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CE ARTICLE SAFE LABELING PAGE 34

SPOTLIGHT ON

NUTRITION

SUZANNAH HALL MAYNARD PAGE 56

TAKE GOOD CARE NURSES • SURGICAL TECHS • NURSE MANAGERS

BETTER SKIN PAGE 64

JULY/AUGUST 2017

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READ OUR CORPORATE PROFILE ON PAGES 46-49

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OR TODAY | July August 2017

CORPORATE PROFILE With innovation and improvement at its forefront, TSO3 strives not only to meet todayâ&#x20AC;&#x2122;s standards, but also those that will govern the practice of low-temperature sterilization a decade from now. TSO3 offers distinctive solutions to problems others have yet to solve. TSO3 received FDA clearance to market the STERIZONE VP4 Sterilizer in 2014 and expanded claims in 2016 as the only low-temperature sterilizer cleared to terminally sterilize multichannel scopes of up to 4 channels with certain dimensional characteristics.

SHINING A LIGHT ON

COVER STORY Despite progress in recent years, hospital-acquired infections (HAIs) still claim the lives of thousands of patients each year. The good news is that a number of new disinfection techniques and technologies have been developed to help combat HAIs, including the use of ultraviolet light.

SPOTLIGHT ON: Suzannah Hall Maynard enjoys the handson nature of service in her position with MossRehab Hospital in Philadelphia, where she works day shift in the spinal cord injury unit. Maynard focuses on bedside care and enjoys being able to support her patients as they learn how to manage their day-to-day activities.

OR Today (Vol. 17, Issue #6) July/August 2017 is published monthly by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 30269-1530. POSTMASTER: Send address changes to OR Today at 18 Eastbrook Bend, Peachtree City, GA 30269-1530. For subscription information visit www.ortoday.com. The information and opinions expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher. Reproduction in whole or in part without written permission is prohibited. ÂŠ 2017

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July/August 2017 | OR TODAY

CONTENTS

departments

PUBLISHER

John M. Krieg | john@mdpublishing.com

VICE PRESIDENT

Kristin Leavoy | kristin@mdpublishing.com

EDITOR

John Wallace | jwallace@mdpublishing.com

ART DEPARTMENT Jonathan Riley Jessica Laurain Kara Pelley

ACCOUNT EXECUTIVES

Lisa Gosser | lgosser@mdpublishing.com Jayme McKelvey | jayme@mdpublishing.com

ACCOUNTING Kim Callahan

66 INDUSTRY INSIGHTS 11 16 18 20 22

News & Notes AAAHC Update Webinar Series Adopting New Technologies Company Showcase: Soma Technology

WEB SERVICES Cindy Galindo Kathryn Keur

CIRCULATION Lisa Cover Laura Mullen Jena Mattison

IN THE OR 27 28 34 42

Market Analysis Product Showroom CE Article Suite Talk

OUT OF THE OR 58 Fitness 60 Health 64 Nutrition 66 Recipe 68 Pinboard

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

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NEWS & NOTES

Automatic Sampling for Channel Check Healthmark has announced the ACF-001 to its Endoscopy product line. The ACF-001 is designed to inject specific volumes of water through channels of flexible endoscopes and other lumened devices when testing with the ChannelCheck. It will not only automate the injection of water for sampling, but allow sampling of the entire suction/ biopsy circuit of flexible endoscopes – even when laying horizontally.

The ACF-001 comes with one solution source tube, a large and small delivery tube, as well as the following selectable sampling solution volumes: 7mL, 10mL and 20mL. The compact unit is equipped with a two-position selector switch for choosing the correct delivery tube line, and features an easy-to-navigate digital display screen. It also includes mountable hardware, a 250 mL graduated cylinder and an endoscope channel block. •

Advanced Cooling Therapy Announces Name Change Advanced Cooling Therapy is changing its corporate name to Attune Medical. The name change reflects the company’s commitment to temperature management therapy in all clinical contexts and better represents the corporate culture of remaining attuned to clinical needs, patient safety and the state of science. Over 20 million patients in the United States experience a clinical event that warrants active temperature management each year, but researchers estimate that less than 10 percent receive the appropriate therapy, and that part of this WWW.ORTODAY.COM

discrepancy is attributed to work-flow challenges. Attune Medical’s proprietary technology simplifies access to the patient’s core and allows providers to control patient temperature, whether warming or cooling, through the esophagus when clinically indicated. This prompted the renaming of Attune Medical’s primary device, the Esophageal Cooling Device (ECD) to EnsoETM, reflecting the product’s simplicity and the broader focus on Esophageal Temperature Management. The EnsoETM is designed to modulate and control patient temperature through a single use,

fully enclosed triple lumen system that is inserted into the esophagus. Two lumens attach to an external heat exchange unit while a third, independent, lumen simultaneously allows gastric decompression and drainage. The EnsoETM can be rapidly placed by most trained health care professionals, in similar fashion to a standard gastric tube, and can be used to control patient temperature in the operating room, recovery room, emergency room or intensive care unit. No other products on the market are approved to use the esophageal environment for wholebody temperature modulation. • July/August 2017 | OR TODAY

INDUSTRY INSIGHTS NEWS & NOTES

STAFF REPORT

Key Surgical and Interlock Merge Key Surgical Inc. and Interlock Medizintechnik GmbH have merged to create one of the world’s leading providers of sterile processing and operating room supplies. Water Street Healthcare Partners, a strategic investor focused exclusively on the health care industry, led the merger of the U.S. and European providers and invested in the newly combined company. “We are tremendously excited about the combination of our companies and the benefits it will bring to our customers,” said Scot Milchman, chief executive officer, Key Surgical. “Key Surgical and Interlock are highly regarded in the U.S. and Europe for our expertise, broad product offering and exceptional customer service. Together, we will offer hospitals and surgical centers a comprehensive portfolio of products and supplies that support the industry’s highest quality standards for patient care and safety in the surgical setting.” Financial terms of the transaction are not being disclosed. •

Stryker’s Endoscopy Division Opens ‘OR of the Future’ Stryker’s Endoscopy division has opened its Customer Experience Center in San Jose, California. The facility features a high-tech, glass-enclosed “Operating Room of the Future,” leveraging Microsoft HoloLens, the first self-contained holographic computer, and allowing customers to conceptualize a Connected Hospital. The Operating Room (OR) of the Future allows customers to envision how Stryker’s surgical equipment and displays will function in their ORs by bringing design to life through holographic technology. Surgeons, nurses and hospital administrators can use hand gestures to move, turn and manipulate equipment around the virtual OR, optimizing the layout to allow physicians and OR personnel to do their jobs efficiently, while enhancing the patient experience. “The tremendous value for hospital customers is in the ability to visualize OR design and collaborate in ways that they’ve never been able to before,” said Andy Pierce, president of Stryker’s Endoscopy division. “Holographic technology allows our customers to virtually ‘stand’ inside of the operating room they are going to build. It allows ORs to be designed in a way that is completely 12

OR TODAY | July/August 2017

focused on patient safety and surgical staff efficiency.” The new facility allows surgeons, nurses, and hospital administrators to move through dedicated areas that replicate a fully scaled operating room, a wet lab, integration with hospital IT networks, and a redefined patient experience. It also features: • A MultiTaction Media Wall, which provides advanced visualization and touch screen technologies to collaborate and engage customers and facilitate the design process. • The Homer Stryker Innovation Hall featuring a wide variety of Stryker product innovations, such

as the Mako Robotic-Arm Assisted Surgery System. • The Connected OR Operating System, which integrates device control and the routing, capture and streaming of patient data into one system, introducing a new way to communicate with surgeons, OR staff and patient families. • The William Chang Solutions Workshop, a “top-secret” space containing prototypes of future products, named for Stryker’s Chief Technology Officer. • A History Wall illustrating more than 75 years of Stryker’s innovation in medical technology. • WWW.ORTODAY.COM

NEWS & NOTES

Innovative Medical Products Forms Cooperative Relationship Innovative Medical Products and the Center for Education, Simulation and Innovation (CESI) at Hartford Hospital have entered a cooperative relationship to share the latest ideas and technologies that support simulationbased surgical training including the development of patient positioning solutions that promote patient safety and improve patient outcomes. CESI is a national and international simulation-based training facility located at Hartford Hospital in Connecticut. It is one of the only facilities in the United States offering a fully comprehensive range of robotic and high technology training capabilities to a wide range of medical

providers from virtually every medical specialty. About 11,000 practitioners come through the center every year. Innovative Medical Products designs and manufactures patient positioning devices for health care and sports related surgeries. The cooperative effort will give CESI wide access to IMP’s extensive portfolio of patient-positioning devices, as well as the opportunity to work with IMP on developing positioning equipment specifically related to CESI’s simulation-based training needs. IMP, on the other hand, will be able to present itself to CESI’s broad range of clients interested in patientpositioning solutions. •

FDA clears new da Vinci X Surgical System Intuitive Surgical’s new da Vinci X Surgical System has received FDA clearance in the United States. The da Vinci X System will provide surgeons and hospitals with access to some of the most advanced roboticassisted surgery technology at a lower cost. FDA clearance of the da Vinci X System follows CE Mark, which was announced in April. The launch of the da Vinci X System underscores Intuitive’s commitment to meeting customers’ needs with a strong value-oriented portfolio and an array of financing options. “This new system enables access to Intuitive’s leading and proven robotic-assisted surgical technology at a lower price point,” said Dr. Gary Guthart, CEO of Intuitive Surgical. “Customers around the globe have different needs from a clinical, cost and technology perWWW.ORTODAY.COM

spective; Intuitive’s goal is to meet those needs by providing a range of products and solutions: the da Vinci X System helps us continue to do so.” The da Vinci X System offers surgeons and hospitals access to Intuitive’s portfolio of advanced, innovative robotic-assisted surgical technologies – and its full ecosystem of programs, support, services, and solutions – at a lower price. The system uses the same vision cart and surgeon console that are found on its flagship product, the da Vinci Xi System, enabling customers the option of adding advanced capabilities, and providing a pathway for upgrading. The da Vinci X System enables optimized, focused-quadrant surgery including procedures like prostatectomy, partial nephrectomy,

benign hysterectomy and sacrocolpopexy, among others. The system features flexible port placement and 3D digital optics, while incorporating the same instruments and accessories as Intuitive’s flagship system. The new system drives operational efficiencies through set-up technology that uses voice and laser guidance, drape design that simplifies surgery prep, and a lightweight, fully integrated endoscope. The da Vinci X System will be available for sale in the U.S. this year. • July/August 2017 | OR TODAY

INDUSTRY INSIGHTS NEWS & NOTES

DisCide Updates Ultra Disinfectant Kill Claims Palmero has announced approved and expanded kill claims for DisCide ULTRA. DisCide ULTRA is a one-step, quaternary ammonium, intermediate, high-level alcoholbased disinfectant that’s laboratory-proven to kill deadly pathogens in one minute or less. Palmero’s DisCide ULTRA disinfecting towelettes and DisCide ULTRA disinfecting spray meet stringent federal EPA standards. They are also FDA approved, EPA registered, and meet OSHA’s requirement of Bloodborne Pathogen Standard 29 CFR 1910.1030. Also, the company has released and enhanced its Refreshing Patient Facial Wipes. The new, softer towelette sheets are formulated with Vitamin E and natural oils, as well as a calming lavender scent. The facial wipes are a great refresher for clinicians and patients. •

Healthmark Releases EndoGal CEU Sequel Healthmark has announced the launch of its newest CEU game, “EndoGal2” on Crazy4Clean.com. EndoGal is back with a new learning adventure! This time, EndoGal shows proper care of endoscopes. This game will help individuals learn all about the proper care of endoscopes through mini-games about decontam, cleaning verification, storage and microbial surveillance. • Go to www.crazy4clean.com?pmc=EG2-PR to play and earn one CEU.

3M Submits 510(k) Application for BI System 3M has filed for 510(k) clearance with the U.S. Food and Drug Administration (FDA) for an additional indication for its Attest Rapid Biological Indicator (BI) System for vaporized hydrogen peroxide sterilization (VH202) to provide BI test results in just 24 minutes. Pending clearance, the 24-minute results are anticipated to be the fastest BI readout on the market for VH202 sterilization and will make the practice of every load monitoring increasingly feasible. “Every minute counts when it comes to patient safety,” said Cindy Kent from the 3M Infection Prevention Division. “Central sterile departments deserve simple and effective solutions to help minimize the risk of healthcare acquired infections from surgical instruments. Faster BI readout times can increase feasibility to monitor every sterilization load, helping to provide ultimate confidence that every patient receives the same high standard of care.” A 24-minute result would be a significant advancement over 3M’s current market-leading time of four 14

OR TODAY | July/August 2017

hours, achieved with the 2016 release of the 3M Attest Rapid Biological Indicator System for VH202. With a continued focus on system enhancements following the 4-hour readout launch, 3M scientists were able to increase system capabilities including a faster readout time.

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INDUSTRY INSIGHTS AAAHC UPDATE

BY ANGELA FITZSIMMONS

AAAHC UPDATE

CHOOSING A CONSULTANT

aving a fresh set of eyes review what you’re doing and how you’re doing it can be a great way to identify strengths and weaknesses in your organization. It’s one of the main benefits of using an accrediting organization like AAAHC that approaches the survey process with a collegial, consultative mindset. But sometimes, having a fresh set of eyes that doesn’t also make a recommendation regarding your organization’s accreditation status is what you really want. In other words, you want a consultant.

Consultants can potentially provide a myriad of services to an ASC or office-based surgery setting but it’s important to do some homework before entering into an agreement for consulting services. New and existing surgery centers have differing sets of concerns. A good place to start your search for consultative help in preparing for a survey is with an inward look at your organization. WHO ARE YOU (AS AN ORGANIZATION)?

Are you a pre-construction ASC, preparing to build from the ground up and concerned about meeting requirements for your physical plant? If so, you may want to ask candidates about the code sets they are most familiar with. If they don’t immediately cite the NFPA codes currently in use by CMS and/or your accrediting organization, you’ll be paying for their education in addition to your own. 16

OR TODAY | July/August 2017

Are you a start-up trying to get your policies and procedures in place? If so, you’ll want to know how many organizations the consultant has prepared for accreditation that are similar to yours. Assuming that he/she is familiar with your setting, you’ll want to know if you’ll be handed a set of pre-drawn policies or if they’ll be customized to your organization. One size rarely fits all and there’s nothing more frustrating to a surveyor than to be directed to a set of policies with another organization’s name at the top and a set of requirements that don’t match the services of the ASC being surveyed. Have you chosen your accreditor? If you know (or are leaning toward) a specific accrediting organization, or have opted for state inspections, you’ll want to ask potential consultants to describe their expertise with the standards and the process of that reviewing body. You should

ask about his/her win-loss percentage. While this might be information that a consultant doesn’t share, what you’re really seeking is a description of how they see their role if the survey and/or decision go badly. Are you an existing ASC looking to preempt survey deficiencies or to fix what has already been identified as a problem? Many consultants will perform mock surveys that can be viewed as a live gap analysis. The question to consider is how you plan to address any gaps that are identified. Does your current staff have the capacity to make corrections or do you need additional help to prepare and execute a plan of correction? If you’re hoping that a consultant will fix what’s wrong, an important consideration is how corrective actions will be transitioned to your staff. In other words, what does the hand off look like; what kind of training or education (if any) can you expect? These questions should help you frame the scope of services you need. Next, you’ll want to compile a short list of potential consultants. Use listservs, online searches and professional recommendations to develop your initial list. Then, turn your focus outward to explore the experience and expertise that each individual or firm can offer. WHO ARE THEY?

At the most basic level, you’ll want to ask: WWW.ORTODAY.COM

AAAHC UPDATE

• How long have you been a your language but the specific dialect ample, if the agreement is to prepare consultant? of your specialty? the organization and see it through • What qualifies you to advise me? the survey, what happens if a Plan of These basic questions get at the WHAT’S SHOULD YOU EXPECT Correction is required post-survey? professional experience the consulFROM THE PROCESS? You want to maximize the benefits tant will be bringing to your orga Ask your candidates: of engaging a professional consulnization. Consider the professional • how they scope their services and tant by taking the time to make a license/academic credentials of your what form(s) the services will thoughtful choice. If you do it right, candidates along with their experitake: phone consultation? Mock this person can become an ongoence with organizations similar to surveys? Staff training? ing sounding board and a resource yours. Consultants should be will• What are the terms of service? extension for your clinical or admining to share contact information for Are you buying a pre-defined istrative staff. previous or current clients and it’s number of hours or is that openAPPROVED CHANGESofNEEDED your responsibility to perform the due PROOFended based on completion the Angela FitzSimmons is Director, Mardiligence of following up with these project? keting and Communications, for AAAHC CLIENT SIGN–OFF: references. Your goal here is to find • What will it cost? and its family of companies. Since 2011, out what it’s like to work with this And, ofCONFIRM course, you’ll about she hasCORRECT focused on bringing best pracPLEASE THATask THE FOLLOWING ARE person. Will they be easily accessible fees. LOGO Find out what exactly is includtices to life by developing educational GRAMMAR PHONE NUMBER WEBSITE ADDRESS SPELLING and as comprehensive as the scope ed and if there are additional fees resources for AAAHC-accredited organiof your needs? Do they speak not just that you might incur later. For exzations based on the Standards.

PROOF S

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INDUSTRY INSIGHTS WEBINAR SERIES

WEBINAR SERIES

OR TODAY WEBINARS RECEIVE HIGH MARKS SERIES CONTINUES TO IMPRESS.

he recent presentation “SUD Reprocessing: Financial and Environmental Impacts for the OR” sponsored by Association of Medical Device Reprocessors (AMDR) received a great rating from attendees. Those who attended the webinar gave the session a 4.6 rating on a 5-point scale with 5 being the best possible score. The webinar featured AMDR President and CEO Daniel Vukelich. Most U.S. hospitals leverage single-use medical device (SUD) reprocessing as a proven strategy to reduce supply chain costs and regulated medical waste generated in the OR. SUD reprocessing safely saves hospitals hundreds of millions of dollars and diverts tens of millions of pounds of waste annually in the U.S. The webinar served as a primer on regulatory controls for SUD reprocessing in the U.S. Further, as SUD reprocessing has grown in recent years, new trends have emerged that can adversely impact the success of a program in the OR. This session provided an overview of those developments and shared tips for maximizing finan18

OR TODAY | July/August 2017

cial and environmental savings in the OR. For example, it looked at newly published data that can increase clinician support for SUD reprocessing. The webinar also shared examples of contract arrangements that could unnecessarily limit a facility’s reprocessing savings potential. The webinar concluded with an informative Q&A session where Vukelich shared his expert insights to help attendees with the challenges they are facing at their health care facilities. Attendees were grateful for the insights as seen in the comments collected via a post-webinar survey. “Great presentation very knowledgeable speaker,” Tammy R. said. “It was a very professional and edu-

cational webinar,” Darlene H. said. “Excellent webinar. Very good information,” Gina L. wrote in her survey. In another recent session, Lucy Lee, RN, MBA, B.M, PMP, shared her knowledge with OR Today readers via “Art and Science of Block Schedule Management.” Lee is director and co-founder of Hospital Performance Management (H.O.P.E. Management). She is an experienced people and project manager with 20 years of clinical, managerial and consulting experience in health care. She has provided management-consulting services within a variety of acute care institutions in the teaching, community and for-profit sectors. Lee has led a variety of perioperative department turnaround, productivity improvement and operational cost reduction projects in comprehensive engagements. Efficient and effective operating room utilization is the cornerstone of a financially productive department. A well-designed and managed block schedule creates the framework for a highly dynamic process. Lee’s presentation reviewed industry principles surrounding the creation and WWW.ORTODAY.COM

STAFF REPORT

maintenance of a block schedule, and key points of an effective policy and procedure. She explored a real life case study of block schedule policy and procedure refinement, in particular, the implementation and reinforcement of the policy, and the best practices that have been embraced to facilitate ongoing management of the block schedule. Her interactive dialogue led attendees to identify common errors, potential pitfalls and proactive tactics to avoid issues. During the presentation, participants learned the essential elements of an effective block scheduling policy, procedures and success factors of policy enforcement. The webinar provided a definition and calculation

methodology of key performance indicators and solutions to complicated scenarios of block utilization measurement. Lee also described practical strategies to drive collaborative decisions and optimize the use of OR time and resources through data-driven block management. The webinar received high marks from attendees in a post-webinar survey. “I found the webinar presented today both informative and motivating to maximize utilization within our facility,” Christy B. wrote in her survey. “This presentation validated some areas we are doing well at and gave

inspiration to areas of opportunity,” Karen J. shared. “The webinar was very timely as this is a huge challenge here and we are working toward effective and fair management of our blocks that are currently controlled by the chief of surgery. Taking control of our blocks will be paramount to successful OR resource management,” Randall R. added. For more information about the OR Today webinar series, including recordings of previous webinars and a schedule of upcoming webinars, visit ORToday.com and click on the “Webinars” tab.

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July/August 2017 | OR TODAY

INDUSTRY INSIGHTS BY ROSE SEAVEY, MBA, BS, RN, CNOR, CRCST, CSPDT

A SYSTEMATIC APPROACH TO ADOPTING NEW TECHNOLOGIES FOR THE STERILE PROCESSING DEPARTMENT (SPD) AND OPERATING ROOM (OR)

echnological advancements in the health care field are critically important, as they can both lengthen and improve quality of life.

Despite the potentially significant benefits of implementing new advancements immediately, health care facilities often delay implementation as they await updated standards and subsequently manufacturer’s Instructions for Use (IFUs) reflecting these new technologies. Though while still relevant, these standards remain a major impediment to the adoption of emerging technologies, including those within the realm of sterile processing. Many national standards, including those maintained by the Association for the Advancement of Medical Instruments (AAMI) and the Association of periOperative Registered Nurses (AORN), are updated on a fiveyear cycle. Even standards with more frequent updates or amendments, such as the AAMI ST79 steam sterilization standards, can’t possibly keep pace with technology. The process of updating the ST79 standards requires stakeholder meetings (including manufacturers’ representatives, laboratories, federal regulatory agencies and 20

OR TODAY | July/August 2017

Rose Seavey President/CEO of Seavey Healthcare Consulting

health care workers), a public comment period, and then final adoption by the Sterilization Standards Committee. This arduous process can typically take up to three years, by which time even more advanced innovations may have come to market. Given this gap, health care institutions need an avenue by which to

evaluate and adopt newly developed products and technologies that current standards presently do not address. Health care facilities owe it to their patients to not delay implementation of new technology or tools that can improve patient care, particularly when these advancements can do one or more of the following: • Enhance patient safety • Decrease the risk of infection transmission • Increase speed or improve efficiency • Decrease cost of care Fortunately, there is an alternative to waiting until the recommended practices catch up with technological advancements: facilitating an in-house multidisciplinary risk assessment. Rose Seavey is President/CEO of Seavey Healthcare Consulting and formerly the Director of the Sterile Processing Department at The Children’s Hospital of Denver. She served on the AORN Board in 2008-2010 and is past President ASHCSP. She serves on several AAMI committees writing national standards for reprocessing. Find out more online at ortoday.com/new-technologies/ WWW.ORTODAY.COM

INDUSTRY INSIGHTS COMPANY SHOWCASE

COMPANY SHOWCASE SOMA TECHNOLOGY

EO and President Peter Leonidas started Soma Technology, Inc. in 1992. The company refurbishes products for health care facilities located in more than 50 countries. Medical Dealer magazine recently learned more about Soma Technology from Sales Director Ashish Dhammam, Sales Director Ria Asnani and Marketing Coordinator Alyssa Adler. Q: WHAT ARE SOME ADVANTAGES YOUR COMPANY HAS OVER THE COMPETITION?

SOMA TECHNOLOGY: Our strong engineering team and commitment to excellent service is our greatest advantage. We offer our customers a one-stop shopping experience. Our product categories include heart-lung machines, heater/coolers, IABPs, C-Arms, portable X-rays, DR plates, mini C-Arms, NICU equipment, obstetrical equipment, operating room equipment, anesthesia machines, surgical tables, electrosurgical units, infusion pumps, ventilators, ultrasounds and much more. A complete offering can be viewed on our website at www.somatechnology.com and www. equipomedicocentral.com. Also, Soma Technology is an approved vendor for all major GPOs, IDNs and distribution networks in the U.S. 22

OR TODAY | July/August 2017

Q: WHAT ARE SOME CHALLENGES THE COMPANY FACED LAST YEAR?

SOMA TECHNOLOGY: Soma Technology prides itself on predicting proper demand and stocking this inventory. With the Affordable Care Act, we have seen health care facilities consolidate and become part of larger corporations; decisions previously made by physicians are being made at the corporate level. We were able to convince these corporations of our ability to provide products for largescale purchases. Q: WHAT ARE YOUR COMPANY’S CORE COMPETENCIES AND UNIQUE SELLING POINTS?

SOMA TECHNOLOGY: We offer products at a fraction of the cost of OEMs, lifetime phone technical support and carry a comprehensive inventory of OEM parts and new replacement accessories. By refurbishing products, Soma Technology is devoted to a green standard, where we reduce, reuse, and re-

cycle our equipment, contributing to a healthier planet. Q: WHAT PRODUCT OR SERVICE ARE YOU MOST EXCITED ABOUT?

SOMA TECHNOLOGY: As one of the few companies to offer bladder scanner calibration, we are able to eliminate the need for our customers to rely on OEMs or outside companies for service and calibration. We offer comprehensive service and calibration on infusion pumps, defibrillators, C-Arms, contrast injectors, and more. Q: WHAT IS ON THE HORIZON FOR SOMA TECHNOLOGY?

SOMA TECHNOLOGY: Our team is working on a number of new surgery centers. In order to better facilitate repairs and service, we are adding service centers around the country. Our private label offering, AXIA Surgical, is starting to become an established brand name for new monitors, imaging tables and surgical lights. Q: CAN YOU SHARE WITH US HOW YOU “SAVED THE DAY” FOR A CUSTOMER?

SOMA TECHNOLOGY: Biomeds are often surprised by our ability to supply parts and accessories that are difficult to acquire. Most hospitals utilize our rent-to-own option thus WWW.ORTODAY.COM

SOMA TECHNOLOGY

Peter, Maria and Mario are our longest serving employees.

Biomedical engineer Sachin, works on a C-Arm

New sales hires, Steve and Ryan in product training

saving money and time; enabling easier capital spending decisions. Through these savings, medical facilities are able to invest in other revenue streams.

We are proud that all Axia Surgical products are manufactured and assembled in the United States.

by helping facilities purchase brand name medical equipment without compromising quality or service.

Q: CAN YOU TELL ME MORE ABOUT YOUR COMPANY’S FACILITY?

Q: WHO MAKES SOMA TECHNOLOGY A SUCCESS?

SOMA TECHNOLOGY: Soma Technology has a very large, diverse workforce. We are an equalopportunity employer offering full benefits to our employees. The skill sets of our employees include technical, sales, marketing, purchasing, management and, of course, engineering. A large percentage of our employees have a master’s degree in biomedical engineering from reputed universities.

Q: IS THERE ANYTHING ELSE YOU WANT READERS TO KNOW?

SOMA TECHNOLOGY: We have a state-of-the-art facility with ISO certification. We designed the facility around workflow from inventory, to technical refurbishment, to cosmetics and logistics. Our technical staff is OEM trained and we invest in their education, test equipment and tools. We encourage customers to visit our facility and showroom to plan their upcoming OR. Q: HAVE THERE BEEN ANY RECENT CHANGES?

SOMA TECHNOLOGY: Last year, our private label Axia Surgical added DR plate and video laryngoscope solutions to our many offerings – with more products yet to come.

Q: WHAT IS SOMA’S MISSION STATEMENT?

SOMA TECHNOLOGY: Soma Technology’s main mission is to provide high-quality new and refurbished medical equipment to health care facilities worldwide at affordable prices. Our priority is improving patient care

SOMA TECHNOLOGY: Soma Technology has exciting plans for the future. We have redesigned our Parts and Accessories’ webpage; somamedicalparts.com. This redesign provides customers with an individualized e-commerce experience with parts and accessories offered at a fraction of the cost compared to OEMs. To better serve our Spanish-speaking customers, we launched the website; equipomedicalcentral.com. Soma Technology takes pride in delivering on our promises to customers. We are very active on LinkedIn, Facebook, Twitter, Google Plus, YouTube and Instagram as “Soma Technology.” We are celebrating our 25th year, and look forward to continued excellence!

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July/August 2017 | OR TODAY

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IN THE OR MARKET ANALYSIS

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ccording to recent reports, the market for ultraviolet-C disinfection is expected to hit $80 million by the end of this year. In fact, UVC disinfection is such a popular topic that the ECRI Institute included it on its 2017 C-Suite Watch List.

“Hospital-acquired infections (HAIs) may be acquired through surgery, the use of medical devices, the hospital environment, the patient’s own flora, and from contact with health care workers (HCWs) and visitors. W ith an estimated one in 25 hospitalized patients having at least one hospital-associated infection on any given day, this serious issue continues to cause morbidity and deaths while adding billions to health care costs,” according to ECRI. “The thoroughness of terminal cleaning of patient rooms is one area of focus to reduce HAIs, and some hospitals have adopted environmental disinfection systems that use ultraviolet-C light or hydrogen peroxide vapor (HPV) to complement existing infection control protocols,” ECRI adds. “Two of ECRI Institute’s previous Top 10 Hospital C-suite Watch Lists featured devices using ultraviolet (UV) light (disinfection robots) and visible LED ceiling fixtures (Indigo-Clean lights). These devices can also help to battle hard-to-eradicate pathogens like Clostridium difficile (C. diff), methicillin-resistant Staphylococcus aureus (MRSA), and other multidrug-resistant organisms. Challenges of using UV roWWW.ORTODAY.COM

bots include their bulk, significant time required to disinfect a room, and lack of continuous disinfection protection. LED fixtures installed in the ceiling can provide continuous disinfection over areas they cover, but may provide undesirable lighting effects that patients don’t like for long periods in their rooms. And neither of these technologies is used to disinfect mobile technologies, such as phones and stetho-

North America is the hub for the UV disinfection equipment market due to hygiene and safety concerns, mainly in food and health care industries. scopes, which clinicians carry from patient to patient.” The market growth of UV-C devices is expected to continue. “As more hospitals take initiative in proactively fighting infectious diseases, demand will continue to grow,” Chuck Dunn, president and

CEO of Tru-D SmartUVC, said in a news release. North America is the hub for the UV disinfection equipment market due to hygiene and safety concerns, mainly in food and health care industries, according to Allied Market Research. This includes water treatment and surface disinfection among other smaller market segments. “The UV disinfection equipment market would garner revenue of $3.6 billion by 2020,” according to Allied Market Research. “The significance of alternative disinfection methodology such as UV disinfection is growing by the day, as these methods are better than conventional chemical based disinfection. The key driving factors for the market are cost effectiveness as compared to other new disinfection methods, new government initiatives for UV disinfection, concerns of emerging nations to provide safe drinking water, environmentally friendly disinfection system and the use of UV LED in disinfection saves energy. However, there are some restraints such as low cost of conventional disinfectants such as chlorine, lack of treating the residuals by UV disinfection equipment and decline in the share of food and beverage and surface disinfection applications. The key opportunities for the market lie in health care and chemical industries for air treatment application and Millennium Development Goals (MDGs) of the UN for water treatment.” July/August 2017 | OR TODAY

IN THE OR PRODUCT FOCUS

CLOROX HEALTHCARE OPTIMUM-UV ENLIGHT SYSTEM The Clorox Healthcare Optimum-UV Enlight System is an all-in-one solution providing powerful surface treatment enhanced by ultraviolet-C (UV-C) technology to kill more than 30 pathogens including Clostridium difficile spores, carbapenem-resistant enterobacteriaceae (CRE), vancomycin-resistant Enterococci (VRE) and Methicillinresistant Staphylococcus aureus (MRSA), for superior infection prevention and patient safety. The Optimum-UV Enlight System provides the optimal balance of strong performance, quality, user-friendly design and affordability, with advanced data collection and reporting capabilities that help health care facilities ensure they are maximizing device usage and getting the efficacy they are counting on. â&#x20AC;˘

OR TODAY | July/August 2017

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PRODUCT FOCUS

DIVERSEY CARE MOONBEAM3 AND SKY 7XI UVC DISINFECTION Diversey Care’s MoonBeam3 is a lightweight UVC disinfection device for area, room and non-critical equipment disinfection. Designed to be used in conjunction with regular cleaning and disinfection, the unit uses three individually adjustable arms to optimize the UVC dose delivered to surfaces.Using UVC light to penetrate the cells of viruses, bacteria and spores, the SKY 7Xi safely disinfects high-touch devices such as tablets and smartphones in one minute or less. The easy-to-use and compact unit has desktop, wall mount and mobile cart options, and ensures fast and effective disinfection of facility-owned, health care worker and visitor devices. •

SURFACIDE HELIOS Helios by Surfacide is a revolutionary, patented triple emitter UV-C hard surface disinfection system that data indicate eradicates multi-drug resistant organisms, including C. Diff, MRSA, VRE, CRE and Acinetobacter. Designed to precisely target all areas – even those hidden by shadows – the Helios system’s advanced laser mapping technology scans a room, creates a plan and gets to work. Helios is the only UV-C system to use three light emitting towers to safely and effectively disinfect all areas of a hospital room, including tough to reach areas like bathrooms. Environments are safely disinfected and ready for use in just one efficient cycle. •

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July/August 2017 | OR TODAY

IN THE OR PRODUCT FOCUS

TRU-D SMARTUVC Tru-D SmartUVC is a portable UV disinfection robot that delivers an automated, measured dose of UVC to consistently disinfect an entire OR suite from top to bottom in one cycle. Tru-D operates from a single position within the room, ensuring significant percent pathogen reduction in direct and shadowed areas and eliminating the threat of human error in the disinfection process. Validated by more than a dozen independent studies including the only randomized clinical trial on UV disinfection, Tru-Dâ&#x20AC;&#x2122;s combined automated, measured dosing capabilities and real-time usage-tracking feature make it one of the most precise and advanced UV disinfection systems available. â&#x20AC;˘

OR TODAY | July/August 2017

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PRODUCT FOCUS

XENEX LIGHTSTRIKE DISINFECTION ROBOTS Xenex understands the impact and economic burden that HAIs have on hospitals and their patients. Despite your hospital’s best efforts, traditional disinfection methods can be ineffective and leave hospital administration and staff feeling helpless and confused. Patients don’t go to hospitals to contract infections. Xenex LightStrike Disinfection Robots can help. Backed by multiple peer-reviewed, published outcome studies, LightStrike’s patented pulsed xenon technology emits UV-C light that quickly disinfects patient areas and ORs to kill the pathogens that cause HAIs. Used for terminal cleaning and now in-between cases, it’s possible to operationalize LightStrike into any hospital workflow. •

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July/August 2017 | OR TODAY

IN THE OR PRODUCT FOCUS

STERILIZ R-D RAPID DISINFECTOR Sterilizâ&#x20AC;&#x2122;s R-D Rapid Disinfector is a proven ultraviolet-C (UV-C) disinfection solution for combating pathogens that cause healthcare-associated infections. The R-D Rapid Disinfector is the only UV-C system available that measures, records and reports data for hospitals to gauge effectiveness. It uses patented remote sensors that measure and ensure delivery of published UV-C doses at all points of disinfection. The R-D works in conjunction with manual cleaning to eradicate bacteria, viruses and spores, such as MRSA, VRE and Clostridium difficile. â&#x20AC;˘

OR TODAY | July/August 2017

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SPEAKER SPOTLIGHT I was fortunate enough to enter the operating room right out of nursing school. It was the typical, “you need to work on the floor for a year first.” When I interviewed for a floor position, I told the manager that I was there as long as it took to get into the operating room. She seemed surprised (OK, maybe shocked). She then excused herself and came back a few minutes later. She had called the director of the operating room to share my story, and the director wanted to interview me. I was hired! To this day the director is still a mentor of mine. She says, “I still remember how excited you were!” I was very excited to be able to realize my dream of being a perioperative nurse. As an educator and manager, I have been fortunate enough to provide that support to other new graduates and transfers from other specialties. My goal for all patient care and education for the future of our profession has been and always will be to challenge mediocrity and promote nursing excellence. •

Dawn Whiteside

Dawn Whiteside MSN, RN, CNOR, RNFA Director of Education Competency and Credentialing Institute

Find out more about Dawn and her experience in perioperative nursing as she presents, “The Educator’s Treasure Chest: Pearls and other jewels for compentency assessment” & “What would Florence do?” at the 2017 OR Today Live conference being held August 27-29 in Washington, D.C.

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July/August 2017 | OR TODAY

IN THE OR CONTINUING EDUCATION CE435

OR TODAY | July/August 2017

BY NANCYMARIE PHILLIPS, PHD, RN, RNFA, CNOR(E)

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CONTINUING EDUCATION CE435

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 40 to learn how to earn CE credit for this module. The goal of this continuing education program is to provide perioperative nurses, surgical technologists, and pharmacists with information about the challenges of and effective strategies for medication and solution labeling in the perioperative setting. After studying the information presented here, you will be able to: •D iscuss the intent of The Joint Commission’s National Patient Safety Goal NPSG.03.04.01 involving labeling medications and solutions on and off the sterile field • Identify the challenges for safe medication administration unique to the perioperative environment • Describe strategies for effective medication and solution labeling on and off the sterile field Everyone is familiar with the adage, “What you see is what you get.” But can healthcare professionals rely on it when it comes to safe medication administration in the perioperative setting — or should “Looks are deceiving” be their motto? This module explores patient safety goals and strategies for effective medication and solution labeling on and off the sterile field in the perioperative environment. Perioperative healthcare professionals and pharmacists must be knowledgeable about these concepts so they can promote patient safety and desirable outcomes.

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SAFE LABELING HELPS PREVENT OR MEDICATION ERRORS SAFE PATIENT CARE

Safe and effective patient care is the core of perioperative practice. AORN (The Association of periOperative Registered Nurses), the professional organization of perioperative RNs, published the Perioperative Patient Focused Model, which recognizes that “there is nothing more important to the practicing perioperative nurse than his or her patient.”1 Publications such as AORN’s Guidelines for Perioperative Practice, articles in peer-reviewed journals, research, safe practice guidelines, and tool kits are valuable resources for safe patient care; however, failures in patient care processes and systems still occur and can result in errors in patient care.1 These occurrences and “near misses” can harm patients. When the error is detected before the care or treatment is administered (a “good catch”), patient harm is avoided. Sometimes, the care is administered but does not appear to cause patient harm. Unfortunately, sometimes the care, treatment, or medication is administered erroneously, resulting in temporary or even long-term harm to the patient. These negative outcomes, including medication errors, receive national attention when they become one of The Joint Commission’s (TJC) sentinel events. The Patient Safety Advisory Group (formerly the Sentinel Event Advisory Group), appointed by TJC in 2002, reviews and investigates reported sentinel events by

performing root cause analyses. Medication errors are reportable sentinel events. Fortunately, national attention to the administration and management of medications was not one of the top 10 sentinel events reported for 2014. A significant reduction in medication errors is noted. Sentinel event data compiled from 1995 to 2016 can be viewed at https:// www.jointcommission.org/assets/1/18/ Summary_4Q_2016.pdf. The Institute of Medicine’s 1999 report on medical errors, To Err Is Human: Building a Safer Health System, has made patient safety initiatives a priority for healthcare organizations and government agencies. In 2002, AORN launched the Patient Safety First campaign to reduce errors in surgical settings and create resources to help perioperative clinicians provide safe patient care. Specific practices include correct patient and surgical site verification and surgical counts, as well as medication safety, which can be found in the AORN Guidelines for Perioperative Practice. TJC first established its National Patient Safety Goals (NPSGs) in 2003, and the NPSGs continue to influence patient care. Goal 3 (improve the safety of using medications) addresses safe medication and solution administration. Perioperative care areas must meet the three specific requirements of Goal 3: • Label any medication that is not in its original container and place it into a syringe, cup, or basin July/August 2017 | OR TODAY

IN THE OR CONTINUING EDUCATION CE435 • Know the medications the patient currently takes, especially blood thinners • Document and report medications the patient takes at home The complete list of TJC patient safety goals for 2017 can be found at https://www.jointcommission.org/standards_information/npsgs.aspx. NPSG.03.04.01. The NPSGs are intended to develop standards and directions for practice to create a national movement for patient safety. NPSG.03.04.01 requires clear labeling for medications and solutions that have been removed from their original containers or packaging and transferred to other containers for use on and off the sterile field by a person other than the preparer. This requirement applies to the entire perioperative environment and procedural components of any patient care setting TOP 10 SENTINEL EVENTS FOR 20142 1. Retained foreign objects 2. Falls 3. Suicide 4. U nanticipated event (burns, choking, drowning, found unresponsive) 5. Delayed treatment 6. W rong patient, wrong site, wrong procedure 7. Intraoperative/postoperative complications 8. Criminal event 9. Perinatal injury or death 10. Surgical site infection

OR TODAY | July/August 2017

in which operative or invasive procedures are performed, including medications used by anesthesia providers. The practice of using labels on all cups, basins, and delivery devices has been effective in decreasing the incidence of medication errors in the OR.3 Most sterile custom set-up packs contain blank labels and a pen or preprinted labels for use in the sterile field. CHARACTERISTICS OF PERIOPERATIVE SETTINGS

A healthcare facility is a complex environment with many departments and patient care units. In general, facilities are similar in their management of patient care; however, the OR is a different and separate entity with unique nuances and distinct management processes and methods of delivering patient care. OR patient populations span the age continuum, from neonates to geriatric patients. It is common to care for pediatric and adult patients in one day, whether within one or several surgical specialties. Age-specific medication information and guidelines should be readily available.4 In many organizations, the perioperative continuum of care is the most involved, with many critical factors, steps, and processes influencing patient outcomes. Several departments and caregivers hand off the perioperative patient in a short period of time. Communication — whether verbal, written or electronic — lends itself to medication error if nonstandard or easily misinterpreted abbreviations are used. Abbreviations should be avoided in medication orders and documentation.5 TJC has published a “Do not use” list of abbreviations that can be printed and posted in the patient care divisions. Generally, the medication process in the OR involves the prescribing physician, the preparing and dispensing pharmacy, the circulating nurse, and the scrub person, who is the final check before the medication is administered from the sterile field. Other variables,

such as the OR environment, staff availability, and administrative support impact the effectiveness of the medication and the solution safety initiative.3 OR ENVIRONMENTAL CONDITIONS

Many surgical procedures require that room lights be dimmed or turned off. The X-ray view box, a lamp on the anesthesia cart, surgical spotlights, or a lighted workspace provides alternative or indirect lighting. Visibility is compromised, especially for reading medication labels and preparing and managing medications and solutions on and off the sterile field. The workspace in the circulating nurse’s area can be small and cluttered with equipment and retrofitted computers and keyboards.6 From “patient-in” to “patient-out,” the OR is a busy area. Conversations take place between team members. Distractions and interruptions are common. During the surgical procedure, the circulating nurse manages multiple priorities of the patient, anesthesia provider, surgeon, and scrub person while still monitoring the sterile field. The circulating nurse works in a constant state of anticipation of who might need what next.6 STAFFING

Adequate staffing with the appropriate skill mix and assignments is important for safe patient care. The current realities of short staffing, temporary and contract staff, and novice team members create challenges. Complex or multiple specialty procedures requiring additional staff create further demands.3,6 Additional staffing is beneficial during complex or multiple specialty procedures with extensive setup and during the initial patient positioning, prepping, and incision time. Typically, these procedures have several priorities for the patient, anesthesiology provider, and surgeon. A second circulating nurse can work exclusively with the scrub person to prepare, dispense, and label the mediWWW.ORTODAY.COM

CONTINUING EDUCATION CE435

cations or solutions.6 The work schedule should be managed to avoid extended work hours since fatigue contributes to medical errors. OR TIME MANAGEMENT INFLUENCES

Time is an important indicator when evaluating performance and productivity in the OR. Shorter procedure times, quicker turnover, increased case volume, and total procedure minutes are monitored. A sense of “faster, faster, faster!” exists. Certain eye procedures take little time to perform, but use multiple medications in the sterile field.6 Some procedures, such as Dilatation and Curettage (D&Cs) and arthroscopies, can leave the team with the feeling the case is over before it starts. It is an environment of rapid interventions. The margin for error is great, especially concerning medications and solutions in the OR. MEDICATION ORDERS

The medication process involves: • Prescribing (a physician’s order) • Processing the order (transcribing and documenting) • Preparing the medication or solution • Dispensing • Administering the medication to the patient • Monitoring and documenting the effect of the medication In the OR, the preference card has long been viewed as the primary source for the physician’s written medication orders and as a “standing order.” The circulating nurse has the professional responsibility to check the medication needs with the surgeon before the case is set up.6 The supplies needed might be different. Medications are sometimes listed on the preference card with options (e.g., if local, use medication “A”; if general, use medication “B”). If preference cards are used, the circulating nurse should update any changes by initialing and dating the revision.6

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The relationship of preference cards to medication errors is cause for concern. Information on preference cards can be outdated, incomplete, or inaccurate. Inconsistent nomenclature (e.g., generic vs. brand name), abbreviations, unclear dosage, and concentration calculations should be clarified with the surgeon before the surgical procedure begins.6 Validation of the medications can be incorporated into the time out procedure as part of the available supplies before the incision is made. This process is important in the prevention of medication errors. Medication orders may be given verbally in the preoperative holding area or during an OR procedure. Medication orders given verbally in the OR are a potential source of error. Masks can muffle speech, the surgeon may have an accent, several conversations are often underway simultaneously, music may be playing, surgical equipment and monitors create ambient noise, and the circulating nurse is usually juggling priorities. Verbal orders should be repeated back and documented as soon as possible, with the physician signing the order. (This can be a problem if the surgeon is scrubbed at the time the order is given.) The surgeon must sign the medication order after the surgical procedure is completed.3,6 MEDICATION PREPARATION

The perioperative setting creates concern about the safe preparation of medication concentrations. Several people handle medications and solutions dispensed to the sterile field before the surgeon administers them. The circulating nurse may need to obtain and reconstitute a drug to a specific concentration before it can be used in the sterile field. The correct diluent and amount (sterile saline or sterile water) is as important as is the correct drug. The circulating nurse’s knowledge of surgical pharmacology is an important factor in preventing medication errors.6

COMMON MEDICATION ABBREVIATION ERRORS TO AVOID 6 Abbreviated drug names such as asa (aspirin), pcn (penicillin), mso4 (morphine sulfate) Dosages • Use only metric units (ml, mg, grams, mcg) • Use micrograms or mcg, not mg (can be confused with mg) • Use units, not U or IU Use or misuse of zeros • Zero should be placed before a decimal point (0.9%) • No zero should be placed after a decimal point (5 mL, not 5.0 mL) Daily doses • Write out exactly; QD or qd can be confused with QOD or qod; tid and bid can be confused with each other Eye medication • Write out eye site (s); OD (right), OS (left), OU (both) can be confused

One surgical procedure can require the preparation and mixing of several medications and solutions. Clear, complete, and accurate instructions and conversion charts for the dosage and concentration calculations (including age-specific information) are critical. The pharmacy is responsible for preparing specialty medications and solutions, such as 4% cocaine hydrochloride for otorhinogologic cases. The circulating nurse cannot mix this preparation and must obtain it from the pharmacy. Other drugs are stored in stock or in a machine referred to as automated machines like Pyxis dispenser. The dispensing machine is activated by using the ID number of the circulating nurse and the patient’s ID number.5 This is another method of documenting a drug for patient use.

July/August 2017 | OR TODAY

IN THE OR CONTINUING EDUCATION CE435 MEDICATION DISPENSING AND ADMINISTRATION

Unique to the OR is the additional team member, the scrub person (who may be an RN or a surgical technologist). After confirming the correct drug, dose, and expiration date, the circulating nurse aseptically dispenses the medication or solution to the sterile field where the scrub person immediately labels the receptacle (cup or basin) and delivery device under sterile conditions. The label should at a minimum include the drug’s name and strength.6 Some facilities require the scrub person’s initials. When the drug is handed to the surgeon, the scrub person repeats the name and strength of the drug. The delivery device (syringe) is premarked by the manufacturer with dosage measurement increments for the surgeon’s use. The surgeon returns the used syringe to the scrub person, who in turn reports the amount used to the circulating nurse.6 The nurse documents the amount used in the patient’s OR record. All original drug containers from the pharmacy are retained by the circulating nurse until the end of the case as validation of correct medication preparation and usage. The systems in place for drugs used in the sterile field contribute to the safety of medication administration in the OR. MEDICATION INTENSIVE

The OR is medication intensive. It is common for several medications to be used during one surgical procedure. The procedure may require several categories of medications — for example, topical and local anesthetics, contrast media, dyes, gases, antibiotics, anticoagulants — as well as solutions (plain or with additives) administered by various routes (topical, injection, infusion, or irrigation).6 These preparations are delivered by the sterile team at the field. Other forms of these drugs are administered by the anesthesia provider in concert with the surgeon. Surgical pharmacology becomes very complicated when deter38

OR TODAY | July/August 2017

mining medication safety and preventing drug interactions. In addition, high-alert medications such as heparin and epinephrine are common in the OR. Once on the sterile field, “look-alike” concerns extend beyond similarities in medications’ names and appearance. Most medications and solutions are clear and look similar, such as irrigation solutions (e.g., saline, sterile water, and lactated ringers) and local anesthetics, whether plain or with additives. Specialty drugs and solutions prepared by the pharmacy may be tinted pale contrast colors for easy identification but nonetheless they should be clearly labeled and these labels checked prior to administration. For example, 4% cocaine hydrochloride is often tinted light green and provided only in 4 to 5 mL increments for topical use in nasal surgery.6 SAFETY GOALS

Perioperative nurses assume the role of the patient’s advocate during the perioperative experience; as the patient’s advocate, the perioperative nurse is many times the most significant barrier to adverse events.1,3,6 With patient safety as the priority, the RN critically assesses every activity and intervention as safe practice. Professional responsibilities require the RN to use best practices and to be aware of changes in practice, as well as knowing the organization’s patient safety initiatives. Patient safety goals provide the RN with an opportunity to be a patient safety leader. ADMINISTRATIVE SUPPORT

Essential to quality or process improvement is the support and ongoing followup from an organization’s leadership. Managers provide leadership for a collaborative, multidisciplinary systems approach to improve processes. They also play an important role in establishing safe practice protocols and identifying necessary core competencies to create highly reliable patient care. This collaborative teamwork fosters mutual respect, with each practitioner knowing his or her role,

understanding the roles of fellow caregivers, and having a sense of responsibility and accountability to teammates. Leadership must provide the resources that staff need to ensure this culture of safety.3,6 These resources may include: • Staffing that provides the appropriate number, skill mix, and assignments • Time for education and training, case setup, and medication preparation • A safe work environment with reduced distractions and interruptions, as well as appropriate lighting and work areas • A nonpunitive culture in which reporting of errors is a routine professional responsibility • Information for increased awareness, quality data, and education and training • Tools and supplies that support safe practice and adherence to policies, including labels and markers, and alternative lighting for work areas on and off the sterile field LABEL INFORMATION

Unlabeled medications are unidentifiable. Transferring medications to the sterile field without labeling is an unsafe practice that neglects basic principles of safe medication management. NPSG.03.04.01 mandates labeling for medications on and off the sterile field. Label information must include a medication’s name and strength as well as amount when medications are mixed (as with antibiotic irrigations, tumescent and heparin solutions, and epinephrine). The unit of measure — percent, grams, milliliters, or units — must be recorded along with the date the medication is prepared. An expiration date is applicable when the medication is not used within a certain time period designated by the manufacturer or if a specific time limit after reconstitution exists. Original containers and delivery devices must be kept in the OR for verification until the procedure is completed.6 Anything in WWW.ORTODAY.COM

CONTINUING EDUCATION CE435

unlabeled containers must be disposed of immediately. The only exception to labeling is when the medication is immediately (no intervening steps or functions before administration) used or disposed of. LABEL QUALITY

Labels are placed on containers, including syringes, medicine cups, pitchers, bulb syringes, and solution bags made of metal, glass, and plastic. The labels are subjected to a wet field for several hours; therefore, labels should be evaluated for the following: • Adhesive durability • Ink that resists smudging when wet or handled often • Adequate size to allow all required information to be legible and clearly visible • Adaptability to fit on a variety of shapes and sizes of containers • Cost effectiveness and availability Several labeling systems are available. Kits and custom packs include pens with permanent ink and labels that are color coded, preprinted, or custom printed to meet a hospital’s needs. TRANSFERRING TO A STERILE FIELD

When two or more qualified people are preparing and administering medications and solutions in the intraoperative setting, they must communicate clearly when transferring the medications and solutions to the sterile field. They must verbally and visually confirm the information on the medication label. To maintain consistency with counting policies, an RN should be one of the people involved. When one person both prepares and administers the medication immediately, the two-person verification is not required.6 If the medication is prepared but not given immediately, labeling is required. Labeling. Medications must be labeled immediately when they are received on the sterile field. Even WWW.ORTODAY.COM

THE SEVEN “RIGHTS” OF PERIOPERATIVE MEDICATION ADMINISTRATION6 Right Patient • “Time out” for patient identification, allergy confirmation, and surgical procedure verification •U se of two patient identifiers, such as full name and birth date Right Medication • Orders: Verify preference card (“written orders”) information with surgeon; “read back” of verbal orders with surgeon signoff when written • Dispensing: satellite pharmacy, controlled access dispensing systems, open access storage areas • Labeling: All medications removed from original container and transferred to secondary containers on and off the sterile field • Verification: Visual and verbal by two qualified people, one of whom must be an RN, when transferring • Verbal verification of name and strength by scrub person when handing to surgeon • Review during breaks, change of shift, and specialty handoffs Right Dose • Pharmacy mixing/preparation • Age-specific dosage and concentration calculation charts

if only one medication or solution is on the sterile setup, it must be labeled. An effective strategy is the use of preprinted labels, which can be included in the custom pack as well as in separate sterile packaging. Prelabeled containers such as bowls, basins, and syringes are not acceptable since the risk exists for a different medication or solution to be transferred to the container. Label one medication at a time to prevent mislabeling and always double check your work. Consistent labeling protocols must be practiced throughout the department in all specialty services. NPSG.03.04.01 focuses on medications that are removed from their original containers, that are both on and off the sterile field, and that are intended to be administered to the patient during the procedure. Solutions with additives, such as electrolytes, antibiotics, and epinephrine, that are delivered from the original container

•V erbal and visual verification by two people Right Route • Topical, injection, irrigation, infusion, flush • Competency using delivery equipment (irrigation pumps, specialty syringes, ultrasonic suction, irrigator, aspirators, etc.). Right Time • Medication or solution prepared and transferred to sterile field at the right stage of procedure • Expiration time or date for time limits after reconstitution or if not used immediately Right Reason • Appropriate antibiotic/antimicrobial for known infectious after culture and sensitivity confirmation • Experimental drugs used only with appropriate process and informed consent Right Documentation • Signature affirmation by surgeon for drugs ordered in the perioperative setting • Delivered dose recorded

by a device such as an irrigation pump must also be clearly labeled. Labeling is required for “one-person scenarios” (i.e., when one person prepares the medication or solution but does not administer it immediately). Verification on the field. When passing a medication or solution to the surgeon, the scrub person must say the medication or solution name and strength out loud.6 Many times, the surgeon cannot take his or her focus from the immediate surgical field, has asked for several items at a time, or may be continuing a discussion with other team members. The surgeon must confirm the name and strength of the medication or solution as well. COMMUNICATION

Another unique aspect of patient care in the OR is that the primary scrub person and circulating nurse can transfer responsibilities of direct and indirect July/August 2017 | OR TODAY

IN THE OR CONTINUING EDUCATION CE435 patient care activities. Procedures and protocols must be established for communication of medication information during temporary relief for turnover, case setup, and breaks, and during permanent relief for patient handoffs at change of shift and to specialty teams. Information discussed by the entering and exiting team members must include the medication or solution name, strength, concentration, and amount administered. It is important to discuss medications used during the procedure in the postanesthesia handoff report.7 NPSG.03.04.01 provides a focus for safe medication administration in perioperative practice. A review of the facility’s medication administration process will determine revisions and resources required for safe practice policies and procedures. Having the perioperative team use consistent medication labeling and verification processes as the standard of practice helps reduce medication errors. Editor’s Note: Cynthia K. Halvorson, MSN, RN, CNOR, the original author of this educational activity, has not had an opportunity to influence the content of this version. OnCourse Learning guarantees that this educational activity is free from bias. Nancymarie Phillips, PhD, RN, RNFA, CNOR, is a tenured professor and the head of the perioperative education department at Lakeland Community College in Kirtland, Ohio. Her curriculum includes perioperative nursing, registered nurse first assistants, and surgical technology. She has 40 years of experience in perioperative nursing and is the author of several texts and articles about perioperative practice. The author has declared no relevant conflicts of interest that relate to this educational activity. References 1. Perioperative patient-focused model. In: Guidelines for Perioperative Practice. Denver, CO: AORN; 2015: 4. 2. Punke H. Top 10 sentinel events in 2014. Becker’s Infection Control & Clinical Quality. June 4, 2015. http://www.beckershospitalreview.com/ quality/top-10-sentinel-events-in-2014.html. Accessed May 10, 2016. 3. Landers R. Reducing surgical errors: Implementing a three-hinge approach to success. AORN J. 2015;101(6):657-665. doi: 10.1016/j. aorn.2015.04.013. 4. Wallace J, Paauw DS. Appropriate prescribing and important drug interactions in older adults. Med Clin N Am. 2015;99(2):295-310. doi: 10.1016/j.mcna.2014.11.005. 5. Collard B, Royal A. The use of abbreviations in surgical note keeping. Ann Med Surg (Lond). 2015;4(2):100-102. doi: 10.1016/j.amsu.2015.03.008. 6. Phillips NM. Berry and Kohn’s Operating Technique. 12th ed. St. Louis, MO: Elsevier; 2012. 7. Petrovic MA, Aboumatar H, Scholl AT, et al. The perioperative handoff protocol: evaluating impacts on handoff defects and provider satisfaction in adult perianesthesia care units. J Clin Anesth. 2015;27(2):111-119. doi: 10.1016/j.jclinane.2014.09.007. 40 OR TODAY | July/August 2017

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

DEADLINE Courses must be completed by 6/30/2018. 3. If the course you have chosen to take includes a clinical vignette, you will be asked to review the vignette and answer 3 or 4 questions. You must answer all questions correctly to proceed. If you answer a question incorrectly, we will provide a clue to the correct answer. 4. Once you successfully complete the short test associated with the clinical vignette (if there is one), proceed to the course posttest. To earn contact hours, you must achieve a score of 75%. You may retake the test as many times as necessary to pass the test. 5. All users must complete the evaluation process to complete course. You will be able to view a certificate on screen and print or save it for your records.

ACCREDITED In support of improving patient care, OnCourse Learning is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. OnCourse Learning is also an approved provider by the Florida Board of Nursing, the District of Columbia Board of Nursing, and the South Carolina Board of Nursing (provider #50-1489).” OnCourse Learning’s continuing education courses are accepted by the Georgia Board of Nursing. OnCourse Learning is approved by the California Board of Registered Nursing, provider #CEP16588.

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CONTINUING EDUCATION CE435

CLINICAL VIGNETTE The relief team for the primary ophthalmology group arrives as the surgery concludes and the eye patch is placed on the surgical patient. The relief team asks the primary team to immediately take its break since they have a full relief schedule. The relief RN transfers the patient to the PACU and then completes the next case setup for cataract extraction with lens implantation and trabeculectomy with the relief scrub person. Expected case setup time is seven minutes; the case will take roughly 20 minutes to complete. The medications are prepared and transferred to the sterile field using needle gauge and syringe size combination for identification of the medications and solutions. The balanced saline solution (BBS), an isotonic irrigating solution to maintain pupil dilation and keep the eye moist, is hung on the phacoemulsification unit. Several milliliters of the BSS are flushed through the phacoemulsifier tubing and the hand piece into a glass medicine cup to prime the unit and hand piece. The relief circulating nurse pours 500 mg of vancomycin (Vancocin) in 10 mg of normal sterile saline into a second glass medicine cup while the scrub person prepares the Mayo stand instrumentation. The relief scrub person prepares the medications and solutions, matching syringe size and needle gauge for identification, including a 3-cc syringe filled with BSS from the glass medicine cup to avoid opening another BSS sterile dose bottle (15 mL) at the end of the procedure. This syringe is placed between the medicine cups on the back table. The relief scrub person places the glaucoma drainage device implant into the vancomycin mixture in the second medicine glass until the surgeon is ready to implant the device. The primary team returns from break as the surgical prep is completed. Since the primary team and surgeon have a long-term working relationship, the surgeon rarely needs to ask for the next instrument, medication, or solution during procedures. At the end of the cataract procedure, the surgeon seals the surgical wound and injects the incision with BSS from the 3-cc syringe prepared during the case setup. As the surgeon returns the syringe to the Mayo stand, the primary scrub person realizes it is unclear whether the syringe was filled from the medicine glass containing BSS or the one containing vancomycin. Since antibiotics are toxic when injected into the eye — and vancomycin has a long half life in normal eyes — a retinal ophthalmologist is called to the OR to perform emergency management with aggressive BSS lavage. The trabeculectomy procedure is not performed because of the emergency situation. Since the patient is at risk for a loss of visual acuity and even blindness, additional postoperative follow-up is required. In addition, the patient requires continued medical management of the glaucoma until it is appropriate to reschedule the trabeculectomy.

3. Correct Answer: D – The labeling of all medications and handoff review between relief staff improves safe patient care and reduces medication errors. The effect of medication errors can range from little impact to significant and long-term harm to the patient. WWW.ORTODAY.COM

3. To avoid future medication errors, the ophthalmology service should implement which strategy? a. Take breaks when there is a delay or at the end of the case schedule b. Deny operating privileges to the surgeon involved c. View the incident as a statistical inevitability d. Label syringes and other containers on the sterile field and conduct a handoff review of medications and amounts given

1. Correct Answer: A – Although a routine practice, a lack of labeling the medications transferred to the sterile field created a point of risk in the administration of the medications.

2. Medication errors during surgery resulting from unlabeled secondary containers and syringes on the sterile field are significant for: a. Obligating any future surgical procedures for the patient to be on an inpatient basis

b. Causing potentially long-term harm to the patient c. Managing interventions by the anesthesia provider d. They have no significance beyond the immediate surgical procedure

2. Correct Answer: B –

1. What is a contributing factor in this medication error? a. Lack of labeling of medications transferred from the original container to syringes on the sterile field b. Long-term specialty team working with the surgeon c. Verbal confirmation of medications as passed to the surgeon d. Appropriate handoff between the two OR teams

July/August 2017 | OR TODAY

IN THE OR SUITE TALK

STAFF REPORT

SUITE TALK

Conversations from the OR Nation’s Listserv

NO IV IN THE OR? We have a new orthopedic surgeon that insists we do not use an IV for some of the “simpler” procedures that are performed in the operating room. These are usually quick trigger finger releases or carpal tunnels. There is no sedation, just local. What experience do you have with these cases? How do you document them? We have a separate circulating RN for the procedure and another RN for the patient. This is new to us. We have always had IV access before and are comfortable giving and monitoring patients with IV sedation. It is the “no IV” that is troubling us. A: For all locals, we do not place an IV. Just like going to the dentist for a filling, they do not place an IV before giving local. A: I would consult with anesthesia to determine if this would meet their guidelines. I realize that anesthesia is not involved in the case as it is a straight local but they are ultimately responsible for emergency care if it were to arise in these patients. I have always had policies that stated all patients going to surgery would have IV access even if it were just a saline lock. I do not believe there is a

hard and fast rule, but I would definitely get anesthesia to sign off on the practice. If anesthesia is comfortable I would then document that in a policy or guideline just so everyone is on the same page. A: We do not place an IV for a local procedure unless there is conscious sedation involved. A: No patient should ever go to surgery without an IV. Do you have a policy to cover your practice?

DREADLOCKS IN THE OR Is it acceptable to have dreadlocks in the OR? Can one scrub with dreadlocks? A: I would consider dreadlocks in the same manner I do any hair. It must be contained within the surgical cap. If contained, scrubbing should be fine in my opinion.

OR TODAY | July/August 2017

A: As long as everything is secure within the bouffant. A: As long as all the hair is clean and can be covered, I don’t think we should discriminate because of hairstyle. WWW.ORTODAY.COM

SUITE TALK

LUNCH RELIEF When staff purchase lunch instead of bringing a lunch they often take more time. Is this fair? Is this a common situation? How does one remedy this situation? A: That is very common and the organization A: Lunches and breaks are 30 and 15 minhas to choose its path of enforcement. utes for all regardless of where they obtain their meal. A: We give 45 minute lunches. The staff do not get any afternoon break, so we combine A: OR charge nurse assigns lunches and this into the lunch. breaks based upon case load – taking into consideration “built-in” breaks and lunches A: Time allotted for lunch is per your policy. when staff are between cases. Be consistent.

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

SPEAKER SPOTLIGHT Back in the day when nurses were known for eating their young I got my first job as a nurse. This was after a long, successful career as a school teacher among colleagues who supported each other. The Med-Surg unit I was assigned to was staffed by a very close knit (clique) of young nurses. I was definitely not clique material and I needed help clinically. To put it mildly mentoring was not their strong suit and although not young, I came to understand what was meant by “eating their young.” I began to think maybe I had made a poor career choice and perhaps should return to teaching. And then I got assigned to work on nights with a different crew. I was about to head off with the linen cart to start my rounds and complete my many assigned tasks when one of the nurses said to me “Where are you going? You don’t need to do that alone,” and added that on this shift, “we all work together.” I will never forget those words. I learned, I improved clinically, I gained confidence – I thrived. And, I made a decision that I would never hoard knowledge to keep others out, and would mentor as I had been mentored. I have never wavered and it has made me a better nurse. I doubt that those nurses on the night shift ever knew that it was because of them and their mentorship that I remained in nursing. One take-away is that each of us has the power to make a difference in the life of a new nurse -it is a gift that should never be taken lightly. I will always be grateful to those night shift nurses and to the operating room nurses who helped me move from novice to expert.

SURGICAL CONFERENCE

Cynthia Spry

Cynthia Spry, MA, MS, RN, CNOR(E), SPDT, Spry Consulting

Find out more about Cynthia and her experience in perioperative nursing as she presents, “Cleaning and Care of Surgical Instruments: A shared responsibility” at the 2017 OR Today Live conference being held August 27-29 in Washington, D.C.

Visit ortodaylive.com WWW.ORTODAY.COM

July/August 2017 | OR TODAY

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CORPORATE PROFILE

TSO3 CORPORATE PROFILE

t TSO3 – a leader in innovation within the field of low-temperature sterile reprocessing of medical devices – three goals drive inquiry, experimentation and development: 1. Sterilizing equipment not previously sterilizable 2. Providing robust mixed-load sterilization and 3. Sterilizing more rapidly and, by connection, more cost effectively. Headquartered in Quebec City, Quebec, with a U.S. office in Myrtle Beach, South Carolina, TSO³ offers distinctive solutions to problems competitors have yet to solve. TSO³ received FDA clearance to market the STERIZONE® VP4 Sterilizer in December 2014 and subsequently expanded claims in July 2016 as the only low-temperature sterilizer cleared to terminally sterilize multichannel scopes of up to 4 channels with certain dimensional characteristics. TSO³ markets its products via a multi-year global distribution and service agreement with Getinge Infection Control. With innovation and improvement at its forefront, TSO³ strives not only to meet today’s standards, but also those that will 46

OR TODAY | July/August 2017

govern the practice of low-temperature sterilization a decade from now. TSO³ President and CEO Ric Rumble sat down with OR Today, providing insights into the company and predictions regarding what is yet to come in the field of sterilization. Q: WHAT ADVANTAGES DOES YOUR COMPANY HAVE OVER THE COMPETITION?

Rumble: Our advantage is pretty simple – our sterilizer can accomplish what no one else’s can. The STERIZONE® VP4 Sterilizer is the only FDA-cleared sterilizer that can sterilize flexible, multi-channel instruments. Furthermore, this sterilizer can hold more items in a load than any other sterilizer. And as if these two advantages weren’t

sufficient, users can place a more robust mix of instruments in our sterilizer than in any other available on the market. These advantages save end users time and money. Most importantly, the benefits allow end users to provide their patients unparalleled care by using a sterilized instrument for each and every procedure, which, given the limitations of other low- and high-temperature sterilizers, was previously impossible. Q: WHAT ARE SOME OF THE CHALLENGES THAT YOUR COMPANY HAS FACED? HOW HAVE YOU BEEN ABLE TO OVERCOME THEM?

Rumble: Developing our sterilizing solutions has required a tremendous amount of effort, dedication and perseverance. Two particular challenges most significantly impacted the speed and direction of growth and product development at TSO3: Industry and regulatory hurdles Bringing innovation into the marketplace is always a challenge, particularly in the field of sterilization where change happens slowly. Once medical faciliWWW.ORTODAY.COM

SPECIAL ADVERTISING SECTION

ties invest in solutions, they often don’t consider alternatives for a decade or longer. In addition, the industry is highly regulated, and product manufacturers must invest a significant amount of time and labor in proving that their products function as advertised and in a safe manner. Interestingly, some of these very issues — and recommendations on how to navigate — were brought to light in a recent OR Today article by infection control specialist Rose Seavey, RN: http://ortoday.com/ new-technologies/ The development of the STERIZONE® VP4 Sterilizer meant the introduction of brand new processes to the art of sterilization. Validating these processes took extensive research. While the rigorous validation process presented a challenge, we at TSO³ recognized the importance of these hurdles and overcame them with hard work and good science. Robust training requirements A tool is most effective when its operator understands how to capitalize on the benefits it affords. When we brought the STERIWWW.ORTODAY.COM

ZONE® VP4 Sterilizer to market, we uncovered the need to retrain operators. Previously, operators had been trained to amass and sterilize loads that fit within the confines of their sterilizers’ limitations. Standard practice meant they couldn’t load certain instruments together, nor could they load over a certain weight capacity. The STERIZONE® VP4 Sterilizer removed these limitations. Due to the flexibility of our lowtemperature sterilizing solution, operators have more options when loading instruments. Additionally, they can enjoy a more rapid turnaround of sterilized instruments, changing the logistical planning that went into stocking and purchasing instruments. Because we know robust training is requisite to proper product use, we have maintained a close link with end users. By working with the medical professionals who use our sterilizers, we can assess progress and provide training as needed. We also get the chance to witness how our customers benefit from our technology when it’s applied within real-world settings. Our technicians regularly visit

our customer facilities where our products are in use to monitor the functioning of these solutions and provide ongoing support to ensure that we deliver on our promises. Q. CAN YOU EXPLAIN THE COMPANY’S CORE COMPETENCIES AND UNIQUE SELLING POINTS?

Rumble: Our core competency is creating innovative solutions. We don’t just want to sell sterilizers. We want to provide low-temperature sterilizing solutions that improve upon previous offerings and, in doing so, improve the quality of life for medical professionals and the patients they serve. Three particularly unique selling points set us apart from our competitors: Use of a Dynamic Sterilant Delivery System™ Legacy devices used the same quantity of sterilant regardless of the quantity or quality of instruments being sterilized – which seemed nonsensical to us. The STERIZONE® VP4 Sterilizer uses a dynamic delivery system. As the load changes, so does the chemistry. No two loads run through this system will see the July/August 2017 | OR TODAY

CORPORATE PROFILE

exact same amount of chemistry. Our machine recognizes the load condition and meters the dose of sterilant to maximize sterilization efficacy. To provide dynamic dosing technology to our customers, we not only had to develop the science that allows for such an offering, but we also had to document the functioning of this system and prove its effectiveness. Use of dual sterilant Ours is the only FDA-cleared sterilizer that operates with two distinct chemistries in the same chamber at the same time, thereby increasing the efficacy of the sterilization process. Use of the microcondensation layer The STERIZONE® VP4 Sterilizer operates at a low temperature, approximately 40 degrees Celsius. While the environment inside the sterilizer isn’t hot, it is warm enough that a condensation layer forms when devices that are of a cooler temperature are present. Our sterilizer is programed to create an ultrathin layer of chemistry on each device to be sterilized. Our design capitalizes on the existence of a microcondensation layer. We use this layer to facilitate sterilization. Q. WHAT EXCITES YOU MOST ABOUT YOUR PRODUCTS OR SERVICES?

Rumble: The most exciting element of our business – what gets everyone at TSO³ out of bed each and every morning – is the fact that we are authentically making significant differences in the world of sterile processing. We are driving down the cost of this process and, by connection, doing our part to drive down the inflating costs of health care. With our sterilizer, end users can: • Sterilize more instruments per load than with any other sterilizer • Sterilize more types of instruments 48

OR TODAY | July/August 2017

• Sterilize rigid and flexible instruments together • Sterilize devices they couldn’t previously sterilize, such as videogastroscopes and colonoscopes • Terminally sterilize flexible instruments with multiple channels up to 3.5 meters long – a previously unheard of task Quite simply, it’s exciting that the team at TSO³ has made the impossible possible and, in doing so, has decreased the cost, and improved the quality, of health care. Q: WHAT IS ON THE HORIZON FOR YOUR COMPANY, AND HOW WILL IT EVOLVE IN THE COMING YEARS?

Rumble: At TSO³ , we believe that the next evolution in the field of sterilization has already begun. Today, we can offer customers sterilizing solutions for low-temperature, and many traditionally hightemperature, devices within a single cycle of a single sterilizer. Driving our continued excitement are the changes we have been able to facilitate within the industry. For example, we have been able to facilitate the sterilization of duodenoscopes, devices used in Endoscopic Retrograde Cholangiopancreatography (ERCP) procedures. These devices were and continue to be linked to super-bug contamination and, specifically, have been identified as the vector of contamination, causing infections which, in some cases, resulted in death. We have already established the claim in Canada for specific devices and are now beginning to see these devices sterilized. We plan to position our technology for use in sterilizing these tools in the U.S. as well and have pledged to file with the FDA this year. Every day, we see the ability of the STERIZONE® VP4 Sterilizer.

We believe that medical facilities should be using a sterile device for every single procedure. Not just surgical, but also diagnostic. Our fundamental philosophy drives us to create and deploy tools that improve the standard of care in sterility processing. Q. HAVE THERE BEEN ANY RECENT CHANGES TO YOUR COMPANY?

Rumble: The most notable change in the landscape at TSO³ in recent years has been our expansion into the U.S. We have always been a proud Canadian company, calling Quebec City home. However, recently we have made a substantial investment in Myrtle Beach. With its proximity to multiple deep-water ports, allowing for easy product export, and its robust and stable workforce, Myrtle Beach has become a natural second home. Just like Quebec, it is an excellent location for customer visits and training. Our expansion into the U.S. includes a laboratory where we conduct compatibility testing. We have established full teams for both research and engineering and built the support capacity necessary to assist facilities in adopting our technologies by providing information on indications along with endorsement letters. And while there have been many changes in the technologies and methods used throughout our development as a company, our guiding philosophy has remained consistent – a dedication to innovation. At TSO³ , we’re never done exploring or improving. We know that new and innovative procedures are developed each and every day, and we pride ourselves on being innovation leaders in our field. For more information about TSO3, visit http://www.tso3.com/ WWW.ORTODAY.COM

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† Getinge is a registered trademark of Getinge AB or its subsidiaries or affiliates in the United States or other countries. • Copyright 2017 Getinge AB or its subsidiaries or affiliates. • All rights reserved. MCV00050168 REVA

SHINGING A LIGHT ON

BY DON SADLER

50 OR TODAY | July/August 2017

WWW.ORTODAY.COM

espite progress in recent years in the area of infection prevention, hospital-acquired infections (HAIs) still claim the lives of thousands of patients each year. An estimated one in every 25 hospitalized patients has at least one HAI on any given day, according to the Centers for Disease Control and Prevention Thorough terminal cleaning and cleaning of ORs between cases remains the most effective ways to reduce HAIs. The good news is that a number of new disinfection techniques and technologies have been developed to help combat HAIs. COMMON CAUSES OF HAIS

“There are many types of HAIs, but among the most common are those associated with indwelling devices used in medical procedures,” says Laurie Rabens, senior product manager, Clorox Healthcare. “These include central line-associated bloodstream infections (CLABSIs), catheterassociated urinary tract infections (CAUTIs), and ventilator-associated pneumonia (VAP).” Rabens points to a 2014 multistate pointprevalence survey of HAIs, as reported to the National Healthcare Safety Network (NHSN), that found that Clostridium difficile (C.diff ) was the most common cause of HAIs, followed closely by Staphylococcus aureus (MRSA). “Many surfaces in the OR are contaminated with organisms that cause infections,” says Sam Trapani, the president and CEO of Steriliz, a supplier of ultraviolet-C light disinfection technology. “Sometimes, these surfaces are not sufficiently cleaned, either between cases or terminally at the end of the day. When someone makes contact with the surfaces, they become a vector and transmit the pathogen to the patient.”

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July/August 2017 | OR TODAY

SHINING A LIGHT ON

DISINFECTION

Laurie Rabens, Senior Product Manager, Clorox Healthcare.

According to Rabens, establishing and maintaining thorough daily cleaning (both between cases and terminally) and disinfecting procedures is a cornerstone of any effective infection control program for surgical settings. ECRI Institute’s 2017 Top 10 Hospital C-Suite Watch List report notes

using bleach or other liquid disinfectants achieves only a 30 to 50 percent disinfection of contaminated surfaces. “This is why it’s necessary to implement advanced disinfection technologies that measure the delivered UV-C dose to kill pathogens,” he says. “We stand by terminal cleaning and cleaning between cases – these are normal protocol in any OR,” says Kerry Riek, a senior associate in ECRI Institute’s Applied Solutions Group. “This includes manual cleaning with bleach and other liquid disinfectants. Devices using UV light, like disinfection robots, and visible LED ceiling fixtures can be used as supplements to manual cleaning.” Amber Wood, MSN, RN, CNOR, CIC, FAPIC, senior perioperative practice specialist, the Association of periOperative Registered Nurses (AORN), concurs. “Room decontamination technologies as an adjunct to manual cleaning may be useful tools to

“ emerging technology for room decontamination should only be used as an adjunct to manual environmental cleaning procedures.” -Amber Wood that some hospitals have adopted environmental disinfection systems that use ultraviolet-C (UV-C) light or hydrogen peroxide vapor (HPV) to complement existing infection control protocols. “UV light has been increasingly used as an effective method to kill microorganisms,” says the ECRI Institute report. According to Trapani, studies have shown that manual cleaning 52

OR TODAY | July/August 2017

help prevent infection by enhancing environmental cleanliness,” says Wood. “There is no replacement for manual cleaning and disinfection of surfaces,” adds Wood. “If contaminates are not removed from a surface, the surface cannot be disinfected. Therefore, emerging technology for room decontamination should only be used as an adjunct to manual environmental cleaning procedures.”

Sam Trapani, President and CEO of Steriliz, a supplier of ultravioletC light disinfection technology.

HOW UV DISINFECTION TECHNOLOGY WORKS

Dr. Mark Povroznik, vice president, quality/CQO at United Hospital Center in Bridgeport, West Virginia, has spoken frequently about the use of UV light in hospital disinfection. He explains that there are three basic forms of UV light: UV-A, UV-B and UV-C. “UV-C has proven effective as a no-touch germicidal,” says Povroznik. “It can be recreated via the use of two light sources: mercury and xenon. At United Hospital Center, we’ve utilized both types of UV devices.” In simple terms, pulsed xenon UV destroys pathogens in a different way than mercury UV, says Povroznik. “And it does so much faster,” he adds. In 2010, United Hospital Center opened a new state-of-the-art hospital that deployed mercury UV devices as part of its strategy to control environmental bio-burden. Then in February of this year, it modified from mercury-based UV to pulsed xenon UV. “We have 11 ORs that are disinfected nightly,” says Povroznik. “BeWWW.ORTODAY.COM

cause of the size of the ORs, we run the LightStrike xenon UV robot for 10 minutes in two different positions after the room has been terminally cleaned.” Povroznik stresses that it’s important to run the UV disinfection device in multiple positions to ensure that all surfaces are properly disinfected. “In addition, our robots are deployed in special procedure areas and sterile mixing in the pharmacy,” he says. Hospital-wide infection rates have remained low at UHC and the targeted units have seen a modest reduction in a relatively short period of time, says Povroznik. “For matched time periods, HAIs have been further reduced by 27 percent,” he says. NO SILVER BULLET

Rabens stresses that UV disinfecting technologies are not a silver bullet that can be used alone to decontaminate hospital rooms. “It’s important to remember that these technologies are designed to supplement, not replace, manual surface cleaning and disinfection with EPA-registered disinfectants,” she says. “Manual disinfection is still essential for removing soils and killing pathogens on environmental surface,” Rabens adds. Rabens recommends using UV devices after manual disinfection to reach areas of the OR that may otherwise be missed or insufficiently addressed due to human error. “Also, the presence of organic matter, such as dried blood, can shield pathogens from the UV light and reduce the treatment’s effectiveness,” she adds. When selecting a surface disinfecting product, Rabens says it’s important to consider a few key factors such as relevant pathogen kill claims, wet-contact times (or how long the product needs to stay wet on the surface in order WWW.ORTODAY.COM

BATTLING MISCONCEPTIONS

Amber Wood, MSN, RN, CNOR, CIC, FAPIC, Senior periOperative Practice Specialist, AORN

to kill the pathogens), ease-of-use and safety. “Sodium hypochlorite, the active ingredient in bleach, is one of the few actives that is effective at killing C. difficile spores on environmental surfaces,” says Rabens. “It is cited by more clinical studies to kill C. difficile than any other active ingredient.” Rabens adds that Clorox Healthcare bleach germicidal disinfectants are designed to be fast-acting and kill a broad range of pathogens. These include C. difficile spores as well as emerging and reemerging pathogens like MERS-CoV, SARS-CoV, Enterovirus D68 and the Measles virus. Clorox offers a UV-C device in its Optimu-UV Enlight System.

Povroznik says there are some common misconceptions when it comes to the use of UV disinfecting technologies in hospitals. One of them is how much additional time using these technologies will take. “While UV disinfection does add time, this can be managed by sequencing the cleaning and deployment of the robots based on room design,” he says. Another misconception involves single room placement of UV disinfecting devices versus multiple sites in the room. “Studies have proven that while UV light can reflect off of surfaces, it does not do so in high enough intensity to be equally germicidal over distances,” says Povroznik. The optimal way to use UV-C light in an operating room is to disinfect with multiple positions in the room and to account for equipment and overall room size, Povroznik adds. EVALUATING THE TECHNOLOGY

Wood believes that further research is needed to determine the applicability of UV disinfecting technologies in the perioperative setting. “In the operating room, these technologies should be evaluated for their efficacy, safety for personnel, compatibility with equipment, impact on environmental controls, time per cycle and cost,” says Wood. “Some systems may be practical for use between procedures while others may be better suited for use at terminal cleaning.”

“ the presence of organic matter, such as dried blood, can shield pathogens from the UV light and reduce the treatment’s effectiveness.” -Laurie Rabens, July/August 2017 | OR TODAY

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SPOTLIGHT ON: SUZANNAH HALL MAYNARD By Matt Skoufalos

rowing up in rural Maine, Suzannah Hall Maynard’s primary care provider was the Arthur Jewell Community Health Center, a federally qualified health center in the tiny town of Brooks. Jewell was a beloved doctor who tended to its population, and after whom the “little frontier outpost of medicine” she remembered growing up was named. Her time at the Arthur Jewell stuck in Maynard’s mind when, years later, she arrived in Philadelphia and needed treatment for a broken foot. “I didn’t know how you were supposed to do it,” Maynard said. “Here, with all of the doctors, do I just make an appointment with my orthopedist? Do I go to the urgent care? Do I go to the ER?” “I realized how health careliterate I wasn’t growing up,” she said. “I get some of the realities for people that aren’t literate about health care, and I still find myself with questions.” Maynard holds undergraduate and graduate degrees in engineering, which she applied to

OR TODAY | July/August 2017

performing data analysis for the Maine department of transportation, calculating route efficiencies for highway cleanup and transit (“I was doing a lot of mapmaking,” she said). As her career in data visualization progressed, Maynard began working on social programs, helping build a unified digital intake form for state benefits applicants. By then, it was 2012, and her work became ever more closely tied to the emergence of the Affordable Care Act (ACA). “My husband is a policy analyst, and there was much discussion about health care in our house,” Maynard said. “I got to thinking I would like to be more directly involved in health care.” So she went back to school at Thomas Jefferson University in Philadelphia, Pennsylvania. By 2014, she’d graduated with her BSN, and her career outlook had slightly shifted focus. “My vision when I went in was that I would get my bachelor’s in nursing and work while I got my WWW.ORTODAY.COM

MSN, and maybe find a rural clinic and work there,” Maynard said. “I understand better that there is a lot of urban need, too.” In Philadelphia, Maynard was able to follow the intersection of real-time policy and health data efforts. Nonprofits like Project HOME, which works to eliminate homelessness, and the Public Health Management Corporation, a 45-year-old group that specializes in outreach to marginalized Philadelphians, are leading the way, she said. So too is Dr. Jeffrey Brenner of the Camden Coalition of Healthcare Providers, recently given $15 million from UnitedHealthcare for his research on the impact of wraparound services for the most vulnerable (and most frequent) users of health services in Camden, New Jersey. Programs like these energize and motivate her professionally, and Maynard said she still hopes to land “somewhere that’s WWW.ORTODAY.COM

being innovative about getting the help to populations that don’t have good access to it.” For now, she enjoys the hands-on nature of service in her position with MossRehab Hospital in Philadelphia, where she works day shift in the spinal cord injury unit. Maynard focuses on bedside care, and said she most enjoys being able to support her patients as they learn how to manage their day-to-day activities. “They’re there so they can have intensive inpatient therapy,” Maynard said. “We make sure they’re up and dressed for their therapy, and that everyone has their medicine.” “I like that I’m talking to people,” she said. “I connect with people. It’s not like a patient comes and goes. We get to know them for two to six weeks, and you get to talk to them about their injury, and how it fits into their life, and how their life should change.”

Those conversations can lead to deep, however brief, relationships with patients and their families. Maynard recollects juvenile victims of gun violence, young cancer patients, and other people whose lives have intersected her own. During a particularly difficult Mother’s Day, a surprise from a former patient provided welcome relief. The man had promised to cook his caretakers “a real Italian meal” –meatballs, pasta, chicken parmesan – which he packed up and drove two hours to the center in honor of Nurse’s Week. The food and the sentiment behind it had arrived exactly at the moment they were needed. The emotional complexity of the job is matched only by its physical demands; in the spinal-cord injury wing “there are a lot of jobs that are not one-person jobs,” Maynard said. “Getting a person who can only move from the neck up into a wheelchair is not a one-person job,” she said. “It’s really personal stuff. You’re helping people with things that they don’t want help with.” For someone whose gifts are as hands-on – Maynard is a scratch baker and practiced knitter – as they are intellectual, nursing has provided her with a complement to the engineering worldview with which she grew up. “It is a different way of thinking,” she said. “In engineering, you can define the answer more clearly; in nursing you have to be a lot more flexible.” While she was in school, Maynard said she had not appreciated the variety of career options for nurses. She’s currently pursuing a master’s degree to become a nurse practitioner, and wants to follow her impulse to improve conditions for underserved populations. “There’s a lot of need and there are a lot of people that I think are living kind of like I was at one time,” Maynard said. “Health care is not a world that is very easy to understand, and that has become even more true.” July/August 2017 | OR TODAY

OUT OF THE OR FITNESS

BY STAFF REPORT

PERSONALIZED WORKOUTS MAY HELP

PREVENT HEART DISEASE

ersonalized workouts to prevent heart disease can be designed by a new digital instrument, according to research published in the European Journal of Preventive Cardiology. The EXPERT tool specifies the ideal exercise type, intensity, frequency, and duration needed to prevent a first or repeat cardiovascular event. “Exercise reduces cardiovascular risk, improves body composition and physical fitness, and lowers mortality and morbidity,” said lead author Dominique Hansen, associate professor in exercise physiology and rehabilitation of internal diseases at Hasselt University, Diepenbeek, Belgium. “But surveys have shown that many clinicians experience great difficulties in prescribing specific exercise programs for patients with multiple cardiovascular diseases and risk factors.” The European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) 58

OR TODAY | July/August 2017

tool generates exercise prescriptions for patients with different combinations of cardiovascular risk factors or cardiovascular diseases. The tool was designed by cardiovascular rehabilitation specialists from 11 European countries, in close collaboration with computer scientists from Hasselt University. EXPERT can be installed on a laptop or personal computer (PC). During a consultation, the clinician inputs the patient’s characteristics and cardiovascular risk factors, cardiovascular diseases and other chronic conditions, medications, adverse events during exercise testing, and physical fitness (from a cardio-

pulmonary exercise test). The tool automatically designs a personalized exercise program for the patient. It includes the ideal exercise type, intensity, frequency, and duration of each session. Safety precautions are also given for patients with certain conditions. The advice can be printed out and given to the patient to carry out at home, and reviewed by the clinician in a few months. “EXPERT generates an exercise prescription and safety precautions since certain patients are not allowed to do certain exercises. For example, a diabetic patient with retinopathy should not do highintensity exercise,” Hansen said. “This tool is the first of its kind,” Hansen added. “It integrates all the international recommendations on exercise to calculate the optimum training program for an individual patient. It really is personalized medicine.” There are different exercise goals for each cardiovascular risk WWW.ORTODAY.COM

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OUT OF THE OR HEALTH

BY HARVARD HEALTH LETTERS

COULD YOU HAVE A HEART ATTACK AND NOT KNOW IT?

ere’s a surprising fact: Nearly half of people who have a heart attack don’t realize it at the time. These so-called silent heart attacks are only diagnosed after the event, when a recording of the heart’s electrical activity (an electrocardiogram or ECG) or another test reveals evidence of damage to the heart.

One explanation for this phenomenon may be a higher-than-average tolerance for pain. Some people mistake their symptoms as indigestion or muscle pain, while others may feel pain, but in parts of their upper body other than the center of the chest, says Kenneth Rosenfield, M.D., who heads the vascular medicine and intervention section at Harvard-affiliated Massachusetts General Hospital. DIFFERENT SENSATIONS?

“Many people don’t realize that during a heart attack, the classic symptom of chest pain happens only about half of the time,” he says. 60 OR TODAY | July/August 2017

People sometimes describe heart attack symptoms as chest discomfort or pressure, while others say they feel an intense, crushing sensation or a deep ache similar to a toothache. Certain people are less sensitive to pain than others, or they may deny their pain and “tough it out” because they don’t want to appear to be weak. Not everyone has a good sense of their own pain tolerance, however, and a host of other factors (such as your emotional state) can affect pain perception. Of note: People with diabetes may be less sensitive to pain because the disease can deaden nerves

(a condition known as diabetic neuropathy), theoretically raising their risk for a silent heart attack. WHERE IT MAY HURT

During a heart attack, the location of the pain can also vary quite a bit from person to person, notes Rosenfield. It may occur in the arm, shoulder, neck, jaw or elsewhere in the upper half of the body. “I had one patient who had earlobe pain, and another who felt pain in his wrist,” says Rosenfield. Other non-classic symptoms people often don’t attribute to a heart attack include nausea, vomiting and weakness. During his career, Rosenfield has seen many thousands of people who’ve had heart attacks. “There’s no question that women are more likely to experience nonclassic heart attack symptoms, but it’s important to remember that men can have those symptoms, too,” says Rosenfield. WWW.ORTODAY.COM

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CLASSIC SYMPTOMS

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SPEAKER SPOTLIGHT I knew from the time I was in high school that I wanted to be a nurse., When I graduated from nursing school, I couldn’t wait to begin my career. I worked at a large metropolitan hospital on a renal unit. The patients I cared for often had several comorbidities: diabetes, peripheral vascular disease, hypertension, as well as renal failure. While it was a great experience that helped develop my nursing and critical thinking skills, I didn’t truly love it. It just felt like a job, and I questioned my decision to become a nurse. It was disheartening to think that what I had wanted to do for most of my life may not have been the right choice. After about a year, the hospital I worked at realized they had a significant shortage of OR nurses and started an “extern program” to train floor nurses to become OR nurses. I knew very little about OR nursing but was excited at the idea, so I applied. After

interviewing with the OR Director, I was offered a position. That’s when it happened; that’s when I found my passion for nursing. I loved the atmosphere and the fast-paced, often intense cases. I loved the teamwork and communication that’s required to keep patients safe. I loved the focus on one patient at a time. I even loved the quirky and sometimes difficult personalities. Working in the OR changed my feelings of nursing from “just my job” to “nursing is my career.” To this day, I love the OR and everything I learned in that experience. Over the years, I worked in a variety of OR settings and in a variety of roles. Eventually, I transitioned into more informatics-focused positions, and moved into the perioperative IT vendor world. I’ve been fortunate to have the opportunity to help hospitals utilize analytics solutions to achieve their clinical and business goals. I

Andi Dewes, RN-BC, BSN, CNOR

feel fortunate to work with a variety of hospitals around the country, and still be connected to the OR. Looking back over my time as a nurse, I would never have thought I’d be where I am today, continuing to grow and develop in my career, and still so happy to be part of the nursing profession. •

Find out more about Andi and her experience in perioperative nursing as she presents, “Cracking the Code on Improving Block Utilization” at the 2017 OR Today Live conference being held August 27-29 in Washington, D.C.

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OUT OF THE OR NUTRITION

cocoa

BY MATTHEW KADEY, M.S., R.D.

green tea

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EAT YOUR WAY TO BETTER SKIN

ou know the age-old saying: you are what you eat – and if we’re talking about complexion, the path to youthful looking skin might be through your stomach. Scientists are uncovering a number of nutrients found in certain foods that can help lessen the signs of aging skin, including wrinkles and dryness.

COCOA

Embracing your inner Willy Wonka could be good news for your complexion. A 2015 study in the Journal of Nutrition determined that the consumption of high amounts of cocoa flavonols can reduce signs of photoaging (like age spots and wrinkles), namely by having a positive impact on facial wrinkles and elasticity. Flavonols are powerful antioxidants that protect your skin against the damaging effects of environmental stressors like UV rays. Products with the most flavonols include dark chocolate bars (at least 70 percent cocoa), cacao nibs and natural (non-alkalized) cocoa powder. GREEN TEA

Sipping this ancient beverage might be the answer to a youthful glow. An investigation by German scientists discovered that polyphenols in green tea may serve your skin well by offering up protection against UV radiation, as well as improving measures of skin 64

kiwi

OR TODAY | July/August 2017

quality such as elasticity and dryness. This skin-boosting power is likely owing to the ability of green tea polyphenols to increase blood flow and oxygen delivery to the skin. Aim to drink two or more cups of green tea daily. SWEET POTATO

If you enjoy spending time in the great outdoors, make sure to eat plenty of beta-carotene rich foods, like sweet potatoes, carrots and dark leafy greens, such as kale and collards. The nutrient has been shown to confer some natural protection against sunburn, which, in turn, may lower signs of photo-aging, as well as skin cancer risk. What’s more, a 2016 study in the Journal of the American Academy of Dermatology flax seeds found that higher intakes of vegetables and fruits can be protective against adult acne. FLAX

Reach for that bag of ground flaxseed more often. A report in the British

Journal of Nutrition determined that daily flax consumption can reduce skin reddening and improve skin hydration, which limits roughness and dryness. The abundance of omega-3 fats can help your skin retain moisture. Other omega-3 powerhouses include hemp seeds, chia, walnuts and fatty fish including salmon, sardines and mackerel. KIWI

Just one of these fuzzy fruits has more than a day’s worth of vitamin C, making it a skin-loving edible. British researchers showed that people who took in the most vitamin C had the lowest risk of a wrinkled appearance and skin dryness. Vitamin C plays an important role in the synthesis of collagen, a structural protein responsible for holding the connective tissue in your skin together. As an antioxidant, vitamin C can also help mop up the free radicals that wreak havoc on healthy skin cells and accelerate skin aging. You can also get more skin-friendly vitamin C through oranges, strawberries, bell peppers, broccoli and kale. Environmental Nutrition is the awardwinning independent newsletter written by nutrition experts dedicated to providing readers up-to-date, accurate information about health and nutrition in clear, concise English. For more information, visit www. environmentalnutrition.com. WWW.ORTODAY.COM

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OUT OF THE OR RECIPE

BY DIANE ROSSEN WORTHINGTON ENTRÉE

TASTY TIPS • Look for cherry pitters in cookware stores or on online like the Oxo pitter (oxo.com). • Use this recipe as a template for other seasonal fruits, such as apricots, plums, apples or pears. • This is also good for breakfast, brunch or afternoon tea. • Use a serrated peeler to peel the peaches.

OR TODAY | July/August 2017

WWW.ORTODAY.COM

RECIPE

FRUIT IS THE STAR OF THIS RUSTIC DESSERT

hile I’m usually more than satisfied to enjoy a handful of bright red cherries or bite into a juicy white peach, with its rosy-hued flesh, sometimes I want to step it up with a baked dessert.

INGREDIENTS White Peach and Cherry Clafoutis Serves 6 to 8

One of my favorite summer desserts is a French-style pudding. This giant baked pancake showered with confectioners’ sugar is a spectacular, yet rustic dessert – and the good news is that it is the definition of a Seriously Simple dessert. Cherry Clafoutis – pronounced “klah-foo-TEE” – became popular in France in the 19th century in the town of Limousin, where they cooked the unpitted cherries in a vanilla-scented batter. Each family had their own closely guarded recipe. The thinking was that the pits added extra flavor. They obviously didn’t have a cherry pitter gadget that makes pitting cherries painless and quick.

Any variety of cherry is fine to use, though I tend to prefer Bing, Queen Anne or Rainier – the sweeter the better. Make sure to remove the stems and then pit them using a pitter. If you are really in a hurry, you can use frozen pitted cherries; but thoroughly defrost and drain them first. White peaches have a distinctly floral quality, but you can use any fresh peach variety or even nectarines. Serve this directly from an ovenproof baking dish or you can serve it from a nonstick gratin dish or cast iron skillet, which gives it a casual, homey touch. This is best served right out of the oven.

1 cup granulated sugar 2 medium white peaches, peeled and sliced 2 cups pitted fresh sweet cherries or thawed, drained frozen cherries 1 cup all-purpose (plain) flour 1 teaspoon baking powder Pinch of salt 4 large eggs 1 3/4 cups half-and-half

DIRECTIONS

2 teaspoons pure vanilla extract

1. Preheat the oven to 425 F. Butter a 9-by-13-inch baking dish. Place the baking dish on a baking sheet. Sprinkle the bottom of the dish with 2 tablespoons of the granulated sugar. Spread the peaches and cherries in the bottom of the dish and bake for 10 minutes. There may be a lot of juice; do not drain. Set aside. 2. While the fruit is cooking, in a bowl, whisk together the flour, baking powder and salt. In a large bowl, using an electric mixer on medium speed, beat the eggs with 3/4 cup of the granulated sugar until blended, about 1 minute. Add half the flour mixture, then the half-andhalf, then the rest of the flour mixture. Add the vanilla and lemon zest, and stir to combine. 3. Pour the batter over the fruit. Sprinkle with the remaining 2 tablespoons granulated sugar. Bake until puffed and golden brown, 30 to 35 minutes. Transfer to a wire rack to cool slightly. Dust the top with confectioners’ sugar, using a fine-mesh sieve, and serve immediately.

Grated zest of 1 lemon

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Confectioners’ sugar for dusting

Diane Rossen Worthington is an authority on new American cooking. She is the author of 18 cookbooks, including “Seriously Simple Parties,” and a James Beard Award-winning radio show host. You can contact her at www.seriouslysimple.com. July/August 2017 | OR TODAY

OUT OF THE OR PINBOARD

PINBOARD

The News and Photos That Caught Our Eye This Month

OR TODAY

CONTESTS • JULY/AUGUST • ARE YOU IN THE KNOW? Have you attended an OR Today webinar? Email a photo of yourself with a workbook from any OR Today webinar to Editor@MDPublishing.com to be entered to win lunch for your department. One lucky person will win a $50 gift card to Subway! Find out more about the OR Today webinar series, including workbooks and a calendar of upcoming webinars, at www.ORToday.com/Webinars.

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PINBOARD

WHAT IS ORGANIC, CAGE-FREE AND FREE-RANGE Buying a simple carton of eggs, like a lot of things in life, has become more complicated. Egg-cellent! Do you want free-range? Cage-free? Here’s how to understand what all those words on the carton mean so you can decide which matter. ORGANIC Organic eggs are certified to have been laid by cage-free or free-range

hens raised on organic feed and with access to the outdoors. However, a recent report by the Cornucopia Institute indicates that many larger producers don’t always comply with these requirements (especially the outdoor access). Most small-scale farmers were found to be in compliance. CAGE-FREE When eggs are “cage-free” the hens can roam in a building, a room or an open area instead of a battery cage, a 16-by-20-inch cage that houses up to 11 birds. This does

not necessarily mean that hens have access to the outdoors. Nor does it indicate how much room they have to move around. FREE-RANGE Eggs labeled “free-range” were laid by hens that have access to the outdoors. This can simply mean the hens have an indoor space connected to an outdoor area – not that they are roaming around “free.” In addition to eating grain, these hens may forage for wild plants and insects. – EatingWell.com

THE SOLAR STAMP The Postal Service has released a first-of-its-kind stamp that changes when you touch it. The Total Eclipse of the Sun Forever stamp, which commemorates the August 21 eclipse, transforms into an image of the moon from the heat of a finger. Tens of millions of people in the United States hope to view this rare event, which has not been seen on the U.S. mainland since 1979. The eclipse will travel a narrow path across the entire country for the first time since 1918. The path will run west to east from Oregon to South Carolina and will include portions of 14 states. The stamp’s first-day-of-issue ceremony took place on June 20 at the Art Museum of the University of Wyoming (UW) in Laramie. As part of a summer solstice celebration. The back of the stamp pane provides a map of the August 21 eclipse path and times it may appear in some locations. The stamp image is a photograph taken by astrophysicist Fred Espenak, aka Mr. Eclipse, of Portal, Arizona, that shows a total solar eclipse seen from Jalu, Libya, on March 29, 2006. In the first U.S. stamp application of thermochromic ink, the Total Eclipse of the Sun Forever stamps will reveal a second image. Using the body heat of your thumb or fingers and rubbing the eclipse image will reveal an underlying image of the Moon (Espenak also took the photograph of the full moon). The image reverts back to the eclipse once it cools. Thermochromic inks are vulnerable to UV light and

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should be kept out of direct sunlight as much as possible to preserve this special effect. To help ensure longevity, the Postal Service will be offering a special envelope to hold and protect the stamp pane for a nominal fee. A total eclipse of the Sun Total Eclipse S occurs when the Moon tamp completely blocks the visible solar disk from view, casting a shadow on Earth. The 70-mile-wide shadow path of the eclipse, known as the “path of totality,” will traverse the country diagonally, appearing first in Oregon (mid-morning local time) and exiting some 2,500 miles east and 90 minutes later off the coast of South Carolina (mid-afternoon local time). A total solar eclipse provides us with the only chance to see the Sun’s corona — its extended outer atmosphere — without specialized instruments. During the total phase of an eclipse the corona appears as a gossamer white halo around the black disk of the Moon, resembling the petals of a flower reaching out into space. Art director Antonio Alcalá of Alexandria, Virginia, designed the stamp. The Total Eclipse of the Sun stamp is being issued as a Forever stamp, which is always equal in value to the current First-Class Mail 1-ounce price. •

July/August 2017 | OR TODAY

INDEX ALPHABETICAL

AAAHC………………………………………………………… 65 AIV Inc.………………………………………………………… 33 American Ultraviolet………………………………… 44 Belimed…………………………………………………………… 4 C Change Surgical………………………………………… 9 Cincinnati Sub-Zero………………………………… IBC Clorox…………………………………………………………… 26 Cygnus Medical………………………………………………21 Flagship Surgical, LLC……………………………… 59

Healthmark Industries Company, Inc.…61, 54 Innovative Medical Products…………………… BC Jet Medical Electronics Inc……………………… 59 MD Technologies inc.………………………………… 63 MedWrench………………………………………………… 62 Mobile Instrument Service & Repair……… 10 Pacific Medical……………………………………… 6, 45 Palmero Health Care………………………………… 61 Paragon Services………………………………………… 55

Polar Products………………………………………………17 Pure Processing……………………………………………… 5 Ruhof Corporation………………………………………2-3 Soma………………………………………………………… 22-24 STERIS………………………………………………………………… 15 TBJ Incorporated………………………………………… 25 Tetra…………………………………………………………………17

Palmero Health Care………………………………… 61 Pure Processing……………………………………………… 5 Ruhof Corporation………………………………………2-3 TBJ Incorporated………………………………………… 25 TRU-D…………………………………………………………… 19 TSO3…………………………………………………………46-49

SAFETY Flagship Surgical, LLC……………………………… 59 Healthmark Industries Company, Inc.…61, 54

TRU-D……………………………………………………………………19 TSO3……………………………………………………………… 46-49

INDEX CATEGORICAL ANESTHESIA Paragon Services………………………………………… 55 Soma………………………………………………………… 22-24 ASSOCIATION AAAHC………………………………………………………… 65 C-ARM Soma………………………………………………………… 22-24 CARDIAC PRODUCTS C Change Surgical………………………………………… 9 Jet Medical Electronics Inc……………………… 59 CARTS/CABINETS Cincinnati Sub-Zero………………………………… IBC Cygnus Medical………………………………………………21 Flagship Surgical, LLC……………………………… 59 Healthmark Industries Company, Inc.…61, 54 STERIS………………………………………………………………… 15 TBJ Incorporated………………………………………… 25 DISINFECTION American Ultraviolet………………………………… 44 Clorox…………………………………………………………… 26 Cygnus Medical………………………………………………21 Palmero Health Care………………………………… 61 Ruhof Corporation………………………………………2-3 ENDOSCOPY Clorox…………………………………………………………… 26 Cygnus Medical………………………………………………21 Healthmark Industries Company, Inc.…61, 54 Mobile Instrument Service & Repair……… 10 Ruhof Corporation………………………………………2-3 STERIS………………………………………………………………… 15 ERGONOMIC SOLUTIONS Pure Processing……………………………………………… 5 FLUID MANAGEMENT SOLUTION Flagship Surgical, LLC……………………………… 59 GENERAL AIV Inc.………………………………………………………… 33 INFECTION CONTROL American Ultraviolet………………………………… 44 Belimed…………………………………………………………… 4 Clorox…………………………………………………………… 26 Cygnus Medical………………………………………………21 Healthmark Industries Company, Inc.…61, 54

OR TODAY | July/August 2017

INSTRUMENT STORAGE/TRANSPORT Belimed…………………………………………………………… 4 Cygnus Medical………………………………………………21 LIGHTING/VIDEO PRODUCTION STERIS………………………………………………………………… 15 MONITORS Pacific Medical……………………………………… 6, 45 Soma………………………………………………………… 22-24 ONLINE RESOURCE MedWrench………………………………………………… 62 OR TABLES/BOOMS/ACCESSORIES Innovative Medical Products…………………… BC Soma………………………………………………………… 22-24 STERIS………………………………………………………………… 15 OTHER AIV Inc.………………………………………………………… 33 TRU-D…………………………………………………………… 19 PATIENT MONITORING AIV Inc.………………………………………………………… 33 Jet Medical Electronics Inc……………………… 59 Pacific Medical……………………………………… 6, 45 POSITIONING PRODUCTS Cygnus Medical………………………………………………21 Innovative Medical Products…………………… BC REPAIR SERVICES Cygnus Medical………………………………………………21 Jet Medical Electronics Inc……………………… 59 Mobile Instrument Service & Repair……… 10 Pacific Medical……………………………………… 6, 45 Soma………………………………………………………… 22-24 REPROCESSING STATIONS Pure Processing……………………………………………… 5 TBJ Incorporated………………………………………… 25

SINKS Pure Processing……………………………………………… 5 TBJ Incorporated………………………………………… 25 STERILIZATION American Ultraviolet………………………………… 44 Belimed…………………………………………………………… 4 Cygnus Medical………………………………………………21 Healthmark Industries Company, Inc.…61, 54 TBJ Incorporated………………………………………… 25 TSO3…………………………………………………………46-49 SURGICAL Soma………………………………………………………… 22-24 STERIS………………………………………………………………… 15 SURGICAL INSTRUMENT/ACCESSORIES C Change Surgical………………………………………… 9 Cygnus Medical………………………………………………21 Healthmark Industries Company, Inc.…61, 54 SURGICAL MAT SOLUTIONS Flagship Surgical, LLC……………………………… 59 TELEMETRY AIV Inc.………………………………………………………… 33 Pacific Medical……………………………………… 6, 45 TEMPERATURE MANAGEMENT C Change Surgical………………………………………… 9 Cincinnati Sub-Zero………………………………… IBC Polar Products………………………………………………17 WARMERS Belimed…………………………………………………………… 4 Cincinnati Sub-Zero………………………………… IBC STERIS………………………………………………………………… 15 WASTE MANAGEMENT Flagship Surgical, LLC……………………………… 59 MD Technologies inc.………………………………… 63 TBJ Incorporated………………………………………… 25 WOUND MANAGEMENT Tetra…………………………………………………………………17

RESPIRATORY Soma………………………………………………………… 22-24

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CSZâ&#x20AC;&#x2122;s Normothermia Products

Preventing unintended hypothermia can be simple with the right approach. You can count on PTM solutions from CSZ Medical to support your patients throughout the continuum of surgical care. For more than 50 years, we have been focused on PTM and have developed the expertise that you can count on for your patients.

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12011 Mosteller Road Cincinnati, OH 45241 P: 513-772-8810 Toll-Free: 800-989-7373

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Secure positioning, easy access, unmatched patient safety. Introducing...

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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 TrenMAXTM 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 TrenMAXTM 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 TrenMAXTM is a trademark of Innovative Medical Products, Inc. – PATENT APPLIED FOR TrenMAXTM Clamp - PATENT APPLIED FOR The Sticky PadTM is a trademark of Innovative Medical Products, Inc.