OR Today - July/August 2016 by MD Publishing

SPOTLIGHT ON

ARIC CAMPLING PAGE 52

TAKE GOOD CARE

OR TODAY LIVE

SURGICAL CONFERENCE PAGE 10

NURSES • SURGICAL TECHS • NURSE MANAGERS

HEALTH

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CONTENTS

features

OR TODAY | July/August 2016

STOP THE BLEEDING

Due to the wide range of different types of bleeding scenarios, there is a variety of methods that can be used to control bleeding during surgery, or hemostasis. These include conventional methods and newer technological advances that address critical hemostasis needs in various surgical bleeding situations.

CORPORATE PROFILE: PACIFIC MEDICAL

Pacific Medical is a trusted name in the health care industry that specializes in monitors, modules, telemetry, infusion pumps, suction regulators, fetal transducers, SpO2/ECG/Temp/ NIBP cables, O2 blenders, endoscopes and gas analyzers.

SPOTLIGHT ON: ARIC CAMPLING As the medical profession becomes more technologically complicated, clinicians with a background in computing, information technology, or other digital expertise are ever more valuable in the workplace. This new environment is true in the field of nursing, where informaticists like Aric Campling are helping bridge the needs of staff in the clinical and IT departments.

OR Today (Vol. 16, Issue #6) July/August 2016 is published monthly by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 30269-1530. POSTMASTER: Send address changes to OR Today at 18 Eastbrook Bend, Peachtree City, GA 30269-1530. For subscription information visit www.ortoday.com. The information and opinions expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher. Reproduction in whole or in part without written permission is prohibited. ÂŠ 2016

WWW.ORTODAY.COM

July/August 2016 | OR TODAY

CONTENTS

departments

PUBLISHER

John M. Krieg | john@mdpublishing.com

VICE PRESIDENT

Kristin Leavoy | kristin@mdpublishing.com

10 17

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

Chandin Kinkade | chandin@mdpublishing.com

ACCOUNTING Kim Callahan

WEB SERVICES

INDUSTRY INSIGHTS 10 12 18 20

OR Today Live! News & Notes OR Today Webinar AAAHC Update

Taylor Martin Adam Pickney Cindy Galindo

CIRCULATION Lisa Cover Laura Mullen

IN THE OR 22 25 26 32

Suite Talk Market Analysis Product Showroom CE Article

OUT OF THE OR 58 60 62 64 68

Fitness Health Nutrition Recipe Pinboard

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

PROUD SUPPORTERS OF

70 Index

OR TODAY | July/August 2016

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INDUSTRY IN THE OR INSIGHTS OR TODAY LIVE

BY JOHN WALLACE

SURGICAL CONFERENCE

GET READY FOR OR TODAY LIVE!

EMPOWERING THE SURGICAL SERVICES COMMUNITY

“O

ne of the best conferences around! Can’t wait til 2016,” Marie Paulson, Director Perioperative Services, Kaiser Permanente, said after the inaugural OR Today Live! Surgical Conference last year. The wait is over. Registration is now open for the 2016 OR Today Live! Surgical Conference set for August 28-30. The conference hotel is the Hilton Chicago/Oak Brook Hills Resort and Conference Center. Positive reviews and word-of-mouth advertising from conference attendees means the 2016 OR Today Live! Surgical Conference will exceed expectations. Attendees are already signing up for the conference, making travel arrangements and booking their hotel rooms. “People are excited about the convenient location in the Chicagoland area,” MD Publishing Vice President Kristin Leavoy said. OR Today Live! offers a unique opportunity to learn from industry leaders, address challenges, network with influential colleagues, hone management skills, discover new resources and services, and ultimately

OR TODAY | July/August 2016

deliver solutions to improve the performance of your facility. The cost to attend OR Today Live! is $595 and there is a $100 Early Bird discount that has been extended to August 1 for OR Today readers! The Competency & Credentialing Institute (CCI) is once again partnering with OR Today magazine for the surgical conference. Attendees can earn valuable continuing education contact hours at the conference via CE Super Sessions and several pertinent educational sessions. There is also the opportunity to sign up for the pre-conference workshop “Fundamentals of OR Management” presented by the CCI which will gain attendees 26 CE contact hours upon completion of the course. “With the support of our Education

“ Overall, I feel this is one of the top conferences I have ever attended. The activities allowed for networking, building relationships. The classes … were all pertinent and well presented.” – C. Knight Committee, I feel we have an exceptional line-up for this year’s conference,” Leavoy said. “As a Continuing Education Provider certified by the California Board of Registered Nursing, we strive to provide top of the line education.” The opportunity to reconnect with vendors and add new companies and WWW.ORTODAY.COM

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names to your contact list is another reason to attend the 2016 OR Today Live! Surgical Conference. The exhibit hall features vendors showcasing the latest technology, tools and product knowledge that will greatly benefit your facility. Scheduled networking events are a huge benefit of attendance. The signature atmosphere of the OR Today Live! Surgical Conference also promotes interaction throughout the three-day event. OR Today Live! is the conference for executives, leaders and managers who make significant purchasing decisions from acute care settings and surgery centers. Additional reasons to attend include: • New Practices – OR Today Live! will give you access to new ideas via education, networking and collaboration from colleagues; • Financial Performance – Address the challenges, regulations and WWW.ORTODAY.COM

changes facing professionals to manage the business side of the surgical suite; and • Patient Safety – Establish new management practices ensuring each patient has a positive experience by learning new practices that will reduce errors and readmissions for your facility. Of course, the schedule includes an opportunity to relax and recharge with the ’80s Night Karaoke Party “Overall, I feel this is one of the top conferences I have ever attended. The activities allowed for networking, building relationships. The classes … were all pertinent and well presented,” C. Knight said about the 2015 conference. FIND OUT MORE and register to attend the 2016 OR Today Live! Surgical Conference at www.ORTodayLive.com.

Infection Prevention • Maintain regulatory standards among vendors • Reduce risk of cross contamination

Cost Reduction • Eliminate costs associated with vendor attire • Reduce lost and stolen inventory

Vendor Management • Enhance visibility and tracking reports • Reduce vendor traffic

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INDUSTRY INSIGHTS NEWS & NOTES

DECONTAMINATOR OF THE YEAR AWARD ANNOUNCED At the 2016 International Association of Healthcare Central Service Materiel Management (IAHCSMM) Conference held in San Antonio, Texas, Healthmark announced Patricia Pabon as the winner of the IAHCSMM 2016 Anne Cofiell Decontaminator of the Year Award. Pabon is the certified registered central sterile technician at St. John’s Riverside Hospital and has spent the last five years working in the sterile processing field. Sponsored by Healthmark, the Anne Cofiell Decontaminator of the Year Award is given out annually by IAHCSMM. This award recognizes an individual who demonstrates exceptional understanding of the importance of decontamination to achieve proper reprocessing of medical devices. The winner receives $1,000 toward expenses to attend the annual IAHCSMM Conference and also receives a commemorative plaque. •

AMPRONIX RELEASES ULTRA HIGH DEFINITION 4K LARGE SCREEN DISPLAY Ampronix has announced the release of its ultra high definition medical display, the HYBRIDPIXX. The 8MP display is sleek and lightweight while delivering clear and consistent images. “At 58 inches, the QFHD display and automatic luminance stabilization system ensure precise and reliable images, which will indeed make HYBRIDPIXX especially useful in hybrid operating rooms, where visualization is the key to performing minimally invasive procedures. But it’s not just limited to that – HYBRIDPIXX can be utilized for any surgical or interventional radiological needs, or anywhere else where monitoring is critically important,” according to a news release. Upon request, Ampronix can also supply a HYBRIDPIXX video 12

OR TODAY | July/August 2016

manager, which gives physicians the ability to select desired images from the display, making it an ideal candidate for large-scale viewing or multi-screen monitoring. With hundreds of potential layout options, the amounts of customization

possibilities are infinite. The video manager also makes it easy to maneuver or scale images to customize viewing at the discretion of the individual. Additionally, it can input up to 27 analog or digital signals. •

WWW.ORTODAY.COM

NEWS & NOTES

ACELITY EXPANDS WOUND CARE PORTFOLIO IN U.S. Acelity has announced that its Tielle foam dressing family is now available in the United States. The Tielle dressing family expands the advanced wound therapeutics portfolio from Acelity. This expansion complements a broad range of existing solutions for chronic and acute wounds and provides clinicians with efficient and cost-effective options for treating patients. The company announced the availability of these products at the joint meeting of the Symposium of Advanced Wound Care and the Wound Healing Society (SAWC Spring/WHS) in Atlanta. “Our goal was to reinvigorate the range of proven Tielle dressings and introduce it to clinicians here in the U.S. who are seeking effective solutions for all patients, including the most compromised,” said Joe Woody, president and chief executive officer of Acelity. “We aim to strengthen our partnership with nurses and physicians by broadening our platform to include an extensive range of dressings, advancements in negative pressure technology and new innovations designed to help speed healing for patients and reduce the overall cost of care.” The Tielle foam dressing family was designed to meet the needs of health care professionals, including exudate management and reduced pain for the patient at dressing removal. •

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July/August 2016 | OR TODAY

INDUSTRY INSIGHTS NEWS & NOTES

MEDLINE LAUNCHES ANNUAL PINK GLOVE DANCE CONTEST Some people walk for breast cancer. Others race. Since 2011, more than 250,000 dancers nationwide, including health care professionals, EMTs and firefighters, have danced while wearing pink exam gloves to celebrate breast cancer survivors and those fighting the disease. It’s all part of the Medline Pink Glove Dance video competition. The company recently announced the launch of its sixth annual competition. “The Pink Glove Dance reflects Medline’s commitment to saving lives through raising awareness and funds for early detection of breast cancer,” said Sue MacInnes, Medline’s chief market solutions officer and co-founder of the Medline Pink Glove Dance campaign. “It is the only campaign to

unite thousands of health care professionals, patients, survivors and communities – all through the joy of dancing. With nearly 247,000 new cases of invasive breast cancer expected this year, the annual campaign is a unique opportunity to honor the strength and courage of patients and survivors.” The Medline Pink Glove Dance is open to participants of the U.S. and Canada (excluding Quebec) and is split up into three categories – small-bed, large-bed and nonhealth care organizations. Each team must submit a 150 word or less entry highlighting their inspiration for supporting breast cancer awareness through the creativity of a pink glove dance video. Their video must be no

longer than 90 seconds and be accompanied by one of Medline’s selected songs. Additionally, each team is required to raise $2,000 for a breast cancer charity of their choice. Videos are due by Aug. 5. From Sept. 12 through Sept. 23, the public is encouraged to vote for a favorite video to help determine which charities funds will be directed toward. Results will be announced Sept. 30 with the winning team receiving a $15,000 donation in their name to the breast cancer charity of their choice. Other prizes will also be awarded.• For information or to register for the video competition, visit www.pinkglovedance.com.

PILLOW MANAGEMENT GUIDE FIGHTS INFECTION Michelle Daniels, Encompass Director of Marketing for The Pillow Factory, has a mission. Her mission is to fight Hospital Acquired Infections (HAIs) starting with improving pillow management and increasing awareness. The company published a Pillow Management Program Guide in February. “With decades of experience behind us, we put key points in our guide as a tool for anyone managing health care inventories,” Daniels said. “HAIs are on the rise, as a growing number of antibiotic-resistant strains of bacteria are emerging,” Daniels said. “Soft surfaces are a potential source of contamination posing a significant risk of infection. In a recent study, more than 30 types of bacteria and other pathogens were found on samples of hospital pillows. One out of 20 hospital patients develop an HAI, with an annual cost of $35 billion to the health care industry.” The Pillow Factory division of Encompass Group wants to be a partner in infection prevention starting with what’s resting under the patient or resident’s head. “Our trusted, high-quality pillow lines include varied, 14

OR TODAY | July/August 2016

beneficial choices for patient care and protection,” Daniels said. “Patients are provided the right balance of comfort and performance.” Current Pillow Factory products include DreamAngel and Brilliance pillows for launderable comfort and performance; RevolutionaryCARE, Easy Care, Comfort Care, CareGuard Plus, Pro-Barrier for fluid and stain resistance; and Fresh Start Personal Pillows for single-patient-use providing maximum breathability and freshness.•

WWW.ORTODAY.COM

NEWS & NOTES

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Getinge Group has appointed Jens Viebke as the new President of the Acute Care Therapies Business Category Unit. Viebke will be a member of the Getinge Group Executive Team and succeeds Heinz Jacqui who will step down from his current position after four years with the group. Acute care therapies is one of Getinge’s three business category units and is responsible for developing technologies and solutions for cardiac, pulmonary and vascular therapies and products and therapies for intensive care. The group has made significant investments in quality management systems in recent years, particularly in areas related to the acute care therapies business category unit. •

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July/August 2016 | OR TODAY

INDUSTRY INSIGHTS NEWS & NOTES

SURGICOUNT SAFETY-SPONGE SYSTEM SURPASSES 10M PROCEDURES Stryker Corp. has announced that more than 180 million SurgiCount Safety Sponges have been used in an estimated 10 million surgeries around the United States in the past five years. “The successful implementation of SurgiCount at nearly 500 hospitals nationwide demonstrates the difference hospitals can make in strengthening patient-safety protocols,” said Dylan Crotty, vice president and general manager of Stryker Surgical. “SurgiCount can help protect a hospital’s patients, staff and bottom line by helping to reduce the risk of the most common surgical error, retained sponges.” 16

OR TODAY | July/August 2016

Despite efforts by hospitals nationwide to improve patient safety, retained surgical items (RSIs) continue to be the No. 1 reported surgical “never event.” Numerous independent organizations – including The Joint Commission, the Association of periOperative Registered Nurses and the American College of Surgeons – recommend the use of adjunct technology to supplement manual sponge counting to reduce the risk of retained sponges. The SurgiCount Safety-Sponge System utilizes uniquely identified sponges and towels to provide a precise, real-time count so the surgical team can close a procedure – and a patient – with confidence. Unlike the traditional manual

counting procedure, which relies on a whiteboard that is erased at the end of a procedure, a record of the SurgiCount-verified correct count is maintained in the hospital’s SurgiCount 360 software so that surgeons, nurses and hospital administrators have a permanent record of the verified count. When used in conjunction with the manual counting process, SurgiCount significantly reduces the risk of retained sponges by addressing the problem of false-correct counts. The SurgiCount system is currently in use in more than 480 hospitals nationwide, and in an estimated 10 million-plus procedures, the system has never failed to identify a retained sponge.• WWW.ORTODAY.COM

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HALYARD HEALTH INTRODUCES DUALPURPOSE GLOVE Halyard Health, formerly KimberlyClark Health Care, has announced the launch of a new exam glove for EMS professionals and law enforcement personnel. The Black-Fire PowderFree Nitrile Exam Glove with Quick Check breach detection technology is a dual-purpose glove with both a black side and a high-visibility orange side to quickly identify breaches in protection PUBLICATION caused by cuts and tears, and to help MEDICAL DEALER TECHNATION reduce the risk of cross-contamination BUYERS GUIDE OTHER and infection. “EMS professionals have long had to MONTH rely on multiple gloves to adequately protect their patients and themselves J F Mthey A M J J A S O from the variety of situations encounter on the scene day to day,” said DESIGNER: JL Greg Metcalf, global director for gloves and apparel at Halyard Health. “Halyard Health is proud to introduce the Black-Fire exam glove. Its dualpurpose system combines the capability of two gloves and the ability to identify cuts and tears more quickly. As an added benefit, Black-Fire can help reduce costs associated with waste and it can free up storage space.” •

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July/August 2016 | OR TODAY

INDUSTRY INSIGHTS WEBINAR

STAFF REPORT

WEBINAR SERIES

HYBRID OR WEBINAR DELIVERS T he OR Today webinar series continues to host informative educational material on pertinent topics. The most recent webinar “Education and Staﬃng the Hybrid OR” was sponsored by St Luke’s Health System and included the insights of presenter Joby Hyman, BSN, RN, CSSM.

Hyman is the Clinical Category Director of Supply Chain Management at St. Luke’s Health System in Boise, Idaho. He is an experienced and dynamic nursing leader, with specific training and expertise in open heart, endovascular and vascular surgery, cardiac catheterization lab and interventional radiology. The number of hybrid operating rooms throughout the country is growing. The need for nurses and health care leaders who understand the complexities of this new space and how to optimize staffing and resources is crucial. Hyman’s webinar provided participants with the tools necessary to make informed decisions to maximize their hybrid OR. Hyman also addressed specific questions during an insightful Q&A session. 18

OR TODAY | July/August 2016

More than 100 people registered to attend the webinar. The session received praise in post-webinar surveys. “We have just completed building and implementing a new hybrid OR. This presentation provided reinforcement that we planned appropriately. Always great to see what we planned for is what is recommended by others,” Nancy T. wrote. “As a team who is in the middle of construction of our two-room hybrid suite, the information provided was very helpful in confirming decisions already made, as well as helping to plan for staffing plans and education,” Mary C. wrote. “I really enjoy listening and watching the OR Today’s webinar series. I always learn something from them. I usually watch all of them whether it pertains to my practice or not, because I am always

“The information provided was very helpful in confirming decisions already made, as well as helping to plan for staﬃng plans and education.” -Mary C.

eager to learn new things,” Sherry W. wrote. “Our facility has been talking about a hybrid OR for the past couple of years. Today’s webinar helped me think about future educational needs that should be discussed at some point during the planning phase. Team is a big piece in relation to how well it will work,” Nancy C. wrote. FOR MORE INFORMATION about the OR Today webinar series, including recordings of all previous webinars, visit ortoday.com/webinars. WWW.ORTODAY.COM

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INDUSTRY IN THE OR INSIGHTS AAAHC UPDATE

BY KATHY WILLIAMS BEYDLER

THE WHAT, WHY AND HOW OF PEER REVIEW P eer review is a way of implementing organizationwide self-assessment by the people most qualified to assess it: similarly licensed health care professionals. Your organization and your patients will benefit from an effective, ongoing process of performance improvement based on peer review. WHAT IS THE PURPOSE OF PEER REVIEW?

Peer review provides a method to review, assess, and validate the current competence of providers within a health care organization. Collecting and analyzing data, including trends and occurrences affecting patient care, provides an overall picture of the level of care provided by individuals and by the organization as a whole.

HOW DOES PEER REVIEW DIFFER FROM PEER REFERENCES?

Peer references are used for initial appointment only. Since a new provider will not have completed cases at the facility, references are needed to verify current competence. Once the provider has been credentialed and granted privileges, peer review becomes an ongoing process. WHAT IS THE VALUE OF PEER REVIEW?

For individual providers, this overall picture of their performance is part of 20

OR TODAY | July/August 2016

what is presented to the governing body when making decisions about re-appointment and the granting of privileges. The governing body is responsible for organizational oversight and for ensuring that the criteria for reappointment are applied in a consistent manner. At the organizational level, peer review is used to establish internal benchmarks. For instance, counting surgical site infections, or measuring transfers to the hospital for each provider over time, will provide an internal benchmark based on current performance. It is important to know if an individual provider’s performance fails to meet the benchmark. Often, the self-awareness created through the use of scorecards that allow providers to compare their performance is enough to correct smaller discrepancies in performance. Positive outliers can be studied for best practices and individual interventions can be implemented for low performers or negative outliers. If the aggregate trend of performance over time shows a decline (or if it isn’t adequate to begin with), a quality

improvement study may be warranted. Analysis of the peer review data is key. Trending and physician scorecards should be included in the reappointment process and review of these should be noted in the governing body minutes. WHAT ELEMENTS SHOULD BE INCLUDED?

The elements should be determined with input from the providers being peer reviewed. Review elements will be different for each type of provider based on their practice. In a surgical setting, the surgeons should have input into the development of their key performance metrics. Chart audits may be part of the process but may not be the entire process. Elements for review should be consistent with the organization’s policies and procedures and might include components such as the presence of a complete history and physical on each chart, an immediate post-operative note that includes the required elements, infection rates, patient satisfaction, acceptable and unacceptable outcomes, etc. The governing body will approve the elements for review. WHO PARTICIPATES IN PEER REVIEW?

Providers who are credentialed and privileged should participate in peer review. Allied health professionals, if WWW.ORTODAY.COM

AAAHC UPDATE

DON’T MISS IT! AUGUST 28-30

employees of the organization, may be privileged within a job description. WE ONLY HAVE ONE SOLO PRACTITIONER. HOW CAN PEER REVIEW BE DONE FOR THIS PRACTITIONER?

Peer review should be provided by an outside practitioner who is similarly licensed. At least two physicians or dentists are involved in the peer review process. This can be accomplished by providing the peer review criteria and data to the outside practitioner for assessment. Some solo practitioners are hesitant to have their care reviewed by another provider in the same area due to concerns about competition. It is not necessary for the provider to be from the same area, merely that he or she is similarly licensed. Or perhaps the reviewer feels compelled to “go easy” on a colleague. In this case, the requesting provider should make clear that the assessment is to be based strictly on the objective data. As with any peer review, the data should include any trends and unexpected outcomes to provide an overall picture of the care provided. CAN A STAFF NURSE OR PA PEER REVIEW A PHYSICIAN OR CRNA?

A provider must be peer reviewed by a similarly-licensed peer. Peer review cannot be done by a lower level of WWW.ORTODAY.COM

licensure to a higher level of licensure. For instance, a CRNA cannot peer review a physician because the physician has the higher level of licensure. A physician can review a CRNA. A staff nurse cannot peer review a CRNA. But a CRNA can review a staff nurse. A physician’s assistant (PA) cannot peer review a physician; however, the physician can review the PA. A successful peer review program requires a willingness on the part of everyone in the organization – from the governing body to members of the medical staff – to work together collaboratively. Done well, peer review is an integral part of a system for improving efficiency and raising the quality of care across an organization. ABOUT THE AUTHOR Kathy Williams Beydler is a surveyor for AAAHC and, previously, was the Director of Surgical Services at Regional One Health, a Level I Trauma Center in Memphis, Tennessee. In Outpatient Surgeries, she was the administrator of a start-up surgery center and later transferred to the flagship center in Memphis. As a surveyor, she especially enjoys the opportunities to teach during her surveys and encourage centers to become the best they can be.

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July/August 2016 | OR TODAY

IN THE OR SUITE TALK

SUITE TALK

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

PRE-OP ANESTHESIA ASSESSMENT Hi. Would love to hear your process for anesthesia involvement in the pre-anesthesia assessment. We are a small OR and the RNs in the department all do a pre-op interview in person with scheduled surgery patients. They run any medical history issues by the CRNA on for the day based on our anesthesia testing protocols. But, that is really the only anesthesia involvement until the day of surgery when they review the chart and consent the patient. Do your anesthesia providers speak with the patient sometime in the days prior to surgery?

A: Our anesthesia providers do a chart review several days in advance and sometimes will call the patient or PCP regarding medical concerns. Any patient with a history of medical/anesthesia issues has a consult from the referring physician to have a pre-op anesthesia visit to hopefully avoid day of surgery delays. Our pre-op testing nurses also screen for concerns when they do their assessment a week prior and communicate with anesthesia. All inpatients are seen when scheduled for surgery. A: We run the same way. We do not have anesthesiologists. Our CRNAs see the charts before surgery and the patient the morning of.

A: We are a small OR as well. We have a PAT Department with one full-time RN, a full-time secretary and a per diem RN. Our process is basically the same. We have PAs who review the charts as well as the charge nurse in same-day surgery to look and identify any issues as well as ask that the charts be delivered seven days out. (That seldom happens). If any issues are identified the PA or charge nurse, based on protocols, will contact anesthesia who then will attempt to solve things before the patient arrives. However, we still end up with some cancellations. We are currently looking at a few electronic solutions for PAT that will automatically triage the patient based off the software. We are just not big enough to have a full-time anesthesia provider in PAT all day.

BEING ON THE OTHER SIDE

Recently I was a patient undergoing surgery in the facility where I work. I was not nervous in the least. It was somewhat surreal. I was surrounded by all my co-workers. I felt at ease. Everything went great. It was eye opening to be on the other side and see and hear things that I was unable to hear and see from a staff personâ&#x20AC;&#x2122;s point of view. It has re-energized my commitment to excellent nursing care. I am blessed to be surrounded by such caring and competent individuals. It is not a bad idea to occasionally be on the other side. I have always wanted to implement an annual competency, if you will, that would require staff to undergo a mock procedure. Just being pushed around on a stretcher in only a cotton gown and being the only one in the suite without a mask is quite a humbling experience. A: Wonderful that you are able to say this about your facility and team. A: When on the other side, the level of vulnerability you feel is humbling. Everyone in perioperative service areas should experience it.

OR TODAY | July/August 2016

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SUITE TALK

ENDOSCOPY PATIENTS

I am wondering if anyone has answers regarding the very small population that absolutely has no ride home. They have arranged for medical transport buses but these do not provide any personnel who would respond if the patient had an emergency. It is a glorified taxi service. We feel bad when we have to cancel these folks but the rules are clear. Our only option is to admit them as a 23-hour but that is not financially feasible. A: We’ve kept some of these patients a little longer and then arrange for the transport bus or taxi home. Most family members wouldn’t be able to respond to an emergency either except for calling 911 which the drivers would also do. A: We cancel the surgery if we find out ahead of time (even that morning). If we find out afterwards (i.e. the patient’s ride “doesn’t show up”), then we recommend a

transfer to the hospital for 23-hour observation. We’ve never had a patient agree to that, instead, they sign an AMA form. That probably happens once a year, typically, once we tell them we’ll have to transfer them to the hospital, they magically track down a relative or neighbor to give them a ride home and sign off on discharge papers. A: We admit ours as a hospital convenience for 23 hours or until the next morning.

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IN THE OR MARKET ANALYSIS

STAFF REPORT

INNOVATION POWERS HEMOSTASIS MARKET

emostasis and coagulation products play an important role in the operating room whether in a hospital or an ambulatory surgery center. These products help prevent uncontrolled bleeding during surgery reducing the occurrence of complications, including death in extreme cases. “Bleeding during surgical procedures puts extra stress on the patient’s organs, which can lead to other problems,” says Dr. Terry Norchi, the CEO of Arch Therapeutics. “Also, when patients bleed significantly during surgical procedures, the visual field can become compromised for surgeons, which can increase the risk of error.” Transparency Market Research, a next-generation provider of research and consulting services, recently issued a report on the hemostasis market with a forecast period ending in 2019. “In the hemostats and sealants market, several formulations of fibrinogen and thrombin have been developed, the most popular and commonly used product being the liquid fibrin sealant product in which the fibrinogen and thrombin are stored separately as lyophilized powder or frozen liquid. The other popular product which has captured large share of market is recothrom by the Medicines Company,” according to Transparency Market Research. “Recrothrom is the human recombinant thrombin used as an aid for hemostasis. The market WWW.ORTODAY.COM

“ The industry is expected to witness lucrative growth over the next seven years owing to an increase in demand supported by rising surgery volumes.” for this segment is increasing rapidly as these products act quickly and are safe in comparison to the topical agents. Topical agents sometimes cause infection leading to fatal consequences.” Innovation and new products are among reasons Transparency Market Research predicts growth in this market. “The hemostasis market is growing at a faster pace with Johnson & Johnson (JNJ) being the major market player,” the Transparency Market Research report adds. “Johnson & Johnson offers distinguished products in hemostasis market under its wholly owned subsidiary Ethicon 360. Ethicon

360’s products which are under hemostasis product portfolio are approved by the Food and Drug Administration (FDA). Recently, in October 2013, JNJ received clearance from FDA for Harmonic Ace +7, the first ultrasonic surgical devices indicated to seal vessels up to 7 mm. Extensive research and the new innovative products are the major reasons which are helping the market to grow. As recently, Arch Therapeutics Inc. has developed a revolutionary product to stop bleeding faster than any other product available in market by the name AC5. AC5 is currently in preclinical testing and takes an average time of 15 seconds to stop bleeding in comparison to 80 seconds to 300 seconds taken by other treatments methods.” Grand View Research, a U.S. based market research and consulting company, expects the hemostasis and tissue sealing agents market to expand through 2022. “Global hemostasis and tissue sealing agents market size was valued at $3.3 billion in 2014. Hemostats and sealants are medical devices used to cease bleeding and hemorrhage caused by injuries and surgical procedures,” according to the Grand View Research report. “The industry is expected to witness lucrative growth over the next seven years owing to an increase in demand supported by rising surgery volumes.” July/August 2016 | OR TODAY

IN THE OR PRODUCT SHOWROOM FOCUS

BY AUTHOR NAME

ARCH THERAPEUTICS INC. AC5 SURGICAL HEMOSTATIC DEVICE The AC5 Surgical Hemostatic Device (AC5 ) is a peptide nanofiber scaffold designed to achieve hemostasis in laparoscopic and open surgical procedures. The time to hemostasis with AC5 is measured typically in 15 to 30 seconds. It is also being designed to conform to irregular wound geometry, to allow for normal healing and to help maintain a clear field of vision in the wound area during surgery. When squirted or sprayed onto a wound, the clear, transparent liquid intercalates into the nooks and crannies of the connective tissue where it self-assembles itself into a lattice-like gel. AC5 is currently in clinical trials and not yet available for purchase in the United States. •

OR TODAY | July/August 2016

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PRODUCT SHOWROOM

BARD ARISTA AH Arista AH is a 100 percent plant based absorbable hemostatic powder derived from purified plant starch. When applied directly to the source of bleeding, Arista AH immediately begins dehydrating the blood to achieve hemostasis â&#x20AC;&#x201C; quickly, safely and effectively. Arista AH provides broad area coverage on rough surfaces and in hard-to-reach areas. The Arista AH particles are fully absorbed and cleared from the wound site within 24 to 48 hours. Arista AH is ready on demand, with no preparation or special storage requirements. Consult product labels and inserts for any indications, contraindications, hazards, warnings, precautions and instructions for use.â&#x20AC;˘

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July/August 2016 | OR TODAY

IN THE OR PRODUCT SHOWROOM

BAXTER TISSEEL ADVANTAGE TISSEEL is a fibrin sealant indicated for use as an adjunct to hemostasis in adult and pediatric patients (>1 month of age) undergoing surgery when control of bleeding by conventional surgical techniques (such as suture, ligature, and cautery) is ineffective or impractical. TISSEEL is effective in heparinized patients. It has shown clinically proven eﬃcacy in the reversal of temporary colostomies and provides leakage prevention through reinforcement. TISSEEL is expected to be completely resorbed in 10-14 days. TISSEEL is also a fibrin sealant indicated as an adjunct to standard surgical techniques (such as suture and ligature) to prevent leakage from colonic anastomoses following the reversal of temporary colostomies. •

OR TODAY | July/August 2016

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PRODUCT SHOWROOM

ETHICON EVARREST EVARREST is a fibrin sealant patch indicated for use with manual compression as an adjunct to hemostasis for control of bleeding during adult liver surgery and soft tissue bleeding during open retroperitoneal, intra-abdominal, pelvic, and non-cardiac thoracic surgery in adults when control of bleeding by standard surgical methods of hemostasis (e.g., suture, ligature, cautery) is ineffective or impractical. Limitations for Use: Cannot be used in place of sutures or other forms of mechanical ligation in the treatment of major arterial or venous bleeding. Please visit www.ethicon.com for more detailed information, including full prescribing information. â&#x20AC;˘

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July/August 2016 | OR TODAY

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IN THE OR CONTINUING EDUCATION CE734

OR TODAY | July/August 2016

BY NANCYMARIE PHILLIPS, PHD, RN, RNFA, CNOR(E); CONNIE C. CHETTLE, MS, MPH, RN; AND BARBARA BARZOLOSKI-Oâ&#x20AC;&#x2122;CONNOR, MSN, RN, CIC

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CONTINUING EDUCATION CE734

REDUCING THE RISK OF SURGICAL SITE INFECTIONS

with the Surgical Care Improvement Project (SCIP)

atients are used to signing consent forms that list infection as a potential risk of surgery, but they probably don’t grasp the scope of the problem. An estimated 1 of 25 patients has a hospital-acquired infection on any given day, according to the Centers for Disease Control and Prevention. A 2011 CDC report indicated that of 722,000 HAIs, there are about 157,500 associated surgical site infections (SSIs).1 An article in the New England Journal of Medicine ranks both SSIs and pneumonia as No. 1 in the distribution of HAIs in 2014, both approaching 40%. The article found that 39.1% of the pneumonia cases were ventilator associated.1 .2

OnCourse Learning 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 39 to learn how to earn CE credit for this module. The goal of this continuing education program is to provide perioperative nurses, pharmacists and surgical technologists with information about preventing surgical site infections. After studying the information presented here, you will be able to: • List three physiologic risk factors in patients associated with increased potential for SSIs • Discuss the rationale for administering prophylactic antibiotics as close to the time of surgical incision as possible • Describe how perioperative caregivers can help prevent SSIs

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Patients with an SSI have longer hospital stays (seven to 11 days) and higher morbidity. Patients with an SSI have an increased risk of dying as a direct result of the SSI at a rate of 77%.3 SSIs also contribute significantly to U.S. healthcare expenses, costing an estimated $3.5 billion to $10 billion each year.3 WHAT IS A SURGICAL SITE INFECTION? An SSI is an infection related to an operative procedure that occurs at or near the incision (incisional or organ/space) within 30 days — or within one year if an implant is left in place.3 SSIs complicate the recovery of 2% to 5% of patients with extra-abdominal surgeries (e.g., thoracic and orthopedic surgeries) and of up to 20% of patients with intra-abdominal procedures (e.g., gynecologic and colon surgeries). SSIs account for nearly 40% of all healthcareassociated infections among surgical patients and are the second most commonly reported healthcareassociated infections, making up 22% of all such infections.2

REDUCTION OF SSI The Surgical Care Improvement Project is a set of performance measures developed by The Centers for Medicare & Medicaid Services, The Joint Commission, CDC, American College of Surgeons and American Hospital Association to serve as a framework to monitor progress and improve patient safety. The high numbers of SSIs have raised concerns about patient safety and led the national organizations to design the SCIP, focused on reducing patient surgical complications and reducing preventable surgical morbidity and mortality by 25% by 2010. (It has not been determined whether it has achieved its goals.). The organizations developed performance measures as part of SCIP to reduce the morbidity and mortality associated with postop SSIs. As an added incentive for preventing SSIs, CMS has stopped paying hospitals the extra costs of treating patients with some of the HAIs that reasonably could be prevented by following evidencebased guidelines. Medicare diagnosis-related group payments

July/August 2016 | OR TODAY

IN THE OR CONTINUING EDUCATION CE734 What Is a Surgical Site Infection?3 Type of infection

Tissue

Signs and symptoms

Superficial incisional SSI

Skin or subcutaneous tissue. No deeper than adipose tissue. Muscle and fascia not involved.

Purulent drainage

Deep SSI • Deep incision primary is when one incision is used. • Deep incision secondary is when two or more incisions are used.

Deep soft tissues, such as fascia or muscle

Purulent drainage from deep incision but without organ/ space involvement

Organ/space SSI

Involves underlying anatomic structures manipulated during the surgery not including the skin, muscle or fascia

One sign of inflammation, such as pain or tenderness, induration or erythema

Deep incision dehiscence, or surgeon deliberately opens incision because of signs of inflammation. Aerobic or anaerobic microorganisms Identification of an abscess above the level of the fascia.

will also be affected by how well hospitals perform in SCIP measures. Private insurers will likely follow Medicare’s lead in withholding payments in the near future. Monetary penalties may be what are needed to ensure that every hospital follows the SCIP initiatives for reducing SSIs. More than 10 years ago, the CDC issued guidelines for the prevention of SSIs. These were followed by guidelines from the Surgical Infection Prevention Project in 2002 and then by the SCIP performance measures in 2005. Over the years, the measures have changed slightly to incorporate not only 34

Organisms isolated from fluid/ tissue aerobic organisms

OR TODAY | July/August 2016

Purulent drainage from a drain placed into the organ/space Organisms isolated from a culture of fluid or tissue in the organ/space below the level of the fascia. Usually anaerobic microorganisms Identification of an abscess in the organ/space

infection-related elements, but also measures for beta blocker use and venous thromboembolism prevention. Yet despite evidence showing the effectiveness of the guidelines, many providers inconsistently comply.4 This module will provide healthcare professionals of various disciplines with the latest information about SCIP performance measures to reduce SSIs, including: 1. The prevention of infection through proper selection, timing and administration of antimicrobial prophylaxis. Doses are adjusted according to body weight. Obese patients require larger doses for

increased periods of time.3 2. Proper hair removal with clippers or depilatory outside the OR3,5 3. Maintenance of the patient’s body temperature between 36 C and 38 C (96.8 F and 100.4 F) within one hour of leaving the OR By following these recommendations, an estimated 40% to 60% of SSIs can be prevented.3 PREDICTING THE RISK FOR SURGICAL SITE INFECTION SSIs occur despite the best surgical techniques, the thoroughness of skin disinfection and the OR staff’s prevention strategies. At the time of incision, every surgical site becomes contaminated with bacteria inward from the skin or outward from the internal organ being operated on if disease-causing microorganisms are present. Most contamination is due to the patient’s endogenous flora present at the surgical site on the skin, on mucosal membranes or in the hollow digestive viscera. Other contamination can come from exogenous sources, such as the OR staff and environment, including the air ventilation system and surgical instruments.5 But for most patients, bacteria in a wound does not result in infection. Usually, innate host defenses can eliminate the contaminating organisms.5 When SSIs do develop, among the most important contributing factors are the amount of bacteria inoculated into the wound, virulence of the bacteria and local blood flow — the delivery of oxygen, inflammatory cells, cytokines and nutritional components to the surgical site.3,5 Also important are the appropriate administration of antibiotics and the adequacy of host immune defenses — innate or acquired. Patient-related risk factors also influence the development of SSIs, including advanced age, obesity, WWW.ORTODAY.COM

CONTINUING EDUCATION CE734

diabetes, malnutrition, poor tissue perfusion, the use of steroids or other immunosuppressant drugs, a preoperative stay in a hospital (more than four days), colonization with Staphylococcus aureus or remote infection at the time of surgery.5 Additional factors include radiation therapy to the surgical site, blood transfusion (causes reduced macrophage activity) and previous history of SSI.3,5 Diabetic patients with poor blood glucose control are at significant risk for postoperative infection. Patients with a preoperative blood glucose level of 200 mg/dL or more have a greater risk of SSI. Hyperglycemia results in impaired host defenses by impairing polymorphonuclear leukocyte functions, including adherence, chemotaxis, phagocytosis and bactericidal activity. In a study of cardiothoracic patients, hyperglycemia was associated with a 102% increase in the risk for wound infection.3 It appears that the risk of infection increases fourfold if the patient becomes hyperglycemic at any time on the first postop day.3 Patients’ blood A1C levels should be maintained below 7%.3 Hospitals should have a standardized glucose management protocol for all patients undergoing surgery. Procedural techniques can influence the risk for infection, such as using the electrocautery on the skin. Residual “dead space” in the wound after closure can lead to infection by creating favorable living conditions for bacteria to multiply. Some surgeons use a wound edge protector drape or an adhesive incise sheet over the exposed skin before the incision is made as a preventive measure. The incise sheets can be plain clear plastic or impregnated with iodophor. A common practice is to irrigate the surgical site with sterile saline or antibiotic solution WWW.ORTODAY.COM

before closing the skin.5 Environmental considerations include adequate surface cleaning with EPA-approved disinfectants and minimizing dissemination of particulates in the air. Surfaces such as push plates, cabinet handles and knobs/buttons/keyboards can harbor harmful bacteria and endospores, such as clostridia (e.g., Clostridium difficile). ORs have specialized air-handling systems that exert positive pressure when the door is opened and negative pressure in the corridors. This prevents additional particulate matter from being pulled into the room from the hallway if the door is opened.5 Some specialty rooms have a system of laminar airflow that directs the cleanest air possible toward the sterile field. Some entryways have ultraviolet light for additional bacteriostatic protection. The air quality is maintained at the cleanest levels possible, but air itself is never sterile.5 Human factors in bacterial spread include the attire of the OR staff: sterile gowns and gloves, hair covers that completely cover the hair and ears, and masks. Skull caps should be avoided because the hair at the nape of the neck protrudes and can shed bacteria and particulate into the surgical site.5 The amount of bacteria in the incision at the end of surgery is the major determinant of SSIs. More than 40 years ago, the CDC used a clinical estimate of the amount of bacteria likely to be encountered in the surgical site during surgery to develop a surgical wound classification system. Four classes of surgical procedures were determined: clean, cleancontaminated, contaminated and dirty or infected — each with a distinctive infection risk rate:5 • Class 1: Clean procedures: an

uninfected primary surgical incision without inflammation; respiratory, GI, biliary or genitourinary tracts not entered; 1% to 2% infection rate without prophylactic antibiotics. Closed by primary intention and may be drained with closed-system drainage. May be a nonpenetrating blunt trauma injury opened for exploration in the OR. No break in sterile technique • Class 2: Clean-contaminated procedures: surgical incisions in which respiratory, GI, biliary and genitourinary tract are entered under controlled conditions with minimal spillage and no encounter with infected urine or bile; 6% to 9% infection rate without prophylactic antibiotics. No break in sterile technique • Class 3: Contaminated procedures: open, fresh, accidental wounds (of less than four hours duration) and surgeries with major breaks in sterile technique (e.g., open cardiac massage) or gross spillage from the GI tract; also includes incisions in which acute, nonpurulent inflammation is encountered; 13% to 20% infection rate without prophylactic antibiotics • Class 4: Dirty/infected procedures: purulent inflammation present. Includes old traumatic wounds (of more than four hours duration) with retained dead tissues and those that involve existing clinical infection or perforated viscera; about 40% infection rate without prophylactic antibiotics Surgical risk is further defined by three additional risk factors that play a significant role in wound infections: an operation lasting more than two hours, one involving the abdomen or one performed on a patient having three or more underlying diagnoses (indicative of July/August 2016 | OR TODAY

IN THE OR CONTINUING EDUCATION CE734 the patient’s clinical comorbidity). The addition of these three factors to the CDC wound classification system makes predicting the risk of a wound infection twice as helpful as the traditional wound classification alone.3,5 Note that wound class is documented at the end of the surgical procedure and not before. The perioperative nurse has no way to predict what conditions may be encountered during the procedure or if a major break in technique might occur before closure. For example: A Class 2 cholecystectomy can become a Class 3 if bile spills into the abdomen.5 KNOWLEDGE VS. PRACTICE The introduction of antibiotics in the 1940s led to the belief that treating wound infections with antibiotics after surgery might be the answer to SSI. However, bacteria developed drug resistance that continues into modern times. It has taken hundreds of clinical trials to understand the most effective and appropriate methods of using antibiotics to prevent SSIs. The efficacy of antibiotics against SSIs was established in the 1960s, when studies determined they were most effective in preventing wound infections when given before the inoculation of bacteria into the wound and ineffective if given three hours after inoculation.3 Studies also confirmed that giving antibiotics for more than 24 hours after wound closure offered no additional benefits unless the patient was obese with poor tissue perfusion.3 Although this important information resulted in good evidence-based guidelines, surgeons continue to use and time antibiotics inappropriately in many surgical procedures in U.S. hospitals. Surgeons, nurses, surgical 36

OR TODAY | July/August 2016

technologists, anesthesiologists, infection control practitioners, pharmacists and hospital administrators can work together to improve patient safety by providing care consistent with medical evidence and clinical practice guidelines. The following evidencebased SCIP performance measures can serve as a framework to monitor progress in improving surgical patient safety:3,5 SCIP — Infection 1: Prophylactic antibiotic received no earlier than one hour before surgical incision or within two hours before incision if vancomycin (Vancocin) or a fluoroquinolone (ciprofloxacin) is required for prophylaxis. Timing is also important if a tourniquet will be used. The drug should be permitted to have adequate penetration time before the tourniquet is inflated.3,5 Improving the timing of antibiotic administration is a crucial first step in preventing SSIs. Antibiotics should be given as close to the time of incision as clinically practical and no more than 60 minutes before surgery or tourniquet inflation unless the use of a fluoroquinolone or vancomycin is indicated.3 When a surgical incision disrupts tissue integrity, an inflammatory exudate (neutrophils, macrophages, blood cells, coagulation cascade proteins and fibrin strands) begins filling the space around the wound, embedding the contaminating bacteria in a fibrin clot matrix. To penetrate the fibrin clot matrix, the antibiotic must be present at the time of fibrin formation. To ensure a therapeutic level of antibiotic at the time of incision and during the surgical procedure, the patient should receive the antibiotic just before the incision is made.3 After an incision is closed, antibiotics have no appreciable effect on preventing infections. In

addition, after the wound is closed, the increased hydrostatic pressure secondary to edema formation makes it difficult for antibiotics to gain access to the area around the wound space.3 Hospitals need standard protocols to ensure that prophylactic antibiotics are delivered no more than one hour before the surgical incision is made. Patients should receive antibiotics when they reach the preop area or the OR rather than “on call.” With on-call dosing, case delays can result in patients’ not receiving preoperative doses within the recommended time frame. If an “on call” dose is given followed by delay, the patient should be redosed.3 Redosing may be necessary if the patient has experienced a large volume of blood loss.3 SCIP — Infection 2: Prophylactic antibiotic selection for surgical patients. Surgical patients should receive prophylactic antibiotics in accord with current published guidelines for each type of procedure.3 For most surgeries, cephalosporins are the drugs of choice, and first- or secondgeneration cephalosporins, such as cefazolin (Ancef, Kefzol) or cefoxitin (Mefoxin) for colon surgeries, are ideally suited for prophylaxis.2,3 Colon procedures on patients requiring a mechanical bowel prep can also benefit from simultaneous oral antibiotics. Cephalosporins have a broad spectrum of activity against gram-positive and gramnegative bacteria and a wide ratio of therapeutic to toxic dosages. Cephalosporins are also inexpensive and easy to administer, and allergic reactions are rare.3 The average adult dose of cephalosporin is usually 2 g for a 70 kg to 80 kg patient. Obese patients’ doses range around 3 g for a 120-kg patient. Pediatric doses are usually 30 mg/kg.3 WWW.ORTODAY.COM

CONTINUING EDUCATION CE734

To ensure that appropriate antibiotics are used for prophylaxis, hospitals should follow recommendations from the American Society of HealthSystem Pharmacists, Infectious Diseases Society of America, Sanford Guide to Antimicrobial Therapy or Surgical Infection Society.3 Hospitals with epidemiologists on staff should consult with them for recommendations on endemic pathogens and antimicrobial prophylaxis. Vancomycin should not be routinely used for surgical procedures.2 ,3 However, sometimes it may be the best choice for prophylaxis. For example, vancomycin may be used when a patient has a documented beta-lactam allergy, is colonized with methicillin-resistant S. aureus or is at high risk for MRSA because of an acute inpatient hospitalization or nursing home stay within a year before admission, has an inpatient stay of more than 24 hours before the surgery or is in a facility with a high rate of MRSA infections.3 The average adult dose of vancomycin is 15 mg/ kg. Obese patients can be dosed at the same weight-based amount plus an increase of 40% for excess weight.3 The number of patients with MRSA has increased significantly in U.S. hospitals. Some physicians prescreen the patient for nasal microorganisms by preoperative nasal culture and then treat with antimicrobial mupirocin cream (Bactroban) accordingly.3 SCIP — Infection 3: Prophylactic antibiotics discontinued within 24 hours after the end of surgery . Discontinuing prophylactic antibiotics within 24 hours after surgery (except cardiothoracic surgery, when 48 hours is appropriate) is recommended. Evidence shows that continuing antibiotic prophylaxis beyond WWW.ORTODAY.COM

24 hours after the incision is closed offers no additional benefits. In fact, prolonged use of antibiotics can lead to infection with Clostridium difficile and the emergence of antibiotic-resistant organisms.3 Clinicians on the healthcare professional team can use protocols and standard order sets to ensure that antibiotics are stopped after 24 hours. Surgeons are advised to avoid using antimicrobial sutures coated with triclosan as a routine measure. Researchers are reviewing the relationship between this product and the development of antibiotic resistance. Additional studies are ongoing to determine the effect of triclosan within the human body since it has been found in urine and breast milk.5 SCIP — Infection 6: Appropriate hair removal The nicks and scrapes from preoperative razor shaving are linked to an increased risk of SSIs from skin-associated bacteria. Even with conscientious skin preparation, up to 20% of skin-associated bacteria remain on the skin beneath the surface in hair follicles and sebaceous glands. Shaving allows these bacteria to penetrate the microscopic cuts in the skin.3 To reduce SSIs, current practice recommends no hair removal, or if hair removal is necessary, removal in the immediate preop period with electric clippers and a disposable, single-patient-use cutting head. Clipping should not be performed in the immediate area where the surgery is done. Particulate-bearing microorganisms could become airborne and enter the incison.5 Razors should be removed from OR supply carts and surgical shave prep kits so they are not used on patients. Healthcare professionals should educate patients not to

shave operative or other body sites before surgery.3 SCIP — Infection 9: Urinary catheter removed on postoperative day 1 or 2 with day 0 being the day of surgery Device-associated infections are a problem with all patients and can be reduced by eliminating or minimizing the prolonged use of invasive devices. Numerous studies have demonstrated the benefits of prompt removal of urinary catheters after surgery when there are no indications to leave the catheter in, such as after bladder surgery or the need to measure strict output. In one study, postoperative patients who had indwelling urinary catheters beyond the second day were twice as likely to develop a urinary tract infection.3,5 Many hospitals have a nurse-driven protocol to encourage the timely removal of urinary catheters. SCIP — Infection 10: Surgery patients with immediate postoperative normothermia (36 C to 38 C) within the first hour after leaving the OR Hypothermia (a core body temperature less than 36 C, or 96.8 F) almost always occurs in unwarmed patients during surgery. It develops from exposure to the relatively cool OR and the effects of anesthesia. General or major regional anesthesia impairs the body’s normal thermoregulation and causes a shift of heat from the body’s core to its periphery. In the first hour after induction, the core temperature drops by 1.0 C to 1.5 C. It drops another 1.1 C during the subsequent two to three hours of anesthesia time, reaching a plateau at about 34 C, or 93.2 F. As the body becomes hypothermic, vasoconstriction reduces the perfusion of subcutaneous tissue. This reduces the oxygen supply to the wound and July/August 2016 | OR TODAY

IN THE OR impairs immune function, including T-cell mediated antibody production and the oxidative killing of pathogenic bacteria by neutrophils. As an illustration, in colon resection patients, a 1.9 C drop in core temperature (core temperature

of 34.7 C) triples the incidence of surgical wound infections and increases the length of stay by a week or longer.3 Mild hypothermia also increases time in the hospital for uninfected patients. While this performance measure

is used to apply only to colorectal surgery, all patients should maintain temperatures as close to 37 C (98.6 F) (normothermia) as possible when they undergo surgery. This is done by keeping the OR warm and by using preoperative and

CLINICAL VIGNETTE At her hospital’s quarterly infection control committee meeting, Sharon, an infection control nurse, presented the hospital-acquired infections surveillance results for the quarter. SSIs were significantly higher than in previous quarters. A subcommittee was formed to find out why.

Which of the following practices could be increasing SSIs? A. Prophylactic antibiotics were given to each patient within 30 to 60 minutes of incision. B. Cefazolin (Ancef) was the drug of choice for most surgeries. C. The surgical sites of all patients were shaved the night before surgery D. All patients bathed with an antimicrobial soap the night before surgery.

Although most surgeons at the hospital were giving prophylactic antibiotics within 30 to 60 minutes of incision time, a few continued to order antibiotics to be given in the recovery room after surgery. What reasons could Sharon give to support giving antibiotics before incision time? A. Antibiotics are not able to penetrate into the surrounding surgical area through the fibrin clot matrix that begins forming immediately when tissue integrity is disrupted by a surgical incision. B. The high blood sugar levels that occur in many patients shortly after surgery reduce the effectiveness of antibiotics. C. Antibiotics should not be given after surgery because they increase the time the patient has to remain in the recovery room so that nurses can watch for allergic reactions. D. Nearly all patients become hypothermic in the recovery room. The resulting vasoconstriction prevents antibiotics from reaching the bacteria.

Sharon told committee members that by following SCIP performance measures, they would be able to improve healthcare quality. Several committee members asked about SCIP. She can say that: A. SCIP (Start Comparing Insurance Premiums) was designed to help patients compare what costs their health insurance would cover for surgeries. B. SCIP stands for the Secure Communication Implementation Protocol, a HIPAA measure to secure patient confidentiality. C. SCIP (Senior Care Information Program) is a new Joint Commission standard created to provide elderly patients with information on what to expect when entering a hospital for surgery. D. SCIP (Surgical Care Improvement Project) was designed to reduce the morbidity and mortality associated with postoperative SSIs.

The committee found that several surgeons were using vancomycin (Vancocin) for all their patients undergoing surgery. The committee decided that vancomycin prophylaxis should be used only: A. In the absence of a beta-lactam allergy B. When a patient is in a facility with a high rate of MRSA infections C. For colorectal surgery D. The decision to use or not use vancomycin should be left up to surgeons

1. Correct Answer: C—Shaving causes microscopic cuts in the skin that allow surface bacteria to penetrate, causing infections 2. Correct Answer:A—A culture of safety is characterized by reporting and open discussion of errors, with the goal of preventing similar errors. AutThe inflammatory exudates that form when tissue integrity is disrupted by a surgical incision embed the contaminating bacteria in a fibrin clot matrix, making it difficult for antibiotics to reach the bacteria. 3. Correct Answer: D—An organization that encourages patients and families to participate in The Joint Commission’s Speak Up program is making SCIP was designed by a partnership of national organizations focused on reducing patient surgical complications by 25% by 2010. 4. Correct Answer: B—TOne of the indications for using vancomycin is when the patient is at risk for MRSA. 38

OR TODAY | July/August 2016

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intraoperative measures to warm the patient, such as warmed IV fluids.2,3,5 Although some SSIs are unavoidable, surgical complications can be significantly reduced and patient safety improved by following the SCIP performance measures and other evidencebased practice recommendations. Preliminary studies on the success of SCIP suggest that adherence to all of the measures has more impact than adherence to a single measure and indicates better overall quality care. Healthcare professionals as a team, including nurses, surgeons, surgical technologists, infection control practitioners and pharmacists, have a responsibility to follow these recommendations to make sure that patients receive the safest surgical care possible. OnCourse Learning guarantees this educational activity is free from bias. NANCYMARIE PHILLIPS, PhD, RN, RNFA, CNOR(E), is a professor and head of the department of perioperative education at Lakeland Community College, Kirtland, Ohio.

CONNIE C. CHETTLE, MS, MPH, RN, is an epidemiologist living in St. George, Utah. BARBARA BARZOLOSKI-O’Connor, MSN, RN, CIC, is the infection control manager at Howard County General Hospital in Columbia, Md. REFERENCES 1. Healthcare-associated infections. CDC Web site. http://www.cdc.gov/HAI/surveillance. Updated January 12, 2015. Accessed April 10, 2015.

2. Magill SS, Edwards JR, Bamberg W, et

al. Multistate point-prevalence survey of healthcare-associated infections. N Engl J Med; 2014;370(13):1198-1208. doi: 10.1056/ NEJMoa1306801. 3. Anderson DJ, Podgorny K, Berríos-Torres SI, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(6):605627. doi: 10.1086/676022. 4. Hand L. Surgical site infection monitoring inconsistent. Medscape Medical News. http:// www.medscape.com/viewarticle/835732. Accessed April 9, 2015. 5. Phillips N. Berry and Kohn’s Operating Room Technique. 12th ed. St Louis, MO: Mosby Elsevier; 2012.

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HOW TO EARN CONTINUING EDUCATION CREDIT 1. Read the Continuing Education article. 2. Go online to ce.nurse.com to take the test for $12. If you are an Unlimited CE subscriber, you can take this test at no additional charge. You can sign up for an Unlimited CE membership at www.nurse.com/ unlimitedCE for $49.95 per year.

DEADLINE Courses must be completed by 4/15/2017. 3. If the course you have chosen to take includes a clinical vignette, you will be asked to review the vignette and answer 3 or 4 questions. You must answer all questions correctly to proceed. If you answer a question incorrectly, we will provide a clue to the correct answer. 4. Once you successfully complete the short test associated with the clinical vignette (if there is one), proceed to the course posttest. To earn contact hours, you must achieve a score of 75%. You may retake the test as many times as necessary to pass the test. 5. All users must complete the evaluation process to complete course. You will be able to view a certificate on screen and print or save it for your records.

ACCREDITED OnCourse Learning is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. Accredited status does not imply endorsement by the provider or ANCC of any commercial products displayed in conjunction with this activity. OnCourse Learning is also accredited by the Florida Board of Nursing and the Georgia Board of Nursing (provider # 50-1489). OnCourse Learning is approved by the California Board of Registered Nursing, provider # CEP16588.

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

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

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CORPORATE PROFILE

ONE SOLUTION FOR ALL YOUR PATIENT MONITORING NEEDS

QUALITY Y SOLUTIONS FOR PATIENT MONITORS AND MORE

acific Medical opened its doors over a decade ago. It continues to grow and is thriving in the medical industry. Pacific Medical President and CEO Andy Bonin started the business because he saw the need for quality equipment in the medical repair industry. His goal was to provide outstanding customer service while meeting industry needs. The company achieved Bonin’s goal and continues to grow and provide excellent customer service throughout the world. Pacific Medical has established itself as a trusted name in the health care industry that specializes in monitors, modules, telemetry, infusion pumps, suction regulators, fetal transducers, SpO2/ECG/Temp/NIBP cables, O2 blenders, endoscopes and gas analyzers. Patient monitor devices and accessories are the areas where Pacific Medical stands out as a trusted and established leader for the purchase and repair of equipment. Pacific Medical is unlike its competitors. It is made up of an incredibly strong team that excels in a team environment. Since the very beginning, the company has been powered by a sense of trust between leadership and the employees and that has carried over to its relationships with customers. The company holds dual ISO certifications (9001:2008, 13485:2003) and that further strengthens Pacific Medical’s credibility by demonstrating that its products and services meet customers’ expectations. The dedicated team at Pacific Medical also continues to meet emerging industry

OR TODAY | July/August 2016

demands in patient safety and quality. Pacific Medical’s demand for quality and superior customer service results in satisfied clients. The company’s approach has also fueled accelerated growth as more and more health care providers depend on Pacific Medical for its equipment needs. Pacific Medical has grown exponentially through the years. Bonin points out that the company’s success is based on his formula to provide outstanding customer service while meeting industry needs. “We are a quality-focused, customerfacing organization which understands and delivers innovative solutions for the greater good of our customers and biomeds. This approach, in-turn, ensures the safety of millions of patients worldwide,” Bonin says. “Pacific Medical carries the largest patient monitoring inventory in the industry and is recognized for its cutting-edge customer service response team,” Bonin adds. “Today, Pacific Medical has expanded its repair competencies which now cover

multiple equipment modalities. Our success has been driven by our commitment to be the absolute best with a core group of repairs.” The growth and success over the first 10-plus years is a sign of things to come. The future is very bright for Pacific Medical as its high-quality employees continue to focus on excellence in every aspect of the company’s operations. “Pacific Medical’s mission is about giving back to the customer, community and team. We also feel our mission and job is not just service, but to lead and partner with key biomed industry partners while providing them with solutions based on their specific needs,” Bonin says. “The executive management team is committed to hearing and serving our biomed partners and working together to the end result as a strategic partnering team.” The ISO certifications are one sign WWW.ORTODAY.COM

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“Pacific Medical’s mission is about giving back to the customer, community and team. We also feel our mission and job is not just service, but to lead and partner with key biomed industry partners while providing them with solutions based on their specific needs.” WWW.ORTODAY.COM

of Pacific Medical’s dedication to maintain the highest level of quality. It is this approach that powers the company and its employees to exceed the work of its competitors. “Pacific Medical strives to outperform its peers through operational excellence, in accordance with providing a dynamic and challenging environment for employees to excel,” Bonin says. “Our vision is to continue to strengthen our position as the recognized industry leader, with the ability to sustain life through reliable medical equipment services.” Another crucial element of Pacific Medical’s success is the leadership’s decision to invest in the company. Capital improvements to maintain a top-notch facility is one example of this objective. Pacific Medical is constantly reinvesting in itself by ramping up a robust inventory of parts and complete off-the-shelf ready units to outfit a large hospital. The company also stays abreast

of all of the latest and greatest technology in the industry to maintain its position as a leader that customers can depend on. Pacific Medical is comfortable with this environment of fastpaced growth that continues to be supported by proper planning at the executive level. An example of this growth is Pacific Medical’s recent addition of a telemetry building. The facility was created to meet an increase in the demand for a volume of repairs and customers’ requests for critical turn times. “The new building was acquired as a solution to support the rapid surge of Pacific Medical’s telemetry business and to provide for future growth,” Bonin says. “The telemetry department offers dedicated repair areas for the different types of telemetry devices, including a separate room for testing and quality control.” The expansion also provides room to meet other needs. “We also now have the extra space for the assembly of July/August 2016 | OR TODAY

CORPORATE PROFILE

complete transmitter units on the shelf for purchase that can ship within the same day. We also created a dedicated department that offers a complete inventory of accessories including our disposable patient ready packs,” Bonin says. Pacific Medical’s pride in continuing to increase cost efficiency and volume while adhering to its strict ISO processes is evident. Pacific Medical’s telemetry repair department capacity has quadrupled since the new building opened, expanding its capability for testing hundreds of telemetry units per day. Pacific Medical is able to complete the entire telemetry repair process within 48 hours. The success is a result of the foundation Bonin established to provide quality equipment more than 10 years ago when he started Pacific Medical. “Pacific Medical’s core competencies are quality, innovation, customer service, flexibility and outstanding turn times,” Bonin says. “The heart and soul of our success is showcased in our satisfied customers. We go above and beyond to meet our customers’ needs and provide the solution for lowercost, high-quality solutions.” Pacific Medical’s philosophy has carried over into biomedical departments who have contacted the company to partner with them and 44

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provide services over several facilities. “We work with our customers to drive down their operational costs through volume discounts that include repair services, parts acquisition and accessories,” Bonin says. “As the organization has fully integrated their repair process into its CRM system, it creates a seamless platform for partnering organizations.” Expert quality repairs are what customers want and Pacific Medical is there to deliver. The company Bonin says Pacific Medical is continuously on the lookout for ways to make life easier for customers. “Pacific Medical is always looking for more solutions to take our products to the next level,” Bonin says. “It doesn’t stop at telemetry, and we are always looking to stay one step ahead. Our job is not just to service, but to lead and partner with our hospitals and biomed teams to meet their budget, on time and with a turn time of less than 48 hours.” Pacific Medical’s focus on service extends to its desire to make a positive impact on the community. The company and its employees are deeply committed to community service and giving back. “We are proud to have team members who dedicate their time to bettering the lives of others. Pacific

Medical proudly stands by those who possess strength of character so in observance of Pancreatic Cancer Awareness Month, the entire Pacific Medical rallied together in a show of support for those who suffer from this diagnosis and we plan to do it again this year,” Bonin says. In short, Pacific Medical fosters a sense of community with its employees creating an innovative and team-oriented organization that champions support and solutions for its customers. “Our organization is run on trust and a strong family-type of environment. Everyone genuinely cares about each other and our organized success,” Bonin says. “I have an open door policy and strong communication with my team. The culture is friendly, successful and cutting edge. Everyone owns their contribution and is continually looking ahead to take their team and their projects to the next level of success.” The goal to provide quality equipment and outstanding customer service to meet industry needs is alive and well at Pacific Medical. It is a hallmark that guides every aspect of its business as it soars to new heights in the future. For more information about Pacific Medical, visit them online at pacificmedicalsupply.com.

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HEMOSTATIC AGENTS ILLUSTRATE COST-SAVINGS BY DON SADLER

“Using the right product at the right time allows surgeons to control surgical bleeding efficiently. The optimal use of available hemostatic options may lead to significant cost savings for controlled surgical bleeding.” DR. RICHARD KOCHARIAN, Franchise Medical Director for Ethicon

evere or excessive patient bleeding is one of the most common problems or complications experienced by OR personnel during surgery. It’s estimated that major bleeding occurs in anywhere from one-third to two-thirds of all open procedures.

The patient repercussions of severe bleeding can be severe – including, in a worst-case scenario, patient death. In fact, uncontrolled bleeding can raise the patient mortality rate up to 20 percent. There’s also a financial cost to excessive bleeding and related complications, since they are associated with increased hospital utilization, extended surgery time and extended hospital stays. EVERY SURGERY IS IMPACTED

“Bleeding control is a variable that impacts every surgery in every discipline in the operating room,” says Simona Buergi, vice president of sales and marketing for Tricol Biomedical Inc. “Bleeding control occupies a significant share of a surgeon’s mind and time,” adds Dr. Terry Norchi, the CEO of Arch Therapeutics. Norchi points out other problems and complications related to excessive bleeding. “Bleeding during surgical procedures puts extra stress on the patient’s organs, which can lead to other problems,” he says. “Also, when patients bleed significantly during surgical procedures, the visual field can become compromised for surgeons, which can increase the risk of error.” 48

OR TODAY | July/August 2016

There is an increased risk of bleeding for patients on antithrombotics (or blood thinners), Norchi adds. Almost half of patients using over-the-counter blood thinner products do not inform their doctors, he notes. “So, surgeons and patients are often faced with a difficult dilemma,” says Norchi. “Should the antithrombotic drug be stopped before the procedure? This challenge seems to be increasing given the significant increase in the use of antithrombotic drugs, including direct oral anticoagulants.” Margaret A. Camp, RN, BSN, MSN, Division Director of Clinical Education for Healthone in Denver, Colorado, notes that the increase in the number of minimally invasive procedures in the OR and other clinical areas has also led to more problems and complications due to severe bleeding. “In this scenario, traditional techniques like using pressure, sutures or cautery can’t be used,” she explains. Patient factors can also contribute to the increased risk of surgical bleeding, says Dr. Richard Kocharian, Franchise Medical Director for Ethicon.

“Controlling bleeding reliably saves procedural times and reduces blood loss, which ultimately improves patient safety and outcomes.” SIMONA BUERGI, VP of sales & marketing, Tricol Biomedical Inc.

“Many elderly patients are on chronic antiplatelet and anticoagulant therapies and have a growing number of comorbidities like obesity, diabetes and chronic cardiovascular and liver disease,” he says. “These are all associated with an increased risk of surgical bleeding by adversely affecting the body’s natural clotting process.” WWW.ORTODAY.COM

“Bleeding control occupies a significant share of a surgeon’s mind and time.” DR. TERRENCE NORCHI, CEO of Arch Therapeutics

ACHIEVING HEMOSTASIS

Due to the wide range of different types of bleeding scenarios, there is a variety of different methods that can be used to control bleeding during surgery, or hemostasis. These include conventional methods like clips, clamps, sutures, ties and electro-cautery, which can be effective in the right situations. “However, these primary approaches often are not enough to control bleeding efficiently,” says Kocharian. “In these situations, adjunctive hemostats can help control bleeding and minimize blood loss.” “For example, adjunctive hemostats are advantageous when bleeding is difficult to access or tissue topography is uneven, or when the surgeon wants to limit char and necrosis from simple energy devices,” Kocharian adds. “In these cases, using an adjunctive hemostat in addition to primary methods can result in faster time to complete hemostasis.” Norchi points out that many of the tools surgeons use to stop bleeding can result in their own challenges. “These include the risk of damaging vital structures when energybased devices like cautery are used to achieve hemostasis,” he says. “There is also a host of risks associated with the use of many hemoWWW.ORTODAY.COM

static agents that are commonly, although not necessarily accurately, called biomaterials,” Norchi adds. These hemostatic agents include gelatin, collagen, cellulose, polymers, thrombin and fibrin sealants. One of the biggest problems with using hemostatic agents to stop bleeding during surgery is that they are often unreliable, slow to work, and difficult to prepare or use, says Norchi. “Many of them are known to be associated with a risk of foreign body reactions, infections, granuloma formation, inflammatory responses or adhesions in recipient patients,” he says. “And their efficacy is often challenged if a patient is taking an antithrombotic drug or does not have an intact clotting cascade.” Also, certain agents sourced from animals have been reported to cause a potentially fatal immune response in some patients. Or they conflict with the religious beliefs and practices of some patients, says Norchi. TECHNOLOGICAL ADVANCES IN HEMOSTASIS

The good news on the hemostasis front is that technological advances are being made to address critical hemostasis needs in various surgical bleeding situations. One example of this is the EVARREST Fibrin Sealant Patch,

which was developed by Ethicon. “EVARREST is a unique, bioabsorbable adjunctive hemostat that drives durable clot formation by augmenting the human coagulation system,” explains Kocharian. “It’s an innovative product that stops problematic bleeding on the first attempt in indicated patients.” According to Kocharian, clinical studies have demonstrated that EVARREST is greater than 94 percent effective in controlling bleeding across challenging patient types and surgical situations in soft tissue and adult liver bleeding when compared to the current standard of care for that time point. Camp says that she is aware of positive clinical outcomes using EVARREST to achieve hemostasis in surgical bleeding situations. “In my experience, it works quickly and is an effective and noninvasive way to control hemostatic events,” Camp says. “Using the right product at the right time allows surgeons to control surgical bleeding efficiently,” Kocharian adds. “The optimal use of available hemostatic options may lead to significant cost savings for controlled surgical bleeding.” Tricol Biomedical manufactures the GuardaCareXR Surgical tempoJuly/August 2016 | OR TODAY

rary surgical hemostats. Buergi says these hemostats have the proven ability to control all levels of bleeding minutes, from oozing nuisance bleeding all the way to severe arterial bleeding in. This technology utilizes Chitosan, which offers the ability to control bleeding independently of the clotting cascade, says Buergi. “This means that it does not rely on the patient’s coagulation cascade to achieve a clot,” she explains. Arch Therapeutics also manufactures products designed to stop surgical bleeding and control leaking. “These products are made of peptides, which in turn are made up of

amino acids,” explains Norchi. “What differentiates our technology from traditional peptides is that our peptides self-assemble – hence, the name self-assembling peptides, or SAP.” He says that Arch Therapeutics’ primary product candidate, AC5 Surgical Hemostatic Device, is being designed to achieve hemostasis. “When applied as a liquid or spray to a wound, AC5 locally self-assembles (or builds itself ) into a nanofiber structure that provides a physical barrier on the tissue,” he explains. “This mechanically seals the wound in order to stop substances like blood from leaking.” In tests, Norchi says that AC5 has

demonstrated rapid average time to hemostasis when applied to a variety of animal tissues. “Many of these tests have shown a time to hemostasis of under 15 to 30 seconds when AC5 was applied to bleeding wounds,” he says. Norchi says that a human trial for AC5 is now underway as the company continues toward commercialization. The company expects to announce data and anticipates a CE Mark filing this summer. “Controlling bleeding reliably saves procedural times and reduces blood loss, which ultimately improves patient safety and outcomes,” says Buergi.

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SPOTLIGHT ON

ARIC CAMPLING By Matt Skoufalos

OR TODAY | July/August 2016

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s the medical profession only grows more increasingly technologically complicated, those clinicians with a background in computing, information technology, or other digital expertise are ever more valuable in the workplace. That holds true especially in the field of nursing, where informaticists like Aric Campling are helping bridge needs of staďŹ&#x20AC; in both the clinical and IT departments with a diverse set of skills that extends from caregiving to programming.

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July/August 2016 | OR TODAY

SPOTLIGHT ON

ARIC CAMPLING

ampling entered the field as a cardiac care telemetry nurse. After a number of years, he’d worked in ICU stepdown units, open-heart surgery recovery units, and catheterization labs. When Bethesda Memorial Hospital of Boynton Beach, Florida, began implementing a bar code medication administration project as part of its electronic medical record (EMR) system, Campling was selected to become a program super-user. His job was to adopt the software first to alleviate the burden on the IT staff of teaching everyone else in his unit, and then help his peers learn to navigate the system. Over the course of that implementation, a nurse in the IT department took an interest in him, won over by Campling’s digital abilities, and invited him to cross over into their department. “I’d had a particularly terrible day in the nursing unit, which doesn’t happen often, but when it does, (it) leaves you vulnerable to poaching from the IT department,” Campling said. “I was aiming for a career in nursing informatics, and I stumbled into it a few years early.” Self-taught in computing, Campling studied under Virginia Saba during his undergraduate nursing career at Georgetown. Saba was at the forefront of the development of the nursing informatics specialty in the late 1990s. “I thought, ‘I could do this; I’ll get some bedside experience, [and] I’ll go back to school,’ ” Campling said. “Rather than going back to school, I ended up being hired into it, and working as an informaticist for a few years.” Campling considered completing more formal schooling in informatics, but after talking it over with a colleague, decided it was better for him to keep working in the field and working out fundamental theories from textbooks instead. Working in nursing informatics while still having the knowledge base of a cardiac care

OR TODAY | July/August 2016

“It was a bit of an uphill battle in the ’90s and the 2000s, getting health care organizations to recognize that technology was the way of

port because there’s an issue with the system, I can understand the language that they’re speaking, somewhat uniquely the workflows and the issues that they’re facing, and the urgency of a request that comes in, and be able to help understand from a clinical standpoint what they’re facing,” he said. It also earns him the trust and respect of IT experts who Campling said are “steeped in the clinical tradition.” “Sometimes clinicians will sort of wave their hands and turn their noses up at IT folks because they don’t come from a traditional IT background,” he said. “It helps grease the wheels because we’re all speaking the same language.” On the flip side, the barriers between the clinical and IT worlds are shrinking, Campling said. Programmers who’ve never worked in clinical settings may not have an easy

the future.” nurse which is “generally portable and serves a variety of purposes,” unites his clinical experiences, technical language, and workflow understanding in the clinical environment, Campling said. “Even if an EMR user calls in and needs sup-

Campling is a black belt in Shaolin Wushu-Kung and is now studying Tai Chi.

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Campling has been running a webcomic since 1999.

time establishing relationships with health care workers, but with informaticist translating between the IT and the clinical sides of things, “that all comes together,” he said. “It was a bit of an uphill battle in the ’90s and the 2000s, getting health care organizations to recognize that technology was the way of the future, but it’s much more recognized now to the extent that WWW.ORTODAY.COM

meaningful use money worked to benefit providers and patients,” Campling said. “Sooner or later everybody’s going to have to do it, especially if they receive Medicare and Medicaid funding. Not only is it an interesting field to be in, it’s one that increasingly has good job security.” Currently, Campling works as an Integration Architect at the Bear Institute, a partnership

between Cerner and the Children’s National Health System in Silver Springs, Maryland. His role involves bringing innovation and support to a larger set of operational responsibilities. Recently, he’s been working on a major version upgrade for the Cerner EMR that requires unifying the responsibilities he’s developed in the IT and clinical worlds. “I have a high-level view of the way that various systems work together, or are supposed to,” Campling said. “From a clinical background, all the different systems work together, and we’re supposed to make sure they’re doing so. We have a good team of application experts here, and sometimes they need additional support. I can help them out with application solutions, trying to understand the issues that are going on so that we can get information for the end users.” When he’s not in the office, Campling stretches out the remainder of his quite versatile set of talents. His interest in illustration and comics production led to his creation of a webcomic he’s maintained since 1999; Campling has also published a short story in a comics anthology that was released this January, and is working on another for Square City Comics. He’s a black belt in Shaolin Wushu-Kung Fu and last year began studying Tai Chi. Swing dancing is another of his hobbies (since marrying a swing dance instructor, learning was “mandatory,” he said). In the rare moments when he takes a break, Campling can be found curled up with a book, a video game or taking in some sun in his garden. July/August 2016 | OR TODAY

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OUT OF THE OR HEALTH

BY HARVARD HEALTH LETTERS

TURN AWAY FROM NECK PAIN

eck pain is a nagging ailment that affects everyone at some time. In fact, approximately 80 percent of people experience neck pain during their lifetime, and 20 to 50 percent deal with it annually, according to Frank Pedlow, M.D., an orthopedic spine surgeon at Harvard-aﬃliated Massachusetts General Hospital. Besides the obvious problem of physical discomfort, neck pain can trigger headaches and cause numbness, tingling, or weakness in your arms. You may have trouble sleeping and difficulty turning your head, which can make driving dangerous. “Recurring episodes of chronic neck pain also can be associated with serious medical problems, including heart disease, rheumatoid arthritis, or infection,” says Pedlow. If you suffer from constant neck pain, you should consult your doctor to see if it is related to a medical condition. But for everyday pain that comes and goes, there are ways to keep your neck strong, healthy and pain-free. THE NECK AT WORK

Your neck has many functions. The neck muscles run from the base of the skull to the upper back and work together to bend the head and assist in breathing. Neck movements are divided into four categories: rotation, 58

OR TODAY | July/August 2016

lateral flexion, flexion and hyperextension. Rotation is moving the head from side to side, lateral motion brings the ear toward the shoulder, flexion moves the chin toward the chest, and hyperextension tilts the head back. Most neck pain comes from muscle strains and tension caused by everyday situations; for instance, slouching, poor posture or sleeping with your neck twisted. The mainstays of conservative treatment are nonsteroidal anti-inflammatory drugs (NSAIDs), which offer short-term relief. However, first check with your doctor, as they can have side effects, such as nausea and dizziness, and may interfere with other medications. Besides this, Pedlow also suggests ice and heat therapy. “Ice after an acute injury like a strain helps control immediate pain, stiffness, and inflammation,” he says. Apply an ice pack to the sore spot, 15 to 20 minutes at a time, several times a day, for the first 48 to 72 hours. If the pain lingers, switch to hot compresses or a heating

pad, or take a warm shower. Keeping the muscles strong and flexible by stretching the neck muscles can further help relieve soreness. Other possible treatments are acupuncture and the Alexander technique, according to a study published in the Nov. 3, 2015, Annals of Internal Medicine. Acupuncture uses hair-thin needles to stimulate specific points on the body to trigger physiological processes that relieve pain. The Alexander technique teaches you how to avoid unnecessary muscular tension by improving posture and alignment. In the study, researchers recruited 517 patients who had suffered from neck pain for an average of six years. They were randomly placed into groups: one group was offered up to 20 half-hour Alexander technique lessons; those in the second had up to a dozen 50-minute sessions of acupuncture. After a year, pain was reduced by 32 percent for the acupuncture patients and 31 percent for those who had Alexander lessons. CHANGE YOUR HABITS

One of the best treatments for neck pain, though, is prevention. Lifestyle factors like obesity and stress can raise your risk, so addressing those issues though a proper diet and regular exercise offers protection, WWW.ORTODAY.COM

HEALTH

says Pedlow. Here are some other strategies to follow: • When sitting for long periods, like at the computer or watching TV, avoid slouching or sitting with your head tilted forward. Sit straight, with your lower back supported by a pillow or lumbar support, feet flat on the floor, and shoulders relaxed. Stand every 20 minutes and stretch your neck muscles. • Adjust the computer monitor so the top is at eye level. Use a document holder that holds your work at the same level as the screen. • Position your car seat to a more upright position that supports your head and lower back. Avoid having to reach for the steering wheel. Your arms should be slightly flexed. • Cervical pillows may relieve neck stress by supporting your neck when you sit or sleep. Another option: fold a towel lengthwise into a four-inch-wide pad and wrap it around your neck. • When you read in bed, use a wedge-shaped pillow to support your back and keep your neck in a neutral position. NECK STRETCH

• Relax your shoulders and tilt your head toward one shoulder until you feel the stretch. Hold for 15 to 30 seconds. Repeat on the other side. Repeat two to four times in each direction. • For an added stretch, use your hand to gently pull your head toward your shoulder.

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• Turn your head slightly toward the left and tilt your head diagonally toward your chest and hold for 15 to 30 seconds. Repeat to the right side. • Repeat two to four times in each direction. • For an added stretch, use your hand to pull your head forward on the diagonal. GET YOUR NECK CHECKED FOR ARTHRITIS

Age raises your risk of neck arthritis, which affects more than 85 percent of people over 60. As you age, the cervical discs in your neck, which help to absorb shock to the spine, can slowly degenerate, become dehydrated and shrink, which can lead to neck pain. The good news: a study published online Jan. 12, 2016, by Clinical Interventions in Aging found this change tends to slow after age 60. X-rays and CT scans can confirm a diagnosis of arthritis. Physical therapy is often used to help strengthen muscles in the upper back and neck, which may help with pain. Over-the-counter pain relievers, muscle relaxants and steroid injections also may offer relief. “Still, it is possible to have neck arthritis and not experience symptoms,” says Pedlow. WWW.ORTODAY.COM

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OUT OF THE OR FITNESS

BY MARILYNN PRESTON

EXERCISE DROPOUT? A GENTLE INVESTIGATION OF SELF-SABOTAGE

s exercise good for you? Duh. Regular workouts give you strength, energy, a trimmer body, a healthier heart, a calmer mind and a much lower risk of at least 35 (!) different devastating diseases, including high blood pressure, stroke, osteoporosis, nonalcoholic fatty liver disease, diverticulitis, Type 2 diabetes, colon and breast cancer and, yes, even that star of prime-time TV: erectile dysfunction. In spite of what we know, we don’t do. According to the latest research, 92 percent of adolescents and 95 percent of adults in the U.S. do not meet the minimum guidelines for physical activity. Oh, dear. When I think about the gap between what we know about the benefits of exercise versus how much we actually do, I get weak in the knees. And then I remember this: There is a right way and a wrong way to approach exercise. Do it thoughtlessly, impatient for quick results, and you are setting yourself up to fail. Do it consciously, and your chances of lifelong success are greatly improved.

OR TODAY | July/August 2016

Here are some of the ways in which people sabotage their own fitness, and, yes, dear reader, I may be talking to you: 1. YOU AREN’T TRULY COMMITTED.

Saying you want to get in shape is not enough. You’ve got to have a deepdown, nothing-will-stop-me commitment. Change will happen only when you are ready, and when you are – hallelujah! – not only will you be able to overcome every obstacle; you will actually enjoy the process. 2. YOU HAVE FAILED BEFORE.

Many people don’t understand that change is not linear. It’s often two

steps forward, one step back. Exercise dropouts have failed before, and the fear of failing again often makes them quit. You can break this self-defeating cycle by taking fear of failure off the table. Know you can succeed, and you will succeed, if you are patient and persistent. 3. YOU PUNISH YOURSELF INSTEAD OF REWARDING YOURSELF.

Negative self-talk will derail you. Listen to your inner voice. If it says you’re lazy, stupid, ate too much and can’t get to the gym today, tell it to take a hike. Start a new inner dialogue based on kindness and compassion for the healthier, happier person you want to be. Create positive affirmations, like “I am capable of change and growth,” and repeat them often. 4. YOU COMPARE YOURSELF TO OTHERS.

Your best pal runs half-marathons and you struggle with a 10K. Wendy can cycle 40 miles and you can WWW.ORTODAY.COM

It’s 7:38 a.m.

FITNESS

Are You Counting the Minutes Past or the Dollars Lost?

barely finish 20. So what? Jealousy and envy are counterproductive and will lead you astray. Run your own race at your own pace. If you see others who are stronger, more flexible, thinner or more athletic, be happy for them … smile ... and return your focus to your own situation. Be grateful you have a situation. 5. YOU REFUSE TO KEEP A JOURNAL.

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This may sound like a homework assignment from your PROOF APPROVED CHANGES NEEDED dreaded algebra teacher, but the truth is, keeping a journal is a great tool for staying on track. So trySIGN–OFF: it. Just a CLIENT few observations: what you did; how long you did it; how PLEASE you felt. Once you have the exercise habit in place, youCONFIRM THAT THE FOLLOWING ARE CORRECT LOGO PHONE NUMBER WEBSITE ADDRESS can stop with the journaling. 6. YOU EXPECT QUICK RESULTS.

Impatience is a big problem for people just starting to exercise regularly. You expect immediate results, and when you don’t see them, you find a reason to quit. Outsmart yourself. Take it day by day. Find joy in just showing up. In time, all the benefits of regular exercise will come your way. It takes the time it takes. 7. YOU SEE YOURSELF AS THE VICTIM.

MARILYNN PRESTON is a healthy lifestyle expert, well being coach and Emmy-winning producer. She is also 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. WWW.ORTODAY.COM

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Many exercise dropouts blame their failure on someone or something: I can’t take time away from my kids. My job is too demanding. I travel too much. These are excuses created to test your true intention. When you take responsibility for your own health and wellness, you give up being a victim and start living the more active, balanced, joyful life you’ve always wanted. The beauty of self-sabotage is, whatever you do, you can undo. No guilt, no shame, just a willingness to start where you are – this time with a new, improved attitude and greater understanding about what it takes to succeed. And what does it take?

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OUT OF THE OR NUTRITION

BY MARSHA MCCULLOCH, M.S., R.D. ENTRÉE/ENVIRONMENTAL NUTRITION

DIETARY RELIEF FROM GERD T

he burning sensation of heartburn in your chest, caused by stomach contents flowing back up into your esophagus (food pipe), can be agonizing. If you experience this more than twice a week for a few weeks, you may have GERD (gastroesophageal reflux disease). GERD affects approximately 20 percent of people in the U.S. and is on the rise due to the epidemic of obesity. Although some people rely on antacids to soothe their symptoms, dietary and lifestyle changes can be a big help. RECOGNIZING REFLUX

Heartburn is a tell-tale sign of acid reflux, but some people with acid reflux don’t experience heartburn. “Throat symptoms such as a chronic cough, hoarseness, frequent throat clearing, throat burning, difficulty swallowing and/or a lump-like sensation in the throat may indicate a more severe form of 62

OR TODAY | July/August 2016

acid reflux disease,” says Jonathan Aviv, M.D., an otolaryngologist, the clinical director of the Voice and Swallowing Center at ENT and Allergy Associates in New York City, and author of “Killing Me Softly from Inside: The Mysteries and Dangers of Acid Reflux.” “Such throat symptoms are better predictors of risk for esophageal cancer than traditional heartburn symptoms,” he continues. This cancer risk is a big reason you shouldn’t ignore any symptoms of reflux and should be evaluated by your doctor. “A precursor of esophageal cancer that we examine patients for is Barrett’s esophagus, which is an abnormal lining of the lower part of the esophagus caused by chronic acid reflux,” says Pankaj Vashi, M.D., a gastroenterologist and chair of the department of medicine at Cancer Treatment Centers of America in Zion, Illinois. MEDICATION PRECAUTIONS

Television ads promote many over-the-counter (OTC) drugs for reflux.

“The general recommendation is to take OTC acid reflux medication for two weeks, then stop the medication to see if the symptoms come back. If the reflux symptoms return, you need to go to your primary care doctor,” Vashi says. Doctors may prescribe stronger doses of drugs called proton-pump inhibitors (PPIs), such as Prilosec and Nexium, for longer-term use, but they’re not risk-free. PPIs can weaken bones over time since they suppress acid production, which impairs calcium absorption. “I prefer to try to get people to change their diet and lifestyle rather than relying on medication,” Aviv says. DIET AND REFLUX

Although any food can potentially trigger reflux if a person is sensitive to it, certain foods more frequently cause problems, Aviv says. He divides common problem foods into two categories: acidic foods and foods that loosen or relax the muscle (the lower esophageal sphincter or LES) that acts as a control valve WWW.ORTODAY.COM

NUTRITION

vated and can start eating away at separating the stomach from the your throat and esophagus, causing esophagus, thus allowing reflux to damage and inflammation,” Aviv occur. The dietary items that relax says. the LES include caffeine, chocolate, This mechanism is also described alcoholic beverages, mint, onions in a 2011 scientific paper published and garlic. Fatty, spicy and fried in Annals of Otology, Rhinology & foods also may relax the LES, Laryngology. according to the American Society The interaction between acidic for Gastrointestinal Endoscopy. food and displaced pepsin means The reason that acidic foods can trouble for people trying to selfbe problematic in reflux is complex. treat heartburn with apple cider Aviv explains that when a person has vinegar and lemon juice, based on acid reflux, pepsin (an enzyme in the the incorrect idea that reflux is stomach that is activated by acid and triggered by insufficient stomach digests protein), travels with CHANGES the PROOF APPROVED NEEDED acid. stomach contents up the esophagus “When we examine patients who and can stick like Velcro in the CLIENT SIGN–OFF: drink this highly acidic concoction, it esophagus, throat and mouth. looks like a bomb went off in their “When a person consumes PLEASE CONFIRM THAT THE FOLLOWING ARE CORRECT throat,” Aviv says. “There is no something that’s very acidic, such LOGO NUMBERscientifiWEBSITE ADDRESS c paper that supports this as tomato juice, thePHONE pepsin that’s lodged in these places gets actitreatment, and it’s dangerous.”

LIFESTYLE AND REFLUX

In addition to dietary changes, Vashi emphasizes these strategies to reduce reflux: • Lose weight, if overweight. Excess weight puts pressure on your stomach and relaxes the LES. • Wear loose-fitting clothing around the waist. • Avoid smoking and second-hand smoke. • Eat smaller meals and avoid eating for three hours before lying down. • Elevate the head of your bed a bit (up to 30 degrees).

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OUT OF THE OR RECIPE

OR TODAY | July/August 2016

BY DIANE ROSSEN WORTHINGTON

WWW.ORTODAY.COM

RECIPE

SOPHISTICATED SUMMER DESSERT

FEATURES FRESH PEACHES

hen white peaches are in season, I can’t get enough of them. I make poached peaches in wine, chilled peach soup with yogurt, peach cobblers and more. Of course, eating a perfectly ripe white peach over the sink, with all is juiciness, is the epitome of summer eating to me. In the spirit of my Seriously Simple cooking philosophy, I offer you this traditional Catalan dessert called “mel i mato” which means, fresh cheese drizzled with honey in Spanish. This recipe, adapted from Seamus Mullen’s “Hero Food: How Cooking with Delicious Things Can Make Us Feel Better” (Andrews McMeel Publishing, LLC.), includes white and yellow peaches, but if you can’t find white peaches, this will still be delicious. Author Mullen prefers to use a mandoline to slice the peaches so they resemble whisper-thin flower petals. Don’t worry if you don’t have

a mandoline; just thinly slice the peaches with a sharp knife. It’s important to use a fresh whole-milk ricotta cheese for this recipe. The flavor and texture work beautifully for this dessert. I think of this as a sophisticated dessert that is easy to put together, beautiful to look at and divine to finish any meal. The drizzle of fruity olive oil is not necessary but an interesting finish to this not-too-sweet dessert.

INGREDIENTS: White Peaches, Ricotta, Honey and Toasted Pistachios SERVES: 4 2 or 3 firm white peaches, plus a yellow one Juice of 1 lemon 12 ounces fresh ricotta cheese 4 tablespoons honey 1/4 cup shelled pistachios, toasted in a dry, hot pan for 30 seconds 2 tablespoons fruity olive oil (optional)

DIRECTIONS: 1. Quarter and pit the peaches, then slice into thin curls on a mandolin or thinly slice with a knife. Place in a small bowl and toss with the lemon juice. 2. Divide the ricotta among 4 glass dessert bowls, then drizzle a tablespoon honey atop each bit of ricotta and toss in a handful of toasted pistachios. Top each glass with a few curls or peach slices and a drizzle of olive oil, if desired, and serve.

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Diane Rossen Worthington is an authority on new American cooking. She is the author of 18 cookbooks, including “Seriously Simple Parties,” and a James Beard Award-winning radio show host. You can contact her at www.seriouslysimple.com.

July/August 2016 | OR TODAY

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OUT OF THE OR PINBOARD

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POWER RANGERS TOOTHPASTE, FLOSSERS ARRIVE IN U.S.

Busy parents know it can be diﬃcult to instill good habits in their children. Now, they have a super helper in the Power Rangers. Sunstar Americas Inc. has announced the completion of the GUM Power Rangers line of children’s oral care products by releasing a red, berry-flavored toothpaste and themed colored Oral Care Line flossers in the United States. Kids can confidently conquer plaque with a little help from their favorite superheroes, Saban’s Power Rangers. The three items required for a complete oral health regimen include a toothbrush, toothpaste and a tool for between teeth cleaning, such as flossers. The GUM Power Rangers kids oral care line features new red-colored, berry-flavored toothpaste and red, blue and dark gray flossers. These products match the power and timer-light toothbrushes currently available in the United States. The toothpaste contains the dentist and FDA recommended level of fluoride, which actively fights against cavities, and the tasty flavor has been kid tested and approved, ensuring children will look forward to brushing their teeth.

OR TODAY | July/August 2016

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BITE BACK AGAINST MOSQUITOES From annoying itchy welts to serious conditions like Malaria and West Nile virus, mosquitoes have been making humans miserable and sick for thousands of years. And now, there’s Zika – a mosquito-spread virus that may be linked to serious birth defects. In fact, according to the National Institute of Allergy and Infectious Diseases, the diseases mosquitoes spread make them the deadliest animal on the planet. The arrival of warm weather means it’s time to step up your mosquito prevention and protection efforts in order to help protect your family. The National Pest Management Association recommends some ways you can help reduce your exposure to mosquitoes: Zika Mosquito • Eliminate breeding areas: Mosquitoes need only about a half-inch of standing water in which to lay their eggs. Get rid of any stagnant water around your home. • Use repellent: Whenever you spend time outside, protect your skin from mosquito bites by applying an insect repellent that contains at least 20 percent DEET, picaridin or oil of lemon-eucalyptus. • Be aware of the time of day: Mosquitoes are most active around dawn and dusk, although the variety that transmits Zika prefers to bite during the day. Minimize outside activity during peak biting hours, or, if you must be outside, wear long sleeves, pants and repellent to thwart mosquitoes. • Watch what you wear: Dark colors, floral prints and sweet-smelling perfumes or colognes can attract mosquitoes to you. Wear light colors and forego perfume when spending time outside. Sometimes, despite your best efforts at control, mosquitoes on your property can still be a problem. To find a licensed pest control professional near you, visit the NPMA’s website at pestworld.org.

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July/August 2016 | OR TODAY

INDEX ALPHABETICAL AAAHC ……………………………………………………… 57 AIV Inc. ……………………………………………………… 50 Ansell Healthcare, Inc. …………………………… 31 Arthroplastics, Inc. …………………………………… 63 Belimed Inc. ……………………………………………… 59 C Change Surgical ……………………………………… 4 Cardinal Health ………………………………………… 13 Checklist Boards Corp. …………………………… 56 GelPro ………………………………………………………… 19 Glacier Tek …………………………………………… 51, 56 Gopher Medical ………………………………………… 66

Healthmark Industries……………………………… 67 Innovative Medical Products, Inc ………… BC Interpower Corporation …………………………… 5 Jet Medical Electronics ………………………………17 Kenall Mfg/Indigo Clean …………………………… 6 MAC Medical …………………………………………… IBC Medi-Dose/EPS ………………………… 13,15,17,19,23 Medi-Kid Co. ……………………………………………… 61 MD Technologies ……………………………………… 59 Pacific Medical LLC …………………………… 42-45 Palmero Health Care ……………………………… 24

Paragon Service ……………………………………… 30 Polar Products, Inc. ………………………………… 15 RepScrubs …………………………………………………… 11 Ruhof Corporation ……………………………………2-3 Sealed Air ………………………………………………… 40 SMD Waynne Corp. ………………………………… 56 Specialty Care …………………………………………… 61 Surgical Power ………………………………………… 66 TBJ, Inc. ………………………………………………………… 9 USOC Medical …………………………………………… 41 Whitney Medical Solutions …………………… 24

ACCREDITATION AAAHC ……………………………………………………… 57

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

RADIOLOGY Checklist Boards Corp. …………………………… 56

ANESTHESIA Checklist Boards Corp. …………………………… 56 Gopher Medical ………………………………………… 66 Paragon Service ……………………………………… 30

INFECTION CONTROL/PREVENTION Belimed Inc. ……………………………………………… 59 Cardinal Health ………………………………………… 13 Palmero Health Care ……………………………… 24 RepScrubs …………………………………………………… 11 Ruhof Corporation ……………………………………2-3 Sealed Air ………………………………………………… 40 Whitney Medical Solutions …………………… 24

REPAIR SERVICES Pacific Medical LLC …………………………… 42-45

INDEX CATEGORICAL

APPAREL Healthmark Industries……………………………… 67 ASSOCIATIONS AAAHC ……………………………………………………… 57 BEDS Innovative Medical Products, Inc ………… BC

INSTRUMENT STORAGE/TRANSPORT Belimed Inc. ……………………………………………… 59 Medi-Dose/EPS ………………………… 13,15,17,19,23 KNEE SYSTEMS Innovative Medical Products, Inc ………… BC

SAFETY GEAR Cardinal Health ………………………………………… 13 Glacier Tek …………………………………………… 51, 56 SHOULDER RECONSTRUCTION Innovative Medical Products, Inc ………… BC SIDE RAIL SOCKETS Innovative Medical Products, Inc ………… BC STERILIZATION Belimed Inc. ……………………………………………… 59 Specialty Care …………………………………………… 61 TBJ, Inc. ………………………………………………………… 9

CARDIOLOGY C Change Surgical ……………………………………… 4 Gopher Medical ………………………………………… 66 Specialty Care …………………………………………… 61

LABORATORY TBJ, Inc. ………………………………………………………… 9

CARTS/CABINETS MAC Medical …………………………………………… IBC

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

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

MONITORS Jet Medical Electronics ………………………………17 USOC Medical …………………………………………… 41

SURGICAL Arthroplastics, Inc. …………………………………… 63 Checklist Boards Corp. …………………………… 56 Kenall Mfg/Indigo Clean …………………………… 6 MD Technologies ……………………………………… 59 Surgical Power ………………………………………… 66 Whitney Medical Solutions …………………… 24

OR TABLES/ ACCESSORIES Arthroplastics, Inc. …………………………………… 63 Innovative Medical Products, Inc ………… BC

SURGICAL SUPPLIES Cardinal Health ………………………………………… 13 Ruhof Corporation ……………………………………2-3

ORTHOPEDIC Surgical Power ………………………………………… 66

SUPPORTS Innovative Medical Products, Inc ………… BC

OTHER Ansell Healthcare, Inc. …………………………… 31 AIV Inc. ……………………………………………………… 50 Medi-Dose/EPS ………………………… 13,15,17,19,23 Medi-Kid Co. ……………………………………………… 61 SMD Waynne Corp. ………………………………… 56 TBJ, Inc. ………………………………………………………… 9 Whitney Medical Solutions …………………… 24

TELEMETRY USOC Medical …………………………………………… 41

PATIENT MONITORING Gopher Medical ………………………………………… 66 Pacific Medical LLC …………………………… 42-45 Specialty Care …………………………………………… 61 USOC Medical …………………………………………… 41

WARMERS Belimed Inc. ……………………………………………… 59 Glacier Tek …………………………………………… 51, 56 MAC Medical …………………………………………… IBC

CLAMPS Innovative Medical Products, Inc ………… BC CRANIOFACIAL RECOVERY PRODUCTS Medi-Kid Co. ……………………………………………… 61 DISINFECTANTS Palmero Health Care ……………………………… 24 Sealed Air ………………………………………………… 40 DISPOSABLES Pacific Medical LLC …………………………… 42-45 ENDOSCOPY MD Technologies ……………………………………… 59 Ruhof Corporation ……………………………………2-3 TBJ, Inc. ………………………………………………………… 9 FALL PREVENTION GEL PADS GelPro ………………………………………………………… 19 Innovative Medical Products, Inc ………… BC GENERAL AIV Inc. ……………………………………………………… 50 GelPro ………………………………………………………… 19 Surgical Power ………………………………………… 66 HAND/ARM POSITIONERS Innovative Medical Products, Inc ………… BC

OR TODAY | July/August 2016

POSITIONERS/IMMOBILIZERS Cardinal Health ………………………………………… 13 Innovative Medical Products, Inc ……………………………………………… BC

TEMPERATURE MANAGEMENT C Change Surgical ……………………………………… 4 Glacier Tek …………………………………………… 51, 56 MAC Medical …………………………………………… IBC Polar Products, Inc. ………………………………… 15

WASTE MANAGEMENT Sealed Air ………………………………………………… 40 WOUND MANAGEMENT Cardinal Health ………………………………………… 13

POWER COMPONETS Interpower Corporation …………………………… 5

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Quality built, American made

Medical Equipment

MAC Medical, Inc. manufactures the highest quality medical equipment available. Our engineering capabilities allow us to custom design any specific product your facility may have. With no project too large or too small for our capability, we are committed to providing solutions for your custom needs with our American made products. Some of our products include: • Warming Cabinets • Stretchers • Surgical Scrub Sinks • Processing Sinks • Cabinetry • Tables • Carts • IV Stands • Mayo Stands • Solution Stands

• Prep & Pack Workstations • Linen Hampers • Kick Buckets • Step Stools • Wall Shelves • Pass Through Windows • Peg Boards • MR Conditional Products • Any other customized stainless steel need

Corporate Office 325 West Main Street Belleville, IL 62220 Manufacturing Plant 820 South Mulberry Street Millstadt, IL 62260 Phone: 618-476-3550 Toll Free: 877-828-9975 Fax: 618-476-3337 sales@macmedical.com www.macmedical.com

For more information, contact our customer service department at 618-476-3550 or 877-828-9975, or by email at sales@macmedical.com.

Customer needs are our first priority. Check out our new redesigned website

www.macmedical.com

Making Knee Positioning Easier and More Precise. Again. Introducing the De Mayo V2E.

V2E™ Off Table

V2™ On Table

Surgeon can stand between patient’s legs and does not need to bend or stoop. >

Choose between traditional spring-loaded handle or new flip handle.

Positive Lock Clamp. >

Tilt control allows varying degrees of lateral movement by pushing the slidebar in increments from open to close.

Extending the simplicity and flexibility of the De Mayo V2 Knee Positioner®. TM

The De Mayo V2E Knee Positioner gives you more options for unobstructed access – extension arm positions knee off the operating table. TM

• • • • • •

Surgeon can stand between patient’s legs for greater access approaching the medial compartment Straight-on knee access provides line of sight to surgical site – no need to lean over OR table More precise control of lateral movement and improved boot-holding capabilities Removable Carriage is easier to clean and maintain Lighter Base Plate and handle options improve ease of use New Side Rail Clamp with a positive lock Learn more about the unique features of the De Mayo V 2 ETM Knee Positioner at www.impmedical.com or call 800-467-4944 for more information or to speak with a representative.

The operative word in patient positioning. www.impmedical.com

De Mayo V2ETM Knee Positioner is a trademark of Innovative Medical Products, Inc. U.S. Patent No. 8,132,278 V2ETM Clamp is a trademark of Innovative Medical Products, Inc. U.S. Patent No. 7,003,827