proceduralist and anesthesia as to whether or not they want to proceed. If they are willing to proceed, we ask the patient to sign a waiver. WWW.ORTODAY.COM

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April 2016 | OR TODAY

COMPANY SHOWCASE SURGIDAT

SPECIAL ADVERTISING SECTION

SURGIDAT

urgiDat Software applications are delivered in Australia, New Zealand and throughout North America. SurgiDat’s software solutions cater for whole facility information or can be deployed at a department or even a layered level in Surgical and Acute healthcare facilities. OR Today interviewed SurgiDat CEO and President Todd Kemp to find out more about the company and its innovative solutions.

Please explain your company’s core competencies and unique selling points. KEMP: SurgiDat enables department and multi-department communication, coordination and quality through financial, materials and clinical systems. SurgiDat brings disparate systems together and provides seamless point-ofuse, interactive, production, workflow coordination and quality control software solutions layered on existing systems.

What are some advantages that your company has over the competition? KEMP: SurgiDat is a grass roots company, we listen to our customers and have the ability to enhance or integrate systems rapidly to support their specific needs. SurgiDat has a wealth of production knowledge to help our customers reach their full potential in automating systems and procedures – just let us know what your need is!

What are some challenges that your company faced last year? How were you able to overcome them? KEMP: One of the major challenges is while SurgiDat incorporates the three silos of health data and manages this across all disparate departments – hospitals are still not set up at the executive level to cope with decision-making across these areas within their health systems. It is a major challenge to find the correct person within a health system or facility who understands the total picture and

OR TODAY | April 2016

has the authority or willingness to make decisions that would allow data and outcome driven production changes, through Episodic Pathways™ and Care Redesign. SurgiDat “Layers into health systems to provide a NEW functional view and workflow for end users, while keeping the existing systems in place.” SurgiDat is seeing a growing trend by CMS driving Accountable Care Organizations which essentially is asking hospitals to do what SurgiDat provides out of the box through managing quality and financial Episodic Pathways™ across the complete continuum of care providing the basis for Care Redesign through process control.

What product or service that your company offers are you most excited about right now? KEMP: Two Exciting Systems that are simple but very effective in the delivery of services to OR cases and quality surgical outcomes. The SurgiDat SPD 365 Service – SurgiDat healthcare expert’s complete quarterly assessments to keep your SPD department up to date 365 days of the year. This service is billed monthly and includes Instrument Tracking Software for SPD “Free of Charge” to help coordinate OR and SPD quality outcomes. This Service assists managers across departments identifying areas to enhance and meet the growing demands on the service. We would welcome your call to discuss the new SurgiDat SPD 365™ and get your

two-day free Department review. The other exciting solution is simple in form and allows for better production, less mistakes, reduces immediate use sterilization and is very simple to implement. Introducing SurgiDat High Visual Handle Tags – Days of the week loan set tagging ensures at a glance which instrument sets are required for what day for Implant Loan Set procedures. Also missing instruments and repair tags. SurgiDat products are split between two verticals. Local Departmental systems Web-based solutions for the management of medical devices in OR, Preference Card Automation, Case Setups, SPD, GI Lab, Sterile Stores and BioMed Services + Quality, Costing and Replenishment. SurgiDat Enterprise Solutions Looking for a cost-effective, single solution to run your surgical center that understands your business? Looking to gain control of your costs and streamline production workflows? SurgiDat Enterprise Acute Care Facility Management System is what you need – or – lay it in to manage CMS LEJR ACO requirements. It includes: PAS, Billing, Materials, Clinical, Electronic Referral Interfacing, Bookings, Financial Reporting and Quality Reporting, OR Scheduling, Surgeons Electronic Preference Cares, Full Episodic Pathway™ Control And Reporting, OR Control, Materials and Clinical Documentation Solutions. At SurgiDat, we have invested significantly over the past 10 years in building these solutions and work side by side with our customers to enhance their specific needs. What is your need? How can we help?

FOR MORE INFORMATION, visit www.surgidat.com. WWW.ORTODAY.COM

SurgiDat SurgiDat -- Enterprise Enterprise Health Health Information Information System System Automate Existing Systems - SurgiDat Ease of Use Single Platform Solution Automate Existing Systems - SurgiDat Ease of Use Single Platform Solution Question: Are you involved in a new facility or redesign in your department? Question: Are you involved in a new facility or redesign in your department? * Ask SurgiDat about their fully automated end to end Health System Application ** Ask their automation fully automated end to end Health Use SurgiDat SurgiDat about to manage at a departmental levelSystem Application ** Use SurgiDat to manage automation at a departmental level Need Help in automating procedures in your facility? Let us know what your need is! * Need Help in automating procedures in your facility? Let us know what your need is!

SurgiDat Patient Centric Service Orientated Automation -- Software Applications SurgiDat Patient Centric Service Orientated Automation -- Software Applications * Help and communicate with your SPD with our SurgiDat SPD 365™ Service * Help and communicate with your SPD with our SurgiDat SPD 365™ Service • Includes FREE Tracking software Includesto FREE Tracking software for policy and procedural •• Reports OR and SPD managers EW •• Reports to ORobservations and SPD managers for policy and procedural NEW Assessments, and recommendations are focused on N • ANSI/AAMI Assessments, observations and recommendations are focused on ST79, AORN, SGNA, TJC, OSHA ANSI/AAMI ST79, AORN, SGNA, TJC, OSHA GI Lab Solutions GI Lab Solutions

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April 2016 | OR TODAY

HOW TO MAXIMIZE YOUR STORAGE CAPACITY STEP 1: Take advantage of expert consulting and design services. Tell us about your preferences and challenges. At no charge to you, our design professionals will evaluate your storage areas and show you how to optimize your capacity using 3D drawings of your space.

STEP 2: Select the components that work best for you. Choose from a complete selection of wire shelving, bins, totes, containers, medical carts, cabinetry, customizable lockers and more.

STEP 3: Work with us to implement your new storage system. Is there anything we can do to help? We can coordinate product shipments and deliveries, and even come to your facility to unpack, assemble and install all your new products. Just let us know.

OR TODAY | April 2016

Contact your Medline representative or email Natalie Klemko at nklemko@medline.com today!

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IN THE OR MARKET ANALYSIS

STAFF REPORT

MARKET ANALYSIS ‘Lucrative growth’ forecast for antimicrobial wound dressings market

nfection, extended patient stays and patient satisfaction are all factors expected to send the wound dressing market to new highs. The market is predicted to grow at a compound annual growth rate of close to 5 percent through 2022, according to a report from Grand View Research report.

“Global wound dressing market size was valued at $9,163.4 million in 2014 and is expected to grow at a CAGR of 4.4 percent over the forecast period,” according to a Grand View Research. The report also indicates that a rise in the incidence of sports injuries coupled with the growing awareness among sports clubs, schools, and institutions to maintain medical budgets is expected to expedite the growth of the wound dressing market. “Rise in the incidence of infections caused in the lesions is expected to further accentuate the growth of this industry. Lesions when not treated at the right time lead to infections, thus the growth in the awareness among health care practitioners and the patients is boosting wound dressing market growth,” the report states. WWW.ORTODAY.COM

“Various advancements in the applications of these products have led to a spurred use of these products globally,” according to Grand View Research. “Furthermore, commercialization of novel therapies such as electromagnetic therapy, electrical stimulation, nanotechnology, and the use of silver and other combination bandages are enhancing the wound dressing market. These advancements render better relief to patients during any trauma treatment, and hence is a high-impact rendering driver for the wound dressing market.” A variety of products is another reason for the expected growth. “Key product segments of this industry include traditional products and advanced products. Advanced product segment comprises moist, antimicrobial, and active products that dominated the overall wound dressing market at over 56.1 percent revenue share in 2014,” Grand View Research reports. “This market position can be attributed to high usage and improved utility of products.” “Antimicrobial products, which consist of silver and non-silver dressing products, are expected to exhibit lucrative growth over the forecast period owing to their benefits, which include ease-of-use and wide availability,” the report adds. “Moreover, antimicrobial

“Rise in the incidence of infections caused in the lesions is expected to further accentuate the growth of this industry. Lesions when not treated at the right time lead to infections, thus the growth in the awareness among health care practitioners and the patients is boosting wound dressing market growth.” products have increased the healing rate, thereby reducing the ambulation time as compared to the other available alternatives.” North America is expected to remain a major player in the global market. “The North American wound dressing market was the largest in 2014 accounting for over 35.1 percent of the overall revenue owing to the presence of large geriatric population base, increased patient awareness levels, and rapidly increasing geriatric population in this region, especially in the U.S.,” according to Grand View Research. Key players operating in this industry include 3M Healthcare, ColoPlast, Medline Industries, HARTMANN, BSN Medical, Medtronic Plc, Smith & Nephew, ConvaTec, Derma Sciences and Systagenix. April 2016 | OR TODAY

IN THE OR PRODUCT SHOWROOM

MEDLINE OPTIFOAM GENTLE ANTIMICROBIAL POST-OP STRIPS Medline’s Optifoam Gentle Antimicrobial Post-Op Strips provide powerful antimicrobial protection from a gentle and repositionable foam dressing. Optifoam Gentle Ag+ eliminates 99.99 percent of bacteria within two hours and remains effective for up to seven days. The ionic silver provides an effective barrier for managing repeated bacterial introduction. The numbered liners make these post-op strips very easy to apply. The dressing acts as both a primary and secondary dressing. For increased patient comfort, these strips use a thin and conformable adhesive border that is waterproof, flexible and breathable. The new silicone adhesive is designed for a more gentle feel and allows for the dressing to be repositioned. The dressing’s wear time of up to seven days helps reduce the need for disruptive and unnecessary dressing changes. •

OR TODAY | April 2016

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PRODUCT FOCUS

ACELITY SILVERCEL NON-ADHERENT ANTIMICROBIAL ALGINATE DRESSING More than 40 percent of patients consider pain at dressing change to be the worst part of living with wounds. SILVERCEL Non-Adherent Antimicrobial Alginate Dressing is designed for easy, pain-free removal, and is intended for use in the management of all indicated moderate to heavily exuding wounds, including surgical and traumatic wounds. Its EasyLIFT Precision Film wound contact layer allows for intact removal, protection of tissue, and exudate absorption. Available in four convenient sizes, SILVERCEL helps maintain a moist environment beneficial to healing and offers an effective antimicrobial barrier against wound pathogens. To learn more, visit www.acelity.com. •

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April 2016 | OR TODAY

IN THE OR PRODUCT SHOWROOM

MEDTRONIC TYRX ANTIBACTERIAL ABSORBABLE ENVELOPE The Medtronic TYRX Absorbable Antibacterial Envelope is an innovative mesh envelope that holds an implantable cardiac device – such as a pacemaker, implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy (CRT) device – and is designed to stabilize the device after implantation and reduce surgical-site infections. The TYRX Absorbable Antibacterial Envelope releases two antimicrobial agents, rifampin and minocycline, to the surgical site to help prevent infection. The envelope stabilizes the device, elutes the antimicrobial agents, then dissolves and is fully absorbed approximately nine weeks after implantation. The TYRX Absorbable Antibacterial Envelope is both FDA-cleared in the United States, and CE-Marked in Europe. •

OR TODAY | April 2016

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PRODUCT PRODUCTSHOWROOM FOCUS

ENTROTECH LIFE SCIENCES CHLORADERM ANTIMICROBIAL TRANSPARENT FILM DRESSING entrotech life sciences (ELS) has received FDA 510k clearance of ChloraDerm, the first and only edge-to-edge transparent film dressing to provide the Chlorhexidine Advantage; a safe, colophony- and acid-free chlorhexidine matrix for wound and catheter site protection for up to seven days. Compared to common non-antimicrobial dressings ChloraDerm demonstrates substantially greater effectiveness against multi-drug-resistant organisms at one, three and seven days, without adding increased cost or complexity. For information, visit www.entrotechlifesciences.com. â&#x20AC;˘ WWW.ORTODAY.COM

April 2016 | OR TODAY

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IN THE OR CONTINUING EDUCATION CE480D

OR TODAY | April 2016

BY KIM STRELCZYK, MSN, RN, ACNS-BC, CIC, AND BETH WALLACE, MPH, CIC

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CONTINUING EDUCATION 472C

MRSA MAY BE WAITING RIGHT AROUND THE CORNER

ake was two weeks out from a heart and kidney transplant that saved his life. He had spent many weeks of the past year in and out of the ICU with his failing heart and kidneys. But this afternoon he began to feel nauseated and spiked a fever of 101.4 F. He had pain at the entry site for his central line, so the clinician removed the dressing to inspect the site. It was red and swollen. The clinician reported her findings to Jake’s physician, who immediately ordered blood cultures and made plans to remove the central line. Broad-spectrum antibiotics and vancomycin (Vancocin) were started. A rapid test showed presumptive MRSA in the blood sent for culture. The next morning, the gram-stain report showed gram-positive cocci. Jake’s condition was deteriorating rapidly. Despite the clinicians’ best efforts, Jake developed a profound hypotensive episode that night, which in turn led to ventricular tachycardia and cardiac arrest. Resuscitation efforts were futile. Jake succumbed to sepsis caused by a hospital-acquired infection.

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 purpose of this CE program is to provide nurses, dietitians, dietary managers, health educators, physical therapists, occupational therapists, pharmacists, laboratory professionals and imaging technologists with information about the growing problem of MRSA in healthcare and strategies to reduce its spread. After studying the information presented here, you will be able to: • Discuss the epidemiology of MRSA • Identify three factors that put hospital patients at risk for MRSA • Describe three strategies healthcare professionals as a team can use to prevent and control the spread of MRSA in healthcare facilities

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This scenario, based on a true story, remains all too familiar these days. Nearly 20% of MRSA infections are primary skin and soft tissue infections, with another significant proportion involving pneumonia, bloodstream infections and complications of invasive devices. In 2000, the occurrence of MRSA in hospitalized patients had increased dramatically compared to prior years. But in 2011, a CDC study showed that invasive (life-threatening) MRSA infections in healthcare settings are declining. In 2011, there were nearly 31,000 fewer (a 54% reduction) invasive MRSA infections than in 2005, and in 2011 the majority of invasive MRSA infections were not identified in hospitalized patients, but in those who had been hospitalized recently.1,2 All medical team members must play an active role in adopting, modeling and encouraging practices to prevent the spread of MRSA in healthcare facilities. In addition, they can educate the public about MRSA, providing accurate information to counterbalance the sometimes sensational reports in the lay media. Staphylococcus aureus is a grampositive cocci. Many healthy people carry S. aureus with no negative health consequences, but it can cause

infection with a break in the host defenses. Gram-positive cocci is a microbiological way of describing how this organism looks under a microscope with certain stains; basically on first glance in the micro lab, S. aureus appears as small, purple spheres often clustering in pairs and chains.3 MRSA VS. MSSA Two main types of S. aureus cause infections significant to hospitalized patients: MRSA and methicillin-susceptible S. aureus (MSSA). The difference between these two types of S. aureus is in the antibiotics required to kill or inhibit the organism. In this module, “S. aureus” will include both MSSA and MRSA. Overall, S. aureus infections are not increasing noticeably in U.S. hospitals. But the proportion of S. aureus infections that are methicillin resistant have risen dramatically, particularly in the ICU. In 1974, 2% of S. aureus infections were caused by MRSA, but 30 years later, in 2004, 64% of S. aureus infections were caused by MRSA rather than its more antibiotic-susceptible and treatable counterpart (MSSA).4 Current data suggests that more than half of two of the most commonly tracked and targeted hospitalassociated infections, central-line April 2016 | OR TODAY

IN THE OR CONTINUING EDUCATION 712 associated bloodstream infections and catheter associated urinary tract infections, that are caused by a strain of S. aureus are found to be MRSA.5 THROUGH THE DECADES S. aureus was discovered in the 1880s.6 Since then, we have recognized the vast number of infections for which S. aureus is responsible. S. aureus most often causes skin and soft tissue infections, which are often mistaken for spider bites. S. aureus can also be responsible for more serious infections, including pneumonia, meningitis, urinary tract infections, endocarditis, surgical site infections and toxic shock syndrome. Before the antibiotic era, many of these infections proved fatal.7 In the 1940s, penicillin (Bicillin) and other antibiotics became available in the U.S., and it seemed that modern medicine would conquer its bacterial foes. But almost as soon as the medical profession started prescribing these wonder drugs, S. aureus and most other pathogenic bacteria began to develop resistance mechanisms that allowed them to survive in the presence of these drugs. In the late 1940s, S. aureus began to develop resistance to penicillin, and methicillin (Staphcillin) became the drug of choice. However, by 1961, the first strain of MRSA was discovered, and the first human case of MRSA in the U.S. was diagnosed in 1968.4,6 MRSA has been an issue in healthcare settings since then.8 MRSA is becoming increasingly common in hospitals each year, as are many other multidrugresistant organisms. In 2006, the Association for Professionals in Infection Control and Epidemiology conducted a prevalence study of U.S. inpatient facilities. The study found that about 46 of every 1,000 inpatients are colonized or infected with MRSA. This study was repeated in 36

OR TODAY | April 2016

2010, and discovered that about 66 of every 1,000 inpatients are colonized or infected with MRSA. While this may seem discouraging, this is likely a more accurate picture than that depicted by the 2006 study because many more facilities perform active surveillance for MRSA. In addition, the 2010 data reflect more colonization than active infection.9,10 S. aureus can coexist with a human host without causing infection, and most often does so by living in the nares and sometimes on the skin. Infections with S. aureus are much more common in people colonized with the bacteria than in those who are not colonized. Saying that a person is “colonized” with bacteria indicates that the bacteria live on or in the person without causing any infection. More than 30% of the U.S. population is colonized with S. aureus.6 Colonization with MRSA can also occur simultaneously with MSSA, in the same body sites. Less than 1% of the U.S. population is colonized with MRSA, and while this may seem insignificant, that number translates into more than 2 million people.6 Among healthcare-associated S. aureus infections, 21% are caused by MRSA.11 TRANSMISSION OF MRSA IN HEALTHCARE Healthcare-associated MRSA (HA-MRSA) can lead to a variety of outcomes. Patients may be transiently or permanently colonized without symptoms, or they may develop disease immediately or in the future, especially in the presence of invasive devices or after surgical procedures. In hospitals, healthcare workers across various disciplines can transmit MRSA from a colonized/ infected person to a previously unexposed person. Antibiotic-resistant organisms like MRSA are transmit-

ted in the same way as more susceptible bacteria, patient to patient, most often by contaminated hands. Healthcare workers’ hands can become contaminated by touching a person with MRSA or an inanimate object or surface contaminated with MRSA, such as blood pressure cuffs or blood glucose monitors.12 The CDC classifies bacteria on the hands as resident or transient. Resident bacteria are organisms that attach to deeper parts of the skin, making them more difficult to remove with hand hygiene. However, resident bacteria are less often associated with infection than transient bacteria. Transient bacteria are easy to remove with proper hand hygiene because they tend not to attach to the deeper areas of the skin.13 Organisms, including MRSA, that typically cause healthcareassociated infections are most often transient bacteria on the hands of healthcare workers. If healthcare workers of various disciplines don’t practice appropriate hand hygiene, they can carry MRSA easily to the next patient or patient care item they touch. Uniforms or lab coats that come in contact with a person infected or colonized with MRSA also can be a source for transmitting MRSA to other patients.11 A number of risk factors associated with MRSA predispose hospitalized patients to MRSA infections. One of the primary risk factors is already being colonized with MRSA or having had a MRSA infection in the past.6 Additional risk factors include a recent protracted hospitalization, especially in the ICU and especially when two or more patients in the unit were colonized or infected with MRSA. Invasive devices, including central venous catheters and mechanical ventilators, also put patients at greater risk for MRSA. Previous antibiotic use affects a WWW.ORTODAY.COM

CONTINUING EDUCATION 472C

patient’s likelihood of developing MRSA infection, as well.7,14 Dialysis is a common risk factor for MRSA infection.7 Additional risk factors may include inadequate healthcare staff and the lack of adherence to hand hygiene and environmental disinfection that occurs with understaffing.15 OUTBREAKS MRSA can be a stubborn foe, as the following case from a Wisconsin hospital shows. From July to October 2000, the burn unit at the University of Wisconsin hospital began to notice hospital-acquired MRSA among its patients. This was despite active surveillance cultures on admission and twice weekly throughout the patient stay, and the use of gloves and gowns when MRSA was identified in a patient. During the epidemiologic investigation, no environmental swabs were positive for MRSA, and because environmental cultures had not uncovered the reservoir, staff members were cultured. Of the 40 people cultured, two were found to be positive. DNA testing revealed that one of the 40 healthcare workers, a nurse who had been involved in caring for all of the new MRSA-positive patients, had the same strain of MRSA as seven patients in the burn unit. Despite the nurses’ decolonization attempts, the outbreak continued through January 2001. From July 2000 through April 2001, 21 cases of nosocomial MRSA were identified. Eventually, the unit instituted contact precautions on all patients in the unit regardless of MRSA status. This intervention was successful, resulting in an almost 50% reduction in the unit’s HAMRSA rate.16 DANGER IN THE NICU Neonatal ICUs are often plagued with MRSA outbreaks. Despite a greater understanding of infection WWW.ORTODAY.COM

Keeping MRSA at Bay Healthcare providers as a team can help reduce the burden of MRSA with these simple measures:

• Good hand hygiene practices • Contact precautions • Adequate cleaning and disinfection of equipment • Dedicated equipment in isolation rooms • Thorough daily cleaning and disinfection of the patient care environment • Surveillance cultures • Use of care bundles • Educating other health professionals as to proper procedures when working with patients • Educating family members and other visitors as to proper procedures when in contact with patients

Source: Centers for Disease Control and Prevention

transmission and more attention to prevention, many NICUs still have problems controlling the spread of MRSA. In 2007, a hospital in Lancashire, England, temporarily closed its NICU because of HA-MRSA in six infants, one of whom had a bloodstream infection with the organism. One of the unique aspects of this outbreak was the presence of Panton-Valentine leukocidin, a toxin that makes MRSA even more capable of causing invasive infection.17 This toxin is most often associated with community-associated MRSA (CA-MRSA), not the hospitalassociated strain. CA-MRSA, though more virulent than HA-MRSA, is less resistant to antibiotics and thus easier to treat. Usually a course of trimethoprim-sulfamethoxazole (Bactrim/Septra) can treat CAMRSA successfully.18 Hospitals are reporting the transmission of the CA-MRSA strain more often. Given this increase, more hospitals will probably begin to have outbreaks with the fastergrowing and frequently more virulent CA-MRSA strains.18

STILL TREATABLE The media have called MRSA a “deadly drug-resistant strain of staph,” which may give the impression that treatment options aren’t available. But to date, every strain of MRSA has been treatable with antibiotics other than methicillin. The trouble with MRSA is that front-line treatments are no longer options. Vancomycin (Vancocin), daptomycin (Cubicin) and linezolid (Zyvox) are common choices for HA-MRSA.19 Other options exist, including quinupristin-dalfopristin (Synercid), clindamycin (Cleocin), trimethoprim-sulfamethoxazole (Bactrim), ceftaroline (Teflaro) and telavancin (Vibativ).19 But antibiotic susceptibility and site of infection must be considered to ensure appropriate treatment. Many issues arise with the treatment options available for MRSA that do not arise with treatments for MSSA, including harsh adverse effects. The antibiotics required to kill MRSA are more toxic than the standard antibiotic treatments. Also, most antibiotics April 2016 | OR TODAY

IN THE OR CONTINUING EDUCATION 712

For More Information • Healthcare Infection Control Practices Advisory Committee. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings http://www.cdc.gov/hicpac/2007IP/2007isolationPrecauti ons.html • HICPAC 2006 Guidelines for Management of MultidrugResistant Organisms in Healthcare Settings http://www.cdc.gov/hicpac/mdro/mdro_toc.html • 5 Million Lives Saved from Harm Campaign http://www.ihi.org/offerings/Initiatives/PastStrategicInitiat ives/5MillionLivesCampaign/Pages/default.aspx • SHEA/IDSA Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals http://www.jstor.org/stable/10.1086/676534 • Ginny’s Story http://www.youtube.com/watch?v=s5x1f3_NJX8

effective against MRSA cannot be taken orally, often leading to extended use of the invasive catheters that have put patients at risk in the first place. MRSA, like all bacteria, adapts to its environment, meaning that it will continue to acquire and develop additional resistance mechanisms to allow it to live in the presence of more antibiotics, which will leave caregivers with even fewer treatment options in the future.20 Preventing the spread of MRSA in healthcare facilities is key to reducing the burden of this deadly disease, and healthcare professionals must collaborate toward this end. Fortunately, the solution, although multifaceted, is simple. A number of measures, when combined, have been shown to reduce the transmission of multidrug-resistant organisms in healthcare facilities. Many studies 38

OR TODAY | April 2016

in the U.S. and abroad have shown successful control and eradication of MRSA. Nearly all of them reported the use of a median of seven or eight interventions to achieve results.21 The following is a description of those interventions. All healthcare workers as a team must discuss, understand and follow the procedures to prevent the spread of MRSA when they are working with patients. Hand hygiene: Healthcare workers’ hands become contaminated easily during routine patient care. When adherence to hand hygiene is poor, workers can transfer the contaminants to other patients. Washing for 15 seconds before and after patient care with soap and water or using alcohol-based hand cleaners provides adequate decontamination of hands.13

GOWN AND GLOVES Contact precautions: Contact precautions involve using a gown and gloves to prevent contamination of clothing and reduce the chance of spreading the bacteria to patients.12 A private room is preferred for patients in contact precautions. However, many hospitals do not enjoy the luxury of having a large number of private rooms. In such cases, it may be necessary to cohort patients with like infections. For instance, a patient with MRSA infection could be cohorted with another patient with MRSA.12 Dedicated equipment: Whenever possible, patient care equipment should be dedicated to the isolation room and not used on another patient. Using disposable stethoscopes and BP cuffs, and single-patient-use thermometers in contact isolation can reduce greatly the number of items traveling from patient to patient.21 KEEPING IT CLEAN Cleaning and disinfection of patient care items: Items that are used on multiple patients (such as BP cuffs, stethoscopes, electronic thermometers and blood glucose monitoring devices) can be a source of disease transmission if not properly disinfected between patients.12,18,21 Most equipment can be disinfected easily using a disinfectant wipe or other hospital-approved disinfectant.12, 21 Environmental cleaning: Thorough, daily cleaning of the patient care environment helps reduce the burden of contamination and prevent transmission. In some cases, it may be necessary to clean contact precaution rooms more frequently WWW.ORTODAY.COM

CONTINUING EDUCATION 472C

than nonisolation rooms, especially high-touch surfaces, such as doorknobs and bed rails.12 Clean supplies in patient rooms should be stored to prevent contamination. Large supply carts with multiple drawers are usually necessary in critical care areas, but the contents of the drawers may become contaminated unless drawers are emptied and disinfected between patients. Surveillance cultures: Active surveillance cultures reduce rates of MRSA transmission when used with other prevention and control methods (e.g., preemptive use of contact precautions at admission until cultures are negative). An active surveillance culture involves collecting swabs of commonly colonized areas of the body from patients who are at high risk of colonization.21 Usually these are done at admission, but some programs routinely culture patients in the ICU (e.g., every Monday while the patient is in the ICU). Surveillance cultures from the nares will identify most patients colonized with MRSA. A successful active surveillance culture program depends upon many factors, including meticulous planning of a protocol, adequate resources for collecting and processing the cultures, communication of results to caregivers and monitoring of adherence. Some facilities couple surveillance cultures with targeted decolonization. Most successful decolonization programs are focused on ICU.22 EVIDENCE-BASED Bundled care measures: Recently, many hospitals have implemented groups of evidence-based practices, or “bundles,” outlining the care of ventilated patients and those with central venous catheters to reduce ventilator-associated pneumonia WWW.ORTODAY.COM

and central venous catheter-related bloodstream infections. One of the most important measures in the bundle is to get the catheter out as soon as it is no longer needed. The ventilator bundle calls for aggressive weaning to extubate the patient as soon as possible. In its 5 Million Lives Saved from Harm campaign, the Institute for Healthcare Improvement recommended certain actions for hospitals to take to reduce the burden of MRSA. Specifically, the institute recommended increasing adherence to hand hygiene practices and implementing active surveillance cultures.18,23 EVER MORE DANGEROUS MRSA is not new to healthcare. But the organism’s recently acquired ability to produce the Panton-Valentine leukocidin toxin has enabled it to thrive outside hospitals.24 Younger people with immature immune systems have succumbed to overwhelming sepsis due to CA-MRSA, and the incidence of this strain is also increasing in hospitals. While interventions to reduce multidrug-resistant organisms are not all directed toward reducing MRSA, reducing hospital-acquired infections overall may in turn reduce the spread of MRSA. Healthcare professionals across all disciplines must collaborate to prevent the spread of this devastating disease. KIM STRELCZYK, MSN, RN, ACNSBC, CIC, a healthcare consultant in the North Texas area, has worked in infection prevention and control for the past 19 years. BETH WALLACE, MPH, CIC, is the manager of infection prevention at Methodist Charlton Medical Center in Texas.

REFERENCES 1. Active bacterial core surveillance (ABCs) report: methicillin-resistant Staphylococcus aureus, 2011. CDC Web site. http://www.cdc.gov/abcs/reportsfindings/survreports/mrsa11.html. Updated July 24, 2014. Accessed December 17, 2014. 2. Dantes R, Mu Y, Belflower R, et al. National burden of invasive methicillinresistant Staphylococcus aureus infections, United States, 2011. JAMA Intern Med. 2013;173(21):1970-1978. 3. Jensen M, Wright D, Robison R. Microbiology for the Health Sciences. 4th ed. Upper Saddle River, NJ: Prentice Hall; 1997. 4. Klevins R, Edwards J, Tenover F, et al. Changes in the epidemiology of methicillin-resistant Staphylococcus aureus in intensive care units in U.S. hospitals, 1992-2003. Clin Infect Dis. 2006;42(3):389-391. 5. Sievert DM, Ricks P, Edwards JR, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009-2010. Infect Cont Hosp Epid. 2013;34:1-14. 6. Methicillin-resistant Staphylococcus aureus. National Institute of Allergy and Infectious Diseases Web site. http:// www3.niaid.nih.gov/topics/antimicrobialResistance/Examples/mrsa. Accessed December 17, 2014. 7. Kuehnert M, Kruszon-Moran D, Hill H, et al. Prevalence of Staphylococcus aureus nasal colonization in the United States, 2001-2002. J Infect Dis. 2006;193(2):172-179. 8. Klevens RM, Morrison MA, Nadle J, et al. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA. 2007;298(15):1763-1771. 9. Jarvis WR, Schlosser J, Chinn RY, Tweeten S, Jackson M. National prevalence of methicillin-resistant Staphylococcus aureus in inpatients at U.S. April 2016 | OR TODAY

IN THE OR healthcare facilities, 2006. Am J Infect Cont. 2007;35(10):631-637. 10. Jarvis WR, Jarvis AA, Chinn RY. National prevalence of methicillin-resistant Staphylococcus aureus in inpatients at U.S. healthcare facilities, 2010. Am J Infect Cont. 2012;40(3):194-200.

11. Nichols R, Florman S. Clinical presentations of soft-tissue infections and surgical site infections. Clin Infect Dis. 2001;33(s2):s84-s93. 12. Siegel J, Rhinehart E, Jackson M, Chiarello L. 2007 guideline for isolation precautions: preventing transmission

of infectious agents in healthcare settings. United States Centers for Disease Control and Prevention Web site. http:// www.cdc.gov/hicpac/2007IP/2007isolat ionPrecautions.html. Update December 9, 2010. Accessed December 17, 2014. 13. CDC. Guideline for hand hygiene

CLINICAL VIGNETTE Sharon O’Grady is five days postcoronary artery bypass graft and has just been transferred from the CVICU to a telemetry bed. Because of diabetic neuropathy, COPD and difficulty in weaning from the ventilator, her recovery has been slow. Vital signs at 4 p.m. were T 102.4, P 104, R 12, and BP 120/72. The central venous catheter placed in surgery remains in place but is no longer in use. The insertion site is clean, and without redness or drainage. A chest X-ray from 7 a.m. was clear. No other signs of infection are evident, so two sets of blood cultures are drawn. The preliminary gram-stain report shows gram-positive cocci. The following morning at 4 a.m., the micro lab reports presumptive MRSA from both sets of blood cultures. Vital signs are T 102.5, P 130, R 16, BP 60/40. Sharon is transferred back to CVICU with a diagnosis of septic shock. Vancomycin 1 g is ordered IV.

1. The fact that Sharon’s central venous catheter is still in place even though not in use should guide the care team to which of the following evidence-based practices? A. Blood cultures should be drawn since the central venous catheter has been in too long. B. The central venous catheter should be removed since it is no longer needed C. The central venous catheter should remain in until discharge in case emergency medications are indicated. D. The central venous catheter should be removed, and the catheter tip cultured. 2. As soon as the MRSA culture report is received, Sharon’s nurse should implement which of the following evidence-based practices? A. Airborne precautions B. Contact precautions C. Droplet precautions D. Blood and body fluid precautions 3. Now that Sharon has cultured positive for MRSA, she is more at risk for which of the following in the future? A. Community-acquired pneumonia B. Hospital-acquired pneumonia C. Community-acquired MRSA D. Another MRSA infection

3. Correct Answer: D—Becoming infected with MRSA is one of the primary risk factors for developing another MRSA infection in the future 2. Correct Answer: B—Contact precautions have been shown to reduce the transmission of multidrug-resistant organisms in healthcare facilities, and the CDC recommends them for patients with MRSA. 1. Correct Answer: B —EBPs for central line care include removing the line when it is no longer needed.. 40 OR TODAY | April 2016

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HOW TO EARN CONTINUING EDUCATION CREDIT in healthcare settings: recommendations of the healthcare infection control practices advisory committee and the HICPAC/SHEA/ APIC/IDSA Hand Hygiene Task Force. MMWR. 2002;51(RR16):1-39. 14. Oztoprak N, Cevik M, Akinci E, et al. Risk factors for ICU-acquired methicillin-resistant Staphylococcus aureus infections. Am J Infect Cont. 2006;34(1)1-5. 15. Dancer S, Coyne M, Speekenbrink A, Samavedam S, Kennedy J, Wallace P. MRSA acquisition in an intensive care unit. Am J Infect Cont. 2006;34(1)10-17. 16. Safdar N, Marx J, Meyer N, Maki D. Effectiveness of preemptive barrier precautions in controlling nosocomial colonization and infection by methicillin-resistant Staphylococcus aureus in a burn unit. Am J Infect Cont. 2006;34(8):476-483. 17. Baby unit shut over MRSA outbreak. BBC News Web site. http://news.bbc.co.uk/2/hi/uk_ news/england/lancashire/7046528.stm. October 16, 2007. Accessed December 17, 2014. 18. Klevins R, Morrison M, Fridkin S, et al. Community-associated methicillin-resistant Staphylococcus aureus and healthcare risk factors. Emerg Infect Dis. 2006;12(12):1991-1993. 19. Johns Hopkins point of care information technology ABx guide. Johns Hopkins Web site. http://www.hopkins-abxguide.org. Accessed December 17, 2014. 20. Boucher HW, Talbot GH, Bradley JS, et al. Bad bugs, no drugs, no ESKAPE! An update from the Infectious Diseases Society of America. Clin Infect Dis. 2009;48(1):1-12. 21. Management of multidrug-resistant organisms in healthcare settings, 2006. United States Centers for Disease Control and Prevention Web site. http://www.cdc.gov/hicpac/mdro/mdro_toc. html. Updated December 29, 2009. Accessed December 17, 2014. 22. Calfee DP, Salgado CD, Milstone AM, et al. Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute care hospitals: 2014 update. Infect Cont Hosp Epid. 2014;35(7):772-796. 23. 5 Million Lives Saved from Harm Campaign. 2006. Institute for Healthcare Improvement. Web site. http://www.ihi.org/offerings/Initiatives/PastS trategicInitiatives/5MillionLivesCampaign/Pages/ default.aspx. Accessed November 5, 2014. 24. Huang R, Mehta S, Weed D, Price CS. Methicillin-resistant Staphylococcus aureus survival on hospital fomites. Infect Control Hosp Epidemiol. 2006;27(11):1267-1269. WWW.ORTODAY.COM

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Healthmark Industries is looking forward to an exciting future with its continued expansion of staff and products. With almost 50 years of experience Healthmark continues to adapt to the business needs of their customers. Over the years, the company has experienced a great deal of growth with a variety of products and services. Known for providing innovative solutions for infection control to healthcare facilities, they are currently expanding their product line. The company has over 100 employees and is in the transition process of moving its headquarters that is an overall size of around 100,000 square feet in Fraser, Michigan.

The latest focus at Healthmark includes the expansion of products for managing the proper reprocessing of flexible endoscopes. Products like the Elevator Mechanism Brush are specifically designed to clean the elevator mechanism of duodenoscopes, as directed by the endoscope manufacturer. “The flexible neck provides ease of access when cleaning the elevator mechanism and the areas around it at the distal end of the endoscope,” says Ralph Basile, Vice President. 44

OR TODAY | April 2016

Healthmark also announced in 2015 that they added Mary Ann Drosnock MS, CIC, CFER, RM (NRCM), as its new Manager of Clinical Education for Endoscopy. “Her expert knowledge and experience in the GI field will play a vital role in the development of our GI product line and providing guidance and support to our GI customers,” says Basile. One way the company is adapting to meet customers’ needs is by offering continuing education credits through online games.

“CSSD professionals can also earn free CEUs on our website Crazy4Clean.com,” Basile says. “There are educational games that when you play and take a quiz, you earn one free CEU.” Healthmark’s growth has prompted a need for a structure of professional commitment for healthcare facilities throughout the country and that is why it has representatives in designated territories throughout the country. Cleaning verification continues to be an important issue in healthcare across the

country. News headlines often consist of articles about complications from surgeries caused by instruments and equipment that have not been properly cleaned. It has affected the healthcare field in recent years. Healthmark added products to its ProFormanceTM monitoring tools over the past 15 years to help ensure surgical instruments and other equipment are reprocessed correctly. AAMI1 and AORN2 recommend at least weekly testing of the cleaning process. These products are WWW.ORTODAY.COM

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designed to help facilities comply with standards and ensure they are reprocessing equipment and cleaning surgical instruments properly. “One of the ongoing challenges in the healthcare industry is to consistently reprocess surgical instruments effectively,” Basile said. Healthmark has products designed to help hospitals and healthcare facilities provide safe environments and prevent infections. Researchers have discovered that devices that haven’t been reprocessed correctly can emerge from the cleaning process with bits of bone, blood and tissue from the previous operation, contaminants that can become reservoirs for WWW.ORTODAY.COM

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some potentially lethal bacteria. Proper cleaning and sterilization are essential for ensuring that medical and surgical instruments do not transmit infectious pathogens to patients. According to the Centers for Disease Control and Prevention (CDC), multiple studies

in many countries have documented a lack of compliance with established guidelines for disinfection and sterilization. Failure to comply with scientifically based guidelines has led to numerous outbreaks. “Our ProFormanceTM products are designed to help hospitals and health-

Designed for compliance with OSHA standard CFR 1910.1030 Perforated tab for easy labeling of “Dirty” and “Clean” instruments Designed for transporting materials considered a biohazard, while acting as an essential communication tool in the process

care facilities meet the challenge to regularly test their cleaning process in order to ensure their medical devices are being reprocessed properly. Once reprocessed, inspection will need to take place to ensure the surgical instructions are indeed clean,” Basile explained. Healthmark continues April 2016 | OR TODAY

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to offer new innovative products that are designed to provide solutions for their customers. The new Transportation Identification Tag is produced precisely for transporting materials considered a biohazard, while acting as an essential communication tool in the process. By labeling a cart or container as “clean” when it goes out and a “biohazard” upon its return to the sterile processing department, the Transportation Identification Tag assists in supplying information to the OR/Procedure Room. Furthermore it has a check list for the surgical/procedure room/sterile processing team to ensure adequate delivery of the case cart or container in question. Another innovative product Healthmark has recently launched is the Flexible Inspection Scope. It features a distal tip composed of a light source and camera lens at the end of a 50cm, flexible shaft. 46

OR TODAY | April 2016

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Designed for instruments 3.2mm in diameter or larger. The camera and light are powered by the USB connection on a PC. Compatible with Windows PCs, the included software allows viewing and recording from most computers. Paired with the optional Flex Arm, the Flexible Inspection Scope can be securely fastened to a workstation to free both hands for manipulation of the scope and the target medical device. It is the perfect tool to visually inspect any device after cleaning, particularly those with internal channels and lumens. Quality is a key component to Healthmark’s business as well as ensuring the satisfaction of it’s customers. Healthmark offers you a 30-day free trial evaluation of any product it sells. Healthmark also has a website, www.healthmark.info/hmarkqa. html, that is a non-biased forum to encourage healthcare workers to

ask questions and share solutions anonymously. It is easy to sign up and share experiences with other peers within the industry. If you are looking for industry news, helpful hints and other information, Healthmark produces a weekly newsletter that is distributed to thousands of readers. Each Healthmarket Digest features a story written by a member of the Healthmark team as well as a weekly coupon. ^FOR MORE INFORMATION about Healthmark Industries, visit www.hmark.com or call 800-521-6224.

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Visit www.HealthmarkGI.com reprocessing of your endoscopes. Healthmark and our GI products help the Endoscopy center manage the reprocessing of their scopes. We do this through organize and track the steps in reprocessing (accessories, including labels). If it is not clean, it can not be considered high-level

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April 2016 | OR TODAY

IN THE

By Don Sadler

The topic of bullying has gotten a lot of attention in recent years as the negative effects of the bullying suffered by children have become more apparent. Children are being encouraged to report bullies and stand up for friends who are bullied. Unfortunately, children aren’t the only ones who are suffering at the hands of bullies. Bullying has long been an under-the-radar problem in the OR, but it is starting to attract more attention in the health care industry.

It’s going to take courageous souls willing to speak up and courageous hospital leadership that’s willing to implement regulations with teeth and enforce them in order for bullying in the OR to stop.” – Phyllis Quinlan, PhD, RN-BC

We see frequent examples of OR staff who are being bullied via unfair scheduling practices. It is usually new nurses and those with less seniority who are bullied in this way.” – ChrysMarie Suby

How Prevalent is OR Bullying? This is due in part to The Joint Commission identifying “intimidating and disruptive behavior” in a Sentinel Event Alert as fostering medical errors and contributing to poor patient satisfaction and preventable adverse outcomes (Issue 40, July 9, 2008). Also, studies are revealing just how prevalent bullying really is in the OR. For example, in a study conducted by the Association of periOperative Registered Nurses (AORN) in 2013, 59 percent of perioperative nurses and surgical technicians reported witnessing coworker bullying on a weekly basis, while 34 percent reported witnessing at least two bullying acts per week. Bullying was also consistently listed by respondents to the 2015 OR Today Readership Survey as a problem in the OR. For example, Carol Giese, MSN, RN, CSSM, CNOR, the manager of surgery and anesthesia at CHRISTUS St. Michael Health System in Texarkana, Texas, noted that lateral violence is among the top five most pertinent issues for OR nurses and surgical techs. “I have observed this lateral violence in the OR throughout my entire 30-year career in perioperative nursing,” says Giese. A study conducted by the Robert Wood Johnson Foundation revealed that nurses are more likely to be

OR TODAY | April 2016

bullied if they’re young, working on the day shift or working in an understaffed unit. It identified a number of ill effects of bullying in the OR, including poor work group cohesion, more work-family conflict, and poor relations between nurses and surgeons. Deﬁning OR Bullying So what exactly constitutes “bullying” in the OR? In the Sentinel Event Alert, The Joint Commission states that “intimidating and disruptive behaviors include overt actions such as verbal outbursts and physical threats, as well as passive activities such as refusing to perform assigned tasks or quietly exhibiting uncooperative attitudes during routine activities.” These behaviors “are often manifested by health care professionals in positions of power,” the Alert continues. “Such behaviors include reluctance or refusal to answer questions, return phone calls or pages; condescending language or voice intonation; and impatience with questions.” Why does bullying occur in the OR? Obviously, the OR is a high-stress environment, and some surgeons just aren’t good at controlling this stress. Workplace bullies tend to want to be in control of all aspects of the work environment, and this certainly holds true for bullying surgeons in the OR. Phyllis Quinlan, PhD, RN-BC, the

president of MFW Consultants, says that the problem of bullying in the OR goes back many years. “For a long time the attitude at hospitals was to keep the surgeons happy no matter what because hospitals couldn’t afford to lose them,” she says. “It was the Golden Rule: He who has the gold makes the rules.” Quinlan says The Joint Commission’s Sentinel Event Alert about bullying was a turning point in the issue of bullying getting the attention it deserves. “In fact, this led to the ‘stop the line’ practice in the OR in which anyone in the OR has the right to speak up and stop the procedure if they don’t think something is right,” she says. “Before this, heaven forbid if anyone questioned a surgeon.” ChrysMarie Suby, the president and CEO of the Labor Management Institute, says that bullying in the medical profession, and in the OR specifically, is not uncommon. “In my work, I see it coming from three sources in the OR and other perioperative units: patterns of condescension, secondary bullies who have learned how to survive in the organization, and institutional bullies,” says Suby. “The latter are managers, charge nurses, supervisors, service line directors, and C-suite and administrator-level leaders who bully those below them.”

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“I have seen different variations on bullying in the OR every since I first became a perioperative nurse in 1991,” says Diana Lopez-Zang, RN, CNOR, the director of system perioperative education at Northwell Health. “A big reason for bullying is the hierarchical environment in the OR.” Lopez-Zang says she has actually seen surgeons throw instruments in the OR, and one time an OR nurse was hit in the ankle with a dirty instrument. “Mostly, though, bullying consists of verbal abuse by surgeons, including cursing,” she says. “Bullying in the OR is still a problem today that I think it’s going to take some time to resolve due to the long history,” Lopez-Zang adds. “Unfortunately, I don’t think it’s getting much better yet — anecdotally, I’d say it’s about the same as it’s always been.” Solving the Problem According to Suby, awareness of the problem is a good first step toward minimizing and eventually eliminating bulling in the OR. “However, nothing will change and the problem will only get worse if nothing is done to intervene,” she says. The Labor Management Institute offers hospitals a Schedule Best Practice Audit© that can identify scheduling and staffing behaviors that demonstrate workplace bullying. “We see frequent examples of OR staff who are being bullied via unfair scheduling practices,” says Suby. “It is usually new nurses and those with less seniority who are bullied in this way.” Once your hospital has conducted a scheduling audit, address the findings of the audit and involve human resources and professional committees to be sure that discipline policies are being used and codes of conduct enforced.

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“We often find that organizations have these in place but victims are being intimidated from using them,” says Suby. “With the audit’s findings in hand, hospitals can provide education and training to help fix scheduling and staffing conflicts at their roots,” she adds. Quinlan says that solutions to OR bullying can be narrowed down to two main things: peer pressure from others in the OR to stop bullying behavior, and HR regulations, policies and procedures that create a zero-tolerance environment for intimidating, disruptive and uncivil behavior. “Education and remediation are also needed to put a stop to these behaviors that can put both OR personnel and patients at risk,” adds Quinlan. In fact, she says that families of patients are starting to report conflicts between surgeons and perioperative nurses due to concerns that these conflicts are putting their loved ones at risk. Taking a Stand The good news on the OR bullying front is that younger perioperative nurses who are entering the field today are less likely to tolerate bullying than many nurses may have been in the past, according to Quinlan. “Many Generation X and Millennial perioperative nurses have taken a stance on what’s right and wrong,” she says. “They often tend to be a little more idealistic and they want to stand up and make a difference for the profession.” “It’s going to take courageous souls willing to speak up and courageous hospital leadership that’s willing to implement regulations with teeth and enforce them in order for bullying in the OR to stop,” says Quinlan. “Nothing’s going to really change until these things happen.”

Education and remediation are also needed to put a stop to these behaviors that can put both OR personnel and patients at risk.” –Phyllis Quinlan, PhD, RN-BC

April 2016 | OR TODAY

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OR TODAY | April 2016

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MU IC AND COMPASSI N

Interpersonal skills achieve success By Matthew Skoufalos

orn and raised in New Orleans, Louisiana, music was always an important part of Joby Hyman’s life. As his nursing career took him farther and farther from home, Hyman’s mother always encouraged him to continue singing. So when St. Luke’s Health System in Boise, Idaho, received its fourth designation as a magnet hospital and the keynote speaker was choral conductor and composer Eric Whitacre, the moment served as a reminder not only of how far he’d come professionally, but of the lasting presence of his family along the journey. Whitacre’s Virtual Choir project, which involves linking up singers around the world through telepresence, is a unique one for musicians. Adding the challenge of digital latency to choral arrangements creates a wrinkle that more than complicates traditional performance. But in the effort, Whitacre and his singers made adjustments to create a performance that values expression and global engagement over technical perfection. The analogy was not lost on Hyman. Like music, nursing is a profession that requires compassion, and he believes that professional compassion is most accessible when people are free to be vulnerable.

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April 2016 | OR TODAY

Spotlight on: Joby Hyman

“You have to be able to open yourself up and let other folks in on something that’s important to you,” Hyman said. “If you get into nursing for the money or the pursuit of glory, you might as well not do it because you won’t be successful. You have to be a servant. You have to give of yourself.” Hyman entered the medical field at a time when his education had reached a crossroads. His aunt, who was just beginning nursing school, told him, “This is right up your alley.” When he was accepted into a program, he imagined it would be a five-year commitment until he discovered the next opportunity. But after 21 years, Hyman’s nursing career has continued to evolve.

lucky if you get lunch.” Hyman had worked in pre-op and recovery, but had never been in an operating room. He asked the OR manager for the opportunity to train. “It was the challenge of the process; it wasn’t the challenge of the procedure,” Hyman said. “It hits home for me in these things. The surgery team has to work collaboratively. The folks who are scrubbed in, their assistants, the folks who provide anesthesia; we all have to work together as a team to make sure the patient has the best outcome.” Hyman also enjoyed streamlining those processes to drive greater efficiencies in the surgical suite wherever possible. He strove to pare down the amount of time from

“Surgeons are always concerned about what’s going on, what anesthesia is doing, the person that’s across from them assisting them, the person who’s across from them in the room, maybe asking for images to be put up on the monitors,” Hyman said. “My job is to go in there and for things to go as smoothly as possible, and for them to not remember a thing about it, especially me." “Any place I’ve gone to, I’ve always gotten the comment that I pay attention,” he said. “Being a nurse in the OR means being able to make decisions that help move things along.” As conscientious as nurses must be in task management and in the execution of clinical techniques,

“You have to be able to open yourself up and let other folks in on something that’s important to you.” “With just a small amount of experience within the clinical realm, you can go into almost any area,” he said. “You can’t do engineering or architecture, [but] you can do legal, you can do sales; a plethora of things that folks who pigeonhole themselves into one area don’t have.” On one travel nursing assignment, Hyman recalled hearing a coworker complain one day that “the folks in surgery didn’t get their 15-minute break and somebody had not brought their breakfast.” He thought to himself, “I’ve got to get admitted into that gig; in most units you’re 56

OR 56 TODAY OR TODAY | April| April 2016 2016

the patient’s entry into the room to the start of the procedure. Anticipating surgeons’ needs, from instrumentation to planning to on-the-fly adjustments, were all areas in which Hyman saw opportunities to improve workflow in the suite, improve surgical outcomes, and limit the amount of time the patient is under anesthesia. He discovered that the best way to achieve those ends is by functioning as a key facilitator to the surgeons in his suite, who must process a staggering amount of information in real-time to perform their tasks.

however, nursing is more than changing dressings and fitting IVs, Hyman said. Without a strong secondary set of interpersonal skills, including the ability to assess patients and engage compassionately with their families, nurses aren’t as effective as they can be. Without those communication tools, they can even create a deficit at their position instead of becoming an asset to their patients’ wellness. “What makes you a nurse is being able to talk to a patient, look at a patient, listen to a patient, and figure out what’s going on with that patient,” Hyman said. “There have WWW.ORTODAY.COM WWW.ORTODAY.COM

is seen at the Joby Hyman agnet Nursing 2015 ANCC M Atlanta. e Conferenc in

Joby H yman a n Hyman , are pic d his wife, She ry tured w ith their l Zeien children .

been many, many times we have picked up on things that physicians don’t, that family members aren’t aware of, that have helped that patient get better.” Those powers of observation also apply to helping nurses advance their careers. Today, Hyman has risen to become the Clinical Category Director of Supply Chain Management at St. Luke’s Health System in Boise, Idaho. He would not have attained the position without the ability to communicate the things he observed in practice to the leaders in his department. For nurses interested in similarly advancing their careers, Hyman advocates parlaying a strong bedside manner and clinical routine into process improvement. WWW.ORTODAY.COM

“There have been times in my career where folks have not taken my enthusiasm positively,” Hyman said. “Decisions are made strategically from the C-suite and the E-suite, and those filter down. If nurses can have conversations with their directors or managers and say, ‘I hear the change, what can I do to help?’ you’re definitely recognized." “I’ve very rarely had a leader that I brought solutions to that fit within the framework of the culture of the organization and been told, ‘We don’t need your help,’ ” he said. “Everybody’s trying to go through these changes, and we all need help. The folks who do the front-line work have the best thought process in how we can accomplish things,

and sometimes you have to reshape the thought process so that folks understand where we’re headed. When you’re able to do that … folks who really drive the organization [can] really build culture.” Those “best thought processes” are similar to the skills Whitacre uses for his Virtual Choir project. It is no surprise that both men have achieved success. April 2016 | OR TODAY

OUT OF THE OR HEALTH

BY CLEVELAND CLINIC NEWS SERVICE

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WWW.ORTODAY.COM

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calories/day April 2016 | OR TODAY

Mos

OUT OF THE OR FITNESS

BY MARILYNN PRESTON

TIME FOR NEW SHOES? Some Fitting Advice

saw a friend out running the other day. He was running; I was racewalking, hat pulled down to avoid the odd stare. He didn’t look happy, and his gait was off. “What’s wrong?” I asked. “Shoes hurt,” he answered, pointing to a snazzy new pair in a neon color I can’t name. “Brand-new, and they’re killing me.” When I saw Dan a few days later, he was smiling. No pain, no limp, no new shoes. “I’m back to my old ones,” he said. “They feel great.”

I hate to be a scold, but sports medicine-wise, dear Dan is making a big mistake. Running in brokendown shoes is a major cause of aches and injuries because you’re not getting the cushioning and support you need. Your four-year-old ASICS 60

OR TODAY | April 2016

may feel cozy in the short run, but over time can lead to doctors, medication, and downtime from your favorite sport. Today’s take home? Prevention! Self-care is the best care. You can prevent many running injuries by replacing your shoes when needed. WHEN TO REPLACE Every shoe will wear differently, depending on many factors including your size, weight, biomechanics, running speed and surface. Some lucky light-footed runners might get 800 miles on a single pair. If you’re hard on shoes, then you might need new ones after half that distance. If you’re a casual runner doing 20 miles a week on a treadmill, you may need to replace the shoes after 6 months (or between 400-500 miles.) Mark the start date of your new pair under the tongue to keep track. Here’s a simple way to tell if yours need replacing: Set them on a flat surface and look at them from behind.

If the seam on the back of the heel is no longer vertical, or if the soles show more wear on one portion than others, or if the uppers are badly stretched, or if the midsoles are brittle, thank your shoes for carrying you as far as they have, and recycle them. One option is www.Soles4souls. org – “Give shoes. Give love.” – and Nike’s been turning donated worn out shoes into sustainable playing fields for years. “Shoes die. Soles live on.” TALK TO EXPERTS Beware the hype. The No. 1 rated shoe in the magazines may not be the best one for you. Talk to an experienced sales person. Tell him/ her how much you run and on what kind of terrain, and bring in your old shoes, so wear patterns can be discussed. If your shoes are worn down toward the outside heel and inside of the toe area, you pronate (rotate your foot inward), and will probably do better with a shoe that offers strong WWW.ORTODAY.COM

FITNESS

“ Today’s take home? Prevention! Self-care is the best care. You can prevent many running injuries by replacing your shoes when needed.”

arch support and a solid, stable heel. If you see wear on the outside edge of your shoe, you supinate, and would benefit from a different design. Some runners do well wearing shoes with less support and structure because they like the idea that their feet and legs have to work harder and get stronger. If you want to explore this innovative less-is-more option, take it slowly so your body can gradually adjust.

GO FOR COMFORT A new running shoe should feel good from the get-go. It doesn’t need “breaking in.” Walk around the store. Ask to take it for a trial run. You want your heel to fit snuggly in the shoe and feel well-supported by the firm heel counter that provides stability for the entire foot and leg. The toe box should be roomy, but not too big. Too tight and you’ll end up with battered toes. If the shoe rubs or pinches anywhere, don’t buy it. DO A HANDS-ON INSPECTION Quality control can be slipshod even in $200 shoes. Before you buy, inspect for defects. Are the arches firmly in place? Do both shoes flex in the same place when you press down? Run your hands along the

inside seams of the shoe, checking for rough spots or bulges. If you find a problem, hit reject and inspect another pair. And know this please: Running shoes are designed for running and walking. They are not designed for lateral motion sports like basketball, volleyball, tennis, Ultimate Frisbee. If you cheat and make do, you’re not preventing injuries, you’re inviting them. MARILYNN PRESTON – Healthy lifestyle expert, well-being coach and Emmy-winning producer – is the creator of Energy Express, the longest-running syndicated fitness column in the country. She has a website, marilynnpreston.com, and welcomes reader questions, which can be sent to MyEnergyExpress@aol.com.

Your Patient Monitoring Experts 844-246-7437

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April 2016 | OR TODAY

OUT OF THE OR NUTRITION

NUTRITION

IS CONVENIENCE WORTH IT?

steaming plate of homemade spaghetti with tomato sauce is a good go-to for a pleasing meal. But when time is too short to simmer a homecooked sauce, store-bought sauce comes to the rescue. A container of premade, red pasta sauce can help you whip up spaghetti – or lasagna or manicotti, for that matter – in no time. But, when you turn to convenience, are you losing out on nutrition?

vitamins A and C. In addition, pasta sauces are primarily made from cooked tomatoes and a touch of olive oil. Tomatoes are a great source of lycopene, which is a fat-soluble compound with antioxidant properties. Lycopene is absorbed better by your body in cooked tomatoes, and the addition of oil helps enhance absorption even more. Thus, pasta sauce is an exceptionally good source of lycopene, which offers a variety of health benefits, including helping to lower the risk of prostate cancer and protection against stroke.

Yes and no. As is the case with so many convenience foods, sodium content is a danger in prepared pasta sauces. With some pasta tomato sauces, you also want to keep an eye on fat and saturated fat. But premade sauces have their nutritional pros, too. Some are decent sources of potassium, and

KEEP THE FOLLOWING IN MIND WHEN CHOOSING YOUR PASTA TOPPER:

OR TODAY | April 2016

WATCH YOUR LADLE. A serving size of pasta sauce is one-half cup. Ladling double or triple that amount onto your pasta is easy. It’s important to be aware

of how much you’re consuming, to know how much fat, sodium, and other nutrients you’re getting.

KEEP SUGAR IN CHECK. All sauces contain sugar (some comes naturally in tomatoes), but some have as much as 2 1/2 teaspoons per half-cup serving, which can add up when you’re trying to keep sugar intake to a minimum.

HAVE SALT SENSE. Sauces with meat and cheese tend to contain more sodium, however, sodium content can still vary greatly from sauce to sauce. Be sure to compare labels to find sauces low in sodium content. – Environmental Nutrition is the award-winning independent newsletter written by nutrition experts. For more information, visit www.environmentalnutrition.com. WWW.ORTODAY.COM

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OUT OF THE OR

RECIPE

BY EATINGWELL

OR TODAY | April 2016

WWW.ORTODAY.COM

RECIPE

TACKLE LIFE WITH DELICIOUS CHICKEN PIZZA

ooking for a lighter pizza option to enjoy? The bold flavors of garlic, crushed red pepper and lemon make up for the fact that this white chicken pizza recipe has less sodium than a typical pizza.

Not a fan of bitter greens? Opt for broccolini or broccoli instead. And if you need to save time, look for prepared whole-wheat pizza dough at your supermarket, fresh or frozen, made without partially hydrogenated oils.

BROCCOLI RABE AND CHICKEN WHITE PIZZA Position a rack in lowest position of oven; preheat to 425 F. Line a large rimmed baking sheet with parchment paper or coat with cooking spray. Roll out dough on a lightly floured surface to about the size of the baking sheet; transfer to the prepared baking sheet. Bake until puffed and crisped on the bottom, 8 to 10 minutes. Meanwhile, cut chicken in half lengthwise and then crosswise into thin strips. Heat 3 tablespoons of oil in a large skillet over medium-high heat. Add garlic and cook, stirring, until just starting to brown, 30 seconds to 1 minute. Add the chicken, broccoli rabe (or broccolini or broccoli), lemon zest, crushed red pepper and salt; cook, stirring, until the chicken is just cooked through, 4 to 5 minutes. Remove from heat.

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Serves 5, 2 slices each Active Time: 35 minutes Total Time: 45 minutes INGREDIENTS: 1 p ound whole-wheat pizza dough 12 ounces boneless, skinless chicken breast, trimmed 4 tablespoons extra-virgin olive oil, divided 1/4 cup thinly sliced garlic 6 cups chopped broccoli rabe or 4 cups chopped broccolini or broccoli 1 lemon zest 1/2 teaspoon crushed red pepper, plus more to taste 1/4 teaspoon salt 1/2 cup part-skim ricotta 1 tablespoon lemon juice

When the crust is done, remove from the oven, flip it over and brush with the remaining 1 tablespoon of oil. Using a slotted spoon (to help drain any excess liquid), transfer the chicken mixture to the crust and spread evenly. Combine ricotta and lemon juice and dollop all over the pizza. Return the pizza to the oven and bake until the crust is crispy on the bottom, 6 to 8 minutes more. RECIPE NUTRITION: Per serving: 432 calories; 20 g fat (3 g sat, 10 g mono); 45 mg cholesterol; 44 g carbohydrate; 1 g added sugars; 3 g total sugars; 25 g protein; 4 g fiber; 443 mg sodium; 350 mg potassium. â&#x20AC;&#x201C; EatingWell is a magazine and website devoted to healthy eating as a way of life. Online at www.eatingwell.com.

April 2016 | OR TODAY

OUT OF THE OR PINBOARD

PINBOARD

The News and Photos That Caught Our Eye This Month

OR TODAY

CONTESTS • APRIL • ARE YOU IN THE KNOW?? Send us a photo of yourself or a colleague reading a copy of OR Today magazine to be entered in a contest to win a $50 Subway gift card! Snap a photo with your phone and email it to Editor@MDPublishing.com to enter. It’s that easy! Good luck! • Email your entry to Editor@MDPublishing.com!

Win Lunch! 66

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{

THE WINNER GETS A$50 SUBWAY GIFT CARD

NATIONAL VOLUNTEER MONTH

April is National Volunteer month in the United States. This month is dedicated to honoring all of the volunteers in our communities as well as encouraging volunteerism throughout the month. Please take a moment to say “Thank you” to a volunteer or consider becoming a volunteer. •

ALL ABOUT THE LADIES!

The Coobie Seamless Bra is designed for the active woman. It is described as “ultra comfortable, supportive and affordable,” in a press release from the company. Coobie S eamless B The Coobie ra Seamless Bra provides shape and support. It can be worn to workout in and as an everyday bra. These one size fits most bras (32A through 36D), really do fit almost every body. And because of the high demand and popularity, Coobie has designed a fuller size bra that fits 38-42D. Each design comes with removable pads and is made of a spandex/nylon blend. Perfect for the active lady or just to sleep in, Coobie puts comfort back into undergarments. • FOR MORE INFORMATION visit www.shopcoobie.com. WWW.ORTODAY.COM

PIN BOARD

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CONTEST WINNERS • JANUARY • FEBRUARY •

r! indy Painte C o t s n io t Congratula

Congratula tions to L ori Ballard !

We love our contests and are excited to announce our winners. Cindy Painter is the winner of the January contest thanks to her photo of her team reading OR Today magazine, . Lori Ballard is the winner of our February contest. She submitted this photo of herself and Jenni Graffice, Clinical Director of Nursing, reading a copy of OR Today at Surgery Alliance. •

“The OR team at Summersville Regional Medical Center loves OR Today magazine.”-Cindy Painter

“Success is simple. Do what’s right, the right way, at the right time.” –Arnold H. Glasow

WWW.ORTODAY.COM

April 2016 | OR TODAY

AUGUST 28-30, 2016

CHICAGO, ILLINOIS

OAK BROOK HILLS RESORT

NETWORKING

EDUCATION

EXHIBIT HALL

OR Today Live! will allow

The OR Today Live! Surgical

Our top-of-the-line vendors will

you to network with other

Conference has partnered with the

showcase the latest technology,

professionals in the industry.

Competency and Credentialing

tools and product knowledge that

You will meet surgical services

Institute (CCI) to provide

will greatly benefit your facility.

professionals who experience

valuable CE education to all of its

the same issues as you and be

attendees. Offering different tracks

able to share and gain ideas for

for education, there is something

solutions in your facility.

for everyone.

For information on exhibiting at OR Today Live! visit www.ortodaylive.com

OR Today Live! Surgical Conference has been approved and is licensed to be a Continuing Education Provider with the State of California Board of Registered Nursing. License #16623

LEARN MORE AT WWW.ORTODAYLIVE.COM

Empowering

the Surgical Services Community

AUGUST 28-30, 2016 â&#x20AC;˘ CHICAGO, ILLINOIS

"Loved this conference!!!!" R. Watts

"You are on the right track to an exciting, educational, and fun conference." M. Arciniega "Very informative and educational. Ability to network and socialize were great. Planned events were extremely fun and engaging" J. Hyman

The official partner of the OR Today Live! Surgical Conference.

SURGICAL CONFERENCE

OR Today Live! Surgical Conference has been approved and is licensed to be a Continuing Education Provider with the State of California Board of Registered Nursing. License #16623

LEARN MORE AT WWW.ORTODAYLIVE.COM

INDEX ALPHABETICAL AAAHC…………………………………………………………15 AIV Inc.……………………………………………………… 23 ASCA………………………………………………………… 32 C Change Surgical……………………………………… 4 Clorox Professional Products……………… 10-11 Dabir Surfaces………………………………………… 53 Encompass Group, LLC…………………………… 53 GelPro………………………………………………………… 23 Gopher Medical……………………………………………61 Healthmark Industries……………… 44-47, IBC

Innovative Medical Products, Inc……………… BC Innovative Research Labs, Inc……………………… 12 Interpower Corporation…………………………… 5 Jet Medical Electronics…………………………… 52 MD Technologies…………………………………………61 Medline Industries, Inc.…………………………… 26 MedWrench……………………………………………… 63 Pacific Medical LLC…………………………………… 6 Palmero Health Care……………………………… 32 Paragon Service…………………………………………13

Ruhof Corporation…………………………………… 2-3 Sealed Air……………………………………………………21 SMD Waynne Corp.………………………………… 52 Summit Medical Inc.………………………………… 43 Surgical Power………………………………………… 53 SurgiDat Corp……………………………………… 24-25 TBJ, Inc.……………………………………………………… 33 Tru-D……………………………………………………………… 9 VBM Medical Inc.……………………………………… 42

GEL PADS GelPro………………………………………………………… 23 Innovative Medical Products, Inc………… BC

SurgiDat Corp……………………………………… 24-25 TBJ, Inc.……………………………………………………… 33

INDEX CATEGORICAL ACCREDITATION AAAHC…………………………………………………………15 ANESTHESIA Gopher Medical……………………………………………61 Innovative Research Labs, Inc……………………… 12 Paragon Service…………………………………………13 APPAREL Healthmark Industries……………… 44-47, IBC ASSOCIATIONS AAAHC…………………………………………………………15 ASCA………………………………………………………… 32 BEDS Innovative Medical Products, Inc………… BC CARDIOLOGY C Change Surgical……………………………………… 4 Gopher Medical……………………………………………61 CARTS/CABINETS Encompass Group, LLC…………………………… 53 Medline Industries, Inc.…………………………… 26 SurgiDat Corp……………………………………… 24-25 CLEANING SUPPLIES Ruhof Corporation…………………………………… 2-3

GENERAL AIV Inc.……………………………………………………… GelPro………………………………………………………… MedWrench……………………………………………… Surgical Power…………………………………………

23 23 63 53

HAND/ARM POSITIONERS Innovative Medical Products, Inc………… BC HIP SYSTEMS Innovative Medical Products, Inc………… BC INFECTION CONTROL/PREVENTION Clorox Professional Products……………… 10-11 Encompass Group, LLC…………………………… 53 Palmero Health Care……………………………… 32 Ruhof Corporation…………………………………… 2-3 Sealed Air……………………………………………………21 Summit Medical Inc.………………………………… 43 SurgiDat Corp……………………………………… 24-25 Tru-D……………………………………………………………… 9 INTERNET RESOURCES MedWrench……………………………………………… 63

CLAMPS Innovative Medical Products, Inc………… BC

INSTRUMENT TRANSPORT Medline Industries, Inc.…………………………… 26 Summit Medical Inc.………………………………… 43

CRITIAL CARE Innovative Research Labs, Inc……………………… 12

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

DISINFECTANTS Clorox Professional Products……………… 10-11 Palmero Health Care……………………………… 32 Sealed Air……………………………………………………21

LABORATORY TBJ, Inc.……………………………………………………… 33

DISPOSABLES Pacific Medical LLC…………………………………… 6 ENDOSCOPY Clorox Professional Products……………… 10-11 MD Technologies…………………………………………61 Ruhof Corporation…………………………………… 2-3 SurgiDat Corp……………………………………… 24-25 TBJ, Inc.……………………………………………………… 33 FALL PREVENTION Encompass Group, LLC…………………………… 53

OR TODAY | April 2016

LEG POSITIONERS Innovative Medical Products, Inc………… BC MONITORS Jet Medical Electronics…………………………… 52 OR TABLES/ ACCESSORIES Dabir Surfaces………………………………………… 53 Innovative Medical Products, Inc………… BC

PATIENT MONITORING Gopher Medical……………………………………………61 Pacific Medical LLC…………………………………… 6 SurgiDat Corp……………………………………… 24-25 POSITIONERS/IMMOBILIZERS Innovative Medical Products, Inc……………………………………………… BC POWER COMPONETS Interpower Corporation…………………………… 5 RESPIRTORY Innovative Research Labs, Inc……………………… 12 REPAIR SERVICES Pacific Medical LLC…………………………………… 6 SHOULDER RECONSTRUCTION Innovative Medical Products, Inc………… BC SIDE RAIL SOCKETS Innovative Medical Products, Inc………… BC SOCIAL MEDIA MedWrench……………………………………………… 63 STERILIZATION Summit Medical Inc.………………………………… 43 SurgiDat Corp……………………………………… 24-25 TBJ, Inc.……………………………………………………… 33 SURGICAL AAAHC…………………………………………………………15 MD Technologies…………………………………………61 Surgical Power………………………………………… 53 VBM Medical Inc.……………………………………… 42 SURGICAL SUPPLIES Key Surgical Instrument, Inc.……………… IBC Ruhof Corporation……………………… 2-3, 42-44 VBM Medical Inc.……………………………………… 42 SUPPORTS Innovative Medical Products, Inc………… BC

ORTHOPEDIC Surgical Power………………………………………… 53

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

OTHER AIV Inc.……………………………………………………… 23 Encompass Group, LLC…………………………… 53 SMD Waynne Corp.………………………………… 52

WARMERS Encompass Group, LLC…………………………… 53 WASTE MANAGEMENT Sealed Air……………………………………………………21 WWW.ORTODAY.COM

Is that

e Scopsafe? Check the cleanliness of ﬂexible endoscopes with EndoCheck™ from Healthmark

Visit Healthm ark at AORN !

Booth 12

Flexible endoscopes are notoriously diﬃcult to clean. More EndoCheck™ is a miniature chemistry kit that is simple to use and interpret. Simply swab the biopsy channel of the scope with

check for a color change. Depending on the type of test used, a color change indicates that blood residue or protein residue remains in the channel, and should be reprocessed.

HEALTHMARK INDUSTRIES • WWW.HMARK.COM • 800 521 6224 WWW.ORTODAY.COM

April 2016 | OR TODAY

Enhanced Humbles LapWrap Positioning Pad ®

Now even more secure with two-way performance!

Free Sample Evaluation Anesthesiologist Frank Humbles, M.D. knows the importance of patient positioning.

Call 800-467-4944 and reference promo code “Secure” for your free Humbles LapWrap sample today.* ®

The Enhanced Humbles LapWrap®. • Positions patients arms while allowing easy access for leads and IV’s • Secures patient to OR table • Is dual sided for increased flexibility • Optional extensions can be attached for the extremely obese

Designed to meet

The operative word in patient positioning.

AORN

recommendations

www.impmedical.com

*While supplies last

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.

US Patent 72 No. OR8,001,635 TODAY | April 2016

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