OR Today - August 2018 by MD Publishing

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OR TODAY | August 2018

contents features

40 THE LATEST TRENDS AND TIPS IN PATIENT SAFETY When you stop and think about it, recent advancements in surgical technology and medical care are truly astonishing. However, there’s still significant risk every time a surgeon’s scalpel touches a patient’s skin. It’s up to perioperative personnel and surgical teams do everything within their power to reduce these risks.

The surface disinfectants market is expected to reach $789 million by 2022. In this issue of OR Today we feature some of the latest products designed to help keep surfaces clean and patients

The environment has become everyone’s responsibility. Health care professionals as a team can make a difference by working to reduce waste at their work sites. If medical waste is not disposed of properly, not only

OR Today recently held mixers in Lexington, Kentucky as well as Nashville, Tennessee and Knoxville, Tennessee promoting the upcoming OR Today Live Surgical Conference. Each mixer was a huge success with exceptional

safe.

can it threaten the local environment, but it may lead to disease.

networking, insightful presentations and information about the conference.

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OR Today (Vol. 18, Issue #08) August 2018 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. © 2018

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contents features

PUBLISHER John M. Krieg

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VICE PRESIDENT Kristin Leavoy

OR TODAY CONTEST

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Find out last month's winner and how you could win!

EDITOR John Wallace

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ART DEPARTMENT Jonathan Riley Karlee Gower Kathryn Keur

ACCOUNT EXECUTIVES Jayme McKelvey Megan Cabot

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DIGITAL SERVICES Travis Saylor Cindy Galindo Kennedy Krieg

Martha Becker

Tangy Kale Slaw

SPOTLIGHT ON

RECIPE OF THE MONTH

CIRCULATION Lisa Cover Melissa Brand

WEBINARS Linda Hasluem webinar@mdpublishing.com

INDUSTRY INSIGHTS 10 News & Notes 18 ASCA 21 Webinar Recap

IN THE OR

23 Market Analysis 24 Product Focus 30 CE Article

OUT OF THE OR

49 Fitness 50 Health 52 Nutrition 54 Recipe 58 ORTL Mixer Scrapbook 62 Pinboard 65 Index

8 | OR TODAY | AUGUST 2018

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INDUSTRY INSIGHTS

news & notes

ABC Announces Credentialing Tool Anesthesia Business Consultants (ABC), a provider in billing and practice management for the anesthesia and pain management specialty, has announced F1RSTCred, a new physician credentialing and provider enrollment tool for clients. ABC’s F1RSTCred proprietary software streamlines the process of physician credentialing by maintaining a secure database to house client data and forms. Uploaded documents are available at the touch of a button, along with a built-in tracking system for expiration dates on certifications, licenses, etc., utilizing automated alerts, workflows and follow-up indicators. F1RSTCred also works to secure provider participation by enrolling clients to contract with various insurance networks, allowing auto-population of pre-mapped insurance applications utilizing built-in provider profiles, including the standardized processes that government agencies (i.e., Medicaid and Medicare) use. ABC submits, on behalf of its clients, health plan applications and the associated documentation. F1RSTCred’s integrated dashboard provides insight of the overall picture as well as status updates on pending/ completed requests. It maintains the extensive documentation, eliminates confusion and provides regular follow-up with insurance companies until the credentialing and contracting processes are finalized. “F1RSTCred makes the physician credentialing and provider enrollment processes so much more efficient,” Anesthesia Business Consultants CEO Tony Mira said. “It allows access to client data and forms in one location via a secure database. It also provides secure role-based access for users and departments to manage and view provider information. Physicians can fill in their data using the pre-mapped process without worry of overwriting credentialing work already in progress.” •

10 | OR TODAY | AUGUST 2018

Baxter Announces U.S. FDA Clearance of Spectrum IQ Infusion System Baxter International Inc. has announced U.S. Food and Drug Administration (FDA) clearance of the Spectrum IQ Infusion System with Dose IQ Safety Software. The Spectrum IQ system is the first-of-its-kind designed specifically for bi-directional electronic medical records (EMR) integration with new exclusive features to help ensure the correct medications and fluids are delivered to the patient. The Spectrum IQ system also builds upon proven Spectrum infusion pump technology and Baxter’s comprehensive approach to patient safety to help make drug library compliance, protection for high-risk infusions and auto-programming more consistently achievable for health systems. The Spectrum IQ system provides the broadest range of auto-programming workflows and feature sets as well as embedded on-screen barcode technology that helps eliminate the need for a sticker barcode and provides clinicians with scan prompts to help maintain or increase auto-programming compliance and automatically document infusion data into the EMR. In addition, the Spectrum IQ pump is the only infusion pump to feature Line Check Notification technology that supports line management by providing a visual notification matching the infusion pump and the medication being infused. For the Spectrum IQ Infusion System, Baxter has partnered with First Databank (FDB) to integrate FDB Infusion Knowledge – an evidence-based library of IV medications – into Dose IQ Safety Software to help make delivery of infusions safer. •

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news & notes

HFAP Receives Renewal as ASC Accreditation Agency in California HFAP, a health care accreditation program founded in 1945, was recently renewed as an approved accreditation agency for ambulatory surgery centers (ASC) in California. HFAP already has deeming authority for ASCs from the Centers for Medicare and Medicaid (CMS), allowing HFAP to conduct accreditation surveys and assess compliance with the Medicare Conditions for Coverage for ASCs. The Medical Board of California awarded the approval after HFAP met all of the application requirements including accreditation standards and payment of renewal fees. The approval is valid through December 31, 2019. “At HFAP, we pride ourselves on our customer-centered approach to accreditation that provides health care organizations with a relevant and comprehensive survey, as well as ongoing support and interaction with our team throughout the accreditation cycle,” said Meg Gravesmill, CEO of HFAP. “All organizations have ready access to resources and education to ensure continuing opportunities for learning, growth and advancement before, during and in between surveys.” HFAP also holds deeming authority for clinical laboratories and acute care and critical access hospitals. In addition, HFAP’s new joint arthroplasty certification will join lithotripsy services, and wound care, as specialty recognition relevant to ambulatory facilities. • For more information on HFAP accreditation programs, visit www.hfap.org.

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CleanCision Earns Award Prescient Surgical, innovator of advanced tools and technologies to fight and defend against the sources of surgical site infection, announced that its CleanCision active cleansing technology, earned the 2018 Medical Device Excellence Award (MDEA) Bronze Medal in the ER and OR tools category. CleanCision also earned the overall MDEA Reader’s Choice Award, which spans all categories in the competition. CleanCision is the first in a new FDA device class of irrigating wound protectors developed to retract the surgical incision, provide abdominal access, and consistently and continuously irrigate the wound edge with a surgeon-selected fluid therapy to actively fight and remove the root cause of surgical site infection – wound contamination – without disrupting current surgical practice. Developed and designed collaboratively with surgeons and infection control experts, the first-inclass CleanCision system continuously clears harmful bacteria from surgical incisions by combining wound protection and irrigation into an intuitive and easy-to-use retraction system. “We share this award with the surgeons and infection control experts who collaborated with us to create an intuitive design that is filling a critical gap in hospital surgical site infection control programs,” said Jonathan Coe, president, CEO and co-founder of Prescient Surgical. •

AUGUST 2018 | OR TODAY |

INDUSTRY INSIGHTS

news & notes

New Technology Integration Showcased at HIMSS Conference Hill-Rom has debuted enhanced workflow efficiency and security features for its Welch Allyn Connex vital signs monitoring portfolio. The devices now integrate secure access technology from Imprivata, a healthcare IT security company, to enable stronger protection of patient data collected or stored on Connex devices used in EMR-connected workflows, while providing clinicians a faster, easier way to access or update patient data. Medical devices commonly require a user to log in to gain entry. With this new technology integration, Connex vitals monitoring devices have the ability to read a clinician’s hospital security badge via barcode or RFID, offering one-step device access at the bedside. This faster, more efficient log-in to the device helps clinicians move quickly to their primary focus – patient care – while also protecting data integrity into the EMR. The technology enhancements to Welch Allyn’s vitals portfolio also include the ability to restrict device access to just those people who need it, which means less potential for data to be compromised, either by accident or by design. These technology enhancements for the Connex family of vital signs devices debuted during the 2018 HIMSS (Healthcare Information and Management Systems Society) conference. •

12 | OR TODAY | AUGUST 2018

umf Corporation Develops Rechargeable Broad-Spectrum Antimicrobial Additive umf Corporation has developed Micrillon, a rechargeable broad-spectrum antimicrobial polymer additive that will have a significant impact on the spread of drug-resistant infections and preventable hospital associated infections (pHAIs), now considered the fourth-leading cause of death in the United States. Micrillon, which has earned multiple patents worldwide, can be incorporated into a wide range of polymer (plastic) products to help mitigate risk of such infections. The first Micrillon product – a hospital privacy curtain-pull, ideal for use in hospital, long term care and nursing homes – was introduced at the Association for Professionals in Infection Control and Epidemiology (APIC) conference. Micrillon is a disruptive, innovative chemistry that has the potential to help prevent pHAI’s head-on. The broadspectrum antimicrobial is the result of more than a decade of research and development of best-in-class products and training – including color-coded systems and a ONEperROOM methodology for reducing the risk of cross-contamination in leading hospitals. Micrillon’s unique properties include antiviral efficacy, the ability to recharge for the life of the product, and no leeching into the environment. When incorporated into a product made from plastic, the entire surface, whether a fiber or solid part, can be charged with chlorine molecules. When bacteria, mold and viruses come into contact with the Micrillon surface, they are eliminated. A Micrillon fiber wiper then can be used with a disinfectant or chlorine-containing sanitizer to remove soil and organic matter while simultaneously recharging the surface. The Micrillon cycle concept is simple, and the chemistry can be incorporated into all people touch points in hospital rooms, intensive care, the OR and ER. So, everything that people touch – such as light switches, bed rails, door handles, curtain pulls, walls and grout – would be a rechargeable Micrillon antibacterial/antiviral surface. When cleaned, all these touch points would be recharged. The first product in the Micrillon line is a hospital privacy curtain-pull. In the coming year, umf will introduce additional Micrillon products, including surgical wipes, cubicle curtains, bath towels and HVAC/filtration products. •

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Pass-Thru Endoscope Reprocessor Installed at U.S. Facility Hennepin Healthcare, a comprehensive health system dedicated to advancing endoscope reprocessing standards, announced its partnership with Cantel Medical to install the ADVANTAGE PLUS Pass-Thru Automated Endoscope Reprocessor (AER), the nation’s very first pass-through AER. Due to highly complex device designs and conflicting industry reprocessing standards, health care facilities nationwide have experienced challenges to standardize processes that safely disinfect flexible endoscopes. While many today meet basic industry standards for high-level disinfection of flexible endoscopes, there is still more that can be done to ensure an endoscope is clean to better protect patients from infections. The Pass-Thru Automated Endoscope Reprocessor establishes a physical separation between dirty and clean reprocessing areas to support a one-way workflow that streamlines processes while minimizing the risk of cross contamination and human error. “At Hennepin Healthcare, our patients come first and we want to do everything we can to ensure they receive the best possible care at our facilities,” said Uggen Jigmey, sterile processing department manager, Hennepin Healthcare. “The Pass-Thru AER, along with other innovations from Medivators, help us elevate our reprocessing workflow to increase efficiency and enhance infection prevention to the highest level possible. This is an element of our work that patients should never have to think about – and yet it’s our highest priority.” In addition to installing the first U.S. pass-thru AER, Hennepin Healthcare completely transformed its endoscope reprocessing room during the building of its new clinic and specialty center. As part of continuing renovations, Hennepin Healthcare will upgrade all of its flexible endoscope reprocessing facilities to the new system in the next 18 months. •

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INDUSTRY INSIGHTS

news & notes

Rhode Island Law Mandates Smoke-free Operating Rooms Rhode Island is the first state to require all licensed hospitals and freestanding ambulatory surgical facilities to adopt policies to use a smoke evacuation system for surgical procedures that generate surgical smoke. Rhode Island Governor Gina Raimondo earlier this year signed into law legislation that will require the elimination of surgical smoke by use of smoke evacuation systems in Rhode Island operating rooms. As the first state to address surgical smoke evacuation by law in the United States, Rhode Island has set a national precedent in the protection and safety of perioperative nurses and their colleagues on the surgical team. Hospitals are required to report to the Department of Health within 90 days that policies regarding surgical smoke ventilation have been adopted. The Association of periOperative Registered Nurses (AORN), advocates for surgical nurses’ workplace safety, spearheaded the law’s passage in collaboration with the Rhode Island State Nurses Association and provided testimony on the dangers of surgical smoke, a by-product of use of energy-generating devices. “There are no specific standards for laser and electrosurgery plume hazards,” said Danielle Glover, manager of AORN Government Affairs. “Instead, the safety policies have been left to the facilities and, nationwide, too few have taken action to protect their health care workers. We hope Rhode Island’s proactive legislation will lead other states to follow suit.” Donna Policastro, executive director of Rhode Island State Nurses expressed her appreciation to Rep. Joeseph McNamara and Senator Cynthia Coyne for their support of nurses and their work to pass legislation that insures a safe work environment. “Rhode Island State Nurses Association is proud to lead the way in creating a ‘culture of safety’ for our nurses and all surgical team members in our state,” Policastro said. According to the Occupational Health and Safety Administration (OSHA), each year “an estimated 500,000 workers, including surgeons, nurses, anesthesiologists, and surgical technologists, are exposed to laser or electrosurgical smoke.” This smoke, also known as plume, includes carbon monoxide, polyaromatic hydrocarbons, and a variety of trace toxic gases. Prolonged exposure can lead to serious and life-threatening respiratory diseases. •

14 | OR TODAY | AUGUST 2018

ASCA Applauds Veterans’ Access to Private-Sector Care Legislation Congress has passed the VA MISSION Act to reform the U.S. Department of Veterans Affairs (VA) health care system. The Ambulatory Surgery Center Association (ASCA) applauds Congress for taking this important step to ensure access to ambulatory surgery centers (ASCs) for veterans across the country. The VA MISSION Act will coalesce all non-VA provider programs into one Veterans Community Care Program in 2019 and institute a new, more reliable claims reimbursement process. ASCs proudly provide high-quality, cost-effective surgical and preventive care, including orthopedic, endoscopic, pain management and other important procedures, to veterans. Unfortunately, challenges within the current non-VA provider programs cause significant delays in reimbursement to providers. Most ASCs are small businesses and depend on timely reimbursement to remain viable in a fluid health care environment. To address these challenges, ASCA endorsed the Veterans Deserve Better Act (H.R. 4783 / S. 2239), introduced by Congresswoman Jacky Rosen (D-NV) in the U.S. House of Representatives and Senator Debbie Stabenow (D-MI) in the U.S. Senate. This bill, whose language was included in the VA MISSION Act, would enable the more than 5,600 Medicarecertified ASCs nationwide to continue to deliver efficient community care to veterans through a reliable claims process that requires claims be reimbursed in 30-45 days for non-VA providers. “ASCs have provided veterans with essential services for years. That said, our members encounter untenable wait times for claims reimbursement—often waiting longer than 12 months to receive payment for services rendered,” stated ASCA Chief Executive Officer William Prentice. “Our members save the health care system billions of dollars annually, as ASCs are reimbursed by Medicare and the VA at 53 percent of the rate in similar sites of care for the same procedures. ASCs are committed to providing high-quality outpatient care, and the expedited claims reimbursement process outlined in the VA MISSION Act will support ASCs in serving our veterans.” For more information on veterans’ health care issues, visit ASCA’s website. •

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ORLink Raises $1M in Early Stage Capital SAYJ Global Partners has announced that ORLink, a surgical workflow platform for operating room professionals, attracted $1 million in expansion funding from investors for a unique, smart system managing the entire surgical context for surgeons. “ORLink saves hospitals time and money, while improving communication and workflows for surgical teams,” said Rick Baker, serial entrepreneur and ORLink’s CTO. “Our team changed static preference cards in operating rooms into an AI enhanced mobile cloud-based software service.” According to CEO Jason Harris, M.D., “the platform helps control facility costs, increases staff efficiency, and improves patient outcomes.” Harris said the Journal of Neurosurgery details an estimated $1,000 of waste per case in a single service line, annualized to nearly $3 million of lost revenue yearly. “Today, with an average of seven operating rooms per hospital and multiple procedures in each OR per day, savings using our licensed platform add up quickly. We are re-capturing lost revenue and the vital communication originally intended with surgical preference cards,” Harris said. ORLink, formed in 2016, was developed by surgeons and OR professionals. The technology incorporates a variety of AI/sensor-based applications to track each piece of equipment entering and exiting surgical theaters. With ORLink, existing surgical instructions on file for doctors with hospital privileges are put into the cloud and tracked. Besides cost savings, there is less danger to patients and reduced liability for insurers. “It has been a great experience to watch ORLink gain acceptance in medical markets,” said Judith Iglehart, partner at SAYJ Global Partners. “Our firm is excited to be working with ORLink in gaining access to strategic partnerships for the licensing of the platform to hospitals in North America and offshore.” “The concept behind ORLink started when Dr. Wayne Colin, realized how impractical and difficult it was to move his preference cards from one hospital to another when performing surgery,” said Asli Gozoren, SAYJ partner. “Once medical doctors showed the same concerns and started joining Dr. Colin as he redefined the process, it began to be a compelling story for angel investors. By creating less waste during surgical procedures, ORLink will have a profound social impact on medicine.” •

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INDUSTRY INSIGHTS

news & notes

McKesson Completes Acquisition of Medical Specialties Distributors McKesson Corporation, a global leader in health care supply chain management solutions, has completed the previously announced acquisition of Medical Specialties Distributors. “Medical Specialties Distributors (MSD) is a leading post-acute service solutions provider serving the home infusion, home medical equipment and oncology markets. MSD and its portfolio brands, First Choice Medical Supply and Attentus Medical Sales Inc., provide a comprehensive offering of medical products, distribution services, biomedical repair and maintenance, medical device sales and rental, and patient technology solutions. MSD’s Total Enterprise Solution are specifically designed to improve both operational efficiencies and profitability so our customers can

focus on the most important thing, patient care,” according to the company’s website. McKesson Corporation, currently ranked sixth on the FORTUNE 500, is a global leader in health care supply chain management solutions, retail pharmacy, community oncology and specialty care, and healthcare information technology. McKesson partners with pharmaceutical manufacturers, providers, pharmacies, governments and other organizations in health care to help provide the right medicines, medical products and health care services to the right patients at the right time, safely and cost-effectively. • For more information, visit www.mckesson.com.

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INDUSTRY INSIGHTS asca

Independent Research Proves Quality Benefits of the ASC Model By William Prentice, ASCA CEO n my last column, I talked about the importance of identifying, capturing and using quality measures for all sites of service. I discussed the ASC industry’s unique experience with quality measures, from the collaborative development of a quality program through the ASC Quality Collaboration (ASC QC) to the difficulties comparing the quality data ASCs report to quality data from others.

Now, I’d like to share some of the data we have seen recently that presents compelling evidence that ASCs offer a quality of care that is on par with, and often superior to, the care available from other outpatient surgery providers. Please keep in mind that while I am sharing data regarding quality here, to determine value, you need to look at quality and cost. Multiple studies show that ASCs provide significant cost savings to both the federal government and commercial payers. This is important. Even if ASCs could demonstrate only that they provide equal, rather than exceptional, quality performance relative to other outpatient settings, they would still represent remarkable potential for tremendous cost savings in the U.S.

18 | OR TODAY | AUGUST 2018

WILLIAM PRENTICE, ASCA CEO

health care system. The studies I am discussing here are just one piece of what health care professionals, policymakers and business managers need to know to understand ASCs’ overall value proposition. Let’s begin with a study published last December in the Journal of Health Economics. That study looked at patient outcomes in ASCs vs. hospital outpatient departments (HOPDs). The researchers found that patients undergoing procedures in an ASC were less likely to experience a subsequent inpatient hospital admission than those who underwent the same procedure in HOPD. Not only that, a reduction in post-procedure adverse events was seen in patients at all risk levels, leading the authors to conclude

that there is “no evidence that patients of any risk level … are made worse off by treatment in ASCs.” A study published in Health Services Insights in April 2017 found similar results. Using private claims for 88 outpatient procedures, the authors found ASCs to have a significantly lower risk-adjusted readmission rate after procedures than physician offices or HOPDs. In particular, the researchers found, patients who undergo surgery in an HOPD are twice as likely to require a hospital readmission within seven days of their procedure than patients who undergo the same procedure in an ASC. Recently, there has been a great deal of discussion about total joint procedures moving to the outpatient space. ASCA was encouraged by CMS’ movement of total knee arthroscopy (TKA) off the Medicare inpatient-only payable list in their CY 2018 OPPS Final Rule – a signal of federal recognition that such procedures will eventually be eligible for reimbursement in ASCs. Quality and outcome data supports that movement. For example, a February 2017 study in the Journal of Elbow Surgery examined a sample of patients undergoing total shoulder arthroplasty (TSA) in an ASC against a similar sample (in age and comorbidities) in a traditional inpatient setting. The study WWW.ORTODAY.COM

INDUSTRY INSIGHTS

asca

found no significant difference in complication rates and concluded that “outpatient TSA is a safe alternative to hospital admission in appropriately selected patients.” Another recent study published in the Journal of Arthroplasty concluded that “TKA can be performed safely as an outpatient [procedure] … with a complication rate similar to an inpatient stay.” I mentioned that we are just at the beginning of understanding the exceptional value and quality of care ASCs provide, and I’ll end on a study that represents that idea nicely. A literature review published in March in Neurosurgery, the official journal of the Congress of Neurological Surgeons, systematically reviewed any clinical studies that dealt with morbidity or outcomes for certain major spine procedures from the last 25 years. After reviewing all

the available literature, the authors conclude that there exists a “plethora of real-world clinical data [that] creates a formidable argument for serious investments in ASCs for multiple spine procedures.” Though they caution that further understanding patient selection will be key, the authors nonetheless see “robust and growing” evidence for the safety and utility of outpatient spine procedures in ASCs. These studies illustrate what many health care providers and health policy makers have known, intuitively, for a long time. It makes sense that by focusing on a smaller number of outpatient procedures ASCs can find greater quality, efficiency and savings than sites of service that are responsible for delivering wide-ranging care. Everyone who takes an interest in health care policy – including patients, insurers

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and state and federal government officials – can also see massive untapped potential for a greater diversity of procedures, greater savings and greater patient satisfaction yet to come. At ASCA, we are encouraged to see a growing number of independent researchers delve into ASC quality data in recent years and hope to see that trend continue as the volume and range of procedures performed in ASCs continues to grow. We look forward to seeing what future researchers will be able to discover as ASCs and outpatient surgery continue to become ever more prominent parts of the American health care system. William Prentice is the Chief Executive Officer for the Ambulatory Surgery Center Association

1 2 3 4 5

Pressure ulcers are a painful and unnecessary side effect of surgery, and the incidence of OR-related pressure ulcers may be as high as 66%.2 Lessen the risk to your patients and facility by incorporating Mepilex® Border dressings in the perioperative environment. Only Molnlycke’s Mepilex Border dressings have Deep DefenseTM technology to provide proven protection against all 4 extrinsic factors that cause pressure ulcers – pressure, shear, friction and microclimate. Don’t just protect patients from pressure, provide them with Deep DefenseTM against all the factors that contribute to OR pressure ulcers. Learn more at www.molnlycke.us/see-the-proof 1. Poster presented at AORN 2017 Conference: A Formal Process for Reducing the Risk of Perioperative Pressure Injury. Diane Kimsey RN, MSN, MHA, CNOR • Christine Flannigan RN, BSN, CNOR • Jan Quill RN, CRNFA, CNOR 2. Positioning the Patient in the Perioperative Setting; Perioperative Standards and Recommended Practices. 2013. We’re here to help. Call your Mölnlycke Health Care Representative or Regional Clinical Specialist. 1-800-843-8497

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The Mölnlycke and Mepilex trademarks, names and logo types are registered globally to one or more of the Mölnlycke Health Care Group of Companies. Distributed by Mölnlycke Health Care US, LLC, Norcross, Georgia 30092. © 2018 Mölnlycke Health Care AB. All rights reserved. 1-800-882-4582. MHC-2018-36492

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AUGUST 2018 | OR TODAY |

INDUSTRY INSIGHTS

webinar

Continuing Education Webinar a Hit Staff report he recent OR Today webinar “CE is Not a Commodity” was presented by Jim Stobinski, CEO of the Competency and Credentialing Institute (CCI). He discussed the use of continuing education (CE) in the nursing profession.

engage in a transactional basis detached from the original intent of the learning activity. A proposed new model of continuous professional development was provided in the webinar. The proposed model melds the business needs of surgery and the enhancement of nursing competency. Webinar attendees provided posiMany nurses are required to earn tive feedback regarding the webinar CE to facilitate renewal of their in a post-webinar survey. license and various nursing creden“I enjoyed today’s presentation. tials utilize CE as part of the recerThe slides were clear and easy to tification mechanism. follow. The speaker was able to Stobinski said that the use of establish the importance of why the CE in American professions has a current standard needs to change long history and it is a method with which is important in implementwhich many health care workers are ing any change, especially one that very familiar. However, the evidence changes a standard that has been linking CE and enhancements in the long held,” said W. Henderson, OP competency of the learner are, at coordinator. best, tenuous. “OR Today offers current and relThe purpose of the webinar was evant webinars for those nurses who to acquaint learners with how the want to stay on the cutting edge use of CE has been commercialof perioperative nursing practice. ized in nursing. CE has become a The information was new and will commodity of sorts in which nurses affect my learning and practice in the future, as well as my re“I think these webinars are certification considerations,” said K. Knapp, Clinical great – very timely and helpful Supervisor. “I think these webinars information in the real world.” are great – very timely and helpful information in the – T. Ralls, Clinical Safety Business Partner real world,” said Clinical Improvement Safety Business WWW.ORTODAY.COM

Partner T. Ralls. “I was very impressed with Jim’s presentation today. He shared a small bit of this change at the CCI CSSM Standard Setting and Form Review committee meeting I attended in late May 2018, and after his explanation today I am very glad I listened to him, both on the webinar and in Denver,” said P. Borello, CNM Periop Services. “OR Today’s webinar series never disappoints! Topics are always relevant! Thank you,” said B. Holder, QI/IC/Safety/RM/Compliance Officer. “OR Today’s webinar series through independent professional accountability provides valuable updated evidence-based information that enhances professional knowledge which leads to improved patient care,” said Perioperative Educator C. Curcin. “This is my first experience with OR Today’s webinars – I found it to be very informative. I highly recommend this particular webinar, and look forward to attending future webinars,” Director of Nursing J. Maple said. For more details about the OR Today webinar series, visit ortoday.com/ upcoming-webinars.

AUGUST 2018 | OR TODAY |

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IN THE OR

market analysis

Disinfection Spend on the Rise Staff report global medical instruments disinfection market report from Research and Markets predicts growth in the coming years.

The global medical instruments disinfections market is expected to reach $4.8 billion by 2024. The surface disinfectants market is expected to reach $789 million by 2022 while growing at a compound annual growth rate (CAGR) of 8.3 percent from 2017 to 2022, according to MarketsandMarkets. The increasing number of surgical procedures, rising geriatric population and subsequent growth in the prevalence of chronic diseases are major factors that are driving the growth of this market. A report from Grand View Research also predicts growth for the market. “Global surface disinfectant market is expected to reach over $600 million by 2022, growing at an estimated CAGR exceeding 11 percent over the forecast period. Increasing health care expenses, increasing number of hospital-acquired infecWWW.ORTODAY.COM

tions and increasing surgical operations are expected to drive market growth over next seven years,” according to Grand View Research. “Strict guidelines along with legislative guidelines such as Affordable Care Act have forced hospital authorities to ensure cleanliness in their facilities. Rising concern regarding health care-acquired infections, as it affects the base line of existence of these facilities, is expected to drive the surface disinfectant demand over the forecast period,” according to Grand View Research. According to the World Bank estimates, global health care spend has witnessed remarkable growth from 2003 to 2013, growing at a CAGR of 7 percent over the forecast period. In the same period, public health care spending increased at a CAGR of 7.28 percent. This high growth rate along with huge size of health care spending is expected to drive surface disinfectant market growth. “Rapidly increasing geriatric population and consequent rise in chronic diseases have increased health issues. Increasing incidents of

infectious and human-transmitted diseases, especially within health care workers, have put forward the need for surface disinfection in hospitals. Government initiatives to increase awareness regarding need for cleanliness and disinfection are expected to foster market growth,” according to Grand View Research. Rising awareness regarding home cleanliness and need for disinfection is also expected to fuel the product demand. Rising disposable income coupled with increasing focus on child health has positively affected the home disinfectants demand. Recent infectious disease outbreaks such as Ebola, influenza and chikungunya are expected to fuel the surface disinfectant demand over the forecast period. “North America holds maximum share in the global surface disinfectant demand and is expected to retain its position over the forecast period. High standards of living have driven home cleanliness and other hygienic habits in consumers. Government initiatives and enforcements regarding public health and hygiene have also driven market growth,” according to Grand View Research. AUGUST 2018 | OR TODAY |

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product focus

C. diff Solution Tablets 3M C. diff Solution Tablets provide a proven, effective alternative to bleach and peracetic acid disinfectants to ensure the well-being of patients and staff. Used by health care providers worldwide, the tablets are now available for use in the U.S. The tablets are EPAregistered to kill C. diff spores in four minutes and are effective against Norovirus without pre-cleaning. They are safer than bleach and peracetic acid, featuring an NFPA rating of 0,0,0 with no personal protective equipment required at use dilution and are ready-to-use pH of 5.5 to 6.5, which is closer to neutral than bleach or peracetic acid. â&#x20AC;˘

Clorox Healthcare VersaSure Cleaner Disinfectant Wipes

Clorox Healthcare VersaSure Cleaner Disinfectant Wipes are Environmental Protection Agency (EPA) registered to kill 44 pathogens, including bacteria, viruses and fungi, in two minutes or less. The unique, low-odor, low-residue formula features patented technology that enhances quat activity on surfaces to deliver broader efficacy and faster kill times without co-actives. The result is a versatile, one-step cleaner disinfectant wipe with the speed and efficacy health care facilities rely on and superior aesthetics, wetness and cleaning power needed for convenient, compliant use facility-wide. â&#x20AC;˘

24 | OR TODAY | AUGUST 2018

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product focus

Medline

Micro-Kill One Disinfecting Wipes Room turnover time and maintaining a clean environment is important everywhere in a hospital, but it is most critical in operating rooms. When it comes to disinfection, Medline’s Micro-Kill One Disinfecting Wipes feature a one minute contact time for difficult to kill pathogens such as tuberculosis, norovirus, VRE and more. The one minute contact time provides confidence to “wipe and walk away,” and the disposable nature helps reduce cross contamination. • For more information, visit www.medline.com.

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AUGUST 2018 | OR TODAY |

IN THE OR

product focus

Palmero Healthcare

DisCide Ultra Surface Disinfectant Many disinfectants need up to 10 minutes to take effect – crucial time when it comes to keeping your practice surfaces clean and safe for patients, clinicians and staff. DisCide Ultra Disinfectant is a one-step intermediate hospital grade disinfectant, cleaner and decontaminant. With its expanded list of kill claims, DisCide is proven to kill 27 deadly pathogens (including TB) in 1 minute or less, accelerating your practice’s operatory turnover. DisCide Ultra is EPA registered and ready to use without any mixing or measuring. Available in towelettes, spray and bulk gallon refills, DisCide Ultra spray and large-sized towelettes are available in identical formulations to ensure efficacy when liquid and towelettes are used together. • For more information, call 800-344-6424

26 | OR TODAY | AUGUST 2018

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IN THE OR

product focus

Ruhof

Biocide Detergent Disinfectant Pump Spray Ruhof Biocide Detergent Disinfectant Pump Spray is a ready-to-use quaternary germicide cleaner and disinfectant for use in patient rooms, operating rooms, ICU areas, public restrooms or any other area that needs to be disinfected. It is formulated to be highly effective against a broad-spectrum of pathogenic microorganisms, including bacteria, antibiotic resistant bacteria, viruses, fungi, mold and mildew. Ruhof Biocide Detergent Disinfectant Pump Spray is for use on all hard, non-porous inanimate environmental surfaces: floors, walls, metal surfaces, stainless steel surfaces, bathrooms, shower stalls, bathtubs, cabinets, etc. In addition, this product deodorizes smelly areas. When used as directed, the product is effective against Mycobacterium tuberculosis (BCG) at 20 degrees C, Staphylococcus aureus, Salmonella choleraesuis, Pseudomonas aeruginosa, Clostridium difficile vegetative form (C.diff), Escherichia coli 0157:H7, Methicillin resistant Staphylococcus aureus (MRSA), Vancomycin intermediate resistant Staphylococcus aureus (VISA), Vancomycin resistant Enterococcus faecalis (VRE), H.I.V.-1 virus (associated with AIDS), Canine Parvovirus, Poliovirus Type 1, Hepatitis B virus (HBV), Tricophyton mentagrophytes (athleteâ&#x20AC;&#x2122;s foot fungus), mold and mildew. â&#x20AC;˘ For more information, visit www.ruhof.com

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AUGUST 2018 | OR TODAY |

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IN THE OR

continuing education

IN THE OR

CE489

continuing education

For a Healthy Environment‚ Clinicians and Hospitals Have to Go Green(er) Sheila J. Leis, MS, RN-BC

eing “green” has become a common term. Younger generations have been made aware of the environment at an early age. Many schools integrate basic environment friendly vocabulary and teach children the meaning of words like “reduce,” “reuse,” and “recycle.” Moreover, “going green” is also a common feature in larger stores, which now offer organic foods, sell fluorescent light bulbs, and ask customers to bring their own bags or use paper bags. Organic products with reduced or recycled packaging that reduce waste and environmental impact are common. “An Inconvenient Truth,” the documentary about global warming presented by former Vice President Al Gore, won two Oscars and earned $49 million at the box office worldwide.1 So what is all the fuss about? Why should healthcare professionals as a team care? The environment has now become everyone’s responsibility, including healthcare professionals across disciplines. Trash is contributing to global warming, and U.S. hospitals generate 5.9 million tons of waste per day, equating to 29 pounds of waste per staffed bed in just one day.2 Healthcare professionals as a team can make a difference by working to reduce waste at their work sites. Healthcare professionals of various disciplines who deal with medications, radioactive materials, and body tissues also can play a role in the WWW.ORTODAY.COM

protection of the environment by decreasing waste and disposing of it properly. Knowingly or unknowingly, many health professionals generate a high amount of waste products, which can be reduced in many cases. There is now a great urgency in training selected healthcare employees to become responsible for hospital waste. This is not only born out of necessity, but also for patient safety and betterment of the environment.3

Global Warming 101 Earth’s atmosphere is made up of several gases besides oxygen. The three major greenhouse gases are: nitrous oxide, carbon dioxide, and methane. Greenhouse gases function to regulate the climate by absorbing and retaining heat from the sun in an atmospheric blanket around the Earth’s surface. In our industrialized society, almost every product that is manufactured results in production of greenhouses gases that affect the overall global climate.4 Overwhelming evidence exists that humans affect the global climate. Ever since the Industrial Revolution, which started some 250 years ago, humans have contributed significantly to polluting the environment and generating greenhouse gases that have resulted in warming of the Earth. Some of the warmest years ever recorded have occurred in the last decade alone. Evidence indicates that this global warming continues to adversely affect the health of humans.5 Extremes in temperature, i.e., intense heat and freezing cold, are known to be

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

Goal and objectives The goal of this program is to inform nurses and pharmacists about the environmental and financial effects of hospital waste and the steps they can take to minimize those effects. After studying the information presented here, you will be able to: • Explain how greenhouse gases and global warming affect health • Describe the types of hospital waste • Discuss how hospitals can decrease their environmental impact

AUGUST 2018 | OR TODAY |

IN THE OR

continuing education lethal, especially in infants and the older adults. Other adverse effects of global environmental changes can lead to hypothermia and heat-induced stress. In cities all over the globe, pollutant gases cloud the atmosphere and continue to trap warm air and smog, leading to worsening of asthma and bronchitis. There are many anecdotal reports of deaths from exacerbation of respiratory ailments and heart disease because of adverse climate changes. In 2003, more than 70,000 deaths were reported from excess heat in Europe alone.5 From 2006 to 2010, more than 1,300 deaths per year in the United States were reported to be due to extreme cold and more than 600 due to extreme heat.6 The long-term health of populations relies on the stability and functioning of the biosphere’s lifesupporting systems. The overall good health of the public globally depends on the availability of safe drinking water, noncontaminated food, satisfactory living conditions, and shelter from the environment. We as health professionals need to be concerned about living conditions because unsatisfactory ones contribute to poor overall health. A changing climate not only affects the poor, but also can cross geographical borders and affect people of all cultures, some more severely than others.5

Prescription for Earth Environmental health is defined as the theory and practice of assessing, controlling, preventing, and correcting physical factors present in the local and global environment that adversely affect health. The benefits of going green are sustained and may last generations.7 But environmental health education is not a standard part of the curriculum for health professionals of many disciplines. Most healthcare professionals on the team have little knowledge about

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hazardous waste or how it is managed. In most cases, hospital waste is disposed of by incineration or transfer to landfills. Small amounts of methane, carbon dioxide, and nitrous oxide are generated at landfills; incineration is associated with instant release of large amounts of nitrous oxide and carbon dioxide. Both methods contribute to greenhouse gases and global warming. The liquid waste from healthcare facilities is vast, diverse, and variable. Hospital liquid waste varies in its infectious potential and is often more difficult to manage than solid waste.8 Hospitals generate not only regular trash but also enormous amounts of medical and hazardous waste. Hospitals function 24 hours a day, and accumulation of medical waste is inevitable. All hospitals assign trained personnel to be responsible for collection, separation, and storage of the medical and hazardous waste from the regular trash. Over the years, local and state laws have been established to determine how hospital waste should be managed. Hospitals also have their own regulations, which protect healthcare professionals of various disciplines from exposure to medical and infectious materials. However, disposal of hospital waste is a time-consuming, labor-intensive chore that also is expensive. The costs can have a substantial impact on overall hospital finances and provide a significant incentive for everyone to reduce waste generation.8 In a recent study, a “green” OR with initiatives on recycling and reduction of energy waste and conversion from soap to alcohol-based scrubs led to enormous money and water savings.9

Biohazards Ahead Regulated medical waste is a subset of medical waste. It’s also known as “biohazardous” waste or “infectious

medical” waste. Healthcare professionals of various disciplines are taught to recognize containers with sharp wastes and those containing infectious medical waste in red bags. Hospitals also generate a lot of cardboard, paper, and food waste that is not biohazardous, but still needs to be disposed of. On average, healthcare facilities pay at least six times more to dispose of regulated medical waste than to dispose of solid waste.8 Providing education to all employees involved may allow hospitals to reduce red bag waste to 6% to 10% of their total waste.10 Hospitals deal with many regulatory agencies and standards in handling regulated medical waste. Hospital waste is chiefly regulated by a state agency, which in turn has many subsidiary agencies that supervise the diverse aspects of waste management. All states have medical waste regulations, but the standards vary.11 In certain states, disposal and handling of medical waste is based on the Federal Medical Waste Tracking Act of 1988; other states do not use this federal law to govern the management of medical waste. Today, the Occupational Safety and Health Administration, the Environmental Protection Agency (EPA), the Department of Transportation, The Joint Commission and the Centers for Disease Control and Prevention have regulations or standards on how medical waste should be managed.11 All these rules and agencies can lead to confusion.

A Burning Issue If medical waste is not disposed of properly, not only can it threaten the local environment, but also may lead to disease. Before 1997, close to 90% of all potentially infectious waste was incinerated.12 However, incineration releases high levels of nitrous oxide, carbon dioxide, and dioxin, which is a known carcinogen and can cause defects in the immune system, birth WWW.ORTODAY.COM

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continuing education

defects, and other harmful health effects ranging from allergies to chronic diseases.13 Data indicates that incineration of improperly disposed hospital equipment also may be responsible for releasing mercury into the environment.13 Mercury is a heavy metal and a known neurotoxin. Besides the central nervous system, the metal is known to damage the lungs, kidneys, and peripheral nerves. Other pollutants generated during incineration include toxic acidic gases, organic aldehydes, furans, heavy metals, and noxious particulate matter. A few states require that hospitals incinerate medical waste, such as unused chemotherapeutic agents, body parts, and infectious liquids, but this is not a universal requirement.13 Today, several other options are available for disposing of medical waste. These options include thermal treatment (such as microwave and kilns), steam sterilization (such as autoclaving), electropyrolysis, and chemical mechanical systems.12 In 2001, Health Care Without Harm, an international coalition working to reduce pollution in healthcare, published “Non-Incineration

Medical Waste Treatment Technologies,” a report that explored the environmental and economic impacts of about 50 technologies. These international experts recommended that incineration of medical waste should be discontinued or phased out because there are other alternatives.14 From 1997 through 2013, the EPA updated regulations related to incineration of medical waste, resulting in requirements for annual hospital, medical, and infectious waste incinerators equipment and air pollution control device inspections, which are reported to the EPA, in support of the Clean Air Act.15

The Hazardous Criteria The term “hazardous waste” is usually reserved for items that meet the WWW.ORTODAY.COM

criteria set by the EPA.16 Wastes are usually described as hazardous if they have at least one of four characteristics: • • • •

Ignitability Reactivity Corrosivity Toxicity

The EPA has joined forces with local and state authorities to ensure that the hazardous waste regulations are enforced. Hazardous wastes include certain pharmaceutical products, organic mercury, radioactive wastes, laboratory chemicals, certain pesticides, disinfectants, and other chemicals used in the sterilization process.16 Regulations exist for the collection, storage, treatment, transportation, and disposal of hazardous wastes. They must be segregated from regular trash and the regulated medical waste stream. Healthcare professionals of many disciplines may encounter hazardous chemical materials during patient care.

More About Mercury Mercury has three forms. One is metallic liquid mercury, found in thermometers, sphygmomanometers, and dental fillings. Another is inorganic mercury salt, found in mercury batteries. A third form is organic mercury compound (e.g., methyl mercury), which is generated in small amounts by certain microorganisms found in soil, certain foods, and fish. Each of the mercury forms has distinct physical properties, and the toxicity varies depending on the amount and duration of exposure.17 If a person inhales mercury vapor, as much as 80% is absorbed into the bloodstream. Short-term exposures can cause poisoning, pneumonitis, bronchitis, and bronchiolitis. Repeated exposure to relatively low toxic levels can cause muscle tremor, irritability, personality changes, and gingivitis.

Nerve damage from mercury may start as a simple loss of sensitivity in hands and feet, difficulty in walking, or slurred speech. Mercury has also been known to affect the development of prenatal life and infants. Very small concentrations of mercury emissions can pose a threat to human health because of the tendency of mercury to become concentrated in animal tissue as it moves up the food chain. Along with its use in thermometers and sphygmomanometers, medical uses of mercury may include esophageal dilators; feeding tubes; certain laboratory chemicals (e.g., fixatives, stains, reagents, preservatives); medical batteries; fluorescent bulbs and highintensity lamps; pressure gauges; and some electrical switches. A large hospital may have more than 100 pounds of mercury onsite in hundreds of devices in dozens of locations.18 While many facilities still have mercury-containing products, more than 4,000 have pledged to become mercury free.19

Take Charge of Batteries Batteries are everywhere in healthcare, in pagers, pumps, flashlights, and many diagnostic devices. There are many types of batteries: alkaline, lead acid, nickel cadmium, mercury, lithium, dry cell, and zinc air. Some can be recycled; others must be disposed of as hazardous waste. Most batteries should be collected separately from other wastes and not be discarded in red bags or sharps containers. Batteries in landfills and incinerators may leak into the environment and enter the food chain, posing risks to humans and animals. In 1996, the federal government passed the Mercury-Containing Rechargeable Battery Management Act to help reduce and discontinue usage of mercury in batteries.17 In addition, laws have pushed manufacturers to develop more efficient and cost-effective disposal methods of used lead acid, nickel cadmium, and other industrial batteries.20 AUGUST 2018 | OR TODAY |

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continuing education

Health facilities often have fluorescent lighting fixtures, and each lamp contains mercury. If a fluorescent bulb is broken or improperly disposed of, mercury may be released into the air, water, and soil. The vast majority of mercury-containing lamps are considered hazardous waste. Most states have adopted the Federal Universal Waste Rule, designed to reduce hazardous waste in the municipal solid waste stream. Recycling mercury-containing lamps is a sound alternative to expensive hazardous waste disposal.

The Polyvinyl Chloride-Dioxin Link Polyvinyl chloride or PVC plastic is widely used in medical devices. It is popular because of its strength, flexibility, and suitability for steam sterilization. The material also is resistant to bending/kinking, is transparent, and is relatively inexpensive. Products using PVC include basins, bedpans, IV bags and tubing, catheters, gloves, enteral feeding devices, lab equipment, inflatable splints, ID bracelets, respiratory therapy products, thermal blankets, and packaging. It is now believed that prolonged exposure to PVC plastic material may be harmful to patients, the environment, and public health. Dioxin can be formed during the manufacture of PVC and during the incineration or burning of PVC products.21 Medical waste incineration is a source of dioxin pollution, in part because of the many disposable PVC plastic products used by hospitals. Dioxins are highly toxic and have a seven- to 11-year half-life in the human body, leading to a cumulative effect, including reproductive problems, damage to the immune system, and cancer.22 Because of its toxicity, PVC plastic cannot be recycled. The only option is to find alternatives for it.

Smart Shopping “Environmentally preferable purchasing” is the act of buying products and

34 | OR TODAY | AUGUST 2018

services that are less damaging to the environment. In general, environmentally friendly products are claimed to be less toxic, less polluting, safer for workers, and more energy efficient as well as degradable. Some of these products have a higher recycled content with less packaging.23 Some hospitals have “new product” committees to ensure that the life cycle of a product is considered before purchase.

Digging Deeper In a modern lined landfill, trash is buried so it does not contaminate the groundwater or air. The buried trash is isolated from the environment with a bottom liner, a daily covering of soil, and a leachate collection system.24 (Leachate is the water that has percolated through the landfill and contains contaminating substances.) But the surrounding soil and water cannot safely absorb the waste products unless they are biodegradable and organic. A landfill is an oxygen-poor environment, and the breakdown of trash occurs in the absence of oxygen but very slowly. The byproducts of this breakdown are methane and carbon dioxide.24 Some landfills collect methane gas formed during the breakdown of trash and convert it to useable energy. If methane is not recovered for fuel, it is emitted into the atmosphere along with carbon dioxide, increasing the concentration of greenhouse gases. Trash in a landfill stays there for a long time — 40-year-old newspapers with easily readable print have been found in excavated landfills.24

Recycling Basics Much of a healthcare facility’s waste is nonhazardous solid waste. Paper, cardboard, paperboard, aluminum, and certain types of plastics are common recyclable materials found in hospitals. Hospitals can start programs to divert recyclable materials from the solid waste stream and, in some cases, lower disposal costs. Recycling basic cardboard and paper can result in a 15% to 20% facility

recycle rate, and an overall rate of up to 45% can be achieved by establishing a comprehensive recycling program.25 St. Joseph’s Medical Center in Stockton, Calif., has promoted a program of growing trees and reducing garbage. The biggest impact has been in terms of paper recycling. In addition, the hospital has taken steps to eliminate all mercury from its premises, including in thermometers, blood pressure devices, and pharmaceuticals.26 As much as 20% to 30% of hospital waste comes from the OR.27 Some of this waste includes OR instruments that were opened and never used. One hospital system achieved an annual cost reduction of nearly $42,000 by identifying and removing infrequently used items from hand surgery packs.28 Recycling also reduces greenhouse gases. The reduction is the result of several mechanisms. Through recycling, less organic material, such as food, paper, and yard waste, ends up in landfills, where it leads to greenhouse gas emissions from decomposition. In 2014, the United States generated about 258 million tons of municipal solid waste, with 89 million tons of this solid waste recycled or composted, equivalent to a 34.6% recycling rate. This resulted in an annual reduction of more than 181 million metric tons of carbon dioxide equivalent emissions, comparable to the annual emissions from more than 38 million passenger cars.29 The goal of any recycling program is to divert as much waste as possible from landfills and incinerators and return valuable resources into circulation in the economy.

Reduce and Reuse Source reduction and reuse go along with recycling.26 Source reduction is the process of eliminating waste before it is created. Hospitals could do something as simple as buying cases of paper in which the paper is not packaged in individual reams, eliminating WWW.ORTODAY.COM

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continuing education

waste from the package wrapper of those individual reams. Reportedly up to 75% of the American waste stream is recyclable, but only 30% is actually recycled.30 Waste can be reduced by purchasing reusable products rather than single-use or disposable ones. Source reduction and reuse improve the effectiveness of a hospital’s waste reduction program. The cost of reusable items is sometimes higher than that of disposable alternatives. However, hospitals should consider the life-cycle costs of each option, such as purchase price, employee handling and distribution time, cleaning or sterilization costs for reusable items, and waste disposal costs for single-use items. Hospitals also can consider the impact of healthcare waste on the community and environment. Healthcare is based on the dictum “first, do no harm.” Florence Nightingale said, “No amount of medical knowledge will lessen the accountability of nurses to do what nurses do, that is, manage the environment to promote positive life processes.”7 RNs can advocate for healthcare practices that don’t harm the public health environment outside healthcare facilities, the American Nurses Association (ANA) states on its Environmental Health webpage.31 Practice Greenhealth is a program of the ANA, the American Hospital Association, the EPA, and Health Care Without Harm. Practice Greenhealth offers information on the reduction of mercury and regulated medical waste, environmentally preferable purchasing, fluorescent light bulb recycling, and green cleaning.

sharps containers? Educate yourself and your colleagues of different disciplines about hospital policy on regulated medical waste. Ask questions about the battery and fluorescent bulb collection/recycling programs at your facility. Remember that batteries should be kept out of the incineratorbound waste stream. Many hospitals have “green teams” to address these issues. You may be surprised by what your hospital is already doing. One example of “going green” in a healthcare setting is at Legacy Good Samaritan Hospital in Portland, Ore. The 341-bed facility purchased several hundred permanent waterproof mattresses to replace about 96% of disposable egg crate foam mattresses (it is still necessary to use foam mattresses in some situations). The initial purchase was significant, but the decision paid for itself in just one year. Savings in purchasing costs per year: $80,710. Disposal savings per year: $817. Waste prevention in pounds per year: 16,350.32 Then, look at your own lifestyle. Do you use polystyrene foam (“Styrofoam”) cups and plastic silverware and bags? Bring a reusable mug and silverware and a canvas bag instead, and encourage coworkers to do the same. Think globally and act locally. Be knowledgeable, get involved, and help change the world you live in now and for the future.

References 1. Al Gore: climate advocate. TED Web site. http://www.ted.com/speakers/al_gore.html. Accessed March 1, 2017. 2. Less waste. Practice Greenhealth website. https://practicegreenhealth.org/topics/lesswaste. Published 2016. Accessed March 1, 2017. 3. Ozder A, Teker B, Eker HH, Altındis S, Kocaakman M, Karabay O. Medical waste management training for healthcare managers — a necessity? J Environ Health Sci Eng. 2013;11(1):20. doi: 10.1186/2052-336X-11-20. 4. Braks M, van Ginkel R, Wint W, Sedda L, Sprong H. Climate change and public health policy: translating the science. Int J Environ Res Public Health. 2014;11(1):13-29. doi: 10.3390/ijerph110100013. 5. Climate change and human health: fact sheet. World Health Organization Web site. http://www.who.int/mediacentre/factsheets/ fs266/en. Accessed March 1, 2017. 6. The Impacts of climate change on human health in the United States: a scientific assessment. U.S. Global Change Research Program Web site. https://health2016.globalchange. gov. Accessed March 1, 2017. 7. Buchanan M. Rebuilding the bridge: health and the environment are major nursing concerns. Am J Nurs. 2005;105(4):104. 8. Frequently asked questions. Practice

EDITOR’S NOTE: Lisa Riedel, DNP, MS, CRNA, and Steven S. Bhimji, MD, PhD, past authors of this educational activity, have not had an opportunity to influence

Greenhealth Web site. https://practicegreen-

the content of this version.

CL, et al. The green operating room: simple

health.org/node/16157. Published 2016. Accessed March 1, 2017. 9. Wormer BA, Augenstein VA, Carpenter changes to reduce cost and our carbon foot-

What Can You Do?

OnCourse Learning guarantees this educational activity is free from bias.

To help the environment, the first step is to consider your own practice. Observe red bag and sharps waste in your practice and that of your floor. Is regular trash going into red bags and

Sheila J. Leis, MS, RN-BC, is an assistant professor of post-licensure nursing. She has worked in an 800-bed Magnetdesignated hospital as a nurse manager

WWW.ORTODAY.COM

and professional development specialist. She has been certified in medical/surgical nursing for more than 25 years. The author has declared no relevant conflicts of interest that relate to this educational activity.

print. Am Surg. 2013;79(7):666-671. 10. Reducing regulated medical waste. Healthcare Environmental Resource Center Web site. http://www.hercenter.org/rmw/ reducingrmw.cfm. Published 2015. Accessed March 1, 2017. 11. Regulated medical waste — overview. AUGUST 2018 | OR TODAY |

IN THE OR

continuing education Healthcare Environmental Resource Center

dioxins Accessed March 1, 2017.

channels/community/article_4f75089a-2023-

Web site. http://www.hercenter.org/rmw/

22. Dioxins and their effects on human

11e5-845d-77ea3aaa4065.html. Published July

rmwoverview.cfm. Published 2015. Accessed

health: key facts. World Health Organization

1, 2015. Accessed March 1, 2017.

March 1, 2017.

Web site. http://www.who.int/mediacentre/

28. Albert MG, Rothkopf DM. Operating room

12. Medical waste. U.S. Environmental Protec-

factsheets/fs225/en. Updated October 2016.

waste reduction in plastic and hand surgery.

tion Agency Web site. http://www.epa.gov/

Accessed March 1, 2017.

Plast Surg (Oakv). 2015;23(4):235-238.

osw/nonhaz/industrial/medical/mwfaqs.htm.

23. Purchasing goals. Health Care Without

29. Advancing sustainable materials man-

Published 2015. Accessed March 1, 2017.

Harm Web site. http://noharm.org/us_cana-

agement: facts and figures. Environmental

13. Nonincineration medical waste treatment

da/issues/purchasing/goals.php. Accessed

Protection Agency Web site. https://www.epa.

technologies. Health Care Without Harm Web

March 1, 2017.

gov/smm/advancing-sustainable-materials-

site. http://noharm.org/lib/downloads/waste/

24. Freudenrich C. How landfills work: how

management-facts-and-figures. Updated

Non-Incineration_Technologies.pdf. Published

much trash is generated? HowStuffWorks

December 14, 2016. Accessed March 1, 2017.

August 2001. Accessed March 1, 2017.

Web site. http://science.howstuffworks.com/

30. Office of sustainability. Waste & recycling.

14. Alternatives to incineration. Health Care

environmental/green-science/landfill1.htm.

Indiana University Bloomington Web site.

Without Harm Web site. http://noharm.org/

Published 2016. Accessed March 1, 2017.

http://www.indiana.edu/~sustain/living-sus-

us_canada/issues/waste/alternatives.php.

25. Develop and/or enhance the facility’s

tainably/waste-and-recycling.php. Published

Published 2016. Accessed March 1, 2017.

recycling program. Sustainability Roadmap

2016. Accessed March 1, 2017.

15. Fact sheet: hospital/medical/infectious

for Hospitals Web site. http://www.sustain-

31. Environmental health. American Nurses

waste incinerators: promulgated amendments

abilityroadmap.org/pims/39#.WEBWNdIrLIU.

Association Web site. http://www.nursing-

to the federal plan to implement standards

Accessed March 1, 2017.

world.org/Environmental-Health. Published

of performance for existing facilities and

26. Goldeen J. Hospital heals more

2016. Accessed March 1, 2017.

promulgated amendments to the new source

than lives. Recordnet.com Web site.

32. Waste reduction activities for hospitals.

performance standards. Environmental

http://www.recordnet.com/apps/pbcs.

Pollution Prevention Infohouse Web site.

Protection Agency Web site. https://www.

dll/article?AID=/20060503/MON-

http://infohouse.p2ric.org/ref/35/34492.pdf.

epa.gov/sites/production/files/2015-12/

EY/605030305/1003. Published May 3, 2006.

Accessed March 15, 2017.

documents/hmiwi_fact_sheet_040413.pdf.

Accessed March 1, 2017.

27. Reducing waste in the operating room.

16. Hazardous waste management at health-

Sustainable City Network Web site. http://

care facilities. Wisconsin Department of

www.sustainablecitynetwork.com/topic_

Natural Resources Web site. http://dnr.wi.gov/ topic/HealthWaste/Hazardous.html. Updated

Clinical VignettE ANSWERS

December 28, 2016. Accessed March 1, 2017. mental Protection Agency Web site. http:// epa.gov/mercury. Updated October 4, 2016. Accessed March 1, 2017. 18. Mercury in healthcare facilities. Healthcare Environmental Resource Center Web site. http://www.hercenter.org/hazmat/mercury. cfm. Accessed March 1, 2017. 19. Go mercury-free. Health Care Without Harm Web site. https://noharm-uscanada.org/ issues/us-canada/go-mercury-free. Accessed March 1, 2017. 20. A guide to batteries used in health care: the problem with batteries. Practice Greenhealth Web site. https://practicegreenhealth. org/pubs/epp/guidetobatteries.pdf. Accessed March 1, 2017. 21. PVC Incineration/dioxins. PVC Web site.

1. Answer: B, One of the ways to make an impact on the environment is by walking or cycling to work. While this is practical in many rural areas, it is not always easy in cities, where the distance and traffic may make cycling hazardous. In this case, carpooling is an excellent method of going green. 2. Answer: B, A classic example of “going green” in a healthcare setting is the practice at Legacy Health System in Portland, Ore. This healthcare system now encourages all workers to use all-plastic recyclable cups rather than single-use disposable plastic/paper cups. Employees who do so are offered discounts of 10% to 20% in the cafeteria. 3. Answer: A, To help the environment, the first step is to consider your own practice. Observe red bag and sharps waste in your practice and that of your floor. Is regular trash going into red bags and sharps containers? Educate yourself and your colleagues about hospital policy on regulated medical waste. Ensure that all physicians dispose of infectious waste in red bags. 4. Answer: A, Plastic products used in the OR are not sent for recycling. These products often are not biodegradable and remain the environment for decades. Paper, cardboard, paperboard, aluminum, and only selected types of plastics are common recyclable materials found in hospitals. Other products made from these materials but which come into contact with bodily fluids should not be recycled and must be discarded with infectious waste.

17. Mercury in your environment. U.S. Environ-

http://www.pvc.org/en/p/pvc-incineration-

36 | OR TODAY | AUGUST 2018

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CE489

Clinical VignettE For CE489 Beth is an OR nurse in a small community hospital. She drives five miles to work and then stops in the hospital lounge for her morning coffee. She takes a polystyrene foam (Styrofoam) cup, adds cream and sugar from individual packets, and uses a plastic stirrer as she heads into the locker room to change. Setting up for the first case of the day, she drapes the OR table with paper sheets, opens sterile instrument trays, and takes disposable foam positioning pads out of plastic wrap to prepare for the patient. The anesthesia provider performs a spinal anesthetic using a prepackaged tray. After the spinal is performed, the anesthesia provider dumps the entire tray and her sterile gloves into the red bin. At the end of her busy day, Beth drives to the gym and runs on the treadmill before heading home. She tosses her empty water bottle into the garbage with the newspaper she read while eating dinner from a paper plate.

1 Beth could reduce her environmental impact before arriving at work by:

a. Saving water by not showering b. Running/walking/biking/carpooling to work c. Getting ready in the dark d. Drinking coffee several times a day at the hospital lounge

2 Another way Beth can reduce her environmental impact at work is to: a. Wear the same scrubs for two days b. Keep a reusable mug at work instead of using plastic and foam cups c. Wash her hands only when necessary to save on water d. Keep the same OR mask all week

simple step the anesthesia provider can 3 A

take to reduce regulated medical waste is to:

a. Put only infectious material in the red bin at the end of the spinal anesthetic b. Reuse syringes during the day c. Change gloves only when necessary

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 https://www.nurse.com/ sign-up for $49.95 per year.

Deadline Courses must be completed by 3/15/2019 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 Learningâ&#x20AC;&#x2122;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.

d. Use the least amount of oxygen required

hich can Beth recycle? 4 W a. Her water bottle and newspaper b. The paper OR sheets c. Patient IV bags

ONLINE

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

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d. Her sterile gloves

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The Latest Trends and Tips in

PATIENT SAFETY BY DON SADLER

hen you stop and think about it, recent advancements in surgical

technology and medical care are truly astonishing. However, there’s still significant risk every time a surgeon’s scalpel touches a patient’s skin. It’s up to perioperative personnel and surgical teams to do everything within their power to reduce these risks. “This starts with creating a culture where ensuring patient safety is a core organizational value,” says Patricia McGaffigan, RN, MS, Vice President, Safety Programs, at the Institute for Healthcare Improvement (IHI).

“

Surgical site infections, wrong site surgery, retained surgical items, medication errors, patient burns and injuries related to positioning remain the most common safety risks in the OR.

”

Lisa Spruce, DNP, RN, CNS-CP, CNOR, ACNS, ACNP, FAAN, the Director of Evidence-Based Perioperative Practice for the Association of periOperative Registered Nurses (AORN)

Common Patient Safety Risks Lisa Spruce, DNP, RN, CNS-CP, CNOR, ACNS, ACNP, FAAN, the Director of Evidence-Based Perioperative Practice for the Association of periOperative Registered Nurses (AORN), reels off a long list of safety risks faced by patients undergoing surgery. “Surgical site infections, wrong site surgery, retained surgical items, medication errors, patient burns and injuries related to positioning remain the most common safety risks in the OR,” says Spruce. At the core of these risks is often poor communication among members of the surgical team. According to Spruce, 70 percent of adverse events in patient care can be contributed to a breakdown in communication. “There’s still a fear of punishment among some OR nurses about speaking up if they think something’s wrong,” says McGaffigan. “Perioperative leaders need to identify communication breakdowns like this and be proactive about addressing them.” Spruce says that improving communication in the OR starts with leaders promoting an environment where all perioperative team members are empowered to speak up when a threat to patient safety is identified. “Effective teamwork, a systems approach and blameless communication are the best strategies for building a patient safety culture,” she says.

Using Safe Surgery Checklists One of the best ways to standardize safety measures in the OR is to adopt a

42 | OR TODAY | AUGUST 2018

safe surgery checklist. Since it was adopted by the World Health Organization in 2008, the Surgical Safety Checklist has represented the global standard of care. Now used in approximately 50 million operations performed worldwide each year, the Surgical Safety Checklist reduces surgical complications and mortality rates by up to 47 percent. The checklist identifies three critical pause points during surgery: 1. Before the induction of anesthesia. 2. Before the incision in the skin. 3. Before the patient leaves the operating room. “At each pause point, the checklist encourages preparation, communication and adherence to important practices that reduce errors and help surgical teams work together better,” says Alex Haynes, MD, MPH, Director for the Safe Surgery Program at Ariadne Labs and Associate Professor of Surgery at Harvard Medical School. “By using the Surgical Safety Checklist to build effective communication and teamwork, surgical teams can minimize the most common and avoidable risks endangering the lives and well-being of their patients,” Haynes adds. Ariadne Labs and the South Carolina Hospital Association recently concluded a five-year study to gauge the large-scale impact of using safe surgery checklists. The study revealed a 22 percent reduction in post-surgical deaths at hospitals that voluntarily completed implementation of the Surgical Safety Checklist. Spruce says that surgical safety checklists can serve as “valuable practice standardization tools by providing structure for all perioperative team members to

know what’s important in practice situations and be prepared to perform tasks at the right time.” Spruce believes it’s important that surgical checklists be designed by the perioperative team members that will be using them. “Input from individual team members helps identify care relevant to specific patient populations and decrease variability,” she says. “When checklists are designed by individual teams, they become more meaningful and relevant and not just something else team members are required to do,” Spruce adds. AORN has developed a comprehensive surgical checklist that includes specific steps to be followed at four key surgical phases: pre-procedure checkin, sign-in, time-out and sign-out. The AORN comprehensive surgical checklist can be downloaded at www.aorn.org/ AORNSurgicalChecklist.

Trends in Patient Safety A noteworthy recent trend identified by Spruce when it comes to improving patient safety is the adoption of simulation training by more hospitals. “This provides an avenue where team members can practice patient safety scenarios and discuss team decisionmaking in a safe environment,” says Spruce. “Simulation training teaches effective teamwork, a systems approach and blameless communication. These are the best strategies for building a culture where patient safety comes first.” Spruce also recommends using the latest new technologies to mitigate risk in the OR and improve patient safety. “For example, using RFID technology in addition to manual counts can reduce the risk of retained surgical items,” says Spruce. “OR professionals and leaders should be aware of new technologies and evaluate their use in perioperative practice to help minimize risk to patients.” McGaffigan points to yet another major patient safety risk in the OR: surgical fires. “The FDA recently made recommendations to all health care professionals involved in surgical procedures to help reduce instances of surgical fires and related patient injuries,” she says. WWW.ORTODAY.COM

The Latest Trends and Tips in “We’re also seeing a move away from woven linen fabrics to polypropylene drapes and gowns to reduce linting in the OR,” he adds. Additional steps recommended by Freidman to limit the risk of linting include: • Opt for powder-free gloves • Cover linting clothing while walking in and out of critical areas • Ban newspapers from the OR because they contain cellulose with dyes and ink • Clean, dry and assemble devices in low-linting sterile processing areas • Make sure that air filtration units are performing optimally According to Freidman, some surgical gowns meet AAMI Level 3 and 4 requirements for protection.

The Risk of Linting

National Patient Safety Goals

Kevin J. Freidman, the medical director at Halyard Health, points to another common but less-publicized OR patient safety risk: linting. “Lint and foreign debris from gowns, drapes and other common OR products can contaminate surgical instruments and devices, increasing risk of infection,” says Freidman. “The consequences can be life-threatening.” To reduce this risk, Freidman says many hospitals are moving toward standardization with regard to surgical apparel.

The 2018 National Patient Safety Goals published by The Joint Commission focus on problems in health care safety and how to solve them. The goals include correct patient identification, improved staff communication, safe use of medicines and alarms, infection prevention, identification of patient safety risks and the prevention of surgical mistakes. To download the complete list of 2018 National Patient Safety Goals, visit https://www.jointcommission.org/assets/1/6/2018_HAP_NPSG_goals_final.pdf.

“

By using the Surgical Safety Checklist to build effective communication and teamwork, surgical teams can minimize the most common and avoidable risks endangering the lives and

”

well-being of their patients.

Alex Haynes, MD, MPH, Director for the Safe Surgery Program at Ariadne Labs and Associate Professor of Surgery at Harvard Medical School

WWW.ORTODAY.COM

PATIENT SAFETY

According to the FDA, surgical fires can occur at any time when all three elements of the “fire triangle” are present: an oxidizer, fuel source and ignition source. Most surgical fires occur in oxygen-enriched environments where the concentration of oxygen exceeds 30 percent. To reduce the possibility of surgical fires occurring in the OR, the FDA recommends conducting a fire risk assessment before each surgery begins. Health care professionals should also practice the safe use and administration of oxidizers and any surgical suite items that could serve as fuel or ignition sources. In addition, health care professionals should plan and practice how to manage a surgical fire if one erupts in the OR, says the FDA.

AUGUST 2018 | OR TODAY |

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SPOTLIGHT ON Martha Becker BY MATT SKOUFALOS

C R NA , B S N

During her senior year of high school, Martha Becker informed her mom, Edith McCarren, that she was going to take a year

off after graduation to figure out what she wanted to do. Her

mother informed her that she’d better figure out something else.

mid a nursing shortage, McCarren, a former teacher, had been trying to re-enter the workforce via a competitive nursing program at Montgomery County Community College in Blue Bell, Pennsylvania. She told Becker to fill out the paperwork to enroll, too. After they both interviewed, Becker got into the program; McCarren did not. “A hundred of us were accepted for the class to start, and I was one of five who were just outside of high school,” Becker said. “It was really an education to see how women could juggle divorce, kids, jobs, and still be going to school.” A year later, McCarren joined her daughter in the RN program. She died in May 2018, after having worked 26 years in the field, fully retiring when she was 84. “It was interesting to go to school with her,” Becker remembers. “She was a lifelong learner; she was still in book club when she died. She truly was a role model of learning, learning, learning.” McCarren’s career took her throughout Abington Hospital-Jefferson Health, in Abington, Pennsylvania, where her caregiving approach served her as an inpatient psychiatric nurse, and also as a a fill-in nurse in the Philadelphia public school system.

46 | OR TODAY | AUGUST 2018

Abington is also where Becker’s career was established. In 1980, she began working as a charge nurse at the age of 20. After 38 years in the field, she can still recall how she was too green to be scared at the beginning. “People would say, ‘Oh you’re so calm,’ and I said, ‘Do they know something I don’t know?’ ” Becker laughed. She stayed at Abington for four years, until she had the oldest of her three children. Becker didn’t return to full-time work right away because the health system froze hiring while it evaluated the impact of the newly rolled-out Diagnosis Related Groups (DRG) system for reimbursement. She ended up in the operating room at Roxborough Memorial Hospital, eight miles away. While working and raising her daughter, Becker returned to school at Hahnemann University Hospital for her BSN, which she completed in 1989. “Then I ended up having two more kids, and life got in the way, and along the way, I thought, ‘Maybe I’ll be a school nurse,’ ” Becker said. After completing her school nursing certification at Widener University, she was in that setting just nine months before she was accepted into anesthesia school at Our Lady of Lourdes Hospital in Camden, New Jersey.

“I loved it, and I’ve been doing that ever since,” Becker said. Today, she’s back at Abington Hospital-Jefferson Health as a nurse anesthetist with United Anesthesia Services. After nearly 40 years in the field, she still believes “it’s the greatest.” “You never get punished for changing and doing something else,” Becker said. “That’s of very high value for me. I’ve been able to raise kids, I’ve been able to work part-time, relief time, casual time when I was in school. I could move to a lot of different places to get a job. I had a lot of flexibility. I worked night shift for five years when the kids were really little.” Although Becker said she wasn’t a strong student at the outset of her vocational path, she truly became a career student. She credits a love of learning, instilled by her mother, and a fascination with the human body and its mechanics that only deepened as she aged. “All of a sudden, it was so interesting to learn more,” Becker said. “Then I was in the OR for 10 years and then I had to get unit experience. The body is very interesting. That’s what you’re learning about all the time, what your body is experiencing.” An intimate understanding of what

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Although Becker said she wasn’t a strong

student at the outset of her vocational path,

she truly became a career student. She credits a love of learning, instilled by her mother,

and a fascination with the human body and

its mechanics that only deepened as she aged. happens to the human body, particularly during end of life, has informed Becker’s bedside manner and assessment of what patients and families need. She recalled how, when McCarren was hospitalized by illness in her final days, a young resident doctor asked whether she’d considered intubating her 88-year-old mother – until the fire in her eyes sent him hustling out the door. “Family members should really know what they’re signing up for,” Becker said. “I think patient educa-

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tion is a huge priority.” After years in the profession, Becker said she’s also learned a lot about self-advocacy and finding her voice at work, whether in the operating room, at the patient bedside or in circulation. Nobody is tougher on nurses than they are on themselves, at times, she said. “I think doctors are figuring it out finally that we’re actually their eyes, ears and everything else while they’re not there,” she said. “I think we’re

valued a lot more than we were when we first started. We all have a voice; I think that’s all part of team building.” Becker also applied her lifelong love of learning to medical mission work in Central America. She’s participated in two different missions there, helping with outpatient surgeries where there aren’t the skills or resources to resolve without visiting support. Even though she acknowledged the same work is needed stateside, Becker said the experience of being able to take her family with her for the same kind of education has been a big piece of her participation. “I’ve been able to take my kids to these trips,” she said. “They can’t get this exposure in America. Let them see, let them work, let them do screenings. It was great.”

AUGUST 2018 | OR TODAY |

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OUT OF THE OR fitness

3 Ways Millennials Can Help Parents Get Fit by ronnie blair

ging baby boomers who neglect their health and fitness don’t just harm themselves. Their lifestyles also affect their adult children, who eventually could end up caring for them – both financially and physically – as their health declines.

sermon,” he says. “But you should remind them of how important exercise and healthy eating are, and how much you care about having them around for you and for the grandchildren.” There is plenty of nutrition and exercise advice that can help older people. Brenkus shared a few starter tips:

Of course, that’s not the only reason those adult children might feel concerned. They also may like having mom and dad around, and want that to continue for years to come. So they have a vested interest in encouraging their parents to get fit and stay fit. But young adults who cringe at their parents’ eating and exercise habits may be reluctant to broach the subject. How can they start such a conversation? And what are some suggestions for healthy living their parents are likely to put into practice? One thing that might be tempting, but probably won’t work, is a harsh lecture, says Jaime Brenkus, a nationally recognized fitness expert and fitness coach for Evergreen Wellness, which provides videos and articles to help older adults enjoy healthier lives. “You don’t need to give them a

Encourage them to drink more water

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This may sound basic, but not everyone drinks as much water as they should – even though this is a healthy habit that’s simple to accomplish. A CDC study, for example, revealed that 43 percent of adults drink fewer than four cups of water a day and seven percent don’t drink any glasses of water at all. (Presumably, they get their fluids from other beverages that have water in them.) Baby boomers grew up drinking a lot of soda and Kool-Aid. Later, they graduated to coffee and alcoholic beverages. Many of them have adapted to today’s bottled-water culture, but for some those old habits may die hard and water isn’t always their first choice when thirst beckons.

Recommend they try strength training The most effective way to increase metabolism and to help reverse the

aging process is stimulating muscles by lifting challenging weights to increase lean muscle mass, Brenkus says. “More strength will make daily life easier for them,” he says. “It will give them better balance and they will be less likely to fall. It also can strengthen the heart, and it makes them look and feel younger.”

Make sure they socialize This isn’t directly related to exercise, but studies have shown that people who are active socially are healthier and live longer lives. Socializing, for example, helps reduce the stress that can contribute to a number of health problems. If socializing is combined with exercise (playing tennis, taking regular walks with a friend), then that’s all the better. “Helping your parents adopt a healthier lifestyle is about encouraging them to change their habits for eating, cooking, shopping and fitness,” Brenkus says. “And even more importantly, it’s about helping them to change their thinking habits. “Maybe sometime in the past they tried a diet or fitness regimen and they failed at it. That doesn’t mean they can’t try again – and this time with you as their cheerleader.”

AUGUST 2018 | OR TODAY |

OUT OF THE OR health

Choosing the Right Mental Health Provider By Adam P. Stern, M.D.

hen faced with mental health conditions such as depression, anxiety or other symptoms of the mind and brain, it can be difficult to know where to find the best care. In part, the challenge of finding the right professional for you stems from the highly variable manner in which mental health concerns can emerge. One person’s depression, for example, may be very different than someone else’s, and the same can be said for anxiety, post-traumatic stress, obsessionality, attentional issues, substance use disorders and even psychosis.

care doctor about your symptoms, and if necessary asking for a referral to a specialist, is a good place to begin. If your doctor determines that specialized care is needed, you may be referred to a psychiatrist who can do a global assessment of your clinical needs. It may be the case that you will benefit most from an integrated treatment approach that features both psychotherapy and medications, or you may be referred primarily to one treatment or another. Here’s some additional information about the different kinds of mental health providers and the treatments they offer to help diagnose and treat psychiatric issues.

There are also lots of different kinds of mental health providers out there doing all kinds of distinct clinical work. It can be intimidating to even know where to start searching for help, but often telling your primary

Psychiatrists

50 | OR TODAY | AUGUST 2018

Psychiatrists are medical doctors who have graduated from medical school and completed at least four years of additional specialized training, through residency and often fellow-

ship, in the medical treatment of mental disorders. Because of their advanced medical training, psychiatrists are able to prescribe medicine and also have at least basic training in most evidence-based psychotherapeutic approaches. Some choose to see patients for medication management only, while others focus on therapy and still others integrate both approaches into the same clinical sessions. Also, psychiatrists are generally the only mental health providers who can perform electroconvulsive therapy, transcranial magnetic stimulation, or other neuromodulatory treatments that use devices to noninvasively stimulate the brain in severe or medication-resistant cases. Though some psychiatrists still practice traditional psychoanalysis involving multiple sessions “on the couch” each week, this kind of approach has become less available and less common in recent years, in part because insurances generally WWW.ORTODAY.COM

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are your patients covered? do not cover it, and in order to practice it providers must complete additional psychoanalytic training for several years after residency. Often, psychiatric nurse practitioners or other appropriately trained “physician extenders” can take on the traditional role of a psychiatrist, though it is important that they have access to adequate supervision, particularly for complex cases.

Therapists and counselors Many types of professionals can provide the variety of psychotherapeutic approaches used in the treatment of mental health disorders. Therapists who have obtained Ph.D. or Psy.D. degrees with a focus in clinical psychology, for example, have perhaps the most extensive training in providing talk therapy, including psychodynamic or “insight-oriented” therapy, cognitive behavioral therapy, interpersonal therapy and others. Clinical social workers and mental health counselors may also have excellent training in particular therapeutic areas that can be very helpful to patients. Therapists and counselors may even offer some therapies, such as eye movement desensitization and reprocessing, that psychiatrists generally have less experience with. In each of these areas, it is important to remember that there is a spectrum of quality, and so it is essential for people with mental health concerns to find welltrained and credentialed providers that seem to be a good fit with them individually. – Adam P. Stern, M.D., is a contributor to Harvard Health Publications. This content is from Harvard Health Letters.

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AUGUST 2018 | OR TODAY |

OUT OF THE OR nutrition

Fatty Fish, Camelina Oil Beneficial By UNIVERSITY OF EASTERN FINLAND ating fatty fish increases the size and lipid composition of HDL particles in people with impaired glucose metabolism, according to a new study from the University of Eastern Finland. These changes in the size and lipid composition of HDL particles make them beneficial for cardiovascular health. Published in Molecular Nutrition & Food Research, the study also found that camelina sativa oil decreases the number of harmful IDL particles.

52 | OR TODAY | AUGUST 2018

The researchers studied the effects of camelina oil and fatty fish intake on the size and composition of cholesterol-carrying lipoproteins. The HDL lipoprotein is commonly known as “the good” cholesterol, although the health effects of HDL particles actually are dependent on their size and composition. Earlier research has shown that large HDL particles are associated with a reduced risk of cardiovascular diseases, whereas a small HDL particle size may increase the risk. The IDL lipoprotein, on the other hand, is the precursor of LDL, which is also known as “the bad” cholesterol. Previous studies have shown that long-chain omega-3 fatty acids found in fish have a beneficial effect on lipoprotein size and composition. Camelina oil, on the other hand, is rich in alphalinolenic acid, which is an essential omega-3 fatty acid whose associations with lipoproteins aren’t well understood yet.

The study involved 79 Finnish men and women aged between 40 and 72, and with impaired glucose metabolism. Study participants were randomly divided into four groups for a 12-week intervention: the camelina oil group, the fatty fish group, the lean fish group, and the control group. People in the lean and fatty fish groups were instructed to eat lean or fatty fish four times a week, and people in the camelina oil group were asked to use 30 millilitres of camelina sativa oil daily. Participants in the control group were allowed to eat fish once a week, and the use of camelina oil and other oils containing alpha-linolenic acid, such as rapeseed oil, was prohibited. The researchers found that eating fatty fish increased the size and lipid composition of HDL particles, and that the use of camelina oil decreased the number of harmful IDL particles. Both of these changes can reduce the risk of cardiovascular diseases. Eating lean fish, however, was not associated with changes in the number, size or composition of lipoprotein particles.

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AUGUST 2018 | OR TODAY |

OUT OF THE OR

Recipe

recipe

the

54 | OR TODAY | AUGUST 2018

TANGY KALE SLAW

INGREDIENTS:

• • • • • • • • •

2 Tbsp. red wine vinegar 1 Tbsp. mayonnaise 1 Tbsp. honey 1 1/2 tsp. fresh cilantro leaves, chopped 3/4 tsp. granulated sugar 3/4 tsp. fresh lime juice 1/4 tsp. kosher salt 1/8 tsp. freshly ground black pepper 2 cups fresh kale leaves, washed, tough stems removed, sliced 1/8”

• 1/2 cup fresh red cabbage, cored and shredded • 1/2 cup fresh carrot, peeled and shredded • 1/4 cup green onions (scallions), trimmed and sliced 1/8” (white and green)

Note: Since everyone’s health history and nutritional needs are so different, please make sure that you talk with your doctor and a registered dietitian to get advice about the diet and exercise plan that‘s right for you.

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OUT OF THE OR recipe

Switch Up Your Menu with Plant Forward Recipes With the right ingredients, healthy, plant forward meals (those with vegetables-ascenter-of-the-plate, with smaller portions of meat) can be colorful, creative, delicious, and packed with nutrients. Aramark, the largest U.S.based food services provider, and the American Heart Association (AHA), the nationâ&#x20AC;&#x2122;s largest voluntary organization dedicated to fighting heart disease and stroke, are working together to improve the health of Americans 20 percent by 2020, through healthy menu and recipe innovation and health awareness and education programs. Currently, as part of its Healthy for Life 20 By 20 commitment with the AHA, 30 percent of the main dishes Aramark serves across its dining operations in health

care, higher education and business dining are vegan or vegetarian. Aramark has also partnered with the Humane Society of the United States (HSUS) to conduct plantbased culinary trainings for its chefs, to enable them to create innovative recipes that center on foods including vegetables, whole grains, legumes and nuts. Because more and more people are enriching their diet with fruits, veggies, whole grains, nuts, beans, lentils and seeds, Aramark collected some plant forward recipes from its network of more than 1,000+ chefs, who are responsible for serving nearly two billion meals each year, and the AHA leveraged its national network of experts, to create a plant forward menu everyone can enjoy.

TANGY KALE SLAW (Serves 6 as a side dish) 1.

Combine vinegar, mayonnaise, honey, cilantro, sugar, lime juice, salt and pepper. Whisk until well blended. 2. Add remaining ingredients. Toss to coat. 3. Cover. Keep chilled for service or use as directed in recipe. For more plant forward tips and recipes, visit www.fyp365.com or join the conversation on Instagram.

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AUGUST 2018 | OR TODAY |

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OUT OF THE OR scrapbook

SURGICAL CONFERENCE

SCRAPBOOK R Today recently held mixers in Lexington, Kentucky as well as Nashville, Tennessee and Knoxville, Tennessee promoting the upcoming OR Today Live Surgical Conference. The mixers averaged about 60 people and great presentations by Riki Watts, Director of Surgical Services at St. Claire Regional Medical Center and James “Jim” Stobinski, PhD, RN, CNOR, CSSM, CEO of the Competency and Credentialing Institute (CCI). Each mixer was a huge success with exceptional networking, insightful presentations and information about the 2018 OR Today Live Surgical Conference in Nashville. For more information about the conference, visit ORTodayLive.com.

58 | OR TODAY | AUGUST 2018

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OUT OF THE OR scrapbook

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AUGUST 2018 | OR TODAY |

SPEAKER SPOTLIGHT I love my work and work my love – perioperative nursing. I believe strongly that I have made a difference to my patients, colleagues and the profession at every level of my career. I have been blessed with a supportive family, including a husband who knew I was capable of achieving my dream of becoming a nurse, even though I started at age 27. When I graduated from high school in 1963 I did not have the grades to enter a college nursing program. I worked as a surgical technologist, raised my family and attended college while matriculating in my associate, bachelor’s and master’s degrees in nursing programs. Each degree took me 5 years going to school part-time at night. Continue reading online at ortodaylive.com/sharon

Sharon McNamara

Sharon McNamara, RN Perioperative Consultant, OR Dx+Rx Solutions for Surgical Safety

Sharon will be presenting “Perioperative Assessment: The eyes are the windows to the soul” at the 2018 OR Today Live conference being held August 26-28 in Nashville, TN. SURGICAL CONFERENCE

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AUGUST 2018 | OR TODAY |

OUT OF THE OR pinboard

OR TODAY

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The News and Photos that Caught Our Eye This Month

OUT OF THE OR pinboard

5 Ways To Fight Fatigue Feeling tired is a common complaint people express. Sometimes the self-description morphs into “I feel tired all the time,” and experts say that’s when extreme tiredness becomes better known as fatigue. “People would be amazed at how much energy they’d have and how much better they’d feel if they treated themselves better,” says Dr. Raj Gupta, founder of Soul Focus Wellness Center. “We all have busy lives, but there are simple ways to not let your schedule overwhelm you and make your health suffer as a consequence.” Stress, Dr. Gupta says, can lead to fatigue symptoms such as a craving for sweets and salty foods, difficulty sleeping and irritability. He suggests five ways to fight fatigue and regain energy: • Run on the right fuel. Ideally, your diet should consist of eating approximately five times a day with a combination of complex carbohydrates – fruits and veggies – and lean protein.” • Cut caffeine, add water. Research indicates too much caffeine causes fatigue in some people. • Stop burning the candle on both ends. Gupta says fatigue is often directly related to sleep deprivation. “When you sleep is when most of your healing takes place,” Gupta says. “Without enough sleep, your immune system breaks

down. It’s recommended you get 6-8 hours of sleep per night.” • Get regular exercise. Gupta stresses that no matter how busy people are, they need to make time for exercise on a regular basis, ideally for 20 to 30-minute sessions a minimum of four times per week. • Body adjustments. The body can come more alive with a chiropractic alignment that provides proper functioning. "A chiropractic adjustment increases one’s vitality and turns up their energy, Gupta says.”

Arlington, Va. is New #1 ‘Fit City’ Arlington, Va., edged out Minneapolis, Minn., for the coveted “most fit city in America” title by only half a point in the annual ACSM American Fitness Index Ranking (Fitness Index). Arlington’s neighbor, Washington, D.C., came in third, 3.7 points behind. The 11th annual Fitness Index was released by the American College of Sports Medicine (ACSM) and the Anthem Foundation. For the first time, the ACSM Fitness Index evaluated America’s 100 largest cities using 33 health behaviors, chronic diseases and community infrastructure indicators. Previously, the Fitness Index measured evidence-based indicators for the 50 largest Metropolitan Statistical Areas (MSA). In 2017, the Minneapolis-St. Paul MSA won the crown. With the twin cities split, St. Paul now ranks #8 in the 2018 Fitness Index. Madison,

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Wis.; Portland, Ore.; Seattle, Wash.; and Denver, Colo. finished fourth through seventh, respectively, in the 2018 Fitness Index ranking. Arlington residents were found to have the lowest smoking rate and highest reports of very good or excellent health compared to the other 99 communities in the Fitness Index. The suburban Virginia community’s balance of both healthy behaviors and community infrastructure earned it the #1 rank with a score of 77.7. While Arlington ranked #4 in personal health and #5 in community indicators, the balance of its combined scores was enough to edge #2-ranked Minneapolis’ overall score of 77.2. Overall findings from the 2018 Fitness Index rankings included: •7 7.5% of adults in all Fitness Index cities were physically active in the previous month, with only 51.5%

meeting aerobic activity guidelines and 22.2% meeting both strength and aerobic guidelines • The average smoking rate across all cities was 15%, the highest was 25.7% •3 5% of residents in all cities reported their mental health was not good in the past 30 days •6 5.4% of residents in all cities indicated getting at least seven or more hours of sleep per night •3 0% of adults reported eating at least two servings of fruit per day, while only 18% indicated eating three or more servings of vegetables per day The ACSM American Fitness Index is available in its entirety at www. americanfitnessindex.org. Visit the website to compare city rankings, download resources and request assistance for your city.

AUGUST 2018 | OR TODAY |

BOOTH 303

INDEX

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Alphabetical Advance Medical Designs, Inc.…………………………17 AIV Inc.…………………………………………………………………13 Alco Sales Service, Co.…………………………………… 48 ASCA………………………………………………………………… 56 Avante Health Solutions………………………………… 45 C Change Surgical………………………………………………15 Case Medical, Inc.…………………………………………… 20 CSZ, A Gentherm Company…………………………… 38 Cygnus Medical…………………………………………………… 9 D. A. Surgical…………………………………………………… 67 Doctors Depot………………………………………………… 57

Encompass Group………………………………………………51 Fobi…………………………………………………………………… 48 Healthmark Industries Company, Inc.…………… 4 Innovative Medical Products………………………… 68 Jet Medical Electronics Inc…………………………… 53 Key Surgical……………………………………………………… 66 MD Technologies inc.……………………………………… 53 MedWrench…………………………………………………………61 Microsystems…………………………………………………… 64 Mobile Instrument Service & Repair…………… 44 Mölnlycke ……………………………………………………………19

Pacific Medical………………………………………………… 29 Palmero Health Care……………………………………… 22 Paragon Services……………………………………………… 28 Ruhof Corporation……………………………………………2, 3 SIPS Consults…………………………………………………… 56 Soma………………………………………………………………………16 TBJ Incorporated………………………………………………… 5 TIDI C-Armor……………………………………………………… 6 TRU-D………………………………………………………………… 39

ANESTHESIA

Doctors Depot………………………………………………… 57 Paragon Services……………………………………………… 28 Soma………………………………………………………………………16

SIPS Consults…………………………………………………… 56 TBJ Incorporated………………………………………………… 5 TIDI C-Armor……………………………………………………… 6 TRU-D………………………………………………………………… 39

Mobile Instrument Service & Repair…………… 44 Pacific Medical………………………………………………… 29 Soma………………………………………………………………………16

ASSET MANAGEMENT

INSTRUMENT STORAGE/TRANSPORT

TBJ Incorporated………………………………………………… 5

categorical

Microsystems…………………………………………………… 64

ASSOCIATION

ASCA………………………………………………………………… 56

C-ARM

Case Medical, Inc.…………………………………………… 20 Cygnus Medical…………………………………………………… 9 Key Surgical……………………………………………………… 66

INSTRUMENT TRACKING

Soma………………………………………………………………………16

Case Medical, Inc.…………………………………………… 20 Microsystems…………………………………………………… 64

CARDIAC PRODUCTS

INVENTORY CONTROL

C Change Surgical………………………………………………15 Jet Medical Electronics Inc…………………………… 53

Key Surgical……………………………………………………… 66

CARTS/CABINETS

Fobi…………………………………………………………………… 48

Alco Sales Service, Co.…………………………………… 48 Case Medical, Inc.…………………………………………… 20 Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.…………… 4 TBJ Incorporated………………………………………………… 5

CS/SPD

Case Medical, Inc.…………………………………………… 20 MD Technologies inc.……………………………………… 53 Microsystems…………………………………………………… 64

DISINFECTION

Case Medical, Inc.…………………………………………… 20 Cygnus Medical…………………………………………………… 9 Palmero Health Care……………………………………… 22 Ruhof Corporation……………………………………………2, 3

DISPOSABLES

Alco Sales Service, Co.…………………………………… 48

ENDOSCOPY

Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.…………… 4 MD Technologies inc.……………………………………… 53 Mobile Instrument Service & Repair…………… 44 Ruhof Corporation……………………………………………2, 3

FALL PREVENTION

MEDICAL GAS MONITORS

Doctors Depot………………………………………………… 57 Pacific Medical………………………………………………… 29 Soma………………………………………………………………………16

Advance Medical Designs, Inc.…………………………17 Alco Sales Service, Co.…………………………………… 48 Cygnus Medical…………………………………………………… 9 Encompass Group………………………………………………51 Healthmark Industries Company, Inc.…………… 4 Palmero Health Care……………………………………… 22 Ruhof Corporation……………………………………………2, 3 WWW.ORTODAY.COM

SINKS

TBJ Incorporated………………………………………………… 5

STERILIZATION

Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.…………… 4 TBJ Incorporated………………………………………………… 5

SURGICAL

SURGICAL INSTRUMENT/ACCESSORIES

D. A. Surgical…………………………………………………… 67 Innovative Medical Products………………………… 68 Soma………………………………………………………………………16

OTHER

C Change Surgical………………………………………………15 Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.…………… 4 Key Surgical……………………………………………………… 66

AIV Inc.…………………………………………………………………13 TRU-D………………………………………………………………… 39

SURGICAL LAMPS

PATIENT MONITORING

SURGICAL TABLE

AIV Inc.…………………………………………………………………13 Avante Health Solutions………………………………… 45 Jet Medical Electronics Inc…………………………… 53 Pacific Medical………………………………………………… 29

PATIENT WARMING

POSITIONING PRODUCTS

INFECTION CONTROL

Healthmark Industries Company, Inc.…………… 4 Key Surgical……………………………………………………… 66 TIDI C-Armor……………………………………………………… 6

OR TABLES/BOOMS/ACCESSORIES

ONLINE RESOURCE

GENERAL

Alco Sales Service, Co.…………………………………… 48

Soma………………………………………………………………………16

SAFETY

MedWrench…………………………………………………………61

Avante Health Solutions………………………………… 45

CSZ, A Gentherm Company…………………………… 38 Encompass Group………………………………………………51

HOSPITAL BEDS/PARTS

RESPIRATORY

Avante Health Solutions………………………………… 45 Fobi…………………………………………………………………… 48 MD Technologies inc.……………………………………… 53 SIPS Consults…………………………………………………… 56 Soma………………………………………………………………………16 TIDI C-Armor……………………………………………………… 6

ONCOLOGY SERVICES

Alco Sales Service, Co.…………………………………… 48 Encompass Group………………………………………………51 AIV Inc.…………………………………………………………………13

REPROCESSING STATIONS

Advance Medical Designs, Inc.…………………………17 Cygnus Medical…………………………………………………… 9 D. A. Surgical…………………………………………………… 67 Innovative Medical Products………………………… 68 Mölnlycke ……………………………………………………………19

RENTAL/LEASING

Avante Health Solutions………………………………… 45

Fobi…………………………………………………………………… 48 Fobi…………………………………………………………………… 48

TELEMETRY

AIV Inc.…………………………………………………………………13 Pacific Medical………………………………………………… 29

TEMPERATURE MANAGEMENT

C Change Surgical………………………………………………15 CSZ, A Gentherm Company…………………………… 38 Encompass Group………………………………………………51

WARMERS

CSZ, A Gentherm Company…………………………… 38

WASTE MANAGEMENT

Advance Medical Designs, Inc.…………………………17 MD Technologies inc.……………………………………… 53 TBJ Incorporated………………………………………………… 5

REPAIR SERVICES

Cygnus Medical…………………………………………………… 9 Doctors Depot………………………………………………… 57 Jet Medical Electronics Inc…………………………… 53 AUGUST 2018 | OR TODAY |

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