OR Today - March 2017

SPOTLIGHT ON

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CONTINUING EDUCATION

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TAKE GOOD CARE NURSES • SURGICAL TECHS • NURSE MANAGERS

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MARCH 2017

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CONTENTS

features

OR TODAY | March 2017

Spotlight On: Sharon Sikora

40

PREVENTING INFECTIONS HAIs occur in between five and 10 percent of all hospitalized patients – and they claimed the lives of 75,000 hospital patients in 2014. Infections aren’t just dangerous for patients – they’re also bad news for hospitals, which lose between $26 billion and $33 billion every year due to HAIs, according to the CDC. OR Today looks at this issue and how health care professionals can implement an infection prevention strategy.

46

SPOTLIGHT ON: SHARON SIKORA Sharon Sikora is pursuing a joint BSN and an MSN with an specialization in informatics from American Sentinel University of Aurora, Colorado. Her pursuit of ever-advancing degrees has contributed not only to her career advancement, but to her personal fulfillment within it. Her advice to nurses is to follow your passion.

OR Today (Vol. 17, Issue #2) March 2017 is published monthly by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 302691530. POSTMASTER: Send address changes to OR Today at 18 Eastbrook Bend, Peachtree City, GA 30269-1530.

For subscription information visit www.ortoday.com. The information and opinions expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher. Reproduction in whole or in part without written permission is prohibited. © 2017

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March 2017 | OR TODAY

7

CONTENTS

departments

PUBLISHER

John M. Krieg | john@mdpublishing.com

VICE PRESIDENT

Kristin Leavoy | kristin@mdpublishing.com

22

EDITOR

John Wallace | jwallace@mdpublishing.com

11

ART DEPARTMENT Jonathan Riley Jessica Laurain Kara Pelley

ACCOUNT EXECUTIVES

Warren Kaufman | warren@mdpublishing.com Jayme McKelvey | jayme@mdpublishing.com

26

Chandin Kinkade | chandin@mdpublishing.com

ACCOUNTING

57

Kim Callahan

WEB SERVICES Taylor Martin Cindy Galindo Adam Pickney

INDUSTRY INSIGHTS 11 News & Notes 16 AAAHC Update

CIRCULATION

IN THE OR 18 21 22 26

Lisa Cover Laura Mullen

Suite Talk Market Analysis Product Showroom CE Article

OUT OF THE OR 48 Fitness 50 Health 54 Nutrition 57 Recipe 64 Pinboard 66 Index

8

OR TODAY | March 2017

SURGICAL CONFERENCE

SAVE THE DATE AUGUST 27-29, 2017, WASHINGTON DC

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

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INDUSTRY INSIGHTS NEWS & NOTES

FREE CEU GAME ADDED TO WEBSITE Healthmark Industries announces the launch of “EndoGal” – its newest game on Crazy4Clean.com.

It’s a game that takes players on a learning adventure. It educates players all about flexible endoscopes Join the EndoGal at www.crazy4clean.com?pmc=EndoGal-PR to learn about the different types of flexible endoscopes and their uses, as well as how to properly inspect and transport them. Players can complete the quiz at the end of the game to earn one free CEU from either IAHCSMM or CBSPD! •

DE MAYO V2 E KNEE POSITIONER BENEFITS UNICOMPARTMENTAL KNEE SURGERY The De Mayo V2 E Knee Positioner, from Innovative Medical Products, is useful for orthopedic surgeons performing unicompartmental replacements where the surgical site is on the inside of the patient’s knee.

IMP’s positioner uses a patentpending sterile extension arm that extends the knee positioner base plate off the end of the OR table, enabling the surgeon to stand between the patient’s legs and allows the surgeon the ability to look straight down onto the surgical site. Surgeons no longer have to lean over the OR table when performing procedures. IMP is the first company in the marketplace to make and sell a sterile extension.

Besides its innovative benefit for WWW.ORTODAY.COM

surgeons, the De Mayo V2 E Knee Positioner increases patient safety with new features to the knee positioner’s locking mechanisms. The system’s carriage has been fitted with a sliding bar, the Varus Tilt Control, that prevents a patient’s knee/leg from tilting out, regardless of patient height or weight. Patients stay solidly in place during the entire surgical procedure, while still allowing the surgeon to adjust the rotation, flexion and extension of the knee. The V2 E Knee Positioner also comes with an optional new handle on the carriage for ease of locking the boot.

The De Mayo V2 E Knee Positioner has been made lighter, without decreasing its positioning strength.

Hospital staff can easily disassemble the system’s carriage for cleaning, as well as easily replace the plastic Teflon pad used to slide the carriage back and forth on the positioner.•

March 2017 | OR TODAY

11

INDUSTRY INSIGHTS NEWS & NOTES

EXACTRAC WITH VERSA HD REACHES MILESTONE Brainlab and Elekta have announced the installation of the 50th fully integrated system at Southampton General Hospital, which consists of Elekta’s Versa HD linear accelerator and ExacTrac X-Ray, patient positioning and monitoring technology

by Brainlab. Institutions are increasingly selecting this combined solution for the precise delivery of stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT).

“Integrating the treatment delivery potential of all our Versa HD systems with the imaging capabilities of ExacTrac provides our service with the advanced technology to deliver a 12

OR TODAY | March 2017

safe and effective SRS program to our patients,” stated Claire Birch, Head of Radiotherapy Physics at Southampton General Hospital.

Versa HD is a versatile, multifunctional, high-definition dynamic stereotactic and conventional radiotherapy (RT) solution that removes traditional treatment constraints, offering the capability to deliver SRS and SBRT in routine, standard treatment slots, with end-to-end precision and accuracy.

ExacTrac adds the flexibility to image the patient at any couch or gantry angle either prior to or during treatment delivery, helping to ensure no planning compromises need to be

made due to in-room verification limitations. ExacTrac allows fast and reliable independent room-based imaging, creating a highly advanced frameless system that helps to assure the patient is adequately immobilized.

“The Versa HD and ExacTrac solution provides customers with a streamlined workflow that can simplify the complexities associated with stereotactic radiation delivery for individuals with cancer,” commented Claus Promberger, Director Product Definition at Brainlab. “This is due to its accuracy and the ability to efficiently detect and manage intra-fractional patient motion during treatment delivery.”• WWW.ORTODAY.COM

NEWS & NOTES

TELEFLEX ARROW VPS RHYTHM DEVICE WITH OPTIONAL TIPTRACKER TECHNOLOGY CLEARED Teleflex Inc. has announced that its Arrow VPS Rhythm Device with Optional TipTracker Technology has been issued 510(k) Clearance to commercialize the device in the United States.

The Arrow VPS Rhythm Device provides ECG-based tip confirmation in a portable and lightweight design.

The Arrow VPS Rhythm Device assists in placement and confirmation of a catheter tip in the SVC-CAJ (superior vena-cava-cavoatrial junction); it may be used with a broad range of catheter types and brands. Intravascular P-wave

changes are saved as the catheter approaches the SVC, helping to identify the lower one-third of the SVC, near the CAJ, eliminating the need for confirmatory chest X-ray or fluoroscopy in adult patients. When paired with the singleuse TipTracker Stylet for insertion of peripherally-inserted central catheters, the Arrow VPS Rhythm Device provides real-time visual navigation by tracing the catheter pathway with a blue line on a color screen. The device has an expansive sphere of visual navigation to provide easy navigation of the PICC during insertion. •

HILL-ROM SURGICAL SOLUTIONS LAUNCHES ALLEN ADVANCE TABLE LATERAL SYSTEM Hill-Rom Surgical Solutions has launched the Allen Advance Table Lateral System, a unique new offering to compliment the Allen Advance Table.

“Our new Advance Table Lateral System is designed for lateral approaches in spinal surgery,” said Dr. Dirk Ehlers, president, Hill-Rom Surgical Solutions. “The System provides a flexing, lateral platform and allows for a unique 90 degree rotation of the patient from lateral directly into a prone position when used with the Allen Advance Table.”

Choll W. Kim, M.D., Ph.D., at The Spine Institute of San Diego, is an expert in minimally invasive lateral spine surgery and assisted with the development of this product. Kim and his team have been using the Allen Advance Lateral System and are already seeing benefits.

“We’ve noticed some significant improvements in time efficiency and a drastic decrease in the number of people that are required to maneuver the patient from one position to another,” said Kim. “Furthermore, the development of the flat radiolucent table capable of flexion along with refinements in the hip bump and arm positioners, makes lateral positioning more stable and affords superior intra-operative imaging capabilities. This is a significant improvement over current systems, both in terms of time efficiency as well as ergonomics.” • WWW.ORTODAY.COM

March 2017 | OR TODAY

13

INDUSTRY INSIGHTS NEWS & NOTES

IATRIC SYSTEMS ANNOUNCES NEW FLEXBUTTON APPLICATION Iatric Systems Inc. has launched FlexButton, expanding its suite of solutions aimed at increasing access to patient data. FlexButton works with an array of EHR systems, alerting clinicians to key patient information in various healthcare IT systems and bringing it into the EHR workflow so clinicians avoid the burden of managing multiple sign-ons and passwords.

Iatric Systems used its years of integration experience to create a solution that easily exchanges data between disparate systems without disrupting workflow or increasing data entry. This allows care providers to access the same patient’s information on third-party systems directly from the EHR, making clinician workflows more efficient and allowing clinicians to spend more time with patients.

FlexButton delivers vital patient data to providers when and where they need it most. Data is presented through seamless links to patient screens on other systems, pulling data from those systems into the provider’s EHR. FlexButton lets clinicians and health care organizations streamline care delivery by: • Enabling certain actions to trigger pop-ups and alert caregivers to critical patient conditions or information from other solutions, which helps users provide better, timely, and more efficient patient care; • Avoiding the need to re-authenticate when accessing third-party solutions from within the EHR system; and • Injecting data and information from third-party vendor systems into the health care workflow. •

KARL STORZ RECEIVES INNOVATIVE TECHNOLOGY DESIGNATION FOR BLUE LIGHT CYSTOSCOPY KARL STORZ Endoscopy-America Inc.’s system for performing Blue Light Cystoscopy with Cysview (BLCC) has received an Innovative Technology designation from Vizient Inc. The designation was based on reviews of BLCC by hospital experts who attended Vizient’s Innovative Technology Exchange in September 2016. The event provided medical technology suppliers the opportunity to demonstrate their product and gain direct feedback from 1,300 onsite clinical experts and health care providers on the impact their products may have on improving clinical care, safety, or benefits to an organization’s care and business model.

The BLCC system uses the KARL STORZ D-Light C Photodynamic Diagnostic (PDD) system in conjunction with Cysview, an optical imaging agent distributed in the U.S. by Photocure Inc. The combined system is used to enhance the detection and management of Non-Muscle Invasive Bladder Cancer (NMIBC) in patients with known or suspected bladder cancer, based on prior cystoscopy. Use of the technology begins with placement of Cysview into the bladder prior to the procedure, where it accumulates in tumor cells and is converted into porphyrins within the tumor. When viewed with the D-Light C PDD system, the tumor cells appear red or pink in contrast with normal cells, which appear blue in color. The system is capable of delivering both conventional white light to illuminate the bladder 14

OR TODAY | March 2017

during routine cystoscopy, as well as a special blue light to induce and view fluorescence after the placement of Cysview.

“Use of the KARL STORZ D-Light C PDD system for BLCC procedures gives vital new capabilities to physicians,” says John Martineau, Director of Marketing Urology, KARL STORZ. “Used as an adjunct to whitelight cystoscopy, BLCC is the only FDA-approved technology that is shown to improve detection of bladder cancer tumors hence leading to improved and more comprehensive tumor resection.”•

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INDUSTRY IN THE OR INSIGHTS AAAHC UPDATE

BY BELLE LERNER, MA

BENCHMARKING (INTERNALLY AND EXTERNALLY) TO IMPROVE THE

QUALITY OF PATIENT CARE

O

ne of the ongoing projects of the AAAHC Institute for Quality Improvement is conducting clinical benchmarking studies. The studies are segmented into six-month periods and address a range of common clinical procedures (cataract, colonoscopy, knee and shoulder arthroscopy, low back injection, to name a few). Participating organizations provide data on a minimum of 15 routine cases and we provide the data analysis that identifies the range of performance and takes a close look at the best practices of the highest performers.

Still, we find that many organizations see benchmarking as an unnecessary extra, rather than using it as a tool for evaluation and improvement. For 2017, we have added a universal study to the roster: Safe Injection Practices. Our hope is that a topic applicable across virtually all patient care settings will broaden participation and understanding of the value of benchmarking.

WHAT IS BENCHMARKING? Simply put, benchmarking is creating a ranking of results. By systematically comparing products, services, or work processes among similar organizations, departments, or providers, you can identify and implement the practices that lead to the best outcomes. Internal benchmarking looks at the performance of peers within an organization over time. External benchmarking is a comparison among different entities. Because there are unique benefits to external and internal benchmarking, organizations that perform both have the most to gain.

WHY DO IT? Benchmarking can: • Identify performance relative to peers.

• Help you reach a performance goal that you are struggling to meet.

• Mitigate complacency among providers within an organization. Sometimes, work colleagues or even entire organizations start to show signs of declining efforts toward quality improvement because of unfounded

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OR TODAY | March 2017

belief that their performance is equal to or better than their peers.

• Drive realistic goals for a QI study. When a health care organization tries to identify a problem and set realistic, measureable goals for a QI study, one easy way is to look at benchmarking results.

Gathering peer best practices and metrics provides organizations with insights into the performance level that is achievable in their field. After setting goals based on best performers’ achievements, organizations can continually identify opportunities to improve. This can take some time to accomplish; regular benchmarking can “jump-start” learning and accelerate success.

AN EXAMPLE OF INTERNAL BENCHMARKING Internal benchmarking can lead to exchanging best practices with colleagues in an organization or examining performance over time to make sure performance is not slipping. For example, staff at a freestanding, single specialty ambulatory surgery center that performs roughly 1,000 cataract extraction with lens insertions annually (Organization CAT) may notice that there has been an increase in patient complaints about the time it takes for them to be discharged from the facility after surgery.

Discharge times are defined as when the patient is deemed medically ready to leave the facility.

If this is a process issue, the organization can begin tracking discharge times by each

provider. If the results determine that discharge times vary significantly by provider, the providers with the shortest discharge times should be encouraged to share their “best practices” with their colleagues. Examples of best practices could include: administering oral sedation in the majority of cases, providing patients with detailed instructions during the pre-op visit, and having standardized discharge instructions. The benefit in this case is not only improved organizational efficiency but potentially increased patient satisfaction.

Before embarking on internal benchmarking for this topic, the organization should be sure the issue is not related to patient transportation home. If patient transportation home is the issue, improvement efforts would be better focused on patient communication prior to the day of the procedure than on individual provider technique.

AN EXAMPLE OF EXTERNAL BENCHMARKING To take the above example one step further and turn it into external benchmarking that can potentially lead to further process efficiencies and greater patient satisfaction, Organization CAT may want to compare their discharge times with other similar organizations (i.e., free-standing, single specialty ambulatory surgery centers that perform approximately 1,000 cataract extractions with lens insertions annually) to determine if there is room for further improvement in reducing discharge times.

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TRIM 4.5”

AAAHC UPDATE

WHAT ELSE IS THERE TO CONSIDER WHEN BENCHMARKING? Benchmarking may require significant staff time and resources to complete. Be sure to consider the costs and logistics before launching into benchmarking activities. The following functions are key: • Find (for external benchmarking) and recruit peers PUBLICATION • Identify what exactly to measure MEDICAL • Analyze the data and report the DEALER results • Maintain confidentiality of providers BUYERS GUIDE and patients involved MONTH does not If the health care organization have the means to accomplish these tasks alone, there are third party J Fproviders M AthatM conduct end-to-end benchmarking (like JL the AAAHC Institute)DESIGNER: or offer component parts like useful resources or help analyzing results and implementing improvement actions.

Embarking on a benchmarking activity involves planning and resources. Therefore, make your benchmarking activities meaningful to your organization to get the most out of the experience and the results, to find your way to quality improvement.

TRIM 4.5”

Conducting external benchmarking enables organizations to discover what is possible externally in the industry. Some external benchmarking studies actually include details on “best practices” of the top performing participating organizations. The benefit in this case is that, where feasible, other organizations can implement strategies outlined by external top performers to improve their organization’s performance.

Superior benchmarking provides organizations with the tools for a quality improvement (QI) study, combatting persistent performance issues and guiding the development of new policies and practices.

TECHNATION

ORTODAY

OTHER

J

J

AD SIZE 1/3 Page Square 4.5”x4.5” NOTES

A

S

O

N

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ABOUT THE AUTHOR Belle Lerner, MA, has served as Assistant Director for the AAAHC Institute for Quality Improvement since 2012.

Previously, Lerner was a senior policy analyst and market research manager at the American Medical Association.

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March 2017 | OR TODAY

17

IN THE OR SUITE TALK

SUITE TALK

Q

PALS CERTIFICATION Is it a facility-generated rule or is there a standard stating pre-/post-op staff should be PALS certified if your facility does Peds?

A: Facility requirement here. A: I’d refer any questions A: We require it for PreOp, regarding perianesthesia OR, PACU, and extended A: For surgical services – yes. nursing to the American recovery.

Society of PeriAnesthesia A: Yes, in all places I have Nurses (ASPAN). worked.

Q

C-SECTION STANDARD OF CARE What is the standard of care for C-sections today? Does the OR crew do sections? Does the OB crew come over and do the sections? How does one go about transitioning from having the OR crew do sections to having the OB crew do sections?

A: We have an OB department that performs their own C-sections.

A: We have struggled with this for years. Our sections are done in the OR by OR crew but we have been trying like crazy to transition the OB nurses to do them. A long work in progress due to the fact that we are a small community hospital with limited staffing, reluctance on the part of some OB

18

OR TODAY | March 2017

docs and staff and then however, get them to do all there is always doing their section recoveries in enough to keep their the labor room and they competence. Very difficult are great to help out, but but we keep trying. Most still not ready to take over took the periop 101 course that task. as we were going to build an OB suite on OB, but A: We are still doing the then their deliveries elective C-sections, and the dropped so that was put on labor and delivery staff are hold. They are to come performing the emergency over for sections when C-sections. AORN’s Periop their staffing allows and 101 course is a great with a little encouragebeginning to transitioning ment from the house staff in labor and delivery supervisor. We did, to do their own C-sections.

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Q

HAND OFF

SUITE TALK

When PACU nurses transport patients to the floor, who is responsible for obtaining the patient’s family members from the waiting areas? Should the PACU nurse obtain the family members? Should the receiving nurse obtain the family members?

A: PACU should gather the family members so the patient transition to the next level of care is seamless. This gives the PACU staff the opportunity to introduce themselves, allay any fears and escort the family to the next correct location. It will also increase the “RN to patient communication” HCHAP scores for your facility.

them to the same day surgery unit from the waiting room.

A: At my facility, the PACU nurses are responsible for keeping the family updated and informing of patient status in PACU. They are the ones responsible to obtain the family prior to transport to the patient room.

A: At Gettysburg Hospital (small community hospital), the PACU RN rounds back to the surgical waiting room to greet the family and take them to an inpatient room. The PACU RN also goes and gets the family to bring

A: Our PACU nurses obtain the patient’s family members from the waiting area and take them to the Phase II room or sends them to the patient’s room on the floor. They answer any questions at that time with the family.

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

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IN THE OR MARKET ANALYSIS

STAFF REPORT

SAFETY DRIVES GLOVE MARKET HIGHER

D

onning gloves is almost second nature to health care professionals, especially in the operating room. The market has seen significant growth in the past decade and is expected to reach new heights in the near future.

According to a Zion Research report, the global disposable gloves market was valued at around $5.2 billion in 2014 and is expected to reach approximately $8 billion by 2020, growing at a compound annual growth rate of around 5.5 percent between 2014 and 2020.

Demand for disposable gloves in health care industry is very high. The health care industry is expected to exhibit a rapid growth rate due to alertness regarding hygiene among patients and medical professionals, according to Globe Newswire.

The report also states that disposable gloves find major applications in other industries such as food and automotive.

Disposable gloves are made of various products including natural rubber, neoprene, nitride, polyethylene and vinyl. The use of two gloves, or double-gloving, is high in different sectors including the medical and food and beverage industries.

Safety, both for patients and clinicians, is a motivating factor for glove use.

“The theme of safety is not a new one and in today’s ever-changing health care environment, it is more important than ever,” says Mary Cross, RN, MBA, CWCMS, senior consultant of Clinical Operations at Cardinal Health. “Over the next few years, we see the surgical

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A 2016 Transparency Market Research report states that The global disposable gloves market stood at $5.2 billion in 2012 and is predicted to reach $7.8 billion by 2019. gloves market continuing to move toward a focus on improving safety in the OR. Trends such as wearing two surgical gloves to reduce the risk of bloodborne pathogen transmission can have meaningful impact on safety when it comes to surgical gloving.”

“Double-gloving, or wearing two surgical gloves, has a major impact on clinician safety and is a trend we see continuing to grow,” she adds. “In 2013, 27 million surgical undergloves were sold, and this number has increased to 44.5 million in 2015. Wearing two surgical gloves significantly reduces infection risk to operating room personnel the second glove protects against bloodborne pathogens when the outer glove is punctured.”

A 2016 Transparency Market Research report states that the global disposable gloves market stood at $5.2 billion in 2012 and is predicted to reach $7.8 billion by 2019. It is predicted to expand at a compound annual growth rate of 6.20 percent from 2013 to 2019.

“There are majorly two types of medical gloves, namely surgical and examination medical gloves. Medical gloves have better precision, sensitivity, and a more precise sizing and are manufactured to a higher standard than regular gloves used by consumers,” according to Transparency Market Research.

“Factors such as the rising health care spending and the increasing demand from unconventional end-use industries are amongst the prime factors fueling the market for disposable gloves,” Transparency Market Research adds. “In addition, specialized medical gloves being preferred over a number of other types of gloves within the health care industry will also boost the market. On the other hand, the volatile prices of raw materials and currency fluctuations in the market for disposable gloves are amongst the prime factors that may restrain the growth of the market in the coming years.”

Transparency Market Research reports that the segment of nitrile gloves is predicted to be the most swiftly developing segment and is poised to exhibit a 6.80 percent compound annual growth rate from 2013 to 2019.

This is owing to the increasing demand for nitrile gloves within the medical industry.

March 2017 | OR TODAY

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IN THE OR PRODUCT SHOWROOM

PROTEXIS PI SURGICAL GLOVES CARDINAL HEALTH Protexis PI Surgical Gloves offer the protection clinicians need paired with the performance clinicians want. With a track record of proven success, Protexis PI Surgical Gloves are the bestselling surgical gloves in the United States.1 A multipurpose solution that offers tactile response paired with barrier protection, these surgical gloves are engineered to protect in a wide array of clinical cases. Made using a proprietary hand mold with an independent thumb design, Protexis PI Surgical Gloves allow for an anatomical fit and natural movement in the fingers, thumb and palm. In addition, an interlocking beaded cuff design helps to reduce roll-down so clinicians can focus on what’s most important – their patients.

1

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OR TODAY | March 2017

GHX Data 2016 – All channels

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PRODUCT SHOWROOM

GAMMEX® NON-LATEX UNDERGLOVE AND GAMMEX® NON-LATEX SENSITIVE ANSELL GAMMEX® Non-Latex Underglove joins GAMMEX® Non-Latex Sensitive to create a specialized range of advanced latex-free and chemical accelerator-free surgical glove solutions, featuring Ansell’s proprietary SENSOPRENE® formulation. This dedicated neoprene surgical underglove sets a new standard for allergy management, offering easy identification of a glove breach with its contrasting green color. GAMMEX® Non-Latex Underglove offers the additional benefits of unprecedented comfort and sensitivity thanks to Ansell’s proprietary formers with enlarged thumb and palm areas. Featuring SENSOPRENE® formulation, and in combination with Ansell’s triple-dip manufacturing technology, you get a micro-thin yet durable neoprene glove offering excellent sensitivity with minimal bulk when double gloving.

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March 2017 | OR TODAY

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IN THE OR PRODUCT SHOWROOM

DERMASSURE GREEN MEDLINE Medline’s DermAssure Green glove is manufactured with a technologically advanced formulation that is not made with chemical accelerators, but still provides the outstanding comfort and performance you expect and need. DermAssure Green is ideal for general surgery as an underglove or by itself as well as utilized in any surgery where staff may have chemical accelerator sensitivities.

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OR TODAY | March 2017

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PRODUCT SHOWROOM

PURPLE NITRILE MAX HALYARD HEALTH Once again, Halyard Health proves “purple means protection” with the introduction of Purple Nitrile Max, the newest member of its single-use exam glove family designed specifically to meet the increased protection needs of Central Sterilization technicians. Durable, easy-to-don Purple Nitrile Max offers CS techs critical safety features, including a longer 16-inch length, heavier weight, thicker fingertips and fully textured fingertips and palm. With Purple Nitrile Max, CS techs can be sure they’re getting the protection they require within their everyday, wet environment.

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IN THE OR CONTINUING EDUCATION CE431E

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OR TODAY | March 2017

BY MARGARET M. ECKLUND, MS, RN, ACNP-BC, CCRN-K

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CONTINUING EDUCATION CE431E

TO AIR IS HUMAN CARE OF THE PATIENT WITH AN ARTIFICIAL

AIRWAY THREATENS HOSPITALIZED PATIENTS

I

magine you are an acute care nurse. One of your patients has a tracheostomy tube (TT) and is on ventilator support. The patient wishes to speak to family members visiting her for the first time from out of town. Your knowledge of the type of tracheostomy tube your patient has and the adaptations required to facilitate her speech will affect her quality of care. This module provides evidence-based information for the care of the patient with a tracheostomy tube.

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

The goal of this program is to provide nurses with an evidence-based framework for the care of the adult patient with an artificial airway. After studying the information presented here, you will be able to: • Identify the alterations created by an artificial airway and strategies to minimize risk of infection and ensure patency • Describe the types of tracheostomy tubes, citing attributes of each • Discuss communication strategies for the patient with an artificial airway

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Tracheostomy is the procedure that creates an opening from the midline of the throat into the trachea. Tracheostomies date back 3,500 years, but today’s procedure was refined in the early 20th century.

Tracheostomies can be performed surgically in the OR or at the bedside using a percutaneous approach. The percutaneous approach uses dilators guided by bronchoscopy to create a stoma (the opening in the trachea) and to guide the TT into place. A tracheostomy tube, a type of artificial airway, is placed in a stoma to keep it open. Unless the tracheotomy stoma is surgically created as with a laryngectomy, the stoma will close when the artificial airway is removed. Removal of the artificial airway (decannulation) will result in the eventual closure of the stoma over hours or days, depending on the length of elapsed time since the tracheostomy.1 An endotracheal tube is placed for an emergent need for an airway for ventilation. Patients transition from endotracheal tubes to tracheostomy tubes when an ongoing airway need is evident.

TTs remove secretions and relieve airway obstruction due to trauma, bleeding, tumors, tissue swelling, infections, chemical or inhalation burns, and obstructive sleep apnea. TTs are also used when patients cannot protect their own airway and when an oral airway cannot be accessed. Evidence supports the placement of tracheostomy after at least 10 days of intubation. This confirms the need for an ongoing airway.2,3

Early tracheostomy placement is indicated for the following patients based on risk and ongoing needs: • Trauma patients • Patients with traumatic brain injuries • Patients with spinal cord injuries • Neurosurgical patients • Mechanically ventilated patients with chronic lung disease 2 The benefits of transitioning patients from an endotracheal tube to a TT include the following: • Decreased need for sedation • Increased comfort • Increased communication options • Increased potential to eat • Increased mobility • Discharge from the ICU and transition to a less intense level of care1,3 THE BASICS During the normal respiratory process — when no artificial airway is in place — inspired air collects moisture and is warmed as it flows over mucosa in the upper respiratory tract until it becomes saturated. The warmer the air, the more vapor it can hold. Mucous transport is achieved by tiny hairs on the surface of the mucosa (the cilia) that beat roughly 20 strokes per second, depending on the amount of inspired air. The mucous layers in the upper respiratory tract help protect the lungs by trapping viruses and bacteria.

When a patient has an artificial airway, the inspired air bypasses the upper airway, traveling into the lungs via the tracheostomy tube instead of via the nose March 2017 | OR TODAY

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IN THE OR CONTINUING EDUCATION CE431E and mouth. With an artificial airway in place, less humidification and warming of the inspired air occur because the air doesn’t pass through the nose and mouth.

This cool, dry air irritates the mucosa and reduces mucous gland metabolism and cell motility in the upper airway. Mucous glands in the trachea and bronchi become hyperactive, resulting in excess mucous production. Dry air collects moisture from the surface of airways below the tracheostomy tube and causes the mucous layers to become thin, viscous, and less able to trap viruses and bacteria. The tracheostomy tube irritates the trachea and can promote excess secretions with decreased viscosity, or thicker mucus, as the airway compensates for the drying effects of air. Thus, these patients may need increased suctioning.1,4 STANDARD PLAN OF CARE To lessen the risk of injury or infection, healthcare professionals can perform the following interventions: Provide adequate humidification to the TT: At optimal humidity, mucous clearance is effective without increasing the workload of the respiratory tract.

The humidification of inspired gas is recommended when an airway is present.4 Elements required for ventilation and humidification include a humidification device, sterile water, a system to monitor the inspired air temperature, and an alarm to alert caregivers when the temperature falls out of range.

Reduce injury and infection risk: Suctioning the patient’s airway using evidence-based techniques can reduce the risk of injury and infection. Suctioning should be performed when clinically indicated, such as in response to the patient’s nonverbal request and during times of frequent coughing, increased secretion collection in the tubing, low oxygenation, and increased peak airway pressures. Routine scheduled suctioning is not recommended. Patients on mechanical ventilation should be routinely assessed for coarse crackles over the trachea, 28

OR TODAY | March 2017

which are the most common indicator for endotracheal suctioning. Although the practice is common, assessment of lung sounds to determine the need for suctioning is not supported.5,6 Sterile technique should always be used when entering the airway. There are two types of TT suctioning: a closed system and an open system. If a patient is on ventilator support, a closed system is preferred.

Closed system suctioning involves a suction catheter enclosed in a plastic sleeve and attached to the ventilator tubing and the TT. The catheter is guided into the tracheostomy tube when suctioning is needed. It’s cleaned with saline between uses. Between uses, the suction catheter stays within the ventilator circuit and the patient. The catheter is changed according to the institution’s protocols. Handwashing and clean gloves reduce the risk of contamination as the system is closed.6 Open suctioning requires a prepackaged suction catheter and sterile gloves. The healthcare professional opens the package, dons the sterile gloves, and attaches the sterile suction catheter to the suction tubing. The healthcare professional performs suctioning once the ventilator or humidification source is detached. The suction kits are disposed of after each use.6 To reduce the risk of hypoxemia, before suctioning with either the open or closed system, the healthcare professional must hyperoxygenate the patient for at least 30 seconds.

Hyperinflation is another option for patients with marginal oxygenation; it can be performed with a manual resuscitation bag or through the ventilator. Ventilators in the acute care setting allow caregivers to activate 100% oxygen delivery for a limited time. The ventilator resets to the prior settings by default. No evidence exists to support the routine instillation of normal saline into the airway. After suctioning, it’s important to flush inline, closed-system catheters with normal saline.3,6 Reduce the risk of aspiration: Elevating the head of the bed to at least 30 degrees reduces the risk of aspiration.

This is particularly important for patients receiving tube feedings via small-bore feeding tubes or gastrostomy tubes. If a TT has a balloon cuff, inflation of the cuff may stop upper airway secretions from leaking into the lung. Caregivers should routinely monitor the elevation of the head of the bed to ensure patient adherence. Caution is advised to ensure pressure redistribution when the patient has prolonged headof-bed elevation to avoid development of pressure ulcers.

Use of a TT with above-cuff suction port to routinely remove above-cuff secretions has shown benefit in reducing ventilator-associated pneumonia. These tubes have a port attached to suction to remove the accumulated secretions.7 Routine oral care with a soft-bristled toothbrush and oral solution reduces plaque on teeth and bacteria growth in the mouth, which contribute to aspiration risk and pneumonia. As part of oral care, subglottic suctioning using an oral suction device helps clear the pharyngeal area of accumulated saliva containing nosocomial bacteria. Steps to prevent ventilatorassociated pneumonia (VAP) include routine oral care, elevation of the head of the bed and no routine change of ventilator circuits.8,9,10 Promote and maintain stoma health: Healthcare professional team members can promote wound healing and maintain skin integrity by routinely cleansing and drying the stoma. Barrier products, such as a vitamin A & D ointment, also aid wound healing and skin integrity. Periodically changing and verifying the integrity of tracheostomy ties promotes skin integrity at the neck and reduces the risk of decannulation. Velcro tracheostomy tube ties and twill ties can provide comfort and maintain correct anatomical tracheostomy tube location. During the changing of the ties, stabilization of the tube by a second person minimizes the risk of accidental decannulation.11 Adequate nutrition support: Malnutrition can result in decreased lung function, which can include impaired WWW.ORTODAY.COM

strength of respiratory muscles, and cause greater and faster respiratory fatigue and failure.12 Providing nutrition support in the mechanically ventilated population is difficult as it is essential to avoid undernutrition leading to pulmonary muscle weakness and poor ventilation, while also avoiding overfeeding calories that results in excess metabolites (CO2) that must be excreted via the lungs.

TYPES OF TUBES TTs are made of various materials with different characteristics. Institutional and provider preferences and patient need determine the tracheostomy tube selection.

Single or dual cannula tracheostomy tubes with air cuffs are typically used as the initial tracheostomy tube for ventilatordependent patients. A 15-mm hub, standard for most tracheostomy tubes, is necessary for secure ventilator tubing attachment. TTs with inner cannulas allow the healthcare professional to remove the inner cannula to clean it or change a disposable one. The inner cannula must be assessed periodically to prevent the tracheostomy tube from clogging with mucous. Mucous clogging or plugging may be prevented with adequate humidity and single cannula tracheostomy tubes.1,3 Cuff inflation with air is necessary to ensure accurate and adequate tidal volume delivery.

Cuffs inflated with air are optimally filled to achieve minimal leak of the cuff.

A manometer (an instrument to measure gas and vapor pressure) can measure the pressure the cuff exerts on the tracheal tissue. Goal pressures of less than 20 mmHg to 25 mmHg allow adequate capillary refill pressures in the trachea, reducing the chances of tracheal injury.

Cuffs filled with sterile water, tight to shaft tubes (TTS), should be monitored to avoid overinflation and possible rupture. When water-filled cuffs (also called white-tipped pilot balloons) are deflated, the syringe should be pulled back enough to ensure the pilot balloon is flat. A flat balloon indicates that all the water has been extracted.

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Foam cuff tubes, with red-tipped pilot balloons, passively inflate at atmospheric pressure. Air is not used to inflate the cuff, and speaking valves and plugging are contraindicated in foam cuff tubes.11,13 Metal TTs are cuffless and have an inner cannula that can be removed, cleaned of secretions, and reinserted in the outer cannula. The inner cannula of metal tracheostomy tubes lacks a hub and cannot be attached to mechanical ventilation

circuits. Metal TTs are generally used in patients requiring long-term airways who cannot maintain spontaneous breathing.

The metal material allows secretions to pass with coughing. Metal TTs can be capped with a plastic decannulation stopper of equivalent size to promote both airflow around the tube and vocalization.

A 15-mm hub can be custom-made for speaking valve use.

Lastly, the patient’s anatomy dictates

PARTS OF A TRACHEOSTOMY TUBE Phlange: A crossbar at the front edge of the tracheostomy tube external to the stoma. It is used to secure the tracheostomy to the neck.

Hub: An adapter at the end of the tube that is exterior to the stoma. A 15-mm hub is considered standard for ventilator attachment, speaking valve, and manual hyperinflation.

Cuff: The balloon that surrounds the circumference of the shaft.

When inflated, it provides a barrier to the airflow in the trachea around the tube. Cuffs are inflated with air or water, or are made of foam. Deflated cuffs can lie tight to the shaft or fold against the shaft.

Pilot balloon: Attaches to the small tube near the tracheostomy tube hub. The pilot balloon reflects inflation of the cuff for an air- or water-cuffed tube. If flat, deflation is implied. The degree of pilot balloon inflation with either air or water indicates the cuff pressure or filling. Foam cuffs demonstrate opposite filling indicators.

Shaft: The vertical tube of the tracheostomy tube that rests in the trachea, which may be either custom or standard length Obturator: The guide used to insert the tracheostomy tube. It is removed after being placed in the airway and can be saved in a bag in the event of accidental decannulation.

Cannula: The tubular shaft of the tracheostomy tube. A single cannula consists of one tube, and a dual cannula consists of a smaller tube fitted inside a larger one.

Fenestration: Small hole in the shaft that allows additional airflow through the shaft and trachea when open. Complications of the fenestration can be malpositioning, possible airflow obstruction, and tracheal trauma.

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IN THE OR CONTINUING EDUCATION CE431E What Are the Options for Speaking to a Patient With a Tracheostomy Tube?1,3,15,16 • Lip reading (silent) • If the patient is on ventilator support, a cuff leak sufficient for voice that doesn’t affect tidal volume or distress • A communication board • A speaking valve after initial assessment for safety, ventilation needs, and airflow • Capping of the tracheostomy tube if the appropriate tube is in place • Finger occlusion if the cuff is deflated and the patient has been weaned from ventilation • A computer-assisted communication tool • Texting on a cellphone which TT type to use. Larger patients or patients with long necks may require a longer TT, which can be ordered from the manufacturer. The additional tube length may be at the proximal or distal end of the tube. Adjustable phalange tubes provide the flexibility of the tube length for a temporary period as plans for a tube for a longer duration in the airway. The healthcare professional must collaborate with the rest of the healthcare team — including otolaryngology, pulmonology, and respiratory therapy personnel — when choosing TT type and length.1,3 CHANGING TRACHEOSTOMY TUBES A TT may generally be initially changed seven days after the tracheotomy, at the bedside. Caregivers who have demonstrated competence with tracheostomy tube changes should change them with safety measures in place, including having a spare TT, one of a smaller size, a manual resuscitation bag with mask and intubation equipment available in case the stoma gets lost or the airway becomes compromised.1,14 There is no data to support routine changes for patients with TTs in for longer periods of time. The healthcare team determines frequency of change based on tube integrity and patient need.

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DECANNULATION Decannulation occurs when the underlying illness contributing to the need for a TT is resolved. When a patient has been weaned from mechanical ventilation, capping the tracheostomy tube allows assessment of breathing effort and secretion clearance via the patient’s natural airway. TTs can be capped safely only if there is a fenestration in an air-cuffed tube and the cuff is deflated, a tight to shaft silicone tube is in place, or a cuffless TT is in place. If a patient tolerates the capped TT, evaluation of secretion clearance without suctioning is important to guide the decision to remove the TT. When the TT is discontinued, an occlusive dressing, such as petrolatum gauze with an additional dry gauze to cover, are applied and taped to the skin to obstruct airflow into and out of the healing stoma. The patient’s voice and cough may be weak until healing is complete and the stoma closes. Pressure on the gauze dressing to provide occlusion to the stoma may help augment phonation.1,14 Accidental decannulation of a TT can be an airway emergency. To prevent a possibly disastrous outcome, the healthcare professional must have a spare TT of the same size as the original and a manual resuscitation bag at the patient’s bedside. If the TT is less than seven days old, the tube may be difficult to reinsert because the stoma has not fully

formed. Using an obturator — the guide used to insert the tracheostomy tube — the tracheostomy tube can be guided back into the airway. Flat positioning of the patient, hyperextension of the patient’s neck, and application of a watersoluble lubricant to the tube may make reinsertion easier. If the tube still won’t reinsert, assess the patient’s respiratory effort. If reinsertion is still unsuccessful, a smaller diameter tube may be used. If the patient is in distress, the stoma can be covered with gauze while the patient is ventilated with a manual resuscitation bag. Emergency procedures must then be started, possibly including endotracheal intubation. An otolaryngologist, a surgeon, or an anesthesiologist may be needed to reinsert the tracheostomy tube, insert an endotracheal tube, or perform an emergency cricothyrotomy, in which an incision is made into the larynx to open the airway.1,14 COMPLICATIONS Acute complications of TT use can stem from intubation problems, the tracheostomy procedure, or the patient’s underlying illness. Complications include pharyngeal laceration and vocal cord hematoma, trauma, and paralysis. An esophageal fistula or pneumothorax can also occur. The incidence of tracheal stenosis may be reduced with low-pressure TT cuffs. In addition, granulation tissue due to tissue ulcerations can develop and reduce upper airway flow. This becomes evident when the patient progresses to cuff deflation or with use of the speaking valve, or when the tracheostomy tube is capped. Respiratory distress and stridor indicate insufficient airflow due to the granulation tissue. Granulation tissue is visualized in the airway through indirect laryngoscopy and may be treated with laser removal, steroids, or time for healing.

Tracheomalacia is breakdown of tissue in the trachea that alters the integrity of the airway and potentially the cuff seal. A different TT size or length may promote airway patency.1 WWW.ORTODAY.COM

CONTINUING EDUCATION CE431E

COMMUNICATION A patient with a TT needs alternative communication strategies. The speech therapist, respiratory therapist, nurse, and physician work together to maximize patient safety and devise an optimal communication plan. If the TT is without a cuff, options for communication include finger occlusion or capping. With the tracheostomy tube “closed,” the air passes the vocal cords and allows phonation.

Assessment for adequate airflow, secretion clearance, and oxygenation is important to determine the safety of this method.

If a cuffed tracheostomy tube is inflated, air cannot pass the vocal cords, and phonation is not audible. The patient’s ability and the unit’s resources determine options for communication. Lip movement with silent speech works if family and staff can “lip read.” Writing on a writing board or in a notebook can aid in spontaneous communication. Additional options include hand gestures, a computer, or an electrolarynx (a device that creates an electromechanical vibration that can be heard as a speaking tone).1 Speaking valves optimize vocalization by adapting the airway to promote airflow by the vocal cords. Speaking valves may improve a patient’s swallowing by increasing subglottic pressures. To use a speaking valve, the cuff is completely deflated, followed by suctioning and assessment of adequate airflow. If airflow is present and tolerated by the patient, the speaking valve is placed on the opening of the tracheostomy tube.

If there is insufficient airflow within the trachea around the tube, the speaking valve may not be used safely. The most common speaking valve works by being biased closed on exhalation only. It has a 15-mm adapter to attach to the TT hub.

As the patient inhales, air is inspired through the TT, but the valve closes on exhalation, forcing air by the vocal cords, resulting in phonation. An adapter can allow the speaking valve to be placed within the ventilator circuit to allow support of the mechanical ventilator WWW.ORTODAY.COM

What Would You Do?1,3 Can the patient’s tracheostomy be capped?

Yes, if: • There is adequate airflow around the tracheostomy tube, adequate oxygenation, an ability to clear mucus, and no evidence of distress with finger occlusion.

• There is no cuff.

• The cuff is water-filled tight to shaft, the cuff is fully deflated of water, and air can pass without distress.

• The cuff is air filled, only if there is a fenestration in the tube shaft, and the cuff is fully deflated, and air can pass without distress.

No, if: • There is an air cuff and no fenestration (a hole in the posterior aspect of the shaft).

• The cuff is inflated.

• It is a foam cuff tracheostomy tube.

• There is no audible airflow, or if stridor, an inability to clear mucus, or visible distress with finger occlusion exist. during valve use. Speaking valves can also be used in patients who have weaned from mechanical ventilation and who are undergoing supplemental oxygen therapy.

Pulse oximetry and respiratory effort and tolerance are assessed to ensure safety.

Risks of using a speaking valve include airway obstruction, hypoxia, and dyspnea.

Patients should never be allowed to sleep with the valve in place with risk of airway obstruction. Supervision of valve use is protocol driven within institutions.1,16 It is possible for the patient to achieve audible voice with an air leak around the cuff to allow airflow by the vocal cords.

If the patient is comfortable with the loss of tidal volume, it may be an option to use “leak speech technique” without the routine addition of the speaking valve.

The healthcare professional’s knowledge of TTs can improve patient care and outcomes. Plans of care and interprofessional collaboration are geared to the needs of each patient. Quality of life and safety are key areas of concern and require the healthcare professional to maintain adequate knowledge about the artificial airway.

OnCourse Learning guarantees this educational program free from bias.

Margaret M. Ecklund, MS, RN, ACNP-BC, CCRN-K, is a nurse practitioner at Legacy Health in Portland, Oregon.

References 1. Mitchell R, Hussey H, Merati A, et al. Clinical consensus statement: tracheostomy care.

Otolaryngol Head Neck Surg. 2013;148(1):6-20. http://dx.doi.org/10.1177/0194599812460376.

Accessed July 1, 2016.

2. Cheung NH, Napolitano LM. Tracheostomy: epidemiology, indications, timing, technique, and outcomes. Respir Care. 2014;59(6):895-916. doi: 10.4187/ respcare.02971.

3. Dawson D. Essential principles: tracheostomy care in the adult patient.

Nurs Crit Care. 2014;15(2):63-72. doi: 10.1111/nicc.12076.

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IN THE OR 4. Al Ashry H, Modrykamien A. Humidification during mechanical ventilation in the adult patient. Biomed Res Int [serial online].

2014:715434.

5. Sole M, Bennett M, Ashworth S. Clinical indicators for endotracheal suctioning in adult patients receiving mechanical ventilation. AJCC. 2015;24(4):318-325.

6. Chulay M, Seckel M. Suctioning: endotracheal or tracheostomy tube. In: Lynn-McHale Wiegand DJ, ed. AACN Procedure Manual for Critical Care. 6th ed. Aliso Viejo, CA: American Association of Critical Care Nurses; 2011:79-87.

7. Lekgerwood LG, Salgado MD, Black H, Yoneda K, Sievers A, Belafsky P. Tracheotomy tubes with suction above the cuff reduce the rate of ventilator-associated pneumonia in

CLINICAL VIGNETTE Bill, age 80, is in the medical ICU with abdominal pain. An abdominal ultrasound reveals gallbladder stones with common bile duct obstruction and wall thickening. He develops a systemic inflammatory response, which prompts intubation with an endotracheal tube and implementation of required pressure control ventilation for respiratory failure. With failure to wean, Bill receives a surgical tracheostomy. A single cannula air-cuffed TT is placed. Bill begins to mobilize fluids, diurese, and tolerate weaning.

With ventilation, the inflated cuff on the TT results in no vocalization. Bill tolerates cuff deflation and the use of the speaking valve. With ventilator adjustments to maximize vocalization and support breathing effort, Bill is able to speak with close supervision by the respiratory therapist.

As Bill weans, the TT is changed to a No. 6 silicone TTS TT, allowing plugging of TT when the cuff is fully deflated. With plugging, Bill is able to speak, cough, and clear his secretions by mouth. His TT is suctioned when mucus cannot clear. The TT remains plugged by day. At night, Bill rests with the help of mechanical ventilation. Within days, the TT is plugged for extended periods of time. With a strong cough to clear mucus, Bill is decannulated after more than 24 hours have passed without the need for suctioning.

1. Why is Bill unable to speak while on pressure control ventilation? a. The cuff is inflated. b. His vocal cords are severed. c. The tidal volume is too high. d. The TT malfunctions.

3. To implement Bill’s speaking valve, the nurse should: a. Inflate the cuff b. Assess for adequate airflow c. Postpone suctioning d. Increase the tidal volume

2. Which is an appropriate substance to promote wound healing and skin integrity of Bill’s stoma? a. Zinc oxide cream b. A sloughing agent c. A barrier cream d. Adhesive remover

4. The decision for Bill’s decannulation is determined by his: a. Adequate pain control b. Decreased need for suctioning c. Increase in oxygen hunger d. Increased diuresis

4. Correct Answer: B – The ability to clear secretions without suctioning predicts successful decannulation.

2. Correct Answer: C – Care of the stoma with routine cleansing and application of a barrier product, like vitamin A & D ointment, promotes wound healing and skin integrity.

3. Correct Answer B – For a patient to use a speaking valve, the cuff must be completely deflated, followed by suctioning and assessing for adequate airflow.

OR TODAY | March 2017

1. Correct Answer: A – With the cuff inflated, air cannot pass the vocal cords, which hinders Bill’s speech.

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HOW TO EARN CONTINUING EDUCATION CREDIT intensive care unit patients. Ann Otolog Rhinolog Laryngolog. 2013;122(1):3-8. http://www.ncbi.nlm.nih.gov/ pubmed/23472309. Accessed July 1, 2016.

8. Vollman KM, Sole ML. Endotracheal tube and oral care. In: Lynn-McHale Wiegand DJ, ed. AACN Procedure Manual for Critical Care. 6th ed. Aliso Viejo, CA: American Association of Critical Care Nurses; 2011:31-38.

9. AACN practice alert: Ventilator-associated pneumonia. 2008. American Association of Critical-Care Nurses Web site. http://www.aacn.org/wd/practice/ docs/practicealerts/vap.pdf. Accessed July 1, 2016.

10. AACN practice alert: oral care for patients at risk for ventilator associated pneumonia. 2010. American Association of Critical-Care Nurses Web site. http://www.aacn.org/wd/ practice/docs/practicealerts/oral-care-patients-at-risk-vap. pdf?menu=aboutus. Accessed July 1, 2016.

11. Skillings KN, Curtis BL. Tracheal tube care. In: LynnMcHale Wiegand DJ, ed. AACN Procedure Manual for Critical Care. 6th ed. Aliso Viejo, CA: American Association of Critical Care Nurses; 2011:96-104.

12. Reeves A, White H, Sosnowski K, et al. Energy and protein intakes of hospitalized patients with acute respiratory failure receiving noninvasive ventilation. Clin Nutr. 2014:1068-1073. doi: 10.1016/j.clnu.2013.11.012.

13. Skillings KN, Curtis BL. Tracheal tube cuff care. In: Lynn-McHale Wiegand DJ, ed. AACN Procedure Manual for Critical Care. 6th ed. Aliso Viejo, CA: American Association of Critical Care Nurses; 2011:88-95.

14. Skillings KN, Curtis BL. Extubation/decannulation. In: Lynn-McHale Wiegand DJ, ed. AACN Procedure Manual for Critical Care. 6th ed. Aliso Viejo, CA: American Association of Critical Care Nurses; 2011:39-46.

15. A Morris LL, Bedon AM, McIntosh E, et al.

Restoring speech to tracheostomy patients. Crit Care Nurs. 2015;35(6):13-28. http://ccn.aacnjournals.org/ content/35/6/13.full. Accessed July 1, 2016.

16. Passy-Muir valves. Passy Muir Web site.http://www. passy-muir.com/products. Accessed July 1, 2016.

Additional Reading: National Tracheostomy Safety Project. http:// tracheostomy.org.uk/Templates/Home.html. Accessed July 1, 2016.

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The Smart Choice Admittance to a hospital room previously occupied by a patient with an infection or multidrug-resistant organism results in the new patient having an increased risk of acquiring that pathogen by 39-353%*.

Tru-D is the only “smart” UV disinfection robot with patented Sensor360® technology.

By measuring the reflected UVC energy that comes back to the robot, Tru-D is able to provide the precise, lethal dose of UVC needed for thorough room disinfection.

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*Weber, et al. (2016, March). ‘No touch’ technologies for environmental decontamination: focus on ultraviolet devices and hydrogen peroxide systems.

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March 2017 | OR TODAY

37

The Role of the Health Care Environment

A Decade Later, Tru-D Continues to be a Leader the UV Disinfection Industry The pioneer in the UV disinfection industry, Tru-D SmartUVC placed the first UV robot in a health care facility in 2007.

With a commitment to innovation and excellent customer experiences, today Tru-D, short for “total room ultraviolet disinfection,” is deployed in hundreds of health care facilities. Tru-D’s basis of scientific evidence and widespread adoption throughout prestigious hospital systems continues to drive market acceptance of UV disinfection technology.

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OR TODAY | March 2017

Over the past decade, researchers have concluded that manual disinfection is inadequate for terminal room disinfection.

According to studies, more than 50% of health care surfaces are not properly disinfected, leaving behind pathogens that increase the risk of infection by 39 – 353% for the next patient who enters the room1. In fact, according to a study by Jefferson, et al, on average, only 25% of targeted surfaces in 71 operating rooms had been properly cleaned2.

Decreasing the burden of microorganisms in the OR environment can decrease the risk of surgical incision contamination and SSIs3. Despite the best efforts of environmental services personnel, a high percentage of environmental surfaces may remain contaminated even after terminal cleaning4. Health care personnel must strive to create an environment that is free of microorganisms, especially in the OR setting5.

Tru-D’s measured dosing capability has been validated to significantly improve disinfection when added to standard cleaning protocols.

Recently, in a presentation at IDWeek 2016, Microbial Load on Environmental Surfaces: The Relationship Between Reduced Environmental Contamination and Reduction of HealthcareAssociated Infections, researchers concluded that, “Comparing the best strategy with the worst strategy (i.e. Quat vs Quat/UV) revealed that a reduction of 94% of epidemiologically-important pathogens led to a 35% decrease in colonization/infection.”

Every Surface Matters The environment has been proven to play a large role in the transmission of infections, and one surface has not been proven more or less important to disinfect than another. Therefore, it is critical to disinfect the entire room from top to bottom to provide a cleaner, safer operating room environment.

“Sometimes we label areas high risk – tray tables, sink, side rails, call box, chair, etc. – however, no one has ever identified these objects as more likely to be involved in transmission of disease,” said Dr. William A. Rutala in his presentation Role of the Environmental Surfaces in Disease Transmission: “No Touch” Technologies Reduce HAIs at the 2016 Association for the Healthcare Environment Conference. “We absolutely do not know what is more high risk, so we have to focus on all surfaces. Given this data, all room surfaces must be disinfected.”

The UV Robot with a Brain Tru-D is the only “smart” UV disinfection robot with patented Sensor360® technology. By measuring the reflected UVC energy that comes back to the robot, Tru-D is able to provide the precise, lethal dose of UVC needed for thorough room disinfection.

Compensating for size, shape, color (room reflectivity) and amount of equipment in a room, Sensor360® calculates the precise time necessary to disinfect the room. Operating from a single placement, Tru-D reduces human error associated with manual disinfection processes.

“The Sensor360® technology WWW.ORTODAY.COM

sets Tru-D apart. Rather than estimating the necessary UV dose or moving a unit to multiple placements in a room, Tru-D is able to analyze a space and provide a measured, lethal dose of UV light to provide total room disinfection from a single cycle in a single location,” said Greg Rosenberger, Hospitality Services Director of Sarasota Memorial Hospital in Sarasota, Florida.

Minimal Impact on Workflow Tru-D’s single placement method leaves operators free to complete other tasks during the disinfection process, thus maximizing productivity and room turnover time while minimizing labor costs. The significant labor costs associated with devices that require multiple room placements and constant monitoring by EVS staff often require hiring additional full-time employees whose only task is operation of the UV device.

Tru-D Removes the Guesswork from UV Disinfection Tru-D is activated remotely from outside the room. Its intuitive controller is userfriendly and allows for complete documentation of the disinfection process. During the disinfection

cycle, Tru-D automatically uploads disinfection data to the secure MyTru-D portal allowing administrators to track Tru-D usage including specific pathogen data, room number, operator and cycle times.

Real-time reports are customizable, and the concise graphics and exportable spreadsheets put critical data directly in the hands of operators and administrators, maximizing utilization and productivity.

“Tru-D makes it easy for our staff to analyze real-time data on the cleanliness of our patient rooms,” said Greg Rosenberger, Hospitality Services Director of Sarasota Memorial Hospital in Sarasota, Florida. “The ability to track cycles helps us improve our work flow and efficiencies.”

Selecting the Right No-Touch Disinfection Device for Your Hospital When evaluating whether to use these technologies in the OR, facility leaders must consider key factors such as the cycle time, the distance the ultraviolet light travels and the effect on staff members needed to perform the process6.

Tru-D ideally fits within this evaluation process, providing extremely high levels of organism

destruction in a very short period of time with a minimal disruption to process flow.

Tru-D SmartUVC Backed by Science Tru-D was the only UV disinfection device selected for the firstever randomized clinical trial on UV disinfection. The Benefits of Enhanced Terminal Room-Disinfection (BETR-D) study, funded by the Centers for Disease Control and Prevention, proved that enhanced terminal room disinfection strategies reduced the risk of acquisition and infection of target mulitdrug-resistant organisms among patients admitted to the same room by a cumulative 30%.

Additionally, the study concluded that, “A contaminated health care environment is an important source for acquisition of pathogens; enhanced terminal room disinfection decreases this risk.”

The BETR-D study is now published in The Lancet. To learn more about the BETR-D study, visit tru-d.com/BETRDstudy.

For more information, visit tru-d.com.

1) Weber, et al. ‘No touch’ technologies for environmental decontamination: focus on ultraviolet devices and hydrogen peroxide systems. Current Opinion On Infectious Diseases. 2016 29:000–000 2) Jefferson J, Whelan R, Dick B, et al. A novel technique for identifying opportunities to improve environmental hygiene in the operating room. AORN Journal. 2011:93:358-364. 3) Yasli S, Barbut F, Otter JA. Surface contamination in operating rooms: a risk for transmission of pathogens? Surg Infect (Larchmt) 2014; 15(6):694699 4) Rutala WA, Weber DJ. Are room decontamination units needed to prevent transmission of environmental pathogens? Infect Control Hosp Epidemiol. 2011:32(8):743-747 5) Armellino D. Optimal Infection Control Practices in the OR Environment. AORN Journal 2016 104(6):516-522 6) DeBaun B. Looking Forward-Infection Prevention in 2017. AORN Journal 2016 104(6):531-535

WWW.ORTODAY.COM

March 2017 | OR TODAY

39

disarming patient threats

BY DON SADLER

W

ould it surprise you to learn that as many as one out of every 25 hospital patients has

75,000 hospital patients in 2014.

But infections aren’t just dangerous for patients – they’re also bad news for

a healthcare-associated infection (HAI)

hospitals, which lose between $26

on any given day? It’s true, according

billion and $33 billion every year due

to the Centers for Disease Control and

to HAIs, according to the CDC. Also,

Prevention (CDC).

patients suffering from surgical site

Worse yet, HAIs occur in between five

infections (SSIs) typically must stay in

and 10 percent of all hospitalized

the hospital from seven to 11 days

patients – and they claimed the lives of

longer than those without SSIs.

disarming patient threats

Wood points out that hospitals are not reimbursed for care related to HAIs. “Also, their cumulative infection rates determine their reimbursements, or lack thereof, for the fiscal year from CMS,” she says.

“And because infection rates are publically reported, having high infection rates can damage the reputation of a health care organization in the public eye, thus affecting their business negatively,” Wood adds.

'' although infection control practices have advanced in recent years, ssis remain a substantial cause of morbidity, prolonged hospitalization and death.

SOME HOPEFUL SIGNS Barb Connell, Vice President of clinical services at Medline

PROBLEMS ASSOCIATED WITH HAIS

“Although infection control practices have advanced in recent years, SSIs remain a substantial cause of morbidity, prolonged hospitalization and death,” says Barb Connell, vice president of clinical services at Medline.

Connell points to a study that determined that SSIs are associated with a mortality rate of 3 percent, while 75 percent of SSI-associated deaths are directly attributable to the SSI. “HAIs have been shown to increase patient morbidity and mortality, increase the patient’s length of stay in the hospital, and ultimately decrease the patient’s quality of life,” adds Amber Wood, MSN, RN, CNOR, CIC, FAPIC, senior perioperative practice specialist with the Association of periOperative Registered Nurses (AORN).

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OR TODAY | March 2017

Despite these discouraging statistics, there is some good news to report on the infection prevention front. The most recent National and State Healthcare-Associated Infections Progress Report, which was published by the CDC in 2016, reports significant reductions at the national level in 2014 for nearly all infections when compared to the baseline data.

For example, there was a 50 percent reduction in central lineassociated bloodstream infections (CLABSI) between 2008 and 2014, according to the report, and a 17 percent decrease in SSIs during this time.

Wood attributes these decreases to better-informed patients due to public reporting about hospital infections.

“More patients are questioning the infection rates at their health care providers and facilities,” she says. “Also, there has been more emphasis on prevention and monitoring of HAIs in the health care setting due to accreditation and regulatory oversight.”

Wood says that SSIs are the most common type of infection in the OR. “SSIs could be caused by multiple factors, which makes it difficult WWW.ORTODAY.COM

disarming patient threats

to determine the exact cause,” she says. “Many infections arise from bacteria on the patient’s skin, which may be related to postoperative wound care practices, although research in this area is needed.”

INFECTION PREVENTION PROGRAMS

When it comes to infection prevention, Connell believes that prevention strategies should encompass the entire continuum of care of the surgical procedure: pre-operative, intra-operative and post-operative.

“A lack of standardization and variance in practice can be detrimental to any infection prevention program,” she says.

“Utilizing a bundled approach to the prevention of SSIs is gaining acceptance,” Connell adds.

“The bundle contains broad categories that look at the whole surgical process and have been developed from the current SSI guidelines by various regulatory agencies.”

Connell points to the “7 S Bundle” approach to preventing SSIs that was created by Maureen Spencer, RN, M.Ed, a corporate infection preventionist consultant at Universal Health Services, Inc. These seven steps include the following: • Safe operating room practices • S creen for risk factors and MRSA/MSSA • S howers with chlorhexidine • S kin prep with alcohol-based antiseptics • Sutures with an antimicrobial • S olution to irrigate with chlorhexidine • Skin adhesive or antimicrobial dressings to protect incision WWW.ORTODAY.COM

“Patients should also be screened for risk factors like MRSA/MSSA ahead of surgery,” says Connell. “If the patient currently has an infection, the surgery should be delayed if possible until the infection has resolved.”

Pre-op bathing can also help prevent infections, Connell says.

“You should establish preop bathing instructions for patients,” she says. “However, there are no strong clinical guidelines for pre-op bathing with regard to the best product to use and the frequency of preop bathing. This has made it difficult to provide proper guidance to patients.”

According to Connell, Medline has developed a unique pre-surgical patient engagement kit that includes the instructions and tools patients need to prepare their body and their minds before a procedure.

“Helping the patient understand what is going to happen from the time of the pre-op visit to after the surgery can help alleviate fears and provide a more satisfying experience,” says Connell.

Proper instrument cleaning is also critical to infection prevention.

“The often used statement sums it up best: ‘An instrument can be clean without being sterile, but it can’t be sterile without being clean,’ ” says Noreen Costelloe, the marketing manager for Ruhof Healthcare Corp., which manufactures enzymatic detergents and endoscope care and cleaning products “So first things first: Instruments must be properly cleaned before they can be properly sterilized,” adds Costelloe.

She says Ruhof recently launched a number of new products including the CleanStart Bedside Kit, ScopeValet Endo SafeStack, Guardian Disposable Valve Set, and ScopeValet TipGuard.

BASIC AND ADVANCED STEPS

Wood outlines a series of basic and advanced techniques that perioperative team members can adopt to help prevent infections.

“Basic techniques include providing the patient with a clean

Ruhof’s ScopeValet TipGuard and CleanStart Bedside Kit are examples of products used to prevent infections.

March 2017 | OR TODAY

43

disarming patient threats

OR environment; adhering to best practices for sterile technique, disinfection and sterilization; wearing clean surgical attire; minimizing OR traffic and door openings; and monitoring OR temperature, humidity and positive air pressure,” she says.

As for advanced techniques, Wood also recommends a bundled approach utilizing multiple interventions.

“These are more effective when they’re procedure-specific,” she says. Bundle elements Wood recommends include the following: • Antibiotic prophylaxis (selection, weight-based dosing, timing, redosing) • Targeted screening and decolonization of Staphylococcus aureus or universal decolonization • Patient bathing • Preoperative nasal treatment and oral rinse with an antiseptic • Preoperative patient warming to maintain normothermia • Maintaining glycemic control for all patients (diabetics and non-diabetics) • Intraoperative use of wound protectors • Use of triclosan-coated suture to close the surgical wound • Increased oxygenation of the patient to improve wound healing SAFE OR PRACTICES

Connell also stresses the importance of safe operating room practices.

“The operating room environment can greatly impact the risk factors for the development of SSIs,” she says. “A sterile environment is crucial for preventing infections.”

44 OR TODAY | March 2017

'' many infections arise from bacteria on the patient's skin, which may be related to postoperative wound care practices'' Amber Wood, MSN, RN, CNOR, CIC, FAPIC, Senior Perioperative Practice Specialist with the Association of periOperative Registered Nurses (AORN)

There’s often confusion in the OR regarding who is responsible for cleaning what, says Connell.

“So there should be clear, written expectations on cleaning tasks and defined procedures for cleaning and disinfecting spills of blood, body fluid and other infectious substances,” she says.

“These procedures should be detailed and written in easy-to-understand language,” Connell adds.

Operating room traffic should also be minimized.

“Keep OR doors closed during surgery except as needed for passage of equipment, personnel and the patient,” Connell says. “A sign on the door will help remind staff to minimize their traffic into the room during the surgery.”

“Of course, performing excellent hand hygiene and following proper aseptic technique remain two of the most effective infection prevention

steps,” says Wood, who notes that published AORN Guidelines specifically address the prevention of HAIs. “Hand hygiene is a focal point of infection prevention and remains a top priority of surveyors,” says Connell.

She stresses hand hygiene best practices such as providing staff with high-quality products that won’t dry out their hands, placing sanitizer dispensers and sinks in convenient places, and educating staff on hand hygiene guidelines.

“Health care facilities can provide in-service training from outside parties or use online education platforms,” says Connell. “For example, Medline University offers free courses on basic principles of hand hygiene and improvement strategies at the clinical and administrative levels.”

More information about the courses is available at www.medlineuniversity.com.

WWW.ORTODAY.COM

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GREAT SUCCESS

Sharon Sikora ltimately, it was weather that brought Sharon Sikora to the West Coast. A native of Dearborn, Michigan, Sikora “lived through all those lovely winters with the snow and the cold and the ice,” with her husband, Lenny Munari, a native Chicagoan.

A move from Detroit to Chicago didn’t yield any greater seasonal relief, and the couple started looking for a bigger change.

After visiting San Diego for a wedding, the couple started exploring options: Sikora was recruited for an operating-room manager position at Saddleback Memorial Medical Center in Laguna Hills, California, and Munari was able to replace an outgoing perfusionist at its sister hospital. After 11 years on the West Coast, they’re prepared to call it a success.

Today, Sikora is the Clinical Director of Surgery at Presbyterian Intercommunity Hospital Health System in Whittier, California, the result of advancements in a career that began with

46

OR TODAY | March 2017

two years in cardiac and step-down care at Oakwood Hospital in Dearborn, Michigan – the very hospital in which she was born. Sikora recalls performing a variety of nursing services until the facility began its open-heart surgery program in the late 1980s.

“I got invited to be a part of the team, and then I did scrubbing and circulating for a few years, and then back to the heart again,” she recalled. “We had a program there where we taught nurses to first assist, so I joined that group, I RNFA’d for several years, I circulated and scrubbed, and then I could first-assist.”

“It was the best-worst job I’ve ever had,” she said. “It was so fun and so exciting but so physically demanding. It was very interesting and very rewarding, because you got to see the patients and the outcome.”

Sikora entered the profession because of an interest in the human body, and to her, the human heart remains the most fascinating part of it. Helping people is in her DNA, Sikora said, and nursing was a natural career path.

Her mother was a hospital worker, and soon Sikora found herself pushing into the field, too. Breaking into the OR was harder to do without experience, but she acclimated to the training, and continued on while broadening her handson education. Those experiences have continued to serve her well, Sikora said, because the techniques she acquired while working in different specialties continues to inform her approach in the operating room, which in turn accommodates a variety of interests.

“There’s so many different services to work in – neuro, ortho, heart, GYN –

WWW.ORTODAY.COM

Spotlight On: Sharon Sikora

and you can find your little area in the OR that you love and that you’re passionate about and that you find interesting and exciting,” Sikora said. “It makes you a better circulator because you see the surgery from a whole different perspective, and it makes you a better team member. There’s enough variety that I was never bored.”

In the years since, nurses have expanded their roles “more than we ever did before,” Sikora said, and as a result, are working side by side with physicians more closely than ever. After having entered the field with an associate degree, many nurses like Sikora have chosen to bring their professional education up to speed with advanced degree coursework. When her friend decided to return to complete a bachelor’s degree, they went back together – 14 years after she’d started her career – and she’s never stopped.

Sikora completed an allied health course of study at Siena Heights University in Adrian, Michigan, and then WWW.ORTODAY.COM

went from working as a staff nurse in Michigan to leading a cardiac team at Evanston Hospital in Chicago, Illinois, where she helped establish two openheart programs and became a surgical case manager. Not long after, she pushed for more advanced education, and started pursuing a master’s degree in management at North Park University. That led to a position at Evanston’s sister hospital, Glenbrook Hospital, where Sikora became manager of the operating and recovery rooms. She decided to pursue additional education, and earned a master’s of management at North Park University in Chicago, which Sikora said taught her to deal with change, to negotiate with people, and to become a better manager.

“It made me a better worker,” she said.

Today, Sikora is still continuing her education, pursuing a joint BSN and an MSN with a specialization in informatics from American Sentinel University of Aurora, Colorado. The pursuit of ever-advancing degrees has contributed

not only to her career advancement, but to her personal fulfillment within it.

Her advice to aspiring nurses as well as those already deep in the field: follow your passion.

“As nurses, we have a role in people’s life unlike anyone else’s,” Sikora said.

“You meet people at their worst because they’re sick. Find something that makes you happy and just keep looking until you do. Keep looking and keep asking questions.”

When she’s not hitting the books or scrubbing up, Sikora is hitting the trails. Munari is a marathoner, and she is content to support him on those efforts — which she confesses are easier to endure in California temperatures than in Midwestern ones. The couple also resides near some protected wetlands, which Sikora said she loves to explore with her very energetic Labradoodle.

“I love to go up there and just connect with nature,” she said.

March 2017 | OR TODAY

47

OUT OUT OF THE OR OR NUTRITION FITNESS

F

BY MARILYNN PRESTON

TIME FOR A WAKE-UP CALL

or the first time in 20 years, the National Center for Health Statistics reported, life expectancy in the U.S. declined. This is a uniquely American phenomenon, points out Dr. Peter Muennig, a professor of health policy and management at Columbia University. It’s simply not happening in other developed countries.

Out of 43 countries, we are now rated – hold on to your Dunkin’ Donut – 29th for life expectancy, just a tad behind Korea, Slovenia, Chile and the Czech Republic.

What’s making America so sick? For starters, obesity is out of control. It’s not getting better; it’s getting worse.

And that’s only the tip of the melting iceberg. Americans are experiencing rising rates of heart disease, stroke, diabetes, dementia and – the latest screw-up by mainstream medicine – opioid addiction.

All this startling news has been widely reported, but I like to read about it on Mercola.com, where the fearless Dr. Joe Mercola uses evidence-based studies to rail against the corruption and breakdown of the American health care system.

The U.S. anti-obesity campaign is a big fat failure, he writes. I still believe

48

OR TODAY | March 2017

that first lady Michelle Obama deserves her reputation as a force for good in the last eight years, but not only did her anti-obesity campaign not improve the situation; kids are actually heavier than ever, and they are suffering from Type 2 diabetes, heart disease and mental issues in record numbers.

Sick kids – obese, sedentary or stressed – become chronically ill adults, and the cost of tending to them will send health costs even higher than they are now, a whopping 17 percent of gross domestic product!

If U.S. doctors and policy makers decided to reduce health care costs by reducing demand – doctors pushing prevention, not just toxic and addictive drugs – the country would have more than enough money to fix our schools, renew our infrastructure, and support wellness programs throughout the land.

“More than half of all Americans are chronically ill,” Mercola reports. “I don’t know about you, but I find this statistic absolutely astounding.”

Me, too. Astounding! Especially since the majority of chronic illness is related to lifestyle choices: the amount of exercise you get, how you handle stress, how much you weigh, how much sleep you get, and yes, the amount of processed foods you eat and the beverages you drink.

“The root cause of most health problems can be traced back to a poor diet,” Mercola explains. “Most Americans spend the majority of their food dollars on processed foods, most of which contain one or more of the three ingredients that promote chronic disease, namely corn, soy, and sugar beets, all three of which are also typically genetically engineered and contaminated with toxic pesticides.”

WWW.ORTODAY.COM

FITNESS

It’s too early to tell what the health policies of a Trump presidency will actually be, but I’m pretty sure that toxic pesticides have nothing to fear.

Our food, water, air quality, drugs and household poisons will be subject to less regulation in the coming years, not more. Medicare and Medicaid are under attack, and there is no mention whatsoever of the need to prevent illness, not just treat it with expensive drugs that can make you even sicker.

The good news about all the bad news I’ve just burdened you with is that this is your wake-up call. Dr. Uncle Sam is doing next to nothing to

protect you from rising rates of sickness and death. We have a broken health care system that is more interested in corporate profits than your personal health. More than ever, it’s up to you.

And the best news of all is that you can make a difference: • Move! Move! Move! And stop sitting so much.

• E at real food. Maintain a healthy weight.

• Get 7-8 hours of sleep a night.

• Find healthy ways to release stress.

• If you don’t have one, start a meditation practice.

Include two or three of these practices in your life, and even if the U.S. downward spiral continues, you’ll be healthier than ever.Oh, goodie. I’ve ended on a high note.

Marilynn Preston is a healthy lifestyle expert, well being coach and Emmywinning producer. She is the creator of Energy Express, the longestrunning syndicated fitness column in the country. She has a website, marilynnpreston.com, and welcomes reader questions, which can be sent to MyEnergyExpress@aol.com

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March 2017 | OR TODAY

49

OUT OF THE OR FITNESS HEALTH

BY SANDRA BLOCK

DE-STRESS YOUR LIFE TAKE A DEEP BREATH H ow stressed out are we? Consider this: In some cities, "rage rooms," sometimes known as anger rooms, allow customers who are fed up with work, politics or the stress of everyday life to smash old furniture, TVs, dishes and other breakable items..

At the Anger Room in Dallas, prices range from $25 for five minutes of destruction to $75 for the 25-minute "total demolition" package. There are similar places to vent your spleen in Houston and Toronto, and Anger Room is offering franchises to entrepreneurs who want to open facilities in other cities.

Sadly, 25 minutes with a sledgehammer probably won't cure chronic stress, a toxic debility that has been associated with a litany of ailments, from headaches to heart disease. It weakens your immune system, making you more vulnerable to colds and flu.

It makes you restless and irritable, which affects your relationships at home and at work. And it's probably getting worse. More than half of Americans reported that the 2016 50 OR TODAY | March 2017

Stress is a natural response to a life-threatening situation. When you perceive a threat, your brain sets off an alarm – the classic fight-or-flight response.

presidential campaign was a significant source of stress, according to the American Psychological Association.

The stress was bipartisan, with Republicans and Democrats reporting the same amount of anxiety.

Stress is a natural response to a life-threatening situation. When you perceive a threat, your brain sets off an alarm – the classic fight-or-flight response. That causes a number of internal events to occur. Adrenaline increases your heart rate and elevates

your blood pressure. The adrenal glands release cortisol, the primary stress hormone, which increases glucose in the bloodstream. It alters immune systems and suppresses digestion until the threat has passed.

Your body's stress-response system can help you meet an important deadline or leap out of the path of a rogue beer truck. But when those hyped-up hormones fail to recede after the crisis has ended, it can trigger a cascade of health problems.

Call it a failure of evolution: Our brains haven't adapted to a world in which we're not under constant threat from hungry predators.

"There is no other species that has changed its environment so quickly," says Amit Sood, M.D., chair of the Mayo Clinic's Mind-Body Initiative and author of "The Mayo Clinic Guide to Stress-Free Living."

"We are working with a medieval kind of brain, although our challenges are very different," he adds. Fortunately, you can take steps to reduce stress that don't require protective gear.

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51

Unique Immobilizers for Unique Patients The Medi-Kid Co.Inc, is the manufacturer and distributor of pedi-wraps, the most widely used pediatric arm and leg immobilizer.

Visit our website for our complete catalog! www.medi-kid.com

• • • • • •

Fast & easy to use Kid friendly prints Adult sizes available Soft cotton fabrics Machine washable Dryer safe

www.medi-kid.com | 888-463-3543

Treat your feet to the healthy Calzuro

*1.5� heel to reduce fatigue *Sterilize in the Autoclave *Machine Wash or bleach *Heel Strap for an added back *Comfort Insole to wick away perspiration

Personalize Scrubs with 20 Colors!

Try Calzuro on at Booth 2551 at the AORN Calzuro.com 800-257-9472

OUT OF THE OR NUTRITION

BY LORI ZANTESON

HAIL HAZELNUTS!

H

azelnuts aren’t just for the holidays! While especially popular during the holidays – in sweet confections and baked goods – hazelnuts are a nutritious way to eat all year long.

THE FOLKLORE Filberts and hazelnuts (also known as cobnuts and hazels) are different names for the same tree and its small, sphere-shaped nut. The English named it hazelnut, and then French settlers came to call it filbert because the nuts would begin to ripen around August 22, St. Philibert Day. Over the centuries, hazelnuts have been revered. The ancient Chinese considered them sacred nourishment, the Greeks used them medicinally, as a cure for coughing and the cold, and the Celtics saw them as a source of wisdom, knowledge and fertility.

THE FACTS Hazelnuts are the nuts of hazel trees, members of the birch family. Though there are many varieties of hazelnuts, like Butler and Willamette, the common hazel (Corylus avellana) is most available commercially.

54

OR TODAY | March 2017

DAILY CONSUMPTION OF 30 GRAMS OF HAZELNUTS FOR 12 WEEKS IMPROVED OVERALL DIET QUALITY Hazelnut products, such as syrups for flavored coffees, liqueurs to mix drinks, and even oils, both to enhance cooking and for skin care, are favorites.

Enjoying hazelnuts in their whole form, however, is best. A one-ounce serving, about a handful, packs 11 percent Daily Value (DV) of dietary fiber for healthy weight maintenance, 21 percent DV of skin-protecting

vitamin E, and a whopping 86 percent DV of manganese, important for bone health, metabolism, and vitamin absorption. Hazelnuts are also rich in healthy, monounsaturated fatty acids, which can help prevent heart disease.

THE FINDINGS Studies have shown the benefits of regular consumption of nuts, like hazelnuts, on cholesterol levels, cardiovascular health and weight loss (Nutrients, July 2010). Daily consumption of 30 grams of hazelnuts for 12 weeks improved overall diet quality without notable changes in body weight or body fat percentage, according to research in overweight/ obese individuals. Though the hazelnut eaters had higher calorie and fat intakes – as well as vitamin E and potassium – they did not gain weight compared to non-nut eaters (The Journal of Nutrition, 2013).

THE FINER POINTS Fresh hazelnuts come to markets in late fall and early winter. Choose shelled, raw hazelnuts from the bulk bin if possible, to ensure a rich, nutty WWW.ORTODAY.COM

OUR ENVIRON-MATE® DM6000 SERIES

SUCTION-DRAIN™ SYSTEMS MANAGE YOUR SUCTIONED FLUIDS!

NUTRITION

COMPACT, WALL-MOUNTED UNIT • Only 13.5”w X 16”h X 5.5”d • Save Valuable Space

aroma – the best sign of freshness. Packaged shelled and unshelled nuts are available either raw or roasted. Remove skins from roasted nuts by shaking them in a closed container; they’ll store in the freezer up to 24 months. Definitely divine in chocolates and sweet baked goods, hazelnuts also add crunch to salads or a Brussels sprouts or green bean sauté, and they make a wonderful pesto combined with basil or spinach and served with pasta or wholegrain crusty bread.

UNLIMITED FLUID CAPACITY

DM6000-2A

• Arthroscopy, Cystoscopy and Urology • Continuous or Intermittent Operation • Available with Fluid Totalizer

NO MORE CANISTERS! • Reduce Room Turnaround Time • Eliminate Staff Exposure to Fluids • Save Canister and Solidifier Costs

THREE SYSTEMS AVAILABLE! • Surgery/OR - DM6000-2A (Shown) • GI/Endoscopy - DM6000-2

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.

{

THE AAAHC SURVEYOR

• SPD/Utility Room - DM6000

DM6000-2A WITH OPTIONAL FLUID TOTALIZER!

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Your opportunity to get knowledgeable counsel.

We send physicians, nurses, administrators – professionals who live the same world you do.

That’s why more than 6,000 organizations have chosen us.

• We are the leader in ambulatory accreditation.

• Our Standards are nationally-recognized.

• O ur surveys are consultative not just a checklist.

Improving health care quality through accreditation

Contact us to learn more 847-853-6060 • info@aaahc.org • www.aaahc.org

WWW.ORTODAY.COM

March 2017 | OR TODAY

55

Empowering

the Surgical Services Community

AUGUST 27-29, 2017 OR Today Live will allow you to network with industry professionals while gaining valuable education.

You will meet surgical services professionals who experience the same issues as you and be able to share

WASHINGTON D.C.

HYATT REGENCY RESTON

"Very informative and educational. Ability to network and socialize were great. Planned events were extremely fun and engaging" J. Hyman

"You are on the right track to an exciting, educational, and fun conference."

M. Arciniega

EDUCATION

EXHIBIT HALL

and gain ideas for solutions in your facility.

NETWORKING

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

4

LEARN MORE AT WWW.ORTODAYLIVE.COM

OR TODAY | January/February 2017

WWW.ORTODAY.COM

RECIPE

BY DIANE ROSSEN WORTHINGTON

WHAT’S COOKING IN MAINE? CAULIFLOWER APPLE SALAD AND A LOT MORE

I

had heard that Portland, Maine, was filled with amazing restaurants and bakeries, and I couldn’t wait to check them out.

On my visit, I stayed at the unique Press Hotel. Among the many dishes and excellent wines I sampled, this cauliflower and apple salad stood out.

The cauliflower florets are roasted until light golden brown and cooled. Sliced, crisp seasonal apples along with fresh green parsley leaves, toasted pine nuts and shards of pecorino cheese are mixed together to create a unique cold weather salad. The preserved lemon drizzle, a blend of preserved lemon and mayonnaise with lots of cracked black pepper and the faint licorice flavor of tarragon, is the finishing topping on this versatile salad. I like to serve this as a first course or as component on a salad buffet. The best part is that it is best served at room temperature.

Salad: 1 medium head cauliflower 3 tablespoons olive oil, plus extra for drizzle Salt and pepper 2 crisp apples (Fuji, Pink Lady or Jazz) 2 tablespoons flat leaf parsley, loosely packed, stems removed, keep the leaves whole 3 tablespoons toasted pine nuts 1 tablespoon lemon juice 1/4 cup Preserved Lemon Sauce (recipe below) Pecorino cheese for grating

3. C ut the apples into small bite size pieces. Place the chopped apples, cauliflower, parsley, pine nuts and lemon juice in a bowl and toss.

Season with salt and pepper, and drizzle a little olive oil.

Puree all in blender until smooth. Use remaining sauce for crudite, artichokes or other dipping.

DIRECTIONS: 1. P reheat the oven to 425 F. Cut the cauliflower into small bite size pieces, toss with olive oil and season with salt and pepper.

Place on a large baking sheet with a lip.

2. R oast for 25 to 30 minutes, tossing once to evenly brown, or until just cooked and golden brown. Remove from oven and let sit at room temperature until cool. Reserve.

WWW.ORTODAY.COM

Roasted Cauliflower and Apple Salad with Preserved Lemon Drizzle Serves 4

4. S poon some of the salad on to chilled serving plates, drizzle some of the preserved lemon sauce over the salad and grate the pecorino cheese on top. This is best served room temperature.

Preserved Lemon Drizzle: (You can find preserved lemons in glass jars in gourmet markets) 1/3 preserved lemon (homemade or store bought) 1/2 cup mayonnaise 1 teaspoon cracked black pepper 1 tablespoon tarragon

Diane Rossen Worthington is an authority on new American cooking.

She is the author of 18 cookbooks, including “Seriously Simple Parties,” and a James Beard Award-winning radio show host. You can contact her at www. seriouslysimple.com

March 2017 | OR TODAY

57

visit crazy4clean.com to play our newest educational game

endo gal

This new game is part one of a two-game series that will take you on a learning adventure about endoscope reprocessing. Join Healthmark’s clinical educator for endoscopy and endo gal to learn about the different types of endoscopes, their parts, visual inspection and proper transportation.

earn one ceu when you complete the quiz at the end of the game!

F

R

L

U

e Visit HealthmarkGI.com to learn about innovative tools to help effectively manage the proper reprocessing of your endoscopes!

HEALTHMARK INDUSTRIES | WWW.HMARK.COM | 800.521.6224

NEW FEATURED PRODUCT Point of Use Automatic Pre-Cleaning Sink for OR areas.

WE ONLY MAKE ONE SINK‌ THE BEST ONE FOR YOU DESIGNED BY YOU!

Designed for use in the clean core soiled utility/clean up area, the sink is designed to quickly and automatically remove gross soils and bioburden from instruments prior to being sent to the SPD

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.

for further processing. Our unique Hydro-Force System

OPTIONAL FEATURES INCLUDE Integrated Ultrasonic System

Air and water pistols

Auto Fill System

Scope Consolidator

provides a gentle recirculated rinse that removes gross debris in minutes. Features include auto filling of water into the sink, auto enzyme dosing, preprogrammed cycle times, sink cover lid and a compact foot print. Technicians can insert a tray, push a button and walk

Additional Options not shown: Push-button Height Adjustment - Auto sink bowl filling | Heated Sink Bowls | Custom Sink Bowl sizes | DI/RO faucets | Integrated Sonic Irrigator | Etched sink gallon markings | Storage shelves and drawers | Deck mounted Eyewash | Stainless steel peg board storage system

away while the sink does the work. It makes transporting instruments safer and makes further pre-cleaning in the SPD easier and more effective.

717.261.9700 sales@tbjinc.com www.tbjinc.com

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

Power in the quality of our products!

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Mindful of the dangers of micro-organisms Eager to help stop the spread of cross contamination Reliable Observant to the new dangers A name you can trust for over 50 Years!

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

Keep your patients smiling.

Available in Vinyl and Nylon Available in .3mm; .

5mm and Lead Free

FDA Registered CE Registered Made in the USA

Cling-Sheild X-Ray Aprons For more information contact us www.palmerohealth.com

800-344-6424

CUSTOM

CHECKLIST BOARDS ARE USED IN THOUSANDS OF OPERATING ROOMS Checklist Boards include a slider that is moved from red to green indicating task completion.

Each custom designed board contributes to best practices in process improvement, trapping & eliminating errors and standardizing time out procedures.

Among others, Checklist Boards are improving patient outcomes at Hospitals affiliated with the following: SSM Healthcare, Tenet Health, Kaiser Permanente, Tampa General, Rochester Regional Health System, HCA, Veterans Adminstration MCs, BJC, Bon Secours, DMC, HCA, Houston Methodist, Atlanta Northside.

Videos and checklist designs from pre-op, through surgery and recovery, and in to patient rooms are all available at checklistboards.com

Pre-Procedural Verification Name:____________________________ DOB:__________ Procedure:_____________________ Nurse:_____________ Confirmed

Date:____/___/____ Patient Name:___________________________ DOB or Other Identifier:_______________ Allergies:____________________________________Procedure(s):__________________________________ Time-Out

Green Red N/A or Confirmed Not Confirmed

Green Red N/A or Confirmed Not Confirmed

Fire / Safety Risk

1. Patient (two identifier’s)

14. Available ignition source

2. Procedure

15. Is the Surgical Procedure Above Xiphoid Process

3. Side

16. Is Open Oxygen or Nitrous Oxide Being Administered

4. Site, Marked Visible

17. Score = 2, Fire risk score conversion -high risk protocol initiated

5. Position

18. Score = 3, High Fire Risk Protocol Initiated

6. Consent match 7. Antibiotic Given Time: _____ Fluids/Irrigation 8. Anesthesia Type 9. Images, Labs, Blood Availability 10. Equipment 11. Implants within expiration 12. Allergies 13. Safety Issues

Laps

Raytec

Cottonoids

2. Allergies Confirmed per Policy

Other Soft Goods (e.g. radiopaque towels if used) Unity Health

Recovery Checklist

3. Nursing Admission Assessment Completed

4. Pre-Operative Checklist Patient’s Name:___________________________ DOB:__________ Completed & Reviewed Procedure:_______________________________ Date:__________ All Items Must Be Confirmed by All Team 5. Members.

Anesthesia Consent Completed Green Confirmed

Suture Needles

Blades

1. Patient Without Complaint of Nausea

Injectables

De-Briefing 19. All surgical items accounted for

21. Specimens identified, Labeled, Requisition Complete, taken to lab

Hand-Off

Small Misc.

Items

2. Patient Pain Level Less Than 5 0 1 No Hurt

20. Show Us step

2 3 4 5 6 7 8 9 Hurts Hurts Hurts Hurts Little Bit Little More Even More Whole Lot

10 Hurts Worst

3. Discharge Instructions Legible

Completed

23. Procedure

27. Pertinent Medical History

24. R/L

28. Current Situation

25. Allergies

29. Orifice Packing protocol activated if applicable

26. Isolation

30. Recommendations

For best results use only Checklist Board™ markers, other markers may stain the surface. Use a clean dry cloth to wipe clean after every use, do not use harsh chemicals. Order markers and Checklist Boards™ at 585-586-0152 or checklistboards.com.

Red Not Confirmed

6. Surgical/Procedural Consent Completed 7. Blood Transfusion Consent Completed 8. H & P Present & Updated per Policy 9. Implants, Special Equipment, Requirements Available

Other

22. Patient Name

Not Confirmed

1. Patient Identity Verified

4. Discharge Instructions Given To and Reviewed With Patient and Patient Support

For best results use only Checklist Board™ markers, other markers may stain the surface.

Use a clean dry cloth to wipe clean after every use, do not use harsh chemicals.

Order markers and Checklist Boards™ at 585-586-0152 or checklistboards.com.

5. Discharge Teaching Completed

6. Support Person Comfortable With Taking Patient Home 8435LH22 v1

7. IV Discontinued and Documented

Order markers and checklist boards at 585-586-0152 or checklistboards.com

7976SP7

REQUEST A SAMPLE CHECKLIST BOARD TO SHARE WITH YOUR TEAM Call 585-586-0152, email rick@checklistboards.com or visit checklistboards.com

8135SP9 v5

OUT OF THE OR PINBOARD

PINBOARD

The News and Photos That Caught Our Eye This Month

OR TODAY

CONTESTS • MARCH • ARE YOU IN THE KNOW?

{

THE WINNER GETS A $50 SUBWAY GIFT CARD

{

Email us a photo of yourself or a colleague reading OR Today magazine to be entered to win a $50 Subway gift card! Snap a photo with your phone and email it to Editor@ MDPublishing.com to enter. It’s that easy!

Good luck!

Win Lunch!

BOOK GIVES FORMULA TO PREVENT BURNOUT IN NURSES With burnout levels at an all-time high, even the best nurses are unknowingly making mistakes and upsetting patients. Some are so frustrated they are giving up on their life’s work and leaving their careers. This is all due to the massive hole in every nurse’s education. Nurses receive no training on stress management and burnout prevention. That can all end now.

Elizabeth Scala, MSN/MBA, RN announces the release of her new book, “Stop Nurse Burnout – What to Do When Working Harder Isn’t Working.” This is the first field manual for any nurse in any specialty to lower their stress levels, create more life balance and a more ideal career.

“Nurses are often the canary in the coal mine of medicine and that has to change. The most successful health care organizations in the years ahead will be those who take excellent care of their providers and staff. ‘Stop Nurse Burnout’ is an

Elizabeth Scala

authentic breakthrough as the first burnout prevention self-help manual for the modern nurse,” Scala says.

Each of the tools in “Stop Nurse Burnout” has been field tested with hundreds of practicing nurses.

Each technique stands on its own and will lower nurse’s stress at work and/or increase their ability to recharge while off the job. For no additional charge, Scala also provides additional tools and in-depth assistance with their implementation through free membership in her website for book purchasers.

PIN BOARD

OR TODAY NOVEMBER

CONTEST ENTRIES

tions Inc. Emist Innova ith w y he ic OR Today.

Bryan R time to read e m so ok to

SPRING BREAK ISN’T JUST FOR STUDENTS Medical professionals have stressful jobs, especially those who work in the OR. So, they deserve a break.

They, and many other professionals, should take time to relax and recharge.

OR Today magazine applauds the men and women working in the OR and offer the following destinations as just a few places to take some time to unwind with a Spring Break in 2017.

1. BEACH: Sunshine, salty water and fresh air can invigorate the mind and body. Plan to spend a long weekend or a week at the beach of your choice – just be sure to avoid scheduling it at a location that will be jammed packed with

Sebrena Banecker and Marilyn Bennett read about training the next wave of OR nurses in the November issue.

“ A LL OUR DREAMS CAN COME TRUE, IF WE HAVE THE COURAGE TO PURSUE THEM.” -Walt Disney

college spring breakers. Look instead for the quiet, calm, relaxing atmosphere of a remote beach. We like Mexico Beach, Florida, but that is just one of several options.

2. NATIONAL PARKS: These treasures are America’s often-overlooked great escapes.

Being in nature is rewarding on so many levels and we highly recommend it. Plus, national parks can help serve as a celebration of national heritage. It’s about making great connections, exploring amazing places, discovering open spaces and enjoying affordable vacations. Find more information online at www.nps.gov.

3. STAYCATION: The economic downturn from 2007 to 2010 made the stay-at-home vacation popular, but this type of retreat isn’t just for tough times. It is a great way to save money, but be careful not to

get wrapped up in home projects. Enjoy a local swimming pool, explore museums and parks in your city, drop in on a spring festival or just catch up on your sleep.

Go ahead. Take time to unplug and recharge. You will return to work refreshed and ready to conquer the world.

INDEX ALPHABETICAL AAAHC………………………………………………………… 55 Action Products, Inc………………………………………17 AIV Inc.………………………………………………………… 49 American Ultraviolet………………………………… 45 Ansell Healthcare Inc……………………………… IBC Arthroplastics, Inc.……………………………………… 34 Belimed Inc.………………………………………………… 10 Calzuro.com………………………………………………… 53 C Change Surgical………………………………………… 9 Checklist Boards Corp.……………………………… 63

Cincinnati Sub-Zero, Inc.…………………………… 20 Cygnus Medical…………………………………………… 61 D.A. Surgical…………………………………………………… 4 GelPro…………………………………………………………… 19 Healthmark Industries………………………… 34,58 Innovative Medical Products, Inc.…………… BC Jet Medical Electronics…………………………………17 Kaap Surgical Insturments………………………… 51 Key Surgical, Inc…………………………………………… 5 MD Technologies………………………………………… 55

Medi-Kid Co.………………………………………………… 52 Pacific Medical LLC……………………………………… 6 Palermo Health Care………………………………… 62 Paragon Service………………………………………… 60 Ruhof Corporation………………………………………2-3 Sealed Air…………………………………………………… 35 STERIS Corp. Healthcare…………………………… 15 TBJ, Inc.………………………………………………………… 59 Tru-D.……………………………………………………… 36-39

ACCREDITATION AAAHC………………………………………………………… 55

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

ANESTHESIA Checklist Boards Corp.……………………………… 63 Paragon Service………………………………………… 60

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

POSITIONERS/IMMOBILIZERS D.A. Surgical…………………………………………………… 4 Medi-Kid Co.………………………………………………… 52 Innovative Medical Products, Inc………………………………………………… BC

INDEX CATEGORICAL

APPAREL Healthmark Industries………………………… 34,58 ASSOCIATIONS AAAHC………………………………………………………… 55 BEDS Innovative Medical Products, Inc…………… BC CARDIOLOGY C Change Surgical………………………………………… 9 CARTS/CABINETS Cincinnati Sub-Zero, Inc.…………………………… 20 TBJ, Inc.………………………………………………………… 59 STERIS Corp. Healthcare…………………………… 15

INFECTION CONTROL/PREVENTION American Ultraviolet………………………………… 45 Belimed Inc.………………………………………………… 10 Palermo Health Care………………………………… 62 Ruhof Corporation………………………………………2-3 Tru-D.……………………………………………………… 36-39 Sealed Air…………………………………………………… 35 INSTRUMENT STORAGE/TRANSPORT Belimed Inc.………………………………………………… 10 Key Surgical, Inc…………………………………………… 5 INVENTORY CONTROL Key Surgical, Inc…………………………………………… 5 KNEE SYSTEMS Innovative Medical Products, Inc…………… BC

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

LASERS Checklist Boards Corp.……………………………… 63

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

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

DISINFECTANTS American Ultraviolet………………………………… 45 Palermo Health Care………………………………… 62 Sealed Air…………………………………………………… 35

LIGHTING/VIDEO STERIS Corp. Healthcare…………………………… 15

DISPOSABLES Kaap Surgical Insturments………………………… 51 Pacific Medical LLC……………………………………… 6 ENDOSCOPY Cygnus Medical…………………………………………… 61 Kaap Surgical Insturments………………………… 51 MD Technologies………………………………………… 55 Ruhof Corporation………………………………………2-3 FALL PREVENTION Arthroplastics, Inc.……………………………………… 34 FOOTWEAR Calzuro.com………………………………………………… 53 GEL PADS GelPro…………………………………………………………… 19 Innovative Medical Products, Inc…………… BC GENERAL AIV Inc.………………………………………………………… 49 Checklist Boards Corp.……………………………… 63 GelPro…………………………………………………………… 19

66

OR TODAY | March 2017

MONITORS Jet Medical Electronics…………………………………17 OR TABLES/ ACCESSORIES Action Products, Inc………………………………………17 Arthroplastics, Inc.……………………………………… 34 D.A. Surgical…………………………………………………… 4 Innovative Medical Products, Inc…………… BC STERIS Corp. Healthcare…………………………… 15 OTHER AIV Inc.………………………………………………………… 49 Arthroplastics, Inc.……………………………………… 34 Ansell Healthcare Inc……………………………… IBC Arthroplastics, Inc.……………………………………… 34 Medi-Kid Co.………………………………………………… 52 Tru-D.……………………………………………………… 36-39 PATIENT MONITORING Pacific Medical LLC……………………………………… 6

PRESSURE ULCER MANAGEMENT Action Products, Inc………………………………………17 RADIOLOGY Checklist Boards Corp.……………………………… 63 REPAIR SERVICES Pacific Medical LLC……………………………………… 6 SAFETY GEAR Calzuro.com………………………………………………… 53 Key Surgical, Inc…………………………………………… 5 SHOULDER RECONSTRUCTION Innovative Medical Products, Inc…………… BC SIDE RAIL SOCKETS Innovative Medical Products, Inc…………… BC STERILIZATION American Ultraviolet………………………………… 45 Belimed Inc.………………………………………………… 10 SURGICAL Arthroplastics, Inc.……………………………………… 34 Checklist Boards Corp.……………………………… 63 Kaap Surgical Insturments………………………… 51 Key Surgical, Inc…………………………………………… 5 MD Technologies………………………………………… 55 Ruhof Corporation………………………………………2-3 SUPPORTS Innovative Medical Products, Inc…………… BC TEMPERATURE MANAGEMENT Cincinnati Sub-Zero, Inc.…………………………… 20 WARMERS Belimed Inc.………………………………………………… 10 STERIS Corp. Healthcare…………………………… 15 Cincinnati Sub-Zero, Inc.…………………………… 20 WASTE MANAGEMENT Sealed Air…………………………………………………… 35 TBJ, Inc.………………………………………………………… 59

POSITIONING PRODUCTS Action Products, Inc………………………………………17

WWW.ORTODAY.COM

Non-Latex Underglove

DOUBLE GLOVE WITH THE WORLD’S FIRST 100% CHEMICAL ACCELERATOR-FREE UNDERGLOVE FOR OPTIMUM PEACE OF MIND

FEATURING ANSELL’S PROPRIETARY SENSOPRENE‰ GLOVE FORMULATION, GAMMEX‰ NON-LATEX UNDERGLOVE DELIVERS ADVANCED ALLERGY PROTECTION AGAINST BOTH LATEX TYPE I AND CHEMICAL TYPE IV ALLERGIES AND SENSITIVITIES Surgeons and nurses now have a dedicated latex-free and 100% chemical accelerator-free underglove they can rely on to eliminate latex Type I and minimize chemical Type IV allergies and sensitivities.

Featuring Ansell’s proprietary SENSOPRENE formulation, GAMMEX® Non-Latex Underglove is a micro thin glove that provides excellent sensitivity when double gloving, while providing a barrier strength designed to withstand the rigors of surgery.

Feel the difference. To request for samples or find out more information, please visit www.ansell.com/gammexort or contact Customer Service at 1-800-952-9916.

ansell.com/gammex Ansell, ® and ™ are trademarks owned by Ansell Limited or one of its affiliates. © 2017 Ansell Limited. All rights reserved.

Secure positioning, easy access, unmatched patient safety.

Introducing...

• • • •

Secure positioning Fast easy access to surgical field Single-use pad prevents cross contamination Prevents nerve damage by eliminating pressure on the brachial plexus Arm Strap Functionality

>

• Allows access for leads and IV’s • Prevents potential neurological impairment from sheet tucking • Meets AORN recommendations

The Sticky Pad™

>

delivers superior holding power without a chest strap, improving ventilation and without shoulder bumps to reduce pressure on the brachial plexus

>

TrenMAX® Clamps

unique design locks the pad securely to the OR table

The right position for you and for the patient: Estape TrenMAX® You never compromise patient safety, and neither do we. So we designed the Estape TrenMAX® Trendelenburg Pad to meet AORN recommendations in “Recommended practices for positioning the patient in the perioperative practice setting.” It prevents tissue injury and ischemia that may be caused by tucking a patient’s arms at his or her side and so much more. In other words, it’s the system you would have designed yourself.

Learn more about the unique features of the Estape TrenMAX® Trendelenburg Pad at www.impmedical.com or call 800-467-4944 for more information or to speak with a representative.

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

Please visit us at the AAOS Annual Meeting Booths 4123 and 4218 and AORN Booth 1462 TrenMAX is a registered trademark of Innovative Medical Products, Inc. – PATENT APPLIED FOR TrenMAX® Clamp - PATENT APPLIED FOR The Sticky PadTM is a trademark of Innovative Medical Products, Inc. ®

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

All Rights Reserved © 2017 IMP