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PRODUCT FOCUS PATIENT MONITORING
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CE ARTICLE MRSA
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OUT OF THE OR DAIRY-FREE ICE CREAM
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CORPORATE PROFILE
NOVEMBER 2019
POWER of
TEAM WORK
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OR TODAY | November 2019
contents features
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POWER OF TEAMWORK The coaches and players on football teams know the importance of teamwork to achieving their goal of winning a championship. Teamwork within a health care facility is just as important to achieving the goal of delivering exceptional patient care and achieving high levels of patient satisfaction.
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MARKET ANALYSIS
CE ARTICLE
MRSA continues to be a problem in health care facilities and the community. MRSA market will surpass $27 billion by is a “serious risk” with more than 11,000 2025. One report states that a growing deaths attributed to it each year. All health preference for advanced patient care team members must play an active monitoring devices across the globe will role in adopting, modeling and encouraging positively influence the industry’s growth practices to prevent the spread of MRSA in health care facilities. in coming years. The global patient monitoring devices
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CORPORATE PROFILE: INNOVATIVE MEDICAL PRODUCTS INC.® Since its early beginnings, IMP has grown and become a world leader in surgical patient positioning. The vision of the company’s success has been to design, manufacture and distribute unique, innovative products to a surgical world where patient positioning has been problematic.
OR Today (Vol. 19, Issue #11) November 2019 is published monthly by MD Publishing, 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290. POSTMASTER: Send address changes to OR Today at 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290. 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. © 2019
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contents features
PUBLISHER John M. Krieg
john@mdpublishing.com
VICE PRESIDENT Kristin Leavoy
kristin@mdpublishing.com
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EDITOR John Wallace
SPOTLIGHT ON
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Danielle Glover, CST
ART DEPARTMENT Jonathan Riley Karlee Gower Amanda Purser
ACCOUNT EXECUTIVES Jayme McKelvey Megan Cabot
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DIGITAL SERVICES
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win the ultimate OR TODAY LIVE experience!
Pumpkin Cheesecake
OR TODAY CONTEST
RECIPE OF THE MONTH
Cindy Galindo Kennedy Krieg Erin Register
CIRCULATION Lisa Cover
WEBINARS
INDUSTRY INSIGHTS 10 News & Notes 16 How Intelligent Scheduling Reduces Stress and Surfaces Success in the OR 19 CCI: It’s Time to Recertify My CNOR! How Do I Do It? 20 IAHCSMM: New IAHCSMM Offerings Fuel Knowledge, Feed the Senses 23 oneSOURCE Session Proves ‘Very Informative and Relevant’
Linda Hasluem
ACCOUNTING Diane Costea
IN THE OR 25 Market Analysis: Patient Monitoring Market to Hit $27 Billion 26 Product Focus: Patient Monitors 30 CE Article: MRSA: More Work to be Done
OUT OF THE OR 46 Spotlight On 48 Fitness 51 Health 52 EQ Factor 55 Nutrition 56 Recipe 58 Pinboard
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SAVE THE DATE: 2020 OR Today Live Will Rock the Rockies Less than a month after the successful OR Today Live Surgical Conference in Las Vegas, MD Publishing President and Founder John Krieg has announced plans for 2020. The 2020 OR Today Live Surgical Conference will rock the Rockies August 16-18 just outside of beautiful Denver, Colorado at the Omni Interlocken Hotel in Broomfield. The Rocky Mountains will serve as the perfect backdrop for the growing conference. “OR Today Live Las Vegas far exceeded our expectations and really turned the corner in terms of attendance, quality education and vendor engagement,” Krieg said. “The response from perioperative leaders at the show was just tremendous, they are raving over the intimate yet productive environment, the level of professionalism and overall quality of the program. We will continue to work hard and build on the success of this year’s event and make 2020 even more spectacular!” Perioperative nurses and SPD professionals from across the country are invited to gather at OR Today Live next year to discover new opportunities, broaden their knowledge and exchange ideas. Whether you need an extra boost of motivation in your career or are looking to earn CE credits – OR Today Live is the conference for you. OR Today Live brings together world-class speakers in an environment designed to motivate and empower perioperative professionals.
10 | OR TODAY | NOVEMBER 2019
“I love this conference. I have presented two years now and I love being able to interact in the small groups. The sessions I attended were well done and professional. I also like the ability to collaborate with our colleagues from AORN, Central Service and Surgical Technology. Attendees range from staff personnel to higher management and the intimate ambiance facilitates networking along with learning,” shared Sharon A. McNamara, RN, Perioperative Consultant, OR Dx + Rx Solutions for Surgical Safety. “The food and entertainment are also top quality and free. Come join us in 2020, I plan to be there.” OR Today Live will once again feature education targeting management, clinical and CS/SPD tracks along with the ever-popular pre-conference educational workshops which kick-off the conference. CCI will also present a full-day course on the Fundamentals of OR Management. “OR Today Live sincerely values the support brought by organizations like CCI. As potential attendees look at where to get their continuing education, having an esteemed organization like CCI speaks volumes to the quality education we strive to provide, explained Kristin Leavoy, group publisher of OR Today magazine. • For updates and more information, visit ORTodayLive.com and sign up for the newsletter at the bottom of the page.
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news & notes
Stryker to Acquire Mobius Imaging, Cardan Robotics Stryker has announced a definitive agreement to acquire Mobius Imaging LLC, a leader in point-of-care imaging technology, and its sister company, GYS Tech LLC, in an all cash transaction of approximately $370 million upfront and up to $130 million of contingent payments associated with development and commercial milestones. The acquisition provides Stryker’s spine division with immediate entry into the intra-operative imaging segment and aligns with Stryker’s implant and navigation offerings. Mobius Imaging, founded in 2008, is focused on integrating advanced imaging technologies into medical workflow, which can enhance a clinician’s ability to obtain highquality images. Its Airo TruCT scanner is a best-in-class mobile, real-time, diagnostic-quality CT imaging system. Cardan Robotics, founded in 2015, is working to develop innovative robotics and navigation technology systems for
surgical and interventional radiology procedures. “This acquisition brings expertise in advanced imaging and robotics as well as a robust product pipeline that add to Stryker’s portfolio and will allow the spine division to provide more complete procedural solutions, including sales, service and support,” said Spencer Stiles, Stryker’s group president, orthopaedics and spine. “We look forward to working together to advance Stryker’s mission to make health care better and accelerate our pursuit of category leadership in neurotechnology, orthopaedics and spine.” The transaction is expected to have an immaterial impact to Stryker’s net earnings in 2019. The transaction is subject to customary closing conditions, including expiration of the applicable waiting period under the HSR Act, and is expected to close in the fourth quarter of 2019. •
Pure Processing Offers Pre-Cleaning Solutions Pure Processing provides solutions to eliminate or greatly reduce the injury risk in all these workspaces, and to help make pre-cleaning workflow compliant with regulations and highly productive. Pure Processing understands every aspect of the precleaning environment, from the big-picture guidance and standards compliance requirements, to facility workflow and space needs, to the individual steps of each pre-cleaning task. For example, by providing automated tools that eliminate many repetitive motion tasks and help achieve consistent processes, such as the FlexiPump Independent Flushing System, Pure Processing helps support compliance and cuts down the number of opportunities for injury and days away from work. Also, by achieving proper work depth in Pure Processing’s height-adjustable pre-cleaning sinks, deep bending that causes back and leg strain is eliminated. By organizing tools at the sink within easy reach of the technician, the work is at the proper reaching height to avoid head, neck and shoulder pain.
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By organizing and optimizing the pre-cleaning area’s workflow with compact sinks, versatile mobile soaking and transport solutions, Pure Processing provides visualization and lighting tools, and a host of accessories designed for the safety and convenience of the user. This makes the entire process more efficient, which helps improve daily productivity. Pure Processing solutions are designed to accommodate any facility’s pre-cleaning footprint, from tiny pre-cleaning corners in an endoscopy lab to a full SPD “dirty side.” Systems and accessories can be selected to optimize the tasks and achieve the workflow volume of each specific department. And PureSteel sinks and inserts are available to accommodate all devices in a hospital’s inventory, from tiny screws and parts to large robotic lumens. Also, Pure Processing LLC announced the appointment of Chuck Siems, a seasoned sales administrator with three decades of health care experience, as executive vice president of business development for the company. • For more information, visit www.pure-processing.com.
NOVEMBER 2019 | OR TODAY |
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INDUSTRY INSIGHTS
news & notes
Bridgeport Magnetics introduces ULTRASWEEP Getinge Launches New Mobile OR Table Getinge has introduced the mobile operating room (OR) table Maquet Lyra that offers the stability and functionality needed for almost all surgical disciplines. The Maquet Lyra is an affordable and flexible OR table that meets the needs of most surgical disciplines. “This mobile OR table give surgeons the options they need. It is designed for universal use and we made sure to make it comfortable to position patients for most types of surgical procedures. A stable and flexible table like this improves functionality and increases cost-effectiveness in the OR,” tells Dominik Birkner, product manager OR tables at Getinge. By combining universal usage features with a broad range of accessories, Maquet Lyra is a practical table for all-around use. It features the same interfaces as past Getinge mobile OR tables and the compatibility with existing Getinge accessories ensures seamless integration into surgical suites. “One of the factors specifically important for orthopedics is stability, since strong forces are being applied both to the patient and the table. Our Maquet Lyra has a solid base ensuring stability and safety for patients weighing up to 360 kg, and we have a very good and tight locking mechanism of all four castors on the table. It is also capable of a range of angles and tilts for cross-disciplinary flexibility,” explains Birkner. The special design of the castors allows the table to be used immediately, without being lowered onto a baseplate. The table brakes can be quickly and easily released via the foot pedal. Even in the unlikely event of a table software blackout, the patient remains secure and the table can be safely controlled. “The override panel is hard-wired to a separate circuit, with no software in between,” says Birkner. •
12 | OR TODAY | NOVEMBER 2019
Bridgeport Magnetics Group Inc. has introduced ULTRASWEEP, a low-cost solution for UV-C ultraviolet surface disinfection. ULTRASWEEP is permanently installed in locations with a high risk of touch transferred infections. In addition to considerable cost savings on the robot itself, there is important labor savings as no need for specially trained, dedicated staff, eliminating complicated logistics to move and operate floor-based transportable systems, often around the clock. Target areas include operating rooms, intensive care units, emergency departments and other highrisk patient rooms. At a projected price of $7,500 per room, the ULTRASWEEP Robot is an affordable solution for smaller hospitals and surgical centers. The ULTRASWEEP Robot is permanently installed in the ceiling of the room, suspended 7 to 8 feet above the floor. During a sterilization cycle, the radiation source travels along a 10-foot diameter circle. A cycle is performed in two full revolutions, first clockwise and then counterclockwise, returning to the starting point within 20 to 30 minutes. The UV-C emitters are mounted opposite the drive end and travel almost imperceptibly while covering surfaces with germicidal UV radiation from alternating directions. A hinged panel protecting the UV lamps, opens and closes automatically at the start and end of each cycle. The cycle can be customized for any room sized 100 to 500 square feet by programming stops and dwell times at chosen angles for extended dosage of high touch areas, or at angles 0 and 180 degrees to cover an elongated room. • For more information, visit www.bridgeportmagnetics.com.
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Healthmark Offers New Endoscope Products Healthmark Industries recently introduced two new products. The company added the EndoDolly and Scope Sleeves to its endoscope product line. Manufactured from stainless steel, the EndoDolly is designed for hanging scopes and stands on a five-wheel locking base for ease of transportation. The EndoDolly is equipped with three self-adjusting extension poles that can be individually raised by simply touching a pressure button, which allows the user to extend the two outside poles to 8 feet and the middle pole to 10 feet. Located at the top of each pole is a lock tight hook holder that can accommodate two scopes per pole and supports flexible scopes up to 15 pounds per pole. Each self-adjusting pole comes with polycarbon-
news & notes
ate cups that allow for the scope tip to be placed in during transportation, storage or quality assurance testing. The Scope Sleeves are manufactured of material comprised of 80% cellulose and 20% polypropylene. The single-use Scope Sleeves are designed to cover and protect insertion tubes after reprocessing, during transportation and storage. Open on both ends, the non-linting Scope Sleeves are made of an absorbent material that also provides a barrier to environmental contaminants. The Scope Sleeves are offered in three sizes: 85L x 5W cm, 115L x 5W cm and 190L x 5W cm. The Scope Sleeves are available for purchase in packs of 100. • For more information, visit www.hmark.com.
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INDUSTRY INSIGHTS
news & notes
Philips, B. Braun Launch Onvision Needle Tip Tracking Royal Philips and B. Braun Melsungen AG have announced the launch of Onvision, an ultrasound guidance solution for real-time needle tip tracking in regional anesthesia. Available on the latest version of the B. Braun and Philips Xperius ultrasound system, Onvision gives anesthesiologists the confidence to accurately position the needle tip inside the body. The introduction is part of a multi-year strategic alliance between Philips and B. Braun to innovate in ultrasound-guided regional anesthesia, a rapidly growing alternative to general anesthesia. Onvision was launched at the 38th Annual Conference of the European Society of Regional Anaesthesia and Pain Therapy (ESRA) in Bilbao, Spain. Accurate needle placement is critical to the success of regional anesthesia procedures, such as peripheral nerve blocks, both in terms of effective pain relief and the avoidance of unintended nerve and vessel punctures or collateral damage to surrounding tissue. While real-time ultrasound imaging has proved to be a valuable tool for needle guidance, failure to optimally visualize the needle tip remains a challenge for anesthetists. By simplifying alignment between the needle and ultrasound probe, Onvision reduces the effort needed to interpret the ultrasound image. This allows the anesthesiologist to more confidently guide the tip of the needle to its target. “Regional anesthesia is a rapidly growing alternative to
14 | OR TODAY | NOVEMBER 2019
general anesthesia and has the potential to improve patient outcomes as well as increase workflow efficiency in the hospital,” said Bert van Meurs, chief business leader, image guided therapy at Royal Philips. “By combining B. Braun’s expertise in needle design with Philips’ capabilities in real-time image guidance, we’ve created a solution to one of the biggest challenges in regional anesthesia – accurate positioning of the needle tip in the body. Our alliance with B. Braun is a strong example of our commitment to partner with industry leaders to grow our footprint in the therapy market.” Together, B. Braun’s Stimuplex Onvision needles and Philips’ Onvision needle tip tracking technology indicate the position of the needle tip in relation to the ultrasound viewing plane to an accuracy of better than 3mm. A sensitive micro-sensor placed on the needle, combined with advanced signal processing and visualization techniques on the Xperius system, indicate the real-time location of the needle tip in relation to the 2D ultrasound viewing plane. The increased confidence and predictability offered by Xperius and Onvision will empower more anesthesiologists to embrace regional anesthesia as a viable and effective alternative to general anesthesia. The Onvision solution is CE marked and available for sale across the EU and in Chile. It is not currently available for sale in the United States. •
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news & notes
When Quality Matters
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Sterizo Total Knee Replacement System Launched Fuse Medical Inc., an emerging manufacturer and distributor of medical devices for the orthopedic and spine marketplace, announced the launch of the Sterizo Total Knee Replacement System. The Sterizo Total Knee System is a next-generation technology platform based on proven and accepted design principles in the orthopedic total knee arthroplasty marketplace. Its high flexion engineered, multi-radius design delivers exceptional range of motion. The Sterizo Total Knee System offers a full range of sizes as well as multiple stabilization options, including cruciate retained, ultra congruent anterior stabilized and posterior stabilized. The Sterizo Total Knee System utilizes a streamlined, stackable, two tray modular instrument system for simplicity and to help reduce sterile processing costs. The intelligent design of the Sterizo Total Knee System provides for an improved approach to completing a total knee arthroplasty with great efficiency. “We are excited to expand our orthopedic product portfolio and national distribution footprint with the addition of the Sterizo Total Knee Replacement System,” commented Christopher C. Reeg, chief executive officer of Fuse. “The launch of this technology will present surgeons with advanced options for treatment of their patients requiring total knee arthroplasty. Our primary knee offering will be followed next year by the launch of a comprehensive revision knee system, as well a primary total hip system, highlighting our commitment to advance our competitive product portfolio in the orthopedic marketplace. The Sterizo Total Knee System also provides new opportunities for independent distributors nationwide. Our priority at Fuse is to provide effective solutions for today’s clinical challenges and assist with improving surgical outcomes.”
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INDUSTRY INSIGHTS
scheduling
How Intelligent Scheduling Reduces Stress and Surfaces Success in the OR By Mark Deshur he operating room is an undeniably complex space in the acute care landscape. It involves a multitude of different care providers and stakeholders to carefully manage and coordinate the many phases of surgical work.
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To run smoothly and efficiently, the OR relies on accurate and comprehensive schedules, experienced and engaged providers, and exceptional dedication to patient safety. Because of this, hospitals often rely on their most trusted senior nurse managers to handle the complex and time-consuming task of scheduling. They have deep knowledge of the many rules and dependencies to know who the right people are to schedule at the right time for the right patient, and they don’t want to leave this critical work to chance — or technology. This is exactly what the staff at University Medical Center, a public hospital with 412 patient beds in Lubbock, Texas, faced. Until recently, University Medical Center’s perioperative staff signed up for schedules on clipboards, administrative staff posted paper schedules every day, and vacation requests were emailed and captured in private, onsite systems with zero visibility to employees at home. According to Adria Renegar, MSN, RN, CNOR, the director of operating room services, “If shift swaps – which were handled via paper forms – weren’t received by administrative staff, the incorrect schedule would be posted and cause
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confusion when those called weren’t truly on call. It was an extremely slow and ineffective process.” However, new and intelligent health care technology can help – rather than hinder – providers do their jobs faster and more accurately, without reducing their control over the process. After investing in a new solution to better support its fast-moving surgical suite, University Medical Center saw a spike in employee engagement and team morale – and it had a positive trickledown effect on patients as well. From reconciling tricky schedules to increasing facetime between providers and patients, an automated workforce management solution can be a gamechanger for operating rooms to ensure that they’re securing proper coverage, enhancing productivity, meeting safety measures, and improving the overall patient experience.
Simplify and automate complex scheduling It’s no secret that provider, patient, and staff availability can fluctuate at a moment’s notice, and manual or paper-based scheduling can make managing staff, call, and OR schedules extraordinarily challenging. This is where an intelligent perioperative scheduling solution can help: With powerful artificial intelligence and self-scheduling capabilities, organizations can more easily create fair and transparent schedules that are accessible to providers and staff through mobile devices in real-time. This ensures schedules
are always optimized based on availability, overtime, and coverage requirements. For organizations that are still managing and updating schedules manually or on paper, compliance with labor laws, operating room policies, and rest period requirements is a fool’s errand. With the help of a digital and automated solution, organizations with custom staffing rules, such as University Medical Center, can more effectively develop schedules that take into account employee preferences and capabilities, helping better manage compliance and create an engaged culture with the right people with the right skills working at the right time.
Engage clinicians through t ransparent and mobile-friendly scheduling technology Optimized schedules that account for shift preferences, availability, and realtime changes can empower OR staff to be more present. Imagine a scheduling solution doing all the comprehensive work of spreading out call shifts, aligning patient needs with clinician skills, and matching shift swaps. The time that employees will save on administrative work can be spent on quality initiatives such as staff training and patient communication. Intelligent scheduling can also help organizations reduce the risk of overtime and ensure employees are working preferred and compliant schedules that enhance patient outcomes. With mobile access to schedules, oncall shifts, and time-off requests anytime, anywhere, employees can also achieve a
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INDUSTRY INSIGHTS
scheduling work-life balance that makes sense for them and their priorities. From helping to manage an unforeseen family emergency, to swapping shifts in order to attend a child’s upcoming championship soccer game, mobile workplace technology is now as instantly accessible and easy to use as personal technology. For University Medical Center, the impact of real-time scheduling on the OR workforce has been immense. “Since implementing our periop scheduling software, we’ve seen employee satisfaction scores increase from 83% to 96%,” said Renegar, “the highest score our department has ever had. We’ve reduced fatigue, improved patient safety, and boosted staff morale – which ultimately helps us enhance the quality of care for our surgical services.”
Manage patients in the moment Quality surgical care begins with an accurate nurse scheduling process and
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real-time dashboards that don’t just allow employee participation but invite it. Even the best operating room teams will struggle if there are coverage gaps or mismatched skill sets. Increasingly complex patient procedures necessitate the right number and mix of providers with the right skills and certifications at all times. Effective schedules and access to real-time data makes it easier to ensure staff members are taking needed and recommended rest breaks between shifts, which help reduce staff fatigue and, most importantly, improve patient safety. Mobile-friendly scheduling solutions also empower staff to access upcoming schedules and prepare for the scheduled next-day assignments and procedures. “We live and work at a time when we expect information at our fingertips and our organization is committed to giving that kind of instant access to our employees — which means we demand
the ease of use of popular apps from all technology,” said Renegar. “Our scheduling technology has been a high-impact investment with benefits that we’ve seen reverberate through our hospital. Now, our operating room teams can deliver the highest level of quality care and feel more engaged at work.” In his book “Patients Come Second: Leading Change by Changing the Way You Lead,” Paul Spiegelman wrote, “Hospitals have missed the point that the best way to improve the patient experience is to build better engagement with their employees, who will then provide better service and health care to patients.” It’s a simple equation with an enormous outcome: Happy staff plus happy providers equals happy patients.
Mark Deshur, MD, MBA, is a health care industry consultant for Kronos Incorporated.
NOVEMBER 2019 | OR TODAY |
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INDUSTRY INSIGHTS
CCI news & notes
It’s Time to Recertify My CNOR! How Do I Do It? By Kellie Anderson and Benjamin Dennis ttaining your CNOR certification is a prestigious professional accomplishment. Keep your credential active by recertifying on time. Kellie Anderson and Benjamin Dennis of the CCI Credentialing Team answer FAQs about recertification, CCI’s Take 2 program and more.
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Q: Where can I report my Continuing Education? A: You can report your Continuing Education by logging into the CCI site, then selecting “My CNOR” above your profile details. Next, select the “Continuing Education” tab. Once on this page, you can review/edit previously reported activities, report Contact Hours, report Professional Activity Points, and import AORN contact hours. In order to report AORN Contact Hours, you will need to know your AORN login email and password or your AORN ID number.
Q: What is the difference between my accrual period and recertification year? A: Your accrual period is the five-year timeframe in which you can earn and complete activities to meet the recertification requirement. Accrual periods begin on January 1 of the first year and end on December 31 of the fifth year, regardless of when you initially became certified. For example: January 1, 2014-December 31, 2018. Your recertification year is the year in which you submit your activities, em-
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ployment details and license information to CCI in your CNOR recertification application. This is the only year in which you pay the recertification fee. Your recertification year is the sixth year and subsequent year after your accrual period ends. Once you submit your recertification application and it is approved during this year, it then becomes your first year in the new accrual period.
Q: What are my options for recertification? A: If you are recertifying in 2019, 2020 or 2021 you have the following options for your next accrual period: Contact Hours, Professional Development Activities or recertification by exam. Professional Development Activity categories include academic study, additional perioperative certifications, precepting or mentoring new employees, and many more! You can find a list of our approved Contact Hour providers at: https://tinyurl.com/CEProviders. Please check our new 2019 recertification guide for more categories found here: https://tinyurl. com/CNOR2019. If you just gained your CNOR credential (passed the exam) in 2019, your options for recertification are Professional Development Activities or recertification by exam.
Q: How do I access my CCI account? A: In order to login to your account, you will need to know which email address you have associated with your account. You will never need to create a second account. If you do not know which email address was used, please call us, and we can help you. If you do not know your
password but know which email address was used, please select the “forgot your password?” option. On the next page, enter in the email address associated with your account. You will receive an email with a link that allows you to reset your password.
Q: How do I change my name or contact information on my account? A: After logging into your account, select the “edit contact info” option found under your profile details. On the next page, you can edit your contact information. To change your name, please contact CCI directly.
Q: Where can I verify a credential? A: CCI offers online credential verification at: https://tinyurl.com/CCIVerify
Q: How do I register for my second Take 2 exam? A: Once your first three-month testing window is over, you may register for your second exam by logging into your CCI account, clicking on “My CNOR” and then proceed to the “Exam” tab. If you are eligible, there will be the option to register for the next testing window. Once you have clicked on this button, you will receive your Approval To Test (ATT) email within 24 hours. The letter will contain a new Eligibility ID from Prometric and you may use this to schedule your exam.
Q: Still need more help? A: Please reach out to us! We can be reached by phone at 888-257-2667 and by email at info@cc-institute.org.
NOVEMBER 2019 | OR TODAY |
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INDUSTRY INSIGHTS
IAHCSMM
New IAHCSMM Offerings Fuel Knowledge, Feed the Senses By Julie E. Williamson he International Association of Healthcare Central Service Materiel Management (IAHCSMM) recognizes that today’s sterile processing (SP) professionals are seeking continuing education and knowledge-building opportunities that suit their busy lifestyles and meet their unique learning preferences.
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To help meet those needs, IAHCSMM continues to add to its arsenal of education- and professional-based offerings. On October 15, 2019, IAHCSMM unveiled its new podcast series called “PROCESS THIS!” Hosted by IAHCSMM Clinical Education Specialist Jon Wood, each podcast episode features in-depth interviews of industry professionals and experts whose messages will focus on specific processes that move us forward as professionals, as departments, as health care facilities and as an industry. The introductory podcast, released during International Central Service Week, peels back the layers of the many physical and mental processes that must work in tandem to help ensure SP professionals deliver exceptional service and contribute to positive patient outcomes. “PROCESS THIS!” episodes can be accessed on the IAHCSMM website and streamed on Apple Podcasts, Stitcher, Google Pod-
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casts and Spotify. Each episode is worth 0.5 continuing education (CE) credits and a new episode of “PROCESS THIS!” will be released twice a month. Another recent addition is the yearround IAHCSMM mobile app. Those who attended the IAHCSMM Annual Conference & Expo the past two years are likely already familiar with the conference app that they downloaded onto a mobile phone or tablet, but now the app is available 365 days a year and offers a host of valuable information, right at users’ fingertips. Through the mobile app, users can now access their IAHCSMM account information, online education, Annual Conference & Expo info and much more. The app may be downloaded from the app store on their mobile device (those who downloaded the app at the 2019 conference only need to
open it again to access the year-round version). These two latest offerings come on the heels of other recent additions that have proven invaluable to SP professionals. Last year, the IAHCSMM introduced its educational webinars, and the library – which currently includes 23 webinars – continues to grow. The webinars cover diverse topics along three learning tracks: employee training, employee enrichment and management. Topics range from basic instrument inspection to the role of the CS department in infection prevention to understanding and developing a competency program and much more. The webinars may be used for general SP learning or for continuing education that can be applied toward certification renewals (completion of any IAHCSMM webinar provides 1 CE credit). Additional webinars are slated for release by the end of 2019 and all are free for IAHCSMM members. The cost is only $15 for SP professionals who are non-members/ certified only. For more information and direct access to IAHCSMM’s educational offerings, including the webinars, online lesson plans, publications, courses, and Envision staff training videos, visit www.iahcsmm.org/education.html.
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INDUSTRY INSIGHTS
WEBINAR SERIES
webinars
oneSOURCE Session Proves ‘Very Informative and Relevant’ By John Wallace he OR Today webinar “oneSOURCE Document Site Surgical Instrument, Equipment and Tissue/Implants Database Demonstration” presented by Lindsay Frkovich-Nelson was eligible for one (1) continuing education (CE) hour by the State of California Board of Registered Nursing.
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Frkovich-Nelson, vice president of sales and marketing at oneSOURCE Document Management Services, provided a great presentation. She explained how to navigate the oneSOURCE website and view surgical instrument, equipment and tissue and implant biologic and non-biologic Instructions For Use documents including search instructions, features, benefits, documents viewed, archived documents and requests. More than 300 people registered for the webinar and 158 indviduals tuned in for the live presentation. The webinar received positive feedback in a post-webinar survey and a 3.7 rating on a 5-point scale. “I was happy to find out that oneSOURCE can provide the IFU on our tissue and other implants. Nurses sometimes forget to keep the literature that comes with the implants, so this is a great way to track them. It’s also an answer to The Joint Commission if they ask for our literature on the implants. I was also happy to hear that oneSOURCE can integrate with the tissue tracking,” OR Manager J. McIntyre said. “Due to the ever-changing technology in the medical field, being able to easily find and access current information on use, manuals and updates can be a daunting challenge. After participating in the oneSOURCE webinar, I’ve realized the need and time-saving potential they have to offer,” said J. McLaughlin, BMET II. “Very informative and relevant to the industry. Easy to understand,” said N. Mendez, senior infection control coordinator. “Very informative, provides insight into not only the product, but to how various components can prepare a hospital and specifically SPD in preparing for regulatory surveys,” Director of Perioperative Services J. Olivares said. “The oneSOURCE Document Site database demonstration
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“ Very informative, provides insight into not only the product, but to how various components can prepare a hospital and specifically SPD in preparing for regulatory surveys.” – Director of Perioperative Services J. Olivares provided some excellent new tips for me such as the revision notification email. I plan for staff to renew their training, as well. Many thanks,” said H. Eason, risk manager. “As always, the OR Today’s webinar series is extremely informative,” shared K. Monahan, central supply/sterile coordinator. “It was refreshing to see a straightforward training that directly relates to our everyday duties,” said O. Caraballo, sterile processing supervisor. This was a great webinar. oneSOURCE has always been a great tool. With the new tissue aspect even better and the archive area … wow,” said L. Smith-Zuba, director of perioperative services. For more information about the OR Today webinar series, including recordings of previous webinars and registration for upcoming sessions, visit ORToday.com and click on the “Webinars” tab. Thank you to our sponsor:
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market analysis
Patient Monitoring Market to Hit $27 Billion Staff report report from Global Market Insights Inc., a global market research and consulting service provider, predicts strong growth in the global patient monitor market.
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The global patient monitoring devices market will surpass $27 billion by 2025, according to a report by Global Market Insights Inc. The report states that a growing preference for advanced patient monitoring devices across the globe will positively influence the industry’s growth in coming years. The report says one reason for growth includes digitalization in patient monitors that has helped doctors maintain a record of a patient’s vital parameters throughout treatment resulting in reduced mortality rates. Also, automation in patient monitors have reduced the requirement of skilled staff to operate the devices and as a result are reducing overall operational costs. Increased awareness pertaining to availability of advanced patient monitoring systems in developing and underdeveloped countries will propel business growth, the report adds. The governments of developing economies such as India and China are implementing initiatives and conducting campaigns to raise awareness pertaining to the availability of superior quality monitoring devices. Furthermore, industry players are promoting the benefits of advanced patient monitor-
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ing devices. However, the high cost of patient monitors may hamper market growth. The respiratory monitoring devices segment accounted for more than $1 billion in 2018 and it will grow substantially in coming years, according to the report. Recently developed respiratory monitoring devices provide a multi connectivity option that assists in delivering the right amount of oxygen. It also identifies pulse and respiration rate accurately. Moreover, respiratory monitoring devices store patients’ information enabling clinicians to detect complications that may occur during treatment. Additionally, alert mechanism and real-time detection assists doctors to provide efficient treatments to patients. These aforementioned factors will trigger market growth, according to the report. The global market will see growth in more than one region, but the Asia Pacific segment is predicted to achieve a significant compound annual growth rate (CAGR) up to 2025. The growth is supported by a rising awareness regarding the availability of wearable monitoring devices. The North America patient monitoring devices market share is anticipated to witness more than 4% growth in the forthcoming future, according to the report. Factors such as sedentary lifestyle, consumption of junk food and lack of exercise have boosted incidences of chronic conditions such as cardiovascular diseases
and endocrine disorders due to rise in cholesterol levels. This scenario proves beneficial for the industry growth as it increases the demand for the patient monitors required for continuous monitoring of vital parameters, the report states. Moreover, the growing elderly population has a preference toward remote patient monitoring devices due to convenience and that should elevate the regional market growth. The ambulatory surgical centers (ASCs) segment was valued around $4 billion in 2018. Its considerable revenue size is attributable to advantages offered by ASCs such as low-cost minimally invasive surgeries and a reduced length of patient stay. Thus, a large number of outpatient surgeries are performed that should increase the demand for patient monitoring devices and boost the segmental growth. Technological advances continue to fuel growth. The wireless patient monitoring devices segment of the market is anticipated to witness more than 5% CAGR throughout the forecast time frame, according to the report. Advanced remote patient monitoring techniques assist doctors to examine multiple patients simultaneously. Also, health care professionals can observe patients from rural areas that often do not have a health care facility near by. Thus, the demand for wireless monitoring devices will increase, according to the report.
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product focus
Dräger
Infinity Acute Care System Transform your clinical workflow with the Infinity Acute Care System monitoring solution. This innovative two-screen solution opens the door to a new dimension of patient mobility, connectivity and configurability – providing for seamless transition of the patient and their information with a single monitor that travels with the patient throughout the care path. The system consists of the Infinity M540 patient monitor, integrated with the Dräger Infinity C500 or C700 Medical Cockpit. The M540 is a compact vital signs engine that acquires data at the bedside and on transport, without having to disconnect the patient as they move from care area to care area. •
EarlySense
EarlySense System EarlySense provides contact-free, continuous monitoring solutions across the health care continuum. Used worldwide in hospitals, rehab and skilled nursing facilities, the patented sensor sits underneath a bed mattress and wirelessly monitors patients’ heart and respiratory rates more than 100 times per minute. This real time data enables clinical staff to identify patient deterioration earlier and prevent potential adverse events such as falls and decubitus (pressure ulcers), while allowing recognition of changes in vital signs that might indicate onset of sepsis, opioid-induced respiratory depression and other preventable forms of deterioration/failure to recuse. The solution is used to monitor all non-ICU patients who today are only manually spot checked. •
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product focus
GE Healthcare CARESCAPE Monitor B850
The CARESCAPE Monitor B850 delivers the highest level of monitoring excellence as well as comprehensive parameters in critical and perioperative care. The clinically advanced and highly configurable CARESCAPE Monitor B850 helps clinicians stay a step ahead with tools that meet the needs of the most critical patients. Designed by clinicians, for clinicians, the CARESCAPE Monitor B950 offers flexibility, scalability and exceptional customization all in one userfriendly system that’s tailored to fit how clinicians work and handle patient data. Based on proven Marquette ECG algorithms and Datex Ohmeda’s unique “Adequacy of Anesthesia Concept,” CARESCAPE Monitors are designed for tailored anesthesia. •
Masimo Pathway
Masimo has announced Pathway, a feature for the Root Patient Monitoring and Connectivity Platform. Pathway provides clinicians with a way to visualize a hospital’s recommended resuscitation protocol for a newborn’s oxygen saturation (SpO2) while continuously monitoring SpO2 and pulse rate (PR) during the first 10 minutes after birth. Use of Pathway is intended to help streamline clinician workflow and improve protocol adherence during this critical period. •
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product focus
Philips
IntelliVue X3 Philips IntelliVue X3 is a highly portable, dual-purpose monitor with intuitive smartphone-style operation that helps streamline workflow and boost efficiency by reducing the number of steps to prepare patients for transport. With this monitor, there is no need for clinicians to change patient cables during transport or at bedside, allowing them to spend less time dealing with equipment and more time caring for the patient across all levels of acuity. In addition to integrating seamlessly into the Philips Patient Monitoring solution, data from IntelliVue X3 is also integrated into mobile applications, the hospital network, and interfaces that connect the system to other medical devices and the hospital’s EMR system for virtually gap-free patient information from admission to discharge – even during transport. •
Spacelabs DM4
Spacelabs Healthcare’s DM4 dual-mode monitor is the newest member of the company’s patient monitoring line. The DM4 is designed for use in any patient care environment where basic vital signs monitoring is needed, and it is expected to enable caregivers to adapt to changes in patient condition without having to locate additional equipment. In spot-check mode, the DM4 can wirelessly transmit individual patient records to an electronic medical record system (EMR), or it can be used to efficiently collect and download multiple patients’ records in batch mode from a central location. If more vigilance is required, the DM4 can be quickly switched to continuous monitoring mode with alarm notification support. •
28 | OR TODAY | NOVEMBER 2019
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continuing education
MRSA: More Work to be Done BY NANCY DONEGAN, MPH, RN, CIC AND DEBRA ANSCOMBE WOOD, BS, RN
ake was two weeks postop from a heart and kidney transplant. He had spent many weeks of the past year in and out of the ICU with his failing heart and kidneys. This afternoon he began to feel nauseated and spiked a fever of 101.4 F. He had pain at the entry site of his central line, so the clinician removed the dressing to inspect the it. It was red and swollen. The clinician reported her findings to Jake’s physician, who immediately ordered blood cultures and made plans to remove the central line. Broad-spectrum antibiotics and vancomycin (Vancocin) were started. A rapid test showed presumptive MRSA in the blood sent for culture. The next morning, the gram-stain report showed gram-positive cocci. Jake’s condition was deteriorating rapidly. Despite the clinicians’ best efforts, Jake developed a profound hypotensive episode that night, which in turn led to ventricular tachycardia and cardiac arrest. Resuscitation efforts were futile. Jake succumbed to sepsis caused by a hospital-acquired infection.
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This scenario, based on a true story, remains all too familiar these days. The Centers for Disease Con-
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trol and Prevention reports that invasive (life-threatening) methicillin-resistant S. aureus (MRSA) infections in healthcare settings are declining. In 2015, there were about 10% fewer healthcare-associated invasive MRSA infections than in 2014.1 The CDC has classified MRSA as a “serious risk” with more than 80,000 MRSA infections and more than 11,000 deaths attributed to MRSA occurring each year. 2
MRSA Versus MSSA — HAI Versus CAI Staphylococcus aureus is a bacterial species that can either be benign or be seriously pathogenic. About 30% of Americans carry S. aureus asymptomatically as normal flora in their nares and 20% on their skin.3 This benign carriage is called colonization. A 2013 study found that people entering the hospital who are colonized often had a recent prior hospital stay, a history of being exposed to healthcareassociated pathogens, and some comorbid conditions, such as heart failure, pulmonary disease, diabetes, or immunosuppression.4 S. aureus can also cause a wide range of infections, from mild skin infections to serious, life-threatening infections, such as bacteremia, endocarditis, and osteomyelitis. Different strains of S. aureus have
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 nurses, dietitians, dietary managers, health educators, physical therapists, occupational therapists, pharmacists, laboratory professionals, and imaging technologists with information about the problem of MRSA in healthcare and the strategies to reduce its spread. After studying the information presented here, you will be able to: • Discuss the epidemiology of MRSA • Identify three factors that put hospital patients at risk for MRSA • Describe three strategies healthcare professionals as a team can use to prevent and control the spread of MRSA in healthcare facilities
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continuing education different virulence (degree of harmfulness). S. aureus infections may be subdivided as either methicillin-sensitive S. aureus (MSSA) or MRSA.3 Methicillin is no longer marketed, but S. aureus is still classified by its susceptibility to similar drugs, such as oxacillin (Bactocill) or nafcillin (Nallpen, Unipen).2,5 MRSA as a proportion of total S. aureus infections increased rapidly since the 1960s when methicillin was first introduced. About 2% of the U.S. population is colonized with MRSA.6 From 2011 to 2014, of the 11.8% healthcare-associated infections (HAIs) caused by S. aureus, half were resistant.7 Until recently, MRSA was relatively rare in community acquired infections (CAIs). However, in recent years, the incidence of communityacquire MRSA (CA-MRSA) grew significantly. The CA-MRSA strain was especially likely to cause skin and soft tissue infections, often first appearing with a spider bitelike appearance, and sometimes leading to severe tissue necrosis, sepsis, and systemic infection.6 Even as healthcare-associated MRSA (HA-MRSA) has decreased significantly since 2005, CAMRSA rates have not seen the same degree of improvement.8 In 2015, more than 80% of the MRSA bloodstream infections reported to the CDC were classified as CAMRSA.8 Future prevention efforts will require greater collaboration between acute care, long-term care, home health, and public health to address the full range of MRSA infections. S. aureus, whether it is MRSA or MSSA, and whether it is HAI or CAI, has an affinity for colonizing skin. Commonly, MRSA is spread in the healthcare setting by the hands of healthcare workers.9 It can also be spread by contact with
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the infected wound or by people who are colonized.9
Through the Decades S. aureus was discovered in the 1880s, and infections typically involved the skin and soft tissue.9 Since then, healthcare providers have recognized the vast number of infections for which S. aureus is responsible. S. aureus most often causes skin and soft tissue infections, which are often mistaken for spider bites. S. aureus can also be responsible for more serious infections, including pneumonia, meningitis, urinary tract infections, endocarditis, surgical site infections, and toxic shock syndrome. Before the antibiotic era, many of these infections proved fatal.10 In the 1940s, penicillin G benzathine (Bicillin) and other antibiotics became available in the U.S., and it seemed that modern medicine would conquer its bacterial foes. But almost as soon as the medical profession started prescribing these wonder drugs, S. aureus and most other pathogenic bacteria began to develop resistance mechanisms that allowed them to survive in the presence of these drugs. Overuse, especially for infectious conditions which were not bacterial or effectively treated by penicillin, highly contributed to the development of resistance. In the late 1940s, S. aureus began to develop resistance to penicillin, and methicillin became the drug of choice. However, by 1961, the first strain of MRSA was discovered by British scientists, and the first human case of MRSA in the U.S. was diagnosed in 1968.10 Since then, MRSA has been an ongoing issue in healthcare settings. MRSA became increasingly common in hospitals from 2006 to
2010, when researchers reported that about 66 of every 1,000 inpatients were colonized or infected with MRSA, with 25.3 infections and 41.1 colonizations.11 In addition, the 2010 data reflect more colonization than active infection.10 More recent data from the CDC indicates a decline in serious, life-threatening MRSA infections in healthcare settings.12 Additionally, the CDC reports fewer deaths from severe MRSA infections.12 There have also been decreases in central line-associated bloodstream infections (CLABSIs).12
Transmission of MRSA HA-MRSA can lead to a variety of outcomes. Patients may be transiently or permanently colonized without symptoms, or they may develop disease immediately or in the future, especially in the presence of invasive devices or after surgical procedures. In hospitals, healthcare workers across various disciplines can transmit MRSA from a colonized/infected person to a previously unexposed person. Antibiotic-resistant organisms like MRSA are transmitted in the same way as more susceptible bacteria, patient to patient, most often by contaminated hands.8 The CDC classifies bacteria on the hands as resident or transient.13 Resident bacteria are organisms that attach to deeper parts of the skin, making them more difficult to remove with hand hygiene. However, resident bacteria are less often associated with infection than transient bacteria. Bacteria are easy to remove with proper hand hygiene, because they tend not to attach to the deeper areas of the skin.13 Organisms, including MRSA, that typically cause healthcareassociated infections are most often
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continuing education transient bacteria on the hands of healthcare workers. If healthcare workers of various disciplines don’t practice appropriate hand hygiene, they can carry MRSA easily to the next patient or patient care item they touch. Equipment, uniforms or lab coats that come in contact with a person infected or colonized with MRSA can also be a source for transmitting MRSA to other patients. Hand hygiene is also important in reducing the risk of MRSA infection in the community. The CDC recommends cleaning hands and body regularly, particularly after exercising and cleaning. The CDC also recommends covering cuts or wounds; avoiding sharing towels, razors, or other personal items; washing bedding and clothes and drying them in a dryer; and seeking medical care if signs of infection develop.6
with a MRSA infection In a CDC study conducted in 15 counties in 2015, HA-MRSA invasive infection rates among nondialysis patients were 11.8 per 100,000 in 2015 and 1478.6 per 100,000 among dialysis patients.1 Risk factors for MRSA in patients in ICUs include:18 • Age older than 65 years • Transfer from a long-term care facility • Trauma or medical patient • Patients with a urinary catheter • Patients who have been on antibiotic treatment in the past and have a skin or postsurgical skin infection • Patients who are severely ill with a high APACHE-II score • Patients colonized with MRSA or other multidrug resistant bacteria
Risk Factors
The media have sometimes called MRSA a “deadly drug-resistant strain of staph,” which may give the impression that treatment options aren’t available. But other antibiotics usually are effective. The trouble with MRSA is that first-line treatments that are used for MSSA are no longer options. Vancomycin (Vancocin), daptomycin (Cubicin), telavancin (Vibativ), and linezolid (Zyvox) are common antibiotic choices for MRSA infections.19 The Infectious Diseases Society of America Clinical Practice Guidelines recommend that simple abscesses, incision, and drainage may be sufficient. However, if there is more than one site of infection or progression to cellulitis, other systemic illnesses, comorbidities, immunosuppression, septic phlebitis, or in children or the elderly, antibiotics are needed.
High school wrestlers, people living in crowded or unsanitary conditions, and childcare workers are at higher risk for CA-MRSA than other people.14 One study found that people who participate in high-risk sexual behaviors, illegal drug use, and those who are incarcerated are at risk for CA-MRSA.15 Current or former drug use has been associated with HA-MRSA and CA-MRSA bloodstream infections.16 Other risk factors for MRSA infections include:17 • Patients who are on hemodialysis or hospital care, especially a patient with a surgical wound or IV line • Patients who have been in the acute care setting a long time • A weakened immune system • Recent use of antibiotics • Patients who have been in close proximity to someone
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Still Treatable
Antibiotics are also called for when the abscess is in a place that would be difficult to drain, or the abscess does not respond to incision and drainage. 19 Regardless of site, effective treatment of infection starts with obtaining cultures from the suspected site(s) where possible prior to beginning any empiric therapy followed by initiating an antibiotic appropriate to the site, probably pathogen(s), and patient. Once culture and sensitivity results confirm the causative organism, therapy should be modified to a narrow spectrum agent for the remaining duration of treatment. For outpatients needing empirical coverage, such as cellulitis with no purulent drainage or exudate, clindamycin (Cleocin), trimethoprim-sulfamethoxazole (Septra, Bactrim), or a tetracycline, such as doxycycline (Monodox, Adoxa, Vibramycin, Doryx, others) or minocycline (Minocin, Minomycin, Akamin), and linezolid (Zyvox) are recommended. Rifampin (Rifadin, Rimactane) as a single agent or adjunctive therapy for skin and soft tissue infections (SSTIs) is not recommended.19 Inpatients with complicated skin and soft tissue infections should receive weight-based IV vancomycin, oral or IV linezolid 600 mg twice daily, daptomycin 4 mg/kg/ dose IV once daily, telavancin 10 mg/kg/dose IV once daily (A-I), or clindamycin 600 mg IV or orally three times daily, in addition to surgical debridement based on culture and sensitivity results.19 Treatment should continue for seven to 14 days and be tailored to the patient’s clinical response.19 Children should not be given tetracylcines. Minor infections may be treated with mupirocin (Bactroban) 2% topical ointment. Vancomycin is recommended for
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continuing education children who are hospitalized with complicated SSTIs. They may also be treated with clindamycin if resistance rate is low, or linezolid.19 In recurrent cases of MRSA, decolonization may be considered in select cases, along with hygiene measures and environmental control.19 Oral antimicrobial therapy is not recommended for decolonization. The recommended method for nasal decolonization is muprirocin twice a day for five to 10 days or mupirocin with topical body colonization for five to 14 days.19 Patients with MRSA bacteremia or infective endocarditis should receive vancomycin or daptomycin IV based on culture and sensitivity testing, two weeks for uncomplicated bacteremia, four to six weeks for complicated bacteremia, and six weeks for infective endocarditis.19 Gentamicin (Cidomycin, Septopal, Genticyn, Garamycin, others) with vancomycin or rifampin with vancomycin is not recommended. However, in patients with a prosthetic valve and infective endocarditis, rifampin and gentamicin can be given with vancomycin, and the patient should be evaluated for valve-replacement surgery.19 Patients with MRSA pneumonia should be given IV vancomycin or linezolid or clindamycin. Management of MRSA bone and joint infections includes surgical debridement and drainage in addition to antibiotics. 19 The guidelines outline specific treatments for MRSA in other less common sites.19 Antibiotic susceptibility and site of infection must be considered to ensure appropriate treatment. Many issues arise with the treatment options available for MRSA that do not arise with treatments for MSSA, including harsh adverse effects. The antibiotics required to
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kill MRSA may be more toxic than the standard antibiotic treatments. Also, most antibiotics effective against MRSA cannot be taken orally, often leading to extended use of the invasive catheters that have put patients at risk in the first place. MRSA, like all bacteria, adapts to its environment, meaning that it will continue to acquire and develop additional resistance mechanisms allowing it to live in the presence of more antibiotics, which will leave caregivers with even fewer treatment options in the future. Some cases of MRSA are also resistant to vancomycin.3
Prevention Methods Preventing the spread of MRSA in healthcare facilities is key to reducing the burden from this potentially harmful microorganism. U.S. and other hospitals have shown successful control and eradication of MRSA. Most of them reported the use of a multifaceted approach.20,21 Facilities have used combinations of measures in part because few interventions by themselves have shown clinical evidence of effectiveness. In fact, for some interventions, such as the use of contact precautions and the use of active surveillance cultures, have become controversial as researchers have found conflicting results when studies were done in different settings.20 The Society for Healthcare Epidemiology of America, the Infectious Diseases Society of America, the American Hospital Association, the Association for Professionals in Infection Control and Epidemiology, and The Joint Commission issued updated guidelines in 2014 for the prevention of MRSA and other healthcare-associated infections.21 To prevent MRSA, the guidelines suggest:
• Conducting a MRSA risk assessment • Implementing a monitoring program • Promoting compliance with hand-hygiene measures • Following contact precautions when working with MRSA colonized or infected patients • Cleaning and disinfecting equipment and the environment • Educating workers, patients, and family members about MRSA • Implementing an alert system when the laboratory identifies an infected or colonized patient and when someone with a MRSA colonization or infection is readmitted • Providing stakeholders with data and outcome measures Additionally, special approaches include active surveillance testing, decolonization therapy, and using gowns and gloves when coming in contact with all patients and when in the patient-care environment.21 Hand hygiene: Healthcare workers’ hands become contaminated easily during routine patient care. When adherence to hand hygiene is poor, workers can transfer the contaminants to other patients. Washing hands for at least 20 seconds before and after patient care with soap and water or using alcohol-based hand cleaners provides adequate decontamination of hands. Unless hands are visibly soiled, alcohol-based solutions, with 60% to 95% alcohol, are preferred, because alcohol is effective in killing the bacteria, while handwashing removes material without killing the bacteria.13 Contact precautions: Contact precautions involve using personal protective equipment (PPE) to prevent contamination of clothing
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continuing education and reduce the chance of spreading the bacteria to patients.22 A healthcare worker should wear a gown and gloves when entering the room of a patient on contact precautions. A private room is preferred for patients in contact precautions. However, many hospitals do not have the luxury of having many private rooms. In such cases, it may be necessary to cohort patients with like infections. For instance, a patient with MRSA infection could be cohorted with another patient with MRSA infection or colonization.22 The CDC recommends that healthcare facilities use standard precautions for all patients and amplify standard precautions with contact precautions when a patient is infected or colonized with MRSA or other multi-drug resistant microorganism (MDRO). Standard precautions are a prevention based on the understanding that during care, healthcare providers cannot know all the microorganisms that patients may carry, and so standard precautions require all healthcare workers to use thorough hand hygiene and appropriate use of PPE when caring for all patients. Contact precautions, used when healthcare providers have evidence that a patient has MRSA or another MDRO, emphasize the need for hand hygiene, gloves, and gowns for all care.22 While there are some studies that demonstrate the effectiveness of contact precautions in decreasing the spread of MRSA, there are others that find that isolation can decrease the quality of patient care. One study found standard precautions were as effective as using contact precautions.23 At this time, most facilities follow the CDC and other guidance recommending contact precautions for MRSA.22,20,21 Facilities that follow the CDC-recommended use of contact precautions for MRSA should be alert to possible negative aspects of the program, including patient depression or preventable adverse events (such
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Keeping MRSA at Bay20,21,24,25 Healthcare providers as a team can help reduce the burden of MRSA with these simple measures: · Adequate cleaning and disinfection of equipment · Contact precautions (if facility follows the CDC Isolation Precautions guideline) · Dedicated equipment in isolation rooms · Educate family members and other visitors about proper contact procedures when in contact with patients · Educate other healthcare professionals about proper contact precautions when working with patients · Good hand-hygiene practices · Place the patient in a single room, if possible · Thorough cleaning and disinfection of the patient care environment at least daily · Use care bundles to reduce central line-associated bloodstream infections, ventilator associated infections, and urinary tract infection · Use gloves and gowns · Use standard precautions for all patients and amplify standard precautions with contact precautions when a patient is infected or colonized with MRSA or other MDRO · Engaging in antibiotic stewardship programs with various members of the healthcare team
as pressure ulcers, falls, or electrolyte imbalances) that may be related to decreased care while a patient is isolated.20 Dedicated equipment: Whenever possible, patient care equipment should be dedicated to the isolation room and not used on another patient. Using disposable stethoscopes and BP cuffs, and single-patient-use thermometers in contact isolation can reduce greatly the number of items traveling from patient to patient.24 Cleaning and disinfecting patient care items: Items that are used on multiple patients (such as stethoscopes, electronic thermometers, and blood glucose monitoring devices) can be a source of disease transmission if not properly disinfected between patients.22 Most equipment can be disinfected
easily using a disinfectant wipe or other hospital-approved disinfectant.22 Environmental cleaning: Thorough, daily cleaning of the patient care environment helps reduce the burden of contamination and prevent transmission. In some cases, it may be necessary to clean contact precaution rooms more frequently than nonisolation rooms, especially high-touch surfaces, such as doorknobs and bed rails.22 Clean supplies in patient rooms should be stored to prevent contamination. Large supply carts with multiple drawers are usually necessary in critical care areas, but the contents of the drawers may become contaminated unless drawers are emptied and disinfected between patients. Surveillance cultures: Many hospitals conduct active surveillance testing
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IN THE OR
continuing education
For More Information · Healthcare Infection Control Practices Advisory Committee. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings http://www.cdc.gov/hicpac/2007IP/2007is olationPrecautions.html · Management of Multidrug-Resistant Organisms in Healthcare Settings, 2006. https://www.cdc.gov/infectioncontrol/guidelines/MDRO/index.html · Strategies to Prevent Methicillin-Resistant Staphylococcus aureus Transmission and Infection in Acute Care Hospitals: 2014 Update http://www. jstor.org/stable/pdf/10.1086/676534.pdf
to detect asymptomatic MRSA carriers. The strategy is based on evidence that clinical cultures alone may fail to detect as many as 85% of those who are colonized with MRSA.20 An active surveillance culture involves collecting swabs of commonly colonized areas of the body (usually the anterior nares) from patients.20 Usually these are done at admission, but some programs routinely culture patients in the ICU (e.g., every Monday while the patient is in the ICU).20 There have been conflicting results about the effectiveness of using surveillance cultures to reduce MRSA.20 Healthcare workers also may be tested. This strategy is considered a special approach in the guidelines.21 Decolonization: Decolonization therapy can be implemented by using a topical agent, such as mupirocin ointment or chlorhexidine gluconate bathing to reduce MRSA carriage.20 Some facilities that perform routine surveillance cultures, use targeted decolonization therapy for those who are detected as MRSA carriers.20 Others facilities have had success with targeted decolonization in controlling MRSA outbreaks, or for those increased risk of S. aureus infections (such as those undergoing surgical procedures or patients with burns). Other facilities use universal decolonization with chlorhexidine bathing for all ICU patients.20,21 Rather than
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using decolonization for those detected by culture, some facilities have used it for all ICU patients or all patients with a strategy considered “horizontal” — aimed at the total population. The strategy has been effective in reducing MRSA infections.20 Universal gowns and gloves: Another example of a horizontal approach to reducing MRSA is the use of gowns and gloves for all patients in the ICU.21 Along with contact precautions and standard precautions aimed to reduce transmission between patients, other efforts to reduce infections are important. The incidence of CLABSIs due to MRSA and bacteria has been significantly reduced with a focus on guidelines for sterile technique on line insertion, care of lines, and careful removal of unnecessary lines. Similarly, efforts to reduce ventilator associated pneumonia or surgical site infections have contributed to a significant reduction in the overall incidence of MRSA in hospitals. While interventions to reduce MDROs are not all directed toward reducing MRSA, reducing hospitalacquired infections overall may in turn reduce the spread of MRSA. Healthcare professionals across all disciplines must collaborate to prevent the spread of this devastating disease. Additionally, good antibiotic stewardship will help prevent the development of multidrug resistant bacteria.
As many as half of the antibiotics prescribed in acute care facilities are not appropriate, or unnecessary, according the CDC, which recommends that if empirical coverage was started when clinicians suspected MRSA but the culture comes back MSSA, those antibiotics should be stopped and the patient started on a beta-lactam.26 Although much progress has been made in healthcare facilities to reduce invasive MRSA, efforts must continue. EDITOR’S NOTE: Kim Strelczyk, MSN, RN, ACNS-BC, CIC, and Beth R. Wallace, MPH, CIC, past authors of this educational activity, have not had an opportunity to influence the content of this version. Nancy Donegan, BS, RN, CIC, is an infection control consultant in Washington D.C. Debra Anscombe Wood, BS, RN, a health writer and editor, practices in ambulatory care in Orlando, Fla.
References 1. Emerging infections program network report; methicillin-resistant Staphylococcus aureus, 2015. Centers for Disease Control and Prevention Web site. https://www.cdc. gov/hai/eip/pdf/2015-MRSA-Report-P.pdf. Updated February 28, 2017. Accessed June 7, 2018. 2. Antibiotic resistance threats in the United States, 2013. Centers for Disease Control and Prevention Web site. https://www.cdc.gov/ drugresistance/threat-report-2013/pdf/arthreats-2013-508.pdf. Accessed June 7, 2018. 3. Bush LM, Perez MT. Staphylococcal infections. Merck Manual Professional Version Web site. https://www.merckmanuals.com/professional/infectious-diseases/gram-positivecocci/staphylococcal-infections. Updated September 2017. Accessed June 7, 2018. 4. McKinnell JA, Miller LG, Eells SJ, Cui E, Huang SS. A systematic literature review and meta-analysis of factors associated with methicillin-resistant Staphylococcus aureus colonization at the time of hospital or intensive care unit admission. Infect Control Hosp Epidemiol. 2013;34(10):1077-1086. doi: 10.1086/673157.
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IN THE OR
continuing education Clinical Vignette Sharon O’Grady is five days postcoronary artery bypass graft and has just been transferred from the CVICU to a telemetry bed. Because of diabetic neuropathy, COPD, and difficulty in weaning from the ventilator, her recovery has been slow. Vital signs at 4 p.m. were T 102.4, P 104, R 12, and BP 120/72. The central venous catheter placed in surgery remains in place but is no longer in use. The insertion site is clean, and without redness or drainage. A chest X-ray from 7 a.m. was clear. No other signs 5. Drugs@FDA: FDA approved drug products. U.S. Food & Drug Administration Web site. https://www.accessdata.fda.gov. Accessed June 7, 2018. 6. Methicillin-resistant Staphylococcus aureus (MRSA): general information about MRSA in the community. Centers for Disease Control and Prevention Web site. https://www.cdc. gov/mrsa/community/index.html. Updated March 25, 2016. Accessed June 7, 2018. 7. Weiner LM, Webb AK, Limbago B, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network of the Centers for Disease Control and Prevention, 2011-2014. Infect Control Hosp Epidemiol. 2016;37(11):12881301. doi: 10.1017/ice.2016.174. 8. Healthcare-associated infections in the United States, 2006-2016: a story of progress. Centers for Disease Control and Prevention Web site. https://www.cdc.gov/hai/surveillance/data-reports/data-summary-assessingprogress.html. Updated January 5, 2018. Accessed June 7, 2018. 9. Methicillin-resistant Staphylococcus aureus (MRSA): general information about MRSA in healthcare settings. Centers for Disease Control and Prevention Web site. https://www. cdc.gov/mrsa/healthcare/index.html. Updated May 23, 2018. Accessed June 7, 2018. 10. History, methicillin-resistant staphylococcus aureus, antimicrobial resistance. National Institute of Allergy and Infectious Diseases Web site. https://www.niaid.nih.gov/research/ mrsa-antimicrobial-resistance-history. Updated March 8, 2016. Accessed June 7, 2018. 11. Jarvis WR, Jarvis AA, Chinn RY. National prevalence of methicillin-resistant Staphylococcus aureus in inpatients at U.S. healthcare facilities, 2010. Am J Infect Cont. 2012;40(3):194-200. doi: 10.1016/j. ajic.2012.02.001. 12. Methicillin-resistant Staphylococcus aureus (MRSA): MRSA tracking. Centers for Disease Control and Prevention Web site. https://www.
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of infection are evident, so two sets of blood cultures are drawn. The preliminary gram-stain report shows gram-positive cocci. The following morning at 4 a.m., the micro lab reports presumptive MRSA from both sets of blood cultures. Vital signs are T 102.5, P 130, R 16, BP 60/40. Sharon is transferred back to CVICU with a diagnosis of septic shock. Vancomycin 1 g is ordered IV.
cdc.gov/mrsa/tracking/index.html. Updated July 6, 2017. Accessed June 7, 2018. 13. Boyce JM, Pittet D; Healthcare infection Control Practices Advisory Committee; HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for hand hygiene in healthcare settings: recommendations of the healthcare infection control practices advisory committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR Recomm Rep. 2002;51(RR-16):1-45. https://www.cdc. gov/mmwr/PDF/rr/rr5116.pdf. Accessed June 7, 2018. 14. MRSA infection: overview. Mayo Clinic Web site. https://www.mayoclinic.org/diseasesconditions/mrsa/symptoms-causes/syc20375336. Accessed June 7, 2018. 15. Rhee Y, Popovich KJ. Community-associated methicillin-resistant Staphylococcus aureus and HIV. Future Virol. 2014;9(6):531-535. doi: 10.2217/fvl.14.31. 16. Rhee Y, Aroutcheva A, Hota B, Weinstein RA, Popovich KJ. Evolving epidemiology of Staphylococcus aureus bacteremia. Infect Control Hosp Epidemiol. 2015;36(12):1417-1422. doi: 10.1017/ice.2015.213. 17. Harris A. Patient education: methicillinresistant Staphylococcus aureus (MRSA) (beyond the basics). UpToDate Web site. https:// www.uptodate.com/contents/methicillin-resistant-staphylococcus-aureus-mrsa-beyondthe-basics. Updated August 15, 2017. Accessed June 7, 2018. 18. Callejo-Torre F, Eiros Bouza JM, Astigarraga PO, et al. Risk factors for methicillinresistant Staphylococcus aureus colonisation or infection in intensive care units and their reliability for predicting MRSA on ICU admission. Infez Med. 2016;24(3):201-209. 19. Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011;52(3):285-292. doi: 10.1093/cid/cir034. 20. Calfee DP, Salgado CD, Milstone AM, et
al. Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute care hospitals: 2014 update. Infect Control Hosp Epidmiol. 2014;35(7):772796. doi: 10.1086/676534. 21. Yokoe DC, Anderson DJ, Berenholtz SM, et al. A compendium of strategies to prevent healthcare-associated infections in acute care hospitals: 2014 updates. Infect Control Hosp Epidemiol. 2014;35(8):967-977. doi: 10.1086/677216. 22. Siegel JD, Rhinehart E, Jackson M, Chiarello L; the Healthcare Infection Control Practices Advisory Committee. 2007 guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/hicpac/2007 IP/2007isolationPrecautions.html. Updated October 31, 2017. Accessed June 7, 2018. 23. Bardossy AC, Alsafadi MY, Starr P, et al. Evaluation of contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus. Am J Infect Control. 2017;45(12):1369-1371. doi: 10.1016/j. ajic.2017.06.017. 24. Methicillin-resistant Staphylococcus aureus (MRSA): precautions to prevent the spread of MRSA. Centers for Disease Control and Prevention Web site. https://www.cdc.gov/ mrsa/healthcare/clinicians/precautions.html. Updated March 24, 2016. Accessed June 7, 2018. 25. Perlin JB, Hickok JD, Septimus EJ, Moody JA, Englebright JD, Bracken RM. A bundled approach to reduce methicillin-resistant Staphyloccus aureus infections in a system of community hospitals. J Healthc Qual. 2013;35(3):57-69. doi: 10.1111/jhq.12008. 26. Antibiotic prescribing and use in hospitals and long-term care. Centers for Disease Control and Prevention Web site. https://www. cdc.gov/antibiotic-use/healthcare/index.html. Updated February 1, 2018. Accessed June 7, 2018. https://www.cdc.gov/infectioncontrol/ guidelines/MDRO/index.html. Updated April 5, 2017. Accessed June 25, 2018.
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CE480 1. The fact that Sharon’s central venous catheter is still in place even though it’s not in use should guide the care team to which evidencebased practice?
a. Blood cultures should be drawn since the central venous catheter has been in too long. b. The central venous catheter should be removed since it is no longer needed. c. The central venous catheter should remain in until discharge in case emergency medications are indicated. d. The central venous catheter should be removed, and the catheter tip cultured. 2. As soon as the MRSA culture report is received, to comply with the Centers for Disease Control and Prevention (CDC) guidance, Sharon’s nurse should implement which evidencebased practice?
a. Airborne precautions b. Contact precautions c. Droplet precautions d. Blood and body fluid precautions 3. Now that Sharon has cultured positive for MRSA, she is more at risk for which infection in the future?
a. Community-acquired pneumonia b. Hospital-acquired pneumonia c. Community-acquired MRSA d. Another MRSA infection 4. The hospital where Sharon is has instituted a program to decolonize patients who have MRSA colonization or infection. Which agent may be used for MRSA decolonization?
a. Vancomycin b. 70% alcohol-gel c. Mupirocin ointment d. Nafcillin
Clinical VignettE ANSWERS 1. Answer: B, EBPs for central line care include removing the line when it is no longer needed. 2. Answer: B, Contact precautions have been shown to reduce the transmission of multidrug-resistant organisms in healthcare facilities, and the CDC recommends them for patients with MRSA. 3. Answer: D, Becoming infected with MRSA is one of the primary risk factors for developing another MRSA infection in the future. 4. Answer C, Mupirocin ointment is used topically to decrease colonization with MRSA. The goal of the strategy is to decrease transmission to other patients. WWW.ORTODAY.COM
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.
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CORPORATE INDUSTRY INSIGHTS PROFILE
news & notes IMP
IMP Meets New Rules in Regulatory Compliance Improving Patient Outcomes Innovative Medical Products Inc.® (IMP) had its start in 1983, when two friends, Alan Wasley and Jim Bailey, got together to resolve a hospital’s dilemma. The challenge ultimately turned into the two colleagues sharing the American dream of opportunity and success. At the time, Bailey was a distributor for Zimmer in Long Island, New York. Wasley was a manufacturer in the automotive, aerospace and lighting fields with Wasley Products in Plainville, Connecticut. The manufacturing challenge they faced was to design and supply a surgical hip positioner for a hospital in New York City. The project turned out to be not only a manufacturing success, but led to a lifelong partnership between Wasley and Bailey, creating a highly respected, innovative, manufacturing and distribution company in the health care industry. Since its early beginnings, IMP has grown and become a world leader in surgical patient positioning. The vision of the company’s success has been to design, manufacture and distribute unique, innovative products for a surgical world where patient positioning has been problematic.
38 | OR TODAY | NOVEMBER 2019
IMP’s solutions to universal positioning problems come from years of communication with the best surgeons, the best orthopedic companies and the best hands-on med/ surg support teams that shared ideas for surgical improvements and perceptive opinions on how to improve the patient experience and patient outcomes. Hospitals, ambulatory surgical centers and surgical clinics
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CORPORATE INDUSTRY INSIGHTS PROFILE
news & notes IMP
ABOVE: Supporting IMP’s global reach is a growing Distributor network, including Lateral Medical. This privately owned Australian company's commitment to providing innovation in medical products, improving patient care and clinical outcomes across the hospital systems in Australia reflects the core of IMP’s commitment. RIGHT: IMP has invested in the latest manufacturing equipment, added personnel and improved data processing to meet its customers' needs.
have seen many changes in the way they operate, bundle services and improve products to become more efficient and cost-effective. Toward that goal, IMP has invested in the latest manufacturing equipment, added personnel, improved data processing and expanded territory coverage, nationally and internationally. New regulatory labeling, cleaning and sterilization parameters require a company to be responsive and creative to simplify and save time when preparing products for surgical use. Involvement with international associations of central sterile processing and perioperative organizations is useful when complying with world quality and design requirements. Products like IMP’s Universal SteriBump® reduce the potential for infection while providing a stable, rigid bump for positioning instead of rolled towels or cloth bundling. “The new regulatory issues have changed the nature of the industry just over the past year or two,” IMP President Jim Bailey noted. “Even some major orthopedic companies in the industry find WWW.ORTODAY.COM
the new regulations to be a challenge, to say the least. For IMP, this means not only complying with the new rules and regulations, but also improving products, features and use, and customer benefits, all to enhance our national and international territorial coverage in the global marketplace. Fortunately, IMP is on top of the game in regulatory compliance.”
IMP’s Commitment to Clean, Sterile and Safe Medical Devices Recent events in the knee positioner marketplace have shined a bright light on the processes for cleaning and sterilization. As processes and requirements change, materials, methods and designs must also change to meet those requirements. IMP is fully committed to ensuring its products meet NOVEMBER 2019 | OR TODAY |
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CORPORATE PROFILE IMP
these standards. IMP takes this commitment seriously and has invested heavily in its designs, Instructions For Use (IFUs) and cleaning and sterilization validations. IMP’s cleaning and sterilization validations are performed by independent testing facilities using the latest standards. IMP also has relationships with nationally recognized individuals and organizations that are experts in the sterile processing and certification testing professions. IMP understands that not all sterile processing departments are built the same. Equipment handling, personnel, education and hospital environment are just some of the factors that influence the performance of a department. IMP is willing to work with its customers to assist them in overcoming some of these challenges to ensure the IMP products they are processing meet the set standards. IMP welcomes readers to browse its website, which offers a surplus of useful information that can be viewed and downloaded. The website also showcases some of IMP’s latest products that feature instructional videos.
IMP’s WorldWide Reach In the ever-changing environment of regulatory compliance, Innovative Medical Products continues to meet both national and international standards for its positioning systems and
40 | OR TODAY | NOVEMBER 2019
IMP understands that not all sterile processing departments are built the same. Equipment handling, personnel, education and hospital environment are just some of the factors that influence the performance of a department. accessories. IMP is proud of its commitment to meet these stringent requirements while the company continues to make outstanding products that achieve or exceed user expectations. Supporting IMP’s global reach is a highly qualified network of independent distributors and product representatives that span across the United States, Italy, Japan, Canada, Australia, Russia and Israel. Additional international markets will include Germany, France and the U.K. IMP’s Made-in-America products are supported by an unflagging resolve to change with the times and adapt to new technologies and industry regulations.
Innovative Medical Products: Growth and Success Since its beginning in 1983, Innovative Medical Products has been focused on developing and marketing innovative products to benefit and improve efficiency in operating rooms and hospital clinics where patient stability and positioning
are required. IMP’s products are designed to provide accuracy for the surgeon, ensure patient safety, save time for O.R. personnel and benefit the overall patient surgical experience. Advancements in minimally invasive surgical (MIS) procedures and robotic navigation through computerassisted orthopedic surgery (CAOS) also bring opportunities for IMP to partner with surgeons who are world leaders, and orthopedic companies committed to improving surgical techniques. Besides supporting its customers with continued education, surgical time efficiencies, product bundling and providing superior products where liability is minimized to institutions, IMP offers its Value Added Commitment (VAC) Program that infuses qualified organizations with true value to markedly improve overall performance. In other words: “Every customer’s business and outcomes are important to IMP.” For more information, visit www.impmedical.com WWW.ORTODAY.COM
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Better still, De Mayo Knee Positioners® now feature Gel-Infused Memory Foam Pads, which are larger, easier to insert into the boot, and provide 30% greater load distribution for increased patient safety and comfort. Once again, the most advanced and reliable knee positioners have become even better.
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All Rights Reserved © 2019 IMP
POWER of
TEAM
WORK By Don Sadler
42 | OR TODAY | NOVEMBER 2019
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T
he coaches and players on professional and college football teams know the importance of teamwork to achieving their goal of winning a championship. Teamwork within a health care facility is just as important to achieving the goal of delivering exceptional patient care and achieving high levels of patient satisfaction. However, many health care facilities fall short when it comes to creating a culture where teamwork thrives, notes Dr. Thomas Blasco, MD, MS. Blasco is the senior medical director and co-founder of Surgical Directions, which specializes in helping hospitals improve procedural services. “At many hospitals there is relatively little cooperation between departments such as the OR, anesthesia, SPD, scheduling, patient prep and post-op recovery,” says Blasco. “This results in problematic patient throughput, inefficiency and low-quality patient care.”
The Dangers of Silos Surgical Directions Executive Vice President Lee Hedman says that one of the reasons why some health care facilities fall short in the area of teamwork is the fact that hospital patient care is “siloed” and poorly coordinated. “These silos create a domino effect for patients and surgeons that can lead to poor patient outcomes,” says Hedman. Different silos have different objectives when it comes to the OR, Hedman notes. “For example, surgeons want an OR when they want it, while nurses and anesthesia want ORs full between certain hours,” she says. “Administration, meanwhile, wants ORs running 24/7 with well-paying patients while utilizing staff on straight time.” Ellice Mellinger, MS, BSN, RN, CNOR, senior perioperative education specialist with the Association of periOperative Registered Nurses (AORN), lists a few more obstacles to effective teamwork between departments in the perioperative environment. • Ineffective processes or systems that delay or disrupt work processes. WWW.ORTODAY.COM
• Employees in different departments not knowing each other’s roles or what work is being performed. • A lack of communication between employees in different departments and a lack of respect between these employees. Mellinger believes that this lack of communication and teamwork may play a role in the high patient mortality rates that occur due to medical errors. “Researchers have estimated that between 180,000 and 400,000 deaths occur each year as a result of medical errors,” she says. “If there is poor communication and teamwork between departments, the handoff of critical steps can be missed,” Hedman adds. “This can threaten both patient and employee safety.”
It Starts with Improved Turnover Times According to Hedman, improved turnover time is the best measure of the success of an operating room’s effort in developing improved teamwork and a more collaborative culture. “It sounds simple, but it’s not,” she says. “There are three levels of intervention: leadership/governance, management and process.”
“running the OR.” “Without the collaborative support of the administration or physicians, and surgeons especially, this model does not adequately address the needs of the OR,” he says. “It leads to a distant and often wary relationship between hospitals and surgeons.” The best way to overcome these obstacles to improved teamwork is to develop a new multi-disciplinary leadership model that guides and supports front-line management. Blasco recommends creating a surgical services executive committee, or SSEC, to break down silos and improve teamwork in the health care environment. The SSEC should be comprised of representatives from surgical, perioperative nursing, anesthesia and senior hospital leadership (or the Csuite) and be chaired by the medical director(s) of perioperative services, a surgeon and/or an anesthesiologist. “This committee, functioning as a ‘board of directors’ of the surgical services, will have oversight over OR access and operations while sponsoring and directing frontline management activity,” says Blasco. “Creating a SSEC brings all parties to the table where they can discuss operational issues as a col-
“ If there is poor communication and teamwork between departments, the handoff of critical steps can be missed. This can threaten both patient and employee safety.” – Lee Hedman Blasco points out that the traditional leadership and management model of the OR has defaulted to a nursing director given the responsibility of
laborative group and break down traditional silos,” adds Hedman. “Surgeons are able to take ownership of operations and hold their NOVEMBER 2019 | OR TODAY |
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ELLICE MELLINGER,MS, BSN, RN, CNOR,
Senior perioperative education specialist with the Association of periOperative Registered Nurses (AORN)
“ Multiple departments must work together to ensure that patients are provided sterile instruments for use in their surgery.” peers accountable. Also, decisions are driven and progress is measured by analytics and metrics.”
Positive Examples of Strong Teamwork On the positive side, Mellinger says she has been fortunate to work at health care facilities where teamwork was evident among multiple departments. “I have been an active participant in many intra- and interdisciplinary teams whose goals were to enhance teamwork and perioperative patient care,” she says. “And in my current role at AORN, I have communicated with hundreds of perioperative professionals who are passionate about improving teamwork and providing safe patient care.” One of Mellinger’s favorite examples of strong teamwork is when health care team members across departments work together to ensure proper sterilization of reusable surgical instruments. “Multiple departments must work together to ensure that patients are provided sterile instruments for use in their surgery,” Mellinger says. “Some employees in these departments are indirect patient care providers, but each has an equally important role in the delivery of optimal patient care.” Mellinger stresses the importance of each department using evidencebased practices and guidelines. “When clinical practices are based on evidence rather than on clinical tradition or ‘how we’ve always done
44 | OR TODAY | NOVEMBER 2019
things,’ there’s an opportunity for productive communication and teamwork to solve problems and improve clinical practices,” she says. Standardizing communication processes is also critical to improving teamwork. Mellinger cites safe surgery and procedure checklists like the AORN Comprehensive Surgical Checklist and the Surgical Safety Checklist as examples of standardized communication, along with hand-off communication tools like Situation, Background, Assessment, Recommendation (SBAR).
Putting TeamSTEPPS in Place Some health care organizations are implementing a program developed with input from the Department of Defense as part of their efforts to improve teamwork. Referred to as TeamSTEPPS, this evidence-based framework is designed to improve health care professionals’ teamwork and communication skills as they relate to improving patient safety. TeamSTEPPS was developed jointly by the Department of Defense’s Patient Safety Program and the Agency for Healthcare Research and Quality (AHRQ). According to the AHRQ, TeamSTEPPS is scientifically rooted in more than 20 years of research and lessons from the application of teamwork principles. Mellinger says that TeamSTEPPS is designed to teach Master Trainers a framework of skills they can take back to their health care organizations and share with personnel there. “The goal is to implement and
evaluate new patient safety initiatives, or to change, evaluate or enhance existing initiatives,” she says. “TeamSTEPPS is a positive move in hospitals to improve communication and teamwork through site readiness, training and implementation,” adds Hedman. According to Mellinger, there is evidence that implementing TeamSTEPPS programs and tools in perioperative services and adhering to evidence-based guidelines can help prevent retained surgical item (RSI) events. “RSIs are devastating patient events that can result in a wide range of negative patient outcomes,” says Mellinger. These include injuries and infections, readmission to the hospital, reoperations to remove the item, increased length of hospital stay, emotional harm and even death. There are a number of different ways health care professionals can implement TeamSTEPPS tools and strategies to improve teamwork and patient safety, says Mellinger. These include learning how to be an effective team member, speaking up about patient safety concerns, communicating professionally to resolve conflicts, and increasing efficiency in perioperative process. AORN has produced a video titled, "Perioperative Team Dynamics and Communication" with an accompanying study guide that incorporates some of the TeamSTEPPS tools and strategies. The video is available through the AORN Perioperative Nursing Video Library at tinyurl.com/periop101VL. WWW.ORTODAY.COM
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DANIELLE GLOVER, BY M AT T S KO U FA LO S
A
fter 22 years in the operating room, Danielle Glover can remember the moment she knew she was destined for the surgical suite. At age nine, while flipping through the channels, she saw an open knee surgery on her local public television station. Glover’s grandfather was scheduled to have the same procedure, and so she sat, rapt, as it unfolded. When it was done, she said, “I’m going to work in the OR.” As soon as she was allowed, Glover began volunteering at Underwood Memorial Hospital (now, Inspira Health) in Woodbury, New Jersey. Between the summer after her sophomore year in high school and the summer before her senior year, she put in some 2,000 hours of volunteer service there. Glover started by making beds, worked up to delivering flowers, and eventually became a full-fledged candy striper, including the traditional uniform. During the school year, she found another way to advance her fledgling medical career. The county vocational and technical school offered presentations on trades-based careers, and when Glover saw “surgical technology” in the brochure, she’d found her opening. By senior year of high school, Glover was splitting time among her high school, county vocational school and local college courses. She spent all summer studying so that she could begin coursework at the University of Medicine and Dentistry of New Jersey (UMDNJ), and in the fall, started her surgical technol-
46 | OR TODAY | NOVEMBER 2019
ogy coursework. “I was the first to do everything in school,” Glover said. “Who wants to scrub? Who wants to cut suture? Who wants to staple somebody? I always volunteered.” The UMDNJ curriculum thoroughly prepared Glover for the workforce: within six weeks, she was already working in the operating room. There, she learned how to pick cases, to select instruments for various procedures; to work in a team dynamic. One of her favorite teachers was a surgical technologist turned nurse, and the advice she offered Glover greatly helped in her clinical assignments. The first such assignment took Glover to Cooper University Hospital in Camden City, New Jersey, a little more than a decade before she would eventually join the team there. After that, a practicum at Wills Eye Hospital in Philadelphia (now Jefferson Hospital for Neuroscience) led to her first job as a surgical technician. Three years later, Glover had completed her CST certification. Amid the continuing education and the pace of her career, she often was tempted to consider nursing school, but passed it up three times because she thought she’d miss the OR too much. After a few years at Wills Eye, Glover decided to work closer to home – at Underwood, where she’d began her volunteer
LEFT: Danielle Glover (right) is seen with Dr. Nadia Awad. RIGHT: Danielle Glover poses for a photo with Dr. James Alexander. career – because she was about to get married and start a family. At the same time, Glover found a second family in the OR, where the close camaraderie she shared with her coworkers knitted them closer as they worked their way up the seniority chart. “Every place you work is like a family,” she said. “You always started at the bottom, and then you had to work up seniority to get day shift. We mainly specialized in vascular and orthopedics, but I could take a new employee starting in one service all the way through their orientation.” Underwood offered emergent cases, but not necessarily Level I trauma cases, and so Glover took additional hours at various surgical centers as she built her career. In a freestanding clinic environment, she learned a variety of skills, from materials management to sales to environmental services, to complement her work in the surgical suite. “When you’re there, you have to be everybody,” Glover said; “it’s all hands on deck. If I wasn’t there ordering, someone else was. We would help wash, wrap, string instruments; help take the patient out to the car. WWW.ORTODAY.COM
We’d have to unpack the boxes and put them on the shelf. You don’t just walk in, and open your case, and scrub.” Throughout her career, Glover has worked mostly in vascular and orthopedic settings. Those experiences taught her how best to accommodate the preferences
teenaged son with her second husband, Dr. James Alexander. Her interests in fitness introduced Glover to TRX exercise classes, and she recently became a certified yoga teacher to boot. Glover plans to enhance that training with additional certifications in the coming months. The
“ You become very loyal to people, and they become really appreciative of your loyalty.” of various surgeons (and how to manage their various personalities). Through it all, her enthusiasm for the job and for continual learning has never waned. “I’ve worked with a lot of great doctors,” Glover said. “I was once told by a very prestigious orthopedic surgeon that I have quite the resume of names, but I feel like I am really part of the team. Everyone has an essential part to play.” “You become very loyal to people, and they become really appreciative of your loyalty,” she said. “There are people for whom it’s just a paycheck, but I never thought of it as just a paycheck.” Perhaps as importantly, Glover learned that she can be as dedicated to her career as she likes, and it won’t come at the expense of her family or private life. She’s been married twice, and is raising a
transitions in her career, as varied as it has been, have only made it more interesting, she said. “It’s a lot, but I feel like it’s very rewarding,” Glover said. “There’s always new things to learn. Sometimes you get your first job and you never leave; I always wanted the next place I went to bring more experience. There were weeks I worked 70-80 hours because I loved it.” “There’s nothing I wouldn’t do all over again,” she said. “If this is what you dream about, this is what you should go for.”
Would you like to nominate someone for the spotlight article? Visit ortoday.com/nominations/
NOVEMBER 2019 | OR TODAY |
47
OUT OF THE OR fitness
Having trouble building muscle?
How Often Do You Train Legs? By Miguel J. Ortiz eg work or training is a big component in helping build muscle – even though its commonly neglected. Now, of course, we all have different goals. In order to simplify, let’s concentrate on general strength training. If your goal is to increase muscle then you should also increase your training regimen. From a functional standpoint, training legs is ideal for many reasons. It assists in proper posture, picking up heavy household items and developing stronger core muscles. Let’s take a look at three best ways to incorporate more leg exercises into your routine to ensure we keep your body feeling good and fully functional.
L
First, just doing cardio and calling that strength training legs won’t cut it. You will still need to incorporate strength routines. It may not be a heavy weight, but there should a leg segment to every athelte’s program. So, please at least follow this one tip regardless.
48 | OR TODAY | NOVEMBER 2019
Being able to perform the leg exercise movement without any weight is crucial for keeping good form and preventing injury. It will also assist in providing better muscle memory which will be necessary if you decide to challenge yourself in the future. Having a good range of motion and understanding how exercises like squats, deadlifts, lunges and single leg stepups affect the joints will not prevent pain and build lean muscle. Remember, form always comes first. Second, build up your strength endurance before trying to pack on weight with max strength. Doing exercises weighted (or not) up to 1220 reps or combining them with other leg exercises will increase the muscles time under tension. The additional muscular utilization will help build lean muscle mass. And, since the legs are a large muscle group, you should never skip leg day, but at minimum I work legs in some fashion at least twice per week. Twice a week in addition to cardio work. So, spread your routine out leaving at least 1-2 days between leg days. Maybe try working posterior one day and anterior the
other, there are plenty of variations. Third, make time for recovery. This is huge and should not be taken lightly. Your recovery is extremely critical as tight muscles and joints will lead to muscular imbalances. It can lead to poor posture as well as more pain. And, if we’re getting a workout, we want a reward. We want to look and feel better. Feeling worse wasn’t in the plan, but it’s definitely a part of the fitness journey. If you struggle with stretching, try massage, stretching classes, cryo therapy, yoga or Pilates. These are all great ways to balance out the body and keep pushing forward to crush goals. Recovery is necessary, so don’t leave it out of the playbook. Have fun adding more leg routines into your weekly workouts and never skip leg day!
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
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OUT OF THE OR health
Is Dairy-free Ice Cream
Actually Better For You?
By Julie Upton, R.D. f you follow a dairy-free lifestyle, you no longer need to suffer from FOMO when it comes to enjoying a scoop of ice cream. Whether you’re a part-time flexitarian, lactose intolerant or a strict vegan, grab your spoon because it’s now easy to find oodles of nondairy options that lack animal products – but not flavor.
I
Nondairy is now the fastest growing segment of the frozen dessert category; chances are, your supermarket ice cream case features many different dairy-free flavors as well as numerous novelties like ice cream sandwiches and bars.
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The rise in dairy-free frozen desserts is based on one thing: demand. Significantly more Americans are seeking to follow a more plant-based diet. The reasons for living dairy-free are many, but according to consumer data from Mintel, nearly half of those surveyed believe that plantbased proteins are healthier. However, not all nondairy frozen desserts are healthier than regular ice cream, and some may even be worse for your health. Here’s why: Dairy-less frozen desserts replace milk and cream with an alternative like coconut, soy, almond or cashew milk. Almost all of the other ingredients remain the same between commercially available dairy ice creams and their dairy-free counterparts. Coconut is popular among manufacturers because its saturated fat makes for rich and creamy vegan frozen desserts – but it can pack in more saturated fat than a dairy version of your favorite frozen treat. Pints made with almond, soy, cashew or other nut milks tend to be lower in saturated fat and calories than those made with coconut cream or milk. While great for creating creamy
frozen treats, coconut’s high saturated fat count may elevate harmful LDL cholesterol levels, increasing risk for heart disease. Some coconutbased brands can have up to 250 calories, 15 grams of saturated fat and 20-plus grams of sugar per 1/2cup serving. For context, “regular” dairy-based ice cream has on average up to 150 calories per serving, 2 to 5 grams of saturated fat and 10-plus grams of sugar. If you’re looking for a better-foryou vegan scoop, choose one with less than 200 calories and 5 grams saturated fat and no more than 16 grams of added sugars per 1/2-cup serving. Brands like So Delicious and Almond Dream have healthier nut-based choices, and Halo Top has some of the most diet-friendly pints in the category. Halo Top’s dairy-free options weigh in at 70 to 90 calories, with low saturated fat counts and less than 8 grams of sugar per 1/2-cup serving. (Halo Top uses calorie-free stevia and sugar alcohols to keep calories and sugar counts low.) SOURCE: www.health.com
NOVEMBER 2019 | OR TODAY |
51
OUT OF THE OR EQ factor
The Valuing of Extraverts and Introverts By daniel bobinski ook around at your coworkers. Some have light colored hair, some have dark hair. Some are tall, some are short. Obviously, these differences come from genetic makeup, but did you know the genetic differences also cause extraversion and introversion?
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Occasionally, I have extraverted clients tell me they wish their introverted coworkers would come out of their shells and talk a little more. The opposite happens, too. Introverted clients sometimes whisper that they wish their extraverted coworkers would tone down their intensity. In truth, wishing for people to change their extraversion or introversion style is like wishing a person was taller or shorter. You can wish all you want, it isn’t going to happen. Why? Research has revealed that the different facets of our cognitive style are a result of our brain’s unique electro-chemical composition. Take dopamine, for example. Dopamine is a hormone that functions as a neurotransmitter in the brain, and it plays an important role in motivation and our sense of rewards, among other things. And, your brain releases dopamine whenever it encounters a new activity.
52 | OR TODAY | NOVEMBER 2019
If your brain processes dopamine easily, it’s like your brain can’t seem to get enough of it. More dopamine results in a euphoric happiness, and every new experience, whether it’s a new interaction or a new situation, releases more dopamine. Thus, people with this brain chemistry keep seeking new experiences, and we call them extraverts. People with brains that do not process dopamine quickly we call introverts. Dopamine is released with every new encounter or activity, and in relatively short order their brains are on dopamine overload. This overload actually causes physical discomfort, which plays out by introverts wanting to avoid or get away from new situations or places with a lot of people. Another chemical that impacts our tendency toward extraversion and introversion is the neurotransmitter acetylcholine. If your brain is configured toward introversion, the presence of acetylcholine creates an internal peace. But if your brain is configured toward extraversion, acetylcholine does not produce that sensation. Hence, in the same way that extraverts are drawn to new situations so they can enjoy their dopamine fix, introverts are drawn to peaceful, quiet situations so they can enjoy their acetylcholine fix. How does this information help us with emotional intelligence? Now that
you know these things, you can choose to value the differences instead of criticizing them. Just like we wouldn’t criticize someone for being tall, short, brunette or blonde, we shouldn’t criticize people for the different ways they get their mental energy. Remember, you have a choice. You can choose to see the strengths that someone different from you brings to the team. Are you an extravert? Know that introverts see workplace problems a little differently than you do, and their perspective is probably valuable for finding viable solutions. If you’re an introvert, the reverse is also true. I’ll talk more about the strengths of extraverts and introverts in a future column, but for now, know that these are biological differences, and the team is much better off if we look for ways to capitalize on those differences. 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.
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OUT OF THE OR nutrition
Eating to Beat Cancer By Charlyn Fargo
o we all worry about getting cancer? Hasn’t it affected someone close to you in some way? My mother survived breast cancer twice. Two friends succumbed to ovarian cancer. Another very young friend is battling a rare cancer of the blood. The lifetime risk of cancer in the U.S. is 1 in 3, according to the American Cancer Society.
D
Here’s the good news: More than half of all cancer deaths could be prevented by making healthier food choices, maintaining a healthy weight and keeping active. That sounds so easy, but in reality, small choices we make every day make a huge difference in our chances of keeping cancer at bay. Here are some very practical things you can do to help prevent cancer:
1
Eat more plant-based foods. I don’t think you have to cut out meat entirely, but when you plan your meals, add an extra side of veggies or fruit or have them as a snack.
2
Choose fish or poultry most often and choose processed meats – bacon, sausage, hot dogs and deli meats – less often. Less often doesn’t mean never, just less often.
WWW.ORTODAY.COM
“ More than half of all cancer deaths could be prevented by making healthier food choices, maintaining a healthy weight and keeping active.
”
3
For snacks, choose fruit, veggies or a handful of nuts and seeds rather than chips, pretzels, cookies or candy. This also helps reduce your intake of salty foods.
4
The nutrition trend these days is to choose more whole, unprocessed foods. But these buzzwords can be confusing because nearly all foods are processed to some extent. That doesn’t mean don’t eat canned or frozen foods. It means make it yourself from scratch rather than fixing food from a box.
5
Choose food over supplements. I’m still a believer in taking a multivitamin if you think you aren’t getting enough fruits, vegetables and whole grains (and most of us aren’t). But at the same time, I think we have to prioritize healthy eating. A cheeseburger with fries doesn’t have all the nutrients we need on a daily basis. Can
you substitute a fruit cup for the fries or add a vegetable side?
6
Consider the scale. Having a body mass index of 30 or higher has been linked to at least 13 different types of cancer, according to the American Cancer Society. Make it your mission to exercise and lose weight to get your BMI closer to 25. Losing weight requires good choices at most meals. If you haven’t had a salad in a while, choose one, and go easy on the dressing. The bottom line is you can help prevent cancer in your own life. It all boils down to those daily choices. Charlyn Fargo is a registered dietitian with Hy-Vee in Springfield, Illinois, and a spokesperson for the Illinois Academy of Nutrition and Dietetics. For comments or questions, contact her at charfarg@ aol.com.
NOVEMBER 2019 | OR TODAY |
55
OUT OF THE OR
Recipe
recipe
the
56 | OR TODAY | NOVEMBER 2019
Pumpkin Cheesecake ingredients For the crust: • 12 whole graham crackers, or 1 1/2 cups graham cracker crumbs • 1/4 cup granulated sugar • 1/2 teaspoon kosher salt • 6 tablespoons unsalted butter, melted For the filling: • 3 (8-ounce) packages cream cheese, at room temperature • 3/4 cup packed light brown sugar • 2/3 cup granulated sugar • 3 tablespoons cornstarch • 1 (15-ounce) can pumpkin puree (not pumpkin pie filling) • 3/4 cup sour cream, at room temperature • 1 tablespoon pumpkin pie spice • 1 tablespoon vanilla extract • 4 large eggs • 2 large egg yolks
BY tami weiser Tami Weiser is a contributor to TheKitchn.com, a nationally known blog for people who love food and home cooking. Submit any comments or questions to editorial@thekitchn.com.
WWW.ORTODAY.COM
How to Make Pumpkin Cheesecake umpkin cheesecake has become a fall and winter dessert classic for good reason. The lively, familiar spices of classic pumpkin pie are balanced by the cool and creamy goodness of a New York-style cheesecake. The combination makes each bite memorably delicious and worthy of any celebration – especially Thanksgiving. Pumpkin cheesecake is easier than you think. This recipe was designed to work for the novice baker and the seasoned cook. Keys for Success 1. Use sour cream for flavor and texture. This cheesecake is designed to have a fluffy, but not airy, texture. Sour cream does the job better, and for taste, it’s a necessity to balance the sweetness of the batter. 2. Mix the cream cheese and sugar until smooth and fluffy. The cream cheese, sugar and cornstarch mixture needs to be mixed until it is very, very smooth, pale and fluffy. Make sure to scrape the bottom and side of the bowl, and watch out for cream cheese
P
OUT OF THE OR recipe
that seems to stick toward the top of the bowl. This ensures the final cheesecake is silky, fluffy and creamy. 3. Bake the cheesecake in a water bath for consistent, creamy results. A water bath, or bain-marie, is a classic French baking technique, and it is used for baked custards of all sorts to ensure that the heat of baking is gentle and consistent (read: eggs don’t curdle, and custards set beautifully). 4. Cool the cheesecake slowly in the oven. If you have never made a cheesecake, this is a peculiar direction, but it is very important. Turn off the oven but leave the cheesecake in to cool down slowly for one hour. 5. Make it ahead. To ripen a cheesecake means to make it a day or so in advance. Some argue that it allows the flavors to meld together better, some believe the long chill lets the cake firm up long enough to cut with ease, and some do it out of tradition. All are probably correct.
Pumpkin Cheesecake Makes 1 (8- to 9-inch) cheesecake Serves 12 1.
2.
3.
4.
5.
6.
7.
Prepare the pan for baking. Arrange a rack in the middle of the oven and heat to 350 F. Wrap 2 layers of aluminum foil around the outside of an 8- or 9-inch springform pan; set aside. Make the crust. Break up the graham crackers along their lines and place in the bowl of a food processor fitted with the blade attachment. Add the sugar and salt, and process until the graham crackers are very finely ground, about 30 seconds. Drizzle in the butter, and pulse just until the crumbs are evenly moistened, 5 to 10 pulses. (If starting with graham cracker crumbs, just stir all the ingredients together in a medium bowl.) Transfer the crumbs to the prepared pan, press onto the bottom (not the sides), and flatten with the base of a drinking glass. Bake the crust. Bake until fragrant, 8 to 10 minutes. Place the pan on a cooling rack and cool completely. Reduce the oven temperature to 300 F. Start the filling. Place the cream cheese, brown sugar, granulated sugar and cornstarch in the bowl of a stand mixer fitted with a paddle attachment, or if using an electric handheld mixer, in a large bowl. Beat, starting at medium speed and gradually increasing to high, until creamy, fully combined, and fluffy, 4 to 5 minutes. Stop and scrape down the bottom and sides of the bowl as needed. Add the pumpkin puree, sour cream, pumpkin pie spice and vanilla, and mix on medium-low speed until fully combined and smooth, scraping down the bowl as needed. Gradually add the eggs and egg yolks one at a time, stopping to scrape down the sides and bottom of the bowl after each addi-
tion, until fully incorporated. 8. Place the springform pan in a baking pan that is at least 1 inch deep and at least 1 inch wider than the springform on all sides (a 15.5- by 10.5-inch jellyroll pan or 8- by 12-inch half-sheet pan will work). Transfer filling to the cooled crust and spread into an even layer. 9. Put the cheesecake in the oven and make a water bath. Have a few cups of room temperature water ready. Pull out the oven rack, and place the baking pan and cheesecake on it. Carefully add the water to the outer pan until it comes to about 3/4 inch up the side of the springform, being careful not to splash water onto the filling. Carefully push the oven rack all the way back in, trying not to splash the water, and close the oven door. 10. Bake until the edges of the cheesecake are set but the center still jiggles just a bit, 65 to 80 minutes. 11. Turn the oven off. Let cheesecake sit in the oven for 1 hour. 12. Cool the cheesecake completely. Remove the cheesecake from the water bath, transfer to a wire cooling rack, remove the foil, and let cool for 1 hour. (Do not remove the ring from the pan.) 13. Cover the pan loosely with plastic wrap, and refrigerate until completely cold, at least 24 hours and up to three days. 14. Uncover the cheesecake. Release and remove the ring of the springform. Transfer the cheesecake, still on the bottom of the pan, to a cake or serving plate. Cut into slices with a long, sharp knife (not a serrated one), rinsing and drying the knife with warm water between each slice for picture-perfect cuts.
Recipe notes: The cheesecake can be made, covered, and refrigerated up to three days. It can also be frozen, wrapped well, for up to one month. Defrost in the refrigerator. Crust alternatives: Instead of graham crackers, you can use 18 to 19 gingersnap cookies. Line the bottom of the pan with a single layer of the whole cookies (skip the other ingredients and mixing anything together). WWW.ORTODAY.COM
NOVEMBER 2019 | OR TODAY |
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The News and Photos
OUT OF THE OR
that Caught Our Eye This Month
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SOCIAL NETWORKING SITES AFFECT NURSES’ PERFORMANCE Addiction to social networking sites reduces nurses’ performance and affects their ability to concentrate on assigned tasks, according to a study published in the Journal of Advanced Nursing. Addiction to social networking sites reduces nurses’ performance and affects their ability to concentrate on assigned tasks, according to a study published in the Journal of Advanced Nursing (JAN). JAN contributes to the advancement of evidence-based nursing, midwifery and health care by disseminating high-quality research and scholarship of contemporary relevance and with potential to advance knowledge for practice, education, management or policy. All JAN papers are required to have a sound scientific, evidential, theoretical or philosophical
base and to be critical, questioning and scholarly in approach. The study found that nurses can take “selfmanagement” steps to address the issue. For the study, information was collected through an online-survey taken by nurses in 53 countries across the world. “Our study also has some important implications for hospital management, doctors and nurses,” the authors wrote. They noted that hospital management should limit the use of social networking sites by nurses, devise self-management courses for nursing staff, and provide nurses with an environment where there are no distractions from mobile ringtones and beeps. For more information, visit onlinelibrary.wiley.com/ doi/10.1111/jan.14167.
ition and th, along with nutr al he of r lla pi ird th “Sleep is the t, as a society, y and balanced. Ye th al he us s ep ke at movement, th ing us healthy.” role of sleep in keep e th ue al rv de un ly we real l ren’s Research Hospita , sleep and – Dr. Valerie Crabtree
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FOBI Medical………………………………………………………13
OR Today Webinar Series…………………………………61
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Healthmark Industries Company, Inc.………… 22
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Ruhof Corporation…………………………………………… 2-3
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TBJ Incorporated………………………………………………… 4
C Change Surgical……………………………………………… 6
Jet Medical Electronics Inc…………………………… 45
Tetra Medical Supply Corp.…………………………… 53
Cygnus Medical…………………………………………………… 9
MD Technologies Inc.……………………………………… 50
USOC Medical…………………………………………………… 29
Doctors Depot………………………………………………… 54
MedWrench……………………………………………………… 60
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Doctors Depot………………………………………………… 54 Heartland Medical Sales & Service…………………17
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Microsystems……………………………………………………… 5
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AORN……………………………………………………………………21
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C Change Surgical……………………………………………… 6 Jet Medical Electronics Inc…………………………… 45
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ALCO Sales & Service Co.……………………………… 50 Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.………… 22 TBJ Incorporated………………………………………………… 4
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MD Technologies Inc.……………………………………… 50 Microsystems……………………………………………………… 5 Ruhof Corporation…………………………………………… 2-3
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ALCO Sales & Service Co.……………………………… 50 Tetra Medical Supply Corp.…………………………… 53
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Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.………… 22 MD Technologies Inc.……………………………………… 50 Ruhof Corporation…………………………………………… 2-3
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Pure Processing………………………………………………… 49
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ALCO Sales & Service Co.……………………………… 50
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Pure Processing………………………………………………… 49 Ruhof Corporation…………………………………………… 2-3 TBJ Incorporated………………………………………………… 4
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Healthmark Industries Company, Inc.………… 22
Cygnus Medical…………………………………………………… 9 Ruhof Corporation…………………………………………… 2-3
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FOBI Medical………………………………………………………13
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Avante Patient Monitoring……………………………… 24 Doctors Depot………………………………………………… 54 USOC Medical…………………………………………………… 29
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MedWrench……………………………………………………… 60 OR Today Webinar Series…………………………………61
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Action Products, Inc.……………………………………… 45 Innovative Medical Products…………… 38-41, BC
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AIV Inc.…………………………………………………………………15
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AIV Inc.…………………………………………………………………15 Avante Health Solutions………………………………… 24 Heartland Medical Sales & Service…………………17 Jet Medical Electronics Inc…………………………… 45 USOC Medical…………………………………………………… 29
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Action Products, Inc.……………………………………… 45 Cygnus Medical…………………………………………………… 9 Innovative Medical Products…………… 38-41, BC
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62 | OR TODAY | NOVEMBER 2019
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Microsystems……………………………………………………… 5
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ALCO Sales & Service Co.……………………………… 50
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Pure Processing………………………………………………… 49 Ruhof Corporation…………………………………………… 2-3 TBJ Incorporated………………………………………………… 4
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Ecolab Healthcare………………………………………………18 MD Technologies Inc.……………………………………… 50 AIV Inc.…………………………………………………………………15
Jet Medical Electronics Inc…………………………… 45
ALCO Sales & Service Co.……………………………… 50 Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.………… 22 Pure Processing………………………………………………… 49 Ruhof Corporation…………………………………………… 2-3 TBJ Incorporated………………………………………………… 4
Action Products, Inc.……………………………………… 45
Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.………… 22 TBJ Incorporated………………………………………………… 4
SURGICAL
FOBI Medical………………………………………………………13 Heartland Medical Sales & Service…………………17 MD Technologies Inc.……………………………………… 50
SURGICAL INSTRUMENT/ACCESSORIES
C Change Surgical……………………………………………… 6 Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.………… 22
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FOBI Medical………………………………………………………13
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FOBI Medical………………………………………………………13
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AIV Inc.…………………………………………………………………15 Avante Health Solutions………………………………… 24 USOC Medical…………………………………………………… 29
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C Change Surgical……………………………………………… 6
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MD Technologies Inc.……………………………………… 50 TBJ Incorporated………………………………………………… 4
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Tetra Medical Supply Corp.…………………………… 53
Avante Health Solutions………………………………… 24 Cygnus Medical…………………………………………………… 9 Doctors Depot………………………………………………… 54 Heartland Medical Sales & Service…………………17 WWW.ORTODAY.COM
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A new tool in the race to improve arthroscopic procedures
Arthroscopic Advantages from Precise Femoral Distraction
De Mayo Universal Distractor® Offers Finite Distraction and Outperforms a Stress Post. Experience improved access and control – you’re faster to the finish line with less chance of post-op pain.
n Clear, unobstructed view of
posterior joint regions n Patient protector pad protects
the popliteal area n Works with the De Mayo Knee
Positioner® that features a single locking lever for precise control of flexion/extension, tilt & rotation n Tension release lever for precise
fine-tuning or disengaging distraction n Eliminates potential post-op pain
from stress posts n Hand control for finite adjustment
of distraction n Broad distribution of pressure
with sterile protector pad that will not rotate or roll Finite distraction that’s as precise as you – from an external distractor outside the surgical site. The De Mayo Universal Distractor® delivers maximum arthroscopic exposure through controlled finite joint distraction, without tying up a pair of hands or utilizing stress posts which sometime cause post-op pain. You can fully control and maintain joint distraction, optimizing your view of posterior regions of the joint. To make your arthroscopic procedures more precise, visit www.impmedical.com or call 800-467-4944 today. And get positioned for success.
imp® products are protected by patent & patent pending rights ~ go to impmedical.com/patents
The operative word in patient positioning.
Part of the De Mayo Positioner® Family
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