OR Today - September 2019

26

PRODUCT FOCUS UVC DISINFECTION

30

CE ARTICLE SURGICAL SITE INFECTIONS

54

OUT OF THE OR WORK LIFE BALANCE

40

CORPORATE PROFILE CYGNUS MEDICAL

SEPTEMBER 2019

n e v i r d e c i v Ser

www.ortoday.com

s s e c c u S

WE HAVE THE KITS!

Include the

GUARDIAN DISPOSABLE VALVE SET

IN YOUR OWN CUSTOM PROCEDURE KIT!

The Guardian Valve Set contains a sterile Air/Water Valve, Suction Valve and Biopsy Valve for use in Olympus® Scopes.

ARE YOU COMPLIANT?  All-in-one Endoscope Procedure Pack  Premium Infection Control Supplies  Enables Guidelines Compliance 1-800-537-8463

|

WWW.RUHOF.COM

AD-40 REV2 07.26.19

What’s your surgical case status?

Go

No Go

With SPM, it’s always good to go.

When you need to be absolutely certain, choose SPM. Expect accurate, complete and sterile surgical trays in an optimal condition for use, when and where they’re needed.

Actionable Intelligence.

salesgroup@mmmicrosystems.com

Only SurgiSLUSH™ Makes Slush for You as You Drive to Work.

Modern Slush Sealed Containers - Usable for 24 Hours.

Reduce Equipment Costs Up to 73% SurgiSLUSHTM 4-Liter & 2-Liter

PCS

TM

PCS

TM

Protective Container SystemTM

24-Hour Slush. More Useful.

Automatically Smooth. Protected Until Use. Email info@cchangesurgical.com

Toll-free (877) 989-3737

www.cchangesurgical.com

HealthTrust Contract #12318

°C Change SURGICAL

OR TODAY | September 2019

contents

44

features

SERVICE-DRIVEN SUCCESS Most businesses understand the importance of delivering great customer service to their bottom line. But what about health care organizations and ambulatory surgery centers? How can they adopt customer service practices used by other businesses to improve patient satisfaction and boost the bottom line?

25

30

40

The ultraviolet disinfection market

Health care professionals in every

Cygnus Medical provides innovative

includes wide range of applications

practice setting need to know about

medical products and services. As a

across many industries. The health care

surgical site infections, and those caring

leader in the industry, Cygnus Medical

segment of the market continues to

for surgical patients must understand

does more than listen to customers.

show growth and growth potential. It is

how to prevent this complication.

The company develops unique,

one segment that is pushing the overall

However, health care professionals do

industry-first solutions to specific

market to new heights.

not necessarily receive enough education

problems found in hospitals and health

about SSIs. This updated CE module

care facilities.

MARKET ANALYSIS: UVC DISINFECTION

CE ARTICLE: SURGICAL SITE INFECTIONS

CORPORATE PROFILE: CYGNUS MEDICAL

provides the background information needed to increase their understanding.

OR Today (Vol. 19, Issue #9) September 2019 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. Š 2019

WWW.ORTODAY.COM

SEPTEMBER 2019 | OR TODAY |

7

contents features

PUBLISHER John M. Krieg

john@mdpublishing.com

VICE PRESIDENT Kristin Leavoy

kristin@mdpublishing.com

48

EDITOR John Wallace

SPOTLIGHT ON

editor@mdpublishing.com

Beth Devine, RN

ART DEPARTMENT Jonathan Riley Karlee Gower Amanda Purser

ACCOUNT EXECUTIVES Jayme McKelvey Megan Cabot

DIGITAL SERVICES

62

60

Win a free pair of Calzuro shoes!

South African Chocolate Birthday Cake

OR TODAY CONTEST

RECIPE OF THE MONTH

Cindy Galindo Kennedy Krieg Erin Register

CIRCULATION Lisa Cover Melissa Brand

WEBINARS

INDUSTRY INSIGHTS

11 News & Notes 18 I AHCSMM: Central Service Week Offers Golden Opportunity to Honor Profession 20 CCI: Efficacy in Surgical Services Transition-to-Practice 23 Webinars: Establishing A High School Sterile Processing Clinical Program

Linda Hasluem

ACCOUNTING Diane Costea

IN THE OR

25 Market Analysis: UVC Disinfection Market Trending Up 26 Product Focus: UVC Disinfection 30 CE Article: Surgical Site Infections

OUT OF THE OR 48 Spotlight On 52 Fitness 54 Health 56 EQ Factor 59 Nutrition 60 Recipe 62 Pinboard

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

PROUD SUPPORTERS OF

66 Index

8 | OR TODAY | SEPTEMBER 2019

WWW.ORTODAY.COM

NEW CoreTemp™

The Future of Fluid Warming is Here Accelerate Surgical Readiness Ultra-fast heating of the fluid helps surgical teams set up quickly. The CoreTemp Fluid Management System warms 1L of fluid from room temperature to body temperature in less than 10 minutes.

Push-Button Height Adjustment & Simple Drop-and-Go Drape The system quickly adjusts from 36 to 48 inches to easily align with back table heights or nurse preferences.

Drape is form-fitted to match the basin shape to simplify and speed the draping process.

Automated Fluid Volume Tracking The basin acts as a weight scale and is smart enough to monitor and display fluid volumes in real-time.

The CoreTemp Fluid Management System empowers surgical teams to easily follow evidence-based clinical practice guidelines and improve patient care and outcomes.

Contact your Account Executive TODAY for a CoreTemp demonstration 1.800.824.3027 | www.ecolab.com/coretemp Š 2019 Ecolab USA Inc. All rights reserved.

Detect defective equipment and instruments with confidence using new tools from Healthmark.

Healthmark offers tools to verify that leakage testers and electrosurgical instruments are working properly.

Leak Tester Tester The Leak Tester Tester assists in reducing the poten�al for cross-contamina�on, damage and costly repairs that result from using an endoscope with leaks.

The Leak Tester tester is offered for the following leakage testers: • • • •

Olympus Automated Leak Tester Olympus Handheld Tester Pentax Handheld Tester Karl Storz Handheld Tester

Insulation Tester The low frequency high voltage Insula�on Tester is used to detect and locate defects such as pinholes, cracks and bare spots in the jacket or coa�ng of laparoscopic and bi-polar electrosurgical instruments.

The insula�on tester comes with the following reusable and interchangeable accessories: • Ground Wire with Alligator Clip • Ring Electrode • Tri-Hole Electrode

• Brush Electrode • Saddle

INTELLIGENT SOLUTIONS FOR INSTRUMENT CARE & INFECTION CONTROL HMARK.COM | 800.521.6224

For more of Healthmark’s intelligent solutions for instrument care & infection control, visit

HMARK.COM

INDUSTRY INSIGHTS

news & notes

Report: Negative Pressure Wound Therapy Market to hit $2.5 Billion The negative pressure wound therapy (NPWT) market is predicted to increase from $1.7 billion in 2018 to around $2.5 billion by 2025, according to a 2019 Global Market Insights Inc. report. Increasing prevalence of endocrine and other chronic diseases across the globe will positively influence the NPWT market growth in forthcoming years.

The hospital segment will experience over 5.5% growth in the negative pressure wound therapy market throughout the forecast years and is anticipated to have similar growth trends in near future. Patients suffering from critical wounds such

as foot ulcers, skin burns, pressure and surgical wounds need to stay in a hospital. Additionally, negative pressure wound therapy dressings are changed every 24-48 hours to avoid bacterial build up. As a result, usage of NPWT treatment will be prominently high in hospitals, thereby propelling segment growth.

The single-use negative pressure wound therapy market is estimated to witness around 7.5% growth in coming years.

Single-use NPWT devices are convenient when compared to conventional devices that result in positive patient outcomes. •

John Whelan Joins Healthmark Industries and Introduces Leak Tester Tester Healthmark Industries is proud to announce John Whelan as its newest clinical education coordinator.

“We are very pleased to welcome John to Healthmark Industries,” says Vice President Ralph Basile. “His expert knowledge and experience in the institutional sterilization and high level disinfection field will play a vital role in providing guidance and support to our customers.”

Whelan comes to Healthmark Industries with extensive experience in the health care industry. Most recently, he directed high-level disinfection (HLD) for the University of Michigan Health System. In this role, he had the responsibility of successfully launching and oversight for HLD processes throughout the health system.

His health care career spans more than 35 years, in the fields of emergency services and endoscopy. This has included staff roles, as well as those of educator and manager. He is the coauthor of a recent chapter on endoscope reprocessing in Otolaryngology Clinics of North America. Whelan holds a bachelor of science degree in nursing from Michigan State University. He is an active member of the Society of Gastroenterology Nurses and Associates (SGNA) and

WWW.ORTODAY.COM

the Association for the Advancement of Medical Instrumentation, where he serves as a member for ST/Workgroup 84-Endoscope reprocessing.

In other news, Healthmark Industries added its Leak Tester Tester to its endoscopy product line. Testing a facility’s endoscope leak tester prior to use is a vital and necessary step to ensure leak testing demonstrates accurate results.

Designed to validate the accuracy of air pressure provided by automated and handheld endoscope leakage testers, the Leak Tester Tester assists health care workers in the reprocessing areas their endoscope leak tester is working properly by testing the functionality of the pump and the connector for leaks prior to using. The Leak Tester Tester assists in reducing the potential for cross-contamination, damage and costly repairs that result from using an endoscope with leaks. Manufactured from stainless steel, the testers come in a package of four or can be purchased separately and are offered for the following leak testers: the Olympus automated leak tester, the Olympus handheld tester, the Pentax handheld tester and the Karl Storz handheld tester. Simply attach the desired leak tester tester to an endoscope leak tester, turn it on or pressurize the bulb, and read the pressure on the gauge, which gives a quick and objective result of the amount of air being expelled from leak testers and air pumps. •

SEPTEMBER 2019 | OR TODAY |

11

INDUSTRY INSIGHTS

news & notes

Zoll Medical Corporation Acquires TherOx Inc. ZOLL Medical Corporation has acquired TherOx Inc., a privately held company. TherOx is focused on improving treatment of acute myocardial infarction (AMI) and markets systems to deliver SuperSaturated Oxygen (SSO2) Therapy.

SSO2 Therapy, which was recently approved by the Federal Drug Administration (FDA), has been demonstrated to reduce infarct size after primary coronary intervention (PCI) with stenting in patients with left anterior descending ST-elevation myocardial infarction. When a large ischemic area of muscle damage remains following AMI, the patient condition often deteriorates into debilitating heart failure.

“ZOLL and TherOx are both focused on emergency cardiac care,” said Neil Johnston, president of ZOLL Circulation. “This acquisition expands the ZOLL product portfolio in support of excellence for patients and caregivers.”

“SSO2 Therapy can help reduce infarct size among patients who suffer from large anterior AMIs, which are the most serious heart attacks,” said Kevin T. Larkin, president and chief executive officer of TherOx. “Adjunctive to PCI, SSO2 Therapy is intended to salvage heart muscle and reduce infarct size.”

“We are looking forward to becoming part of ZOLL so that together we can bring this breakthrough treatment option to more patients sooner,” Larkin said.

“No delay in door-to-balloon times and improved clinical outcomes is a combination we think physicians will find appealing,” Johnston added. “Because SSO2 Therapy is delivered following PCI and stenting, there is no disruption of today’s workflow in the cath lab.” •

12 | OR TODAY | SEPTEMBER 2019

FDA Clears Wireless Monitoring Platform Murata Vios Inc., a medical technology company that develops wireless patient-monitoring sensors and software, announced that it has received U.S. Food and Drug Administration (FDA) clearance for two 510(k) submissions for its second-generation wireless patient monitoring platform, the Vios Monitoring System (VMS). The approved suite of products provides a platform designed to reduce the cost of patient-monitoring equipment while simultaneously striving to improve the quality of care and the patient experience.

The second-generation platform collects 7-leads of ECG, heart rate, respiratory rate, SpO2, blood pressure, temperature, pulse rate, patient posture and activity data to monitor patients throughout various clinical environments. Murata Vios Inc. is working with hospitals and post-acute care facilities as it prepares for its U.S. commercial launch.

The VMS is designed to optimize the monitoring of patients throughout the health care facility by providing a lower cost, user-friendly and secure patient monitoring platform. One of the significant advantages is that Vios can continuously monitor and display patient vital signs across a multitude of devices utilizing sensors, unique signal processing IP and propriety software that runs on standard off-the-shelf hardware. Based on the low-bandwidth connected data, health care providers will be able to remotely monitor patient data in near real-time. This design strategy significantly reduces the cost of the overall solution and removes the enormous dependence on expensive proprietary IT networking equipment. •

WWW.ORTODAY.COM

Study: LightStrike Robot Destroys Candida auris Candida auris (C. auris) is an emerging, often multi-drug resistant, fungus that causes serious and often deadly infections in health care settings. The Centers for Disease Control & Prevention (CDC) recently issued a warning about C. auris, terming it a “serious global health threat.”

Nearly 700 C. auris cases have been reported in the U.S. thus far, but hospitals overseas have been battling the deadly pathogen for quite some time. The Netcare Hospital Group, which operates the largest private hospital network in South Africa, was the first and is the only hospital group in South Africa to utilize Xenex high intensity, broad spectrum mobile disinfection robots that have been proven effective against viruses and bacteria that can threaten patient safety.

Dr. Caroline Maslo is senior clinical advisor and head of infection control for Netcare’s Hospital Division, and the lead author of a new peer-reviewed study “The efficacy of pulsed-xenon ultraviolet light technology on Candida auris” that validates the efficacy of LightStrike pulsed xenon ultraviolet (UV) disinfection technology in destroying C. auris.

In the BMC Infectious Diseases study, researchers reported a 99.6% reduction in C. auris after a 10-minute treatment with pulsed xenon UV disinfection, stating, “The PX-UV mobile device is easy to use and has significantly shorter cycle times that makes it easier to disinfect all areas outside the room where the patient received care, as recommended by the CDC.” Dr. Mark Stibich, co-founder and chief scientific officer of Xenex, said, “As an evidence-based company, seeing this research documenting the efficacy of pulsed xenon UV disinfection technology against C. auris is very exciting. We began hearing reports of C. auris some time ago and began testing in government laboratories to create protocols for how our technology should be utilized to combat it. This data from Dr. Maslo’s group further validates our best practices. Adding LightStrike robot disinfection to your hospital’s infection prevention bundle can help combat the spread of C. auris in the hospital environment, and our team is prepared to help health care facilities integrate the technology into their infection prevention strategy.”

Xenex LightStrike robots quickly destroy bacteria, viruses, mold, fungus and spores on hospital surfaces. The portable disinfection robots are effective against the most common as well as the most dangerous pathogens, including Clostridium difficile (C. diff), norovirus, influenza, Ebola, carbapenem-resistant Enterobacteriaceae (CRE), Vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA). Trained hospital cleaning teams operate the robot, which is brought in after the patient has left the room as part of a hospital’s comprehensive infection prevention strategy. The intense pulsed xenon UV light quickly destroys invisible pathogens lurking on surfaces (bedrails, tray tables, door knobs, wheelchairs, etc.). •

When Quality Matters

PowerMATE® Special Purpose Relocatable Power Taps • UL-1363A Recognized • Locking IV Pole Mount • Optional Permanent Mount • Locking Outlet Covers • 15 & 20 Amp Models • ClampMATE Clamps

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

888.656.0755 aivsales@aiv-inc.com

659G

WWW.ORTODAY.COM

SEPTEMBER 2019 | OR TODAY |

13

INDUSTRY INSIGHTS

news & notes

Medline Announces Product EPA-registered to Kill Emerging Pathogen Hospitals and clinics have a new tool to combat Candida auris (C. auris) a multidrug resistant fungus that can cause serious infections in hospitalized patients. Medline has announced that the EPA has cleared its Micro-Kill Bleach Germicidal Bleach Wipes to be marketed as killing the fungus on hard, non-porous surfaces. The fungus, which has a mortality rate of 35%, has been shown to linger in health care facilities despite efforts to eradicate it with traditional disinfectants. The fungus, which can be difficult to treat, has caused outbreaks worldwide, including in New York and Chicago.

“Candida auris has emerged as a new and alarming threat, and until now health care providers and environmental staff (EVS) had no proven tools to combat it. What we’ve shown with the Micro-Kill Bleach Germicidal Wipes is an effective way to disinfect hospital surfaces, where C. auris tends to be persistence in the environment. Our goal is to take a proactive approach to combating this pathogen,” says Rosie D. Lyles, MD, director of clinical affairs at Medline. “Through the collective work of Medline’s infection prevention team, we’ve developed a way to effectively reduce cross contamination of C. auris using Micro-Kill Bleach and proper hand hygiene.”

“As an infection-prevention solutions provider, we are dedicated to staying on top of emerging pathogens and epidemiology trends. We identified C. auris as a potential threat more than two years ago after a handful of cases started to surface. At that time, the EPA had not yet developed a method to test the pathogen. We closely monitored the progress on the EPA testing methods so that as soon as it was made available, we were one of the first in line to get our Micro-Kill Bleach wipes tested,” says Megan Henken, director of product management, Medline Textiles division.

After years of development and rigorous testing, EVS associates can now begin using the wipes as part of infection prevention-informed room turnovers and nurses can use them on medical equipment and high-touch surfaces. •

14 | OR TODAY | SEPTEMBER 2019

Wideblue Develops Softcell pH Monitor Wideblue has developed a new medical device for Softcell Medical which measures and displays the pH of a patient’s tissue in real time during surgery.

This new pH monitoring system comprised of a pH probe and pH monitor has been developed to assist with the assessment of patients who have either sustained injuries, or have developed disease processes that make them susceptible to ischemia or localized tissue death. The pH probe enables a precise assessment of tissue pH, to help prevent the development of compartment syndrome or generalized tissue death. As with all diagnostic and monitoring devices, it should only be used as a guide to the clinician, who should use his or her clinical judgment in addition to the information provided by the pH system, to make the final decision concerning patient care.

“Wideblue has developed and designed this highly accurate pH monitor for Softcell including ergonomic design, software design of the display screens and operation of the device, electronics design, manufacturing of the first units for clinical trials purposes plus production of the packaging, labels and instruction manual,” Wideblue Managing Director Russell Overend said. “The device works on the principle that if the blood supply is limited to parts of the body the organs/tissues become slightly acidic. The level of acid build up will guide the treatment of the patient. The device is used before, during and after an operation to measure and display pH at various sites in the body to allow the surgeon to take appropriate action.” •

WWW.ORTODAY.COM

Adventist Health White Memorial Improves Operating Room Turnaround Time TAGNOS and Zebra Technologies recently announced that Adventist Health White Memorial (AHWM) improved operating room (OR) turnaround time by approximately 10 percent with a joint workflow optimization solution.

Operating rooms and other procedural areas are often left empty for too long causing patient delays as well as financial and operational strains on the entire surgical department. The integrated TAGNOS-Zebra solution strengthened communication and collaboration between nursing staff and environmental services staff (EVS) to quickly and efficiently prepare ORs for waiting patients and reduce costs at the Los Angeles-based hospital.

TAGNOS, is a registered Independent Software Vendor (ISV) in Zebra’s PartnerConnect channel program. The patented TAGNOS OR workflow solution aggregates and analyzes data from radio frequency identification (RFID) tags on patient wristbands, as well as information from a variety of hospital systems, to provide real-time insights into the patient’s journey through the surgical suite. These insights are then communicated to AHWM’s care and

support team via the TAGNOS app on Zebra’s Androidbased TC51-HC enterprise-class mobile computer to more effectively coordinate scheduled surgery times and enable collaborative workflows for faster care delivery and improved patient satisfaction.

“The TAGNOS-Zebra workflow optimization solution has fostered a higher level of teamwork since ambiguity has been removed and everyone can visually see how their tasks are interrelated,” said Randy Saad, director of perioperative services at AHWM. “Since we implemented the solution, we have reduced EVS response times to operating rooms by 41 percent enabling us to significantly improve our operational efficiency and reduce costs while seeing more patients.”

Outdated manual communication and ambiguous information sharing are the primary culprits in slowing the turnaround process and can create a domino effect if surgical start-times become skewed. Anesthesia teams, charge and floor nurses and EVS staff all have a role to play in efficient OR room turnover and on-time starts. •

Do you have a Water Problem in your O.R.?

Stop A Flood With AquaVac® The safest and most cost-effective fluid control system available.

AquaVac®-S (Shoulder Arthroscopy)

• Rapid Fluid Removal: 1 gallon every 70 seconds.

• Increased Productivity and Quick O.R. Turnover time.

• Connects to Standard O.R. suction equipment.

• Easily cleaned with Standard O.R. disinfectant or in a cart washer.

• Economical and Reusable.

• Precision molded rubber with anti-fatigue benefits.

AquaVac®-100 (Knee Arthroscopy)

• Minimize Staff Injury due to slips/falls on wet O.R. Floors.

• Four (4) Models available.

Order Now! Immediate Delivery.

Want to Learn More? www.arthroplastics.com

WWW.ORTODAY.COM

1-800-676-3809

sales@arthroplastics.com

SEPTEMBER 2019 | OR TODAY |

15

INDUSTRY INSIGHTS

news & notes

FDA Clears Vistaseal Open, Laparoscopic Dual Applicator Devices Johnson & Johnson Medical Devices Companies announced that Ethicon has received 510(k) clearance from the U.S. Food and Drug Administration (FDA) for its Vistaseal Open And Laparoscopic Dual Applicators (35 cm and 45 cm), three next generation airless spray devices that combine biologics with device technology to address mild to moderate surgical bleeding.

These biosurgery products are the first to emerge from a recently forged long-term strategic partnership between the global device maker and Grifols, a world leader in the

production of plasma-derived medicines. Grifols developed the Vistaseal Fibrin Sealant (Human), and Ethicon’s devices are designed to deliver the two biological components of the product.

Beyond Vistaseal, the partnership with Grifols will provide a supply of thrombin for Ethicon’s current products. In the future, it will mean even more advances in the field of adjunctive hemostats with the goal of reducing complications and improving the standard of care. •

Compliance Platform Launches New Database for Tissues/Implants oneSOURCE has launched its new tissues/implants database for use in health care facilities across the country. This expansion arms sterile processing and operating teams with an efficient way to manage manufacturer IFUs for implantable materials and devices.

“We couldn’t be more excited to tap into this new vertical,” said Jack Speer, co-founder and president of oneSOURCE. “More than 80 percent of the health care facilities in the U.S. subscribe to our database for manufacturers’ IFUs for surgical and equipment and we aim to accomplish that type of adoption for this new initiative. We continue to keep patient safety as our top priority and are confident that this highly anticipated launch will enable health care professionals to be equipped with the most reliable and readily accessible documents they need to successfully do their job while also adhering to standards set by regulatory organizations such as The Joint Commission and AAMI.” By including exact and most recent versions of manufacturers’ IFUs for Implantable Tissues and Devices, oneSOURCE is empowering health care facilities with the tools they need to stay compliant in the most efficient and accessible way possible. Based on the recommendations of

16 | OR TODAY | SEPTEMBER 2019

database users, new features such as a customizable option, where users can create lists of frequently used IFUs, have also been added. The diverse range of implants and devices that this database will serve as a resource for includes human tissue allografts, cardiac pacemakers, stents, vascular grafts, repair meshes and slings, devices, orthopedic joints, among more. • For more information, visit onesourcedocs.com.

WWW.ORTODAY.COM

Sterile Concepts Offering

AAAHC Opens Applications for New Governance Units The Accreditation Association for Ambulatory Health Care (AAAHC) is seeking enthusiastic health care professionals to volunteer for its new committees, called Governance Units. Supporting AAAHC’s 1095 Strong, quality every day philosophy, the Governance Units will facilitate the improvement and growth of the association, advocate for patient safety, share innovative ideas and provide guidance and strategy on educational opportunities.

“We are eager to receive applicants who are dedicated to creating a better health care environment that promotes patient safety,” said Noel Adachi, MBA, CEO of AAAHC. “Following our 1095 Strong, quality every day philosophy, committee members will help to drive excellence in the ambulatory health care industry.”

The AAAHC structure leverages volunteer expertise and energy to promote opportunities for deeper engagement.

Member volunteers can share their passion and insight, while advancing their profession.

Governance Unit members will be selected based on health care experience and a balance of perspectives to support the charge of the Governance Unit and AAAHC. To be eligible for the accreditation committee and accreditation work group appointments, members must be an AAAHC Surveyor in good standing and have completed at least 10 surveys within five years, including three as a chairperson, and have successfully completed one surveyor re-training program.

“The Governance Units will help AAAHC provide peerreviewed, evidence-based standards that are facility-specific and advance the standards of care all 1,095 days of the accreditation terms,” said Adachi.

“Participation on AAAHC committees has been a careerenriching experience for me, and an opportunity to learn new leadership skills, network with colleagues across the industry, and help define higher standards for patient care, safety and quality in an area in which I am passionate,” said Arnaldo Valedon, MD, AAAHC Board Chair.

All Governance Unit volunteer terms are for one year, and members may serve up to eight years, not necessarily consecutive, on any given Governance Unit. Terms will begin on January 1 and will end on December 31.

For additional details or to apply, visit AAAHC Governance Unit Application Process.

WWW.ORTODAY.COM

Central Service Consulting & Management Solutions

• Pre Joint Commission & CMS Assessments • Instrument Tracking and Optimization • Water Quality, Staining, Rust & Particulate • Staff Training & Certification • Autoclave and Case cart Management • Device & Instrument Management • Sourcing, RFP & Value Analysis 35 YEARS OF SPD EXPERIENCE Solve Your SPD Challenges, contact

402-613-4807 SEPTEMBER 2019 | OR TODAY |

17

INDUSTRY INSIGHTS

IAHCSMM

Central Service Week Offers Golden Opportunity to Honor Profession

By Julie E. Williamson ach year, beginning the second Sunday of October, International Central Service Week (celebrated Oct. 13-19 this year), recognizes Central Service/Sterile Processing (CS/SP) professionals for their enduring commitment to quality, patient safety and professionalism – and the International Association of Healthcare Central Service Professionals (IAHCSMM) urges every CS/SP department and health care professional in every facility to celebrate the discipline’s hard work and vital contributions.

E

I vividly recall the first time I toured a hospital CS/SP department. It was 1997 when I visited a hospital just outside Savannah, Ga., as a naïve reporter who had, up until that time, only written about the world of sterile processing. Shortly after arriving to the department, I found myself “bunnysuited” up and had my eyes opened to the vital and challenging roles and responsibilities of sterile processing.

I vividly recall the sweltering, almost suffocating heat of the decontamination area, and how the technicians meticulously scrubbed, brushed and flushed instrument after instrument, all without complaint. I also recall the breadth of knowledge involved in proper tray assembly and how impressed I was with the team of technicians who could rattle off the names of each instrument and almost instinctively know how to process, disassemble, assemble and carefully handle each one. Mostly, I remember how passionate the team seemed in doing each step correctly, and how patient

18 | OR TODAY | SEPTEMBER 2019

the team members were in showing me the ropes. This experience, and my other visits that came later, have given me a far better understanding and appreciation of the CS/SP profession – and continues to serve as invaluable fodder for my CS/SP-related writing.

It also makes me and my IAHCSMM colleagues passionate about celebrating the profession and all who comprise it, and encouraging every CS/SP professional, Surgical Services team member (and other CS/ SP health care customers), C-level executives, infection preventionists and more to join in the celebration and pay tribute to these hard-working, dedicated instrumentation and sterilization experts.

Celebrating well (on any budget) Although limited budgets are not uncommon, CS/SP professionals can still effectively celebrate CS Week on a shoestring budget with the help of some creativity, brainstorming and group participation – and even some

assistance from other departments, such as the Operating Room, Endoscopy, Labor & Delivery, and beyond.

What follows are some top tips for creating a memorable, fun and educational CS Week that drives strong participation, but without breaking the bank:

Honor the Team through Professional Growth CS Week is a perfect time to reflect on professional development. Contact a local vendor to provide an educational inservice and consider inviting members from other departments, such as the OR, to participate as well. Create a poster for the department that highlights a success story (or several) that occurred in the past year, or a bulletin board with staff pictures and employment history. Managers may also ask C-level executives if they will be willing to fund a certification scholarship for staff to become certified, or they may agree to help distribute certificates to employees who helped

WWW.ORTODAY.COM

“OR Today’s webinar’s presentations are achieve departmental goals. Managers may also send a personal note or card to each member of their team to thank them for their contributions toward better patient safety and care.

These types of personalized tokens of appreciation cost virtually nothing but can go a long way toward improving employee satisfaction and morale.

Build Interest Early for Greatest Participation/Impact Don’t limit CS Week events just to those within the department. Let other health care professionals in the facility and members of the general community know about International CS Week well in advance and share with them why celebrating the profession is so important.

Consider placing CS Week-inspired ads in facility newsletters, post flyers in common areas and, perhaps, even consider writing an article or press release for local newspapers that outlines the facility’s CS Week plans/events (the facility’s human resources and/or public relations teams can help get the word out effectively). The more aware others are of the event, the more likely they will be to participate and lend support.

Celebrate the Entire Week Create a different educational/celebratory opportunity for every day of CS Week. Consider an open house for one day, for example, and recruit vendors to provide educational inservices on another one or two days. Host a lunch, dinner or dessert social, and invite team members from the OR, Infection Prevention and Endoscopy, for example, as well as C-level executives, elected officials and others to participate. While these individuals are present, keep them engaged with educational offerings, such as process demonstrations, videos or standardsbased trivia games. Light snacks and refreshments also serve to draw (and keep) receptive crowds.

WWW.ORTODAY.COM

Court Collaboration In the weeks and days leading up to CS Week, work with health care customers and create poster presentations, bulletin boards or hands-on demonstrations on how each department can assist CS/SP (and vice versa) in doing their job more effectively and efficiently. Stressing the importance of proper point-of-care treatment of instruments (e.g., wiping off gross soil, keeping instruments moist during and ensuring instruments are transported promptly to decontamination after their use) and reminding team members of the importance of diligent instrument inspection and ensuring that instruments are sharp and wellmaintained are just a few examples that could be shared to promote quality and teamwork.

timely, and spot on to the important topics facing today’s OR managers and directors.“ G. Harmon, Director of Perioperative Nursing Services

WEBINAR SERIES

Honor Other Departments CS/SP professionals can garner greater support for CS Week (and their profession, in general), if they take time to honor and recognize their health care customers/partners for their efforts and contributions throughout the year. Infection Prevention Week also falls in October, and this offers a prime opportunity for CS/SP professionals and IPs to partner and create a unified front during each profession’s dedicated week. The same is true of Perioperative Nurse Week, which is celebrated in November. Consider thanking these professionals with a heartfelt note of gratitude and/or delivering baked goods during their respective celebratory weeks, and don’t forget to ask how members of the CS/SP team can help honor their profession. Reciprocation is invaluable for driving support and keeping appreciation going long after each department’s designated week of celebration draws to a close.

For more CS Week ideas and inspiration, visit https://www.iahcsmm.org/ events/cs-week.html.

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

SEPTEMBER 2019 | OR TODAY |

19

INDUSTRY INSIGHTS

CCI news & notes

Efficacy in Surgical Services Transition-to-Practice “Critical Thinking” vs. “Standard Work”

By Brandon G. Bennett urgical services management is perhaps the most complex nursing leadership specialty. The tasks performed by surgical services nurse leaders and the knowledge needed to perform those tasks have been delineated in job analysis findings. The job analysis findings provide a standardized, scientifically valid foundation for assessments and measurements. These findings are the basis for certification examinations and may also serve as a basis to assess competency; a recognized method of describing levels of performance or practice based on predetermined specific metrics, performance goals or measurements.

S

Measurement of achievement by competency has been developed against a broad spectrum of expectations.

The major areas of knowledge for surgical services nurse leaders provide the framework for preparation and measurement. The seven knowledge and skill domains include: (1) communication and relationship management; (2) financial management; (3) human resource management; (4) leadership; (5) operational management; (6) professionalism; and (7) strategic management.

Successful transition into health care professions is achieved by (a) the academic model by certificate or

20 | OR TODAY | SEPTEMBER 2019

diploma or (b) self-study or on-the-job training by competency statement or certification. Neither of these methods is standardized for surgical services nurse leaders and there is ongoing opportunity for improvement.

Educational experiences in academia have evolved to more fully support multi-generational learners; however, concerns remain. The overarching problem with academic preparation of surgical services leaders is the lack of specificity of knowledge and skills. A knowledgeable mentor/ instructor is also needed to guide and direct the learner. There are few academics who have practice experience in the surgical services space and even fewer who have surgical services leadership expertise.

On-the-job opportunities for learning surgical services leadership are plentiful; however, without structure or support, the experience may not be educational or may not support evidence-based and sustainable leadership development. Although learning opportunities can be readily identified, alignment with a mentor/instructor is a challenge most often attributed to availability of the surgical services expert.

Contemporary models of transition into professional practice incorporate clearly delineated learning experiences. These models are most often created using either the (a) intern-toresidency model or (b) the apprenticeship model associated with a variety of artisans and trades.

Brandon G. Bennett, DNP, RN, CNS, CNOR, CNS-CP, CSSM, CEN, NE-BC

Today’s transition-to-practice models are evolving from a traditional critical-thinking format to a more contemporary model using a standardwork format, i.e., there are structured activities from which specific knowledge and unique tasks are learned. The work of surgical services nurse leaders is well delineated with job analysis findings. Thus, surgical services leadership development is poised to reap the benefits of the job analysis work.

Most intern-residency programs for nurses incorporate structured learning activities – standard work – and thereby facilitate entry into the practice of nursing. In internship-residency programs, the student has progressed through formal “academic” educational processes and begins a series of structured experiences. Learning the fundamentals of surgical services management should be structured and should follow the standard work model. It’s not important if the relationship of learner to expert is one of intern, resident or apprentice. What WWW.ORTODAY.COM

LOGO

PHONE NUMBER

WEBSITE

ADDRESS

SPELLING

GRAMMAR

TRIM 4.5”

is crucial is identification and alignment with a learned, prepared expert who has surgical services management acumen.

Recommended fundamentals of surgical services management are well defined through job analysis. Program development and affiliation with experts needs to be outcomes driven and should strategically establish learning that will align with the major areas of knowledge substantiated by job analysis methodology. Competency can then be measured by certification examinations, standardized tests of knowledge and assessments of performance. The attainment of certification is an outward demonstration of commitment of the professional to engage in lifelong learning and to seek and validate evidence-based competency in surgical services management.

TRIM 4.5”

Special Sale Now: GE Dash 4000

Sales, Service, Repairs and Rentals

Brandon G. Bennett, DNP, RN, CNS, CNOR, CNS-CP, CSSM, CEN, NE-BC, has worked extensively with CCI as a presenter and author.

Introducing an Improved Esmarch!

PUBLICATION

MEDICAL DEALER

TECHNATION

ORTODAY

Tetra announces a new Latex Free, Powder Free, OTHER Talc Free, Textured Esmarch Bandage

BUYERS GUIDE MONTH J

F

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

This first of a kind bandage offers M

A

DESIGNER: JL

M

J

J

A

S

O

N

•DExcellent elongation • Textured to allow better gripping and easier application • No weak points • 100% Powder Free and Talc Free

To learn more contact us at 800-621-4041, or visit www.tetramed.com

WWW.ORTODAY.COM

SEPTEMBER 2019 | OR TODAY |

21

ENVIRON-MATE DM6000 SERIES ®

DM6000 Utility/SPD

CALL US BEFORE YOU BUILD OR REMODEL! 800-201-3060 Systems require plumbing most conveniently installed during new construction or remodeling.

S

y

DM6000-2 Endoscopy

USE OUR DM6000-2A IN SURGERY...

(Arthroscopy, Urology)

Screw top minimizes risk of C. Diff.

...TO ELIMINATE THESE!

INDUSTRY INSIGHTS

WEBINAR SERIES

newswebinars & notes

OR Today Delivers ‘Phenomenal Webinar’ Staff report he recent OR Today webinar “Establishing A High School Sterile Processing Clinical Program” was eligible for one (1) continuing education (CE) hour by the State of California Board of Registered Nursing.

T

The 60-minute webinar featured Elizabeth “Betsy” Vane, RN, MS, CNOR, CHL, CRCST, CSPDT, Health Science Teacher at Health Careers High School, and Deborah Austin, RN, BSN MA, Health Department Coordinator at Health Careers High School in San Antonio, Texas. The presenters mentioned that maintaining certified/qualified sterile processing personnel is a challenge for today’s surgical teams. The presenters agree that it is time to move toward teaching high school students about this career field.

Vane and Austin discussed the significant clinical and legal considerations for teaching high school students about the roles and functions of sterile processing personnel in an academic setting and within the hospital(s) in their community. Details about school district support of a national certification process was included.

The Microsystems-sponsored presentation was well attended and drew positive reviews via a post-webinar survey.

“This was a fantastic and timely webinar. We struggle to find trained sterile processing technicians. The department tends to be a revolving door. With each new hire, we start from the ground level again. My organization has already partnered with a local high school. This presentation gave us a roadmap to new opportunities with this existing partnership,” said T. McMeen, Erlanger Health System.

“This webinar was very informational. With the shortage of SPD techs, having this program in our STEM high school would be great! We would provide education and training and jobs! Awesome. Thank You,” shared K. Stengel, PeaceHealth Southwest Medical Center, Quality & Safety Nurse Specialist.

WWW.ORTODAY.COM

“ This webinar was very informational. With the shortage of SPD techs, having this program in our STEM high school would be great!” K. Stengel, Quality & Safety Nurse “This webinar was fabulous! We hope to replicate this high school program! My role is clinical education, primarily nursing education, so I did not know all the info requested regarding specifics in the OR/Central Sterile departments,” said J. Steelman, Erlanger Health System, Clinical Education Administrator.

“Phenomenal webinar! I so would love to develop this in our community,” said S. Weir, Great Plains Health, Periop educator.

“Our SPD has been in need of great improvement for years now. I feel we have just recently reached a point where our new system of tracking, etc. is helping. The employee turnover in SPD is still incredibly high, likely reflective of our ‘outgrowing’ the space and equipment. A program of this sort would be a huge bonus to our departments and to the young workforce. I am excited to take this information to our SPD leadership,” said B. Burton, Wake Forest Baptist Medical Center, RN, CNOR, staff nurse inpatient OR. For more information about the webinar series, including a calendar of upcoming sessions, visit ORToday.com and click on the Webinar tab.

Thank you to our sponsor:

SEPTEMBER 2019 | OR TODAY |

23

PLACEMENT Tru-D’s patented Sensor360® technology calculates a measured, lethal UVC dose that destroys pathogens throughout an entire room from one position.

CYCLE Tru-D’s reflected UVC dose is validated by multiple studies to compensate for room variables and disinfect all surfaces, even in shadowed areas—in one cycle.

GOAL Adding Tru-D’s enhanced UVC disinfection technology to your cleaning protocols has been shown to provide a safer environment for patients. That’s the power of ONE.

Learn more at www.tru-d.com TRU-D.COM • 800.774.5799

I t ’ s Tr u: Tr u - D Po w e r O f O n e . co m | S e e t h e Pr o o f : Tr u - D. co m /s t u d i e s

IN THEINOR THE OR

market analysis

UVC Disinfection Market Trending Up

By John Wallace he ultraviolet disinfection market includes a wide range of applications across many industries. The health care segment of the market continues to show growth and growth potential. It is one segment that is pushing the overall market to new heights.

T

A MarketWatch News report sees the market reaching $5 billion in the near future.

“The global ultraviolet disinfection equipment market is expected to exceed more than $5 billion by 2024 at a compound annual growth rate (CAGR) of 14% during the period 2018-2024,” according to MarketWatch News. “The UV disinfection equipment market would garner revenue of $3.6 billion by 2020. The significance of different disinfection methodology like UV disinfection is growing by the day, as these strategies are higher than typical chemical based disinfection.”

Some driving factors for the market

WWW.ORTODAY.COM

are value effectiveness as compared to alternative new disinfection ways and new government initiatives for UV disinfection, according to the report.

A BCC Research report also predicts continued market growth.

“The global market for UV disinfection equipment should grow from nearly $2.1 billion in 2018 to $4.4 billion by 2023 with a compound annual growth rate (CAGR) of 16.2% for the period of 2018-2023,” according to the report.

Tru-D Smart UVC President and CEO Chuck Dunn also has a positive forecast for the market.

“The UVC disinfection market has grown exponentially in the past few years. Tru-D was the first notouch UVC disinfection device on the market in 2007. Today, the market has grown, and there are several companies that offer various types of UVC disinfection technologies,” Dunn said.

Dunn said research is among the factors that have propelled the market in recent years.

“As more evidence-based research is becoming available on UVC disinfection, including the first and only randomized clinical trial, the ‘BETR-Disinfection study,’ which was published in 2017 in The Lancet, hospitals are realizing the importance of and need for enhanced room disinfection. Notable researchers in infection control and hospital epidemiology have begun to stress the need for no-touch disinfection technology, which has driven acceptance of UVC robots in prestigious health care systems and hospitals throughout the U.S. Further, hospital reimbursements for infections also play a role in the decision to implement UVC disinfection technology,” Dunn said.

He predicts continued growth for the health care segment of the UVC disinfection market.

“As more evidence of UVC disinfection’s efficacy becomes available, enhanced terminal room disinfection strategies will likely become a standard of care for all hospitals,” Dunn said.

SEPTEMBER 2019 | OR TODAY |

25

IN THE OR

product focus

Bioquell BQ-50

This automated decontamination system from Bioquell, an Ecolab solution, offers a mobile and effective solution that can be used hospital-wide to reduce HAIs. The Bioquell BQ-50 utilizes Bioquell’s proprietary 35% Hydrogen Peroxide Vapor technology to eliminate pathogens such as C. diff, MRSA, VRE, Norovirus, CRE, and more. Safe on sensitive electronics and residue-free, users can eradicate 99.9999% of microbial contaminants on all exposed surfaces in an enclosed area. •

American Ultraviolet UVC OR Package

The UVC OR package is the only whole room disinfection solution designed to be used before, during and after a procedure. An automatic daily disinfection cycle requires no staff to initiate and all of the data is collected and saved. The system is unique as it delivers the energy from the ceiling down and this helps to eliminate shadows so one cycle treats the entire room. The package requires no additional staff so facilities save on labor hours and additional FTEs. The package is designed for the space to maximize effectiveness if it is glowing blue it is being disinfected. •

26 | OR TODAY | SEPTEMBER 2019

WWW.ORTODAY.COM

IN THE OR

product focus

Clorox Healthcare Optimum-UV Enlight System

The Clorox Healthcare Optimum-UV Enlight System is an all-in-one solution providing powerful surface treatment enhanced

by UV-C technology to kill more than 30 pathogens including C. difficile spores, CRE, VRE and MRSA, for infection prevention and patient safety. The Optimum-UV Enlight System provides a balance of strong performance, quality, user-friendly design and affordability, with advanced data collection and reporting capabilities that help health care facilities ensure they are maximizing device usage and getting the efficacy they are counting on. • For more information, visit www.CloroxPro.com.

Diversey

MoonBeam3 Disinfection System Diversey’s MoonBeam3 ultraviolet-C disinfection device is a portable, powerful solution that disinfects quickly, reliably and responsibly. MoonBeam3 is cost-effective and designed for fast, on-demand disinfection of environmental surfaces. MoonBeam3 has multiple safety features for protecting staff and patients. The system offers three individually-adjustable arms that can be positioned to enable the UV-C light to surfaces in the OR (both horizontal and vertical), optimizing disinfection energy and dosing for environmental surfaces and non-critical equipment, in just 3 minutes. •

WWW.ORTODAY.COM

SEPTEMBER 2019 | OR TODAY |

27

IN THE OR

product focus

Xenex

LightStrike Xenex’s LightStrike technology helps health care facilities reduce the risk of surgical site infections (SSIs) by quickly destroying the pathogens that can cause infections. Easily integrated into a facility’s comprehensive infection prevention program, the portable LightStrike robot uses pulsed xenon to create intense UV light that spans the entire UV spectrum, hitting key areas where bacteria and spores are most vulnerable. Hospitals using LightStrike for OR disinfection have published research showing 46-100% reductions in Class 1 SSI rates and a 72% decrease in bacterial load after a 2-minute cycle – making between-case disinfection possible. •

Tru-D

SmartUVC Tru-D SmartUVC is a portable UVC disinfection robot that delivers one automated, measured dose of UVC from one placement within the operating room, ensuring significant percent pathogen reduction in direct and shadowed areas and reducing the threat of human error in the disinfection process. The first-ever randomized clinical trial on UVC disinfection, the Benefits of Enhanced Terminal Room-Disinfection (BETRDisinfection) study, showed that enhanced terminal room disinfection strategies using Tru-D decreased the relative risk of colonization and infection of target MDROs among patients admitted to the same room by a cumulative 30% in a hospital setting with 93% compliance of standard disinfection protocols. Individual hospital results may vary. • For more information, visit www.tru-d.com.

28 | OR TODAY | SEPTEMBER 2019

WWW.ORTODAY.COM

IN THE OR

product focus

Skytron

Disinfection Robots Skytron offers a family of three disinfection robots, one to meet every facility’s need and budget. At each price point, they generate UV-C energy resulting in superior disinfection levels and high customer value. Intelligent dose assurance technology automatically calibrates the proper treatment duration to ensure a thorough amount of germ-killing UV-C energy is completely applied to all surfaces in the treatment area eliminating human error and the danger of under-dosing.

Strong germicidal power levels combined with dose assurance technology enables fast single-cycle, whole-room disinfection treatments without repositioning. •

Surfacide

Helios System Helios by Surfacide is a patented tripleemitter infection prevention system protecting against surgical site infections in the OR. The system’s 3 emitter (robots) reach more surfaces than single robots in less time given the proximity of the Surfacide emitter to the fomites. Surfacide provides an evidence-based automated UV-C system that data indicate is effective at reducing surgical site Infections. •

WWW.ORTODAY.COM

SEPTEMBER 2019 | OR TODAY |

29

CE734

IN THE OR

continuing education

Reducing the Risk of Surgical Site Infections with the Surgical Care Improvement Project

BY M AY MEI-SHENG RILEY, MSN, MPH, RN, ACNP, CCRN, CIC, FAPIC BARBARA BARZOLOSKI-O’CONNOR, MSN, RN, CIC

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

P

30 | OR TODAY | SEPTEMBER 2019

and

Patients with an SSI have longer hospital stays (seven to 11 days), increased morbidity, and an increased risk of dying as a direct result of the SSI at a rate of 77%.3 SSIs also contribute significantly to U.S. healthcare expenses costing an estimated $3.5 billion to $10 billion each year.3

What Is a Surgical Site Infection?

An SSI is an infection related to an operative procedure that occurs at or near the incision (incisional or organ/space) within 30 days — or within 90 days if an implant is left in place.3 SSIs complicate the recovery of 2% to 5% of patients with extra-abdominal surgeries (e.g., thoracic and orthopedic surgeries) and up to 20% of patients with intra-abdominal procedures (e.g., gynecologic and colon surgeries).

SSIs account for nearly 40% of all HAIs among surgical patients and are the second most commonly reported HAI making up 22% of all such infections.2

Relias LLC guarantees this educational program 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 continuing education program is to provide perioperative nurses, pharmacists, and surgical technologists with information about preventing surgical site infections. After studying the information presented here, you will be able to: • List three physiological risk factors in patients associated with increased potential for surgical site infections • Discuss the rationale for administering prophylactic antibiotics as close to the time of surgical incision as possible • Describe how perioperative caregivers can help prevent surgical site infections

WWW.ORTODAY.COM

IN THE OR

continuing education

WHAT IS A SURGICAL SITE INFECTION?3,4 Type of infection

Tissue

Signs and symptoms

Superficial incisional SSI

Skin or subcutaneous tissue.

No deeper than adipose tissue; muscle and fascia not involved.

»» Purulent drainage »» Organisms isolated from fluid/tissue aerobic organisms »» One sign of inflammation, such as pain or tenderness, swelling, erythema, or heat.

There are two specific types of superficial incisional SSIs: 1. Primary Superficial Incisional — a superficial incisional SSI that is identified in the primary incision in a patient who has had a surgery with one or more incisions (e.g., chest incision for coronary artery bypass graft) 2. Secondary Superficial Incisional — a superficial incisional SSI that is identified in the secondary incision in a patient that has had a surgery with more than one incision (e.g., donor site incision for coronary artery bypass graft with both chest and donor site incisions) Deep incisional SSI

Deep soft tissues, such as fascia and/or muscle layers

»» Purulent drainage from deep incision but without organ/space involvement. »» Deep incision dehiscence, or surgeon deliberately opens incision because of signs of inflammation. Aerobic or anaerobic microorganisms. »» Identification of an abscess above the level of the fascia.

There are two specific types of deep incisional SSIs: 1. Primary Deep Incisional — a deep incisional SSI that is identified in the primary incision in a patient who has had a surgery with one or more incisions (e.g., chest incision for coronary artery bypass graft) 2. Secondary Deep Incisional — a deep incisional SSI that is identified in the secondary incision in a patient who has had a surgery with more than one incision (e.g., donor site incision for Coronary artery bypass graft with both chest and donor site incisions) Organ/Space SSI

WWW.ORTODAY.COM

Involves underlying anatomical structures manipulated during the surgery not including the skin, incision, fascia, muscle layers

»» Purulent drainage from a drain placed into the organ/space. »» Organisms isolated from a culture of fluid or tissue in the organ/space below the level of the fascia. Usually anaerobic microorganisms. »» Identification of an abscess in the organ/ space that is detected on gross anatomical or histopathological exam or imaging test evidence suggestive of infection.

SEPTEMBER 2019 | OR TODAY |

31

IN THE OR

continuing education

Reduction of SSI The Surgical Care Improvement Project (SCIP) is a set of performance measures developed by the Centers for Medicare & Medicaid Services (CMS), The Joint Commission, CDC, the American College of Surgeons, and the American Hospital Association to serve as a framework to monitor progress and improve patient safety.

The high numbers of SSIs raised concerns about patient safety and led the national organizations to design the SCIP, which focused on reducing patient surgical complications and preventable surgical morbidity and mortality by 25% by 2010. (It has not been determined whether it has achieved its goals). The organizations developed performance measures as part of SCIP to reduce the morbidity and mortality associated with postop SSIs. As an added incentive for preventing SSIs, CMS has stopped paying hospitals the extra costs of treating patients with some of the HAIs that reasonably could have been prevented by following evidence-based guidelines. Medicare diagnosis-related group payments will also be affected by how well hospitals perform in SCIP measures. Private insurers will likely follow Medicare’s lead in withholding payments in the near future.

Monetary penalties may be what are needed to ensure that every hospital follows the SCIP initiatives for reducing SSIs. More than 15 years ago, the CDC issued guidelines for the prevention of SSIs. These were followed by guidelines from the Surgical Infection Prevention Project in 2002 and then by the SCIP performance measures in 2005. Over the years, the measures have changed slightly to incorporate not only infection-related elements, but also

32 | OR TODAY | SEPTEMBER 2019

measures for beta-blocker use and venous thromboembolism prevention.

Yet despite evidence showing the effectiveness of the guidelines, many providers inconsistently comply.5 This module will provide healthcare professionals of various disciplines with the latest information about SCIP performance measures to reduce SSIs, including:3,6 • The prevention of infection through proper selection, timing, and administration of antimicrobial prophylaxis. Doses are adjusted according to body weight. Obese patients may require larger doses for increased periods of time while elderly patients, patients with renal or hepatic disease, and pediatric patients may need decreases in dose • The control of blood glucose postoperatively in cardiac surgery patients to 180 to 200 mg/dL, but not lower than 110 mg/dL • Proper hair removal with clippers or depilatory outside the OR • Maintenance of the patient’s body temperature between 96.8 F and 100.4 F (36 C and 38 C) within one hour of leaving the OR • Appropriate hygiene and gowning prior to OR entry for all members of the surgical team • Appropriate post-surgical wound care and maintenance By following these recommendations, about 40% to 60% of SSIs can be prevented.3

Predicting the Risk for Surgical Site Infection SSIs occur despite the best surgical techniques, the thoroughness of skin disinfection, and the OR staff’s prevention strategies. At the time of incision, every surgical site becomes contaminated with bacteria inward from the skin or outward from the

internal organ being operated on if disease-causing microorganisms are present. Most contamination is due to the patient’s endogenous flora present at the surgical site on the skin, on mucosal membranes, or in the hollow digestive viscera. Other contamination can come from exogenous sources, such as the OR staff and environment, including the air ventilation system and surgical instruments.6 But for most patients, bacteria in a wound does not result in infection. Usually, innate host defenses can eliminate the contaminating organisms.6 When SSIs do develop, among the most important contributing factors are the number of bacteria inoculated into the wound, virulence of the bacteria, and local blood flow (i.e., the delivery of oxygen, inflammatory cells, cytokines, and nutritional components to the surgical site).3,6 Also important are the appropriate administration of antibiotics and the adequacy of host immune defenses — innate or acquired.

Patient-related risk factors also influence the development of SSIs, including advanced age, obesity, diabetes, malnutrition, poor tissue perfusion, the use of steroids or other immunosuppressant drugs, a preoperative stay in a hospital (more than four days), colonization with Staphylococcus aureus, or remote infection at the time of surgery.6 Additional factors include radiation therapy to the surgical site, blood transfusion (causes reduced macrophage activity), and previous history of SSI.3,6 Procedural techniques can influence the risk for infection, such as using electrocautery on the skin.

Residual “dead space” in the wound after closure can lead to infection by creating favorable living conditions for bacteria to multiply. Some surgeons use a wound edge protecWWW.ORTODAY.COM

IN THE OR

continuing education

tor drape, or an adhesive incise sheet over the exposed skin before the incision is made as a preventive measure.

The incise sheets can be plain clear plastic or impregnated with iodophor.

A common practice is to irrigate the surgical site with sterile saline or antibiotic solution before closing the skin.6 Environmental considerations include adequate surface cleaning with U.S. Environmental Protection Agency-approved disinfectants and minimizing dissemination of particulates in the air. Surfaces such as push plates, cabinet handles, and knobs, buttons, and keyboards can harbor harmful bacteria and endospores, such as clostridia (e.g., Clostridium difficile). ORs have specialized airhandling systems that exert positive pressure when the door is opened and negative pressure in the corridors.

This prevents additional particulate matter from being pulled into the room from the hallway if the door is opened.6 Some specialty rooms have a system of laminar airflow that directs the cleanest air possible toward the sterile field. Some entryways have ultraviolet light for additional bacteriostatic protection. The air quality is maintained at the cleanest levels possible, but air itself is never sterile.6 Human factors in bacterial spread include the attire of the OR staff — sterile gowns and gloves, hair covers that completely cover the hair and ears, and masks. Skull caps should be avoided because the hair at the nape of the neck protrudes and can shed bacteria and particulate into the surgical site.6 The number of bacteria in the incision at the end of surgery is the major determinant of SSIs. More than 40 years ago, the CDC used a clinical estimate of the number of bacteria likely to be encountered in the surgiWWW.ORTODAY.COM

cal site during surgery to develop a surgical wound classification system.

Four classes of surgical procedures were determined: clean, clean-contaminated, contaminated and dirty, or infected — each with a distinctive infection risk rate:6 • Class 1: Clean procedures: an uninfected primary surgical incision without inflammation; respiratory, GI, biliary, or genitourinary tracts not entered; 1% to 2% infection rate without prophylactic antibiotics. Closed by primary intention and may be drained with closedsystem drainage. May be a nonpenetrating blunt trauma injury opened for exploration in the OR. No break in sterile technique.

• Class 2: Clean-contaminated procedures: surgical incisions in which respiratory, GI, biliary, and genitourinary tract are entered under controlled conditions with minimal spillage and no encounter with infected urine or bile; 6% to 9% infection rate without prophylactic antibiotics. No break in sterile technique.

• Class 3: Contaminated procedures: open, fresh, accidental wounds (of less than four hours’ duration) and surgeries with major breaks in sterile technique (e.g., open cardiac massage) or gross spillage from the GI tract; also includes incisions in which acute, nonpurulent inflammation is encountered; 13% to 20% infection rate without prophylactic antibiotics.

• Class 4: Dirty/infected procedures: purulent inflammation present. Includes old traumatic wounds (of more than four hours’ duration) with retained dead tissues and those that involve existing clinical infection or perforated viscera; about 40% infection rate

without prophylactic antibiotics.

Surgical risk is further defined by three additional risk factors that play a significant role in wound infections: an operation lasting more than two hours, an operation involving the abdomen, or an operation performed on a patient who has three or more underlying diagnoses (indicative of the patient’s clinical comorbidity).

The addition of these three factors to the CDC wound classification system makes predicting the risk of a wound infection twice as helpful as the traditional wound classification alone.3,6 Note that wound class is documented at the end of the surgical procedure and not before. The perioperative nurse has no way to predict what conditions may be encountered during the procedure, or if a major break in technique might occur before closure. For example: A Class 2 cholecystectomy can become a Class 3 if bile spills into the abdomen.6

Knowledge Versus Practice The introduction of antibiotics in the 1940s led to the belief that treating wound infections with antibiotics after surgery might be the answer to SSI. However, bacteria developed drug resistance that continues into modern times. It has taken hundreds of clinical trials to understand the most effective and appropriate methods of using antibiotics to prevent SSIs. The efficacy of antibiotics against SSIs was established in the 1960s, when studies determined they were most effective in preventing wound infections when given before the inoculation of bacteria into the wound and ineffective if given three hours after inoculation.3 Studies also confirmed that giving antibiotics for more than 24 hours after wound closure offered no additional benefits SEPTEMBER 2019 | OR TODAY |

33

IN THE OR

continuing education

unless the patient was obese with poor tissue perfusion.3 Although this important information resulted in good evidence-based guidelines, surgeons continue to use and time antibiotics inappropriately in many surgical procedures in U.S. hospitals.

Surgeons, nurses, surgical technologists, anesthesiologists, infectioncontrol practitioners, pharmacists, and hospital administrators can work together to improve patient safety by providing care consistent with medical evidence and clinical practice guidelines. The following evidencebased SCIP performance measures can serve as a framework to monitor progress in improving surgical patient safety.3,5

Surgical Care Improvement Project Core Measure Set SCIP — Infection 1: Prophylactic antibiotic received within one hour before surgical incision.

Prophylactic antibiotic received no earlier than one hour before surgical incision or within two hours before incision if vancomycin (Vancocin) or a fluoroquinolone (e.g., ciprofloxacin) is required for prophylaxis. Timing is also important if a tourniquet will be used. The drug should be permitted to have adequate penetration time before the tourniquet is inflated.3,6 Improving the timing of antibiotic administration is a crucial first step in preventing SSIs. Antibiotics should be given as close to the time of incision as clinically practical and no more than 60 minutes before surgery or tourniquet inflation unless the use of a fluoroquinolone or vancomycin is indicated.3 When a surgical incision disrupts tissue integrity, an inflammatory exudate (neutrophils, macrophages, blood cells, coagulation cascade proteins, and fibrin strands) begins filling

34 | OR TODAY | SEPTEMBER 2019

the space around the wound, embedding the contaminating bacteria in a fibrin clot matrix. To penetrate the fibrin clot matrix, the antibiotic must be present at the time of fibrin formation. To ensure a therapeutic level of antibiotic at the time of incision and during the surgical procedure, the patient should receive the antibiotic just before the incision is made.3 After an incision is closed, antibiotics have no appreciable effect on preventing infections. In addition, after the wound is closed, the increased hydrostatic pressure secondary to edema formation makes it difficult for antibiotics to gain access to the area around the wound space.3 If an infection develops post-operatively, the use of antibiotic therapy becomes therapeutic and is not considered preventative. Additional procedures to drain, debride, and culture the wound site may be required and antibiotic therapy should be narrowed down based on laboratory susceptibility results.

Hospitals need standard protocols to ensure that prophylactic antibiotics are delivered no more than one hour before the surgical incision is made. Patients should receive antibiotics when they reach the preoperative area or the OR rather than “on call.” With on-call dosing, case delays can result in patients not receiving preoperative doses within the recommended time frame. If an “on call” dose is given followed by delay, the patient should be redosed.3 Redosing is necessary if the patient has experienced a large volume of blood loss or the procedure lasts longer than two half lives of the given antibiotic.3 Prophylactic antimicrobials should be re-dosed at intervals based upon the guidelines developed by the American Society of Health-System Pharmacists (ASHP), the Infectious

Diseases Society of America (IDSA), the Surgical Infection Society (SIS), and the Society for Healthcare Epidemiology of America (SHEA).3 SCIP — Infection 2: Prophylactic antibiotic selection for surgical patients.

Surgical patients should receive prophylactic antibiotics in accord with current published guidelines for each type of procedure.3 For most surgeries, cephalosporins are the drugs of choice, and first- or secondgeneration cephalosporins, such as cefazolin (Ancef, Kefzol) or cefoxitin (Mefoxin) for colon surgeries, are ideally suited for prophylaxis.2,3 Colon procedures on patients requiring a mechanical bowel prep can also benefit from simultaneous oral antibiotics. Cephalosporins have a broad spectrum of activity against grampositive and gram-negative bacteria and a wide ratio of therapeutic to toxic dosages. Cephalosporins are also inexpensive and easy to administer, and allergic reactions are rare.3 The average adult dose of a preoperative cephalosporin varies but may range from 1 g to 2 g with various redosing intervals. Many agents do not require adjusted dosing for obese patients but some such as cefotaxime should be increased from 1 to 2 g based on expert recommendation.

Pediatric doses are weight based and can range from 30 to 50 mg/kg or as high as 75 mg/kg in the case of ceftriaxone.3 To ensure that appropriate antibiotics are used for prophylaxis, hospitals should follow recommendations from the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Sanford Guide to Antimicrobial Therapy, or the Surgical Infection Society.3 Hospitals with epidemiologists on staff should consult with them for WWW.ORTODAY.COM

IN THE OR

continuing education

recommendations on endemic pathogens and antimicrobial prophylaxis.

Vancomycin should not be routinely used for surgical procedures.2,3 However, sometimes it may be the best choice for prophylaxis. For example, vancomycin may be used when a patient has a documented beta-lactam allergy, is colonized with methicillin-resistant S. aureus or is at high risk for MRSA because of an acute inpatient hospitalization or nursing home stay within a year before admission, has an inpatient stay of more than 24 hours before the surgery, or is in a facility with a high rate of MRSA infections.3 The average adult dose of vancomycin is 15 mg/ kg. Obese patients can be dosed at the same weight-based amount plus an increase of 40% for excess weight.3 For all antibiotic dosing, pharmacists should be routinely consulted to ensure adequate timing and dosing especially for special patient populations like patients who are obese or pediatric patients.

The number of patients with MRSA has increased significantly in U.S. hospitals. Some physicians prescreen the patient for nasal microorganisms by preoperative nasal culture and then treat with antimicrobial mupirocin cream (Bactroban) accordingly.3 SCIP — Infection 3: Prophylactic antibiotics discontinued within 24 hours after the end of surgery.

Discontinuing prophylactic antibiotics within 24 hours after surgery (except cardiothoracic surgery when 48 hours is appropriate) is recommended. Evidence shows that continuing antibiotic prophylaxis beyond 24 hours after the incision is closed offers no additional benefits. In fact, prolonged use of antibiotics can lead to infection with Clostridium difficile and the emergence of antibioticWWW.ORTODAY.COM

resistant organisms.3 Clinicians on the healthcare team can use protocols and standard order sets to ensure that antibiotics are stopped after 24 hours.

Surgeons are advised to avoid using antimicrobial sutures coated with triclosan as a routine measure. Researchers are reviewing the relationship between this product and the development of antibiotic resistance.

Additional studies are ongoing to determine the effect of triclosan within the human body since it has been found in urine and breast milk.6 SCIP — Infection 4: Cardiac surgery patients with controlled 6 a.m. postoperative serum glucose.

Surgical patients with a perioperative blood glucose level of 200 mg/ dL or more have a greater risk of SSI. Hyperglycemia results in impaired host defenses by impairing polymorphonuclear leukocyte functions, including adherence, chemotaxis, phagocytosis, and bactericidal activity.

In a study of cardiothoracic patients, hyperglycemia was associated with a 102% increase in the risk for wound infection.3 In addition, patients with diabetes undergoing cardiac surgery have a two to three times greater risk of infection than patients without diabetes. Hyperglycemia is also risky for noncardiac surgery patients. It appears that the risk of infection increases fourfold if the patient becomes hyperglycemic at any time during the first postop day.3 The risk of surgical wound infections can be reduced by using insulin therapy to maintain tight blood glucose concentrations (between 80 mg/dL and 110 mg/dL).3 While this performance measure is limited to cardiac surgery, maintaining blood glucose levels less than 200 mg/dL is key for other postop patients as well.

Patients’ blood A1C levels should be maintained below 7%.3 Hospitals

should have a standardized glucose management protocol for all patients undergoing surgery.

SCIP — Infection 6: Surgery patients with appropriate hair removal.

The nicks and scrapes from preoperative razor shaving are linked to an increased risk of SSIs from skin-associated bacteria. Even with conscientious skin preparation, up to 20% of skin-associated bacteria remain on the skin beneath the surface in hair follicles and sebaceous glands. Shaving allows these bacteria to penetrate the microscopic cuts in the skin.3 To reduce SSIs, current practice recommends no hair removal, or if hair removal is necessary, removal in the immediate perioperative period with electric clippers and a disposable, single-patient-use cutting head. Clipping should not be performed in the immediate area where the surgery is done. Particulate-bearing microorganisms could become airborne and enter the incison.6 Razors should be removed from OR supply carts and surgical shave prep kits, so they are not used on patients. Healthcare professionals should educate patients not to shave operative or other body sites before surgery.3 SCIP — Infection 9: Urinary catheter removed on postoperative day 1 or 2 with day 0 being the day of surgery.

Device-associated infections are a problem with all patients and can be reduced by eliminating or minimizing the prolonged use of invasive devices.

Numerous studies have demonstrated the benefits of prompt removal of urinary catheters after surgery when there are no indications to leave the catheter in, such as after bladder surgery or the need to measure strict output. In one study, postoperative patients who had indwelling urinary SEPTEMBER 2019 | OR TODAY |

35

IN THE OR

continuing education

36 | OR TODAY | SEPTEMBER 2019

using preoperative and intraoperative measures to warm the patient, such as warmed IV fluids.2,3,6 Although some SSIs are unavoidable, surgical complications can be significantly reduced and patient safety improved by following the SCIP performance measures and other evidence-based practice recommendations. Preliminary studies on the success of SCIP suggest that adherence to all of the measures has more impact than adherence to a single measure and indicates better overall quality care. Healthcare professionals as a team, including nurses, surgeons, surgical technologists, infectioncontrol practitioners, and pharmacists, have a responsibility to follow these recommendations to make sure that patients receive the safest surgical care possible.

EDITOR’S NOTE: Connie C. Chettle, MS, MPH, RN, and Nancymarie Phillips, PhD, RN, RNFA, CNOR(E), past authors of this educational activity, have not had an opportunity to influence the content of this version.

May Mei-Sheng Riley, MSN, MPH, RN, ACNP, CCRN, CIC, FAPIC, is the area director at Providence St. Joseph Health and sits on the prevention strategist editorial panel for the Association for Professionals in Infection Control and Epidemiology.

She is also an author of Mosby’s Nursing Consult for Evidence-Based Nursing Monographs on Infectious Diseases and Infection Prevention.

Barbara Barzoloski-O’Connor, MSN, RN, CIC, is the infection control manager at Howard County General Hospital in Columbia, Md.

References 1. H ealthcare-associated infections: HAI data and statistics. Centers for Disease Control and Prevention Web site. https://www.cdc.gov/HAI/ surveillance/. Updated January 9,

2018. Accessed June 15, 2018.

2. M agill SS, Edwards JR, Bamberg W, et al. Multistate pointprevalence survey of healthcareassociated infections. N Engl J Med. 2014;370(13):1198-1208. doi: 10.1056/NEJMoa1306801.

3. A nderson DJ, Podgorny K, Berríos-Torres SI, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(6):605-627. doi: 10.1086/676022.

4. Surgical site infection event.

Centers for Disease Control and Prevention Web site. https:// www.cdc.gov/nhsn/pdfs/ pscmanual/9pscssicurrent.pdf.

Published January 2018. Accessed June 15, 2018.

5. Hand L. Surgical site infection monitoring inconsistent. Medscape Web site. http://www.medscape. com/viewarticle/835732. Published December 2, 2014. Accessed June 15, 2018.

6. P hillips N. Berry & Kohn’s Operating Room Technique. 12th ed. St Louis, MO: Mosby Elsevier; 2012.

Clinical VignettE ANSWERS 1. C – Shaving causes microscopic cuts in the skin that allow surface bacteria to penetrate causing infections. 2. A – The inflammatory exudate that forms when tissue integrity is disrupted by a surgical incision embed the contaminating bacteria in a fibrin clot matrix, making it difficult for antibiotics to reach the bacteria. 3. D – The Surgical Care Improvement Project was designed by a partnership of national organizations focused on reducing patient surgical complications by 25% by 2010. 4. B – One of the indications for using vancomycin is when the patient is at risk for MRSA.

catheters beyond the second day were twice as likely to develop a urinary tract infection.3,6 Many hospitals have a nurse-driven protocol to encourage the timely removal of urinary catheters.

SCIP — Infection 10: Surgery patients with perioperative temperature management.

Surgery patients with immediate postoperative normothermia (36 C to 38 C) within the first hour after leaving the OR. Hypothermia (a core body temperature less than 96.8 F or 36 C) almost always occurs in unwarmed patients during surgery. It develops from exposure to the relatively cool OR and the effects of anesthesia.

General or major regional anesthesia impairs the body’s normal thermoregulation and causes a shift of heat from the body’s core to its periphery.

In the first hour after induction, the core temperature drops by 1 to 1.5 C. It drops another 1.1 C during the subsequent two to three hours of anesthesia time, reaching a plateau at about 93.2 F or 34 C. As the body becomes hypothermic, vasoconstriction reduces the perfusion of subcutaneous tissue. This reduces the oxygen supply to the wound and impairs immune function, including T-cell mediated antibody production and the oxidative killing of pathogenic bacteria by neutrophils. As an illustration, in colon resection patients, a 1.9 C drop in core temperature (core temperature of 34.7 C) triples the incidence of surgical wound infections and increases the length of stay by a week or longer.3 Mild hypothermia also increases time in the hospital for uninfected patients.

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

WWW.ORTODAY.COM

Clinical Vignette At her hospital’s quarterly infection-control committee meeting, Sharon, an infection control nurse, presented the hospital-acquired infections surveillance results for the quarter. Surgical site infections were significantly increased compared to previous quarters. A subcommittee was formed to investigate possible causes and to explore ways of reducing infection rates.

1. Which practice could be increasing surgical site infections?

a. P rophylactic antibiotics were given to each patient within 30 to 60 minutes of incision. b. A cephalosporin was the drug of choice for most surgeries. c. The surgical sites of all patients were shaved the night before surgery. d. All patients were bathed with an antimicrobial soap the night before surgery.

2. Although most surgeons at the hospital were giving prophylactic antibiotics within 30 to 60 minutes of incision time, a few continued to order antibiotics to be given in the recovery room after surgery. What reasons could Sharon give to support giving antibiotics before incision time?

a. Antibiotics are not able to penetrate into the surrounding surgical area through the fibrin clot matrix that begins forming immediately when tissue integrity is disrupted by a surgical incision. b. The high blood sugar levels that occur in many patients shortly after surgery reduce the effectiveness of antibiotics. c. Antibiotics should not be given after surgery because they increase the time the patient has to remain in the recovery room, so nurses can watch for allergic reactions. d. N early all patients become hypothermic in the recovery room. The resulting vasoconstriction prevents antibiotics from reaching the bacteria.

3. Sharon told committee members that by following SCIP performance measures, they would be able to improve healthcare quality. Several committee members asked about SCIP. She can say that:

a. S CIP (Start Comparing Insurance Premiums) was designed to help patients compare what costs their health insurance would cover for surgeries. b. S CIP (Secure Communication Implementation Protocol, is a HIPAA measure to secure patient confidentiality. c. S CIP (Senior Care Information Program) is a new Joint Commission standard created to provide elderly patients with information on what to expect when entering a hospital for surgery. d. S CIP (Surgical Care Improvement Project) was designed to reduce the morbidity and mortality associated with postoperative SSIs. 4. The committee found that several surgeons were using vancomycin (Vancocin) for all their patients undergoing surgery. The committee decided that vancomycin prophylaxis should be used only:

a. I n the absence of a beta-lactam allergy b. When a patient is in a facility with a high rate of methicillin-resistant Staphylococcus aureus infections c. F or colorectal surgery d. The decision to use or not use vancomycin should be left up to surgeons WWW.ORTODAY.COM

CE734

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 8/31/2020 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 (a Relias LLC company) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

OnCourse Learning is also an approved provider by the Florida Board of Nursing, the District of Columbia Board of Nursing, and the South Carolina Board of Nursing (provider #50-1489). OnCourse Learning’s continuing education courses are accepted by the Georgia Board of Nursing. Relias LLC is approved by the California Board of Registered Nursing, provider # CEP13791.

ONLINE

Questions

Nurse.com You can take this test online or select from the list of courses available.

Prices subject to change.

Questions or for a complete listing of our courses Phone: 877-843-8374 Email: nursesupport@relias.com

SEPTEMBER 2019 | OR TODAY |

37

the medical product support network “An excellent resource.

It’s my first stop when I have a question or need information. An asset to any technician’s toolbox.”

–Mark Cooper, Legacy Medical Imaging

“MedWrench connects a wide range of biomed engineers, helping them to share knowledge and experiences.”

–Fadi Ali, RSS

www.MedWrench.com DISCUSSION FORUMS // FREE TO JOIN // BUY & SELL EQUIPMENT

WEBINAR SERIES

EARNwithCEUs

MONTHLY WEBINARS by industry leaders!

Access our library of past webinars!

The OR Today Webinar Series is very informative and accessible in bite-sized chunks, convenient and provides CEUs ...thank you so much!!”

–M. TUAZON, CLINICAL NURSE EDUCATOR

(CEUs NOT AVAILABLE FOR PAST RECORDINGS)

START LEARNING TODAY! ORTODAY.COM/WEBINARS OR TODAY HAS BEEN APPROVED AND IS LICENSED TO BE A CONTINUING EDUCATION PROVIDER WITH THE STATE OF CALIFORNIA BOARD OF REGISTERED NURSING. LICENSE NO. CEP 16623

CORPORATE profile Cygnus

CORPORATE

PROFILE

ygnus Medical™ provides innovative medical products and services. A leader in the industry, Cygnus Medical does more than listen to customers. The company develops unique, industry-first solutions to specific problems found in hospitals and health care facilities.

C

The Airtime Scope Dryer

Studies indicate there is a strong correlation between moisture and microbe colonization within instrument channels. Cygnus Medical is currently launching the Airtime Instrument Channel Dryer. This product dries flexible endoscope channels, as well as other cannulated surgical instruments. The Airtime Dryer is unique in that it can serve as a stand-alone solution for drying

40 | OR TODAY | SEPTEMBER 2019

instrument channels, or it can be used to expand the capabilities of drying cabinets that a facility may currently be using. For example, if a facility uses cabinets that only dry the instrument’s exterior, Airtime can be used prior to storage to dry the instrument’s channels.

Scopes that are removed from the AER and needed for a procedure can be quickly dried which ensures that scopes are not stored or put into immediate use with wet channels. Properly drying channels reduces the risk of infection.

Airtime is a practical and affordable solution that doesn’t skimp on features. It is a “true” two-pump system that offers users the ability to dry two instruments simultaneously without any loss of air pressure. In addition, it features a filtration system that surpasses the systems in other similar products now in the marketplace. It uses .01 HEPA filtered air (and is also available with a medical grade option) to dry channels after automated reprocessing, and is compliant with the newest AAMI ST 91 standards.

Disposable Airtime adapters and daily tubing sets

allow for fast and easy set up, while reducing the risk of cross-contamination.

For Endoscopes and Surgical Instruments: • Airtime uses HEPA filtered air to dry the air/water, suction and auxiliary water channels after automated reprocessing.

• Uses two independent pumps and timers that will dry two scopes simultaneously. Air pressure will not drop when you begin drying a second scope.

• Airtime’s dual screen allows for two scopes to be dried with independent start and stop times.

• Restricted channel sensors will immediately shut off the Airtime pump and alert the user of a potentially clogged channel.

• Available options: IV pole mounted, wall mounted or on a table stand.

The Oasis™ Scope Transport Tray WWW.ORTODAY.COM

SPECIAL ADVERTISING SECTION

As the market transitioned into single-use options for transporting soiled endoscopes, most options offered little to no support or protection for the scope. As a rigid disposable option, the Oasis™ Scope Transport Tray was the first disposable tray suitable for clean and soiled instruments.

Lapses in the cleaning of reusable endoscope transport trays can lead to crosscontamination in the surgical work area. The Oasis Scope Transport Tray offers an economical single-use alternative that protects patients and staff from contamination and infection. Bedside cleaning is performed within the Oasis Tray, keeping residual run-off contained. This creates a cleaner work environment and reduces the risk of hospital-acquired infections.

Oasis Trays are latex-free and are made of a biodegradable plant-based material. This is a 100 percent renewable resource reducing the facility’s carbon footprint. The tray’s rigid construction protects and contains endoscopes during transport and is large enough to safely hold an endoscope without damaging it. The Oasis Tray’s color-coded reversible lid clearly differentiates clean (green) and soiled (red/orange) scopes. They WWW.ORTODAY.COM

are space efficient, stackable and nestable. Also, the trays meet SGNA recommendations for transporting soiled scopes in a closed container to prevent the spread of infection.

and dispensing it uniformly was difficult. The First Step Bedside Kit simplified the endoscope cleaning process by providing the supplies needed to prevent bioburden from

The First Step Bedside Kit

Prior to the introduction of the First Step™ Kit, the bedside cleaning of flexible endoscopes was a cumbersome step that was often skipped. Although society standards and manufacturers’ instructions for use required bedside cleaning, properly preparing the detergent

drying and solidifying in the endoscope’s channels. Today, industry compliance has dramatically elevated and bedside endoscope cleaning is recognized as an essential step in the cleaning process.

First Step Kits are available in Ready-to-Use and Add Water Kits.

SEPTEMBER 2019 | OR TODAY |

41

CORPORATE profile Cygnus

Ready-to-Use Kits offer convenience of use, which increases staff compliance and turnover time. The readyto-use detergent ensures a properly mixed formula every time. The combined effect is 100% compliance, 100% of the time. The 500 ml Add Water Kit offers ease of storage and a reduction in shipping costs because water is added at the point of use.

The Kits are 100 percent compliant with SGNA and manufacturers’ guidelines, safe for use on all flexible endoscopes, and available with a variety of cleaning pad options, including the popular Draco Microfiber DeepCleaning Pad. First Step Pouches are also user-friendly and space-efficient. All First Step Kits ensure the proper dilution of enzymatic detergent, and are available in 100 ml, 200 ml and 500 ml sizes.

All Kits contain Simple2™ Multi-Tiered Enzymatic Detergent and an endoscopic cleaning pad. Simple2 effectively dissolves blood, fat, tissue, protein and other forms of organic material. Simple2 is low-foaming, nontoxic, non-corrosive, latex-free, neutral pH and safe to use on all flexible endoscopes.

Health care studies and data continue to show the limitations and ineffectiveness of manual cleaning products for flexible endoscopes. Cygnus Medical has taken the amazing properties of microfiber and adapted it for use in cleaning difficult to reach endoscope channels.

The patented Dragontail™ cleaning element is constructed of multiple lint-free Draco™ microfiber strands that are able to capture particles at a 4-micron level as it passes through the endoscope’s channel. Unlike bristles or silicone discs, which glide over adhered contamination, the microfiber cleaning element detaches, captures and removes gross contamination. In a comparative study, under identical conditions, the Dragontail™ Channel Brush cleaned 468 times more contamination than a traditional style channel brush.

These are just a few of the innovative products Cygnus Medical offers its health care customers.

For more information about these products and several others, visit cygnusmedical.com.

The Dragontail™ Microfiber Channel Brush

42 | OR TODAY | SEPTEMBER 2019

WWW.ORTODAY.COM

D e c i v r e S

s s e c c u S n e v i r

Most businesses today understand the importance of delivering great customer service and how it impacts their bottom line.

Hundreds of books have been written about customer service and companies like Amazon, FedEx, Chick-fil-A and Ritz-Carlton have made delivering outstanding customer service a key part of their brand identity.

By Don Sadler

But what about health care organizations – and ambulatory surgery centers (ASCs), in particular? How can they adopt some of the customer service practices used by these businesses to improve patient satisfaction and boost the bottom line?

Adopting a Customer Service Mindset Vangie Dennis, MSN, RN, CNOR, CMLOS, executive director, WellStar AMC, is on a mission to help health care organizations and ASCs adopt more of a customer service mindset.

“Health care is a customer service industry,” says Dennis. “Great health care service starts with adopting a patient-centered perspective and viewing patients as real people, not just a means to generating revenue.”

Ann Shimek, MSN, BSN, RN, CASC, an independent consultant and Ambulatory Surgery Center Association (ASCA) board member, agrees. “When you treat the patient as a customer, you provide a higher level of care that is patient-centric,” she says.

ASCs are especially well-suited for this. “In the ASC space, we have the unique ability to customize care based on the patient’s needs,” says Shimek. “It’s more of a family-based approach where everyone knows each other.”

“Successful retail companies know how valuable happy customers are and spend huge amounts of money training employees on how to provide great service,” adds Brenda C. Ulmer, MN, RN, CNOR, perioperative nurse educator.

“The same concepts are true in a health care facility,” Ulmer adds. “Providing good customer service is just good business – and health care is a business.”

Toxic and Dysfunctional Environments In her job as a clinical educator, Ulmer says she has visited many health care facilities of all types. “It’s easy to quickly pick up on whether I’m in a place where I’d want to have surgery or not,” she says. “Unfortunately, there are environments that seem so toxic and dysfunctional, I’m happy to leave. If I feel that way, I know

WWW.ORTODAY.COM

SEPTEMBER 2019 | OR TODAY |

45

Brenda C. Ulmer, MN, RN, CNOR, perioperative nurse educator

patients probably do as well.”

Shimek points out that patients today are becoming more involved in choosing the setting for surgical procedures.

“Historically, surgeons would direct the site of service for procedures, but we’re starting to see a shift toward more patient input,” she says. “We expect this shift to become more pronounced as CMS sets pricing transparency across all organizations.”

“Patients today have a choice and surgeons are credentialed in multiple facilities,” adds Dennis. “Offering a concierge service approach creates a better customer experience and provides a focal point around which ASCs can shift their thinking to a more progressive population health mindset.”

Set the Right Tone at the Top Dennis stresses that adopting a customer-service mindset in a health care setting starts at the top of the organization. “Chief executives must make it their mission to structure the organization around the goal of providing outstanding service,” she says.

ASCs should also broaden their scope of who a “customer” is. “Patients aren’t the only ‘customers’ in the facility,” says Dennis. “Surgeons, physicians, anesthesiologists and anyone who works in the facility should also be considered a customer.”

The next step is to figure out exactly what it is that your customers value so you can make these things a priority. This can be done by conducting patient, staff and physician/surgeon satisfaction surveys.

“Employees at the facility are the best people to ask what can be done to improve the patient experience,” says Ulmer.

“Look at the data to determine the things you do well and the areas where you need improvement,” says Dennis.

“Also, study what successful businesses in other industries have done to deliver great customer service and use these in

46 | OR TODAY | SEPTEMBER 2019

Ann Shimek,

MSN, BSN, RN, CASC, an independent consultant and Ambulatory Surgery Center Association (ASCA) board member

your facility where appropriate.”

Amazon is well-known for its great customer service. Part of their mission statement is “to be Earth’s most customer-centric company.” Dennis lists several ways that Amazon’s customer service practices can be adapted to a patient care model.

“For example, ASCs can adopt a culture of listening to their patients’ needs and making these a driver of innovation,” she says. “They can also strive to make personal interactions easy and follow up promptly with any continuation of care recommendations. This demonstrates that the staff cares about the patient and his or her experience at the facility.”

Ulmer echoes Dennis’ recommendation that ASCs study the practices used

by Amazon and other customer service leaders. “Browse their websites and see what they’re doing to provide great customer service,” she says.

“For example, buying things on Amazon is so easy I don’t hesitate to make purchases,” says Ulmer. “I get items quickly, I don’t pay for shipping and my money is refunded quickly if I return an item. The process couldn’t be easier or more efficient.”

A Customer Service Success Story Ulmer tells the story of her recent positive experience at an ASC where her husband had surgery performed.

“Every person who came into the room was friendly and seemed genuinely interested in my husband and his procedure,” she says. “And I was included every step along the way. It was a very positive experience from beginning to end.”

After she and her husband returned home, Ulmer discovered a thank-you card among the discharge instructions that had been signed by every person they came in contact with. “That’s great customer service!” she says.

“I smiled when I read the card because it was a visual reminder of everything I had observed throughout the

Vangie Dennis,

MSN, RN, CNOR, CMLOS, Executive Director, WellStar AMC

day,” Ulmer adds. “I was impressed.”

Shimek suggests using technology to identify customer service issues as they are occurring and offering service recovery if there are any problems.

“For example, if a patient is delayed or their procedure is running late, a nice way to provide service recovery would be to give them a gift card to a local restaurant so that they can stop on the way home and get something to eat,” she suggests.

Getting Staff On Board One of the challenges ASCs may face in improving customer service is training staff to adopt a customer service mindset and acclimating them to a different approach to patient care and interactions.

Dennis acknowledges that this can be difficult, especially at first. “However, once staff sees improvements in patient satisfaction results, this helps validate the need for changing the approach.”

Shimek suggests discussing your facility’s commitment to customer service during interviews with potential new employees. “This lets them know what your expectations are when it comes to customer service so there aren’t any surprises later,” she says.

“We also stress the importance of providing great customer service to physicians and surgeons so they continue to bring their cases to our facility,” Shimek adds.

Ulmer again stresses the importance of top leadership setting the tone for adopting a customer service mindset in the ASC. “This requires a culture change, which can be really hard sometimes,” she says.

“I’ve seen facilities where it seemed like the culture would never change and facilities where culture change was done successfully,” “Ulmer adds.

“Ultimately, the staff has to be all in on the change – it takes a commitment from everyone.”

WWW.ORTODAY.COM

WITH THE CHLORAPREP ™ PORTFOLIO, YOUR TEAM GETS THE PREOPERATIVE SKIN PREPARATION THAT’S BACKED BY CLINICAL EVIDENCE AND TRUSTED MOST BY HEALTHCARE PROFESSIONALS. Healthcare-acquired infections are deadly serious. That’s why, with nearly 4 billion applicators sold, more surgeons and facilities continue to choose the rapid, persistent antimicrobial protection of ChloraPrep™ patient preoperative skin preparation products over any other. Available in a full range of tints and sizes, ChloraPrep™ products are sold in 38 countries and backed by more than 50 clinical studies, so you can be confident that you’re protecting patients with the right skin preparation for a safer procedure. And as a BD customer, you’ll gain access to our suite of process improvement programs, including BD Prepping Protocols, our complimentary, expert-led program that helps you identify risks, implement evidence-based infection-control strategies and standardize processes to promote better patient outcomes. Discover the preoperative skin preparation solution trusted most by healthcare professionals. Discover the new BD.

AVAILABLE in a full range of tints

Learn more at bd.com/SkinPrep-DO1 BD, the BD Logo and ChloraPrep are trademarks of Becton, Dickinson and Company. © 2018 BD and its subsidiaries. All rights reserved. SU10247

SPOTLIGHT ON:

Beth Devine,

RN

BY M AT T S KO U FA LO S

When a 19-year-old Beth Devine completed the LPN program at Clark County Community College in southern Nevada, she entered the nursing field, “very young and naïve, and not exactly sure what I was doing.” Undaunted, the Reno native dove right in.

That was 40 years ago. In the time since, she’s traveled extensively – throughout the Pacific Northwest, across the United States, and around the world. She’s worked with health care professionals in a variety of settings, from the nursing home to the NICU; seen technology throughout her career evolve from the earliest microwaves to the most advanced diagnostic imaging.

Devine developed a depth of experience in whatever assignment she chose by cultivating learning wherever she went, and from whomever she was with.

“I still have a lot of gratitude that life, circumstances, and maybe some angels along the way have kept me in this profession,” she said. “I still receive a lot of personal satisfaction from it.

There’s so much lateral movement, so many different types of nursing that people can experience … I learned that there are so many ways of doing the same thing.”

48 | OR TODAY | SEPTEMBER 2019

WWW.ORTODAY.COM

In high school, Devine had been an assistant at a nursing home; her first assignment as a 19-year-old working nurse was in a post-openheart unit in Las Vegas. She spent the next five years in the critical care unit before migrating to the assignment in which she’d spend the next 30 years: the neonatal intensive care unit (NICU).

“NICU nursing is a fabulous place to be,” Devine said. “You are at the beginning of the life cycle. You are touching people at some of their most critical and vulnerable times.”

The critical and vulnerable aren’t only the premature, low-birthweight and medically fragile babies entrusted to their professional caregivers.

They’re also the anxious and exhausted parents who lend the nurses their faith. Devine feels deeply the responsibility of caring for those tiny patients who “have the most distinct personalities,” and in some cases, seeing them grow up.

“There’s always going to be those really special babies that parents and nurses connect, and they’re going to stay in contact for a lifetime because the connection is so intense,” she said. “Parents are trusting you with the valuable commodity that is their children.”

Devine had significant autonomy in the NICU, borne of the ownership she took of her role (“Those were my babies for that shift,” she recalled); comparatively, her next assignment, the operating room, was “much more a team sport.

“You work with surgeons, you work with anesthesia,” Devine said, “and because it is such a team-dynamic environment, I have an equal share at the table when it comes to finding our care for the patient. I am using my critical thinking skills to plan out the best care.”

As she solidified her understanding of her role in the OR, Devine still “kept her finger in the pie” a few

“NICU nursing is a fabulous place to be.

Yo u a r e a t t h e b e g i n n i n g o f t h e l i f e c y c l e .

critical

vulnerable

Yo u a r e t o u c h i n g p e o p l e a t s o m e o f t h e i r m o s t

WWW.ORTODAY.COM

and

times.”

days a month in the NICU… for the next 10 years.

“It was really hard for me to wean off,” she said.

Devine had made the switch as much to take on a new specialty as for a lifestyle change. She had already completed a few travel nursing assignments, and had enjoyed them, but after years in 24-hour-care units, she missed having evenings and weekends to herself. In 2003, she fell into an OR training program, and had the opportunity to bring her caregiving experience into a new assignment.

“One of the things I find as an OR nurse is that we have to really develop our communication skills,” she said.

“We touch people at that really critical point where they’re just about to lose that physical contact with their loved ones, or just about to go to sleep.

Sometimes there are times where we are the last face that patient sees before they go under anesthesia.”

“We don’t have the luxury of getting to know patients over a day, but it’s still very important that we connect with them, and let them know they’re in good hands,” Devine said.

She carried that same outlook with her in 2011, when Devine went to work for the San Francisco Veterans Affairs Health Care System. By now an RN with grown children, including

SEPTEMBER 2019 | OR TODAY |

49

“Both of my parents were veterans, and both of my parents received their end-of-life care

honored

through the VA. I’m very

to work there and take c a r e o f v e t e r a n s .”

the four she’d raised when her sister passed away, Devine was looking for a new opportunity. The opportunity to put her skills to use in service of veterans has connected her with military families of all stages of life. Within six years of starting, she’d also completed bachelor’s and master’s degree nursing programs through Western Governor’s University.

“I really made the conscious decision to go to work for the VA,” Devine said. “Both of my parents were veterans, and both of my parents received their end-of-life care through the VA. I’m very honored to work there and take care of veterans.”

“When you touch these patients as an OR nurse, there is a connection,” she said. Families of patients have

50 | OR TODAY | SEPTEMBER 2019

spotted her in public months after they’d met Devine in the hospital, and stopped her just to thank her for bringing their loved one through a procedure safely. The thought that she is caring and positive to people in need still inspires Devine; it’s one of the virtues she most tries to instill in young nurses.

“My passion is to make sure that these nurses coming out really understand the importance of therapeutic touch,” Devine said. “I have this fabulous opportunity to take all these years of medical experience to convey this confidence. “ It’s a confidence honed over years and distance and connection with

people in a number of personal and professional settings. And the potential variability of it keeps Devine coming back every day, grateful for the moments that have brought her there, informed by the perspectives of those she’s met along the way.

“It really makes you have gratitude for your own life,” she said. “To live with gratitude is a blessing that I try to keep.”

Would you like to nominate someone for the spotlight article?

Visit ortoday.com/nominations/

WWW.ORTODAY.COM

Meeting standards.

Exceeding expectations.

Healthcare Reprocessing Sinks Automated Flushing Systems Soaking & Transport Solutions Visualization Technology

Get wrapped up in the PureSteel™ Ergonomic Workstation!

Visit us at OR Manager Conference booth #127!

VISIT pure-processing.com CALL

877.718.6868

FOLLOW US

OUT OF THE OR fitness

Stretch Your Way Out of Stress

By Miguel J. Ortiz e all have tight muscles and,

W depending on someone’s

consistent movement patterns throughout the day, some may have more than others. These areas can flare up during exercise, can be caused by sitting too long or even become aggravated during other stressful scenarios.

If we have serious training goals and less time to stretch, we tend to compromise our recovery which can lead to many other dysfunctions. Now start to add in other stresses that may distract you from your goals and it begins to seem like the goals you're trying to achieve are even further away. Maybe we don’t always get the fullest stretch we need during yoga, classes, etc. or whatever program routine we have set up for ourselves. So how do we get in more quality stretching and de-stress at the same time?

Using the pain of stretching as a guideline for letting things go can be very helpful. If you are dealing with some stress at work, start with dialing in some focused breathing while you stretch. For example, you have a tight shoulder. Begin by standing up from your desk and perform a light door

52 | OR TODAY | SEPTEMBER 2019

frame stretch to loosen up your chest.

Take a deep breath in while you’re simultaneously starting your stretch, using the pain of the stretch to distract you. When you’re in the fullest range of motion or the furthest you can go into the stretch, the pain of it should distract you and help realign your focus, if not maybe question how hard/ focused your stretching actually is. As you release the stretch, breathe away all negative and unwanted energy. Repeat as needed. Your intention needs to be on what you can control so that as you go through the stretch not only are you loosening up your muscles but stress is also floating away.

Next, it’s important to know when to fight through the pain as we don’t want to add to our stress. The point is to let it all go. Stretching needs to be tolerable so that you can push yourself at appropriate times and actually feel the release happening in the body.

This means understanding your pain threshold and keeping your intentions on relaxing. Yes, I know what you're thinking. How can I relax when the stretching itself is tough? Simple, you’re in control. You don’t have to do the deepest and craziest stretches; I personally would shoot for a 7 out of 10 pain thresholds. This will make it

tolerable and help keep your focus.

And for everyone with a desk, office or both, a lacrosse ball just became your best friend. If you’re dealing with a little stress, take off your shoe, pull out your new lacrosse ball and place it underneath your foot while sitting down. Your feet are the first point of contact with the ground, so why not take care of them? Roll the lacrosse ball around the bottom of your foot finding tight little knots and areas that give your foot a nice release and, when finished, continue about your day. And for all my people doing classes, don’t be afraid to enjoy sitting in a stretch a little longer. The instructor won’t mind and you won’t have to worry about keeping up with the class.

This intention toward stretching will help take your mind off of whatever stresses you are dealing with and allow you to put that energy where it belongs, with you.

Miguel J. Ortiz is a personal trainer in Atlanta, Georgia. He is a member of the National Personal Trainer Institute and a Certified Nutritional Consultant with more than a decade of professional experience. He can be found on Instagram at @migueljortiz.

WWW.ORTODAY.COM

CONTINUE YOUR EDUCATION CLOR

PRE-OPER OX ADVICE ATIVE PROT SPOTLIGHT OCOLSOR TODAY LIVE ON SPOTLIGHT ON PAGE 11 JOBY HYM AN ARIC CAMPLING SURGICAL CONFERENCE PAGE 52 PAGE 10 PAGE 54

HEALTH

SAVE NECK PAIN THE DATE OR TODA PAGE 58 Y LIVE !

PAGE 68

TAKE GOOD

CARE NURSES • SURGICAL TECHS • NURSE MANAGERS TAKE GOOD CARE NURSES • SURGICAL TECHS • NURSE MANAGERS

JULY/AUGUST 2016 www.ortoday.com APRIL 2016 www.ortoday.c om

IN THE

ONE SOLUTION FOR ALL YOUR PATIENT MONITORING NEEDS

READ CORPORATEOUR PROFILE OUR ON PAGES READ CORPORATE PROFILE 44-46 ON PAGES 42-45

WITH A FREE SUBSCRIPTION TO OR TODAY! ortoday.com/subscribe

WWW.ORTODAY.COM

SEPTEMBER 2019 | OR TODAY |

53

OUT OF THE OR health

Work Life Balance

By David Taylor, MSN, RN, CNOR urses’ jobs are hard. In today’s health care industry nurses are taking on more responsibilities and doing multiple jobs due to staffing shortages experienced throughout the country. In 2017, Kronos conducted a survey and found that nursing fatigue was a pervasive problem. They found that 98 percent reported their work is physically and mentally demanding and 85 percent find it difficult to balance body, mind and spirit. Sixty-three percent of respondents reported the work they are required to do is causing burnout. Causes at the top of the list for burnout are excessive workloads and the inability to take a break or eat during their shift. This makes it nearly impossible to refresh so they can process the entire scope of care.1

N

Americans are working harder and longer than ever before and there are no indications that we are slowing down. Between the 1970s and 2000, American workers took approximately 20 days of vacation each year. By 2015 the average dropped to 16 days and 55 percent of them are leaving about 658 million vacation days unused that could have been used for activities other than work. In 2015 it was estimated that 222 million vacation days were forfeited and could not be rolled over into employees’ accounts.2 Research conducted by Alamo Rent A Car looked into the work habits of Americans’ while on vacation and

54 | OR TODAY | SEPTEMBER 2019

upon returning to work. In the 2014 survey, 40 percent of American workers who received paid time off as a benefit did not use all of their available days off. Forty-seven percent cite being too busy, and 19 percent left five or more days as unused. Millennials are most guilty for not using their vacation time. Younger workers are finding it even more difficult to leave work back at the office. Of the Millennials polled, 34 percent reported they worked every day while on vacation. Surprisingly, the survey found that even though they worked while on vacation, they felt less productive upon returning to the office and the most common response was that they felt guilty for taking time off.3 This idea that we cannot unplug when we should be resting, relaxing and rejuvenating is not only detrimental to one’s health, but it creates a huge liability for companies’ bottom lines. Americans are losing $52.4 billion a year because they are not taking paid time off (PTO), burdening U.S. companies with $224 billion of unused vacation time which grew by more than $65 billion in 2014.4 In 2015, the U.S. travel and tourism industry generated $2.1 trillion in revenue, creating over 15 million jobs and more than $231 billion in wages. Forgoing vacation is equal to about $223 billion in lost spending, that could otherwise be used to support businesses, create jobs and move our economy forward.1 According to Project: Time Off, research shows that if we took one additional vacation day, the U.S. economy would see a $73 billion-dollar benefit.5

The 40-hour workweek has become the standard measure for fulltime employment. However, according to Gallup the 40-hour workweek is actually longer, averaging 47 hours logged each week.6 Europe however, logs much less. France, Germany and Italy log an average only, 28, 26 and 33 hours respectively.7 The work all the time attitude and the stressors of our work lives can have a significant health risks such as impaired sleep, depression, heavy drinking, diabetes, impaired memory and heart disease. Those working 11 hours a day or longer are at increased risk of heart disease, the number one leading cause of death in America, by as much as 67 percent. In addition, there is an increasing likelihood of experiencing a major depressive episode.

This lack of time away from work can have significant negative effects on not only our physical health but our emotional health as well and may lead to feelings of resentment, and we are more likely to make mistakes.8-11 We never seem to hit the pause button. We eat at our desks, check emails when we are in bed, take calls when we should be spending time with our family and friends, yet according to Gallup, the hot topic among 40 percent of full-time workers logging more than 50 hours a work is – work life balance. So, why are we not practicing what we preach?

That is a hard question to answer, but some companies are mandating that employees take time off and are even paying them if they disconnect and do not work while away from the office.12 In some case, these companies are

WWW.ORTODAY.COM

offering huge cash incentives to not work.

So, what does the perfect vacation look like? According to a University of Tampere in Finland the ideal length of a vacation is eight days, allowing vacationers the right amount of time to improve overall happiness. The eightday holiday seems to be the perfect amount of time to rest, relax and rejuvenate without creating boredom and without keeping you away from the office too long only to find yourself in mountains of work when you return.

Everyone needs time away from work. Whether it be a vacation to relax, sick time to recover from an illness or time away to manage unex-

pected emergencies. Taking time has been proven to have a profound effect on employees’ creativity, improving their engagement, loyalty and productivity.13-14 Preventing burnout and boosting one’s happiness by taking time off to rebalance is essential.

Reinventing the work-life-balance into work-life-inspiration will help you better understand that certain elements of your life should never be sacrificed for more time in the office.15 In an article published in American Mobile one of the recommendations to avoid nurse burnout was to take a vacation and get away from the working environment and let yourself recharge.16 To refresh one’s soul is a choice. Each nurse is

vital to our profession, what you do is important to the health of our nation and that is why it is so important to take care of yourself first.

6. The “40-Hour Workweek Is Actually Longer – by Seven Hours; http://news. gallup.com/poll/175286/hour-workweek-actually-longer-seven-hours.aspx; Accessed April 18, 2018.

11. The top 10 leading causes of death in the United States; https://www.medicalnewstoday.com/articles/282929.php; Accessed April 18, 2018.

David L. Taylor, MSN, RN, CNOR, is an independent hospital and ambulatory surgery center consultant and the principal of Resolute Advisory Group LLC, in San Antonio, Texas. He has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article.

References 1. Kronos survey finds that nurses love what they do though fatigue is a pervasive problem; https://www.kronos.com/ about-us/newsroom/kronos-surveyfinds-nurses-love-what-they-do-thoughfatigue-pervasive-problem; Accessed April 18, 2018.

2. By skipping your vacation, you’re hurting America; https://www.usnews. com/news/articles/2016-06-17/studyunused-vacation-days-drag-on-economy; Accessed April 18, 2018.

3. New Survey Reports 4 in 10 Americans Leave Paid Vacation Days on the Table; https://www.alamo.com/en_US/ car-rental/scenic-route/family-travel/ unused-vacation-days.html; Accessed April 18, 2018.

4. The Hidden Costs of Unused Leave; https://www.projecttimeoff.com/research/hidden-costs-unused-leave; Accessed April 18, 2018.

5. $224 billion tied up in accumulated vacation time across private sector.

Business success and employee performance at risk when Americans forgo vacation; https://www.prnewswire.com/ news-releases/224-billion-tied-up-inaccumulated-vacation-time-across-private-sector-300045551.html; Accessed April 18, 2018.

WWW.ORTODAY.COM

7. Shorter workweeks are catching on in Europe – American not so much?; https://qz.com/699166/shorter-workweeks-are-catching-on-in-europeamerica-not-so-much/; Accessed April 18, 2018.

8. Working Long Hours ‘Raises Heart Attack Risk;’ http://www.ucl.ac.uk/news/ news-articles/1104/11040501; Accessed April 18, 2018.

9. Revealed: What happens to your physical and mental health if you don’t take enough holiday (take note the 56% of Americans who didn’t go on vacation last year; http://www.dailymail.co.uk/ travel/travel_news/article-3226679/ What-happens-physical-mental-healthdon-t-holiday-note-56-Americans-didnt-vacation-year.html; Accessed April 18, 2018.

10. This is what 365 days without a vacation does to your health; https:// qz.com/485226/this-is-what-365-dayswithout-a-vacation-does-to-yourhealth/; Accessed April 18, 2018.

12. Why some CEOs are ordering employees to take vacation; http://fortune. com/2015/12/15/vacation-packagesproductivity-management/; Accessed April 18, 2018.

13. How your time-off policy can cut costs and improve productivity; https:// www.cio.com/article/2866108/timemanagement-productivity/how-yourtime-off-policy-can-cut-costs-and-improve-productivity.html; Accessed April 18, 2018.

14. Vacation from work: A ‘ticket to creativity’? The effects of recreational travel on cognitive flexibility and originality; https://www.sciencedirect.com/ science/article/pii/S0261517714000685; Accessed April 18, 2018.

15. 9 ways Europeans have nailed the work/life balance; https://www.mydomaine.com/european-work-life-balance; Accessed April 18, 2018 .

16. 8 Ways to avoid nurse burnout; https://www.americanmobile.com/nursezone/nursing-news/8-ways-to-avoidnurse-burnout/; Access April 18, 2018.

SEPTEMBER 2019 | OR TODAY |

55

OUT OF THE OR EQ Factor

Choices and Emotional Intelligence By daniel bobinski irst you’re born, then you pay taxes, right? Wrong.

You don’t have to pay taxes. Of course, if you don’t, you will experience consequences you might not like. For example, an acquaintance of mine spent a year in federal prison because he didn’t pay taxes for nearly a decade. Stated another way, he made a choice to skip paying taxes, and then he suffered unpleasant consequences because of his choice.

F

The point of my story is that first you’re born, then you have choices.

One key to success is knowing the ripple effects of your available choices and then selecting the best available option. Some folks call this smart thinking. Others call it wisdom. Making good choices in how we manage ourselves and our relationships is part of good emotional intelligence.

In all of my classes and coaching, one phrase I have people memorize is, “Value the differences.” I do this because I want people to know they can make emotionally intelligent choices in their communications. By driving home the principle of valuing differences, people develop a mental mindset to look for how different strengths contribute to the team. One

56 | OR TODAY | SEPTEMBER 2019

ripple effect of valuing differences in team members is that a team gets stronger.

Many of us need to make a conscious choice to value differences.

Why? Because our human brains tend to be a bit tribal, which often results in criticizing differences. In other words, it’s human nature to associate with like-minded people and disassociate from those who hold differing views and values. This isn’t a universal truth nor is it necessarily a criticism, but it stands as a social norm more than we realize.

How might this look in the workplace? Let’s say a new employee gets hired because she has great skills, great experience and fresh ideas for how to approach problems. Everyone agrees she’s a great choice and is glad to have her on the team. But several months into her employment, a few folks on your team start criticizing the way she approaches problems.

What was previously seen as a fresh approach is now viewed by some as rocking the boat.

If this team is not careful, they could easily split into two camps, each criticizing and not valuing the other.

In every workplace, co-workers have diverse behavioral and cognitive styles, as well as diverse beliefs and

attitudes about things. To practice good emotional intelligence, we have some choices to make. First, we can choose to criticize differences. This is often a subconscious default, as it takes little effort to do this. The ripple effect is often a divided workplace.

Another choice is focusing on the value in people’s differences. By doing so, our minds start seeing connections and strengths we might not otherwise see. This leads to creative problemsolving and higher levels of efficiency and effectiveness. Another benefit is people looking for how each person’s strengths helps the team perform its mission.

Bottom line, first your born, then you have choices. And choosing to value differences is part of good emotional intelligence.

Daniel Bobinski, M.Ed. is a certified behavioral analyst, a best-selling author and a popular speaker at conferences and retreats.

He loves working with teams and individuals to help them achieve workplace excellence. Reach Daniel through his website, www.MyWorkplaceExcellence.com.

WWW.ORTODAY.COM

NEW FEATURED PRODUCT

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

The TBJ Model 30-96-2TB SPCS work sink is specifically designed for use in GI Labs and Sterile Processing Departments for the pre-cleaning flexible endoscopes.

The unit includes two elongated trough style bowls allowing for the extended linear positioning of endoscopes during the pre-cleaning process to promote cleaning efficiency.

Features include: - (2) trough sinks shall be 72” long x 9” deep - The sink shall include (2) push-button automatic fill systems (one for each bowl) with level sensors and overflows

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

OPTIONAL FEATURES INCLUDE Integrated Ultrasonic System

- One sink shall be designated for dosing and flushing and one sink shall be designated for rinsing and purging - The dosing and flushing sink shall include push-button detergent dosing with two adjustable pre-sets and constant temperature monitoring - Both sinks include integral connec tions ports for flushing, rinsing and purging - The sink top shall be adjustable allowing the sink height to be adjusted from 34” to 42” high via a push-button control - The sink shall include a full-length under counter storage shelf for detergent placement

Air and water pistols

Auto Fill System

Automated Lumen and Scope Flashing

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

717.261.9700 sales@tbjinc.com www.tbjinc.com

CONTINUE YOUR EDUCATION WEBINAR SERIES

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

OPERATING ROOM SOLUTIONS Surgical Table Pads » Waterfall edge construction

» Fluid & stain resistant » X-ray permeable » Antimicrobial » Latex-free

Pro-Tek

Casters Problem?

X

ALCO has your solution!

No More Rusty Casters!

800.323.4282

58 | OR TODAY | SEPTEMBER 2019

Standard

Integra-Gel

Mayo Stands Extra Large Top!

AL-85454

Thumb Operated!

AL-81948

www.ALCOSales.com

WWW.ORTODAY.COM

OUT OF THE OR nutrition

Is Intermittent Fasting a Good Idea?

By Charlyn Fargo

Q: I have a client wanting to try intermittent fasting (where he has long periods of not eating) as a way to lose weight. Does it work?

A: First of all, a word of warning: It’s a diet strategy that can be dangerous for individuals who take prescription medication, those with diabetes or heart conditions and pregnant women.

Before you try it, consult your physician.

Just what does it involve? It involves alternating periods of fasting with periods of eating. Some intermittent fasting involves fasting all but one meal; other intermittent fasting involves fasting for a specific number of hours each day.

The problem is – and my client found this out – you often overeat at mealtimes because you’re so hungry from fasting. That’s tough on your system – to go from not eating to consuming a lot of calories at one time.

And, it didn’t result in any weight loss.

Research is limited and on small groups of people. A study published in JAMA Internal Medicine investigated 100 overweight individuals for a year.

They compared alternate-day fasting with a typical diet of restricting calories. A control group ate normally.

Results showed that participants in both the fasting and restricted calorie groups lost weight. The control group did not. However, 38% of the fasting group quit before the year end, suggesting that it’s a hard diet to maintain.

Here’s the bottom line: There are lots of ways to lose weight – low fat,

WWW.ORTODAY.COM

low carbs, counting calories. One particular way of losing weight may not work for everyone. Many people are successful tracking calories and activity. Others are successful fasting, and some are successful with programs such as Weight Watchers or a plan such as the Mediterranean diet.

Do what works for you. However, the most important thing is to eat healthy.

Include all the food groups – fruits, vegetables, whole grains, lean protein and low-fat dairy.

always trying to lose a few pounds?)

The idea of weighing often is backed by research that shows regular selfweighing is more often associated with maintaining our weight, losing a few pounds and keeping pounds from creeping up. It’s a lot easier to do something about losing 5 pounds than to wait until the scale shows a gain of 15. For those just maintaining their current weight, a weekly weigh-in (at the same time and with the same amount of clothing) is effective.

Q: Are fresh vegetables and fruit more nutritious than frozen?

Q: Should I buy whole flax seeds or milled flax seeds?

A: Not necessarily. Recent studies have found frozen produce contains just as many vitamins and minerals as fresh produce; in some cases, the frozen produce may even be more nutritious than fresh produce. That’s because after fruits and vegetables are harvested, they begin to lose some of their nutrient content. By the time they make it to the grocery store, fresh produce may have a significantly reduced nutrient content compared to when it was just picked. Fresh produce may be picked when it’s not fully ripe so that it will survive transportation, while frozen produce may be picked at peak ripeness and then quickly frozen, preserving the nutrients.

A: Both are good. The whole seeds are an insoluble fiber, and the milled seeds are a soluble fiber. We need both.

Insoluble fiber passes through the digestive system and helps promote regularity and prevent constipation.

Soluble fiber helps lower cholesterol and makes fiber, fatty acids and other phytonutrients more available. It’s best to store either milled or whole seeds in the refrigerator or freezer to prevent rancidity and to prevent the omega-3 fatty acids from breaking down. If you prefer to mill your own, a coffee grinder will do the job. Store leftover ground flax in the refrigerator or freezer as well.

Q: Should I weigh myself every day, or how often?

A: I weigh myself daily. That’s because it’s a useful strategy for weight loss and maintenance. (Aren’t we

Charlyn Fargo is a registered dietitian at Hy-Vee in Springfield, Illinois, and the media representative for the Illinois Academy of Nutrition and Dietetics. For comments or questions, contact her at charfarg@aol.com or follow her on Twitter @NutritionRD.

SEPTEMBER 2019 | OR TODAY |

59

OUT OF THE OR

Recipe

recipe

the

60 | OR TODAY | SEPTEMBER 2019

South African Chocolate Birthday Cake ingredients • • • • • • • • • •

For the cake: 2 cups cake flour 1 teaspoon baking powder 1 teaspoon baking soda 3/4 cup unsweetened cocoa powder 1 teaspoon salt 2 cups sugar 1 cup vegetable oil 2 eggs 1 cup vanilla yogurt 2 teaspoons vanilla extract 1/2 cup very strong black coffee

For the glaze: • 2 ounces semi-sweet chocolate, cut into pieces 1/4 cup heavy cream For an alternative topping: • Powdered sugar

BY Diane Rossen Worthington Diane is an authority on new American cooking.

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

WWW.ORTODAY.COM

OUT OF THE OR recipe

Birthday Cake in the African Bush or our bucket list trip to South Africa, my husband and I decided to “go for the gold” and book a visit to the Royal Malewane private reserve safari camp outside of Kruger National Park.

Let me just say that I always imagined animals inhabiting exotic woods. I was very surprised by the terrain, which is aptly called “African bush.”

This was the most amazing trip of my life. I knew the food would be a big part of it, because that’s my beat, but again was happily surprised by what I found when I got there.

As we entered the open-air reception area at the Royal Malewane, two beautiful matching bronze cheetah sculptures on either side caught our attention. The staff, awaiting our arrival, greeted us with fresh cool towels and cold drinks, and the public room was a riot of colorful furniture in hues of red, green and orange.

Continuing ahead there was a pond with a single “Mr. Hippo” (as I fondly called him) in residence. He entertained us at every meal, as the dining room is adjacent to the lobby and also overlooks the pond.

Our safari ranger, Rudi, was brilliant in his knowledge of the animals we saw on our early morning and late afternoon safaris. For instance,

F

I learned that lions are pretty lazy, sleeping 20 hours a day. We then found a leopard deep in the bush that climbed a tree to devour her prey. The baby elephants are practically attached at the hip to their moms and love to play like frisky puppies.

The animal kingdom gives one a fresh look at life and new meaning to the phrase “survival of the fittest.”

On our last night at Royal Malewane the staff surprised me with a birthday dinner in the bush.

We arrived at an area that was lit up with torches and filled with chefs cooking a large number of different barbecued meats and fish. Candles and a grand pavilion created a romantic and otherworldly environment.

We drank fine South African wines and the food rivaled many celebrity chef offerings that I’ve experienced. But it was the cake that really touched my heart. This rich chocolate cake reminded me of a birthday cake from home. So here is the recipe I have reworked for the at-home baker. I hope you will try it. I chose to bake it in a Bundt cake pan and opted for a light glaze instead of buttercream. You can also opt for a light dusting of powdered sugar, if you like. It’s Seriously Simple to put together; and the best part is you don’t have to be on safari to enjoy it.

South African Chocolate Birthday Cake Serves 12 1. Preheat oven to 350 F. Generously grease and flour a 9-inch Bundt pan.

2. In a medium bowl, whisk together cake flour, baking powder, baking soda, cocoa powder and salt. Set aside.

3. In a large bowl, combine the sugar and vegetable oil. Mix in the eggs, yogurt and vanilla until combined.

Stir in the coffee until well blended. Combine the wet ingredients with the dry ingredients a little at time, mixing after each addition, just until combined. Use a whisk to do this. Pour the batter into pan.

4. Bake in the middle rack for about 40 to 45 minutes, or until a toothpick comes out clean. Do not over bake, as cake will continue to cook as it cools. Cool on a cooling rack until pan is warm to the touch.

5. While the cake is baking make the glaze: In a small glass bowl combine the chocolate and the cream, and melt in the microwave for about 1 1/2 minutes. Mix with a fork. Set aside.

6. Slide an offset spatula around the inside of the pan to loosen the cake from the pan, and flip over onto a cake platter. Drizzle glaze decoratively over the top of the cake. Or sprinkle with powdered sugar instead, if desired. Serve slightly warm or room temperature. To serve, cut thin pieces, place on dessert plates, and accompany with vanilla ice cream.

WWW.ORTODAY.COM

SEPTEMBER 2019 | OR TODAY |

61

OUT OF THE OR pinboard

OR TODAY

• CONTEST • S E PTE M B E R

TAKE YOUR BEST

Win Lu Wn

chA! P A IR IN OF CALZURO SHOES!

Email us a photo of you or a colleague reading a copy of OR Today and you could win a FREE pair of Calzuro shoes!

Snap a selfie and email it to Editor@MDPublishing.com to enter. Good luck!

Best selfie submission gets

a FREE pair of Calzuro shoes!

are not dealing with let us remember we le, op pe th wi ng otion, creatures “When deali th creatures of em wi ng ali de e ar e W creatures of logic. pride and vanity.” s and motivated by ce di eju pr th wi g bristlin

YOU could be the next winner!

– Dale Carnegie

OR TODAY THIS MONTH'S CONTEST WINNER Submitted by:

Catherine Hoover BSN, RN, CNOR

over, o H e n ri Cathe N, CNOR BSN, R

62 | OR TODAY | SEPTEMBER 2019

WWW.ORTODAY.COM

The News and Photos

OUT OF THE OR

that Caught Our Eye This Month

pinboard

4 TIPS FOR PRODUCTIVE MORNINGS

When the alarm rings each morning, do you arise quickly, eager to take on whatever the day brings? Or do you drowsily reach for the snooze button?

Your answer could be crucial because the mindset you start the day with can play a significant role in whether the rest of your day is filled with successes or setbacks.

“Every time the sun rises, so do new opportunities to grow, develop and improve,” says Dr. Rob Carter III, co-author with his wife, Dr. Kirti Salwe Carter, of The Morning Mind: Use Your Brain to Master Your Day and Supercharge Your Life (www.themorningmind.com).

Carter offers these suggestions for starting the day right: • Plan your day the night before. A peaceful morning can quickly turn chaotic if you don’t have things carefully planned out.

“It’s not unusual for people to be heading out the door and discover they can’t find their car keys,” Carter says. A lot of morning stress can be relieved by planning your day the night before, he says, such as deciding what clothes to wear, making sure your phone is charged, and writing the next day’s to-do list.

WWW.ORTODAY.COM

• Make time for yourself. If you’re married with kids, this can be a challenge. But Carter says everyone needs time for reflection, which is unlikely to happen unless you make it a priority. Set aside time to meditate, pray, do yoga or even do nothing for 10 minutes.

“Spending time by yourself,” he says, “allows you to reflect on life’s happenings and can increase productivity and focus, and make you appreciate time with others more.”

• Minimize noise and distractions. Many people start the day by turning on the TV, the radio or other devices. Avoid that urge, Carter says. Instead, devote your energy to getting yourself mentally focused for the day. “You definitely want to avoid watching the news if at all possible,” he says, “because the often-stressful images you’ll see aren’t conducive to a peaceful morning.”

• Create a morning-exercise routine. Exercising gives you a sense of achievement to start the day with, provides you with more energy for the rest of the day, improves your mood, and makes you feel in control of your life. “Research shows that people who exercise in the morning are more consistent with their routine than those who try to fit exercise into their schedule later in the day,” Carter says.

SEPTEMBER 2019 | OR TODAY |

63

CONTINUE YOUR EDUCATION WITH A FREE SUBSCRIPTION TO OR TODAY!

ortoday.com/subscribe

LIFE IN AND OUT OF THE OR

TODAY

Make sure you continue to receive OR Today. Update your subscription today!

Of the business categories below, please choose ONE that best describes yours: Of the titles below, please choose ONE that best describes yours:

0 Hospital

0 Physical T herapy/Rehab Facility

0 Replacement Parts Supplier

erioperative NurseCenter 0 P Outpatient Surgery

Vendor/OEM 0 Equipment Supplier/Servicer

0 Medical Equipment Dealer

irectorIn-House of Perioperative Services 0 D Hospital Repair Service

CS/SPD 0 Education/Training Research

0 Medical Equipment Manufacturer

Perioperative Nurse Manager 0 Group Purchasing Org.

Surgical Technologist

0 Other

Nurse Educator

0 Group Practice Clinic

Please Print Clearly _ Name ____________________ _ Title _ _ _ _ _ _ _ _ _ _ _ _ Hospital/Company-----------------------------­ Address ------------------------------- - - ­ City--------------------------------- - _ Country _ _ _ _ _ _ _ _ _ _ _ _ _ State _ _ _ _ _ _ _ _ _ _ Zip _ _ _ _ _ _ _ Phone____________________________________ _

Fax--------------------------------- - Email--------------------------------- - ­ Website------------------------------- - - -

Signature _____________________ _ Date _ _ _ _ _ _ _ _ _ _ _

SIGN UP TO RECIEVE A

FREE SUBSCRIPTION To renew or start a FREE Subscription, fax this form to 770.632.9090.

The OR Today is available without charge to eligible individuals in the U.S. only. The Publisher reserves the right to determine eligibility for free subscription.

: ,.

INDEX

advertisers

Alphabetical Action Products, Inc………………………………………… 53

Capital Medical Resources……………………………… 58

Microsystems……………………………………………………… 5

AIV Inc.…………………………………………………………………13

Ecolab Healthcare……………………………………………… 9

Mobile Instrument Service & Repair………………17

ALCO Sales & Service Co.……………………………… 58

Healthmark Industries Company, Inc.………… 10

Pure Processing……………………………………………………51

Arthroplastics, Inc.………………………………………………15

Heartland Medical Sales & Service……………… 53

Ruhof Corporation……………………………………………2, 3

Avante Health Solutions…………………………………… 4

Innovative Medical Products………………………… BC

TBJ, Incorporated…………………………………………… 57

BD……………………………………………………………………… 47

Jet Medical Electronics Inc………………………………21

Tetra Medical Supply Corp.………………………………21

C Change Surgical……………………………………………… 6

MD Technologies Inc.……………………………………… 22

TRU-D………………………………………………………………… 24

Cygnus Medical……………………………………40-43, IBC

MedWrench……………………………………………………… 38

Webinar Wednesday……………………………………… 39

INFECTION CONTROL

REPROCESSING STATIONS

categorical ANESTHESIA

Heartland Medical Sales & Service……………… 53

ASSET MANAGEMENT

Microsystems……………………………………………………… 5

CARDIAC PRODUCTS

C Change Surgical……………………………………………… 6 Jet Medical Electronics Inc………………………………21

CARTS/CABINETS

ALCO Sales & Service Co.……………………………… 58 Cygnus Medical……………………………………40-43, IBC Healthmark Industries Company, Inc.………… 10 TBJ Incorporated……………………………………………… 57

CS/SPD

MD Technologies Inc.……………………………………… 22 Microsystems……………………………………………………… 5 Ruhof Corporation……………………………………………2, 3

DISINFECTION

Cygnus Medical……………………………………40-43, IBC Ruhof Corporation……………………………………………2, 3

DISPOSABLES

ALCO Sales & Service Co.……………………………… 58 Tetra Medical Supply Corp.………………………………21

ENDOSCOPY

Capital Medical Resources……………………………… 58 Cygnus Medical……………………………………40-43, IBC Healthmark Industries Company, Inc.………… 10 MD Technologies Inc.……………………………………… 22 Mobile Instrument Service & Repair………………17 Ruhof Corporation……………………………………………2, 3

ERGONOMIC SOLUTIONS

Pure Processing……………………………………………………51

ALCO Sales & Service Co.……………………………… 58 Cygnus Medical……………………………………40-43, IBC Healthmark Industries Company, Inc.………… 10 Pure Processing……………………………………………………51 Ruhof Corporation……………………………………………2, 3 TBJ Incorporated……………………………………………… 57 TRU-D………………………………………………………………… 24

INSTRUMENT STORAGE/TRANSPORT

SKIN PREPARATION

MONITORS

STERILIZATION

Microsystems……………………………………………………… 5 Avante Patient Monitoring………………………………… 4

ONLINE RESOURCE

MedWrench……………………………………………………… 38 Webinar Wednesday……………………………………… 39

OR TABLES/BOOMS/ACCESSORIES

Arthroplastics, Inc.………………………………………………15 Action Products, Inc.……………………………………… 53 Innovative Medical Products………………………… BC

OTHER

AIV Inc.…………………………………………………………………13 TRU-D………………………………………………………………… 24

PATIENT MONITORING

AIV Inc.…………………………………………………………………13 Avante Patient Monitoring………………………………… 4 Heartland Medical Sales & Service……………… 53 Jet Medical Electronics Inc………………………………21

POSITIONING PRODUCTS

FLUID MANAGEMENT

PRESSURE ULCER MANAGEMENT

GENERAL

REPAIR SERVICES

ALCO Sales & Service Co.……………………………… 58

66 | OR TODAY | SEPTEMBER 2019

SINKS

INSTRUMENT TRACKING

ALCO Sales & Service Co.……………………………… 58

HOSPITAL BEDS/PARTS

Healthmark Industries Company, Inc.………… 10 Pure Processing……………………………………………………51 Ruhof Corporation……………………………………………2, 3 TBJ Incorporated……………………………………………… 57

FALL PREVENTION

AIV Inc.…………………………………………………………………13 Capital Medical Resources……………………………… 58

SAFETY

Cygnus Medical……………………………………40-43, IBC Ruhof Corporation……………………………………………2, 3

Action Products, Inc.……………………………………… 53 Cygnus Medical……………………………………40-43, IBC Innovative Medical Products………………………… BC

Ecolab Healthcare……………………………………………… 9

Pure Processing……………………………………………………51 Ruhof Corporation……………………………………………2, 3 TBJ Incorporated……………………………………………… 57

Action Products, Inc.……………………………………… 53 Avante Patient Monitoring………………………………… 4 Capital Medical Resources……………………………… 58 Cygnus Medical……………………………………40-43, IBC Heartland Medical Sales & Service……………… 53 Jet Medical Electronics Inc………………………………21 Mobile Instrument Service & Repair………………17

BD……………………………………………………………………… 47 Cygnus Medical……………………………………40-43, IBC Healthmark Industries Company, Inc.………… 10 TBJ Incorporated……………………………………………… 57

SURGICAL

Cygnus Medical……………………………………40-43, IBC Ecolab Healthcare……………………………………………… 9 Heartland Medical Sales & Service……………… 53 MD Technologies Inc.……………………………………… 22

SURGICAL INSTRUMENT/ACCESSORIES

Arthroplastics, Inc.………………………………………………15 C Change Surgical……………………………………………… 6 Cygnus Medical……………………………………40-43, IBC Healthmark Industries Company, Inc.………… 10

TELEMETRY

AIV Inc.…………………………………………………………………13 Avante Patient Monitoring………………………………… 4

TEMPERATURE MANAGEMENT

C Change Surgical……………………………………………… 6 Ecolab Healthcare……………………………………………… 9

WASTE MANAGEMENT

MD Technologies Inc.……………………………………… 22 TBJ Incorporated……………………………………………… 57

WOUND MANAGEMENT

Tetra Medical Supply Corp.………………………………21

WWW.ORTODAY.COM

For a

Combat Healthcare Associated Infections

FREE

Trial Evaluation,

visit www.impmedical.com Call (800) 467-4944

SteriBump® delivers sterile extremity positioning for dozens of procedures.

Choose Guaranteed OR Sterility with SteriBump®

“WHY BUNDLE...

?

Get a more secure elevated positioning Easier, faster and safer than bundling towels Single use means there’s never a question of sterility Choose multiple heights and angles Eliminates possibility of cross contamination Latex free Lint free imp® products are protected by patent & patent pending rights ~ go to impmedical.com/patents

...WHEN YOU CAN

BUMP ” TM

SteriBump®

The operative word in patient positioning.

Innovative Medical Products, Inc. All Rights Reserved 2019 © 2019 IMP

PHONE: (800) 467-4944 | www.IMPMEDICAL.COM