OR Today Magazine - March 2020

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PRODUCT FOCUS SURGICAL INSTRUMENTS

LIFE IN AND OUT OF THE OR

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CE ARTICLE CLINICAL SETTING

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OUT OF THE OR STRENGTH TRAINING

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OR TODAY | March 2020

contents features

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PAIN MANAGEMENT The opioid crisis is one of the greatest health threats facing Americans today. It is critical that perioperative professionals find the right balance between relieving pain and lowering the risk of opioid addiction for patients.

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PERIOPERATIVE NURSING COMPETENCY In American nursing there has been slow progress on meaningful conversations about competency and competency assessment. There has been even less progress by certification organizations in integrating meaningful competency assessment practices into the credentialing process.

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According to an analysis by Reports and Data, the global surgical instruments market was valued at $11.75 billion in 2018 and is expected to reach $21.52 billion by 2026.

The goal of this evidence-based practice continuing education program is to introduce critical care nurses to EBP and review the differences among evidencebased practice, research and quality improvement.

MARKET ANALYSIS

CE ARTICLE

OR Today (Vol. 20, Issue #3) March 2020 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. Š 2020

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contents

PUBLISHER

features

John M. Krieg

john@mdpublishing.com

VICE PRESIDENT Kristin Leavoy

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44

EDITOR

SPOTLIGHT ON

John Wallace

Darcy DiFede

editor@mdpublishing.com

ART DEPARTMENT Jonathan Riley Karlee Gower Amanda Purser

ACCOUNT EXECUTIVES Jayme McKelvey Megan Cabot

DIGITAL SERVICES

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54

Win a Bath & Body Works gift card!

One-pot Mocha Brownie Cake

OR TODAY CONTEST

Cindy Galindo

RECIPE OF THE MONTH

Kennedy Krieg Erin Register

CIRCULATION Lisa Cover Jennifer Godwin

INDUSTRY INSIGHTS 11 News & Notes 20 CCI: Perioperative Nursing Competency 22 IAHCSMM: Bringing It Home: IAHCSMM’s 2020 Annual Conference & Expo

IN THE OR 24 Market Analysis: Surgical Instruments Market To Exceed $21 Billion 25 Product Focus: Surgical Instruments 30 CE Article: Ensuring Evidence-Based Practice in a Clinical Setting: Structure, Process and Outcomes

ACCOUNTING Diane Costea

EDITORIAL BOARD Hank Balch, President & Founder, Beyond Clean Sharon A. McNamara, Perioperative Surgical Safety Julie Mower, Nurse Manager, Education Development, Competency and

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Credentialing Institute

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58 Index

Linda Hasluem

Consultant, OR Dx + Rx Solutions for

OUT OF THE OR 44 Spotlight On 46 Fitness 49 Health 51 EQ Factor 52 Nutrition 54 Recipe 56 Pinboard

WEBINARS

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David Taylor, President, Resolute Advisory Group, LLC Elizabeth Vane, Health Science Teacher, Health Careers High School

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INDUSTRY INSIGHTS

news & notes

Aspen Surgical Acquires Beatty Marketing & Sales Aspen Surgical Products Inc. has acquired Beatty Marketing & Sales LLP. Beatty provides orthopedic products, including foam positioners, sterile positioning kits and suture retrievers to hospital and ambulatory surgery center customers across North America. The company, based in Redmond, Washington, has demonstrated a consistent track record of driving recurring revenue growth while providing lowercost options to caregivers.

The acquisition of Beatty helps to accelerate Aspen’s leadership in the orthopedic surgical space and complements Aspen’s portfolio of Colby fluid management products and other surgical disposables.

“Over the last 32 years, Beatty has established itself as a trusted supplier in the orthopedic disposables space,” said Jason Krieser, CEO of Aspen. “We will look to leveraging this reputation, along with the Beatty product portfolio, to enhance our existing surgical offering, make us more relevant in the orthopedics space, and expand our reach in the ambulatory surgery center market.”

Jeff Beatty, founder of Beatty, said “We are excited to partner with the team at Aspen and Audax. The complementary product offerings and customer base will allow Beatty to continue its significant growth trajectory. Beatty will continue to flourish under the leadership of Aspen.” • For more information, visit www.aspensurgical.com.

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Key Surgical Expands Team Key Surgical has announced the addition of clinical educators and sales representatives to serve the sterile processing, operating room and endoscopy markets. The enhanced team supports the company’s long-standing focus on processes, procedures and education in sterile processing while expanding into the markets of the operating room and endoscopy.

The Key Surgical clinical education team is comprised of Brandon VanHee CRCST, CIS, CER, CHL, AGTS (clinical education manager), Jamie Zarembinski, CCSVP (clinical educator–sterile processing), Michelle Lemmon, RN, BSN (clinical educator–operating room) and Natalie Reece, CCSVP (clinical educator–endoscopy). The clinical education team will focus on creation of learning materials and providing in-person education, based on industry standards guidelines, needed for technicians to either attain or maintain certification in their field. • For more information, visit keysurgical.com.

Bradley Catalone Joins Healthmark Industries Healthmark Industries is proud to announce Dr. Bradley Catalone as its new senior scientific advisor.

“We are very excited to welcome Brad to Healthmark Industries,” Director of Education Mary Ann Drosnock said. “His expert knowledge and management experience in scientific and regulatory device strategy will provide guidance and insight to our product development efforts.”

Catalone comes to Healthmark Industries with extensive experience in the health care industry. Most recently, he was the chief science officer at TSO3 Corporation. In this role, he had the responsibility of successfully developing regulatory strategy for new and expanded medical device claims, designing scientific studies and managing/expanding international intellectual property portfolio.

Since 1969, Healthmark Industries Company Inc. has developed and marketed innovative solutions to aid health care facilities in the delivery of surgical instruments and other lifesaving medical devices to patients.

Healthmark Industries’ mission is to continue to innovate, continue to support and continue to serve the health care provider industry and support services that make it possible to deliver quality health care. • For more information, visit www.hmark.com.

MARCH 2020 | OR TODAY |

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INDUSTRY INSIGHTS

news & notes

Cenorin Launches Advanced Medical Device Lumen Drying System Cenorin, a health care company offering solutions for infection control management and waste stream reduction, announces the availability of the new Cenorin LD 100 Lumen Drying System. This adjunct to medical device drying cabinets is designed to help reprocessing departments avoid retained moisture events and speed lumen drying and turnaround.

The number of minimally invasive surgeries using endoscopic and robotic devices continues to increase because they offer numerous benefits to patients. Although thorough drying of these devices’ internal lumen surfaces is critical to successful infection prevention protocols, it is challenging to achieve.

In a recent AAMI blog, Mary Ann Drosnock stated, “Previously, it was assumed that an alcohol flush and air purge in an automated endoscope reprocessor (AER) or an alcohol flush and syringe air flush for manual reprocessing were enough to produce a dry endoscope. We now know that this is not true and have seen that further forced air drying is necessary to achieve a dry scope.”

Once installed inside medical device drying cabinets, the

LD 100 lumen dryer helps assure a compliant, effective and efficient drying process for endoscopes and robotic arm lumens, without impeding the simultaneous drying of other devices in the cabinet. The LD 100 system can dry two endoscopes or 10 robotic lumens at a time, in the upright positions required by manufacturers’ instructions for use. HEPA filtered air removes99.97% of particulates larger than .3 microns, and the air is delivered at a low pressure to protect the devices.

The LD 100 user interface is easy to learn and use. It enables at-a-glance process monitoring and includes a timer to allow user-defined drying times. Two brackets each hold up to five robotic devices and are stacked vertically to enable compliant simultaneous drying of all 10 lumens.

“Assuring consistent and effective medical device drying during sterile processing is key to a facility’s infection control and patient safety programs,” stated Drew Radford, president of Cenorin. “In addition to this critical function, the LD 100 system helps ramp up throughput and overall productivity, which can help optimize surgical scheduling. This drying advancement will help health care providers achieve significant return on their investment.” •

Diversey Acquires AHP Intellectual Property from Virox Technologies Inc. Diversey Inc. has announced the acquisition of the global intellectual property rights related to Accelerated Hydrogen Peroxide (AHP) from Virox Technologies Inc. Accelerated Hydrogen Peroxide (AHP) is a globally patented, synergistic blend of commonly used ingredients that produces exceptional potency as a germicide and superior performance as a cleaner. AHP has proven to be a fast, effective, responsible and sustainable solution.

Each year, healthcare-associated infections (HAIs) and food-borne illnesses impact millions of people globally.

Over the past decade, Diversey and Virox have partnered to

12 | OR TODAY | MARCH 2020

develop a number of AHP-based solutions to address these concerns, including leading brands such as Oxivir, Accel and Viper.

In the last several years, Diversey has invested significantly to build a leadership position in health care and infection prevention through thought leadership, innovation and evidence-based product and practice development. This acquisition supports Diversey’s continued mission to reduce preventable infections, control associated costs and ultimately help save lives across world. •

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INDUSTRY INSIGHTS

news & notes

Medtronic Expands Surgical Synergy Medtronic plc announced that the U.S. Food and Drug Administration (FDA) recently cleared the Stealth Autoguide system, the first cranial robotic platform that integrates with Medtronic’s enabling technology portfolio to create an end-to-end procedural solution.

The Stealth Autoguide Platform is a robotic guidance system intended for the spatial positioning and orientation of instrument holders or tool guides used in neurosurgical procedures.

The Stealth Autoguide Platform is cleared for biopsy procedures, stereoelectroencephalography (sEEG) depth electrode placement, and for the positioning of the Visualase™ bone anchor, which is used for catheter placement. These solutions are part of the company’s Surgical Synergy platform, which integrates Medtronic technologies to create consistent, predictable and reproducible procedures.

“Medtronic continues to deliver on its commitment of

developing innovative technologies that helps physicians seamlessly provide high-quality care for cranial and other procedures,” said P. David Adelson, division chief of neurosurgery and director of Barrow Neurological Institute at Phoenix Children’s Hospital. “The precision provided by the Stealth Autoguide system will help my clinical team accomplish unique surgical scenarios with increased accuracy.”

Stealth Autoguide system integrates with StealthStation Image Guidance systems and the Midas Rex high-speed surgical drill platform. The navigation software optimizes the surgical workflow, providing continuous real-time navigation and visual feedback on the robotic alignment for improved efficiency. The system provides visualization throughout the entire procedure, even while drilling, with the ability to drill on the axis of a surgical plan. •

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INDUSTRY INSIGHTS

news & notes

oneSOURCE Partners with instrutrack oneSOURCE has joined forces with medical tracking system, instrutrack, owned by Kiwi Medical Supplies, in order to provide access to hospitals and the acute care space.

This partnership will amplify oneSOURCE’s mission of changing the face of patient safety by furnishing health care facilities throughout the UAE with resources to properly sterilize medical equipment and adhere to regulatory bodies.

“Our relationship with instrutrack and its partners in the UAE increases oneSOURCE’s ability to improve infection control and instrument sterilization in a multitude of medical sectors,” said Jack Speer, CEO of oneSOURCE. “With an 80 percent market share among U.S. health care facilities, advancing our product to a larger international audience is incredibly exciting. This new venture now enables health care professionals across the world to better understand and easily access comprehensive manufacturers’ manuals and

comply accordingly to compliance standards. Through strategic engagements like instrutrack and Kiwi, our databases will continue to flourish and ensure patient safety within medical categories ranging from dental to biomedical.”

Through instrutrack, Kiwi Medical Supplies, will now use oneSOURCE to allow instrutrack customers to connect directly to IFUs through the oneSOURCE platform interface. The integration eliminates multiple database logins and streamlines compliance processes for medical professionals. oneSOURCE’s ability to provide automatic updates to IFUs eliminates the need for manually uploading or contacting the manufacturer for upgrades. Partnering with instrutrack allows facilities to implement a more efficient process to manage and load documents without corresponding with manufacturers. • For more information, visit onesourcedocs.com.

Masimo, Dräger Expand Licensing Agreement Masimo and Dräger have expanded their partnership, whereby Dräger will integrate additional Masimo measurement technologies into Dräger’s family of multi-parameter patient monitors, to help clinicians assess brain function, oxygenation and ventilation status.

After becoming the first patient monitoring company to integrate Masimo noninvasive, continuous rainbow SET technologies, including total hemoglobin (SpHb), in its patient monitors, Dräger will add Masimo SedLine Brain Function Monitoring, O3 Regional Oximetry and NomoLine Capnography measurements to its already comprehensive suite of advanced measurement parameters, tailored for operating rooms and critical care settings.

The three additional technologies are currently available directly from Masimo on the Root Patient Monitoring and Connectivity Platform: Next Generation SedLine Brain Function Monitoring, which assists clinicians in monitoring the state of the brain

14 | OR TODAY | MARCH 2020

under anesthesia, with bilateral data acquisition and processing of EEG signals and an enhanced Patient State Index (PSi).

O3 Regional Oximetry, which may help clinicians monitor cerebral oxygenation in situations in which pulse oximetry alone may not be fully indicative of the oxygen in the brain.

NomoLine “no-moisture” sampling lines, which are designed for low-flow applications and can be used in a variety of clinical scenarios and care settings, on both intubated and non-intubated patients of all ages, in both low- and high-humidity applications.

“For over 20 years, the foundation of our strong relationship with Masimo has been our shared vision to improve patient outcomes while lowering the cost of health care. This expanded agreement allows us to offer our customers the most innovative technologies, helping them to deliver even better patient care and achieve better patient outcomes,” Dräger CEO Stefan Dräger said. •

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Nihon Kohden Offers SubscriptionBased Pricing Nihon Kohden has launched subscription-based pricing models for its patient monitoring and neurology products. The pricing models help align costs with usage, let hospitals and health systems benefit from the latest technology and can lower the overall risk for upgrading technology.

“Hospitals and health systems are under tremendous pressure to drive down costs and maximize every dollar in their budget,” said Yasuhiro Yoshitake, president and CEO of Nihon Kohden America. “Because medical technology is a significant investment, many facilities will put off replacing systems until they can’t repair them anymore. We believe that hospitals, clinicians and the patients they serve deserve better, so we want to remove the cost constraints and make it easier for them to remain current with technological advancements.”

The company’s subscription pricing, which is available to any hospital using an electronic medical record (EMR) system, comes in three models: Monthly subscription – consistent, flat-rate payment each month Census-based subscription – payment adjusted each year based on changes in census Per-patient subscription – fee adjusted each month based on actual usage Subscription models include all costs, so there are no upfront fees for infrastructure, training or installation. Products can be added, updated or refreshed at any time by either increasing the subscription payment or extending the term. Once the term has ended, hospitals and health systems are given the option of buying in-place equipment. •

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INDUSTRY INSIGHTS

news & notes

FDA Clears First Fully Disposable Duodenoscope The U.S. Food and Drug Administration has cleared for marketing in the U.S. the first fully disposable duodenoscope. The EXALT Model D Single-Use Duodenoscope is intended to provide visualization and access to the upper gastrointestinal (GI) tract to treat bile duct disorders and other upper GI problems.

“The availability of a fully disposable duodenoscope represents another major step forward for improving the safety of these devices, which are used in more than 500,000 procedures in the U.S. each year. Unlike duodenoscopes that are used on multiple patients, a fully disposable duodenoscope doesn’t need to be reprocessed, eliminating the risk of potential infection due to ineffective reprocessing,” said Jeff Shuren, M.D., J.D., director of the FDA’s Center for Devices and Radiological Health. “Improving the safety of duodenoscopes is a top priority for the FDA since such devices remain critical to life-saving care for many patients, and the FDA continues to encourage innovative ways to improve the safety and effectiveness of these devices.”

Duodenoscopes are used as a less invasive method than traditional surgery to drain fluids from pancreatic and biliary ducts blocked by cancerous tumors, gallstones or other gastrointestinal conditions. The flexible, lighted duodenoscope is threaded through the patient’s mouth and stomach to access the top of the small intestine. Traditionally, these devices have been intended for use on multiple patients, which has required these devices to be cleaned and disinfected (i.e. reprocessed) in between uses to reduce the potential for infection between patients. However, duodenoscopes are complex medical devices with many small working parts that can be difficult to clean. The device can

16 | OR TODAY | MARCH 2020

trap contaminated tissue or fluid in its crevices and, if not thoroughly cleaned and disinfected, it can transmit infection-causing bacteria between patients. The EXALT Model D Single-Use Duodenoscope is intended for use on a single patient, therefore removing the potential risks associated with ineffective reprocessing.

The FDA previously issued communications to health care facilities regarding risks associated with ineffective reprocessing of duodenoscopes that are used on multiple patients. In August, the FDA released a safety communication recommending that duodenoscope manufacturers and health care facilities transition to duodenoscopes with partially or fully disposable designs, which can simplify or eliminate the need for reprocessing of certain components, therefore reducing or eliminating between-patient duodenoscope contamination. The FDA previously cleared duodenoscopes with disposable endcap and elevator components. Today’s clearance is the first fully disposable duodenoscope device.

Risks of using the EXALT Model D Single-Use Duodenoscope include the potential for injuries, such as, but not limited to, burns, electric shock, perforation, infection and bleeding.

The EXALT Model D Single-Use Duodenoscope was granted Breakthrough Device designation, meaning the FDA provided intensive interaction and guidance to the company on efficient device development to expedite evidence generation and the agency’s review of the product.

The FDA granted clearance of the EXALT Model D Single-Use Duodenoscope to Boston Scientific Corporation. •

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Case Medical Earns Safer Choice Designation Case Medical announced that the CasePrep Non-Enzymatic Pre-Soak Spray and Foam received formal approval to display the U.S. Environmental Protection Agency’s Safer Choice Program seal. All ingredients have been evaluated by the Safer Choice Program and determined to be safer than traditional chemical ingredients for people and the environment, while providing equal or better performance.

Case Medical is the only manufacturer of Safer Choice listed products for medical and surgical instrument care.

CasePrep non-enzymatic pre-soak is particularly suited for facilities that choose not to use enzyme-containing products, such as Eye Surgery Centers. CasePrep pre-soak joins a full line of Safer Choice labeled cleaners and a lubricant formulated and manufactured by Case Medical for use in Sterile processing departments, endoscopy suites, ambulatory surgery centers and anywhere where cleaning and care of surgical instruments is needed.

“Case Medical’s mission is to promote healthier hospitals and patients. Our approach blends high-quality products, customer collaboration, and a sustainability mindset. When customers approached us asking for a highly-effective point-of-use cleaner without enzymes, we developed CasePrep Pre-Soak to meet their needs,” CEO Marcia

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Frieze said.

Point-of-use cleaning, also known as pre-treatment, removes gross soil and bioburden from instruments immediately following use to help prevent biofilm formation and make subsequent processing steps more effective. It’s a critical step and is aligned with industry best practices and standards. ANSI/AAMI ST79 Comprehensive guide to steam sterilization and sterility assurance in health care facilities states that: “Preparation for decontamination of instruments should begin at the point of use. To prevent the formation of biofilm and to reduce the risk of corrosion, cleaning and decontamination should occur as soon as possible after instruments and equipment are used. (AAMI ST79 6.3.1).”

CasePrep non-enzymatic pre-soak spray is provided as a ready to use, foamy solution that quickly loosens and removes organic and inorganic contaminants found on surgical devices, while keeping instruments moist for subsequent cleaning steps. CasePrep solution should be applied directly to items at point of use. Case Medical also offers an enzymatic pre-treatment product, PentaPrep Multi-Enzymatic Pre-Soak Spray and Foam, that carries the Safer Choice designation.

MARCH 2020 | OR TODAY |

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INDUSTRY INSIGHTS CCI

Perioperative Nursing Competency

By Jim Stobinski recently received a notification from the website ResearchGate that an article had been published which referenced a paper I had written in 2008 on perioperative nursing competency.1 “ResearchGate is a European commercial social networking site for scientists and researchers to share papers … ”2 and to interact and collaborate. I quickly went to the article and found that I had been cited by a group of researchers who were writing about perioperative nursing competency among Swedish nurses. 3

I

After reading the article on the work being done by the Swedish researchers, I was struck by two things. First, the education and training of Swedish perioperative nurses is much different than that of American nurses. Witness this statement from the article that describes the operating theater (OT) nurse, “The professional title of OT nurse is protected by law in Sweden and may only be used by nurses registered with the Swedish National Board of Health and Welfare holding a bachelor’s degree who also have a postgraduate diploma in specialist OT nursing of 60 credits.”3That quote tells

20 | OR TODAY | MARCH 2020

us much about perioperative nursing in Sweden. First, entry into practice requires baccalaureate level education.

Nursing in America is still debating the issue of entry level education. We must also consider that the professional title of OT nurse, a perioperative nurse in this country, is protected by law. That title protection is not the case in this country. And a last point, the course of study to practice in the OR is a postgraduate diploma of 60 credits; the equivalent of graduate level coursework in the United States.

In this country, we have yet to standardize the educational preparation to practice in perioperative nursing and there is no equivalent to the NCLEX examination to begin practice in the specialty.

Eleven years have now passed since I wrote that article for the AORN Journal. That brings me to my second thought. Upon reflection I must say that collectively, American perioperative nurses have not made substantial progress on the concept of competency assessment. Donna Scott Tilley sums up the issue clearly when she speaks on American nursing. Tilley states, “Currently, in most states, a nurse is determined to be competent when initially licensed, continuing competency is assumed thereafter unless otherwise demonstrated.”4 Many

American nurses, and their employers, operate from that paradigm.

In American nursing there has been slow, grudging progress on meaningful conversations about competency and competency assessment. Some state boards of nursing are using the terminology but there is no widespread consensus on the use of the term.

There has been even less progress by certification organizations in integrating meaningful competency assessment practices into the credentialing process. In short, we have a way to go to the reach the level of practice in some other countries. Sweden, Canada and Australia are among the countries that are the most advanced on education standards and in integrating meaningful competency assessment to the licensure process. The U.S. lags the efforts of these leaders.

At CCI, we believe that certification bodies can address some of the issues outlined in the preceding paragraphs. It will not be an easy task and the solutions will be disruptive and resource intensive. We believe that the risks associated with implementing competency assessment processes and increasing the education levels of perioperative nurses are well worth taking. The Competency and Credentialing Institute will continue our work on these topics, and we welcome the

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James X. Stobinski, PhD, RN, CNOR, CSSM (E), has in excess of 30 years experience in the operating room. He has 18 years of management experience in perioperative nursing and has published and presented extensively at the national level on perioperative management related topics. He also serves as adjunct faculty at Nova Southeastern University in Ft. Lauderdale, Florida and Wilkes University in Pennsylvania. In February 2017, he began serving as the CEO of the Competency and Credentialing Institute. He maintains an active research agenda centered on nursing workforce issues and certification.

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INDUSTRY INSIGHTS

IAHCSMM

Bringing It Home: IAHCSMM’s 2020 Annual Conference & Expo Chicago event to deliver SPD professionals vital new knowledge, inspiration

By Julie E. Williamson he International Association of Healthcare Central Service Materiel Management’s 2020 Annual Conference & Expo, taking place April 26-29 in Chicago, Illinois, will offer a wide range of educational opportunities to help sterile processing (SP) professionals advance their knowledge and professionalism and give their departments a quality and safety boost.

T

This year’s Conference & Expo theme, “Bringing It Home,” has two notable meanings. Not only is Chicago home of IAHCSMM’s headquarters, the conference’s rich education and speaker lineup and expansive vendor expo will reignite attendees’ passion for the profession by giving them valuable new information and skill sets that they can immediately share and put into action when they go back home to their departments and facilities. Attendees will have an opportunity to network with SP professionals and other industry experts, engage in problem-solving and best practice discussions and discover better ways to meet the evolving needs of their health care customers and improve patient care and safety. Attendees can earn up to 21 continuing education credits to apply toward their recertificaton (and even more CEs can be earned by participating in vendor-provided education during the expo).

Those arriving in Chicago early can participate in pre-conference hands-on labs and workshops Saturday, April 25. Concurrent hands-on labs and workshops are offered to conference registrants at no extra charge. Other pre-conference workshops, including the Educators Forum, Sterile Processing Management Workshop and StrengthFinderTM Workshop, are offered for an additional registration fee and on a space-available basis.

Early registration is recommended for the paid pre-conference sessions. Of course, after a day of education and networking, attendees will also have an opportunity to explore some of the world-renowned dining, shopping, entertainment, art and cultural establishments that make the Windy City such a highly sought destination for domestic and international travelers.

What follows is an abbreviated summary of the 2020 Conference & Expo schedule.

For more information and to register, visit www.iahcsmm.org/ BringingItHome.

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Sunday, April 26 9-10 a.m. – Opening keynote speaker: Jon Dorenbos 10:15-11:15 a.m. – General Session: Medical Device IFU Validations: What’s Going on behind the Scenes?

11:30 a.m.-12:45 p.m. – Welcome lunch 1-2 p.m. – Advocacy Program Updates 2:15-3:15 p.m. – Concurrent sessions (Protective Clothing: All Gowns Are Not Created Equal; Leaders Eat Last: Building a Strong Culture through ‘Corp Values’; How Much? What Happened? Costs & Safety of Gastrointestinal Endoscopic Procedures) 3:30-4:30 p.m. – Concurrent sessions (Communicate!

It’s Service Excellence; Identification & Prevention of Surface Alterations on Surgical Instruments Caused by Waterborne Minerals; UDI Panel Presentation; Upping Your Game for Quality Control in SPD and Endoscopy) 7 p.m. – Opening Reception

Monday, April 27 7-8 a.m. – Concurrent Sessions (10 Must-Have Skills for Frontline Central Service Colleagues; other topics TBD) 8:15-9:15 a.m. – A Guide to the Guidelines: Understanding the AORN Guidelines to periOperative Practice 9:30-10:30 a.m. – Concurrent sessions (Demystifying Standards: AAMI ST79 – A Journey into Newly Released AAMI Standards and TIRs; Washer-Disinfectors: What Goes into a Successful Cycle? Critical Facts: Vaporized H2O2 Low-Temperature Sterilization; Sunday concurrent session video replays) 10:45-11:45 a.m. – Concurrent sessions (What’s New with AAMI ST91? Have You Heard of the Updates?; Crash Course on Process Monitoring and Testing; Audit

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TREAT YOUR FEET

and Assess: How to Optimize Your SPD; Endoscope Drying: A Detailed Look at Method Effectiveness and Microbial Levels; Sunday concurrent session video replays) 11:45 a.m.-12:45 p.m. – Attendee lunch 1-5 p.m. – Vendor Exposition 6:30-7:30 p.m. – Reception

Tuesday, April 28 7-8 a.m. – Concurrent sessions (What Do I Do with These Dental Instruments?; Making the Decision to Go Off-Site) 8 a.m.-12 p.m. – Vendor Exposition 12:15-1:15 p.m. – Attendee Boxed Lunches 1:30-2:30 p.m. – Flexible Endoscope Safety: Evidencebased Advocacy for Quality Management 2:45-3:45 p.m. – Concurrent sessions (AAMI Roundtable: Chamberside Chat; How to Evaluate Strains after Steam Sterilization; The Inside View: Internal Endoscope Anatomy and Its Relationship to Effective Reprocessing; Good Germs Versus Bad Germs: Our Own Microbiome; Monday concurrent session video replays) 4-5 p.m. – Concurrent sessions (Partners in Prevention: Building the Bond with Infection Prevention; Is Work/Life Balance a Real Thing?; Biological Indicators: The Key to Uncompromised Patient Safety; The ‘Why’ behind What We Are Required to Do in SPD; Monday concurrent session video replays)

Wednesday, April 29 8:30-9:30 a.m. – The Optimal Sterile Processing Department: Blending Technology with Expertise 9:45-10:45 a.m. – The Joint Commission Update 11-11:15 a.m. – Closing remarks/Passing of the gavel 11:15 a.m.-12:15 p.m. – Closing keynote speaker: Steven Pemberton Julie E. Williamson serves as IAHCSMM’s communications director and editor. She has written hundreds of articles on topics related to central service, surgical services, infection prevention and materials management.

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market analysis

Surgical Instruments Market To Exceed $21 Billion Staff report ccording to an analysis by Reports and Data, the global surgical instruments market was valued at $11.75 billion in 2018 and is expected to reach $21.52 billion by 2026.

This means the market will see a compound annual growth rate (CAGR) of 7.9%.

A

Surgical instruments are key to successful surgery procedures in today’s world.

China and India, where the population is at par compared to other countries, have large demand for the tools used in surgery. The increasing prevalence of chronic diseases is the most common driver for this industry’s development.

The procedures for heart diseases and road accidents are also major drivers for the growth of this industry. Moreover, the large number of child births in the Asia-Pacific region is another driving factor for this industry.

The number of skilled professionals in the U.S. is another major factor for

24 | OR TODAY | MARCH 2020

industry growth.

The surgical instrument market has a huge potential for progress. But there are some factors which may hinder its development. The cost involved with the equipment is high and that could lead to high costs for surgery procedures.

Alternatives to surgery are increasing and that is a hindrance to market development.

Grand View Research reports that the global hand-held surgical instruments market size was valued at $3.82 billion in 2017 and is expected to exhibit a CAGR of 7.1% through 2025.

Rising prevalence of chronic diseases such as neurological, cardiovascular, infectious and urological diseases is expected to drive the market, according to Grand View Research.

Acumen Research and Consulting, a global provider of market research studies, reported that the global powered surgical instrument market will reach $2.9 billion by 2026 with a CAGR of 4%.

A powered surgical instrument is specifically designed for particular types of surgery. Mostly powered surgical instruments are used in orthopedic, ophthalmic and cardiac surgical procedure.

Furthermore, an increasing number of patients for chronic diseases, cardiovascular diseases, orthopedic conditions and neurological diseases also necessitate surgical interventions.

Rising medical tourism, growing adoption of powered surgical instruments, increased health care investment and an increase in health care facilities across the globe are factors driving the growth of the market, according to Acumen Research and Consulting.

Reports and Data states that key market participants include Zimmer Biomet Holdings Inc., Becton, Dickinson & Company, B. Braun Melsungen AG, Smith & Nephew Plc., Stryker Corporation, Aspen Surgical Products Inc., Ethicon Inc., Medtronic, Alcon Laboratories and Boston Scientific Corporation.

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Anzen

IN THE OR

Safety Scalpel Anzen Safety Scalpel has a reusable stainless steel handle similar in weight and balance to traditional metal handle scalpels, providing surgeons and techs with necessary safety features without losing the familiarity, control and ease-of-use of their current scalpels.

Anzen Safety Scalpel is weighted and balanced to provide instant familiarity, control and comfort with an intuitive design that provides effortless blade exposure. It features a slim cartridge design that does not interfere with view of incision site and the single-use protected blade cartridge makes sharps injury prevention easy and convenient. The protected blade stays retracted when attaching and detaching cartridges. By minimizing unnecessary exposure to the scalpel blade, you can ensure fewer preventable workplace injuries occur in the operating room and spend less time on the administrative pain following a sharps incident. •

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Virtual Incision

MIRA Surgical Robotic System Unlike today’s robots that reach into the body from outside the patient, Virtual Incision’s MIRA Surgical Robotic Platform features a small, self-contained surgical device that is inserted through a single midline umbilical incision in the patient’s abdomen. Virtual Incision’s technology is designed to enable complex multi-quadrant abdominal surgeries utilizing existing tools and techniques familiar to surgeons, and does not require a dedicated operating room or specialized infrastructure. Because of its much smaller size, the robot is expected to be significantly less expensive than existing robotic alternatives for laparoscopic surgery. The MIRA Surgical Robotic Platform is an investigational device that is not available for sale in the United States. •

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product focus

BD

Phasix ST Mesh with Echo 2 Phasix ST Mesh with Echo 2 is a bioresorbable mesh with a removable positioning system designed to help simplify minimally invasive ventral hernia repairs. This new device combines two category-leading technologies, Phasix ST Mesh and the Echo 2 Positioning System, into a single product. Phasix ST Mesh is comprised of a long-lasting, naturally derived bioresorbable mesh that includes a proven hydrogel barrier for intraabdominal placement.

Phasix ST Mesh helps create a strong repair without the need for a permanent implant. The Echo 2 Positioning System is a pre-attached deployment and positioning device that is designed to help facilitate accurate and consistent mesh placement in minimally invasive ventral hernia repairs. •

TransEnterix

Senhance Surgical System The TransEnterix Senhance System is the first new abdominal robotic surgery platform to receive FDA clearance since 2000. It is the first and only digital laparoscopic surgical platform designed to maintain laparoscopic MIS standards while providing digital benefits such as haptic feedback, robotic precision, comfortable ergonomics, advanced instrumentation including 3 mm microlaparoscopic instruments, eye sensing camera control and reusable standard instruments to help maintain per-procedure costs similar to traditional laparoscopy. In the U.S., the Senhance System is cleared for laparoscopic colorectal, gynecological, inguinal hernia and cholecystectomy (gallbladder removal) surgery. The system also has a CE Mark – accepted in over 30 countries – for general, urology, thoracic and gynecology surgery. •

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Medline

Twighline Spine Retractor System Medline’s Konig Twighline spine retraction and distraction system provides the surgeon with instrumentation for exceptional access and visualization to the cervical spine during Anterior Cervical Discectomy Fusion (ACDF) procedures. The double-hinged, low-profile frame and side-loading blade attachment allow for optimal intraoperative adaption and handling. The retractor handles can be used with blades to create handheld retractors for proper blade placement and engagement as well as smooth removal. The colorcoded blades and depth gauge allow for easy blade length identification and selection in order to increase efficiency during the spine procedure. The radiolucent retractor blades facilitate intraoperative imaging which can allow for a more accurate diagnosis.” •

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IN THE OR

continuing education

Ensuring Evidence-Based Practice in a Clinical Setting: Structure, Process and Outcomes

By Eugena Bergvall vidence-based practice (EBP) is defined as a problem-solving approach to integrate a systematic search and the best available scientific evidence for the best available population (patient or practitioner) to answer a clinical, educational, or administrative question.1 Healthcare is dynamic. Unless nursing practice is based on continuous examination of new evidence, it will continue to rely upon habits and the outcomes, as a result, will be unlikely to improve. EBP is a vital part of enhancing critical care nursing practice, which is essential for providing quality care to patients. Incorporating EBP improves patient outcomes and patient, family, and healthcare provider satisfaction. It can also reduce costs and the risk of harm by decreasing unnecessary tests and procedures.2,3

E

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Creating a culture that incorporates EBP into the organization is an important first step. Translating evidence into practice has become important to healthcare with the increased focus on lowering costs through reduced lengths of stay and prevention of hospitalacquired infection. Critical care nurses provide vital care to very sick patients, and even more crucial, nurses are providing care that is proven to be effective. One researcher’s findings suggest that establishing EBP leads to a higher quality of care and reduces costs.4 Creating such a culture helps organizations to obtain high reliability. To allow nurses to effectively apply EBP at the bedside, this course explains the rigorous process of EBP implementation and provides a summary of key EBP practices that should be incorporated into critical care nursing practice.

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 evidence-based practice continuing education program is to introduce critical care nurses to EBP and review the differences among evidence-based practice, research, and quality improvement. After studying the information presented here, you will be able to: •

Describe EBP.

•

Differentiate between EBP, research, and quality improvement.

Barriers to Evidence-Based Care

•

In Crossing the Quality Chasm, the IOM estimated an average delay of seventeen years for research conclusions to be used in practice.5 This

Review the steps of starting an EBP project.

•

Recall EBP evidence related to common critical care practices.

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continuing education delay can be attributed to a number of barriers including: Healthcare provider’s behaviors and mediating factors of the patient which are resistant to change.

Sub-optimal decision making which occurs because of time constraints, socioeconomic issues, current knowledge, and conflicts of interests.6 Failure to disseminate high quality evidence due to lacking the time and confidence to read and assess the literature, and having no authority to change practice.7 A survey conducted in 2012 of 1,000 nurses identified similar barriers: lack of knowledge about EBP and the perception that it is too time consuming; organizations not supporting EBP; a lack of resources, and resistance from colleagues and leadership.4 Given the multiple barriers and resulting delays in implementing evidence, clinical practice is not always consistent with current best evidence.

This research-practice gap occurs when nurses struggle to integrate EBP into clinical practice. Recent studies report that nurses utilize EBP to a limited extent. A systematic search of five databases found that hospital nurses were more likely to use Google and their peers than bibliographic databases in finding evidence for their own nursing practice.8 This review also found that nurses lack skills with evidence retrieval from bibliographic databases. Therefore, identifying these barriers and facilitating an improved environment may aid with improving EBP at the bedside. Getting research into practice does not only include choosing an intervention and hoping that change occurs. Rather, interventions should ideally be tailored to an individual’s stage of change as well as addressing barriers as appropriate.

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Partners in Improved Care Nursing research, evidence-based practice, and quality improvement (QI) each play an important, and complementary, role in improving patient outcomes.

Nursing research is a systematic investigation that includes development, testing, and evaluation. It is the generation of new knowledge, which can be generalized to the population and an example to critical care nurses might be: What is the effect of therapeutic hypothermia on the patient’s skin? If no literature is found on this topic, the critical care nurse should consult a nurse scientist to help design an institutional review board-approved study to address this clinical topic.

Evidence-based practice is a problem-solving approach to the delivery of healthcare that incorporates the best available evidence, clinicians’ expertise, and patient values and preferences.9 An example of an evidence-based project might include investigating the use of pharmacological venous thromboembolism (VTE) prophylaxis for patients who underwent a craniotomy and are recovering in the neuro ICU. A problem-focused trigger was identified because these patients were developing hospital-acquired VTEs. Nurses developed a PICOT question – identifying the population, intervention, comparison, outcome, and timing - and reviewed the literature. Nurses critiqued the research to ensure that it answered the PICOT question and rated it for strength and quality. They monitored the pharmacological prophylaxis application and VTE rate and following this, a protocol was implemented. Pharmacological prophylaxis initially was 20% and increased to more than 90%. Due to this increase, the VTE rate in this patient population fell below the benchmark.

QI is the continual process of using data-guided investigations to produce improvements in nursing care delivery. A QI project’s objective would

be to make changes that will improve patient outcomes, system processes, performance, and professional development. The QI process is continuous and is the responsibility of the health care provider, which makes it very different from research. For instance, a QI project might be collecting and analyzing data to determine the rate of complications for sheath removal after cardiac catheterization. Systematic assessment of an identified problem occurs through a set of related activities including: Implementing nurse-sensitive indicators Checking compliance with established standards Examining the effects of a change in medication administration to reduce medication errors Understanding the differences between research, EBP, and QI helps to clarify these three concepts, and therefore, enables their integration and use. Achieving clarity can also enhance interprofessional collaboration to improve patient care and obtain better outcomes.3

Steps to Integrate EBP into Clinical Practice Developing an institutional culture of EBP is essential to support effective change in practice. The first step to integrate EBP into an institution is the selection of a framework in which decisions are made.

Identifying a Framework EBP continues to evolve and may be difficult to evaluate, so models have been developed to organize and assist nurses in this process. A model or conceptual framework is a guide to help outline the inquiry with a set of strategies. Several different frameworks exist and nurses must understand those differences to identify the best model for the specific process being implemented.10 There are many worthy EBP models including:

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continuing education ACE Star Model of Knowledge Transformation12 Advancing Research and Clinical Practice Through Close Collaboration [ARCC] Model)11 Iowa Model of EBP to Promote Quality Care12 Johns Hopkins Nursing EBP Model1 Despite the varieties, the following steps shared by most frameworks.10 Spirit of Inquiry: asking the question about the clinical practice PICOT Question: formulate the inquiry into a question with a new intervention that would address concerns Search: retrieve the best evidence to answer the PICOT question Appraisal: assess the validity and quality of the evidence retrieved Synthesis and Translation: integrate evidence with practice and provider preference with clinical expertise to make a clinical decision with practice change Evaluate Change: outcomes change from the new practice Disseminate: share findings

Asking the clinical question Developing a PICOT question is crucial to ensure you are identifying the clinical problem.

P: types of patients or patient population. Consideration should include sex, ethnicity, and patients with particular healthcare problems.

I: includes interventions or specific methods or treatments of interest.

C: is comparison or alternatives in treatment or interventions to the problem. This may also include new or alternative ways to achieve the same outcome.

O: is looking at the desired outcome. This must be precise and brief when developing your question.

T: is for timing. This can be optional but may be relevant to the particular clinical question.3

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An example of a PICOT question may be: Problem: family presence with ICU patients Intervention: multidisciplinary ICU rounds Comparison: not being present Outcome: improves patient satisfaction scores in that the nurse and physician kept the patient and family informed The Patient-Centered Outcomes Research Institute (PCORI) and the Agency for Healthcare Research and Quality (AHRQ) can help formulate and write a PICOT question.

Selecting Team Members If the topic is a priority for the organization, the next step is to establish teams. An emphasis on interprofessional collaboration continues to be the key strategy to successful implementation of EBP and performance outcomes. Advanced practice nurses and professional development educators are key stakeholders and experts in implementing EBP. They are also ideal professionals to provide leadership in implementing EBP.

Searching for the Best Evidence Once a PICOT question is developed, a systematic review will need to be completed to answer the clinical question.

Systematic review and meta-analysis generate a rigorous process to summarize data, critically appraise data, and make recommendations for practice.

Medical librarians are invaluable to help translate the PICOT terms to key search words that will ensure you acquire the best literature to answer your clinical question. Databases for an extensive literature search can include those which are publicly available or alternatively, require a subscription or membership to access. See Resource section for web site links.

To support EBP, several critical care and government organizations, includ-

ing the American Association of Critical-Care Nurses, the Society of Critical Care Medicine, the American College of Chest Physicians, the American Heart Association, Cochrane Collaborative, and the Agency for Healthcare Research and Quality, have developed position statements and clinical practice guidelines. These national guidelines are already critically analyzed and provide recommendations for practice. Nurses should be aware that some guidelines do not always answer certain clinical questions.

Appraising Critical Evidence This next step is time consuming and may seem overwhelming to a direct care bedside nurse, however, studies must be evaluated for their validity, reliability, and applicability in answering the clinical question.

The team members need to examine how much high-quality evidence was found during the literature search. The strength of clinical evidence can be noted by assigning each study an evidence level, with the highest level of the hierarchy being the clinical practice guidelines.

Systematic reviews can take various forms; until recently, narrative reviews of quality studies were common, but now meta-analysis has emerged as an important EBP tool.12 Most level hierarchies designate randomized control trials, meta-analyses, or systematic reviews as the highest level of evidence for making clinical judgements.12

Determining recommendation grades When deciding whether to implement findings into practice, the team gauges the strength of evidence and gives it a recommendation grade. This is often stated as Grade A, B, or C, or with plus signs. Grading is an important part of the process, yet is not standardized across health professions.

Fortunately, only a small number of grading systems exist including:12

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continuing education SORT (Strength of Recommendation Taxonomy) Grade Working Group (Grading of Recommendations Assessment Development, and Evaluation) AGREE II (Appraisal of Guidelines for Research and Evaluation 2)

Applying evidence into practice After critically appraising the literature, there needs to be a decision whether to move forward to implement the evidence into practice. This requires a structured plan and a solid process to implement best evidence into patient care.

It is important to analyze after critiquing the evidence, as then it can be determined if there is sufficient evidence to implement a change. If so, it is vital to trial this initially with a small pilot group. This requires identification of achievable outcomes, collection of baseline data, design of EBP guidelines within the pilot unit, and evaluation of the process and outcomes. If there is not sufficient evidence, further research could be conducted or the practice change could be based on lower levels of evidence, such as case reports, theory, or expert opinion.12

Evaluating Outcomes Once an EBP protocol has been implemented, the next step is to ask: Did it make a difference? Did it answer the clinical question? Clinicians must evaluate the expected outcomes from the implementation strategies and this could include a QI process to identify gaps in procedure, environment, staff, costs, and process. From these identified gaps, the nurse will have the opportunity to make adjustments to the process to achieve the desired outcome.

Disseminating the results Communicating the findings could be achieved using podium and poster presentations at professional conferences or at grand rounds in the organization.

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Supporting and Promoting EBP At this stage, implementation can fail because of a lack of education about EBP and inadequate leadership support to integrate EBP fully into organizations. That is why it is important for an organization’s leaders to remove these barriers in support of the spirit of inquiry. Hospitals must create structure and processes, and increase access to databases by staff to promote EBP.12 A study in 2016 found that despite nurses’ positive attitudes about EBP, they lack confidence in their ability to implement EBP practices. The researchers recommend organizations and healthcare systems take a three-prong approach to cultivating EBP, focusing on leadership, education, and mentoring.9 Below are examples of established evidence-based guidelines that are common nursing practices in the critical care area.

Ventilator-Associated Pneumonia (VAP) is the leading cause of death from hospital-acquired infections and affects 10% to 20% of mechanically ventilated patients in the U.S. each year.13 In response to this preventable complication of mechanical ventilation, the Institute for Healthcare Improvement (IHI) developed a “bundle” of measures designed to prevent VAP.14 Developing an evidencebased intervention plan must contain two processes: Identify specific interventions geared towards the desired outcome of improvement.

Select an intervention with the lowest burden and largest benefit.14 In addition, American, Canadian, and European scientific societies have developed evidence-based guidelines to prevent VAP.15 An update to VAP are seen with the prevention bundle.

These key components are:15,16 Elevate the head of the bed to 30 to 45 degrees to prevent aspiration of oral secretions

Utilize the ABCDEF Bundle: A. Assess, prevent and manage pain B. Both spontaneous awakening trials (SAT) and spontaneous breathing trials (SBT) C. Choice of analgesia and sedation D. Delirium monitoring and management E. E arly, progressive mobilization F. Family engagement and empowerment Use of subglottic secretion drainage Avoid scheduled ventilator circuit changes Use peptic ulcer disease prophylaxis to prevent development of stress ulcers as a result of critical illness or mechanical ventilation Use deep venous thrombosis (DVT) prophylaxis to prevent thrombi formation in the patient on bed rest Provide daily oral care with chlorhexidine to reduce the risk for aspiration of potentially infectious oral secretions

Central Line-Associated Bloodstream Infections The Centers for Disease Control and Prevention (CDC) estimates that 41,000 bloodstream infections occur each year in the U.S., costing between $3,700 and $39,000 per episode.17 Most of the progress toward eliminating these infections has occurred in ICUs; however, more work needs to be done.

Independent risk factors for catheter-associated central line infections include:17 Prolonged hospitalization and/or duration of catheterization Heavy colonization at insertion site and/or of the catheter hub Internal jugular catheterization Femoral catheterization in adults Neutropenia Reduced nurse-to-patient ratio in the ICU Use of the catheter for total parental nutrition Substandard catheter care

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continuing education Best practices and recommendations with regard to prevention of and monitoring for catheter-associated central line infections include:17 Before insertion: Receive an evidence-based list of indications for central-line insertion from your institution Provide education for healthcare providers on insertion, care, and maintenance of catheters Ensure that providers who insert central lines go through a credentialing process Bathe patients with chlorhexidine before insertion At insertion:17 Ensure the procedure is completed in a sterile fashion. A checklist will need to be developed to facilitate this A nurse or other trained healthcare professional must observe insertion practices A nurse or other healthcare professional should be empowered to stop the procedure if sterility is broken Hand hygiene must be practiced before the procedure Maximal barrier precautions must be used After insertion:17 Adequate nurse-to-patient ratios in the ICU Disinfection of the hubs before accessing the port Daily assessment by the interprofessional team regarding the continued need for the central line

Catheter-Associated Urinary Tract Infection Worldwide, catheter-associated urinary tract infection (CAUTI) is the most common healthcare-associated infection and is associated with increased patient morbidity, mortality, length of stay, and hospital costs.18 Urinary tract infections are the most common type of healthcare-associated infection reported by acute care facilities, with nearly all associated with introduc-

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tion of a urinary catheter.19 The most effective way to reduce the incidence of CAUTI is to restrict urinary catheterization to patients who have clear indications for it and remove the catheter as soon as it is no longer needed.

Key components of the CDC’s CAUTI guidelines include:19 Perform a daily review of the need for the urinary catheter Use aseptic technique for inserting urinary catheters in the acute care setting; use clean technique for intermittent catherization in the non-acute setting Perform hand hygiene and don gloves before each catheter care procedure Properly secure catheter after insertion to minimize movement Maintain a closed drainage system and unobstructed urine flow Perform routine daily hygiene, including perineal care

Minimizing Alarm Fatigue Alarm fatigue occurs when a person is exposed to an excessive number of sounds. Studies estimate that approximately 90% of alarms in critical care settings are either false or clinically irrelevant.20 This may result in sensory overload and desensitization to sounds.

Patient safety can be compromised when alarm fatigue results in failure to recognize and respond to alarms.20 Several strategies exist for reducing alarm fatigue related to telemetry alarms:20, 21 Organize an interprofessional alarm management team. A team of stakeholders to gather alarm data and develop policies that can help reduce alarms.

Provide adequate skin preparation for ECG electrode placement. Cleansing of the skin before electrode placement can decrease impedance, enhance conductivity, and minimize signal noise. Washing the skin with soap and water

and clipping excessive hair can reduce artifact and increase the skin-electrode interface.

Change electrodes daily. Evidence from QI projects indicates that changing ECG electrodes daily can avoid unnecessary alarms. A QI project initiative that included daily electrode changes with a bundled intervention reduced alarms overall by 89%.21 Customize alarms based on patient need by widening alarm parameters are supported by recent systematic reviews results show in simulation study showed decreased alarms by 70%.

Other evidence-based strategies include placing delays on SpO2 monitors and placing SpO2 monitors on warm extremities to reduce error.21

Prevention of ICU-acquired Delirium Delirium is brain organ dysfunction that is exacerbated in critically ill patients, especially those who require mechanical ventilation. Delirium leads to increased mortality for ICU patients. A set of evidence-based practice guidelines has been established that incorporates the ABCDEF bundle.22 This provides a standardized approach to care that enhances interprofessional communication among care providers and a nurse-driven program to manage ICU patient outcomes. It takes effective communication among care providers with an organized approach to implement this bundle. D is outlined in the bundle as assessing for delirium and the most common tool used is the Confusion Assessment Method for the ICU (CAM-ICU).

This is a series of focused cognitive questions to assess disorganized thinking. The presence of a positive screening from the CAM-ICU test alerts healthcare providers to look for a reversible or treatable risk factor such as sleep hygiene, immobility, and visual/ hearing impairments.

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IN THE OR

continuing education Early Mobilization of Hospitalized Patients The adverse effects of prolonged bed rest are many and all too frequent for hospitalized patients. Pressure wounds, muscle atrophy, cardiopulmonary weakness, and immune-compromised complications are common adverse effects when patients are unable to maintain mobility. A newer trend, supported by research findings, is earlier mobilization of patients who once were deemed “too sick” to get out of bed.

Early mobilization not only improves the patient’s functional status, but also reduces length of hospital stay.23 Mobility efforts should begin as soon as the patient has stabilized hemodynamically and in respiratory status, often within the patient’s first 48 hours in the unit.22 Even patients receiving ventilatory support can exercise. A recent study describes four main barriers towards implementation to mobilization: patient instability, lack of knowledge, unclear protocol criteria, and interdisciplinary team coordination. To facilitate mobilization, these key interventions were identified:23 Manage sedation and delirium Analgesia prior to mobilization Develop a positive team culture Dedicated staffing with appropriate equipment and resources Mobilization activities may not be appropriate for patients who require a high level of ventilator support or those who have unstable hemodynamic parameters.

Venous Thromboembolism Prevention Venous thromboembolism (VTE) is a serious blood clotting condition that includes deep vein thrombosis (DVT) and pulmonary embolism (PE) and is a risk for the critical care patient population. Although it is preventable with anticoagulants and mechanical interventions, VTE occurs in about 50% in patients as a result of a current or recent admission for surgery or acute

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medical illness.24 The American Society of Hematology recently published the 2018 guidelines.24 Key nursing implementation factors included education regarding risk, prevention, and signs and symptoms of VTE. Patients should mobilize as soon as possible to prevent VTE, and those who are at higher risk should be considered for pharmacological prophylaxis. A combination of intermittent sequential devices and pharmacological therapy is recommended for higher-risk patients who have low risk for bleeding. Organizations should have a structured process to evaluate patient risk factors for preventing venous thromboembolism.24

Preventing Falls in Hospitals There are between 700,000 and 1,000,000 patient falls annually in the United States.25 Falls often result in secondary, preventable injuries that lead to increased health care utilization. The additional costs resulting from injuries attributed to falls are not reimbursable, according to the Centers for Medicare and Medicaid Services (CMS), and are therefore absorbed by the medical facility. Fall prevention, through identification of risk factors and optimizing patient safety, is of increasing concern.

The CDC created a STEADI Toolkit which draws from systematic reviews to provide best practices in fall prevention.26 The toolkit also includes letters to encourage leadership engagement of hospital senior management and unit managers. Additionally, an action plan is outlined along with a matrix of all tools and hospital personnel.26

Future of Evidence-Based Practice Evidence-based practice is the keystone of nursing, but marketplace changes call for more collaboration in the implementation of EBP. Current staff can become EBP champions and role models for newer nurses in creating a shared vision for implanting EBP across disciplines.9 As nurses, we cannot an-

swer these practice questions without examining the literature and researching the key components necessary to help us — and our patients and patient families — make sound decisions.

Editor’s note: Victoria A. Kark, MSN, RN, CCRN, CCNS, CSC, and Steve Risch, MSN, RN, CCRN, CCNS, past authors, have not had the opportunity to influence the content of this version.

Eugena Bergvall, DNP, AG-ACNP-BC, AGCNS-BC, ACCNS-AG, BSN, CCRN, CNRN, works as an Advanced Practice Nurse with a dual role as a Clinical Nurse Specialist and Nurse Practitioner at the National Institutes of Health in Bethesda, Maryland.

Resources • CINAHL: https://www.ebscohost. com/nursing/products/cinahl-databases/cinahl-complete • PubMed (MEDLINE): http://www. ncbi.nlm.nih.gov/pubmed • The Cochrane Collaboration: http:// www.cochrane.org • EBSCO Publishing: https://www. ebscohost.com • Honor Society of Nursing, Sigma Theta Tau International: http://www. nursingsociety.org • UpToDate: http://www.uptodate. com/home • TRIP Database: https://www.tripdatabase.com • OVID: http://www.ovid.com/site/ index.jsp • The Joanna Briggs Institute (Library of Systematic Review): http://www. joannabriggs.org • Agency for Healthcare Research and Quality: http://www.ahrq.gov • National Institute for Health and Care Excellence: https://www.nice.org.uk/ • Cochrane Nursing Care: https://nursingcare.cochrane.org/

References 1. Dearholt & Dang. Johns Hopkins Nursing Evidenced-Based Practice: Model And Guide-

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IN THE OR

continuing education lines. 2nd ed. Indianapolis, IN: Sigma Theta Tau

11. Melnyk, B.M. & Fineout-Overholt, E. (2015)

19. Gould, C.V., Umscheid, C.A., Agarwal, R.K. et

Ingernaional:2012

Evidence-Based Practice in Nursing & Health-

al. (2009) Guideline for prevention of catheter-

care: A Guide to Best Practice. 3rd ed. Phila-

associated urinary tract infections. Centers

delphia, PA: Lippincott, Williams & Wilkins.

for Disease Control and Prevention Web site.

2. Chapa, D., Hartung, M.K., Mayberry, L. & Pintz, C. (2013) Using preappraised evidence

https://www.cdc.gov/infectioncontrol/pdf/

sources to guide practice decisions. J Am Assoc

12. Polit, D.F. & Beck, C.T. (2012) Resource

guidelines/cauti-guidelines.pdf. Updated Febru-

Nurs Pract. 25(5):234-243. doi: 10.1111/j.1745-

Manual to Accompany Nursing Research:

ary 15, 2017. Accessed December 2, 2018.

7599.2012.00787.x.

Generating and Assessing Evidence for Nurs-

3. Melnyk, B.M. & Fineout-Overholt, E. (2011) Evi-

ing Practice. Philadelphia: Wolters Kluwer,

20. Michek, K. (2018) AACN issues practice

Lippincott Williams & Wilkins.

alert on reducing alarm fatigue. Patient Safety &

dence-Based Practice in Nursing & Healthcare: A

Quality Healthcare Web site. https://www.psqh.

Guide to Best Practice. 2nd ed. Philadelphia, PA:

13. Build a business case for quality improve-

com/news/aacn-issues-practice-alert-on-reduc-

Lippincott, Williams & Wilkins.

ment. AHRQ Pub. No.16(17)-0018-38-EF.

ing-alarm-fatigue/. Accessed December 2, 2018.

Agency for Healthcare Research and Quality 4. Melnyk, B.M., Fineout-Overholt, E., Galla-

Web site. https://www.ahrq.gov/profession-

21. Jepsen, S., Ruppel, H., Funk, M. & Wahl, S.

gher-Ford, L. & Kaplan, L. (2012) The state of

als/quality-patient-safety/hais/tools/mvp/

(2018) AACN practice alert: managing alarms

evidence-based practice in U.S. nurses: critical

cusp.html . Published January 2017. Accessed

in acute care across the life span: electrocardi-

implications for nurse leaders and educators. J

December 2, 2018.

ography and pulse oximetry. aacn.org. https://

Nurs Adm. 42(9):410-417.

www.aacn.org/clinical-resources/practice-alerts/ 14. How-to guide: prevent ventilator-asso-

managing-alarms-in-acute-care-across-the-life-

5. Tymitz, K., Lidor, A. & Lidor, A. (2011) The In-

ciated pneumonia. Institute for Healthcare

span. Accessed December 2, 2018.

stitute of Medicine: Crossing the Quality Chasm.

Improvement Web site. http://www.ihi.org/

The SAGES Manual of Quality, Outcomes and

knowledge/Pages/Changes/Implement-

22. Pun, B.T., Balas, M.S., Barnes-Daly, M.A.

Patient Safety. 379-386. doi:10.1007/978-1-4419-

theVentilatorBundle.aspx. Updated August 2,

et al. (2019) Caring for critically ill patients

7901-8_37.

2011. Accessed December 2, 2018.

with the ABCDEF bundle: results of the

6. Djulbegovic, B. (2014) A framework to bridge

15. Timsit, J.F., Esaied, W., Neuville, M.,

adults. Crit Care Med. 47(1):3-14. doi: 10.1097/

the gaps between evidence-based medicine,

Bouadma, L. & Mourvllier, B. (2017) Update on

CCM.0000000000003482.

health outcomes, and improvement and imple-

ventilator-associated pneumonia. F1000Res.

mentation science. J Oncol Pract. 10(3):200-202.

6:2061. doi:10.12688/f1000research.12222.1

ICU liberation collaborative in over 15,000

doi:10.1200/jop.2013.001364.

23. Hodgson, C.L., Capell, E. & Tipping, C.J. (2018) Early mobilization of patients in intensive

16. Hellyer, T.P., Ewan, V., Wilson, P. & Simpson,

care: organization, communication and safety

7. Stokke, K., Olsen, N.R., Espehaug, B. &

A.J. (2016) The Intensive Care Society recom-

factors that influence translation into clinical

Nortvedt, M.W. (2014) Evidence based practice

mended bundle of interventions for the pre-

practice. Crit Care. 22:77. https://doi.org/10.1186/

beliefs and implementation among nurses:

vention of ventilator-associated pneumonia. J

s13054-018-1998-9

a cross-sectional study. BMC Nursing. 13(1).

Intensive Care Soc. 17(3):238-243. doi: https://

doi:10.1186/1472-6955-13-8.

doi.org/10.1177/175114371664446.

8. Alving, B.E., Christensen, J.B. & Thrysøe, L.

17. Marschall, J. & Mermel, L., Fakih, M. et al.

ogy 2018 guidelines for management of venous

(2018) Hospital nurses’ information retrieval be-

(2014) Society for Healthcare Epidemiology of

thromboembolism: prophylaxis for hospitalized

haviours in relation to evidence based nursing:

America. Strategies to prevent central line as-

and nonhospitalized medical patients. Blood

a literature review. Health Info Libr J. 35(1):3-23.

sociated bloodstream infections in acute care

Adv. 2:3198-3225. doi: https://doi.org/10.1182/

doi:10.1111/hir.12204.

hospitals: 2014 update. Infect Control Hosp

bloodadvances.2018022954

24. Schünemann, H.J., Cushman, M., Burnett, A.E. et al. (2018) American Society of Hematol-

Epidemiol. 35(7):753-770. doi: 10.1086/676533.

9. Warren, J., McLaughlin, M., Esche, C. et al.

25. Falls. Patient Safety Network Web site. https://

(2016) The strengths and challenges of implant-

18. Hooton, T.M., Bradley, S-F., Cardenas,

psnet.ahrq.gov/primers/primer/40/Falls. Updated

ing EBP in healthcare systems. Worldviews Evid

D.D. et al. (2010) Diagnosis, prevention, and

January 2019. Accessed January 28, 2019.

Based Nurs. 13(1):15-24. doi: 10.1111/wvn.12149.

treatment of catheter-associated urinary tract infection in adults: 2009 International

26. STEADI - Older Adult Fall Prevention. Cen-

10. White, K.M. & Dudley-Brown, S. (2012) Trans-

Clinical Practice Guidelines from the Infectious

ters for Disease Control and Prevention. http://

lation of Evidence into Nursing and Health Care

Diseases Society of America. Clin Infect Dis.

www.cdc.gov/steadi/materials.html. Published

Practice. New York: Springer Pub. Co.

50(5):625-663.

March 24, 2017. Accessed September 29, 2018.

36 | OR TODAY | MARCH 2020

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CE642

How to Earn Continuing Education Credit Clinical Vignette Mitchell, age 58, arrives in the ED complaining of severe chest pain. He is diaphoretic and says his pain is radiating down his left arm and up into his jaw, and adds that he is nauseated. A few minutes after admission, Mitchell suffers a cardiac arrest. He is resuscitated and transferred to the ICU. He is intubated, is on a ventilator, and has a centralline catheter in place.

1. While Mitchell is on the ventilator, the head of his bed should be elevated at 30 to 45 degrees to: a. Prevent aspiration of oral secretions b. Decrease pressure in the brain c. Prevent the development of pressure wounds d. Keep the nasogastric tube in place 2. Part of the plan of care for Mitchell includes a “wake up and breathe” each day. Which statement about sedation interruption is CORRECT? a. It reduces the amount of suctioning needed. b. It reduces the rate of ventilator-associated pneumonia. c. It is not required for patients on the ventilator. d. I t increases the length of time a patient will spend on the ventilator.

3. Which patient is at greater risk for acquiring delirium? a. A 24-year-old admitted with a mild traumatic brain injury b. A 45-year-old who was extubated two hours ago c. A 65-year-old admitted with a fractured hip and has a urinary catheter d. A 50-year-old who underwent a coronary artery bypass graft 4. When can the nurse begin mobilizing Mitchell? a. When he is weaned from the ventilator and extubated b. When he is hemodynamically stable c. When the physician orders it d. When Mitchell requests it

Clinical VignettE ANSWERS 1. Answer A, Elevating the head of the bed 30 to 45 degrees prevents ventilator-associated pneumonia by decreasing the risk of aspiration of GI contents or oropharyngeal and nasopharyngeal secretions. 2. Answer B, Using daily “wake up and breathe” has been correlated with reduction in the rate of ventilator-associated pneumonia. 3. Answer C, Older adults and patients who have catheters are at greater risk for developing delirium. 4. Answer B, Mobilization can begin as soon as hemodynamic and respiratory problems have stabilized, frequently within the first 48 hours after ICU admission.

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1. Read the Continuing Education article.

2. Go online to ce.nurse.com to take the test for $12.

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Deadline Courses must be completed by 10/15/2022 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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h c a o r p p A d e c Balan c i m e d i p E d i o i p Combats O r

By Don Sadle

40 | OR TODAY | MARCH 2020

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The opioid

crisis is one of the greatest health threats

facing Americans today. Between 1999 and 2017, 218,000 people in the U.S. died from opioid overdoses, according to the Centers for Disease Control.

In 2017 alone, opioid overdoses took the lives of more than 47,000 people in the U.S. One out of every three of these deaths involved prescription opioids – a number that was five times higher in 2017 than in 1999.

Finding the Right Balance Given the role that health care professionals play in prescribing opioids to help manage patient pain, it’s critical that perioperative professionals find the right balance between relieving pain and lowering the risk of opioid addiction for patients.

In an effort to help professionals find this balance, the Department of Health and Human Services (HHS) Pain Management Best Practices InterAgency Task Force has issued a set of best practice recommendations in pain management.

“Our report emphasizes safe opioid stewardship, recommending approaches that mitigate opioid exposure,” says Vanila M. Singh, MD, MACM, Chief Medical Officer, HHS Office of the Assistant Secretary of Health, and Chairperson of the Pain Management Inter-Agency Task Force.

The report’s recommendations stress the importance of providing balanced, individualized patient-centered pain management to ensure better clinical outcomes for pain. These outcomes should improve quality of life and functionality for patients dealing with acute injury, chronic and perioperative pain.

A Multi-disciplinary Approach The HHS Task Force encourages the use of a multidisciplinary approach for pain management across various disciplines. It recommends a broad frameWWW.ORTODAY.COM

work of multidisciplinary approaches for treating pain, including the following: Medication, including both opioid and non-opioid Restorative therapies such as physical therapy, aqua and movement therapy Interventional procedures Behavioral health approaches Complementary and integrative health such as yoga, tai chi and acupuncture One or more treatment approaches should be used when clinically indicated to improve outcomes, notes the report. These approaches are reinforced by cross-cutting themes such as risk assessment, stigma, education and access to care.

Comprehensive risk assessment is empowered by open dialog with patients, notes Singh. Conducting a risk assessment helps minimize potential adverse consequences while facilitating treatment of active substance abuse disorders. Meanwhile, the risks of prescribing opioids must be balanced against potential benefits such as improved quality of life and improvements in medical condition, according to the report.

Singh says the task force emphasized the importance of individualized patient-centered care in the diagnosis and treatment of acute and chronic pain.

At the same time, it acknowledged that empathetic, compassionate and patientcentered pain care cannot be delivered effectively through a one-size-fits-all approach.

“Each patient has their own unique set of medical, genetic, environmental and sociocultural factors that affect their medical conditions and lives,” says MARCH 2020 | OR TODAY |

41

Singh. “A biopsychosocial approach is absolutely needed to address each patient’s unique challenges and achieve the best possible clinical outcomes.”

This biopsychosocial approach utilizes the patient’s history, a physical examination, diagnostic screening tools and a prescription drug monitoring program (PDMP).

Barriers to Pain Management The HHS Task Force identified a number of barriers to adequate pain management. These include insufficient insurance coverage for pain management services, complex opioid management requirements, clinicians’ underestimation of patients’ reports of pain and the need for more research on innovative and effective pain management approaches.

“Pain and substance use disorder management is insufficiently covered in medical education and training programs,” says Singh. “This has a downstream impact on the extent to which patients are educated about pain and substance use disorders.”

Stigmatization of patients with pain is another big barrier to pain

management, notes the task force report. The different facets of stigma at the patient, clinician and societal levels collectively serve as a significant barrier to effective pain treatment and management.

According to the report, stigma has far-reaching effects not only on patients and their families, but on everyone involved in patient care.

Feelings of guilt, shame, judgement and embarrassment resulting from stigma can increase the risk of anxiety and depression, which can also contribute to chronic pain.

Due to stigma, only 12 percent of people who require treatment for substance abuse disorders actually seek treatment, notes the report.

About 17 percent of those who don’t seek treatment say they’re concerned about negative judgements by friends or the community at large.

A Personal Perspective Rodrigo Garcia, MBA, APNBC,MSN, CRNA, can relate to all of this from a personal perspective.

He is the CEO of Parkdale Center for Professionals in Chesterton, Ind., which specializes in helping impaired professionals who are

dealing with addiction on the road to recovery.

Before founding Parkdale Center, Garcia became addicted to prescription opiates after surgery for a traumatic sports injury.

“It was the first time in my life I had ever taken an opiate,” says Garcia. “I soon realized that the medication was treating much more than just the physical pain — it also seemed to do wonders for conditions I didn’t even know I suffered from like insomnia, anxiety, depression and stress.”

Garcia believes that stigma is the single greatest hindrance when it comes to addiction treatment and pain management. “Removal of this barrier will improve the likelihood of recovery and effective pain management exponentially,” he says.

“As long as we as a society continue to treat addiction as a moral shortcoming, chronic pain patients as ‘drug seekers’ and addiction as a personal choice rather than a disease process, we will continue to be ineffective in treating this patient population,” Garcia adds.

Garcia believes that nurses are in a unique position to change this mindset. “With a collective voice

"About 17 percent of those who don’t seek treatment say they’re concerned about negative judgements by friends or the community at large."

42 | OR TODAY | MARCH 2020

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Rodrigo Garcia, MBA, APN-BC,MSN, CRNA, CEO of Parkdale Center for Professionals

of nearly four million across the country, nurses can change the stigma borne by pain patients from one of shame and disgrace to one of healing, wellness, compassion and empathy,” he says.

Striking a Balance Singh stresses the importance of striking a balance between mitigating opioid exposure while ensuring that adequate pain treatments are available for patients to have the best quality of life possible.

“It’s important to ensure that the patient is educated on risks and

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alternatives,” he says. “The patient’s history and medical condition are critical components of this assessment.”

According to Singh, the HHS Task Force does not recommend the indiscriminate removal or forced tapering of opioids as a treatment option. “We acknowledge that opioids have the potential to lead to physical dependence and possible opioid use disorder, particularly in certain at-risk populations,” he says.

“Therefore, risk assessment and periodic re-evaluation and monitoring are required and should be a part of the treatment plan,” says Singh. “When the benefits are deemed to outweigh the risks, opioid therapy should be administered for the shortest duration and at the lowest dose of medication required to optimally control the pain.”

Garcia recommends that the entire perioperative team work together to create a robust and comprehensive care plan that includes pain management.

“As a nurse anesthetist, I always appreciate the suggestion from other team members to include regional and local anesthetics or non-opiate medication options,”

Garcia says. “Often I will use a longer acting intrathecal medication for post-op pain or ask the surgeon to use supplemental local anesthesia on the field.”

Discuss Pain Management Openly Perhaps the most important step to reducing the risk of addiction is discussing pain management with patients and their families before surgical procedures. “It’s also critical to start pain management procedures early – well before the pain level is at a 10 out of 10,” says Garcia.

“The most important conversation to be had with patients should be focused on addiction risk,” Garcia adds. “Whether they are currently addicted or have ever been addicted to mood- or mind-altering substances should be a standard pre-op question asked of every patient.”

Garcia stresses that all patients, whether they’re addicts or not, deserve to have their pain controlled.

“But it’s our responsibility to not put them in harm’s way while trying to achieve effective pain management,” he says.

MARCH 2020 | OR TODAY |

43

SPOTLIGHT ON:

Darcy

DiFede,

Left: Darcy DiFede found her niche in nursing.

Right: Darcy DiFede's career has included travel to Morocco and the Bahamas.

Below: Darcy DiFede enjoys sharing her knowledge with others.

RN, BSN, FAHA

By Matt Skoufalos

If there’s any nurse who most personifies the adage that nurses are the masters of their own fates, it’s Darcy DiFede.

A late entrant to the profession, DiFede worked in genetics, urology and cardiology before she considered nursing. As rewarding as her experiences in those fields had been, she believed a bachelor’s degree would open up additional opportunities for her medical career to flourish.

“I said, ‘I want to control my own destiny,’ ” DiFede said. “The only way I was able to do that was to finish a degree, and know that it’s something that I owned.”

She enrolled in the University of Miami to study biomedical engineering, a decision that turned out to be short-

44 | OR TODAY | MARCH 2020

lived. However, being a full-time college student with a full-time job and three children at home made DiFede “have to pick and choose what you really want to do.”

“I really loved research, but I said, ‘the only way I’m going to be able to make this happen is by doing nursing,’ ” she said. “From day one, I didn’t want to be a bedside nurse, but wanted to find that niche that not a lot of nurses are looking at when they go to nursing school.”

While seeking out her niche, other circumstances in DiFede’s life confirmed her decision to transition into nursing.

While she was working at the University of Miami, her brother-in-law received a Stage IV cancer diagnosis. DiFede kept him company throughout 18 rounds of chemotherapy.

“I was his guardian angel, and he basically told me, ‘You’re awesome at this,’ ” she remembered. “He said, ‘You need to finish your career and be the best nurse you could be because I couldn’t stay here if it wasn’t for you.’ ” “He didn’t have a fighting chance to live, and my wish was for other patients to have opportunities, through research, to have that fighting chance,” she said.

Although her brother-in-law died

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from the disease in 2004, DiFede moved into nursing as a full-time academic discipline – along with her responsibilities to her career and family – and “made it happen.”

DiFede found the intersection of her skill sets as a caregiver and scientific researcher while working at the interdisciplinary stem cell institute at the University of Miami, where techniques for coronary artery stem cell injections were pioneered. Amid a tri-hospital study, she was documenting patient experiences, shepherding them through the extensive process of clinical trials and contributing research to the advancement of next-generation treatment models. It was exactly where she wanted to be.

“It just opened up the horizon of treating these patients with a therapy that was science fiction,” DiFede said.

“I’d tell them, ‘You’re going on this journey, and I’m going to be there every step of the way with you.’ ” DiFede said she excelled at helping patients understand what was required of them and guiding them through the process. She boasted a 100-percent compliance rate for patient retention because, in protecting the integrity of the study, she would travel to patients’ homes and bring them in if they didn’t

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turn up for treatment.

“Your data is the most important thing to help move the field forward, and that’s what gives the level of care and commitment you have to the patient,” DiFede said. “The patients knew that I was going to become part of their lives through the duration of their trial.

Whether they were going to have openheart surgery or they had to undergo a heart transplant, I would be there by their side. Whatever oversight, patients give their trust to you.”

The prestige of working in such a cutting-edge field also supported her nursing career. Among the significant achievements of her 20 years at the University of Miami, DiFede counts her time teaching a clinical rotation for students at the university hospital. She instilled in her nurses the significance of the profession beyond bedside care, and the importance of keeping their roles “on an equal footing with physicians.”

“Have your own power, and respect follows,” she said.

“We have achieved a wonderful level of collaboration with physicians because everyone appreciates the work that stem cell nurses are doing,” DiFede said. “That input and level of care is what makes our physicians value us, what gains us respect in the field.”

By the time DiFede left the university, she had enrolled nearly 700 patients into clinical trials; as a testament to the strength of the relationships they formed, she still hears from many of them.

“You keep having these patients come back, and you become a patient

advocate,” DiFede said. “It’s having the ability to give the patient the comfort and the knowledge to get them to understand the process.”

“I still have patients contacting me, and they’ll ask me, ‘What do you think about this group, that group, this doctor, that doctor?’ ” she said. “In my eyes, every patient is vulnerable, so I always took the extra care to help them make the best decisions for themselves and their families and their loved ones.”

When she did depart the university, DiFede transitioned into the biotech field to perform clinical trials overseas.

She traveled to Morocco to help establish a hospital; traveled to the Bahamas to participate in stem cell trials there.

Today she’s the COO for a startup called Regeniself, working with birth products. Her passion still lies with seeking the best thereapies for patients “in the most safe, regulated and appropriate manner for their health.”

“I have my nursing license, and because of that, I can give the best medicine that’s within my reach for my patients,” DiFede said.

“When you’re fresh out of college and you’re a nurse, your whole world is in front of you,” she said. “It’s such a varied career that the world is basically a sea of opportunities waiting to find your niche. You can be an LPN, an RN, a BSN; you can have your master’s, you can do a Ph.D. and have your own lab -- the sky is the limit.”

“I’ve published so many papers; I’ve worked with the most brilliant scientists,” DiFede said. “At the end of the day, it’s you, the nurse, that controls the relationship you foster.”

OUT OF THE OR fitness

3 WAYS TO INCREASE EFFICIENCY DURING STRENGTH TRAINING

By Miguel J. Ortiz hen it comes to strength

W training I have noticed that there are certain behaviors people have been taught to practice yet often neglect during the training session, especially once they get tired. If you are stressed or don’t have the right mindset for your training then these behaviors will most certainly be neglected. Why? Because they deal with focus, discipline and, most importantly, awareness. To me there is no such thing as a bad workout because movement is important for general health. So, what makes up a quality workout that will also guarantee increased efficiency toward any goal? Your breathing, your form and your rest period combine to make the difference between a quality training session and a simple workout.

Breathing Breathing is essential and absolutely talked about with most personal trainers or instructors. I always hear “breathe, push through, you got this” and I myself say it all the time. But, it’s extremely important to time your breathing depending on the movement. During strength training with weights, there are some good and

46 | OR TODAY | MARCH 2020

simple rules to follow. Breathe in during the eccentric part (with gravity) of the movement and breathe out during the concentric (against gravity). For example, during a bicep curl breathe in before you begin the movement, begin to lift the weight and breath out during. As you let the dumbbells fall breathe out and continue. This will ensure focus as you shouldn’t be able to lift and talk to a friend. Also keep in mind your breathing is relative to the movement.

Form I have always said if you want the body to look a certain way then you need to articulate or move your body a certain way. If you’re looking to be a better runner or weightlifter then understand which muscle groups you’re utilizing will be important when considering going the distance. If you want strong muscles you need to preform strong movements. I have had clients who were moving their bodies during exercise in ways that they thought were good, only to find it sometimes was the cause of certain joint issues. After simple adjustments and proper alignment, muscle recruitment, activation and joint function all increased which naturally helps muscular growth. Be disciplined about your form. Good posture and proper alignment will tremendously help shape the body.

REST PERIODS Rest periods; this portion of your training segment really makes the difference between a quality training session and a simple workout. The reason is because when you start adding rest periods you can’t hold conversation for very long, you stay more focused and aware of the people around and make sure you are able to jump into your next set. This is what shows that you came in with a plan, especially if you have limited time. If you haven’t been doing this during strength training start with about 45 to 60 seconds of rest between sets. If the rest seems too long then are you really doing strength training? It might be time you turn the weight up if that seems too long. Or, if it doesn’t seem long enough then you might be lifting too heavy (depending on your goal and rep count of course).

Always have fun with your workouts and remember by paying attention to your breathing, form and rest periods you are sure to have a quality training session.

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.

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OUT OF THE OR health

4

Common Fitness Myths Debunked

Courtesy of BPT

eight-loss tips, fad diets

W and more – these days,

they’re everywhere you look.

And most of it is false information. In fact, the average American wrongly assumes a daily workout must be 95 minutes or more to be impactful, according to a new study conducted by Planet Fitness.

Americans express growing frustration with fad fitness, social media “fitspiration” and the many myths believed to be true about health and wellness.

Here are some commonly held misconceptions about fitness and the real truth behind them:

Myth 1: You have to put in a lot of time to get results.

On average, Americans believe they need to work out for 95 minutes for it to even be beneficial. And those who don’t currently belong to a gym think a single, solid workout requires two full hours of exercise to be effective. However, recent guidelines from the U.S. Department of Health

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and Human Services note that just 10 minutes of exercise will help raise your heart rate and maintain fitness levels.

Myth 2: Working out is like a five-day work week.

Nearly half of Americans believe you need to work out more than five times a week in order for it to be effective – and that’s just not true. Every single episode of physical activity can provide temporary improvements in cognitive function and levels of anxiety. “You don’t have to work out seven days a week, two hours a day, to get healthy,” says Chris Rondeau, chief executive officer of Planet Fitness.

“The truth is that fitness can be fun, affordable, non-intimidating and not all consuming. The key is to just get started and know that every minute truly matters, and over time, can have a significant positive impact.”

Myth 3: Fitness needs to be a competition.

Studies show that head-to-head challenges are demotivating to the major-

ity of Americans who don’t currently belong to a gym. In fact, 68 percent find leaderboards specifically demotivating. When it comes to individual health, all activity counts, not just your position on a scoreboard. Find physical activity that is motivating and fun for you.

Myth 4: Social media helps spread the message of health and wellness.

Quite the opposite. Common “fitspo” phrases such as, “no pain, no gain” or “nothing tastes as good as skinny feels” are ineffective, according to most Americans. On the flip side, 65 percent say that inspirational messaging like “investing in yourself” and “a year from now, you’ll be glad you started today,” is motivating.

“People can work out on their own terms and live healthy, happy lives, versus perpetuating certain myths that you should be ‘living to work out,’ “ says Rondeau. “It’s this mentality that has kept the majority of Americans from believing that they, too, can take that first step toward better health.”

MARCH 2020 | OR TODAY |

49

OUT OF THE OR EQ factor

People Usually Quit Their Boss, Not Their Job By daniel bobinski he names and jobs in the following story have been changed to protect the innocent – and also to keep me from being sued.

T

Thomas had been a technical trainer for several decades. He had great annual reviews, his students always gave him high marks and he loved his job.

One day he was told about an opening on the corporate team that oversaw the company’s training nationwide. It would mean moving back east, but it also meant a significant pay raise. Several senior people on Thomas’ team told him he’d be good in that job, but a few others looked at who Thomas would be reporting to and recommended against it. Peter, the man who had recently been named head of corporate training, did not have a good reputation.

Thomas weighed his options and decided to go for it. He easily got the job, so he uprooted and relocated back east.

That was a year ago. Today, Thomas is looking for another job.

“Peter is the worst boss I’ve ever had,” Thomas told me. “I didn’t think it was possible for someone to be that high up in a company and be so WWW.ORTODAY.COM

unreasonable.”

According to Thomas, the national team has six people, and four are now actively looking for other work.

There’s much more to this story than I have space for, but you should know that Thomas has not only tried talking with Peter, he even went to Peter’s boss. In fact, everyone on the team has talked with Peter’s boss about how bad Peter is as a manager.

Yet, even after all that, the boss continues to think Peter walks on water.

I share this story for two reasons. The first has to do with the company’s bottom line. No matter what Peter’s boss thinks about Peter personally, if everyone on the team is complaining about how bad he is to work with, it only makes sense to invest in some emotional intelligence training for Peter.

The impact on the bottom line should be a no-brainer. Everyone on the national team makes $100,000 or more per year, so the cost of replacing four people will be somewhere between $200,000 and $400,000.

Hiring a coach to help Peter with his people skills can be done for between $8,000 and $15,000. You can do the math and decide if that makes

sense for the company’s bottom line.

Amazingly, even if only three people quit instead of four, it would still be a good financial decision.

The second reason I’m sharing this story is to underscore the need for listening. It takes guts for someone to approach a boss’ boss with a complaint. If one person complains, it might just be a disgruntled employee.

But when everyone complains, that means an issue requires attention.

Bottom line, sometimes people get promoted in spite of their people skills, not because of them. When we consider that the cost of replacing an employee is usually equivalent to that person’s annual salary, and that people quit bosses, not jobs, it only makes sense to invest in people skills for middle and senior managers.

Daniel Bobinski, M.Ed. teaches teams and individuals how to use Emotional Intelligence, and he’s been doing that for 30 years. He’s also a best-selling author and a popular speaker at conferences and retreats. Reach him at daniel@eqfactor.net.

MARCH 2020 | OR TODAY |

51

OUT OF THE OR nutrition

Eat Fruits, Veggies and the Occasional Burger

By Charlyn Fargo

e all know fruits and

W vegetables are healthy, and most of us should eat more of them than we do. But how much is enough?

As a dietitian, I teach clients to fill half their plates with fruits and vegetables, one-fourth with lean protein and one-fourth with whole grains, along with that cup of dairy. But “half” your plate can vary by plate size; the idea behind this guideline is to provide an easy way to get healthy nutrients from fruits and vegetables. At the same time, MyPlate encourages consumers to move toward a more plant-based diet – and fewer starches and animal proteins.

If that’s too broad for you, the U.S. Department of Agriculture offers detailed daily recommendations, including a breakdown by type of vegetable and their serving sizes based on total daily caloric intake. According to Dietary Guidelines, an adult consuming 2,000 calories per day should be eating 2 1/2 cups of vegetables and 2 cups of fruit per day. This is quite a leap from the typical American diet, which includes a mere cup and a half of veggies and one cup of fruit per day, according to the USDA. For the week, try for 1 1/2 cups of dark green vegetables, 5 1/2 cups of red and orange veggies, 1 1/2 cups of legumes, five cups of starchy vegetables and four cups of other veggies.

Why the emphasis on fruits and vegetables? They are full of important nutrients we need daily – folate, magnesium, potassium, fiber and vitamins A, C and K, to name a few. Every vegetable or fruit, depending on its

52 | OR TODAY | MARCH 2020

color and makeup, has its own unique nutritional profile. That’s why eating a variety of food is just as important as balance and moderation when it comes to a healthy diet.

Make it a goal to add a few more veggies to your routine. For instance, add spinach or green and red peppers to your scrambled eggs; have two vegetables for a side dish instead of one; make a smoothie with fruits and vegetables; or eat your hummus with carrot and celery sticks instead of crackers.

Meat Burgers vs. Plant-Based Burgers Should you make the switch to plantbased burgers rather than meat?

At the grocery store where I’m a dietitian, our shelves are bulging with plant-based alternatives, including burgers. Fast-food and restaurant chains, including Red Robin, TGI Friday’s, Carl’s Jr. and Burger King, have also begun offering plant-based burgers.

Are they healthier than meat?

Depends. Some are made from highly processed foods with a long list of ingredients. The more healthful options come from whole foods rather than processed plant-based ingredients. A pea protein isolate, for example, isn’t a whole food. A beef burger, on the other hand, has one ingredient: beef.

Then there’s the fat and sodium content. While many try to avoid the saturated fat in beef, many plant-based burgers contain coconut oil as a main ingredient, also a saturated fat. We went through a phase where anything coconut was perceived as good for you. However, the American Heart Association issued an advisory against

consuming coconut oil, saying it’s 82% saturated fat and can raise LDL (bad cholesterol), similar to the way butter and beef fat do. In reality, coconut oil gives several plant-based burgers similar levels of fat.

Check how much sodium your plant-based burger contains. A chart in a recent issue of Today’s Dietitian had a range of 540 milligrams (Amy’s California Burger) to 130 milligrams (Engine 2 Poblano Black Bean Burger) for one patty. As always, it pays to read the labels to be healthy. Most have around 350 milligrams of sodium.

The calories for plant-based burgers range from 270 (Beyond Burger) to 100 (Boca All American Veggie Burger). By comparison, a ground beef burger has about 250 calories. You’re also likely to pay more for that plantbased burger – on average, three to four times more than meat. Confusing? Like any food, you need to read the label to determine if it’s a good choice.

The bottom line? Plant-based foods are better for the environment because they use fewer natural resources.

However, a healthy diet should limit processed foods of any kind, including plant-based burgers. So, enjoy that beef burger – on occasion – or enjoy a plant-based burger if you prefer the taste – on occasion. Both can fit into a healthy diet.

Just enjoy the one you choose.

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

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OUT OF THE OR recipe

One Pot Mocha Brownie Cake Ingredients: • 1 cup all-purpose flour • 1 cup sugar • 1/2 teaspoon baking soda

Recipe

• 1/2 cup water

the

54 | OR TODAY | MARCH 2020

• 1 stick (1/2 cup) unsalted butter • 1/2 cup unsweetened cocoa, like Droste or Scharffen Berger • 2 teaspoons instant espresso like Medaglia D’Oro • 1/4 cup buttermilk • 1 egg • 1 teaspoon vanilla For the frosting: • 1/2 stick butter • 1/4 cup cocoa • 1/4 cup buttermilk • 1 cup powdered sugar • 1 teaspoon vanilla • 1 cup chopped walnuts

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

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

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OUT OF THE OR recipe

One-pot Mocha Brownie Cake is Easy and Scrumptious

f you are thinking of making a chocolate cake for folks who love coffee, I have the perfect Seriously Simple dessert for you.

The first time I tasted this I thought it was the best home-style chocolate/ coffee cake I had ever tasted. My friend Judy Miller has had this recipe in her family for years and she told me that it is always a hit for both simple gettogethers and larger events. I particularly like it served after a cold weather stew or soup since it has a rustic touch to it.

This moist, brownie-style mocha cake is truly Seriously Simple. Made using an unusual cooking technique, the batter is first blended and cooked in a non-stick saucepan on top of the stove before it is baked in the oven. And for ease in clean up you use the same non-stick saucepan to simmer the cake and make the frosting.

The frosting is poured over the cake, which has holes poked into it to make the cake moist and give it a double dose of chocolate. Make sure to use a high-quality unsweetened cocoa powder like Droste or Scharffen Berger.

The espresso instant coffee not only gives the cake a hint of coffee flavor, but it also enhances the chocolate flavor.

Since it only takes a few minutes to put together, this may become your standby for last minute dinners or even when you just need a chocolate fix.

Serve this warm or at room temperature with a scoop of coffee ice cream.

I

Judy’s One Pot Mocha Brownie Cake Serves 6 to 8 1.

2.

3.

4.

5.

Preheat the oven to 400 F. Butter a 9-inch spring form pan. Combine the dry ingredients together and reserve.

In a medium (3 quart) non-stick saucepan, bring the water, butter, cocoa and espresso to a boil on medium-high heat, stirring for 2 minutes. When it comes to a boil add the dry ingredients, stirring to combine. Reduce the heat to medium. Then add the buttermilk, eggs and vanilla, and mix vigorously until well blended. Remove from the heat. (Do not cook too long or it will affect the rising of the cake.)

Pour into the prepared pan. Bake for about 15 minutes or until the top just begins to crack and the center is still slightly wet when pierced with a skewer.

Clean the saucepan, then while the cake is baking make the frosting. In the saucepan over medium-high heat bring the butter, cocoa and buttermilk to a boil, mixing constantly. When blended add the powdered sugar, vanilla and walnuts, and mix to combine. Remove from the heat.

While the cake is still hot, poke holes in the cake and pour over the frosting. Keep poking the cake after you have poured over the frosting to create a fudgy interior. When the cake is completely set, place it on a platter and release the spring form allowing the frosting to drip down the side. Serve warm or room temperature.

Recipe note: For a crowd, double the recipe and place in a 9-by-13-inch baking pan.

Cut into squares and serve with ice cream.

Advance preparation: This may be prepared a day ahead, covered and kept at room temperature.

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MARCH 2020 | OR TODAY |

55

OUT OF THE OR pinboard

NEW

O R TO DAY

CONTEST M ARC H

WORLD HEALTH ORGANIZATION'S

The Winner Gets a $25 Bath & Body Works Gift Card!

YEAR OF THE NURSE Celebrate the "Year of the Nurse" with us by sharing a standout story about you or a nurse in your life! Each submission will be entered to win a Bath & Body Works Gift Card.

Please visit ORToday.com/Contest to enter or email your story to Editor@MDPublishing.com.

what you can ot do interfere with nn ca u yo t ha w t le t “Do no ge basketball coach

do.”

of Fame colle – John Wooden, Hall

56 | OR TODAY | MARCH 2020

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The News and Photos

that Caught Our Eye This Month

OUT OF THE OR pinboard

STUDY: 1 IN 5 CANCER SURVIVORS BINGE DRINK New research in the January 2020 issue of JNCCN— Journal of the National Comprehensive Cancer Network uses data from the National Health Interview Survey (NHIS) from 2000 to 2017 to examine self-reported drinking habits among people reporting a cancer diagnosis. The researchers found that of 34,080 survey participants, 56.5% were current drinkers, 34.9% exceeded moderate drinking levels, and 21% engaged in binge drinking. This is the first large study to be done on alcohol use in the oncology population.

Given that alcohol has been identified as a risk factor for several cancers (and contributed to 5.8% of cancer deaths in 20122), the researchers were surprised by how high those numbers were.

“We recommend that providers screen for alcohol use at regular intervals and provide resources to assist in cutting down use for those who may engage in excessive drinking behaviors,” said Nina Niu Sanford, MD, Assistant Professor, Dedman Family Scholar in Clinical Care, UT Southwestern Medical Center, Department of Radiation Oncology. “Typically, questions about alcohol use are just asked once when the patient first

enters the medical system and then copied into subsequent notes as part of the patient’s social history.”

For the purposes of the study, excessive drinking was defined as more than one drink a day for women, and more than two drinks a day for men, per CDC guidelines. Binge drinking was defined in the same guidelines as consuming enough alcohol to raise blood alcohol content to at least .08%, which generally means at least four drinks within two hours for women, and at least five for men. For this study, the researchers defined binge drinking as the consumption of at least five drinks in one day at any point over the past year. The authors noted that there aren’t currently studies that establish safe levels of alcohol use when it comes to cancer risk, but studies have suggested the risk is higher for people who engage in binge drinking. • To read the entire study, visit JNCCN.org. Complimentary access to “Alcohol Use Among Patients With Cancer and Survivors in the United States, 2000-2017” is available until April 10, 2019.

OTTERBOX ADDS ANTIMICROBIAL TECHNOLOGY TO AMPLIFY GLASS For something that we put against our faces on a daily basis, our smartphones are shockingly packed with microbes. OtterBox and Corning are showcasing an enhanced Amplify Glass screen protection line with EPA-registered antimicrobial technology.

“We use our phones every day and take them with us wherever we go, including to some not entirely sanitary spaces,” said OtterBox CEO Jim Parke. “Amplify Glass is now formulated with an antimicrobial agent to protect the surface of the screen protector, so you don’t have to give phone grime a second thought.”

The antimicrobial property of Amplify screen protectors is embedded into the glass so it is able to maintain its damage resistance, optical clarity and touch sensitivity. However, the press release announcing this news notes thatAmplify Glass with antimicro-

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bial technology does not protect users or provide any direct or implied health-benefit.

Based on Corning tests, Amplify provides up to five-times greater scratch resistance than other glass protection options. Long-lasting protection against drops and bumps helps to keep the screen crystal clear. These enhanced Amplify Glass screen protectors are easy to install and compatible with OtterBox cases and coming soon for the latest Apple iPhone devices. Other versions of Amplify Glass, including Glare Guard and Edge2Edge, are also available for the latest phones from Apple, Samsung and Google.

Amplify Glass with EPA-registered antimicrobial technology is coming soon to otterbox.com. •

MARCH 2020 | OR TODAY |

57

INDEX

advertisers

ALPHABETICAL Action Products, Inc.……………………………………… 47 AIV Inc.…………………………………………………………………15 ALCO Sales & Service Co.…………………………………21 BD……………………………………………………………………… 60 C Change Surgical……………………………………………… 6 Calzuro.com……………………………………………………… 23 Cygnus Medical…………………………………………………… 9 Diversey …………………………………………………………… 50 Doctors Depot………………………………………………… 39

Fobi…………………………………………………………………… 27 GelPro……………………………………………………………………13 Healthmark Industries Company, Inc.………… 29 Innovative Medical Products………………………… 10 International X-Ray Brokers…………………………… 48 Jet Medical Electronics Inc…………………………… 48 Kapp Surgical Instrument Inc……………………………21 Key Surgical………………………………………………………… 4 MD Technologies Inc.……………………………………… 28

Molnlycke Health Care…………………………………… 59 OR Today Webinar Series……………………………… 28 Ruhof Corporation…………………………………………… 2,3 SIPS Consults…………………………………………………… 47 Soma Technology………………………………………………17 STERIS/Microsystems………………………………………… 5 TBJ Incorporated……………………………………………… 53 TIDI…………………………………………………………………… 18,19 USOC Medical…………………………………………………… 38

INSTRUMENT STORAGE/TRANSPORT

Ruhof Corporation…………………………………………… 2,3 TBJ Incorporated……………………………………………… 53

CATEGORICAL ANESTHESIA

Doctors Depot………………………………………………… 39 Soma Technology………………………………………………17

C-ARM

Soma Technology………………………………………………17

CARDIAC PRODUCTS

C Change Surgical……………………………………………… 6 Jet Medical Electronics Inc…………………………… 48 Kapp Surgical Instrument Inc……………………………21

CARTS/CABINETS

ALCO Sales & Service Co.…………………………………21 Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.………… 29 STERIS/Microsystems………………………………………… 5 TBJ Incorporated……………………………………………… 53

Cygnus Medical…………………………………………………… 9 Key Surgical………………………………………………………… 4 Ruhof Corporation…………………………………………… 2,3 TIDI…………………………………………………………………… 18,19

INVENTORY CONTROL

Key Surgical………………………………………………………… 4

LIGHTING/VIDEO PRODUCTION

STERIS/Microsystems………………………………………… 5

MAMMOGRAPHY

International X-Ray Brokers…………………………… 48

MEDICAL GAS

Fobi…………………………………………………………………… 27

MEDICAL IMAGING TABLES

RESPIRATORY

Soma Technology………………………………………………17

SAFETY

Calzuro.com……………………………………………………… 23 GelPro……………………………………………………………………13 Healthmark Industries Company, Inc.………… 29 Key Surgical………………………………………………………… 4 TIDI…………………………………………………………………… 18,19

SINKS

Ruhof Corporation…………………………………………… 2,3 TBJ Incorporated……………………………………………… 53

SKIN PREPARATION

BD……………………………………………………………………… 60

CS/SPD

International X-Ray Brokers…………………………… 48

DISINFECTION

Doctors Depot………………………………………………… 39 Soma Technology………………………………………………17 USOC Medical…………………………………………………… 38

Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.………… 29 MD Technologies Inc.……………………………………… 28 TBJ Incorporated……………………………………………… 53

ONLINE RESOURCE

SURGICAL

MD Technologies Inc.……………………………………… 28 Ruhof Corporation…………………………………………… 2,3 Cygnus Medical…………………………………………………… 9 Diversey …………………………………………………………… 50 Ruhof Corporation…………………………………………… 2,3

DISPOSABLES

ALCO Sales & Service Co.…………………………………21

ENDOSCOPY

Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.………… 29 MD Technologies Inc.……………………………………… 28 Ruhof Corporation…………………………………………… 2,3 STERIS/Microsystems………………………………………… 5

ERGONOMIC SOLUTIONS

Diversey …………………………………………………………… 50

FALL PREVENTION

ALCO Sales & Service Co.…………………………………21

FLUID MANAGEMENT

MD Technologies Inc.……………………………………… 28

FOOTWEAR

Calzuro.com……………………………………………………… 23

MONITORS

OR Today Webinar Series……………………………… 28

OR TABLES

International X-Ray Brokers…………………………… 48

OR TABLES/BOOMS/ACCESSORIES

Action Products, Inc.……………………………………… 47 Innovative Medical Products………………………… 10 Soma Technology………………………………………………17 STERIS/Microsystems………………………………………… 5

OTHER

AIV Inc.…………………………………………………………………15

OTHER: FLOOR MATS

GelPro……………………………………………………………………13

PATIENT MONITORING

STERILIZATION

Fobi…………………………………………………………………… 27 MD Technologies Inc.……………………………………… 28 SIPS Consults…………………………………………………… 47 Soma Technology………………………………………………17 STERIS/Microsystems………………………………………… 5 TIDI…………………………………………………………………… 18,19

SURGICAL INSTRUMENT/ACCESSORIES

C Change Surgical……………………………………………… 6 Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.………… 29 Kapp Surgical Instrument Inc……………………………21 Key Surgical………………………………………………………… 4

SURGICAL LAMPS

Fobi…………………………………………………………………… 27

AIV Inc.…………………………………………………………………15 Jet Medical Electronics Inc…………………………… 48 USOC Medical…………………………………………………… 38

SURGICAL TABLE

POSITIONING PRODUCTS

AIV Inc.…………………………………………………………………15 USOC Medical…………………………………………………… 38

Fobi…………………………………………………………………… 27

TELEMETRY

ALCO Sales & Service Co.…………………………………21

Action Products, Inc.……………………………………… 47 Cygnus Medical…………………………………………………… 9 Innovative Medical Products………………………… 10 Kapp Surgical Instrument Inc……………………………21 Molnlycke Health Care…………………………………… 59

INFECTION CONTROL

PRESSURE ULCER MANAGEMENT

STERIS/Microsystems………………………………………… 5

REPAIR SERVICES

MD Technologies Inc.……………………………………… 28 TBJ Incorporated……………………………………………… 53

GENERAL

AIV Inc.…………………………………………………………………15

HOSPITAL BEDS/PARTS

ALCO Sales & Service Co.…………………………………21 Cygnus Medical…………………………………………………… 9 Diversey …………………………………………………………… 50 Healthmark Industries Company, Inc.………… 29 MD Technologies Inc.……………………………………… 28 Ruhof Corporation…………………………………………… 2,3 SIPS Consults…………………………………………………… 47 TBJ Incorporated……………………………………………… 53 TIDI…………………………………………………………………… 18,19

Action Products, Inc.……………………………………… 47 Molnlycke Health Care…………………………………… 59 Cygnus Medical…………………………………………………… 9 Doctors Depot………………………………………………… 39 Jet Medical Electronics Inc…………………………… 48 Soma Technology………………………………………………17

TEMPERATURE MANAGEMENT

C Change Surgical……………………………………………… 6

WARMERS

WASTE MANAGEMENT X-RAY

International X-Ray Brokers…………………………… 48

REPROCESSING STATIONS

MD Technologies Inc.……………………………………… 28

58 | OR TODAY | MARCH 2020

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GET AHEAD OF OCCIPITAL PRESSURE ULCERS IN THE OR. Mölnlycke® Z-FloTM Fluidized Positioners can help protect your patients

from occipital pressure ulcers when they are at their most vulnerable. Z-Flo positioners have been shown to reduce occipital pressure ulcers by 87.7%.1 Easily shaped to fit each patient, the positioners will maintain their shape – and the patient’s position – until remolded. Z-Flo positioners can reduce the exposure to occipital stress by up to 65% compared with standard medical foam – an easy prevention measure to put your patients ahead of occipital pressure ulcers.2

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Mölnlycke® Z-FloTM Fluidized Positioners allow you to customize positioning support that won’t bounce back or exert pressure on sensitive areas.

Get the complete story at www2.molnlycke.us/zflopositioners

References: 1. Barakat-Johnson M et al. Evaluation of a fluidised positioner to reduce occipital pressure injuries in intensive care patients: A pilot study. Int Wound J. 2018;1–9.

2. Katzengold R, Gefen A. What makes a good head positioner for preventing occipital pressure ulcers. Int Wound J. 2017;1–7.

We’re here to help. Call your Mölnlycke Health Care Representative or Regional Clinical Specialist.

1-800-843-8497 | www.molnlycke.us | 5550 Peachtree Pkwy, Ste 500, Norcross, GA 30092 The Mölnlycke trademarks, names and logo types are registered globally to one or more of the Mölnlycke Health Care Group of Companies.

The Z-Flo is a trademark in the United States and other countries of EdiZONE, LLC of Alpine, Utah and USA. Distributed by Mölnlycke Health Care, US, LLC, Norcross, Georgia 30092. © 2019 Mölnlycke Health Care AB. All rights reserved. 1-800-882-4582. MHC-2019-37588

Go to www.connect2know.com for professional education including FREE CE Courses to support best practice across your organization.

WITH BD CHLORAPREP™ PATIENT PREOPERATIVE SKIN PREPARATION WITH STERILE SOLUTION AND AN ALL-NEW STERILITY ASSURANCE LEVEL OF 10 –6.* At BD, patient health is an unrelenting priority. It’s why we’ve introduced a whole new level of sterility assurance for BD ChloraPrep™ Patient Preoperative Skin Preparation, the solution that more hospitals count on than any other brand. As pioneers in skin antiseptics, we are raising the performance bar above and beyond FDA skin prep requirements, making our market-leading solution even better. Because when it comes to patient health, no other option gives you more peace of mind. Now you can rely on the lowest risk of intrinsic contamination commercially available in the United States, with a sterility assurance level of 10 –6—reducing the risk of antiseptic solution contamination to less than one in a million.*1 Discover the confidence of BD ChloraPrep™ Applicators. Discover the new BD. *The SAL level indicates there is less than one in a 1,000,000 chance (1000x greater than the minimum requirement) that a sterile ChloraPrep™ applicator containing a sterile solution will contain a single (viable) microorganism following terminal sterilization of the ampules through the new manufacturing process of BD. 1 Degala S, McGinley CM II, Thurmond KB, inventors; CareFusion 2200 Inc., assignee. Systems, methods, and devices for sterilizing antiseptic solutions. US patent 9,078,934. July 14, 2015.

Discover peace of mind in your antiseptic solution at bd.com/One-Trust BD, the BD Logo and ChloraPrep are trademarks of Becton, Dickinson and Company or its affiliates. © 2019 BD. All rights reserved. 0819/3397