OR Today - October 2016 by MD Publishing

SPOTLIGHT ON

LINNETTE JOHNSON PAGE 54

CONTINUING EDUCATION

SCRAPBOOK

TREATING HYPOTHERMIA PAGE 32

TAKE GOOD CARE NURSES • SURGICAL TECHS • NURSE MANAGERS

OR TODAY LIVE! PAGE 74

OCTOBER 2016

www.ortoday.com

AND THE

THE

GOOD BAD UGLY AVOIDING COSTLY INFECTIONS

READ OUR CORPORATE PROFILE ON PAGES 42-45

WWW.ORTODAY.COM

October 2016 | OR TODAY

Prepzyme Forever Wet ®

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

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

For More Information and GENEROUS FREE SAMPLES

1-800-537-8463 www.ruhof.com 393 Sagamore Avenue, Mineola, New York 11501 Tel: 516-294-5888 Fax: 516-248-6456 2

OR TODAY | October 2016

WWW.ORTODAY.COM

AD-008

OR TODAY | October 2016

WWW.ORTODAY.COM

SIMPLE HOSPITAL-GRADE POWER CORD SOLUTIONS Did you know that Interpower® offers a simple solution if you need hospital-grade replacement cords? Our no minimum order requirement allows you to order just 1, 5, 100, or more. Interpower’s North American hospital-grade power cords and cord sets are made in Iowa and approved to the appropriate UL and CSA medical standards. Replacement cords are available, as well as custom orders. All Interpower manufactured cords are electrically tested for safety. Value-added options such as custom packaging and labeling are available upon request. We can provide special labeling for the use of custom identification. We offer a variety of options with an extensive range of clear, black, and gray North American hospital-grade plugs on power cords, cord sets, and replacement cords. •

Made in Iowa

•

No minimum order requirements

•

Same day shipments available for in-stock products

•

1-week U.S. manufacturing lead-time on non-stock Interpower products

•

Over 4 million parts in stock

•

Free technical support

Contact our Customer Service Representatives today for pricing availability and technical aspects, such as application and/or approvals, help in obtaining required documentation, and for assistance in designing specialty products. QUICK PICK REPLACEMENT OPTIONS P/N 86610400 Rating: 10A/125VAC

Conductor Size: 3 x 18AWG

Length: 3.05m/10.0ft

Conductor Size: 3 x 18AWG

Length: 3.05m/10.0ft

Conductor Size: 3 x 14AWG

Length: 3.05m/10.0ft

P/N 86610810 Rating: 10A/125VAC

P/N 86611610 Rating: 15A/125VAC ® 011

ARE YOUR REUSABLE SUCTION TUBES A PROBLEM? "Surgical instruments that cannot be thoroughly cleaned of debris cannot then be sterilized effectively for patient use"

Extended Length

A variety of suction tips were cleaned and tested with a variety of processes and products to determine best instrument cleaning practices. Results of the project were eye-opening: debris was found where debris should not be"

Difficult Angles Small Lumen

AORN J 96 (August 2012) 152-162. Â© AORN, Inc, 2012

MAKE THE SWITCH TO CLEAN AND EFFECTIVE SINGLE USE SUCTIONS FROM BOSS INSTRUMENTS Over 100 Patterns of Procedure-Specific Suctions S074-Frazier Suction 12 Fr

Sold Sterile in Convenient Dispenser Box High Quality - Ergonomic Feel

S189-Teardrop Suction 9 Fr

Dissecting & Atraumatic Tips S177-Fine Suction 5 Fr

FREE Evaluation Samples Also available as part of our expansive line of Single Use Instruments:

Kerrison Rongeurs

Myringotomy Kits

104 Sommerfield Drive Gordonsville, VA 22942 USA www.bossinst.com 6

OR TODAY | October 2016

Aspiration Needles

Toll Free: 800-210-2677 Fax: 540-832-5515 Email: inquiry@bossinst.com WWW.ORTODAY.COM

Boss Instruments is the exclusive US distributor of the Single Use Surgical line of products, manufactured by Pelican Feminine Healthcare (www.pelicanfh.co.uk)

CONTENTS

features

OR TODAY | October 2016

CORPORATE PROFILE: XENEX

Xenex Disinfection Services was founded by epidemiologists Dr. Mark Stibich and Dr. Julie Stachowiak. The company’s mission then – and now – is to stop the pain, suffering and deaths caused by hospital acquired infections by destroying the pathogens that cause them. Today, Xenex LightStrike™ Germ-Zapping Robots™ are being used by more than 350 hospitals, surgery centers, long-term acute care and skilled nursing facilities in the U.S., Canada, Europe, UK and Africa.

AND THE

THE

GOOD BAD UGLY AVOIDING COSTLY INFECTIONS

THE GOOD, THE BAD, AND THE UGLY AVOIDING COSTLY INFECTIONS Infections can be costly to health care facilities. Patients with HAIs are 60 percent more likely to be admitted to the ICU, thus incurring additional health and economic burdens. A recent CDC study determined that each hospital-acquired SSI costs hospitals up to $34,670 in direct costs.

SPOTLIGHT ON: LINNETTE JOHNSON Linnette Johnson grew up wanting to be a nun. “My hero was Mother Theresa,” she says. However, she also wanted a large family. Her compromise was to become a nurse and she currently serves as the Assistant Vice-President for Surgical Services at Florida Hospital Orlando as well as a mother of four.

OR Today (Vol. 16, Issue #8) October 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. © 2016

WWW.ORTODAY.COM

October 2016 | OR TODAY

CONTENTS

departments

PUBLISHER

John M. Krieg | john@mdpublishing.com

VICE PRESIDENT

Kristin Leavoy | kristin@mdpublishing.com

26 18

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 16 18 20

Clorox Advice News & Notes AAAHC Update Company Showcase: Doctors Depot OR Today Webinar

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

60 Health 62 Fitness 66 Nutrition 68 Recipe 72 Pinboard 74 OR Today Live! Scrapbook

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

78 Index

OR TODAY | October 2016

WWW.ORTODAY.COM

OPERATING ROOM

SAFETY SOLUTIONS

State-of-the-Art Surgical Mats • Safety Products • Fluid Management Solutions Disposable, Economical, Practical

Made in the U.S.A.

THE SURGICAL MAT™ PATENTED

FLUID DIAMOND™ FLOOR ASPIRATOR

PATENTED PENDING

www.flagshipsurgical.com

THE MINI MAT™

THE SUCTIONER™

THE ECOSUCTIONER™

PATENTED

SAFE CORD™ FLOOR STRIP

@flagshipsurg #ORergonomics

DRI-SAFE™

ABSORBENT PADS

INDUSTRY INSIGHTS CLOROX ADVICE

BY KENT STIMSON, SUPPORT OPERATIONS MANAGER, DANBURY HOSPITAL, DANBURY CT

THE HEALTHCAREASSOCIATED INFECTION CHALLENGE

ealthcare facilities face a number of challenges when it comes to safeguarding the patient environment. While manual cleaning and disinfection is a crucial step to reducing pathogens that may cause healthcare-associated infections (HAIs), we felt that a more comprehensive approach to environmental infection prevention would better assist our facility in the fight against pathogens and the growing threat of antibiotic resistance. At Danbury Hospital in Connecticut, we continuously review and re-assess processes to ensure the provision of an infection-free environment for our patients. The implementation of three Clorox Healthcare® Optimum-UV® Systems has assisted in achieving this, and has become an important component of our environmental services infection prevention efforts to reduce infections and provide better patient outcomes. EDUCATION AND UV IMPLEMENTATION

When we implemented the Clorox Healthcare® Optimum-UV® System in 2015, it was important to us that our team members understood why this technology should be used to bolster our already strong infection prevention program. UV-C energy kills persistent pathogens, including those of top concern such as Clostridium difficile (C. difficile), carbapenem-resistant enterobac10

OR TODAY | October 2016

teriaceae (CRE) and Methicillinresistant Staphylococcus aureus (MRSA). We started education about the devices early on, using our daily team huddles to discuss how the UV disinfection contributes to patient safety and quality of care and service. It was critical to assess and educate the staff that would eventually use the three devices. We took a core group of employees that are involved with discharge cleaning (both patient unit environmental services employees, as well as supervisory personnel) and brought them in with the sales representative, so that they could be involved in the training process and really see, first hand, how easy it is to use. UV WORKFLOW

I don’t feel that adding the UV technology was a separate process, but rather an extension of what we already do, and a further commitment to patient safety. We did not

dedicate just one person to the UV machine, but rather integrated it into our existing facility-wide processes and workflows. The UV Light unit was initially purchased for our OR procedural rooms, but has since expanded to our Interventional Radiology and CTSCAN procedural rooms. Along with discharge cleans of all contact isolations, we also strive to provide monthly “preventative” service to all 30 rooms in our ICU and Step Down patient units. Overall, the response has been very positive. Our staff sees it as a great addition to our cleaning and disinfection processes. They have seen how the UV-C technology improves our patients’ safety by offering an extra layer of protection, and killing microorganisms in high-risk settings and areas of the healthcare environment that may otherwise be missed or insufficiently addressed. The Clorox Healthcare® Optimum-UV® System is a critical component to our program, and is another means of ensuring a safe and infection-free environment to our patients at Danbury Hospital. Employee engagement and sharing the big picture on how the measures we are taking positively impact the patient experience has helped make all the difference. WWW.ORTODAY.COM

WWW.ORTODAY.COM

October 2016 | OR TODAY

INDUSTRY INSIGHTS NEWS & NOTES

DIVERSEY CARE LAUNCHES OXIVIR 1 DISINFECTANT CLEANER Sealed Air’s Diversey Care division has announced the launch of Oxivir 1 to its product line. Oxivir 1 is a new disinfectant cleaner that is effective against bacteria, enveloped and non-enveloped viruses, TB, and fungi in one minute or less. With 81 disinfectant claims, it now leads Diversey Care’s lineup of fast, effective, responsible and sustainable disinfectant options. Like other members of the Oxivir family, Oxivir 1 has the best possible safety rating (category IV), and the one-step solution, designed for use in health care

environments, is tough enough to clean and disinfect surfaces and equipment in one pass while being gentle on staff and surfaces. It is non-irritating to skin and eyes, requires no personal protective equipment and is compatible with most common health care surfaces and equipment. In addition to being effective as a one-step disinfectant cleaner, Oxivir 1 also has Environmental Protection Agency (EPA) approval as a soft surface sanitizer. • FOR MORE INFORMATION about Oxivir 1, visit sealedair.com

H.E.R.O. NURSE SERVICE AWARD WINNERS ANNOUNCED Ansell recently announced the winners of the 4th annual U.S. Ansell Cares H.E.R.O. (Heal. Educate. Reach. Overcome.) Nurse Service Award. The award serves to recognize nurses who have made lasting impressions on their peers, patients, profession and communities. Nurses from around the country were nominated by friends, family, colleagues, and patients, followed by a voting period. In recognition of their accomplishments, 10 winners received a H.E.R.O. Nurse Service Award plaque and certificate, a nursing reference book of their choice, and will have their story profiled online. In addition, the top vote recipient of the 10 winners will receive a donation to the charity of their choice. The H.E.R.O. with the most votes was Rebecca White, BSN, RN from Texas Children’s Hospital. “As a mother of a child with debilitating chronic illness, I found myself called to the nursing profession, inspired by the heroes I came in contact with in the NICU nine years ago,” says White. Seven years later, she made her way back to that NICU, though this time on the other side. She spends her time off volunteering in the community and going 12

OR TODAY | October 2016

above and beyond at her organization. A $10,000 donation will be made in her name to the Children’s Craniofacial Association http://www.ccakids.com/. This year’s additional winners are: • Paolo Pentines: Legacy Meridian Park Medical Center – Oregon • Verconica Vital: Chamberlain College of Nursing – Arizona • Heather McKelvy: Stanford Children’s Hospital – California • Jean Iris Foxworth: National Park Medical Center – Arkansas • Paula Goff: Advocate Lutheran General Hospital – Illinois • Carla Khristina: Sunrise Hospital – Nevada • Kim Kiser: Novant Health Presbyterian Medical Center – North Carolina • Michele Lynch: VA Hospital NWIHCS – Nebraska • Brenda McFadden: Marathon Health/T.J. Samson Community Hospital – Kentucky • FOR MORE INFORMATION, visit www.ansellhero.com/en/Winners.aspx. WWW.ORTODAY.COM

NEWS & NOTES

ACELITY OFFERS NEW GELLING FIBER ADVANCED WOUND DRESSING Acelity has announced that BIOSORB Gelling Fiber Dressing is available in the United States and has CE Mark in Europe, where it will be available in the coming months. The BIOSORB Dressing is a unique wound dressing that forms a gel when it comes into contact with an exuding wound. This dressing offers increased absorbency and the ability to hold its shape, allowing for intact removal which is designed to make dressing changes less painful for patients. The dressing can be used for a variety of exuding wounds including leg ulcers, pressure

ulcers, diabetic foot ulcers, surgical wounds that exude fluid, partial thickness burns, traumatic and oncology wounds. “The addition of gelling fiber delivers on an important component of our business strategy in that Acelity now has a complete range of advanced wound dressings that will address a full spectrum of patient needs,” said Joe Woody, president and chief executive officer of Acelity. BIOSORB Gelling Fiber Dressing comprises CMC (carboxymethylcellulose) fibers which allow the dressing to absorb many times its

own weight in fluid, protecting the wound edge and surrounding skin. Furthermore, its cellulose fibers reinforce the dressing, allowing it to remain strong and intact when wet. The product is designed to provide ease of application for the clinician, as well as pain-free removal, to create a more comfortable option for patients compared to many other fiber dressings. BIOSORB Gelling Fiber Dressing is currently available in the nonsilver format (non-antimicrobial), with the silver version (anti-microbial) expected to follow early next year. •

MASIMO ANNOUNCES CE MARKING FOR PEDIATRIC O3 REGIONAL OXIMETRY Masimo has announced the CE marking for the pediatric indication for O3 regional oximetry with the O3 pediatric sensor. Regional oximetry, also referred to as tissue or cerebral oximetry, helps clinicians monitor cerebral oxygenation. O3 regional oximetry uses near-infrared spectroscopy (NIRS) to continuously monitor absolute and trended regional tissue oxygen saturation (rSO2) in the cerebral region. Early detection and correction of imbalances in oxygen delivery to the brain and vital organs are important tools in helping patients avoid postoperative morbidity and adverse outcomes. With the release of the O3 pediatric sensor, O3 regional oximetry monitoring of rSO2 is now available to pediatric patients weighing less than 88 pounds. Masimo O3 regional oximetry and SedLine brain function monitoring are both available on a single platform, Masimo Root – opening up a path to better understanding of the brain. O3 regional oximetry for use with adults weighing 88 pounds or greater has received FDA 510(k) clearance. WWW.ORTODAY.COM

O3 regional oximetry for use with pediatric patients weighing less than 88 pounds has not received FDA 510(k) clearance; the O3 pediatric sensor is not currently for sale in the United States. •

October 2016 | OR TODAY

INDUSTRY INSIGHTS NEWS & NOTES

COMPASS HEALTH BRANDS ACQUIRES MERIDIAN MEDICAL Compass Health Brands recently announced the acquisition of Meridian Medical, a manufacturer and supplier of gel overlays, seating/positioning cushions, therapeutic support surfaces, lymphedema systems and respiratory products. Terms of the purchase are not being disclosed. The company will now have a full suite of solutions for pressure prevention to better service HME providers. Meridian Medical markets its products under six the brands: Air Lift, CareFore, Ultra Care, Gel Lite, Core Comfort and MediPress.

“This acquisition expands our best in class product portfolio and provides us a solid platform in the pressure prevention category,” said Stuart Straus, President and CEO of Compass Health Brands. “In addition, Meridian nicely compliments our Roscoe Medical business and greatly enhances our ability to meet the growing needs of our home medical equipment dealer network.” With operations in Knoxville, Tennessee, Meridian Medical will continue to manufacture products in the United States. Mike Cofer will stay on and serve as Director of Manufacturing Operations. •

ALBAHEALTH OFFERS FALL RISK MANAGEMENT KITS Albahealth, a Division of Encompass Group LLC, offers Safe-Steps Fall Risk Management Kits that provide a convenient prepackaged product easily identifying patients at risk for falls. Components include chart stickers, entryway magnets, identification bracelets, patient safety footwear, patient gowns, and a patient throw blanket. The patient throw blanket is available in the premium kit. These components support increased visibility to staff, visitors, and during department transfer of patients at a greater risk for falls. Confetti Treads Patient Safety Footwear, included in the kit, features top of the line slip-resistance and 360-degree protection with a unique, and patented all-around tread profile. “Falls that occur in hospitalized patients are a widespread and serious threat to patient safety. Accidental falls are among the most common incidents reported in hospitals,” said Jennifer Woody, Senior Marketing Manager, Encompass Group. “Our Safe-Steps Fall Risk Management Kits are designed to help improve patient safety with highly visible 14

OR TODAY | October 2016

patient identification products and fall prevention, created with the Encompass belief that better care starts with safety and comfort in mind.” • WWW.ORTODAY.COM

NEWS & NOTES

HEALTHMARK INDUSTRIES ANNOUNCES HEATED VEST Healthmark Industries announces the addition of the Heating Vest to its Personal Protection Equipment (PPE) accessory line. Keep warm in cool environments with the reusable heated vest that emits comfortable levels of warmth for the wearerâ&#x20AC;&#x2122;s torso to keep cozy in cool ambient conditions. Fashioned with a soft-shell barrier fleece fabric, the Heating Vest features zippered front pockets with adjustable elastic cord at the bottom and zipper closure provides comfort The Heating Vest comes equipped with a controller that has three temperature settings for selecting the desired amount of heat, removable heating elements for easy cleaning and a LI-Ion battery that pairs with the supplied charger. â&#x20AC;˘ VISIT www.hmark.com or call 800-521-6224 for more information.

WWW.ORTODAY.COM

October 2016 | OR TODAY

INDUSTRY IN THE OR INSIGHTS AAAHC UPDATE

BY ANGELA FITZSIMMONS

POLICY, PROCESS, PROGRAM:

WHAT DOES IT ALL MEAN

“W

hat does it mean to say that you have an infection control (or risk management or quality improvement) program? You may, for example, have a series of policies that address a variety of infection prevention topics (e.g., hand hygiene, safe injection practices, equipment cleaning, disinfection and sterilization) – but does keeping those policies in one binder make them an IPC program?

Throughout the AAAHC Standards there are requirements for documented policies or plans, activities, and processes. There are also references to specific programs: • Risk management • Infection prevention and control • Safety • Quality management and improvement • Peer review • Biological hazards • Physical hazards What differentiates a program? Simply put, it comes down to scope and scale. In the context of AAAHC Standards, a policy establishes a rule; a plan or process is a repeatable way of doing something, and an activity is a discrete, measurable amount of work. A program, on the other hand, integrates these component parts (and often multiples of each) in an organized way to address a potential problem. POLICY + PROCESS + ACTIVITY = PROGRAM

Let’s look at an example. It is AAAHC policy that an organization must be substantially compliant with the current Standards throughout its term of accreditation. Two processes that we use to implement this policy are on-site 16

OR TODAY | October 2016

accreditation surveys and distribution of any and all updates to the Standards. Observation of a patient-provider interaction and review of a selection of clinical records are activities that we use to measure compliance with this policy. The policy, processes and activities are all elements of the overall accreditation program that addresses patient safety and quality of care in ambulatory health care settings. A MATRIX APPROACH

The infection control policy topics identified in the introductory example could (and should) be elements in an effective infection control program, but a collection of policies is not, in itself, a program. So where do you start? When building a program, think both wide and deep. The first rule of developing a program is: Make it specific to your organization. Achieving this will almost certainly require the buy-in and contributions of a crossfunctional team. Begin by engaging this team in a formal risk assessment. To continue the infection control example, consider who your patients are, what services you provide, who your providers and personnel are, the geography and size

of your facility, infections endemic to your location or population, and analysis of your existing infection control surveillance activities. Then, document and prioritize your risks using a rating scale. For example, consider the likelihood of occurrence (low-medium-high), the level of risk represented (death, permanent injury, temporary injury, none), the potential impact on care, treatment, services, and how well prepared your organization is to deal with the identified risks. With your issues prioritized, you can begin to set goals for the program. Make them SMART: Specific, Measurable, Achievable, Relevant, and Timebound. Rather than, “We will improve hand hygiene compliance,” a SMART goal sounds like, “Hand hygiene compliance will be 90 percent or better by the end of Q2 as measured by rotating observers.” This process (documenting, prioritizing, goal-setting) can be followed for each risk category in each program you develop. Think of building your program as developing a matrix. Each element of the program is important, but that value is magnified in the context of the overall program. Seen in the matrix view, each contributing element of a program has an WWW.ORTODAY.COM

AAAHC UPDATE

associated goal that contributes to the higher level goal of the overall program. KEEP THE PICTURE BIG

Sometimes we lose the forest for the trees in building programs. For example, organizations can become so engrossed in developing quality improvement studies that they confuse them with QI programs. A QI study will, by definition, include a goal, collection and analysis of relevant data, corrective action, re-measurement, and reporting, but a QI program will integrate the study activities with peer review, benchmarking, and risk management. A study has a beginning and an end (although it can certainly be repeated); a program is ongoing – it should evolve in response to changing conditions and regular revision of the risk assessment. Understanding the differences among policy, procedure, activity and program can mean the difference between compliance and noncompliance with many AAAHC Standards. ABOUT THE AUTHOR Angela FitzSimmons is Director, Marketing and Communications, for AAAHC and its family of companies. Since 2011, she has focused on bringing best practices to life by developing educational resources for AAAHCaccredited organizations based on the Standards. WWW.ORTODAY.COM

Total room disinfection in your OR isn’t the future. It’s now. Tru-D SmartUVC is the only automated, no-touch UV disinfection system validated by a methodand device-specific, CDC-funded, randomized clinical trial that ensures a 30%+ reduction of HAIs in hospitals*. Learn more about Tru-D and its cutting-edge SmartUVC technology at Tru-D.com today. * Benefits of Enhanced Terminal Room Disinfection (BETR-D) Study: A Cluster Randomized, Multicenter Crossover Study with 2x2 Factorial Design to Evaluate the Impact of Enhanced Terminal Room Disinfection on Acquisition and Infection Caused by Multidrug-Resistant Organisms (MDRO). (Daniel J. Sexton, MD, et al., 2015)

SEE THE TRU-DIFFERENCE AT TRU-D.COM

(800) 774-5799

October 2016 | OR TODAY

COMPANY SHOWCASE DOCTORS DEPOT

DOCTORS DEPOT

QUALITY STRESSED AT EVERY LEVEL

octors Depot focuses on providing the highest quality refurbished anesthesia machines, monitors and related products. Highly skilled, manufacturer-trained technicians complete all the work in-house. Doctors Depot is a true stocking dealer. The company maintains a large inventory from the top manufacturers. Doctors Depot also provides new and refurbished parts and a depot repair service. A steadily expanding inventory, plus service, parts, and even financing options, make Doctors Depot a customer friendly company. Doctors Depot Founder and President Aaron Frye says he began offering a depot repair service so his customers could avoid paying the flat rate from the manufacturer for simple repairs. He troubleshoots over the phone, and the customer decides whether to send the equipment in or have Doctors Depot send the parts for the repair. Plus, both new and used parts provided through the depot repair service come with a one-year warranty. Doctors Depot’s repair business is largely an extension of its refurbished equipment business. The company has been in business for more than a decade, and along with all the repeat business, Doctors Depot has caught the attention of several large health systems and doctor’s offices across the nation.

OR TODAY | October 2016

Customers are being forced to replace their existing equipment, but what many don’t realize, Frye reveals, is that Doctors Depot stocks refurbished versions of the most current models, at a price point that is much lower than buying brand new. “We sell the newest models that are still supported by the manufacturer,” Frye says. “You cannot tell the difference between a new machine and one of our refurbished machines, and I can typically save my customers 50 percent on most machines.” “One of the advantages Doctors Depot has over our competitors is our specialization,” Frye explains. “We are extremely specific and specialized to anesthesia machines and patient monitors. Our narrow specialization keeps our overhead at a minimum, which enables us to beat anybody’s price without cutting any corners, and most important, quality. Our techs see the same narrow spectrum of equipment day in and day out, so they’re truly experts on it.” “For every piece of equipment Doctors Depot refurbishes, the company has a technician certified by the OEM to work on that equipment,” Frye says.

“ We sell the newest models that are still supported by the manufacturer. You cannot tell the difference between a new machine and one of our refurbished machines, and I can typically save my customers 50 percent on most machines.” “Our refurbishing process is the most extensive process that can be done. We don’t cut any corners.” Doctors Depot’s refurbishing process includes extensive cosmetic and technical procedures. The cosmetic refurbishing includes a new paint job, all the metal is refinished, and anything else that doesn’t look new is replaced. The technical refurbishing goes beyond the manufacturer’s PM procedures. Doctors Depot replaces WWW.ORTODAY.COM

SPECIAL ADVERTISING SECTION

Every piece of equipment Doctors Depot sells comes with a 100 percent money back satisfaction guarantee.

everything that could wear out over time. Finally, calibrations and extensive testing procedures ensure the machine is running like new. All procedures are completed to manufacturer’s specifications. “I’ve put one of our machines next to a brand new machine, and you cannot tell the difference,” Frye says. The appearance of the devices is important, but customer satisfaction is Doctors Depot’s top priority. Frye knows that if you don’t treat each customer as if they’re your only client, then they will seek business elsewhere. “Every piece of equipment we sell comes with a 100 percent money back satisfaction guarantee. If anything is not as we described when received by a customer, they can return it for a full refund or an exchange. Plus, everything we sell comes with at least a one-year warranty,” he explains. A LEGACY OF SUCCESSFUL BUSINESS

The son of Eastern Anesthesia Service Inc. (EAS) founder WilWWW.ORTODAY.COM

liam Frye, Aaron Frye learned at a young age the ins and outs of the refurbished medical equipment market. Not only did Frye’s father build EAS, which he established in 1967, into a lucrative independent service organization for North American Draeger and DatexOhmeda Anesthesia Machines, he also modeled successful business practices for his son. Frye incorporated what he learned from his father’s business into his own company. “Being a field tech for EAS, I saw a need for high-quality refurbished equipment that could compliment EAS’ service,” Frye says. “I worked with EAS for about five years before starting [my own business].” By establishing a company that addressed the other side of the anesthesia market – selling refurbished equipment – Frye could better meet the needs of customers. “As new products are introduced to the market, our techs complete training schools for that equipment,” Frye says.

Not only does this ascertain that the products Doctors Depot sells are top-notch, it also serves as the ultimate model of quality assurance for customers. However, what makes Doctors Depot truly unique, Frye says, is his level of personal involvement with his company. Unlike corporations in which the top executives remain relatively hands-off of the equipment, Frye completes most of the technical procedures himself and maintains a hands-on approach. “I personally supervise the refurbishing process of every piece of equipment that goes out our doors,” Frye reveals. “I believe that this is important because no one cares more about the quality of the product than the owner of the business.” For additional information about Doctors Depot visit www.doctorsdepot.com October 2016 | OR TODAY

INDUSTRY INSIGHTS WEBINAR

STAFF REPORT

WEBINAR SERIES

OR TODAY WEBINARS PROVIDE FREE EDUCATION

he OR Today webinar series continues to provide free educational opportunities to nurses and perioperative professionals. One recent webinar, “The Truth about Surgical Asset Automation – Can it really help the OR?,” was presented by Jennifer Zola, RN, BSN, a Sales Consultant for Censis Technologies. Participants learned about the tools available to help support and improve OR management using surgical asset management systems. Zola reviewed required documentation and processes, discussed what can be missed manually, covered how and where automation brings value, and ended her talk with a look at how to chose a partner. The free webinar was sponsored by Censis Technologies Inc. and received high marks from attendees. “(The webinar) helped me grasp more of the capabilities and benefits that automation for servicing the instruments and equipment in the OR and outside of it, has to offer (in order) to ensure a safer surgery,” Alain A. remarked. Another recent OR Today webinar examined evidence-based 20

OR TODAY | October 2016

outcome evaluation. The webinar “Utilizing EvidenceBased Outcome Evaluation To Simplify Patient Warming” presented by Angie O’Connor, RN, and sponsored by Encompass Group, examined the use of an evidencebased approach to combine best research evidence with best practice knowledge to develop patient-focused strategies to improve outcomes with unplanned hypothermia. O’Connor’s in-depth presentation provided insights regarding the evolving outpatient surgical population and she described the continuing prevalence of hypothermia. She also provided an understanding of the role of perioperative professionals when it comes to maintaining normothermia. She reviewed typical warming methods, defined Evidence-Based Nursing (EBN), showed how to develop an Evidence-Based Outcome Evaluation (EBOE) process and discussed the use of the EBOE process to simplify patient warming. O’Connor followed up her educational webinar with a question and answer session providing additional, customized information for attendees. O’Connor received praise from attendees in post-webinar surveys.

“ OR Today always provides informative seminars related to current patientcentered care topics.” – Nancy C.

“Great presentation! Opportunity to reflect on current practice and ask the question why ... why are we doing it the way we are doing it,” Nancy T. wrote in her survey. “OR Today always provides informative seminars related to current patient centered care topics,” Nancy C. wrote. More than 1,000 people have registered to attended OR Today webinars in 2016 and more webinars are on the way. For information about the free webinars, including a schedule of upcoming presentations, visit ORToday.com/webinars. WWW.ORTODAY.COM

{

AAAHC ACCREDITATION

}

It’s validation of how well you deliver care. We send physicians, nurses, administrators – professionals whose opinion you can respect. Their mission is to help your organization be the best it can be. • We are the leader in ambulatory accreditation.

Improving health care quality through accreditation

• Our Standards are nationally-recognized. • Our surveys are consultative not just a checklist.

WWW.ORTODAY.COM

October 2016 | OR TODAY

IN THE OR SUITE TALK

SUITE TALK

Conversations from the OR Nation’s Listserv

PACU DISCHARGE Is it acceptable to discharge patients from the PACU? Sometimes at small facilities beds are hard to come by. In the event there are no beds available after hours or on the weekends, is it better to discharge patients who have had surgery through the ED or PACU? A: We do discharge from the PACU when we have to. It is the same process just in another location. A: On weekends or after hours, our PACU discharges to home or appropriate floor all patients who originated in the ED. Our ED has become too busy to send them back through the ED. A: We discharge through PACU when necessary, but never through the ED since they don’t know the discharge instructions and follow through that our staff performs. A: We discharge from the PACU – same process as other nursing units.

PACU DISCHARGE PROCEDURES When the OR crew comes in for a case and has to recover the case and they get another case, how does one go about discharging a patient from PACU? Is there a special PACU person on call who is trained to discharge patients home? In small facilities staff have to wear multiple hats, and if the OR call nurse has to recover and discharge patients, this will slow down additional call cases that could be stacking up. A: We are a small surgical services unit and we have an OR RN and PACU RN on call so we meet the ASPAN standard of having two RNs available when a patient is in PACU. A: All of our PACU nurses are also cross-trained to work phase 2 recovery/discharge. With two PACU nurses coming in on call to recover patients, we would be able to care for up to four patients at once per staffing standards. We would enlist the help of the nursing supervisor to assist with taking a patient out to their car or off the unit so that there would always be two RNs in the unit. It does make the process slower, but that’s the way we do it. A: We have separate OR and PACU staff on call. A: We discharge from PACU. The same requirements apply when doing so.

OR TODAY | October 2016

WWW.ORTODAY.COM

FLOOR CARE

Do you wax the OR floors? I cannot find a reference to this in AORN guidelines and would love anyone to share that with me. A: We wax corridors, not the OR rooms.

SUITE TALK

A: We don’t wax the OR floors.

FLOOR CARE Is there a reason that OR floors should not be waxed? We will be opening a new department soon and planned to wax floors annually. A: Our flooring product does not require and the vendor does not recommend waxing. With all the fluids that get spilled on the floor, waxing makes it a higher risk for falls. Check with your vendor to see what the recommendations are for your flooring. A: We do not wax our floors because they become too slippery and we have had some close calls with staff falling. As far as AORN guidelines, I have seen nothing that either promotes or discourages waxing with respect to floors.

THESE POSTS ARE FROM OR NATION’S LISTSERV FOR MORE INFORMATION OR TO JOIN THE CONVERSATION, VISIT WWW.THEORNATION.COM.

MANUFACTURED BY

ANDERSEN S T E R I L I Z E R S

NEXT GENERATION GAS STERILIZATION

Introducing EOGas 4, true 10-6 sterilization to halt nosocomial infections of endoscopes and sensitive materials. FDA cleared, damage-free.

The proven reliability of EtO in a tabletop sterilizer using only 17.6g of gas/cycle.

WWW.ORTODAY.COM

CLEARED

www.anpro.com 1-800-523-1276

October 2016 | OR TODAY

POWDER-FREE SURGICAL GLOVE SOLUTIONS

POWDER-FREE: OUR TIME IS NOW

DISCOVER OUR NEW

ENCORE® Perry® Style 42® PF • Exceptional value in powder-free category • Delivers the same clinical experience as the time-honoured Original Perry Style 42 • Features our new SMART Pack packaging

Powder-free gloves have long been shown to be much safer for both patients and healthcare workers. Now, recent changes in the marketplace mean FDA compliant powdered surgical gloves will no longer be available, and powder-free (PF) will become standard in all hospital environments. Ansell is ready to provide the solutions you need with the addition of the ENCORE® Perry ® Style 42® PF to our already broad ENCORE® PF product range.

So why wait? Let’s move together towards a safer, powder-free world. For more information visit www.ansell.com/powderfree or contact Customer Service at 1-800-952-9916 ® & ™ are trademarks owned by Ansell Limited or one of its affiliates. © 2016 Ansell Limited. All Rights Reserved.

WWW.ANSELL.COM

IN THE OR MARKET ANALYSIS

STAFF REPORT

DISINFECTION ROBOT MARKET ON THE RISE

ontinued growth is in the forecast for the disinfection robot market, according to published reports. In recent years, health care facilities have turned to portable enhanced environmental disinfection systems, sometimes referred to as robots, that feature ultraviolet-C (UV-C) light to assist with infection control measures already in place. This UV technology helps in the battle against multi-drug-resistant organisms.

The prevention of hospital-acquired infections (HAIs) and surgical site infections (SSIs) continue to be crucial in the health care environment, especially considering how they impact patient care, patient satisfaction and reimbursement. Many health care facilities are turning to these robots to help combat Clostridium difficile (C. diff ), methicillin-resistant Staphylococcus aureus (MRSA) and more as pathogens mutate to resist antibiotics and disinfectants. These robots help fight HAIs without additional labor costs. While disinfection robots continue to evolve and improve, the idea of using UV light for fighting infections has been around for years. UV-C light has been used to decontaminate drinking water and air handling systems for quite some time, and UV-C has been used in clean room environments by the pharmaceutical industry for years. Recent studies on the efficacy of UV light disinfection have resulted in positive results and have given hospitals and health care facilities confidence in using robots as part of their disinfection process. WWW.ORTODAY.COM

The ECRI Institute, realizing the growing use of these devices, included disinfection robots on its 2015 C-Suite Watch List among other hot topics. “Introducing these technologies could have large positive implications for infection prevention

time. Implementing disinfection robotics might not only improve patient health outcomes, but also bring about significant savings and cost avoidance for health care systems,” according to The ECRI Institute’s 2015 C-Suite Watch List. According to a report by Allied Market Research titled “UV Disinfection Equipment Market - Size, The global UV disinfec- Industry Analysis, Trends, Growth, and Forecast, 2013-2020,” the global tion equipment market UV disinfection equipment market has a potential to reach has a potential to reach $2.8 billion by 2020, registering a compound annual growth rate of 15.3 percent $2.8 billion by 2020, during 2014-2020. registering a compound The growth of the health care and chemical industry is creating annual growth rate of tremendous opportunities for the UV disinfection equipment market, 15.3 percent during according to reports. UV disinfection finds its uses in 2014-2020. diversified areas, including surface disinfection in health care facilities. However, water treatment leads the practices and capital and operamarket, accounting for almost 60 tional budgets. In addition, admin- percent of the total market share, as istrators could see a return on it is a volume-driven application (in investment due to fewer staff-con- terms of number of UV equipment tracted infections and loss of work utilized). October 2016 | OR TODAY

IN THE OR PRODUCT SHOWROOM

OPTIMUM-UV ENLIGHT® SYSTEM CLOROX HEALTHCARE® Combining manual surface disinfection with UV technology ensures thorough coverage, especially on areas that may be missed during manual cleaning. The Clorox Healthcare® Optimum-UV Enlight® System kills over 30 pathogens in five minutes at a distance of eight feet, including a 4-log reduction of Clostridium difficile (C. difficile) spores and a greater than 5-log reduction of more than 20 pathogens such as MRSA, VRE and CRE. The Optimum-UV Enlight® System combines powerful UV technology with advanced data collection and reporting capabilities, clinically proven efficacy and affordability to enable facility-wide adoption, including the OR. •

OR TODAY | October 2016

WWW.ORTODAY.COM

PRODUCT SHOWROOM

SPECTRA 900 SERIES OVERHEAD SANITIZATION SYSTEM SPECTRA254 The Spectra 900 Series Overhead UVC Sanitization System is a fixed decontamination system similar to an overhead permanently installed UVC light fixture that is designed to kill pathogens in enclosed rooms with typical dimensions of 8 x 8 x 8 feet. The remote-controlled Spectra 900 uses three high-output UVC bulbs to eliminate pathogens on all surfaces and is ideal for laboratories, surgical suites, operating rooms, self-service kiosk medical stations, patient dressing rooms, patient exam rooms and mobile medical stations used for telemedicine. Independent laboratory tests find that the Spectra 900 Series Overhead Sanitization System is 99.9 percent effective in killing C. difficile spores, MRSA and an Ebola surrogate pathogen in as little as five minutes. •

WWW.ORTODAY.COM

October 2016 | OR TODAY

IN THE OR PRODUCT SHOWROOM

LIGHTSTRIKE™ GERM-ZAPPING ROBOT™ XENEX The Xenex LightStrike™ Germ-Zapping Robot™ is the only UV disinfection technology proven, in multiple peerreviewed studies, to help hospitals reduce infection rates. Xenex pulsed xenon UV disinfection robots have helped health care facilities decrease their MRSA, C.diff and surgical site infection rates by more than 50, 70 and 100 percent respectively (according to peer-reviewed literature). Designed for speed, effectiveness and ease of use, the Xenex robot destroys viruses, bacteria and bacterial spores in four-minute disinfection cycles. Unlike other UV devices that use bulbs containing toxic mercury to produce low-intensity UV light, Xenex is the only technology that uses high-intensity Full Spectrum™ pulsed xenon UV light. • 28

OR TODAY | October 2016

WWW.ORTODAY.COM

PRODUCT SHOWROOM

SMARTUVC TRU-D Tru-D SmartUVC is a UV disinfection device backed by a CDC-funded, randomized clinical trial to show that it is capable of reducing the transmission of health care-associated infections by up to 30 percent. More Tru-Ds have been deployed to disinfect hospitals across the globe fighting deadly pathogens such as C. diff, MRSA, CRE, VRE, MERS, Ebola and many more. An effective and innovative technology backed by sound science, Tru-D is on a mission to eradicate HAIs making hospitals safer places for patients and staff. For information and links to independent studies on Tru-D, visit Tru-D.com. â&#x20AC;˘

WWW.ORTODAY.COM

October 2016 | OR TODAY

IN THE OR PRODUCT SHOWROOM

PATHOGON UV DISINFECTION SYSTEM STERIS The PATHOGON UV Disinfection System from STERIS provides assurance and sense of security that the room has been terminally cleaned to the highest standard of care and is ready for the next case. PATHOGON UV reduces the risk of infection and cross contamination in the OR for patients and operating room staff. It delivers a calculated dose of germicidal UV-C energy in as little as 4 minutes to kill pathogens on environmental surfaces and has be shown to deliver a 3-4 log reduction of C-Diff spores and 5-7 log reduction of bacteria and viruses. The system employs a wireless controller that makes it easy to initiate and monitor cycles from outside the room and automatically tracks cycle data and usage. It uses redundant heat/motion sensors to protect staff against accidental exposure. â&#x20AC;˘

OR TODAY | October 2016

WWW.ORTODAY.COM

Doesn’t Your Work Deserve Antimicrobial Clear Silicone Adhesive Dressing with Chlorhexidine and Silver

Finally, a fully transparent post-op dressing that offers the synergistic antimicrobial protection of Silver and Chlorhexidine with the added skin benefits of a silicone adhesive.*

Request an evaluation sample† surgiclear@covalon.com

covalon.com / 1-877-711-6055 * Covalon Technologies Ltd., Data on file. In vitro effectiveness does not predict clinical performance. † Some conditions apply. SurgiClear is a trademark of Covalon Technologies Ltd. © 2016 Covalon Technologies Ltd. 1660 Tech Avenue Unit 5 Mississauga, ON, Canada L4W 5S7.

IN THE OR CONTINUING EDUCATION CE433E

OR TODAY | October 2016

JEFF SOLHEIM, MSN, RN-BC, CEN, CFRN, FAEN

WWW.ORTODAY.COM

CONTINUING EDUCATION CE433E

COLD COMFORT

Treating Hypothermia in the Trauma Patient

ou’re working the night shift in the ED when the ambulance radio crackles to life. Prehospital personnel are en route with a 32-year-old man who lost control of his car and careened off the road into a tree. The hands on the clock mark off the precious minutes of trauma’s golden hour — the 60 minutes after a trauma during which life-saving interventions have some of the greatest effects on morbidity and mortality. The decisions that you and the rest of the trauma team make will significantly affect this patient’s short- and long-term morbidity and mortality.

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 purpose of this continuing education program is to introduce nurses to the physiological effects of hypothermia in the critically injured trauma patient and to provide rewarming strategies to be used during trauma resuscitation. After studying the information presented here, you will be able to: • Define hypothermia as it relates to the critically injured trauma patient • List at least four negative physiological effects of hypothermia on the critically injured trauma patient • Name at least four strategies to prevent or treat hypothermia in the critically injured trauma patient

WWW.ORTODAY.COM

As the nurse on the trauma team who cares for this patient, one of your responsibilities is to assess and monitor vital signs: blood pressure, pulse, respiratory rate and oxygen saturation. But what about the other vital sign? What about temperature? Is temperature measurement really that important during this early resuscitative period? Will it change your treatment decisions? Decreased body temperature, or hypothermia, increases the risk that a trauma patient will require surgical intervention, increases the amount of resources the trauma patient will use (such as blood products) and increases mortality in the trauma patient.1-3 This module will explore the risk factors and effects of hypothermia on the critically injured patient and will examine the nurse’s role in recognizing, preventing and treating this potentially deadly condition. TOO COLD FOR COMFORT

When the word hypothermia is mentioned, visions of a child falling into a frozen lake or a climber trapped for hours on a snow-covered rocky precipice may come to mind. These scenarios encompass the traditional view of hypothermia, which is defined as a body temperature below 95 F (35 C), moderate hypothermia

as a body temperature below 89 F (31.6 C) and severe hypothermia as a body temperature below 82 F (27.7 C).4 Many predictable changes occur to body systems when the core temperature reaches these levels. It is now recognized that many of these deleterious body system changes also affect trauma patients when their core body temperature is allowed to drop, even if they are not exposed to extreme environmental conditions. More specifically, traumatically injured patients may be susceptible to these negative effects at much higher temperatures. In the face of trauma, mild hypothermia is defined as 93.2 F to 95 F (34 C to 35 C), moderate hypothermia as 89.6 F to 93.2 F (32 C to 34 C) and severe hypothermia as less than 89.6 F (32 C).3 In one study, 1.5% of normothermic trauma patients ultimately died while 13.7% of hypothermic patients succumbed to their injuries.5 As such, nurses need to be aware of the important role they play in monitoring and preventing hypothermia in this population of patients. WHO’S AT RISK?

With the knowledge that hypothermia increases the mortality rates of trauma patients, it is distressing to learn that more than 10% of trauma patients have October 2016 | OR TODAY

IN THE OR CONTINUING EDUCATION CE433E core temperatures below normal.5,6 Numerous risk factors contribute to the high percentages of hypothermia in this patient population, including shock states. A majority of traumatically injured patients develop shock, which results in vasoconstriction to nonessential organs and the periphery. Vasoconstriction decreases cellular metabolism to the nonperfused cells throughout the body. Cellular metabolism is one of the bodyâ&#x20AC;&#x2122;s main heat-producing mechanisms and, when decreased, contributes to hypothermia. Therefore, decreased metabolism increases risk for hypothermia.4 Environmental factors: Before arrival at the hospital, patients may have been exposed to environmental conditions that are less than optimal. The event that caused their trauma may have occurred in situations in which they were exposed to cold environmental conditions. The patient also may have been exposed to rain, snow or other forms of moisture that cause evaporative heat losses. Wet and blood-soaked clothing further exacerbates evaporative heat losses. It may have been necessary for prehospital personnel to remove some clothing to gain access to vital body parts for IV initiation or patient assessment. Once the patient arrives in the ED, all clothing will be removed as part of the trauma process, exposing the patient to a temperature far below the ideal body temperature. All these factors contribute to hypothermia.3,6 Fluid resuscitation: Room temperature is usually between 65 F and 75 F (18.3 and 23.9 C). This temperature is significantly lower than normal body temperature of 98.6 F (37 C). Many ambulances do not have the ability to warm IV fluids, so they are administered at the temperature at which they are stored in the ambulance, which is often close to room temperature. Similarly, some EDs fail to warm IV fluids and administer 34

OR TODAY | October 2016

them at room temperature. If room temperature is 22 F to 32 F (12 C to 18 C) below body temperature, it would make sense that bolusing large volumes of IV fluid will quickly reduce the core temperature and predispose patients to hypothermia.6 In fact, each liter of fluid infused at room temperature has the potential to lower the body temperature by 0.9 F (0.5 C).7 Infusion of blood products: In the same way that IV fluids cool a patient if they are infused below body temperature, infusion of refrigerated blood products will lower core body temperature if not adequately warmed. One unit of blood that is not adequately warmed can lower body temperature by 0.5 F (0.25 C).6,7 Alcohol use: Alcohol causes vasodilation, which increases the release of heat from the body into the environment. Therefore, alcohol further increases the risk for hypothermia.8 Use of anesthetics and paralyzing agents for intubation and surgical procedures: These agents can decrease vasoconstriction as well as shivering thresholds and potentially reduce heat production by as much as one-third.6 Area of injury: Injuries that result in significant blood loss as well as spinal and head injuries tend to have greater rates of hypothermia than other injuries.6 Type of injury: Penetrating trauma tends to carry a higher rate of hypothermia than blunt trauma.5,6 This may be secondary to greater external blood loss, which is often associated with penetrating trauma. Exposure of body cavities during surgery: Surgery involving opening the thoracic or abdominal cavity is known to accelerate heat loss.9 FAR-RANGING EFFECTS

Hypothermia has profound effects on numerous body systems that can alter long-term outcomes for the patient.

The anticipated negative effects of hypothermia on the different body systems include the following: â&#x20AC;˘ Cardiovascular system: A trauma-induced increase in sympathetic activity results in vasoconstriction and tachycardia. Vasoconstriction contributes to tissue hypoxia and increases lactic acid production, thus exacerbating acidosis. Acidosis increases the risk for coagulopathies and results in prolonged bleeding, hypovolemia and disseminated intravascular coagulation.10 Tachycardia increases myocardial oxygen demands, which, if extreme, may result in hypoxic-related atrial and ventricular dysrhythmias.11,12 As the temperature falls below 93.2 F (34 C), heart rate and cardiac output decrease; this decrease worsens tissue oxygen delivery and contributes to acidosis and the potential for arrhythmias.3,12 â&#x20AC;˘ Pulmonary system: In early hypothermia, the respiratory rate may increase. However, as the temperature drops, the rate will decrease and negatively affect oxygen delivery.3 Hypothermia also shifts the oxyhemoglobin dissociation curve to the left, which means that cold hemoglobin is less likely to release oxygen to the tissues at the cellular level.11,12 As a result, cellular hypoxia is exacerbated, and anaerobic respiration increases. The byproduct of anaerobic respiration is lactic acid. Lactic acid contributes to acidosis and, as stated earlier, acidosis predisposes patients to many negative effects, including coagulopathies.10,11 Patients with temperatures that drop below normal in the early resuscitative period may experience excessive production of bronchial secretions when they are rewarmed. Because cooling WWW.ORTODAY.COM

CONTINUING EDUCATION CE433E

decreases the cough reflex, these secretions may pool and contribute to a condition known as cold bronchorrhea. Cold bronchorrhea may cause respiratory infections and pulmonary edema in the postresuscitative period.8 • Central nervous system: Cerebral blood flow decreases 6% to 7% for every 1.8 F (1 C) decline in core temperature, which reduces oxygen delivery to the brain. This decrease in oxygen can exacerbate brain injuries and changes in patients’ sensorial response.8 Decreased body temperatures can result in confusion, lethargy, sluggishness and decreased or absent pupillary light reflexes. These changes may alter neurological exams and mask underlying neurological trauma. • Renal system: Hypothermia may suppress reabsorption of sodium in the distal renal tubules, which leads to an increase in renal sodium excretion. Since water always follows sodium, as sodium excretion increases so will fluid excretion. Despite decreased glomerular filtration rates, this excretion leads to diuresis and is sometimes referred to as “cold diuresis.”8 Cold diuresis increases fluid losses and further compounds hypovolemia. • Acid-base balance: As mentioned earlier, hypothermia increases acidosis risk via several mechanisms. More specifically, decreased tissue perfusion secondary to cardiovascular suppression, coupled with shivering, contributes to lactic acid production. The accumulation of lactic acid results in a state of metabolic acidosis. Because hypothermia suppresses the normal hepatic function of lactate clearance, the acidosis worsens. Acidosis, in turn, primes the WWW.ORTODAY.COM

patient for increased bleeding tendencies and coagulopathies, such as DIC.10,11 • Endocrine system: Elevated catecholamine levels intensify glycogenolysis, the breakdown of glycogen stores to produce glucose, which increases circulating blood glucose levels. Hyperglycemia, as well as hypothermia, suppresses the phagocytic abilities of certain white blood cells, thereby predisposing the patient to infection and sepsis.13 • Coagulation effects: The effects of hypothermia on the trauma patient increase bleeding risk. More specifically, enzymatic reactions for blood clotting are temperature dependent and, when altered, result in excessive bleeding. Hypothermia also stimulates fibrinolysis and decreases platelet function.3,8,12,14 These many alterations delay the natural coagulation of bleeding associated with trauma, leading to a variety of trauma bleeding disorders called acute traumatic coagulopathy.15 • White blood cells: Cold body temperature reduces the effectiveness of white blood cells.14 This effect, coupled with the effect of hyperglycemia discussed earlier, predisposes the trauma patient to infection. Knowledge of the negative effects of hypothermia and consequences on patient mortality should motivate the trauma team to monitor for decreased body temperatures carefully. Measurement of temperature must be included on the list of integral vital signs that are closely monitored in early resuscitation. Continuous monitoring of core body temperature should be the standard of care for all critically injured patients. Temperatures measured via

the pulmonary artery catheter are considered the gold standard but require a pulmonary artery catheter, which is invasive. This in turn increases the risk factor for other complications, such as sepsis; therefore, it is not routinely used. An esophageal probe may be used to measure core body temperature although temperatures may be altered if the patient also has a gastric tube inserted that is attached to wall suction. Another option to accurately measure core body temperature is a urinary catheter with a temperature probe attached.12 A patient must have urinary output for this method to be accurate. In the absence of such technology, the trauma unit may choose to monitor temperature through the most appropriate intermittent device: oral, rectal, tympanic or surface thermometers. Facilities should consider policies that institute rapid measurement of body temperature after the patient arrives and continuous or frequent temperature checks during initial resuscitation and in the surgical suite and ICU. WARMING UP

Nurses can use a number of strategies to prevent hypothermia in trauma patients and to elevate the temperature of those who show signs of reduced temperature. The most obvious intervention is to increase the ambient temperature where patient care takes place. The thermoneutral zone of humans, 77 F to 86 F (25 C to 30 C), is the temperature at which we maintain our body temperature without creating or releasing body heat.16 While it is unrealistic to maintain trauma resuscitation rooms and patient rooms at this elevated temperature, the closer healthcare practitioners can come to maintaining a warm environment, the more they can protect the patient from heat loss.15 October 2016 | OR TODAY

IN THE OR CONTINUING EDUCATION CE433E Environmental Hypothermia Versus Traumatic Hypothermia3 Â

Environmental Hypothermia

Traumatic Hypothermia

Mild hypothermia

< 95 F to 89.6 F (35 C to 32 C)

95 F to 93.2 F (35 C to 34 C)

Moderate hypothermia

89.6 F to 82.4 F (32 C to 28 C)

93.2 F to 89.6 F (34 C to 32 C)

Severe hypothermia

< 82.4 F (28 C)

< 89.6 F (32 C)

Interventions to protect the trauma patient from heat loss include ensuring the doors to the trauma and patient rooms are kept closed to prevent drafts from further cooling a patient and replacing all wet clothing, dressings and bedding with dry counterparts to prevent evaporative heat losses. Moreover, the simple act of keeping a patient covered can significantly reduce the incidence of trauma-related hypothermia.3,12 While this intervention may seem obvious, it can be difficult during a hectic resuscitation. Trauma care involves a full assessment of the body, which necessitates removal of all clothing. It is also not uncommon for multiple trauma team members to perform interventions on various parts of the body simultaneously, exposing a large surface area. Covering trauma patients with blankets and exposing only small areas during assessments and interventions can maintain body temperature and should be a goal of all trauma team members. Place warm blankets on the patient. Special blankets, such as fluid-circulating, convective-air and aluminum space, may also be considered, especially if the patient is already hypothermic.12 Overhead radiant warmers may also be used, but they should be used with caution to prevent burns to the skin. As stated earlier, the use of room temperature IV fluids may be a major 36

OR TODAY | October 2016

source of hypothermia risk during early trauma resuscitation. Always consider using prewarmed IV fluids.12,15 Different techniques can make this process easier, including prewarming fluids in a commercially prepared warmer or using rapid infusers, which simultaneously warm solutions to a preset temperature. Similarly, all blood products administered should be warmed to body temperature using similar techniques with careful oversight by the blood bank to ensure the procedures maintain the integrity and safety of blood products. Care should be taken to avoid excessive heating red blood cells because damage to the cells may result in acute hemolysis. In the patient who exhibits indications of hypothermia, a variety of techniques may be considered to help in body temperature elevation. If the patient is receiving oxygen, consider delivering the oxygen through sterile water that has been prewarmed. If, on the other hand, the patient is intubated and mechanically ventilated, humidified ventilator circuits should be warmed.7 Some trauma centers use the continuous arteriovenous rewarming technique. Femoral catheters are placed arterially, and blood is removed from the body under the patientâ&#x20AC;&#x2122;s own systolic pressure. The blood is circulated through a fluid

warmer and returned to the body via a venous femoral catheter. This technique can quickly and safely elevate core temperatures; however, its use is limited because of the lack of equipment in many facilities and the learning curve associated with safe implementation. Hypothermia in the traumatically injured patient is not limited to the initial resuscitation room. The deleterious effects also extend into the surgical suite and ICU. The techniques described here should be considered throughout the continuum of care in the initial hours and days after the traumatic injury. More considerations for the surgical suite include abbreviated surgical interventions, such as direct control laparotomy, which involves only a brief surgical procedure to control bleeding and implement lifesaving repairs. After such repairs, the patient is transferred to the ICU, where temperature control can be maintained. More definitive surgical repairs will be considered after the patientâ&#x20AC;&#x2122;s condition and temperature have been stabilized. Overall, direct control laparotomy helps to reduce the heat loss associated with surgical interventions.10 THERAPEUTIC HYPOTHERMIA

The American Heart Association recommends the use of therapeutic hypothermia in patients who are WWW.ORTODAY.COM

CONTINUING EDUCATION CE433E

resuscitated from potentially lethal dysrhythmias, such as ventricular tachycardia and ventricular fibrillation. The intentional induction of cold body temperatures after successful resuscitation improves long-term neurological outcomes for some patients.17 Cooling blankets, cool IV solutions and other creative means are instituted soon after the patient arrives, with the goal of reducing the body temperature to about 89.6 to 93.2 F (32 to 34 C). (The exact temperature depends on practitioner preference and hospital policy.) The patient may be maintained at these decreased core temperatures for 24 to 72 hours before rewarming.18 With wider acceptance of therapeutic hypothermia, it may be fair to ask whether this treatment contradicts the research that demonstrates hypothermia as detrimental to traumatically injured patients. The answer lies in the patient population in which it is used. This treatment is for patients who regain spontaneous circulation after cardiac arrest. Researchers continue to study whether it is effective after isolated traumatic brain injury, spinal cord injury and even hemorrhagic strokes. Note that in the diagnoses for which therapeutic hypothermia are considered, the injuries are either nontraumatic (return of spontaneous circulation) or single-system injuries (brain trauma, spinal cord injuries and hemorrhagic strokes). In patients without trauma or those with single-system trauma injuries, the risk of developing coagulopathies is minimized when compared with patients with multisystem trauma and significant blood loss. Hypothermia is still considered detrimental in the face of multisystem trauma or trauma that involves large blood loss.12 Therefore, we will likely see efforts to maintain a normal body temperature in multisystem trauma patients or patients WWW.ORTODAY.COM

with significant blood loss while we will also likely see an increase in the use of therapeutic hypothermia in patients with other pathologies. Let’s return to the questions in the beginning of this module. Is temperature measurement in the trauma room important? Will it change our treatment decisions? It should be obvious at this point that, yes, temperature measurement is integral to holistic trauma care and may have longterm consequences to patient outcome. Hypothermia can exert negative effects to a majority of the body systems, thus priming the patient for such sequelae as septicemia, traumatic coagulopathies, metabolic acidosis and cerebral hypoperfusion. Members of the trauma team need to pay careful attention to patient temperature throughout the early resuscitative period, including in the trauma room, OR and ICU. Efforts must be made to quickly reverse hypothermia, which may exist before hospitalization, and interventions instituted to prevent further heat loss once the patient is hospitalized. JEFF SOLHEIM, MSN, RN-BC, CEN, CFRN, FAEN, is the owner of Solheim Enterprises and an educational consultant who speaks internationally on motivational and clinical topics. He has written and edited numerous books and journal articles, and runs his own Third World humanitarian medical organization. REFERENCES 1. Moffatt SE. Hypothermia in trauma. Emergency Medicine Journal Web site. http://emj.bmj.com/content/early/2012/12/13/emermed-2012-201883. short?rss=1. Published December 14, 2012. Accessed May 11, 2015. 2. Epstein DS, Mitra B, O’Reilly G, Rosenfeld JV, Cameron PA. Acute traumatic coagulopathy in the setting of isolated traumatic brain injury: a systematic review and meta-analysis. Injury. 2014;45(5):819-

824. doi: 10.1016/j.injury.2014.01.011. 3. Thorsen K, Ringdal KG, Strand K, Soreide E, Hagemo J, Soreide K. Clinical and cellular effects of hypothermia, acidosis and coagulopathy in major injury. Brit J Surg. 2011;98(7):894-907. doi: 10.1002/bjs.7497. 4. Stephen RL. Hypothermia and frostbite. In: Adams JG. Emergency Medicine. 2nd ed. Philadelphia, PA: Saunders-Elsevier; 2013:1142-1147. 5. Waibel BH, Durham CA, Newell MA, Schlitzkus LL, Sagraves SG, Rotondo MF. Impact of hypothermia in the rural, pediatric patient. Pediatr Crit Care Med. 2010;11(2):199-204. doi: 10.1097/ PCC.0b013e3181b80500. 6. Lapostolle F, Sebbah JL, Couvreur J, et al. Risk factors for onset of hypothermia in trauma victims: The HypoTruam study. Crit Care. 2012;16(4):R142, doi: 10.1186/cc11449. 7. Sessler DI. Temperature regulation and monitoring. In: Miller RD, ed. Miller’s Anesthesia. 8th ed. Philadelphia, PA: SaundersElsevier; 2015:1622-1646. 8. Kellerman RD. Physical and chemical injuries. In: Bope ET, Kellerman RD. Conn’s Current Therapy 2015. Philadelphia: Saunders Elsevier; 2015:1171-1252. 9. Seamon M, Wobb J, Gaughan JP, Kulp H, Kamel I, Dempsey DT. The effects of intraoperative hypothermia on surgical site infection: an analysis of 524 trauma laparotomies. Ann Surg. 2012;255(4):798-795. doi: 10.1097/SLA.0b013e31824b7e35. 10. Rhee P. Shock, electrolytes, and fluid. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 19th ed. Philadelphia, PA: Saunders-Elsevier; 2012:66-119. 11. Gandy WE, Grayson K. Mistakes in trauma care: cold fluids and cold ambulances spell trouble for patients. EMS World. 2012;4(7):32-38. 12. McNeer R, Varon AJ. Monitoring the trauma patient. In: Varon, AJ, Smith CE, eds. Essentials of Trauma Anesthesia. Cambridge, UK: Cambridge University Press; 2012:116-129. 13. Kwon S, Rhompson R, Dellinger P, Yanez D, Farrohki E, Flum D. Importance October 2016 | OR TODAY

IN THE OR

CLINICAL VIGNETTE Ms. Clark, age 22, is 16 weeks pregnant. She is violently attacked by her boyfriend during a domestic dispute, sustaining four stab wounds to her abdomen. Bleeding profusely, she stumbles from her home to the house next door, where her neighbor calls 911. Paramedics find Ms. Clark slumped over her neighbor’s kitchen table. She is helped to the floor, and her bloodied shirt is cut away to reveal four gaping and bleeding stab wounds: three to the left upper quadrant and one to the left lower quadrant. She is awake and alert, oriented to all three spheres on initial assessment. She is maintaining her own airway. Oxygen is delivered via nonrebreather mask. Two large-bore IVs are initiated in each of her antecubital spaces and normal saline boluses are initiated. Dressings are applied loosely to each of the abdominal wounds. Her vital signs are: blood pressure 96/72 mmHg; pulse 114 beats per minute, weak and thready; respirations 34 breaths per minute, shallow but easy; and an oral temperature of 95.4 F (35.2 C). Ms. Clark is immediately transported to the ED. Upon her arrival, her condition is found to be largely unchanged on initial assessment. The remainder of her clothing is cut away and a comprehensive secondary assessment is completed. Her BP remains low despite nearly 2 L of room temperature crystalloid solution infused from the prehospital IVs, so a third liter of room temperature crystalloid is initiated in the ED and type O-negative blood is initiated in the second line. The surgeon arrives in the ED 15 minutes after the patient’s arrival and performs a brief physical examination. He determines that immediate surgical intervention is needed to control intra-abdominal bleeding. Arrangements are made to transfer Ms. Clark to the OR. Almost 50 minutes after arriving in the ED, she is moved to the surgical suite, where intubation is performed before a 190-minute laparotomy. In total, Ms. Clark receives 4 units of crystalloid solution and 2 units of blood before being transferred to the OR. Her vital signs before transfer are BP 104/74 mmHg; pulse 104 beats per minute, weak and thready; respirations 22 breaths per minute, shallow but easy; and an oral temperature of 94.6 F (34.7 C). 1. Which statement about control of Ms. Clark’s temperature in the field is most accurate? a. Hypotension is an unlikely contributor to traumatic hypothermia. b. Hypothermia in the prehospital setting is unlikely if the environmental temperature is above 80 F (26.7 C). c. The use of room-temperature IV solutions in the prehospital setting may cause a temperature drop of more than 1 F. d. Prehospital personnel should have left Ms. Clark’s shirt on until she arrived in the ED. 2. Which factor is LEAST likely to have contributed to Ms. Clark’s hypothermia? a. Location of wounds b. Pregnant state c. Aggressive fluid resuscitation d. Hypovolemic shock 3. Which intervention is most likely to prevent further heat loss to Ms. Clark during her ED visit? a. Increasing the temperature setting in the room to 77 F (25 C) b. Delivering oxygen bubbled through warmed water c. Instilling heated solution into the pleural cavity via chest tubes d. Performing a warm-water sponge bath using bath water heated to 98.6 F (37 C) 4. If Ms. Clark becomes hypothermic during her ED stay, which of the following blood gas abnormalities would most likely be exacerbated by her low core temperature? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis ANSWERS ON NEXT PAGE

OR TODAY | October 2016

WWW.ORTODAY.COM

HOW TO EARN CONTINUING EDUCATION CREDIT of perioperative glycemic control in general surgery: a report from the surgical care and outcomes assessment program. Ann Surg. 2013;257(1):8-14. doi: 10.1097/ SLA.0b013e31827b6bbc. 14. Fukudome EY, Alam HB. Hypothermia in multisystem trauma. Crit Care Med. 2009;37(7 Suppl):S265-S272. doi: 10.1097/CCM.0b013e3181aa60ac. 15. Cripps MW, Cohen MJ, Mackersie RC. Blood and transfusion. In: Peitzman AB, Schwab CW, Yealy DM, Rhodes M, Fabian TC, eds. The Trauma Manual: Trauma and Acute Care Surgery. Philadelphia, PA: Lippincott, Williams and Wilkins; 2012:61-72. 16. Kingma B, Frijns A, van Marken Lichtenbelt W. The thermoneutral zone: implications for metabolic studies. Frontiers Biosci. 2012;4:1975-1985. 17. Peberdy MA, Callaway CW, Neumar RW, et al. Part 9: postcardiac arrest care: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2010;122(18 Suppl 3):768-786. doi: 10.1161/ CIRCULATIONAHA.110.971002. 18. Dichtwald S, Matot I, Einav S. Improving the outcome of inhospital cardiac arrest: the importance of being EARNEST. Semin Cardiothorac Vasc Anesth. 2009;13(1):19-30. doi: 10.1177/1089253209332212.

4. Correct Answer: A - A cold liver is less effective at clearing lactic acid, which contributes to metabolic acidosis. 3. Correct Answer: A - A temperature of 77 F (25 C) is within the thermoneutral zone of humans, a state in which a patient neither loses heat to the environment nor accepts heat from the environment. Therefore, this temperature is likely to prevent further heat loss. Continuous arteriovenous rewarming and bubbling water through heated water may rewarm a patient, but do not prevent further heat loss without other interventions. A warm-water sponge bath may actually cause the patient’s temperature to drop secondary to evaporative heat loss, and the sponge bath certainly won’t prevent any heat loss. 2. Correct Answer: B - Pregnancy is not considered a significant risk factor for hypothermia. Ms. Clark’s abdominal wounds coupled with multiple fluid boluses and her hypovolemic shock are all considered risk factors for hypovolemia. 1. Correct Answer: C -Each liter of unwarmed IV fluid can cause a potential drop in core body temperature of 0.9 F. Because Ms. Clark receives 2 liters before arrival at the hospital, her potential temperature drop is 1.8 F, which is greater than 1 F. Ms. Clark’s hypotension decreases metabolic rates of cellular tissue, contributing to hypothermia. Patients frequently arrive at the trauma unit in a hypothermic state regardless of environmental temperatures. Ms. Clark’s shirt needs to be removed for assessment and treatment in the prehospital setting. Removal of her shirt and replacing it with a dry blanket may actually improve temperatures because wet clothing contributes to hypothermia. WWW.ORTODAY.COM

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 6/30/2017. 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 by the American Nurses Credentialing Center (ANCC), the Accreditation Council for Pharmacy Education (ACPE), and the Accreditation Council for Continuing Medical Education (ACCME), to provide continuing education for the healthcare team. OnCourse Learning is also accredited by the Florida Board of Nursing, District of Columbia Board of Nursing, and 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

October 2016 | OR TODAY

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 40 OR TODAY | October 2016

www.macmedical.com WWW.ORTODAY.COM

get your vascular bootie on the dance floor.

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

call

800.541.7995

or visit keysurgical.com

CORPORATE PROFILE

ON A MISSION TO STOP HAIs enex Disinfection Services was founded by epidemiologists Dr. Mark Stibich and Dr. Julie Stachowiak. The company’s mission then – and now – is to stop the pain, suffering and deaths caused by hospital acquired infections by destroying the pathogens that cause them. Today, Xenex LightStrike™ Germ-Zapping Robots™ are being used by more than 350 hospitals, surgery centers, long-term acute care and skilled nursing facilities in the U.S., Canada, Europe, UK and Africa. Surgical site infections (SSI) devastate patients and create a financial burden for healthcare facilities. They are the most expensive healthcare associated infection (HAI) to treat – and the government now requires hospitals to report their SSI rates. Hospitals and surgery centers spend millions of dollars on OR equipment designed to improve the patient experience, yet many use outdated and ineffective methods to disinfect their ORs and prevent SSIs. Xenex CEO Morris Miller recently took some time to share more about the company and its mission.

Xenex robots are the only UV disinfection technology proven, in multiple peerreviewed published outcome studies, to help hospitals reduce infection rates.

Can you tell us about Xenex Disinfection Services?

Miller: The Xenex system works by pulsing xenon, an inert gas, at high intensity in a xenon ultraviolet flashlamp. This produces the only broadspectrum germicidal ultraviolet C (UVC) light, which penetrates the cell walls of microorganisms including bacteria, viruses, mold, fungus and spores. Their DNA is instantly fused so that they are unable to reproduce or mutate, effectively killing them on surfaces without contact or chemicals. The Xenex robot 42

runs in multiple positions (depending on the size of the room) in a 4-minute cycle and doesn’t require warm-up or cool-down time. While most hospitals run the robot in the ORs at the end of the day during the terminal clean, our

OR TODAY | October 2016

newest LightStrike robot is so efficient that it can be run in shorter cycles in between cases in the OR to further bring down contamination. What sets Xenex apart from every other UV disinfection technology are infection reduction results. Every hospital wants fewer infections – and Xenex Germ-Zapping Robots are the only UV disinfection technology that has been shown in multiple peer-reviewed clinical outcome studies to help hospitals reduce infection rates. Eight

hospitals have published peer-reviewed studies showing a decrease in infection rates including two reporting reductions in SSIs when our pulsed xenon UV technology was used to disinfect their ORs. Lowell General Hospital had a 46 percent reduction in SSIs and Trinity Medical Center experienced a 100 percent decrease in SSIs after they began using pulsed xenon UV for room disinfection. Other hospitals have published peer-reviewed studies showing significant decreases in their C.diff, MRSA and MDRO infection rates. WWW.ORTODAY.COM

SPECIAL ADVERTISING SECTION

Hospitals using the Xenex Germ-Zapping Robot for room disinfection have seen a

46-100% reduction in their SSI rates, according to peerreviewed studies.

What are some advantages your company has over the competition?

Miller: UV has been used for disinfection for decades. According to the GAO, there are 50-plus companies that manufacture UV devices using mercury bulbs. Mercury is toxic and the EPA and World Health Organization want to phase out the use of mercury in hospitals. Unlike the mercury bulb devices, the Xenex LightStrike robot utilizes pulsed xenon to create broad spectrum, high intensity germicidal UV light. Continuous mercury UV produces only single spectrum, low intensity UV light. And intensity matters – pulsed xenon UV destroys pathogens in a different way than continuous mercury UV devices. Some hospitals are reporting materials damage as a result of exposure to continuous mercury UV light. Since the Xenex device uses a pulsing technology (not continuous exposure) to create UV light and destroy pathogens, no hospitals have reported materials/ equipment damage as a result of using Xenex devices. Hospitals are busy and rooms need to be turned over quickly to accommodate patients who need care. In the OR environment, especially, time matters. It’s physically impossible for the cleaning team to get a room disinfected in the time available using traditional cleaning methods. Xenex’s LightStrike Germ-Zapping Robot disinfects a typical patient room in 8-12 minutes using two to three WWW.ORTODAY.COM

4-minute cycles, one cycle on either side of the bed and one in the bathroom. Hospitals are able to disinfect dozens of rooms per day and bring down the facility’s bioburden. In the OR, our robots are used at the end of day for the terminal clean, and they are also used between surgeries, for example when surgeons are doing outpatient total joint cases. It destroys the pathogens lurking on high touch surfaces that you can’t see but can pose a risk to the next patient in that room You also need to consider the safety of hospital employees using the devices. Mercury UV devices require 4 to 28 mercury bulbs (per device) that contain toxic mercury and may require special handling and precautions in the event of bulb breakage. Each mercury bulb may reach 220 degrees and should not be moved until the bulbs cool to a safe temperature. The Xenex robot uses xenon bulbs that are environmentally friendly and don’t require any warm-up or cool down time.

What are some challenges that your company faced last year?

Miller: We spend a lot of time educating hospital decision makers about the technologies available for room decontamination. There is a lot of misinformation in this market, so buyers need to ask the right questions. Not all UV is the same – Xenex has had multiple hospitals report infection rate October 2016 | OR TODAY

CORPORATE PROFILE

reductions in peer-reviewed journals. As professionals are analyzing UV technologies, they need to look at the peer-reviewed literature supporting the device’s claims with regards to reducing infection rates at hospitals. We repeatedly hear the mercury UV vendors tell hospital decision-makers that all UV is the same and that their device works just like pulsed xenon UV. And it’s not true. There are scientific differences between the way that pulsed xenon UV and mercury UV emit germicidal UV-C light. This is like the difference between using a garden hose or a power washer to clean a deck or driveway at a house. Intensity matters!

Hospitals that use Xenex have the opportunity to reduce infections by destroying the pathogens that cause them – which can save or change patient lives.

Can you share success stories?

Miller: That’s the best part of our job – hearing about the success hospitals are having in reducing their infection rates. One hospital recently needed us to help them battle and defeat a MRSA (Methicillin-resistant Staphylococcus aureus) outbreak that occurred in the hospital’s mother and baby unit. They were not yet a customer, but called and asked if Xenex could help. More than four dozen patients (mothers and newborn babies) had become infected with MRSA. Desperate to contain and stop the MRSA infections from spreading, the hospital needed to resolve the situation safely, effectively and quickly. We deployed two of our robots and employees to quickly disinfect the entire unit and no new MRSA infections were reported after the disinfection took place. They are now a Xenex customer. Another hospital selected Xenex because of clinical evidence, but also because of Xenex’s high level of customer support that began even before the robots were implemented. As the hospital was evaluating UV disinfection technologies, they had a norovirus outbreak. At no charge, Xenex came in with staff and robots and disinfected the affected unit. We wiped out the norovirus in three days and the EVS director said that she’s 44 OR TODAY | October 2016

never seen an outbreak contained and shut down so quickly. They have since deployed two Xenex robots and have seen a decrease in their Clostridium difficile (C.diff ) infection rates.

Tell us about your company’s facility?

Miller: Xenex is based in San Antonio, Texas, and that’s where all of our robots are manufactured. Each robot leaves our facility with a name on a nameplate, but hospitals usually choose to rename their robots. Some hospitals host a naming contest among their employees, some invite the community to name their robots, and others have named robots after a donor. The team that uses the robots understand that this is their newest team member – it’s a new weapon in their battle to keep patients safe.

I s there anything else you want readers to know about your company?

Miller: Hospitals that use Xenex have the opportunity to reduce infections by destroying the pathogens that cause them – which can save or change patient lives. Hospi-

tals engaged in HAI reduction programs using Xenex are now analyzing their HAI data against their use of the Xenex robots. There is clear evidence that when robot usage increases, the infection rates decrease. The more you run the robot, the better a reduction in infection rates can be achieved. As professionals are analyzing UV technologies, they need to look at the peer-reviewed literature supporting the device’s claims with regards to reducing infection rates at hospitals. In addition to peer-reviewed evidence that the UV technology can bring down infection rates, hospitals should ask vendors about the implementation and training they provide to ensure infection reduction success. Xenex, for example, sends in an implementation team to work with the hospital’s EVS and IP staff to determine the optimum protocol for running the robots. Xenex team members also train the employees who run the robots. Hospital administrators are given access to a portal where they can review robot usage in real-time, and measure their HAI reduction benchmarks. For more information about Xenex Disinfection Services visit www.Xenex.com. WWW.ORTODAY.COM

HOW CAN YOU MEASURE

THE IMPACT OF LIGHT? We measure it in successful surgeries without infection. The Xenex LightStrike™ Full Spectrum room disinfection system is helping Operating Rooms improve quality and cut the cost of care by significantly reducing Surgical Site Infection (SSI) rates.

CLINICAL OUTCOMES USING LIGHTSTRIKE ROBOTS:

100%

46%

reduction in total joint SSI rates.1

reduction in Class I SSIs.2

$300,000 saved.

$478,000 saved.

FREE WHITE PAPER: SEE HOW ORS ARE WINNING THE BATTLE AGAINST SURGICAL SITE INFECTIONS. xenex.com/surgical |

866-761-6722

AVOIDING COSTLY INFECTIONS BY DON SADLER

Numerous medical advancements that have been made in recent years are truly astounding. This makes it ironic that thousands of patients still die in hospitals each year from the simplest of causes: healthcare-associated infections, or HAIs.

AND THE

THE

GOOD BAD UGLY The most recent statistics with regard to HAIs are sobering. Each day, one in 25 hospital patients suffers from an HAI, according to the Centers for Disease Control (CDC). Worse yet, 75,000 patients with HAIs died during their hospital stays in 2014. THE FINANCIAL COST OF HAIS

Hospitals also pay a heavy financial cost due to infections. “This is especially true in light of new penalties associated with CMS reimbursement,” says Judith Seltzer, MS, BSN, RN, CNOR, the Surgical Clinical Director, National Accounts for Mölnlycke Health Care. According to Seltzer, payment adjustments of up to one percent are imposed on hospitals ranking in the lowest quartile with respect to the Healthcare-Associated Conditions Reduction program. “Also, patients suffering from a surgical site infection (SSI) will likely have hospital stays 7 to 11 days longer than patients without SSIs,” Seltzer says. “In addition, they suffer mortality rates up to 11 times higher than patients without SSIs.” “HAIs have been shown to increase patient morbidity and mortality, increase the patient’s length of stay in the hospital, and increase overall health care costs,” adds Amber Wood, MSN, RN, CNOR, CIC, FAPIC, senior perioperative practice specialist with the Association of periOperative Registered Nurses (AORN). In addition, patients with HAIs are 60 percent more likely to be admitted to the ICU, thus incurring additional health and economic burdens. Seltzer points to a CDC study that determined that each hospitalacquired SSI costs hospitals up to $34,670 in direct costs. “This figure has the potential to rise when indirect costs such as

OR TODAY | October 2016

Stephen M. Kovach, the director of education for Healthmark Industries

“It’s all about teamwork. Each area needs to understand each other and each department’s processes. Both areas have a direct impact on reducing SSIs and HAIs.” increased litigation, decreased referrals, unreimbursed expenses and a patient’s lost wages and potential morbidity are included,” says Seltzer. Meanwhile, the intangible costs to the patient – like pain and suffering, psychological issues, loss of social functioning and curtailment of daily activities – are difficult to calculate. A SILVER LINING

If there’s any good news when it comes to HAIs and SSIs, it’s that awareness of the problem among OR

personnel is increasing. “Almost every professional program or meeting I attend is addressing this concern,” says Stephen M. Kovach, the director of education for Healthmark Industries in Fraser, Michigan. Seltzer concurs. “We have definitely seen an increase in infection prevention awareness in the operating room environment,” she says. “Hospitals are increasing their focus on reduction of HAIs, in part due to the significant financial impact at stake as a result of healthcare reform.” According to Seltzer, 35 states now require hospitals to publically report their infection rates. “Many hospitals are instituting formal initiatives aimed at reducing particular infections or implementation of preventative protocols,” she says. Another reason awareness is increasing is because patients are better informed about HAIs due to public reporting, says Wood. “Patients are questioning the infection rates of their providers and health care facilities,” she says. “Also, there has been more emphasis on prevention and monitoring of HAIs due to accreditation and regulatory oversight.” SSIS AND HAIS

According to the CDC, SSIs are the most common cause of HAIs, causing nearly one-third of all infections. Somewhere between 160,000 and 300,000 SSIs occur each year, affecting between 2 percent and

WWW.ORTODAY.COM

5 percent of all inpatient surgical patients in the U.S. Wood says that SSIs can be caused by multiple factors. “This makes it difficult to determine the exact cause,” she says. “Many SSI prevention efforts are focused on bundling multiple interventions,” Wood adds. “These may include antibiotic prophylaxis, screening and decolonization of Staphylococcus aureus, maintaining patient normothermia, maintaining glycemic control, and increased oxygenation of the patient to improve wound healing.” However, the experts are unanimous when it comes to the most effective steps to infection prevention. “It should go without saying: Wash your hands and follow aseptic technique,” says Kovach. “Perioperative team members can help prevent HAIs by performing excellent hand hygiene and providing the patient with a clean OR environment,” Wood adds. Other infection prevention steps she lists include: • Adhere to best practices for sterile technique, disinfection and sterilization. • Wear clean surgical attire. • Minimize OR traffic and door openings. • Monitor OR temperature, humidity and positive pressure. “In many situations, infection prevention comes down to addressing the basics,” says Seltzer. “For example, there are crucial guidelines in the AORN Guidelines for Perioperative Practice that should be reviewed and followed. Among these are perioperative patient skin antisepsis, sterile technique and sharps safety.” Wood lists the following specific AORN Guidelines that address prevention of HAIs:

WWW.ORTODAY.COM

• Guideline for the Prevention of Transmissible Infections • Guideline for Environmental Cleaning • Guideline for Hand Hygiene • Guideline for Preoperative Patient Skin Antisepsis • Guideline for Sterile Technique • Guideline for Surgical Attire • Guideline for Safe Environment of Care Part 2 • Guideline for Sterilization In addition to practicing proper hand hygiene, Seltzer stresses the importance of thorough environmental cleaning and proper sterilization of all instruments. “It’s also important to screen patients for diseasecausing germs and isolate those with contagious conditions,” she adds. NEW PRODUCT SOLUTIONS

One positive development in the fight against costly infections is the introduction of new product solutions that can help prevent HAIs. “Healthcare organizations and the healthcare industry continue to innovate in the area of providing new and improved products and methodologies to assist in the prevention and reduction of infections in the OR,” says Seltzer. For example, Hibiclens from Mölnlycke Health Care is a patient compliance bundle that helps educate patients about the pre-operative showering process. “Proper education has the potential to improve compliance prior to patients entering the surgical facility,” says Seltzer. Another example is the Biogel Puncture Indication System, which provides a visual alert to the wearer when a glove perforation occurs. “Studies indicate that nearly 90 percent of glove perforations go unnoticed

Judith Seltzer, MS, BSN, RN, CNOR, the Surgical Clinical Director, National Accounts for Mölnlycke Health Care

“Not all HAIs can be prevented, but many can. So what we do today in our infection prevention measures matters in terms of what tomorrow’s health care environment will become.” during procedures,” says Seltzer. Kovach says that OR personnel can now test medical devices for organic soils like protein and hemoglobin using HemoCheck and ProCheckII. “This helps ensure that a device is clean before sterilization takes place,” he says. Clorox Healthcare has several

October 2016 | OR TODAY

AND THE

THE

GOOD BAD UGLY options to help with HAI and SSI prevention, including nasal antiseptic swabs and a line of disinfectants. Ultraviolent technology is a growing aspect of disinfection for many health care facilities with products offered by several companies, including Clorox, Spectra, STERIS, Tru-D and Xenex. THE ROLE OF CSP

The role of Central Sterile Processing (CSP) cannot be overemphasized when it comes to infection prevention in the OR. “It is essential for the CSP staff to build a strong relationship with OR staff,” says Seltzer. “Although CSP maintains the integrity of instrument sterility, it is

the OR staff who can give feedback if they believe, for example, that the parameters of sterility were not met,” she adds. “Building a collaborative relationship will ensure that both areas recognize any opportunities for improvement.” “It’s all about teamwork,” says Kovach. “Each area needs to understand each other and each department’s processes. Both areas have a direct impact on reducing SSIs and HAIs.” “In the perioperative setting, we must function as a team with the patient and our colleagues,” says Wood. “We should speak up for patient safety and hold each other accountable on our mission to keep patients infection-free.” Seltzer says that historically, HAIs

were considered to be “bad luck” and were bound to eventually happen. “Now we can safely say that this attitude has and continues to change,” she says. “Not all HAIs can be prevented, but many can,” Seltzer adds. “So what we do today in our infection prevention measures matters in terms of what tomorrow’s health care environment will become.”

Infusion Pump Support and Power Relocation Devices PowerMATE® Special Purpose Relocatable Power Taps • • • •

AIV Gives You Confidence

CMS Waiver Compliant UL-1363A Recognized Locking IV Pole Mount 15 & 20 Amp Models

Everything we manufacture and repair at AIV is done to ISO-13485 standards.

Infusion Pump Sales & Support • Flat Rate Repairs • AIV Certified Refurbished Pumps • Replacement Parts

888.656.0755 • aivsales@aiv-inc.com • www.aiv-inc.com

616C

50 OR TODAY | October 2016

WWW.ORTODAY.COM

Superbugs require super-vigilance.

Test for cleanliness. Sterilize for safety. Superbugs are super-tough. But that doesn’t mean they can’t be beaten. You can reduce the risk that dangerous, disease-causing organisms remain on your endoscopes, including superbugs like CRE. 3M’s solution makes it possible. New challenges in endoscope reprocessing require new approaches. Protecting patients from potentially fatal infections requires a higher standard of care.

It’s time to make every endoscope safe for every patient. Find out how at go.3m.com/endoscope. 3M™ Clean-Trace™ ATP Monitoring System 3M™ Steri-Vac™ Sterilizer/Aerator GS Series 3M, Clean-Trace and Steri-Vac are trademarks of 3M Company, used under license in Canada. © 2015 3M. All Rights Reserved. WWW.ORTODAY.COM

October 2016 | OR TODAY

EVERYBODY WINS WITH HIGHER

SURGICAL

QUALITY

IMPROVE YOUR FACILITY’S ODDS

WITH SPD SOLUTIONS FROM IMS. Why play games when it comes to a successful OR? When processes break down in the SPD, surgeons don’t get to run the tables as they should. IMS has specialized programs to improve regulatory compliance, decrease errors/infection rates, and increase surgeon and staff satisfaction. Historically, facilities that engage in IMS Solutions reduce instrument-related issues by an average of 33% in the first year. So play your cards right and enroll your SPD today.

WE MAKE PATIENTS SAFER AV-5

i m st e r i s.co m | 1.800.783.9251

OUT OF THE OR FITNESS

BY AUTHOR NAME

By Matt koufalos

any children imagine future careers in medicine, law enforcement, paleontology, even space exploration. Linnette Johnson grew up wanting to be a nun.

“My hero was Mother Theresa,” Johnson said. “She loved all people, no matter where they were in life. As a child, I recognized that she had so much compassion and so much love.

OR TODAY | January 2012

WWW.ORTODAY.COM

FITNESS

WWW.ORTODAY.COM

January 2012 | OR TODAY

LINNETTE JOHNSON Assistant Vice-President for Surgical Services at Florida Hospital Orlando

“The problem was I wanted about six kids,” she said. When Johnson’s parents broke the news to her that Catholic nuns take a vow of celibacy, the devout six-year-old decided that she would be a nurse instead. Her reasoning: nurses “take care of God’s people, they love God’s people, and doctors are like priests,” she recalled. Today Johnson can reflect on a career that has brought both of her priorities into focus: she is the Assistant Vice-President for Surgical Services at the 1,200-bed Florida Hospital Orlando as well as a mother of four. At the time she began her career, however, Johnson recalls the doctors alongside which she worked as emphasizing her latter qualifications over the former. A native Ocalan, Johnson got her first nursing job in the late 1990s, when there was not the shortage of staff that has since emerged. Nurses were expected to pay their dues in convalescent care before graduating to a hospital setting, and it was a testament to her capability that she was hired into a 34-bed, post-operative surgical unit without having 56

OR TODAY | October 2016

had to travel that route. By far the youngest nurse on the unit, Johnson recalls stepping into an environment of “very mixed emotions,” where nurses were expected to yield their seats to doctors, or to chase after them with charts if they needed something. Her first encounter with the hierarchies of the workplace involved being berated by a surgeon. “We went into the room together, and he started screaming about the dressing on the patient’s arm,” Johnson said. “The patient was scared to death. I wasn’t that experienced with anything that was going on, and he wouldn’t stop yelling. So I ran out of the room, and lo and behold, the man follows me, screaming.”

shift, Johnson had collected herself enough to confront the situation. “I said, ‘If I do something wrong, or if there is something I can learn from, I want to learn,’” Johnson said. “‘But I need you to communicate with me in a way that fosters our relationship, that makes me want to come to you, and that doesn’t delay patient care.’” To this day, Johnson is still in contact with that surgeon, a talented doctor whose gifts she respects. Without the moment of communication they eventually shared, however, their relationship may have been irreparably breached. At the time, she said, the hospital had no mechanism for correcting the behavior she experienced.

" I need you to communicate with me in a way that fosters our relationship, that makes me want to come to you, and that doesn't delay patient care." One of her clearest memories of the moment is that “nobody came to my aid,” Johnson said. “Everybody looked down quickly and then dispersed like ants.” she said. The only thing Johnson could think to do was to lock herself in the hallway bathroom. The surgeon continued to pound on the door for several minutes. She waited until she didn’t hear anything outside, and went back to the nursing station to regroup. Her colleagues were familiar with that doctor’s temperament and had little encouragement to offer her. When the surgeon returned to apologize at the end of his

“There’s a lot of this that happens,” Johnson said. “These are physicians who bring in a lot of revenue; hospitals making 25 to 35 percent on the cases they do. People look the other way. It’s a life-anddeath environment; people are under stress. “Truly, it’s the patient who suffers if nurses and physicians and administrators don’t have good relationships,” she said. When her career took her to Florida Hospital Orlando, Johnson was invited to participate in a physician leadership development course begun by Mark Hertling, its Senior WWW.ORTODAY.COM

"If we want a seat at the table, we have to have table manners." Vice President for Global Partnering, Leadership Development and Health Performance Strategies. Hertling, a retired U.S. Army general, founded the course based upon his 40-year military career and the principles of maintaining unit cohesion founded in it. Johnson said the training taught them all how much her coworkers in every role at the facility shared the same fears: losing authority in their areas of expertise, and failing to be acknowledged on a human level. “When we got to it, we’re really the same,” she said. “Doctors fear that everything they used to have control over, now is dictated by the government, or the payers, or the hospital. By us not fitting with them—not getting that face time, not building that relationship—they fill in the gaps with not-nice things. “Remember, the whole time we’ve got a patient at the center of it who’s the most important person WWW.ORTODAY.COM

Linnette Johnson, RN, BSN, MSN, is seen with Ravi Bissessar, M.D., JLR/USAP Florida, Chief of Anesthesia. Johnson said patient care in a surgical setting is collaboration among doctors and OR staff.

of your life,” Johnson said. “This whole thing about segregating us by doctor class, or nurse class, or executive class…if we’re going to improve outcomes, we’ve got to do it together. Everybody’s got to buy into it, or it’s not going to work.” Johnson said the program helped participants to value one another as people foremost, and to redefine their roles in the hospital cooperatively instead of adversarially. The workshop taught her, “If we want a seat at the table, we have to have table manners,” she said. “I think it’s incredible, and it’s changed the way I work with nurses and physicians,” Johnson said. “My patients deserve that I have the moral courage to do what I think I have to do, that is my duty, that is what I’m supposed to do.” Upon graduation, each class participant was given a challenge coin; a military tradition meant to strengthen morale among all

members of the group, and to demonstrate that they are all part of the same unit. When graduates of the class encounter one another, they may challenge each other to produce their coins to demonstrate that they are keeping faith with the group. People who fail to produce their challenge coins are on the hook for a drink. “This little coin has been a great sign of what the possibilities are,” Johnson said. “It works; it’s powerful.” Nowadays, if she catches a surgeon on a bad day, or if she is concerned about having communicated insensitively with a colleague, Johnson says their leadership training has inspired everyone to take responsibility for making amends for the preservation of the integrity of the workplace. She and her coworkers have expressed their mutual efforts not to take one another for granted. .

October 2016 | OR TODAY

WIDTH 7”

Refurbished Powered Surgical Equipment www.surgicalpower.com

(574) 267-8207 sales@surgicalpower.com

Surgical Power Equipment

Drills Saws Accessories Consoles Batteries Attachments

Our EnvirOn-matE® Dm6000 SEriES

PUBLICATION

AD SIZESystems Since 1990 Wall-Mounted Fluid Management

MEDICAL DEALER BUYERS GUIDE MONTH J

DM6000 - Utility/SPD

HALF PAGEor HORIZONTAL TECHNATION Call us ORTODAY before you build remodel OTHER NOTES

DESIGNER: JL DM6000-2 - Endoscopy

P.O. Box 60 • Galena, Illinois 61036 Ph: (815) 598-3143 • Fax: (815) 598-3110 N D www.mdtechnologiesinc.com

USE These Now in Service at Approximately 1,200 Installations

NOT THESE DM60002A - Cysto/Arthroscopy

OR TODAY | October 2016

Conventional Suction Canisters

WWW.ORTODAY.COM

HEIGHT 4.5”

Sales • Repairs • Service

Patient lives demand quality monitoring equipment. You can trust the Certified Experts at Pacific Medical to deliver precision, accuracy and attentiveness when servicing your equipment. Check out our website or give us a call today to find out more about our special offers on monitoring equipment, cables, repair and much more.

REPAIR

PURCHASE

ONE SOLUTION FOR ALL YOUR PATIENT MONITORING NEEDS

EXCHANGE

ONE SOLUTION FOR ALL YOUR PATIENT MONITORING NEEDS

PARTS & ACCESSORIES

ONE SOLUTION FOR ALL YOUR PATIENT MONITORING NEEDS

pacificmedicalsupply.com ONE SOLUTION FOR ALL YOUR PATIENT MONITORING NEEDS

800.449.5328

#PACMEDLLC

OUT OF THE OR HEALTH

BY SCOTT J. GILBERT PREMIUM HEALTH NEWS SERVICE WWW.AWELLNESSUPDATE.COM

THE ELUSIVE FOUNTAIN OF YOUTH

ore people may be living to 100, and beyond, than ever before. But the real challenge is how to become one of them, and how to care for an aging population.s. Noel H. Ballentine, M.D., director of geriatric health in the Division of General Internal Medicine at Penn State Milton S. Hershey Medical Center, said although good genes help determine how long you live, other factors are less dependent on luck. Good nutrition and plenty of exercise are the top two ways to live a long and healthy life, and neither should come as a surprise. "Eating high-quality foods with lots of fruits and vegetables and controlling your weight are the things I spend most of my time talking about," he said. "And there is lots of data showing that strength training helps even very old people do better." Ballentine suggests getting both nutrition and exercise habits under control while young, since it's more difficult to implement weight-loss

60 OR TODAY | October 2016

plans or exercise routines once you're already in your 70s and beyond. The third factor is avoiding accidental injuries. "If you're in your 60s or 70s and don't have a lot of health issues, you have a better chance of losing your independence from an accidental injury than due to an illness," Ballentine said. That means not standing on a chair to change a light fixture, climbing a 10-foot ladder to clean gutters or going out of the house when the ground is icy. "If you're 40 years old and you fall, you probably won't break your hip, but if you're 70, there's a good chance of very severe injury," he said. Staying socially engaged is also increasingly noted as an important way to stay both mentally and physically healthy.

"Don't become isolated," Ballentine said. "If you live alone and don't have much social contact, you're more likely to degrade mentally and be less active and engaged." Those who are more socially active are also more likely to be more physically active and eat healthier, he said. If depression does happen, recognizing the symptoms and getting treatment can ward off further problems. An aging population living longer could lay a heavy economic weight on society if not handled well, Ballentine said. Although tremendous progress has been made in the treatment of medical conditions such as coronary artery disease, stroke, high blood pressure and infectious diseases that used to take lives earlier, other conditions have stolen the limelight of concern. "Obesity, dementia and addictions are the biggest issues now," Ballentine said. Media focus on obesity is putting pressure on the food industry to make changes and help consumers become WWW.ORTODAY.COM

HEALTH

" EATING HIGH-QUALITY FOODS WITH LOTS OF FRUITS AND VEGETABLES AND CONTROLLING YOUR WEIGHT ARE THE THINGS I SPEND MOST OF MY TIME TALKING ABOUT" more aware of what they are eating, while the federal government has dedicated funds to dementia research. Addiction to narcotics and opiates has recently begun to be classified as a disease rather than a bad habit or lifestyle. Then there is the issue of health literacy: making sure patients understand what is going on medically with their minds and bodies. "Do you know what your pills are for and how to take them? Do you know how to figure out if a suggested treatment is right for you?" Ballentine asks. He adds that the medical community needs more training on managing an aging population: "There aren't enough geriatricians to take care of them, so doctors of all specialties are going to have to care for them and recognize their special needs.". . COURTESY of The Medical Minute, Penn State Milton S. Hershey Medical Center WWW.ORTODAY.COM

NEED PATIENT MONITORING EQUIPMENT? LOOK NO FURTHER. GOPHER MEDICAL has what you need at affordable pricing, backed by our 1-year industry-leading warranty. Patient/Bedside Monitors Vital Sign Monitors Anesthesia Monitors Gas Monitors

Your trusted source for all your patient monitoring needs

Authorized Distributor

DeďŹ brillators Electrocardiographs (EKG) Repairs by factory-trained biomedical technicians

844-2GOPHER (844-246-7437) sales@gophermedical.com www.gophermedical.com

Exclusive National Distributor

Authorized Distributor

October 2016 | OR TODAY

OUT OF THE OR FITNESS

BY MARILYNN PRESTON ENERGY EXPRESS

UNCONVENTIONAL FITNESS:

SQUEEZE YOUR BUTT, INTERVAL TRAINING & SLOWER WEIGHT TRAINING

ust to remind you, lifestyle change is a step-bystep kind of thing. No one can do it for you, not even your next president. Sometimes it’s two steps forward, one step back. And that’s OK, because every day you can begin again, eating smarter, moving instead of sitting, mindfully releasing the stress and heebie-jeebies that come from watching the Hillary and Donald show. WHEN IN TRAFFIC, SQUEEZE.

Body awareness is a marvelous thing. Take your butt, for instance. If you let nature take her course, you will, over time, notice it sagging and becoming listless. Buns of steel naturally turn into buns of cinnamon. Butt it doesn’t have to be that way. Tush muscles are made for squeezing, and the more you engage them, the longer they appear perky. Bottom line? Next time you’re in traffic waiting for the light to change, or standing at your computer, or doing the dishes, use that time to build a stronger butt and draw energy to your core. How? Work those glutes! The maximus, the minimus and the 62

OR TODAY | October 2016

medius. Shift your attention to the base of your spine, and squeeze your glutes as though you were pushing a golden light up your spine, all the way out the top of your head. Hold that squeeze and that energizing visualization for a count of 10. Relax and repeat, whenever you can, for the rest of your life. NEW SLANT ON TREADMILLING

Walking or running on a strong, stable treadmill is one of the most popular ways to exercise. To get the most out of your cardio time, venture out of your comfort zone by cranking up the grade. Walking up a 10 percent grade will burn 75 percent more calories than walking on a flat surface. Walking uphill also makes your muscles work

harder and gets your pulse up more quickly. And may I remind you that aerobic workouts are proven to enhance memory. But, dear reader, don’t torture yourself or elevate to the point of pain. Feeling breathless for too long is counterproductive, so vary the challenge. Move the grade up, and allow yourself to breathe hard for a minute or two; then ease it down when it’s time to recover. It’s called interval training – alternating hard and easy moments in a workout – and it’s one of the hottest old trends in fitness today. A 20- to 30-minute high-intensity training session will improve your cardiovascular fitness in a way that an hour of easy ambling never will, though both have their place when it comes to boosting your overall well-being. IN WEIGHT TRAINING, SLOWISH AND STEADY IS BEST.

Lifting weights is a heroic way to build strength, protect joints and – if you’re patient – reshape your body. But lifting weights in a herky-jerky way, out of alignment WWW.ORTODAY.COM

FITNESS

FOCUS, FOCUS, FOCUS ON THE INNER GAME. YOU’LL BE AMAZED HOW QUICKLY YOUR MUSCLES WILL TIRE JUST BY SLOWING THE PACE AND ADDING CONCENTRATION. and out of control, is a bad habit that can lead to trouble. What’s a better way? Lift with awareness, in control, using your muscle power, not your momentum. Don’t tense your muscles to make them strong. Just the opposite: Relax, and let the energy flow. Experiment with a s-l-o-w count, four counts up, four counts down, and slow it down gradually to eight or 10 counts, up and down. Focus, focus, focus on the inner game. You’ll be amazed how quickly your muscles will tire just by slowing the pace and adding concentration.

And don’t forget to connect to your breath! Your breath is your best friend when it comes to strength training. (And all of life, actually.) On your inhale, expand your lungs, top to bottom, and feel your heart lift. Exhale with great enthusiasm as you lift up the weight. Exhale right into the muscle, joint or body part you’re working with, visually and mentally. It sounds abstract because it is abstract, but there’s no doubt the mind and body are energetically connected. Practice this technique of touching your body with your breath – when you lift, when you stretch

– and you’ll ease tightness and increase your range of motion. You’ll also experience the mind-body connection for yourself. A true aha moment. – Marilynn Preston – healthy lifestyle expert, well being coach and Emmywinning producer – is the creator of Energy Express, the longest-running syndicated fitness column in the country. She has a website, marilynnpreston.com, and welcomes reader questions, which can be sent to MyEnergyExpress@aol.com.

PROFESSIONAL COMFORT FOR SURGEONS, NURSES & TECHNICIANS

Stop the Hurt While You Work GELPRO MEDICAL ANTI-FATIGUE MATS SIGNIFICANTLY REDUCE PAIN AND FATIGUE WHILE STANDING ®

EXCLUSIVE

DUAL DENSITY™ COMFORT

100% GELPRO GEL ENERGY-RETURN FOAM

TOP SURFACE • Provides necessary friction with surgical booties • Easy-to-clean with hospital grade quaternary cleaners • NFPA 260 & CAL 117 compliant • Anti-microbial & anti-bacterial

NON-SLIP BOTTOM • Certified for high traction by National Floor Safety Institute 1.866.435.6287 MADE IN THE USA WITH IMPORTED TOP FABRIC

GelProMedical.com

Ideal for Operating Rooms, Procedure Areas, Cath Labs, Radiology & Pharmacy WWW.ORTODAY.COM

October 2016 | OR TODAY

New & Refurbished Anesthesia Equipment

Refurbished Passport 2

Video Stylet Only $499 each

S/5 Aestiva SPECIAL $9,800

Refurbished Cardiocap/5

Refurbished Mindray Spectrum

New Mindray Passport 8 & 12

Masimo Pronto StimPod Nerve SpHb Spot-Check Stimulator & Locator

Masimo Root w/ EtCO2 & Multigas

Refurbished Fabius GS

Refurbished Aespire 7900

Refurbished S/5 Avance

Regional Biomedical Service In-house Biomedical Repairs New and Refurbished Vaporizers Vaporizer Pole Mounts Gas Fittings and Hoses- All Types Anesthesia Accessories Oxygen Sensors Heine Laryngoscopes Oral Surgery Analgesia Units

New Gomco Aspirators & Suction Equipment

800-448-0814

Paragon Service www.ParagonService.com

SPECIAL Paragon/Penlon $8,900

Fax 734-429-3197

Use the Coupon Code STERILIZE to save $15 on Calzuro Orders

Autoclave Your Calzuro & Personalize Scrubs Today!

The Italian Calzuro is ergonomically designed for medical professionals. The 1.5 â&#x20AC;&#x153; heel reduces fatigue by setting the body anatomically correct. Protect against contamination by sterilzing the Calzuro in the autoclave, machine wash, or disinfecting with bleach. CALZURO.COM 800-257-9472

OUT OF THE OR NUTRITION

BY HEIDI MCINDOO, M.S., R.D ENTRÉE

LIGHTEN UP YOUR SALAD I

f you’re trying to eat more healthfully, but you still want to enjoy a meal out, ordering a salad is the ideal option, right? Not so fast. While a salad can certainly be a healthy, satisfying option, there are plenty on the menu that can actually shortcircuit your wellness goals. The idea of a salad may sound lighter than a burger, but it’s not always the case. Many restaurant salads are loaded with calories, fat (especially saturated fat) and sodium. Some salads contain more than a day’s worth of sodium (2,300 mg), and more fat than a fast food double burger with cheese.

OR TODAY | October 2016

In order to enjoy a restaurant salad without busting your health budget, try to find one that is moderate in calories, fat and sodium, and rich in fiber and protein – nutrients that will help you feel satisfied. Don’t be afraid to make special alterations on your order. Request your salad sans the high-fat, salty ingredients like creamy dressings, cheese, bacon and fried chicken. And include fiber- and/or protein-rich ingredients, such as beans, grilled chicken, whole grains and nuts. HELPFUL HINTS

Keep these ideas in mind when ordering a salad for your meal. • C ut it in half. Choose half-size salads if available, or eat half of your full-size salad and bring the rest home for another meal.

• Fat check. Skip the saturated fat- and sodium-filled toppings, like croutons, bacon and creamy dressing. Instead, opt for healthy fats in vinaigrettes, an avocado slice and a sprinkling of walnuts or sunflower seeds. • D ressing on the side. Yes, it’s an oft-heard tip, but it works. Ordering the dressing on the side allows you to drizzle on a small amount, or dip each bite for just a bit of flavor vs. drenching the entire salad. Environmental Nutrition is the award-winning independent newsletter written by nutrition experts dedicated to providing readers up-to-date, accurate information about health and nutrition in clear, concise English. For more information, visit www. environmentalnutrition.com WWW.ORTODAY.COM

Zero to One then there is none! Zero to One then you’re done! You can’t see them or hear them! (GERMS) You are mortified they exist! (GERMS) You can’t see it or hear it disinfecting! (DisCide Ultra) But you will be glad it’s there! DisCide Ultra protects YOU! Protection YOU can count on! Kills over 21 deadly pathogens! Kills in 1 minute or less without you even seeing it!

Request a free sample http://www.palmerohealth.com/requestSamples Please mention ORTODAY when requesting a sample

WWW.ORTODAY.COM

800-344-6424

October 2016 | OR TODAY

OUT OF THE OR RECIPE

OR TODAY | October 2016

EATINGWELL ENTREE

WWW.ORTODAY.COM

RECIPE

ELEVATE YOUR CLASSIC BURGER

WITH ‘SPECIAL SAUCE’

low-cooked onions add moisture and flavor to these lean beef burgers. A quick blend of mayonnaise, ketchup, relish and vinegar makes a perfect tangy, sweet and creamy “special sauce” for this burger. We love the dill relish here, but use sweet relish if you prefer it. Serve with sweet potato fries.

Classic Hamburger SERVES: 4 Active Time: 45 minutes Total Time: 45 minutes INGREDIENTS

DIRECTIONS: 1. P reheat grill to medium-high (or see stovetop variation). 2. Combine onion, oil and 1 tablespoon ketchup in a medium saucepan. Cover and cook over medium-high heat, stirring often, until the onion is softened, 5 to 7 minutes. Reduce heat to medium-low, uncover and cook, stirring occasionally, until very soft, 5 to 8 minutes more. Transfer to a medium bowl and let cool for a few minutes. 3. M eanwhile, combine the remaining 1 tablespoon ketchup, mayonnaise, relish and vinegar in a small bowl. Set aside. 4. Add beef, Worcestershire (or steak sauce) and pepper to the onion and gently combine without overmixing. Form into four patties, about ¾-inch thick.

WWW.ORTODAY.COM

5. Oil the grill rack (see note). Grill the burgers, turning once, until an instant-read thermometer inserted in the center registers 165 F, 4 to 5 minutes per side. 6. Assemble the burgers on toasted buns with the ketchupmayonnaise sauce, tomato slices and lettuce. Recipe notes: To oil a grill rack, oil a folded paper towel, hold it with tongs and rub it over the rack. (Do not use cooking spray on a hot grill.) Stovetop variation: Coat a nonstick pan, preferably cast-iron (or a grill pan), with cooking spray and heat over medium-high heat for 1 to 2 minutes. Add burgers, reduce heat to medium and cook, turning once, until an instant-read thermometer registers 155 F (for pork and bison) or 165 F (for beef or chicken), 4 to 5 minutes per side. Recipe nutrition: Per serving: 375

1 medium onion, chopped 1 tablespoons canola oil 2 tablespoons ketchup, divided 2 tablespoons low-fat mayonnaise 2 teaspoon dill pickle relish 1 teaspoon distilled white vinegar 1 pound lean (90 percent or leaner) ground beef 2 tablespoons Worcestershire sauce or steak sauce 1/2 teaspoon freshly ground pepper 4 sesame-seed or other hamburger buns, toasted 4 slices tomato 4 leaves green-leaf lettuce

calories; 16g fat (4g sat, 7g mono); 71mg cholesterol; 31g carbohydrate; 4g added sugars; 8g total sugars; 27g protein; 2g fiber; 536mg sodium; 518mg potassium.

– EatingWell is a magazine and website devoted to healthy eating as a way of life. Online at www. eatingwell.com.

October 2016 | OR TODAY

TRIM 4.5”

CONTINUE YOUR EDUCATION WEBINAR SERIES

TRIM 4.5”

WITH OR TODAY’S FREE WEBINAR SERIES ortoday.com/webinars

ON DEALER

OTHER

HATE BROKEN EQUIPMENT?

TECHNATION

GUIDE

: JL

AD SIZE 1/3 Page Square 4.5”x4.5”

ORTODAY

NOTES

REFER A BIOMED TO

Help your Biomed Department solve equipment problems, gain access to industry resources, and connect with colleagues by sending them to MedWrench.

Join over 33,000 members at www.medwrench.com!

OR TODAY | October 2016

WWW.ORTODAY.COM

WE ONLY MAKE ONE SINK… the best one for you

TBJ sinks are designed specifically for the pre-cleaning of surgical instruments and endoscopes. All of our sinks are custom made to order to enable you to design a system around your specific needs. A wide range of optional features and accessories enable you to tailor a design that puts the tools you for efficient, effective and ergonomic pre-cleaning right at your fingertips.