OR Today Magazine May 2020 by MD Publishing

PRODUCT FOCUS DISINFECTION

CE ARTICLE HIPAA

OUT OF THE OR SCAPULA THERAPY

LIFE IN AND OUT OF THE OR

COMPANY SHOWCASE

MAY 2020

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contents features

HAND HYGIENE When the latest coronavirus threat first emerged, the number one recommendation was to wash hands frequently and thoroughly. Similarly, the best way to prevent healthcare associated infections and the transmission of disease is to practice good hand hygiene.

COMPANY SHOWCASE TBJ Inc. offers a wide variety of products for the hospital market as well as the laboratory and pharmaceutical markets. The company's ability to customize products to meet the specialized needs of each individual customer has propelled its success and growth.

The surface disinfectant market is projected to be worth $1.2 billion by 2024, according to a new report.

The purpose of this program is to provide healthcare professionals with information about the Health Insurance Portability and Accountability Act (HIPAA), especially as it relates to protected health information.

DISINFECTION MARKET ANALYSIS

CE ARTICLE

OR Today (Vol. 20, Issue #5) May 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. ÂŠ 2020

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MAY 2020 | OR TODAY |

contents

PUBLISHER

features

John M. Krieg

john@mdpublishing.com

VICE PRESIDENT Kristin Leavoy

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EDITOR

SPOTLIGHT ON

John Wallace

Lindsey Jones, RN, BSN, CPN, CHPPN

editor@mdpublishing.com

ART DEPARTMENT Jonathan Riley Karlee Gower Amanda Purser

ACCOUNT EXECUTIVES Jayme McKelvey Megan Cabot

DIGITAL SERVICES

Win a Bath & Body Works gift card!

Stir-Fried Lamb with Eggplant and Scallions

OR TODAY CONTEST

Cindy Galindo

RECIPE OF THE MONTH

Kennedy Krieg Erin Register

CIRCULATION Lisa Lisle Jennifer Godwin

INDUSTRY INSIGHTS 10 News & Notes 20 Company Showcase: TBJ 23 CCI: The Potential of Microcredentials in Perioperative Nursing 24 IAHCSMM: Instrument Damage Often Begins in the Operating Room 26 Webinars: Attendees Applaud Live Sessions

29 Market Analysis: Disinfection Market Nears $1 Billion 30 Product Focus: Disinfection 36 CE Article: HIPAA and Confidentiality: Practice May Change, But Principles Endure

OUT OF THE OR

8 | OR TODAY | MAY 2020

ACCOUNTING Diane Costea

EDITORIAL BOARD Beyond Clean Sharon A. McNamara, Perioperative Consultant, OR Dx + Rx Solutions for Surgical Safety Julie Mower, Nurse Manager, Education Development, Competency and

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62 Index

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Hank Balch, President & Founder,

IN THE OR

48 Spotlight On 50 Fitness 53 Health 54 EQ Factor 57 Nutrition 58 Recipe 60 Pinboard

WEBINARS

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

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INDUSTRY INSIGHTS

news & notes

Study Uncovers Gap in Widely Accepted Practice for Safe Endoscope Drying A recent study published in the American Journal of Infection Control found that the practice of drying an endoscope for just 10 minutes prior to putting it into storage does not produce a dry, patient-ready endoscope. Drying is an essential part of endoscope reprocessing, and this study challenges the current industry standards around drying procedures. This information fundamentally shifts how health care facilities should approach their drying procedures. This is significant because 20 million gastrointestinal procedures are performed with an endoscope annually. The study, “Endoscope reprocessing: Comparison of drying effectiveness and microbial levels with an automated drying and storage cabinet with forced filtered air and a standard storage cabinet,” evaluated both dryness and microbial levels of endoscopes that had completed high-level disinfection and had been placed in an automated drying cabinet or a standard storage cabinet. The results of the study showed the automated drying cabinet (ENDODRY Cabinet, Cantel Medical), using instrument grade air, dried the inner lumens of

10 | OR TODAY | MAY 2020

the endoscopes in 60 minutes and the external endoscope surfaces in three hours. The study also showed that the automated cabinet was able to store the endoscopes for up to 31 days without an increase in microbial levels. The standard cabinet showed an inability to dry the scopes at 24 hours and allowed microbial growth throughout the study. “Although patient-to-patient infection transmission via endoscope is exceedingly low, there have been a number of high-profile outbreaks over the last decade, despite strict adherence to endoscope reprocessing guidelines,” states Darren Dahlin, director of clinical education at Cantel Medical. “We need to do our part in reducing infection risk by closing current gaps in reprocessing, specifically drying and storage. There is room for advancement in technology to assist the current state of endoscope reprocessing. Studies like this one are needed to show that the current standard of care is not ideal and that there are viable alternatives that can decrease risk and increase peace of mind.” Until this study, the accepted industry standard, supported by a

widely cited study from 1991, was a minimum dry time of 10 minutes. However, the same study showed the endoscopes weren’t entirely dry after 10 minutes. “While it can be tempting to opt for a shorter dry time in order to schedule more procedures, it puts the patient at a higher risk for infection,” said Cheri Ackert-Burr Ph.D., fellow for clinical practice at Cantel Medical. “Ten minutes begins the drying process, but hasn’t been shown to complete it. This study challenges the industry to put patient safety at the forefront.” Effective drying helps preserve the patient-ready condition of an endoscope after high-level disinfection because removing moisture as soon as possible helps prevent foreign body microbial growth. Any microbes that may remain on the endoscope can proliferate in a dark, wet environment. Drying is crucial when the endoscope is going to be stored because a dry environment does not support microbial growth and can help prevent infection. • For more information, visit www. relyondry.com.

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HealthStream Acquires NurseGrid HealthStream has acquired NurseGrid, a Portland, Oregon-based healthcare technology company. Through this acquisition, the company gains NurseGrid Mobile, the #1 rated and top downloaded app for nurses, and its corollary application for nurse managers, NurseGrid Enterprise. HealthStream’s focus has always been on improving the quality of health care through the development of the people who deliver care. There are approximately 3.1 million registered nurses in the U.S. – and nurses make up the largest audience across the HealthStream ecosystem. NurseGrid Mobile has an audience of over 260,000 nurses as monthly active users, which continues to grow virally. “NurseGrid has an incredibly active and engaged community of nurses who have made our app part of their routine,” said Rob MacNaughton, Chief Executive Officer, NurseGrid. “Much of NurseGrid’s growth, to date, has been word of mouth. Now, with HealthStream, we can expand the reach of NurseGrid Mobile and NurseGrid Enterprise by tapping into the HealthStream network.” NurseGrid Mobile is the #1 rated app for nurses with a 4.9-star rating and over 40,000 reviews in the Apple app store. NurseGrid Mobile is among the top downloaded apps for nurses and has a highly engaged audience of monthly active users, of which over 40 percent use the app daily (i.e. daily active users). NurseGrid Mobile was launched in 2015, is free to nurses and is available in the Apple and Android app stores. Nurses use NurseGrid Mobile to manage and share their schedules, swap shifts, communicate with one another, and to coordinate work and non-work activities. NurseGrid Mobile users can invite their colleagues to connect within the app. The NurseGrid Enterprise application helps health care managers more efficiently publish work schedules to their nursing staff, view and approve shift swaps and communicate with their teams. Given NurseGrid’s top rating by nurses and its viral user growth, HealthStream made an investment in NurseGrid in February 2019. The continued growth of nurses using NurseGrid Mobile, the development and release of NurseGrid Enterprise, and the opportunity to further engage and support such a large and growing audience of nurses across the HealthStream ecosystem contributed to the company’s decision to acquire NurseGrid. •

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INDUSTRY INSIGHTS

news & notes

Cenorin Disinfectors Receive Updated 510(K) Clearance Cenorin, a health care company providing solutions for infection control management and waste stream reduction, received an updated FDA 510(k) clearance on September 9, 2019 for the Cenorin 610 and 610HT Washer-Pasteurizer/High Level Disinfectors. These systems are designed to provide safe, efficient and effective automated cleaning and high-level disinfection using a full immersion pasteurization process. They are intended for reprocessing semi-critical and non-critical reusable medical devices such as those used in respiratory therapy, sleep labs (including CPAP accessories), anesthesia, intensive care departments, diagnostic labs, emergency departments and patient clinics. Independent worst-case and in-use testing has shown that the Cenorin 610 wash/pasteurization cycle achieves the 6-log reduction of all representative organisms that is required by FDA for high-level disinfection. “When using chemical disinfection methods for high-level disinfection, users must deal with toxicity risks for patients and workers in addition to the added costs,” said Drew Radford, president of Cenorin. “The Cenorin 610 and 610HT systems provide a cleaning and high-level disinfection option for heat-sensitive medical devices that is sustainable, safe and economical.” “The full immersion pasteurization cycle provides a sustainable high-level disinfection process without the need for HLD chemistries that may produce chemical waste effluent,” according to a press release. “In addition, reprocessing reusable devices can reduce the hospital waste stream by replacing many single-use devices.” “The process controls assure proper cycle completion,” the release states. “Specific safeguards are included in the design of the hardware and software to assist the user in safe use of these systems. The process record meets Joint Commission, AORN, IAHCSMM and APIC recommendations. The user interface notifies staff when system maintenance is required. In addition, staff safety and ergonomics are incorporated into design elements in these units.” •

MAY 2020 | OR TODAY |

INDUSTRY INSIGHTS

news & notes

PurpleSun Announces Strategic Partnership with APIC PurpleSun Inc. has announced a strategic partnership with the Association for Professionals in Infection Control and Epidemiology (APIC), the largest association for infection prevention and control (IPC) professionals. APIC’s infection preventionist (IP) members work to prevent healthcare-associated infections (HAIs) in health care facilities. An estimated 633,000 hospitalized patients get HAIs each year and 72,000 die during their hospital stay, according to the Centers for Disease Control and Prevention. The APIC Strategic Partner program establishes longterm relationships with industry partners united in the common goal of reducing the risk of infection. Partners play an important role in supporting many of the educational initiatives and services that make the APIC membership valuable to IPs on the frontlines in the fight against HAIs. “PurpleSun is pleased to partner with APIC to help prevent HAIs and expand education and resources for IPs,” said Luis F. Romo, CEO and founder of PurpleSun. “We share APIC’s patient safety mission and hope this partnership will help to strengthen APIC’s efforts to create a safer world through the prevention of infection.” Scientific studies have shown that certified IPs are better prepared to interpret evidence and act as champions for key infection prevention practices. Hospitals with IPC programs led by certified IPs reported significantly lower rates of MRSA bloodstream infections.

12 | OR TODAY | MAY 2020

“We are excited to welcome PurpleSun as an APIC Strategic Partner,” said APIC CEO Katrina Crist, MBA, CAE. “Together, APIC and PurpleSun will work to improve health care outcomes and advanced education and certification for IPC professionals.” PurpleSun is partnered with some of the largest health care systems in the U.S., and are on a mission to create the standard for light-based disinfection. PurpleSun treats equipment and patient rooms in 90-second cycles using proprietary FMUV Shadowless Delivery technology with 99.99% germicidal performance, for the purposes of point of care disinfection. PurpleSun’s solutions allow for hospital-wide application, with one of the only products not requiring evacuation of the room during use. With the fastest cycle times, the products can integrate seamlessly with hospital operations with no impact on turn-over time. As recently published in the American Journal of Infection Control (AJIC), a clinical trial demonstrated that PurpleSun FMUV was 96% effective in comparison to standard health care chemicals which were 38% effective for disinfection of hospital environments. As a data-driven organization, PurpleSun builds comprehensive and sustainable protocols for its customers that are expandable over time and can be monitored from the iOS app. Technology seminars are offered for continued education based on the latest research published and cited in AJIC and Association of periOperative Registered Nurses (AORN). •

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INDUSTRY INSIGHTS

May Brings National Nurses Week OR Today joins in celebrating National Nurses Week (May 6-12) this month. National Nurses Week is celebrated annually from May 6 through May 12, the birthday of Florence Nightingale, the founder of modern nursing. Special days recognized during the week include National Student Nurses Day on May 8; National School Nurse Day on May 8; and International Nurses Day on May 12. The World Health Organization (WHO) has declared 2020 as the International Year of the Nurse and the Midwife to mark the bicentenary of the birth of the founder of modern nursing, Florence Nightingale and to recognize the critical contribu-

tion both professions make to global health. Nurses and midwives play a vital role in providing health services. These are the people who devote their lives to caring for mothers and children; giving lifesaving immunizations and health advice; looking after older people and generally meeting everyday essential health needs. In many developing countries they are often the first and only point of care in their communities. The world needs 9 million more nurses and midwives if it is to achieve universal health coverage by 2030. OR Today magazine joins the World Health Organization in celebrating

news & notes

the 200th anniversary of Florence Nightingale’s birth and the Year of the Nurse in 2020. As part of the celebration, OR Today will feature perioperative professionals in a new contest! You could win a Bath & Body Works gift card! Every nurse is a leader! Please share a memory that illustrates a time when a nurse in your life or career served as a leader. This can be a peer, an experienced nurse who shared their wisdom, an educator or anyone from the profession. Help us shine the spotlight on these leaders while at the same time encouraging others to lead. Please share your story at ORToday.com/Contest. •

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INDUSTRY INSIGHTS

news & notes

Philips Launches HealthSuite System of Engagement with AI Capabilities Royal Philips has announced the HealthSuite System of Engagement, an integrated, modular set of standards-based capabilities that support the development of digital health propositions, including new capabilities for cloud-based managed AI workflow and DICOM interoperability. “While there are compelling examples of digitalization improving health care delivery, too often patients and care providers struggle within a complex, fragmented technology and data landscape that hampers the deployment of innovative health care services,” said Jeroen Tas, chief innovation & strategy officer, member of the executive committee Royal Philips. “The HealthSuite System of Engagement is at the core of Philips’ digital transformation. It’s a highly secured, modular set of capabilities that can liberate and integrate data from disparate systems and accelerate the development and deployment of digital propositions across the health continuum in a secure environment.” In contrast to many ‘systems of record,’ which are typically based on static, siloed files of patient information, the HealthSuite System of Engagement enables patients and all the staff they interact with to better manage the care experience and pathways. By taking a federated approach to data integration, HealthSuite System of Engagement supports health care providers in capturing the value of data from across their existing IT infrastructure, reducing complexity for health care professionals and opening new opportunities for care innovation. HealthSuite System of Engagement provides capabilities for Internet of things (IoT), identity and access management and HIPAA-compliant data management. Deployment models include hosting and operating health applications in the cloud, edge and on-premise. HealthSuite enables clinical and operational data to be federated and shared across systems and solutions from Philips and third parties within the health care enterprise. HealthSuite leverages this longitudinally federated data in its intelligence, dynamic workflow and user experience capabilities to allow health care providers to unlock the power of data in their Electronic Medical Records (EMRs) and other systems of record in care pathways, connecting users seamlessly with data to provide actionable insights. New capabilities include cloud-based storage and standards-based interoperability for Digital Imaging and Communication in Medicine (DICOM) data, in addition to native FHIR support. The new HealthSuite De-

14 | OR TODAY | MAY 2020

Identification Services automate the removal of personal and sensitive information from structured data in order to enable patient privacy when data is made available for data science research. The HealthSuite Clinical Data Lake is a new scalable micro-service that acts as a centralized big data repository for high-volume clinical data collection studies and includes controls to curate and manage data in a manner that addresses regulatory requirements. HealthSuite System of Engagement is powering a wide range of both Philips and third-party connected health care applications, including: Philips’ flagship Image-guided therapy platform Azurion, which allows clinicians to easily and confidently perform a wide range of routine and complex procedures, helping them to optimize interventional lab performance and provide superior care. Philips Care Orchestrator for sleep and respiratory therapy, a smart cloud-based application that connects homecare providers, physicians, and payers with patients quickly and easily to critical data across devices and locations. Philips Electronic Medical Records and Care Management (Tasy EMR), a comprehensive health care informatics solution that touches all areas of the health care environment, connecting the dots across clinical and non-clinical domains along the healthcare continuum. The Philips remote patient monitoring program (eCareCoordinator and eCareCompanion), which provides care teams with tools to remotely track the health of their patients at home, collaborate with the patients’ doctors and help detect problems before they lead to readmissions. •

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INDUSTRY INSIGHTS

news & notes

Diagnostic Errors Top ECRI’s 2020 Patient Safety Concerns ECRI, an independent nonprofit organization improving the safety, quality, and cost-effectiveness of care across all health care settings worldwide, today released its "Top 10 Patient Safety Concerns 2020", naming diagnostic errors and maternal health in the top two spots. The annual report helps organizations identify looming patient safety challenges across the continuum of care, and includes suggestions and resources for addressing them. The launch is in conjunction with Patient Safety Awareness Week, March 8-14. “Unsafe health care delivery harms millions of patients,” said Marcus Schabacker, MD, PhD, president and CEO, ECRI. “Our annual patient safety report provides a roadmap to help health care leaders know what goes wrong and how to prevent harm.” ECRI’s "Top 10 Patient Safety Concerns" relies on the analysis of more than 3.2 million patient safety events in its Patient Safety Organization reporting program, as well as the judgment and experience of its interdisciplinary patient safety and medication safety experts. This list identifies areas that are high priorities for a variety of reasons, such as new risks, existing concerns that are changing because of new technology or care delivery models, and persistent issues that need focused attention or pose new opportunities for intervention. ECRI’s list of patient safety concerns for 2020:

4. Responding to and Learning from Device Problems – Incidents involving medical devices or equipment can occur in any setting where they might be found, including aging services, physician and dental practices, and ambulatory surgery. 5. Device Cleaning, Disinfection, and Sterilization – Sterile processing failures can lead to surgical site infections, which have a 3% mortality rate and an associated annual cost of $3.3 billion. 6. Standardizing Safety across the System – Policies and education must align across care settings to ensure patient safety. 7. Patient Matching in the HER – Organizations should consistently use standard patient identifier conventions, attributes, and formats in all patient encounters. 8. Antimicrobial Stewardship – Overprescribing of antibiotics throughout all care settings contributes to antimicrobial resistance. 9. Overrides of Automated Dispensing Cabinets (ADC) – Overrides to remove medications before pharmacist review and approval lead to dangerous and deadly consequences for patients. 10. Fragmentation across Care Settings - Communication breakdowns result in readmissions, missed diagnoses, medication errors, delayed treatment, duplicative testing and procedures, and dissatisfaction.

1. Missed and Delayed Diagnoses – Diagnostic errors are very common. Missed and delayed diagnoses can result in patient suffering, adverse outcomes, and death. 2. Maternal Health across the Continuum – Approximately 700 women die from childbirth-related complications each year in the U.S. More than half of these deaths are preventable. 3. Early Recognition of Behavioral Health Needs – Stigmatization, fear, and inadequate resources can lead to negative outcomes when working with behavioral health patients.

The full "Top 10 Patient Safety Concerns" report provides detailed steps that organizations can take proactively to prevent adverse incidents. The executive brief version is available for public download at www.ecri. org/2020patientsafetytop10. In keeping with its mission of effective, evidence-based health care globally, ECRI launched a publicly available COVID-19 (Coronavirus) Outbreak Preparedness Center to help hospitals protect health care workers and patients as the threat of coronavirus rapidly spreads across the globe.

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INDUSTRY INSIGHTS

news & notes

Group One Uniform Apparel Program Unveiled Encompass Group announces Group One Staff Uniform Program, an apparel solution designed to reinforce a brand message, create caregiver role identity, deliver style and quality for staff, and provide safety and comfort for patients. Many facilities are adopting a branded, color-coded staff uniform program to help customers understand the role of each staff member. Encompass offers a wide range of uniform fabrics, colors and sizes, including lab coats and health

16 | OR TODAY | MAY 2020

care kitchen apparel. “The right apparel can improve both staff and patient satisfaction,” said Joe Przepiorka, Encompass Group vice president, marketing. “We offer a branded, color-coded uniform program supported by management tools and reports, program tracking options, multiple-facility shipping, and optional custom embroidery for logos and personalization. In staff uniforms and apparel, Encompass delivers everything you need for your facility.” •

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TREAT YOUR FEET

CEO Richard Twomey Leaving Mölnlycke Richard Twomey, president and CEO of Mölnlycke, is leaving Mölnlycke after six years with the organization. “Richard has with his deep knowledge and experience within the medical technology industry developed Mölnlycke into an even stronger company in its field. During his time the company has made significant progress, especially in emerging markets. It has also made big strides in innovation and the establishment of solid clinical evidence and health economics related to our products. Going forward, the strategy remains the same as we are now speeding up the execution phase,” says Chairman Gunnar Brock. “I am proud that I have been able to contribute to the success of Mölnlycke. The company has a solid foundation with a strong product portfolio, very dedicated employees and an owner committed to long term investment in the business,” Twomey says. The search for a new president and CEO is underway. Twomey will maintain his current position until he has assisted in the introduction of his successor. •

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TBJ Incorporated

Q: Can you highlight any recent changes to the company, inventory, services, etc.? Campbell: This past September, TBJ purchased Geddis Inc. – a small manufacturing company based in Florida that designed and developed a product called the SurgiSonic 1211X that features a patented dual hook-up method for pre-cleaning da Vinci instruments utilizing a filtered, independent flushing system combined with ultrasonic action. The unit is independently tested for cleaning effectiveness and exceeded AAMI TIR 30. Because a tight seal on robotic instru-

ments separates the distal jaw/pulley end from the proximal shaft/control box end, the patented dual hook-up method was created for independently cleaning both the distal and the proximal segmented areas of the da Vinci robotic instrument at the same time. Three da Vinci robotic instruments can be cleaned at the same time using this dual hook-up-method. The system is also ideal for other types of non-robotic submersible tubular instruments as six instruments can be pre-cleaned simultaneously. This is available in an economical counter top unit or floor standing unit with automatic water filling and automatic drain control.

Q: What is TBJ’s mission statement or what is most important to you about the way you do business? Campbell: Our goal is to ALWAYS have a satisfied customer that is happy with their TBJ product. We go to great lengths to make sure the customer is happy with the equipment that they purchased from us and also that it is meeting their needs … not only when it is under warranty but for as long as they have the equipment in use. For more information, visit tbjinc.com.

TOP: TBJ work sinks are customized for pre-cleaning surgical instruments and endoscopes.

TBJ offers a complete line of specialty stainless steel casework and equipment designed for the OR and SPD areas.

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BELOW: TBJ’s health care product line consists of highly specialized equipment for use in hospitals in areas such as sterile processing departments, GI endoscopy labs, operating rooms, and more.

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CCI news & notes

The Potential of Microcredentials in Perioperative Nursing By Dawn Whiteside, MSN, RN, CNOR, NPD-BC, RNFA, and James Stobinski, PhD, RN, CNOR, CSSM(E) s mentioned in previous columns, CCI is heavily engaged in the professional literature of perioperative nursing and the credentialing industry. Recently, we came upon two relevant blog posts. The first post is by Nicola Heath on microcredentials and the second is by Liz SebagMontefiore on the related subject of upskilling. We would like to expand on these topics and speak to the application of our profession.

Heath tells us that microcredentials are a new model of learning that have the potential to address the need for “ … upskilling and retraining in the digital economy.” (2020). She describes microcredentials as, “ … chunks of certified learning offered in short courses.” Microcredentials can be used to validate competency in a narrow skill set using diverse assessment methods and learning activities. The reader should not construe the rise of microcredentials as a substitute for well-established credentials such as the CNOR certification or the BSN degree, but rather as a supplement or enhancement to these achievements. Sebag-Montefiore describes upskilling as, “ … the process of teaching your employees new skills … and new jobs which require specialized skillsets … ” Upskilling can fill vacancies and creates opportunities for employees. The OR setting is replete with new technology and workflows that generate a need for new skillsets. The combination of the need for upskilling and the utility of microcredentials can be a most opWWW.ORTODAY.COM

portune match and we believe each has application in the perioperative setting. To meet these salient needs CCI recently launched its Strategic Management microcredential, covering one subject from the CSSM certification. This credential is offered to a wide audience, including health care professionals who are not currently holding a certification with CCI. Learners must complete multiple activities that include a SWOT analysis, strategic planning exercises and reflective learning activities in our Learning Management System (LMS). Completion is documented with a digital badge, another new offering by CCI. The digital badge is on a certificate that may be shared directly to social media. CCI believes the new model of learning inherent in microcredentials and the use of an LMS has great potential and we have begun efforts to develop materials pertinent to perioperative nursing. The flexibility of microcredentials and the need for upskilling are an opportunity to address succession planning needs. We also believe that the microcredential model can be integrated with credentialing and certification processes to provide meaningful, ongoing professional development for perioperative nurses. We see these offerings as fulfilling eligibility criteria for certification testing, satisfying recertification requirements and as standalone credentials. We are working closely with a diverse group of for profit and not-for-profit sponsors to develop additional microcredentials in the coming year. It is our belief that our profession should take ownership of the professional development needs for upskilling

and retraining in a time of rapid change. We concur with the sentiment expressed by both Heath and Sebag-Montefiore that formal degrees granted years ago may not meet the current continuous professional development needs of perioperative nurses. Microcredentials allow for focused learning consistent with a philosophy of lifelong learning; a concept expressed in the Future of Nursing report (2010). These new methods of learning can enhance existing human capital and dovetail nicely with succession planning initiatives. CCI is encouraged by the materials submitted thus far by the early adopters to our first microcredential offering. The documentation and evidence of learning far exceeds what is currently seen in continuing education courses. We will have a large presence at the 2020 OR Today Live conference as we are based in Denver. CCI welcomes the opportunity to meet with you and discuss your ongoing professional development needs which may include certification and microcredentials.

References Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Accessed March 5th, 2020 from: http://books.nap. edu/openbook.php?record_id=12956&page=R1 Heath, N. (2020). [blog post]. It’s a small world: Skilling up with micro-credentials. Accessed February 27th 2020 at: https://www.intheblack. com/articles/2020/02/01/skilling-up-withmicrocredentials Sebag-Montefiore, L. (2019). [blog post]. Upskilling the Workforce. Accessed February 27th, 2020 at: https://theundercoverrecruiter.com/ upskilling-the-workforce/ MAY 2020 | OR TODAY |

INDUSTRY INSIGHTS

IAHCSMM

Instrument Damage Often Begins in the Operating Room By Julie E. Williamson onsistent, on-time availability of clean, sterile, well-functioning instrumentation is essential for safe, high-quality surgical outcomes. Although sterile processing (SP) professionals bear much of that responsibility, it’s essential that surgical services professionals recognize how improper care and handling of instrumentation in the surgical suite can lead to costly device damage and, sometimes, the need for premature instrument replacement.

What follows are some of the most common instrument care and handling mistakes that take place during and after surgical procedures, along with recommendations for preventing them.

Using instruments for the wrong purpose Instruments used for purposes other than which they were designed can lead to costly damage and dangerous malfunction. Hemostats, scissors and needle holders are several commonly misused devices. Hemostats are designed to clamp blood vessels, grasp and secure tissue during surgery, or more deeply explore areas of a surgical site to improve the surgeon’s visualization; however, they are sometimes improperly used to clamp tubes. Only a tube occluding clamp should be used for this function. Hemostats have finer jaws than a tube clamp and hemostats’ box lock is also not as strong as tube clamps; therefore, using hemostats for this purpose can lead to cracks in the box lock. Also, serrations on hemostats can damage tubing.1 A pair of fine scissors, which are designed to cut fine human tissue, should never be used to cut bandages, suture, gauze or other materials; doing so can dull the tip and place unnecessary stress on the hinge area. A dull blade can tear tissue. Needle holders are designed to hold the needle to close an incision, but surgeons may incorrectly use them to pull and twist wire (this underscores the importance of ensuring needle-nosed pliers, which are designed for such a purpose, are included in the set). Needle holders should never be

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used in place of pliers because irreparable cracks can occur.2

Not performing appropriate point-of-use instrument care Post-procedure instrument care begins at the point of use, not in the sterile processing’s decontamination area. Dried blood and bioburden make cleaning far more challenging and can contribute to biofilm formation, which requires more aggressive cleaning processes to remove. Scratches and other damage can occur when aggressive cleaning is required, which makes future cleaning and sterilization processes more difficult as well.3 Blood and bioburden that’s allowed to dry and harden onto instrument surfaces can also lead to staining, rusting and pitting. During and following the procedure, gross blood and bioburden should be gently wiped from each device with a sponge moistened with sterile water and kept moist with a dedicated moisturizing spray or enzymatic cleaner (in the absence of such products, instruments can be covered with a lint-free, water-moistened towel). Note: Before applying any point-of-use treatment product, be sure to check the instrument manufacturers’ instructions for use to ensure compatibility. Saline should never be used because it can lead to corrosion. Instruments should be transported to the decontamination area for proper cleaning and high-level disinfection or sterilization as soon as possible following the conclusion of the procedure. WWW.ORTODAY.COM

INDUSTRY INSIGHTS

IAHCSMM

Failing to transport delicate devices in the proper container It’s not uncommon for SP professionals to receive instruments from the OR in a state that can cause damage, such as heavier instruments being piled on top of delicate instruments. Devices with fine tips should be separated from regular instruments to prevent those tips from becoming bent, broken or otherwise damaged during transport. Basins or trays containing instruments should never be stacked on top of unprotected instruments (doing so can not only damage the unprotected devices, it can also create an unlevel surface that makes it more likely for instruments to shift or fall during transport. This increases the odds for instrument damage and can jeopardize employee safety). Endoscopes are sophisticated, expensive pieces of equipment and require special care and handling. Endoscopes should be transported in their own protective containers, away from sharps and other instruments that can damage the delicate lens and other components of the endoscope. The endoscope’s distal end is highly prone to damage, which often occurs during impact with another surface (such as when the device is dropped or banged against other instruments, equipment, etc.). The endoscope’s cord must also not be too tightly coiled during transport, and the device should be placed in its container with knobs facing upright and in the unlocked position.

References 1. Schultz R. Hemostats 101: Understanding One of the Most Common Surgical Instruments. PROCESS. Nov/Dec 2019. International Association of Healthcare Central Service Material Management. Chicago, IL. 2. Schultz R. Needle Holders: Proper Care and Inspection Crucial to Their Performance. PROCESS. Sept/Oct 2019. International Association of Healthcare Central Service Material Management. Chicago, IL. 3. International Association of Healthcare Central Service Materiel Management. Instrument Resource Manual, First Ed. 2018, pp. 28-29. Chicago, IL.

IAHCSMM Cancels Conference, Offers Educational Opportunities On March 13, in response to COVID-19 (Coronavirus) concerns and associated recommendations from the World Health Organization, the Centers for Disease Control and Prevention, and state and federal officials, the international Association of Healthcare Central Service Materiel Management (IAHCSMM) made the difficult, but prudent decision to cancel its 2020 Annual Conference & Expo, which was to have taken place in Chicago from April 25-29. Because continuing education of health care professionals is an essential contributor to the delivery of safe, high-quality patient care, IAHCSMM wants to remind all sterile processing (SP) professionals to explore the many other valuable learning opportunities that exist. IAHCSMM’s website (www.iahcsmm.org) alone offers a wide range of educational opportunities for all SP professionals, including access to lesson plans, webinars, podcasts and staff training videos. Now is also a perfect time to log into the IAHCSMM member portal to access current and archived issues of PROCESS magazine, and archived editions of Central Source, both of which offer valuable opportunities to brush up on knowledge and educate new and existing staff members. Social media can also be an educational ally, with standards-based advice, recommendations and best practices available at a click of a button (IAHCSMM posts weekly expert Q&As on its social media pages, for example, along with other pertinent news and articles and information links on Facebook, LinkedIn and Twitter). We also encourage SP professionals to tap their vendor partners for their own unique educational offerings as well. Even if in-person inservices are curtailed, many vendors offer exceptional online educational opportunities to help keep the SP team sharp and ready to tackle any challenges that may come their way (IAHCSMM’s Resource Links section on the website directs users to some vendors’ current educational offerings). Last, but certainly not least, IAHCSMM had a variety of timely educational topics ready to be presented at the Annual Conference (covering decontamination, process improvements, endoscopes, departmental compliance and much more). Because we believe this is important information and was likely a driving factor in registering for the conference, IAHCSMM is actively researching other educational opportunities – including a virtual conference experience – to address some of these topics. More details will be provided as they unfold. – Julie Williamson, IAHCSMM Communications Director

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MAY 2020 | OR TODAY |

INDUSTRY INSIGHTS

WEBINAR SERIES

news & notes webinars

Attendees Applaud Live Sessions Staff report he 2020 OR Today webinar series continues to be wildly successful. The informative sessions have recorded almost 1,500 registrations through early March with an average of 222 attendees per webinar.

Proper Point-of-Use Treatment Webinar OR Today’s presentation of the webinar “The Importance of Proper Point-of-Use Treatment and Transport” received positive feedback from attendees. The recent Healthmark-sponsored webinar attracted almost 300 attendees. It was eligible for one (1) continuing education (CE) hour by the State of California Board of Registered Nursing and eligible for 1 credit for IAHCSMM and CBSPD. The webinar featured Kevin Anderson, clinical education coordinator for Healthmark Industries. He discussed the proper techniques for point-of-use treatment, transportation systems and labeling. The presentation defined the current requirements for proper point-of-use treatment, also known as pre cleaning for medical devices, including transportation from the procedure room to the sterile processing area. In addition to IFU requirements, current standards and guideline recommendations for this process were reviewed along with information from the latest published studies and adverse event reports. Anderson also defined the best practices for point-of-use treatment, including any inspection steps and outlined how to implement these practices in your facility. Attendees gave the webinar a 4.3 rating on a 5-point scale with 5 being the best possible score. They also praised the session in a post-webinar survey. “Thank you so much for the amazing information you shared in yesterday’s webinar. The speaker was superb and the content was most helpful. I appreciated all the download material. I am so glad I attended,” said A. Garg, surgical tech/inst. professor. “The information that was presented was very valuable to myself and the team. Watching the webinar was my director of OR operations, sterile processing supervisor and my administrative assistant. I believe that everyone took away something valuable to look at within our organization,” Service Line Administrator A. Francart said. “The webinars provided by OR Today are great at not only refreshing sterile processing staff but bringing forth new ideas and concepts for leadership to be aware of and understand,” SPD Quality Specialist A. Bredekamp said. “The webinars help me get relevant information that is presented in a concise manner. The one hour time frame is perfect

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“ I find the information and knowledge that I gain from attending OR Today’s webinars keeps me up-to-date with current and best practice standards. I look forward to attending as often as I can, there is always something relevant for me to learn." – K. Mentzer, supervisor for me, as it doesn’t take so much time away from my other work,” shared A. Cuel, OR clinical development specialist. “The speaker was excellent, well-spoken and knowledgeable. The PowerPoint presentation was helpful by showing pictures to illustrate the issues that arise with the lack of point-of-use cleaning. I would recommend webinars put on by OR Today for anyone in acute care in the health care industry,” Supervisor Medical Device Processing L. Oxner said. “OR Today’s webinar on point-of-use treatment and transport of OR instrumentation could not have been emphasized more. The staff on both ends (the OR and SPD) need to know and understand the what, how, when and, most of all, the why of doing this. This is another aspect of surgical conscience. We owe it to our patients,” said M. Falsis-Mittelbuscher, CN II. “I find the information and knowledge that I gain from attending OR Today’s webinars keeps me up to date with current and best practice standards. I always find a tidbit that I wasn’t aware of, affirmation that the issues we are experiencing are the same everywhere, and occasionally can share what our successes have been during a similar circumstance. I look forward to attending as often as I can, there is always something relevant for me to learn,” Supervisor K. Mentzer said.

What Are We Brining Into the OR? The February 20 OR Today webinar sponsored by RepScrubs was described as “very interesting” and “eye-opening” by more than one attendee. The session “OR Food for Thought – LITERALLY! What Are We Bringing Into Our ORs and Why?” was presented by Dr. John Kutz, FACS, Medical Advisor at RepScrubs, and was eligible for one (1) continuing education (CE) hour by the State of California Board of Registered Nursing. Kutz introduced attendees to the culture in a modern OR, how it came to be, what can’t happen and what perioperaWWW.ORTODAY.COM

tive professionals need to do correct the status quo and restore the sanctity of the OR. About 200 people attended the live presentation. A recording of the webinar is online. Attendees gave the webinar high marks with a rating of 4 on a 5-point scale with 5 being the best possible score. They also shared positive feedback in a post-webinar survey. “I thoroughly enjoyed the webinar with Dr. John Kutz. Hopefully, more OR staff and surgeons will come to realize the importance of keeping OR suites clean and free of unnecessary items in the ORs,” said A. Cuel, OR clinical development specialist. “What we bring to our ORs was very interesting and genuine. These items that are coming into the OR pose a huge risk of infection without anyone thinking about it. This was an excellent topic and highly informative,” said D. Robbins, infection preventionist. “This was a very interesting webinar and I’m glad I attended. It opened my eyes to issues in the OR which can relate to my workplace environment. These webinars are very useful and interesting,” said M. Mortensen, CBET. “This was an eye-opening webinar for me as a vendor who spends lots of time at the hospital for my role. I better realize the importance as a vendor to read hospital protocol, rules and guidance before arriving on site. Patient health and safety needs to be at the forefront of everything,” said C. Mello-Blonay, senior manager, facial protection. “One of the best presentations I’ve seen in a long time,” said C. Wyatt, director of HTM.

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For more information about the OR Today webinar series, including recordings of previous webinars and registration for upcoming sessions, visit ORToday.com and click on the “Webinars” tab. Thank you to our sponsor:

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MAY 2020 | OR TODAY |

ProFormance™ Cleaning Verification Clearly Visible, Easy to Interpret, Objective Tests of Cleaning Methods

SonoCheck™ When the ultrasonic cleaner is supplying suﬃcient energy and condi�ons are correct, SonoCheck™ will change color. Problems such as insuﬃcient energy, overloading, water level, improper temperature and degassing will increase the �me needed for the color change. In the case of major problems the SonoCheck™ will not change color at all.

TOSI® Reveal the hidden areas of instruments with the TOSI® washer test, the easy to use blood soil device that directly correlates to the cleaning challenge of surgical instruments. TOSI® is the ﬁrst device to provide a consistent, repeatable, and reliable method for evalua�ng the cleaning eﬀec�veness of the automated instrument washer.

LumCheck™ The LumCheck™ is designed as an independent check on the cleaning performance of pulse-ﬂow lumen washers. Embedded on the stainless steel plate is a specially formulated blood soil which includes the toughest components of blood to clean.

FlexiCheck™ This kit simulates a flexible endoscope channel to challenge the cleaning efficiency of endoscope washers with channel irriga�on apparatus. A clear flexible tube is a�ached to a lumen device with a test coupon placed inside; the en�re device is hooked up to the irriga�on port of the endoscope washer.

HemoCheck™/ProChek-II™ Go beyond what you can see with all-in-one detec�on kits for blood or protein residue. HemoCheck™ is simple to interpret and indicates blood residue down to 0.1μg. The ProChek-II™ measures for residual protein on surfaces down to 0.1μg.

Healthmark Industries Co. | hmark.com | 800.521.6224 | healthmark@hmark.com

IN THE OR

market analysis

Disinfection Market Nears $1 Billion Staff report he surface disinfectant market is projected to be worth $1.2 billion by 2024, according to a new report from MarketsandMarkets.com.

The report â&#x20AC;&#x153;Surface Disinfectant Market by Composition (Quaternary Ammonium, Alcohols, Chlorine, Hydrogen Peroxide), Type (Liquids, Sprays, Wipes), Application (In-house, Instrument), End User (Hospital, Diagnostic, Research Labs) - Global Forecast to 2024,â&#x20AC;? explores the global surface disinfectants market. It projects the market to grow at a compound annual growth rate (CAGR) of 8.4% from 2019 to 2024. This indicates that the market will grow from $837 million in 2019 to $1.2 billion in 2024. The report explains that the growth of this market is majorly driven by the increasing prevalence of hospitalacquired infections (HAIs) globally, the presence of stringent regulations for the use of surface disinfectants (in hospitals, diagnostic laboratories, pharmaceutical and biotechnology companies and research laboratories) as well as by advancements in surface disinfectants. WWW.ORTODAY.COM

On the basis of composition, the surface disinfectants market is segmented into alcohols, chlorine compounds, quaternary ammonium compounds, hydrogen peroxide, peracetic acid and other compositions. The alcohols segment is expected to account for the largest market share. The high use of alcohols on hard surfaces in hospitals and laboratories is driving the growth of this segment. Other segments, such as hydrogen peroxide and peracetic acid are expected to have higher growth rates due to their growing acceptance in surface disinfectant formulations. On the basis of type, the surface disinfectants market is segmented into liquids, wipes and sprays. The liquids segment is expected to account for the largest market share. This can primarily be attributed to the wide usage of these disinfectants, especially in emerging and underdeveloped countries, due to their low cost. By end user, the surface disinfectants market is segmented into hospital settings, diagnostic laboratories, pharmaceutical and biotechnology companies and research laboratories. Hospital settings are expected to

account for the largest share of the market. The large share of this segment can be attributed to factors, such as the high prevalence of infections in hospitals, the increase in hospital reimbursements for surgeries performed in hospitals and growing patient volume in these health care settings. The surface disinfectants market, by application, is segmented into in-house surfaces, instrument disinfection and other applications. The in-house surfaces segment is expected to account for the largest share of the surface disinfectants market. The large share of this segment can primarily be attributed to the large volume of disinfectants required to clean in-house surfaces in health care settings. Based on region, the surface disinfectant market is segmented into North America, Europe, the Asia Pacific, Latin America, and the Middle East and Africa. North America is projected to command the largest share of the surface disinfectants market. The large share of this market segment can be attributed to the high prevalence of HAIs and the presence of stringent infection control regulations in the region. MAY 2020 | OR TODAY |

IN THE OR

product focus

CenTrak

31-Day/Single Use Patient Tags CenTrak’s 31-day and single-use patient tags offer an efficient approach to patient locating and infection control in operating rooms and other clinical environments. The 31-day tag has a waterproof design, allowing for complete submersion/disinfection before reuse, while the single-use tag is affixed to one person before it’s discarded, reducing the risk of infection between patients. These tags come at a fraction of the cost of more permanent options and support improved capacity management, workflow automation and enhanced patient safety. Additional CenTrak infection control solutions include differential air pressure monitoring, hand hygiene compliance monitoring and specialized asset tags for medical scope management. •

Ecolab

OxyCide Daily Disinfectant Cleaner OxyCide Daily Disinfectant Cleaner is an EPA-registered one-step disinfectant for use in hospitals that is effective against Clostridioides difficile spores, Candida auris and a broad spectrum of 32 other organisms. It meets the EPA’s criteria for claims against emerging viral pathogens and therefore can be used against COVID-19 when used in accordance with directions for use for the supporting virus, Norovirus (Feline calicivirus surrogate).1 Its non-bleach formula is compatible with a wide range of materials, is designed for daily use on surfaces in the operating room, patient room and other common areas in the health care setting, and helps standardize and simplify your cleaning process for improved operational efficiency. • 1. Environmental Protection Agency, Emerging Viral Pathogen Guidance for Antimicrobial Pesticides. www.epa.gov/pesticide-registration/emerging-viral-pathogen-guidance-antimicrobial-pesticides

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IN THE OR

product focus

HALYARD and BELINTRA SMART-FOLD Sterisystem

HEALTHMARK TOSI

TOSI is the first device to provide a consistent, repeatable and reliable method for evaluating the cleaning effectiveness of the automated instrument washer. This is possible because the blood soil is manufactured to exacting specifications each and every time. When metered onto the stainless steel plate, the TOSI is completely analogous to a stainless steel instrument soiled with dried blood. Placed in the see-through plastic holder, the challenge is identical to the areas of instruments typically hidden from view (i.e., box locks). The routine use of this test will help insure that your instrument washer is performing at a consistent level, enhancing the routine visual inspection of instruments. â&#x20AC;˘

The SMART-FOLD Sterisystem is a unique system that combines Halyard SMARTFOLD Sterilization Wrap with Belintra's storage and transport system. Together, the system can reduce the risk of tears, cuts and holes in wrapped instrument trays during handling, transport and sterile storage until use in the OR. Its stainless-steel instrument trays and transport shelves enhance organization and eliminate the need for stacking. Additionally, the system reduces touchpoints to two, in line with the AAMI standard 79 guideline that recommends as few as possible. â&#x20AC;˘

For more information, visit www.hmark.com.

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MAY 2020 | OR TODAY |

IN THE OR

product focus

Medline

ERASE Pathogens Operating Room Surface Disinfection System

Palmero Healthcare DisCide Ultra Surface Disinfectant

The Medline ERASE Pathogens Operating Room Surface Disinfection System combines products, process training, and outcomes reporting to help keep the environment safe in health care. ERASE Pathogens features Clean by Sequence Microfiber Booklets, which have icons of the AORN required surfaces on each page of the microfiber booklet. There is one booklet for surfaces around the bed, forcing the “top to bottom” cleaning order and a gray booklet for all anesthesia-related surfaces. The division of booklets by color optimizes a “team cleaning” approach typically found in hospital rooms by making it clear who is cleaning to ensure that all required surfaces are cleaned while reducing cross contamination by assigning fresh pages to each new surface. •

With intermediate level DisCide Ultra, surface disinfectant and decontaminant cleaner, you can accelerate the way you disinfect clinical settings. In just 60 seconds, DisCide Ultra is effective against TB, viruses (HBV, HCV, RSV, HIV-1), bacteria (MRSA, VRE, E. coli) and fungi (C. albicans). Specifically formulated to resist evaporation, it’s non-corrosive, non-staining and leaves no residue. Plus, it meets OSHA’s blood-borne pathogen standard. Ready-to-use for the ultimate in convenience, DisCide Ultra is available in identical formulations in both spray and towelette formats to ensure efficacy when liquid and towelettes are used in tandem. DisCide to be sure with fast acting DisCide Ultra. •

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RUHOF

Biocide Detergent Disinfectant Pump Spray

IN THE OR

product focus

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

TBJ Inc.

SurgiSonic 1211X TBJ’s SurgiSonic 1211X features a patented dual hook-up method for pre-cleaning da Vinci instruments utilizing a filtered, independent flushing system combined with ultrasonic action. The unit is independently tested for cleaning effectiveness and exceeds AAMI TIR 30. Three instruments can be pre-cleaned simultaneously. The system is also ideal for other types of non-robotic submersible tubular instruments as six instruments can be pre-cleaned simultaneously. It is available in an economical counter top unit or floor standing unit with automatic water filling and automatic drain control. • For more information, visit www.tbjinc.com.

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MAY 2020 | OR TODAY |

IN THE OR

product focus

Clorox Healthcare

Hydrogen Peroxide Cleaner Disinfectant Every minute counts in the OR. That’s why hospitals turn to the Clorox Healthcare Hydrogen Peroxide Cleaner Disinfectant portfolio of wipes and liquids. One-minute contact times against over 40 pathogens speed up turnover times. Strong cleaning power against blood stains and other soils can translate into higher cleaning compliance rates, as demonstrated in an AJIC clinical study.† • For more information, visit CloroxHealthcare.com. †Wiemken TL, Curran DR, Kelley RR, Pacholski EB, Carrico RM, Peyrani P, Ramirez JA. Evaluation of the effectiveness of improved hydrogen peroxide in the operating room. American Journal of Infection Control, 2014; 42:1004-5.

HealthSight Clinical Advisor BD HealthSight Clinical Advisor is a new functionality within the BD HealthSight connected medication management platform that aggregates disparate patient data to provide clinicians with the ability to receive near real-time medication stewardship alerts within the pharmacy workflow. These actionable alerts are delivered within the connected medication management process to help health care providers prevent not only the administration of inappropriate antibiotics, but also the potential waste of resources associated with compounding and preparing unnecessary medication for delivery. Clinical stewardship programs are also supported through customized dashboards, robust reports and the ability to automate the submission of antimicrobial utilization data for regulatory reporting. •

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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

CE513

IN THE OR

continuing education

HIPAA and Confidentiality: Practice May Change, But Principles Endure By Julie Smith Jonson, JD, BSN, RN ou will often hear the term “HIPAA” with a variety of meanings depending on the context. The term comes from the Health Insurance Portability and Accountability Act, federal legislation enacted in 1996 and revised since then. HIPAA can refer to guidelines that protect your ability to maintain your health insurance as you move from job to job or place to place (“portability”).1 HIPAA can also refer to efforts to simplify the administration and improve the efficiency and effectiveness of health insurance.2 These efforts include the creation of national standards for diagnostic terms, insurance forms, and provider identification. Perhaps the most common use of the term for healthcare professionals, however, involves protecting the confidentiality and privacy of healthcare information.3,4

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In this course, you will learn about parts of HIPAA, especially as they concern nursing and other disciplines and the protection of healthcare information. Because you play a key role in the production of healthcare information, you play a key role in its protection.

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

HIPAA Basics HIPAA legislation on the portability of health insurance continues to evolve. The U.S. Department of Labor maintains a website with advice for consumers and news about the status of this part of the law. You may be interested in learning more about these issues as a consumer yourself or as an advocate for a patient or client. Additionally, the government maintains a website that helps explain consumer rights and protections under the Affordable Care Act, including how to help maintain existing health coverage during events such as losing or changing jobs, pregnancy, moving, or divorce.5 The provisions of HIPAA that per-

Goal and objectives The purpose of this program is to provide healthcare professionals with information about the Health Insurance Portability and Accountability Act (HIPAA), especially as it relates to protected health information. After studying the information presented here, you will be able to: •

Describe the intent of HIPAA.

•

Implement professional practices that protect patients’ privacy.

•

Incorporate practices that protect security of electronic protected health information.

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continuing education

tain to administration of health insurance fall into three main categories: administrative simplification, protection of privacy and security.

Administrative Simplification One goal of HIPAA is the simplification of the paperwork associated with health insurance reimbursement. Formerly, the wide variety of health insurance forms, codes and standards contributed to confusion and delay. The goal is to improve the delivery of healthcare in general and to reduce the expense of complex and confusing payment systems by encouraging the use of electronic media for transmission of certain patient administrative data.6 A goal of this part of HIPAA is to create a universal insurance claim form, for example.2 While these standards are vital to HIPAA, they generally do not play a direct role in the work of the staff clinician. However, you may hear more about these regulations if you are involved in case management or billing practices. Experts in health information services (medical records) must become familiar with this part of HIPAA.

Protection of Privacy HIPAA establishes national privacy standards to guide the actions of you as an individual and of the healthcare institutions, or “covered entities,” where you may work. The privacy rule applies only to covered entities, which are health plans, healthcare WWW.ORTODAY.COM

clearinghouses, healthcare providers and their “business associates” who electronically transmit and maintain health information for billing or other purposes.7 In discussing privacy, HIPAA uses the term “protected health information” (PHI). The term refers to any information related to the healthcare of an individual as well as any demographic information (e.g., address, birth date, Social Security number). How and when to share a patient’s protected health information constitutes the main focus of these guidelines.3 Since 2003, all covered entities have been obligated to develop and distribute a document called “notice of privacy practices” (NPP). “Covered entities are required to provide a notice in plain language that describes: How the covered entity may use and disclose protected health information about an individual. The individual’s rights with respect to the information and how the individual may exercise these rights, including how the individual may complain to the covered entity. The covered entity’s legal duties with respect to the information, including a statement that the covered entity is required by law to maintain the privacy of protected health information. Whom individuals can contact for more information about the covered entity’s privacy policies.”3 When a patient first receives

services from a covered entity, they receive a copy of the provider’s NPP, and the provider must make a good faith effort to obtain an acknowledgement of receipt from the patient. Furthermore, the provider must prominently post and make available its notice on any website it maintains that offers information about its customer services or benefits. The notice must contain an effective date and must be revised and redistributed whenever a material change in the provider’s privacy practices occurs.3 Covered entities must ensure understating of each of the following issues as they pertain to the HIPAA Privacy Rule.3 Access to medical records. HIPAA protects patients’ rights to request access to and copies of their medical records, and a facility must clearly outline in the NPP their process for providing access and copies. A facility must act on any request no later than 30 days of the request and may deny access only under certain conditions and circumstances. Patients who receive access may obtain copies of their records in the form and format of their choice, including electronic means. Amendments to medical records. Patients have the right to request a change in their medical records if they believe something is wrong or missing. Information on procedures, timelines and management resources are included in the NPP. A healthcare facility is not obligated to agree to a request for a change, but the covered entity is obligated to consider the request, follow prescribed timeframes and processes, and notify the patient of the final decision. In addition, the patient must be informed of their rights subsequent to the denial, including the right to have their disagreement added to the record.3 Restrictions on the use of proMAY 2020 | OR TODAY |

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continuing education tected health information. HIPAA defines the right of patients to restrict the use of their protected health information as long as the restriction does not interfere with activities related to treatment, payment or operations. Access to an accounting. Patients have a right to know who has been given access to their PHI up to six years prior to the date when they request that information. Healthcare facilities must be able to produce, within 60 days of the request, a list of people, companies, research entities or agencies that have received PHI. In addition, the facility must provide the nature of the information shared and the purpose for such disclosure. If the disclosure occurred to implement treatment, to collect payment or otherwise maintain operations, or to comply with law enforcement, intelligence, or national security requirements, the accounting need not include those transactions. Business associates. HIPAA rules require that any external “business associate” of the covered entity who performs services involving access to or use of PHI must enter into an agreement with the covered entity to ensure that the business associate will adequately safeguard the covered entity’s PHI. Business associates are directly liable for adherence to HIPAA rules and are subject to civil and criminal penalties for failure to comply. Confidential communications. HIPAA defines the patient’s right to request an alternative means or location for receiving communications or PHI by means other than the covered entity typically employs, such as through a designed address or phone number. Similarly, an individual may request that the provider send communications about PHI in such a way that the

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sender remains anonymous and the information remains protected. For example, a patient may request that mailed information be placed in envelopes without a return address, or in closed envelopes instead of on postcards. Complaints about violations of privacy. The NPP explains to patients how to file complaints about possible violations of privacy. The NPP must designate a contact person or officer who is responsible for receiving complaints and who can provide more information to the patient. The notice names the facility’s privacy officer and offers guidance about how to contact the officer and what to expect in response. HIPAA requires covered entities to establish a procedure for receiving, assessing and responding to complaints about violations of patient confidentiality. The notice also includes information to guide the patient in contacting the Secretary of the Department of Health and Human Services’ Office of Civil Rights, the federal agency that oversees and enforces HIPAA laws. The department may investigate and can fine providers who have violated HIPAA. Training. To ensure all employees are fully aware of HIPAA privacy requirements, a covered entity must provide training to each employee on PHI as it applies to and as it is required to perform their

individual job. The training must be completed and documented within a reasonable time.

Security The goal of the security rules of HIPAA is to establish standard protections for the electronic (computerized) storage and transmission of protected health information. The rules are guided by three main principles: Protection of the confidentiality of information Protection of the integrity (wholeness) of the information Continued availability of the information Compliance with these rules falls in large part to professionals who maintain computer systems for healthcare organizations. HIPAA requires healthcare institutions to appoint a security officer who establishes policies and practices that meet minimum standards of information security. Common practices such as password protections on computers that store patient care information are required under HIPAA rules of security. The security officer also ensures that organizational security risk assessments are conducted, in compliance with the HIPAA Security Rule, and oversees creation of procedures that protect electronic information in the event of a disaster.4, 8 The effectiveness of security practices depends on your understanding WWW.ORTODAY.COM

IN THE OR

continuing education and cooperation. Your computer sign-on code, for example, is a cornerstone of a secure health information system. Your security officer, in addition to setting up the password system, is responsible for providing education for you and for all employees about safe practices that ensure the confidentiality, integrity and continued availability of critical healthcare information. Whenever you begin work at a new facility, you can expect to hear about that facility’s practices to ensure a secure health information system.4

HIPAA in Your Work Life The “minimum necessary” rule. The “minimum necessary” rule can help you make on-the-spot decisions about whether to share or discuss a patient’s PHI. The rule guides providers to use only the minimum amount of information necessary to get the job done. For example, if you order a wheelchair for a patient, you might need to communicate information about the physical characteristics of the patient, such as height and weight. The actual diagnosis of the patient is not necessary for the correct wheelchair to be delivered. As another example, a patient may have become nonambulatory because of brain abscesses resulting from AIDS, but the vendor does not need to know the patient’s HIV status to provide the right wheelchair.3 Telephone requests for personal health information. Healthcare professionals in many settings are familiar with the privacy issues that arise when telephone inquiries come into a work station inside a hospital. How can a nurse or clerk be sure of the identity of a caller who asks about a patient? What is the best way to support the family and loved ones of patients while still protecting WWW.ORTODAY.COM

patients’ confidentiality? HIPAA does not preclude important communication from taking place, but the provider must exercise caution and remember the minimum necessary rule. To illustrate, when a caller asks for a patient, the provider can verify whether that person is in the hospital, but only if the caller asks for the patient by name. If a caller asks for specific information about a patient, only minimal information about general status should be communicated. The caller can be directed to speak to the patient or family spokesperson for any further details. If the caller asks for a list of patients, or for a broad category (“Do you have any of the schoolchildren involved in the accident?”), the nurse or clerk must not respond in any detail. An exception to this rule would be a member of the clergy who calls asking, for example, for all people who indicate a certain faith preference at the time of admission. A second exception would be a patient who specifically requests anonymity upon admission. The privacy officer will establish a system of notification in the patient rosters to alert all employees to this special status.3 E-mail, text and faxes. E-mail, texts, and faxes are convenient, but information can be inadvertently sent to the wrong destination. To reduce the vulnerability of accidental error in identifying the recipient, e-mails and faxes that contain PHI should have a statement that explains the confidential nature of the information included in the transmission. Faxes should describe the procedure if a person receives a fax in error. The use of speed dial for frequently used numbers or verification through the receipt function of the fax are additional safeguards that can be taken to further protect faxed PHI.

The “minimum necessary” rule is relevant to e-mails and faxes as an added level of security. Precautions should be taken to reduce visibility of received faxes, including consideration of fax machine locations and procedures for timely distribution of faxes. The discarding of protected health information. Often in busy healthcare settings, PHI appears on documents and materials that are not filed in the medical record. For example, patient assignment lists, unused labels and notes taken at change of shift all represent a potential source for violations of privacy. HIPAA does not directly address management of these materials, but many facilities take steps to guard against their being the cause of a privacy breach. At some facilities, these documents are discarded in special locations or sent to a shredder. You should ask your employer how to handle the safe disposal of any documents containing PHI.9, 10 Hallway conversations. Talking about patient information in public places can cause problems. Although HIPAA does not address this problem specifically, its privacy principles reinforce the professional commitment to use care in such situations to avoid unintentional disclosure of information. Talking in elevators, discussing a case over lunch, discussing a difficult situation with friends over dinner — all of these situations raise the possibility that a patient’s PHI will be revealed inappropriately. Certainly, professionals may discuss, and should discuss, difficult situations in a healthy atmosphere of learning and problem solving. Again, the “minimum necessary” rule will help guide these discussions. Remembering to delete identifying information when possible, exchanging only MAY 2020 | OR TODAY |

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continuing education enough information to further the discussion and holding such conversations away from busy public places will improve the ability to protect patient confidentiality.11 Computer passwords. Your computer password is key to the security of electronic protected health information. You must never give out your password or write it down. If someone asks you for your password, refer that person to your charge nurse or supervisor for help in obtaining login credentials. Most computer systems use a protective device with which access to personal health information can be traced back to the user’s password. If you give out your password, you will be vulnerable to the consequences of any violations committed under your password. If you forget your password, follow your organization’s policy to retrieve or reset it.4, 12, 13 The “delete” button. When you delete personal health information from a computer screen, you delete the information only from the screen. The information remains available to “hackers” or professional investigators on the hard drive or within the software. For this reason, most healthcare providers take special precautions to remove hard drives from computers when selling or donating old computers to users outside the healthcare institution. If you use a PDA or a laptop, you should be aware of this vulnerability and proceed with caution if you remove the PDA or the laptop from the facility. Your security officer can help you learn to encrypt such information or protect it with passwords if you frequently use your PDA or laptop outside work.4, 14 Computer viruses. Computer viruses can damage or paralyze

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Resources Information about HIPAA legislation and regulations: U.S. Department of Health and Human Services: www.hhs.gov/ocr/hipaa Information on the portability of health insurance: U.S. Department of Labor: https://www.dol.gov/general/topic/health-plans/portability Information about public health issues and the protection of privacy: Centers for Disease Control and Prevention: https://www.cdc.gov/mmwr/preview/mmwrhtml/m2e411a1.htm

a system, making access to vital patient information impossible. Viruses can also allow for violations of confidentiality by allowing unauthorized personnel such as computer “hackers” access to confidential information. Organizations need strong cybersecurity practices in place to protect patient information, organizational assets, practice operations and personnel. You can help protect the integrity of your organization’s information by practicing caution with your e-mails. You should not open e-mail attachments from unknown senders. E-mail attachments can contain viruses that spread quickly throughout a system just by your opening the documents on your computer. Unauthorized software can also contain viruses that damage a computer system. You can introduce harmful viruses simply by downloading infected programs from the Internet or from software you bring from home. The safety officer will help you determine the safety of any software programs you contemplate installing.4

The Future Whenever you change jobs, as long as you continue working for a covered entity, you can expect to receive a review of your new employer’s efforts to comply with HIPAA. Who is your privacy officer? Who is your security officer? Ask

to see a copy of your employer’s notice of privacy practices so you can be familiar with the information your patients will receive. Get to know the systems your employer uses to protect electronically protected health information. Expect to receive education about passwords and other means to secure the safety of computer systems at your new workplace. The protection of patient confidentiality is not a new idea. HIPAA supports behaviors that have been a part of the healthcare profession for decades.15 What has changed dramatically is the way we collect and store patient information. The systems we develop to practice healthcare may change over time, but the fundamental commitment to protection of confidentiality endures. EDITOR’S NOTE: Margaret Ecker, MS, RN, PNP, is the original author of this educational activity, but has not had an opportunity to influence the content of this current version. Charles F. Bombard, MHA, RN, CPHQ, FACHE, and Catherine E. Jordan, MSA, RN, LNCC, past authors of this educational activity, have not had an opportunity to influence the content of this current version. Julie Smith Jonson, JD, RN, BSN is Registered Nurse with Access Health and Of Counsel to the law firm Montgomery, Rennie and Jonson, LPA in Cincinnati, OH. WWW.ORTODAY.COM

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continuing education

References 1. Health Insurance Portability and Accountability Act of 1996. U.S. Department of Human Services, Assistant Secretary for Planning and Evaluation Web site. https://aspe. hhs.gov/report/health-insuranceportability-and-accountabilityact-1996. Accessed September 4, 2019. 2. Adopted standards and operating rules. Centers for Medicare & Medcaid Services Web site. https://www. cms.gov/Regulations-and-Guidance/ Administrative-Simplification/HIPAAACA/AdoptedStandardsandOperatingRules.html. Updated October 23, 2017. Accessed September 4, 2019. 3. Summary of the HIPAA privacy rule. U.S. Department of Health and Human Services Web site. https:// www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index. html. Updated July 26, 2013. Accessed September 4, 2019. 4. Privacy and security information. Centers for Medicare & Medcaid Services Web site. https://www.cms. gov/Regulations-and-Guidance/ Administrative-Simplification/HIPAAACA/PrivacyandSecurityInformation. html.Updated June 21, 2016. Accessed September 4, 2019. 5. HealthCare.gov Web site. https:// www.healthcare.gov. Accessed September 4, 2019. 6. Administrative simplification over-

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view. Centers for Medicare & Medcaid Services Web site. https://www. cms.gov/Regulations-and-Guidance/ Administrative-Simplification/HIPAAACA/index.html. Updated March 21, 2018. Accessed September 4, 2019. 7. Are you a covered entity? Centers for Medicare & Medcaid Services Web site. https://www.cms.gov/ Regulations-and-Guidance/Administrative-Simplification/HIPAA-ACA/ AreYouaCoveredEntity.html. Updated March 14, 2019. Accessed September 4, 2019. 8. Summary of the HIPAA security rule. U.S. Department of Health & Human Services Web site. https:// www.hhs.gov/hipaa/for-professionals/security/laws-regulations/index. html. Updated July 26, 1013. Accessed September 4, 2019. 9. HIPAA guidance materials: Small providers, small health plans, and other small businesses. DHHS Web site. https://www.hhs.gov/hipaa/ for-professionals/privacy/guidance/ index.html. Updated June 26, 2019. Accessed September 4, 2019. 10. The HIPAA Privacy and security rules: Frequently asked questions about the disposal of protected health information. U.S. Department of Health & Human Services Web site. https://www.hhs.gov/sites/ default/files/disposalfaqs.pdf. Accessed September 4, 2019.

11. Incidental uses and disclosures. U.S. Department of Health & Human Services Web site. https://www. hhs.gov/hipaa/for-professionals/ privacy/guidance/incidental-usesand-disclosures/index.html. Updated July 26, 2013. Accessed September 4, 2019. 12. Security rule guidance material. U.S. Department of Health & Human Services Web site. https://www.hhs. gov/hipaa/for-professionals/security/guidance/index.html. Updated August 29, 2019. Accessed September 4, 2019. 13. HIPAA security series. 2 Security standards: administrative safeguards. DHHS Web site. https://www.hhs. gov/sites/default/files/ocr/privacy/ hipaa/administrative/securityrule/ adminsafeguards.pdf. Updated March 3, 2007. Accessed September 4, 2019. 14. Guide to privacy and security of electronic health information. Office of the National Coordinator for Health Information Technology (ONC) Web site. https://www. healthit.gov/sites/default/files/pdf/ privacy/privacy-and-security-guide. pdf . Published April 2015. Accessed September 4, 2019. 15. Code of ethics for nurses with interpretive statements. American Nurses Association Web site. https:// www.nursingworld.org/coe-view-only. Published January 2015. Accessed September 4, 2019.

MAY 2020 | OR TODAY |

Clinical Vignette

At the request of his physician, David Smithson arrives in the ED waiting area to hear the results of his recent bone marrow biopsy. The physician arrives, sits down with Mr. Smithson in the busy waiting room and tells him the biopsy results are positive for leukemia. Visibly shaken by the diagnosis, Mr. Smithson is comforted by the charge nurse, Sarah Brink. Composing himself, Mr. Smithson says he wants to return to work. Later that afternoon, Sarah finds Mr. Smithson’s biopsy results in the waiting room. She decides to call his office number, which was listed on the report. Mr. Smithson’s receptionist says he is not in at the moment, but she is happy to take a message. Sarah says that Mr. Smithson has been diagnosed with leukemia, and he left his biopsy results in the ED waiting room. The receptionist is upset at this news and breaks down while on the phone. Sarah spends time on the phone trying to calm her. During the conversation, Sarah is interrupted by one of the other nurses on duty, who tells her she cannot access the computer system. Sarah gives the other nurse her password. At the end of her shift, Sarah tells several other nurses about Mr. Smithson as they walk from the hospital. 1. The physician in this case should have: a. Talked in a lower tone of voice when telling the patient the diagnostic information b. Taken Mr. Smithson to a private area in the ED for the discussion c. Asked the waiting ED patients to move d. D one nothing because the ED is an appropriate setting for this discussion 2. Sarah violates HIPAA privacy standards when she: a. Comforts Mr. Smithson in front of other patients b. G oes to the waiting room instead of staying in the treatment area c. Doesn’t throw the biopsy results away d. Tells the receptionist of Mr. Smithson’s diagnosis 3. It is always a good idea to: a. Keep passwords written down b. Give your password to others c. Take every precaution to protect your password d. Make your password easy to figure out 4. Sarah violates one of the basic rules of protecting patient privacy when she: a. Comforts Mr. Smithson in the ED waiting room b. Tries to calm the receptionist down after she learns about Mr. Smithson’s diagnosis c. Picks up the biopsy report in the ED waiting room d. D iscusses the patient’s case with other nurses when leaving the hospital

CE513

How to Earn Continuing Education Credit 1. Read the Continuing Education article. 2. Go online to ce.nurse.com to take the test for $12. If you are an Unlimited CE subscriber, you can take this test at no additional charge. You can sign up for an Unlimited CE membership at https://www.nurse.com/ sign-up for $49.95 per year.

Deadline Courses must be completed by 10/1/2022 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.

Clinical VignettE ANSWERS 1. Answer: B, The physician should have tried to find a private area where the sensitive discussion could not be overheard. 2. Answer: D, Discussing a patient’s diagnosis or condition is a breach of confidentiality. 3. Answer: C, Giving someone else your password, writing it down for others to see or making it easy to guess your password gives others the opportunity to access, under your name, electronic protected patient information. 4. Answer: D, Discussing a patient’s diagnosis or condition is a breach of confidentiality.

42 | OR TODAY | MAY 2020

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

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COVE R

STORY

BY DON SADLER

". . . p r o p e r h a n d h y g i e n e i s p r o b a b l y t h e m o s t a b u s e d a n d m i s u s e d p r e v e n t i v e m e t h o d o l o g y i n e v e r y d a y l i f e . . ." 44 | OR TODAY | MAY 2020

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hen the latest coronavirus threat, or COVID-19, first emerged in January, the number one recommendation for protecting oneself from the virus and preventing its spread was to wash hands frequently and thoroughly. Similarly, the best way to prevent healthcare associated infections and the transmission of disease in the operating room and across health care settings is to SHARON A. practice good hand hygiene. MCNAMARA “We all learned in kinderBSN, MS, RN, CNOR garten and in Health Class 101 how to wash our hands properly,” says Sharon A. McNamara BSN, MS, RN, CNOR. “But proper hand hygiene is probably the most abused and misused preventive methodology in everyday life and, sadly, in health care as well.”

Preventing Disease Transmissions An estimated two million patients contract a healthcare associated infection (HAI) each year and 99,000 of them die from their infection, according to the Centers for Disease Control and Prevention. Additionally, HAIs cost hospitals an estimated $45 billion annually. “Practicing effective hand hygiene is the best way to prevent the transmission of diseases in the OR,” says Amber Wood, MSN, RN, CNOR, CIC, FAPIC, senior perioperative practice specialist with the Association of periOperative Registered Nurses (AORN). “The danger of not performing hand hygiene correctly is that we put our patients and ourselves at risk for acquiring infectious pathogens.” “Contamination inside the operating suite can lead to surgical site infections,” says Jill Holdsworth, MS, CIC, FAPIC, NREMT, CRCST, manager, infection prevention at Emory University Hospital Midtown in Atlanta, Georgia. “Good hand hygiene in the OR can assist with preventing contamination of the surgical wound, instruments and skin after sterile prep,” Holdsworth adds. “All of these areas are important when looking at maintaining a sterile environment and preventing surgical site infections.” According to Wood, hand hygiene compliance is only about 50 percent in the periWWW.ORTODAY.COM

operative setting. McNamara confirms this anecdotally. “My observations of anesthesia providers, nurses and technologists in the OR reveal that they frequently omit proper hand hygiene practices during patient care activities,” she says. Wood attributes the low hand hygiene compliance rate to the fact that there is a high number of contacts between perioperative personnel and OR patients. “So there’s a high number of opportunities for hand hygiene to occur, especially during induction and emergence from anesthesia.” David Reinhart, MSN, MBA, RN, CNOR, specialty director perioperative services, blames a lack of availability and/or poor placement of hand sanitizer dispensers. “Conflicting responsibilities in relationship to on-time surgery starts is another factor,” he says. McNamara concurs. “I believe that inadequate placement or lack of hand gel dispensers and hand wash sinks is a big factor in low rates of hand hygiene compliance,” she says. According to Wood, most interactions with the patient occur at the bedside or in the center of the room. “Sometimes it’s not safe to JILL HOLDSWORTH leave the patient to go over MS, CIC, FAPIC, NREMT, CRCST to the wall and perform hand hygiene or into the hallway to wash hands at the sink,” she explains. “Having alcohol-based hand rubs in strategic locations near the bedside or wearing personal dispensers are two strategies to combat this problem.”

Guidance from the CDC and WHO The CDC and World Health Organization (WHO) recommend that appropriate hand hygiene be performed by health care workers at specific times, including the following: • Before and after patient contact. • Before performing a clean or sterile task. • After risk for blood or body fluid exposure. • After contact with patient surroundings. • Any time hands are visibly soiled or dirty. MAY 2020 | OR TODAY |

COVE R

STORY

THE CORONAVIRUS

PANDEMIC

The Coronavirus outbreak that first emerged as a threat earlier this year presented an immediate and serious challenge to health care workers all over the world. However, there is still a lot of misinformation and misunderstanding about the threat posed by the virus. Here are a few common questions and answers about COVID-19 from the CDC:

Q: HOW DOES THE CORONAVIRUS SPREAD?

A: The first infections were linked to a live animal market in China, but the virus soon began spreading from person to person through respiratory droplets. This is why the CDC recommends that infected patients be quarantined in a hospital or at home, depending on how sick they are, until they no longer pose an infection threat to others.

Q: WHAT CAN PEOPLE DO TO PREVENT THE SPREAD OF COVID-19?

A: Since a vaccine for the Coronavirus has not yet been developed, it’s important that individuals take steps to prevent its spread and protect themselves from infection. These include the same practices that can help prevent the spread of any respiratory illness, such as avoiding touching the eyes, nose and mouth and covering a cough or sneeze with a tissue and then throwing the tissue away. Thorough hand washing is especially important. Hands should be washed often with soap and water for at least 20 seconds. If soap and water aren’t readily available, the CDC recommends using an alcohol-based hand sanitizer with at least 60% alcohol.

Q: WHAT SHOULD HEALTH CARE PROFESSIONALS AND HEALTH DEPARTMENTS DO ABOUT COVID-19?

A: As the availability of diagnostic testing for COVID-19 increases, clinicians will be able to access laboratory tests for diagnosing the virus through clinical laboratories performing tests authorized by the FDA under an Emergency Use Authorization. Clinicians will also be able to access laboratory testing through public health laboratories in their jurisdictions.

46 | OR TODAY | MAY 2020

“How often do you see a practitioner complete the positioning of a patient and then go directly to the computer to document?” McNamara asks. “Or see practitioners transporting patients with or without gloves but not AMBER WOOD gelling or washing their hands before starting MSN, RN, CNOR, the procedure?” CIC, FAPIC Wood recommends not wearing gloves when they’re not indicated. “When gloves are worn for an extended time, we tend to forget that the gloves do not replace hand hygiene,” she says. “For example, we often put gloves on in anticipation of needing them, such as when the patient is emerging from anesthesia,” Wood adds. “Then we leave them on while we’re getting ready to transport the patient and forget to perform hand hygiene before touching the patient.” Technology solutions can also help improve hand hygiene compliance. One example is a group monitoring system (GMS) that electronically monitors, tracks and reports hand hygiene compliance rates in real time. “Electronic hand hygiene monitoring can be very helpful when it comes to monitoring hand hygiene compliance and accurately recording results,” says Holdsworth. “These types of systems can provide valuable information about areas in the facility that are causing specific issues.” Wood recommends that an interdisciplinary team carefully evaluate any technology solutions for hand hygiene monitoring. “Perioperative team members should be involved in the selection of technology for hand hygiene monitoring,” she says. “Many of these systems are set up to capture hand hygiene in and out of a room, but this may have limited benefits for capturing data and improving compliance in the perioperative setting,” Wood explains. “This is because a majority of hand hygiene opportunities in this setting are occurring at the bedside.”

Hand Hygiene TST The Joint Commission Center for Transforming Healthcare has developed the Hand Hygiene Targeted Solutions Tool (TST) to help boost hand hygiene compliance rates. The Hand Hygiene TST is a web-based application designed to help health care organizations understand barriers to successful hand hygiene while implementing evidence-based solutions that lead to reductions in HAIs. The Hand Hygiene TST will guide health care organizations through a step-by-step process to accurately measure actual hand hygiene performance and identify barriers to success. It will also direct organizations to proven solutions that are customized to address each organization’s particular needs. For more information, visit tinyurl.com/TSThands to learn more about the Hand Hygiene TST.

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MAY 2020 | OR TODAY |

Lindsey Jones SPOTLIGHT ON:

RN, BSN, CPN, CHPPN

By Matt Skoufalos

t six, Lindsey Jones’ son, Tyler, started coming home from school with bruises. Jones, a preschool teacher, decided to follow up with her family pediatrician. Not long after, they were referred to Johns Hopkins All Children’s Hospital in St. Petersburg, Florida, where Tyler was diagnosed with a bleeding disorder.

ABOVE: Lindsey Jones says the support of her family enabled her to become a nurse. BELOW: Lindsey Jones works at the hospital where her son received treatments.

48 | OR TODAY | MAY 2020

For a number of years thereafter, the family spent a significant amount of time under the care of cancer and blood disorders specialists at All Children’s Hospital, which meant weekly visits, lots of testing and extensive discussion of treatment options. Although Tyler’s condition eventually self-corrected by seventh grade, the intervening years made for a complicated time in their lives. Through it all, Jones told her husband, Randy, that she felt like she needed to switch careers and become a nurse. “He said, ‘If that’s what you want to do, then go for it,’” she said. More than that, Randy, Tyler and her younger son, Trevor, all came together as a unit while she did it. The career change was a challenge – nursing school is difficult under any circumstances, much less as a mother of two who’s changing careers – but Jones had “a lot of family support.” “They were really great in helping to make sure that the family part didn’t suffer for the

professional part,” she said. “Everybody was at their after-school activities and doctor’s appointments, and dinner was ready. I am extremely thankful for that.” After she completed nursing school, Jones was hired into the nurse residency program at All Children’s, and began her career on the same floor where Tyler was treated. From that moment, she says, “I never looked back.” Within eight years on the job, Jones went back to school for her bachelor’s degree in nursing. She’s been at the hospital ever since. “It’s pretty cool that I get to work in the same place where my son was treated and give back in that way,” Jones said. She also got to see what it feels like to be at All Children’s from the perspective of a practitioner and not a patient – in short, Jones said it “was definitely an eye-opener.” “Working in nursing in general is not for the faint of heart,” she said. “You see stuff that the normal person isn’t involved in. It makes what I do every day WWW.ORTODAY.COM

Lindsey Jones says her patients sometimes face the biggest challenge of their lives.

very sacred. I never take for granted the fact that our patients are sometimes going through the hardest thing they’ve ever gone through in their entire life. It’s an intimate moment.” Experiencing the other side of managing chronic health conditions as a nurse, Jones still remembered her perspective as a parent and all that came with it, from wanting information and questioning physicians, to managing anxiety over the needs of a child. She had those memories to draw upon as a nurse, as they helped her process the uncertainty of those moments with the roles reversed. “I remembered wanting to know what’s going on, and wanting to do everything that I could to make my kid feel better,” she said. “I think it benefits me in a way because I can see from both sides of how that looks and how that feels.” “I always told my husband if I could help one person, just one person, in the way that we felt we were treated and we were helped – how everybody made sure that we were OK, but also made sure that Tyler was OK – I just WWW.ORTODAY.COM

want to be able to do that,” Jones said. “It will have fulfilled my hopes and dreams for my work.” “Being eight-and-a-half years into it, and being able to say confidently that I’ve been that person for numerous families, it makes my heart so happy,” she said. “I really, truly feel like I’ve found my way, and this is what I want to spend my life doing. It’s a very intimate space that we hold with our patients and their families, and I never ever take that for granted.” For as much as nursing school offered her the textbook knowledge required of the job, the career has another, equally necessary, emotional component that arises in the aspects of patient care and bedside manner that only come with on-the-job experience. Jones said her background in education helped prepare her for managing the variety of personalities she encounters each day. “Being at the bedside, you definitely learn a lot that you don’t necessarily learn in a textbook,” Jones said. “I think it’s good learning, and you get a crash course. You’re not going to mesh

with everybody and that’s OK.” Although Jones has no intentions to transition away from her assignment at All Children’s Hospital, she appreciates how the profession has allowed her to flourish. The knowledge that she could change assignments as the demands of her life require, even if only to pursue a master’s degree, is a comfort. Today, Tyler is a healthy college freshman and Trevor is a healthy high-schooler; the ability to support them in a profession that she loves, and in which she feels valued, offers a great deal of emotional security, she said. “There’s a nurse for everything, so you can always go and do something else,” Jones said. “Sometimes you go into a profession and you’re stuck in that lane. I’m thankful and lucky to work in a place that allows me to do a lot of other things that I’m interested in.” “When I was younger, I never in a million years thought that I would be where I am today,” she said. “I’m a firm believer that everything happens for a reason. Here I am, and I couldn’t be happier with the career path that I’m on and the place that I am.” MAY 2020 | OR TODAY |

OUT OF THE OR fitness

SCAPULA THERAPY

for a Sore Shoulder By Miguel J. Ortiz hen it comes to your upper

W body, shoulder pain tends

to be very common and one of the most tolerated injuries that I see every day. When your day job doesn’t utilize much upper body strength your posture, over time, can manipulate the shoulder causing improper mobility and movement. Some people workout and still get shoulder pain. No one is exempt from shoulder issues. So, if we want to fix our shoulder issues we need to work on core strength. We must understand a very important area of the body, the scapula. The shoulder blade, as we commonly know it, is only vital for posture and assists in all upper body movements. To get started we need a foam roller and a lacrosse or massage ball. Now, we can look at the three main areas around the shoulder blade and ways to assist in bringing some relief. First, if you’re having trouble simply raising your arm it could be the latissimus dorsi muscles (LAT) which could be pulling down on the shoulder causing internal rotation. There are plenty of ways to stretch the shoulder, but I find foam rolling extremely effective. Lay on your side, placing

50 | OR TODAY | MAY 2020

the foam roller just underneath your armpit, your arm of that side needs to be over the roller and your head can either rest on your arm or I recommend grabbing a pillow and placing it between your head and shoulder so you can rest and ease into the pressure. If you’re in quite a bit of pain and you find the pressure is deeper you may want to see a trainer or massage therapist who knows how to help release spots that are hard to hit with a roller. The second area of focus as we continue to stay on the posterior, or back of the body, is the upper, mid and lower trapezius. Grab your lacrosse ball and an open spot against the wall. Start by putting your back against the wall with your feet about a foot and a half apart and knees lightly bent. Place the massage ball either over the right or left side of your trap, just to the left or right of the spine. Once in place, stand a little taller allowing the ball to be manipulated by your positioning so you can either focus on upper traps, our general stress holder, mid traps which is in between the shoulder blade and spine, and the lower traps which you may need to reposition for it to be comfortable. Allowing the ball to get that low will require some unique repositioning as we want to be able to focus on the release of the

shoulder, not a struggle against the wall. Some of these positions can also be done on the floor if more pressure is needed. Finally, your chest, this area tends to be very tight when it comes to bad posture as most cases have serious kyphosis, which an excessive curvature of the thoracic spine or middle back I find most people naturally have a tight chest with this position. We have all seen 90 degree or door frame stretches and I like those a lot as long as the shoulder is not internally rotated during the stretch. But with the corner of the wall you can also use the lacrosse ball to massage the chest and on the floor using a larger ball, a soft ball and even your foam roller will do. This kind of therapy and consistent pressure on the muscle when done properly will have an amazing effect on your recovery. Focus on these three areas when it comes to the shoulder and you’ll be moving that shoulder freely in no time. Miguel J. Ortiz is a personal trainer in Atlanta, Georgia. He is a member of the National Personal Trainer Institute and a Certified Nutritional Consultant with more than a decade of professional experience. He can be found on Instagram at @migueljortiz. WWW.ORTODAY.COM

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DURING MY FIRST DAYS AS A NURSING STUDENT, BACK WHEN WHITE SHOES WERE STILL MANDATORY AND I HAD MORE GEL IN MY HAIR THAN NURSING CAP, I BECAME AWARE OF THE INCREDIBLE ROLE OF THE NURSING EDUCATORS AND THE PRECEPTORS. THIS BLUEPRINT FOR THE EDUCATOR STAYED WITH ME AS I HAD THE OPPORTUNITY DURING MY CAREER TO WORK WITH STUDENTS. – Delores O’Connell, LPN, BA, AGTS, CRCST, CIS, CHL, CSPDT, ASQ-CQIA

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Delores is a speaker at OR Today Live! To learn more, visit www.ortodaylive.com.

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MAY 2020 | OR TODAY |

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OUT OF THE OR health

Want a Sharp Mind, Strong Memory? Ramp up activities. e all want to keep our minds

W sharp and our memories

strong as we get older. So, what can we do right now to prevent cognitive decline in later years? Engaging in regular aerobic exercise for at least 30 minutes a day, five days a week, probably has the biggest effect on people of many ages. Convincing evidence also suggests that a Mediterranean-style diet of fish, olive oil, avocados, fruits, vegetables, nuts, beans and whole grains is beneficial. But what about social and mental activities – do they help at all? Previous research convincingly demonstrates that older people who engage in social activities, have a positive mental attitude and work to learn new things maintain their cognitive abilities longer than those who are socially isolated, have a negative attitude and do not try to learn new things. However, several questions remain. When is the ideal time to do these activities: in middle age or later in life? Does it help to do multiple activities, or is a single activity as good as several? And what about other common mental activities, such as reading books and WWW.ORTODAY.COM

playing games – do they help too? A study from researchers at the Mayo Clinic followed 2,000 cognitively normal men and women age 70 or older for about five years. Participants filled out surveys regarding their engagement in five common mentally stimulating pursuits – social activities, reading books, playing games, making crafts and using a computer – in midlife (between ages 50 and 65) and in late life (ages 70 and above). The researchers also performed face-to-face evaluations every 15 months. These evaluations included a neurologic interview and exam, detailed history of their abilities at home and in the community, and neuropsychological testing for memory, language, visuospatial skills, attention and executive function. When the study ended, the researchers looked at whether participants remained cognitively normal or developed mild cognitive impairment (MCI). MCI is diagnosed when a concern about a person’s thinking and memory is confirmed by testing that shows impairment on one or more tests of thinking and memory. However, day-to-day functioning is essentially normal, and the person is not demented. The study yielded several important findings: Engaging in two, three, four or

five mentally stimulating activities in late life correlated with a lower risk for developing MCI. A trend suggests a greater number of activities is linked to a greater reduction in risk. Three activities – computer use, social activities and games – had benefits when pursued in both midlife and late life. However, crafts were beneficial only in late life. Reading books showed no benefit.

The bottom line If we want to keep our minds sharp and our memories strong, the evidence suggests that there is much we can do today. We can engage in regular aerobic exercise. We can eat a Mediterranean-style diet. We can work to learn new things and keep a positive mental attitude. And lastly, with a nod to this new research, we can pursue social activities, play games and use computers from midlife onward, and engage in crafts in late life. Books, on the other hand, should be read whenever we are seeking knowledge, wisdom, enlightenment or enjoyment. – Harvard Health Letters MAY 2020 | OR TODAY |

OUT OF THE OR EQ factor

Different Ways We Can Be Motivated by Knowledge By daniel bobinski ast month I provided an overview of six learned (extrinsic) motivators. By studying these motivators, we develop better self-awareness, which is the starting point for emotional intelligence. Learning about motivators also helps us understand others, which improves our relationship management.

For the next six months, I intend to explore each of the six motivators one by one.

The motivational spectrum of knowledge First on the list of six motivators is knowledge. Think of it as a scale, or spectrum, about the different ways people are motivated to acquire and use knowledge. At one end of the scale are people we might describe as “instinctive.” These folks prefer relying on past experiences, seeking new knowledge only when it’s needed to accomplish the task at hand. At the other end of the knowledge scale are people driven to acquire as much knowledge as they can in their pursuit of truth. The word “intellectual” would be a reasonable choice to identify people at this end of the spectrum. It’s important to remember that people at both ends of the scale value knowledge; they just value it differently. Also, know this is not an “either/or” idea; it’s a scale. If we were to visualize this,

54 | OR TODAY | MAY 2020

we could set “instinctive” people at the left end of the scale, and “intellectuals” at the right. Know that almost everyone has both motivators, but people tend to rely on one more than the other. The question for improving your selfawareness is which do you prefer more? What about your co-workers? Keep in mind there are no right or wrong motivators here – just differences.

Traits of an instinctively motivated person People at this end of the scale are often very knowledgeable in specific areas. As such, they are comfortable solving problems by relying on their intuition and previous experiences. They get energized relying on hunches and creating solutions based on what they’ve learned from past successes and failures. Rather than take deep dives into subjects, people at this end of the scale prefer using search engines or looking for instructional videos on YouTube to get whatever snippet of knowledge they need to move forward with the task in front of them.

Traits of an intellectually motivated person These folks often conduct research until a subject is exhausted. They want as much information as possible! Often, they aren’t comfortable starting a project until they’ve gathered a broad scope of information on

the topic, because they rely on available facts for making decisions rather than intuition. People on the intellectual side of the scale tend to enjoy seminars and other opportunities to learn. They also enjoy analyzing or clarifying what they’ve learned and finding new ways to systemize it. Let me conclude by saying the knowledge scale does not indicate how smart a person it. It only identifies the different ways people are driven to learn. A key to success in using this information is to value, not criticize, the differences. Humans tend to think everyone else can and should learn the same as themselves. When we realize this is not true and we choose to value the differences, we become more effective in our working relationships.

Daniel Bobinski, M.Ed. is a best-selling author and a popular speaker at conferences and retreats. For more than 30 years he’s been working with teams and individuals (1:1 coaching) to help them achieve excellence. He was also teaching Emotional Intelligence since before it was a thing. Reach Daniel through his website, MyWorkplaceExcellence.com, or his office: (208) 375-7606.

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OUT OF THE OR nutrition

Weight Gain Blues By Charlyn Fargo s a nation, we continue to eat too much. That may not be surprising news to some of us. By 2030, just 10 short years away, nearly 1 out of every 2 adults in this country will have obesity, and nearly 1 in 4 adults will have severe obesity, according to a new report.

Over the time period from 1999 to 2018, the obesity prevalence increased about 12%, from 30.5% of Americans to 42.4% of Americans. Severe obesity almost doubled. The study was conducted by Dr. Craig Hales, a medical epidemiologist with the National Center for Health Statistics at the U.S. Centers for Disease Control and Prevention. The report, published in the New England Journal of Medicine, predicts that 29 states (mostly Southern and Midwestern states), will have obesity rates over 50%, while all 50 states will see rates of at least 35%. Severe obesity (about 100 pounds overweight) is predicted to be higher than 25% in 25 states. Why the concern? Obesity is associated with Type 2 diabetes, heart disease, high blood pressure, stroke, fatty liver disease, sleep apnea, arthritis, gallbladder disease and more. But we all know it’s hard to lose weight, and there are no simple answers. As a nation, we’re blessed to

have an abundance of food, including high-calorie, energy-dense foods that are easy to overeat. Add to that sedentary jobs and busy lives. Too often, we are guilty of distracted eating – eating while we’re doing other things – which results in overeating. My best advice? Eat according to the U.S. Department of Agriculture’s MyPlate rather than a fad diet, which often results in gaining more weight than was lost. Focus on eating a variety of whole foods like vegetables, fruits, whole grains and lean protein. Make food at home so you can control the calories. Try keeping track of your calories with an app such as MyFitnessPal or Lose It. Studies have shown even the simple act of tracking helps many lose weight.

Step by Step Most of us wish there was a simple solution to weight loss and eating healthier. If there was just a pill we could take, or a three-point plan we could follow, that would magically result in good health, we would do that. It just doesn’t work that way. Like most things in life, it’s a journey. It’s the daily choices that put us on the path to better health. Consider a recent study on walnuts. A new long-term observational study from the Harvard University T.H. Chan School of Public Health

found that after analyzing more than 20 years of data, the consumption of nuts, including walnuts, was associated with less weight gain and less risk of obesity in adults. Specifically, increasing walnuts and other tree nuts by just half a serving per day was associated with a 15% and an 11% lower risk of developing obesity, respectively. These findings held true even after considering diet and exercise changes. The key is to take that first step: Include a handful of walnuts in a trail mix or sprinkled on your morning oatmeal. And it’s not just walnuts; that’s not the point. Healthy eating takes discipline – like that exercise plan – of being intentional about what you’re eating. Are you getting enough fruits and vegetables, water, whole grains, healthy fats (think salmon and walnuts), lean protein and low-fat dairy? It’s important that you don’t skip carbohydrates, fats or proteins; include moderate amounts of each. I still believe in that timeless advice – moderation, balance and variety – and that goes for walnuts as well. 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.

OUT OF THE OR recipe

Stir-Fried Lamb with Eggplant and Scallions • 1 pound boneless leg of lamb, sirloin or flank steak, cut into 2-inch-by-1/2-inch-thick strips • 1/4 cup peanut oil

Recipe

• 4 Japanese eggplants, cut into 2-inch-by-1/2inch-thick strips

the

58 | OR TODAY | MAY 2020

• 4 scallions, cut into 1-inch pieces on the diagonal For the marinade: • 1 egg whites • 2 tablespoons soy sauce • 1 tablespoon cornstarch For the sauce: • 3 tablespoons rice wine vinegar • 3 tablespoons hoisin sauce • 2 tablespoons chili paste with garlic • 1 teaspoon dark sesame oil or to taste • 2 tablespoons chicken or beef stock or water

BY Diane Rossen Worthington Diane is an authority on new American cooking. She is the author of 18 cookbooks, including “Seriously Simple Parties,” and a James Beard Award-winning radio show host. You can contact her at www.seriouslysimple.com. WWW.ORTODAY.COM

OUT OF THE OR recipe

Stir-fried Lamb is Fast and Flavorful ears ago, I wrote a stir-fry book for Williams-Sonoma and learned a lot about this cooking process. Stir-frying may be one of the oldest cooking techniques known to man, but it is still one of the most efficient, logical and easiest methods for preparing food.

The trick is to make sure you have everything possible done in advance, from chopping the vegetables to having the final cooking sauce prepared and close at hand. Once you get the hang of how the ingredients are assembled, you can branch out by tailoring stir-fry dishes to your personal tastes. Look for a wok that is made of heavy aluminum, stainless steel or traditional cast-iron. Make sure it is not too thick, though, or it will take too long to heat up. A 14-inch diameter wok is probably the best all-around size, since it can be used to cook a whole fish or a simple sampling of your favorite vegetables. A cover is important when you want to stir-fry something, then have it finish braising in the wok. You may need to use a wok ring if the bottom of the wok is rounded. Youâ&#x20AC;&#x2122;ll love this quick-to-prepare and incredibly flavorful stir-fry. This spicy lamb dish is paired with tender strips of Japanese eggplant. Serve it with steamed white rice and a colorful vegetable. You can use lamb flank steak for this dish as well. Ask your butcher to cut it for you. This marinade also works great with cut-up chicken thighs. Serve this with steamed rice.

Stir-Fried Lamb with Eggplant and Scallions Serves 4 1. Whisk the egg white, soy sauce and cornstarch together in a medium bowl and mix to dissolve the cornstarch. Add the lamb and toss to coat, marinating for 15 minutes to 1 hour in the refrigerator. 2. In a small bowl combine the vinegar, hoisin sauce, chili paste and sesame oil and stir to combine. Set aside. 3. In a wok over high heat add 2 tablespoons of oil, swirling to coat the sides. When the oil is very hot but not smoking, add the eggplant slices and toss every 15 to 20 seconds for 3 to 4 minutes or until the eggplant is slightly softened. Briefly toss the scallions in the wok with the eggplant for a minute and then reserve in a bowl. 4. Add the remaining oil to the wok on high heat, swirling around to coat the sides of the wok. When the oil is very hot but not smoking add half of the lamb and toss every 15 to 20 seconds for 3 to 4 minutes or until the lamb is brown. Spread the lamb evenly around and up the sides of the wok so that the lamb comes into maximum contact with the heat. Add another tablespoon of oil, if needed, and repeat with the remaining lamb. 5. Return the eggplant and scallions to the wok with the lamb and add the sauce. Cook for about 2 more minutes, stirring to evenly coat the ingredients. Serve immediately.

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MAY 2020 | OR TODAY |

OUT OF THE OR pinboard

CH E C K O U T O U R N E W CONTE ST!

OR TODAY

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

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YEAR OF THE NURSE Celebrate the "Year of the Nurse" 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.

H QUOTE OF THE MONT

to change from g in o g is t es b ur Yo t. “Always do your bes you are healthy n he w t en er iff d e b it will ur moment to moment; stance, simply do yo um rc ci y an er nd U . as opposed to sick lf-abuse and regret.” se t, en m g ud -j lf se id o best, and you will av – Don Miguel Ruiz

60 | OR TODAY | MAY 2020

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The News and Photos

OUT OF THE OR

that Caught Our Eye This Month

pinboard

BROWN BAGGER SECRETS You probably have at least one co-worker who, day after day, whips out a colorful Mason-jar salad or veggie-packed wrap. She’s on to something: If you’re hitting up a restaurant for your midday meal Monday through Friday, it’s almost certain you’re paying too much money and eating too many calories. Plus, researchers at Tufts University found that even “healthier” fast-food options still pack more salt and calories than you think. Instead, stock up on the best to-go containers for packing a lunch and learn how to become the type of person who actually uses them.

Leftovers plus creativity Eating the same thing for lunch that you had for dinner last night can get really old, really fast. That’s why people who bring their lunches to work know how to dress up their leftovers. Some ideas: Tortilla wraps can turn a casserole into a burrito. Cooked pasta can be the base of a vegetarian pasta salad by adding roasted veggies, beans and a sauce, like pesto. Most meals can be chopped and thrown on your choice of lettuce with dressing for an instant tossed salad. Reinventing your leftovers tricks your taste buds into believing you’re having a totally new meal, minus all the extra prep.

Go beyond sandwiches Try this take on a big salad bowl by tossing together greens, 90-second plain brown rice, canned beans for protein, whatever veggies are lingering in your fridge and a fat like avocado or cheese. Put homemade vinaigrette or salsa in a little container, and toss the salad at lunchtime.

WWW.ORTODAY.COM

Lunch club fun Divide and conquer workday lunch with a coworker who also brown-bags it. On Monday, bring two servings of lunch to share; then it’s her turn on Tuesday. It’s half the work, but twice the variety. Just make sure your colleague is reliable and motivated – you’ll be stuck grabbing takeout if your friend forgets your food.

Lunch pros plan for a freebie day (or two) It’s a mistake to assume you’ll eat a packed lunch 100% of the time. Inevitably, your friend will ask you to meet for sushi, or you’ll have to take a client out for food. And that’s OK! Aim to bring lunch two to four times per week, depending on what your circumstances are at work. Just like everything else in life, your lunch break requires a little flexibility. – Health.com

MAY 2020 | OR TODAY |

INDEX

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ALPHABETICAL Action Products, Inc.……………………………………… 47

Diversey ……………………………………………………………… 4

MD Technologies Inc.………………………………………IBC

AIV Inc.……………………………………………………………… 55

Doctors Depot………………………………………………… 22

MedWrench……………………………………………………… 52

ALCO Sales & Service Co.…………………………………51

GelPro……………………………………………………………………13

OR Today Webinar Series……………………………… 43

BD……………………………………………………………………… 35

Healthmark Industries Company, Inc.………… 28

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

C Change Surgical……………………………………………… 6

Innovative Medical Products…………………………… 5

SIPS Consults…………………………………………………… 47

Calzuro.com…………………………………………………………17

International X-Ray Brokers…………………………… 27

TBJ Incorporated………………………………… 20-21, BC

Cygnus Medical…………………………………………………… 9

Jet Medical Electronics Inc…………………………… 27

TIDI……………………………………………………………………18-19

ANESTHESIA

Healthmark Industries Company, Inc.………… 28

Jet Medical Electronics Inc…………………………… 27

Doctors Depot………………………………………………… 22

MD Technologies Inc.………………………………………IBC

REPROCESSING STATIONS

CATEGORICAL CARDIAC PRODUCTS C Change Surgical……………………………………………… 6 Jet Medical Electronics Inc…………………………… 27

CARTS/CABINETS ALCO Sales & Service Co.…………………………………51 Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.………… 28 TBJ Incorporated………………………………… 20-21, BC

CS/SPD MD Technologies Inc.………………………………………IBC

Ruhof Corporation…………………………………………… 2,3 SIPS Consults…………………………………………………… 47 TBJ Incorporated………………………………… 20-21, BC TIDI……………………………………………………………………18-19

INSTRUMENT STORAGE/TRANSPORT Cygnus Medical…………………………………………………… 9 Ruhof Corporation…………………………………………… 2,3 TIDI……………………………………………………………………18-19

MAMMOGRAPHY International X-Ray Brokers…………………………… 27

MD Technologies Inc.………………………………………IBC Ruhof Corporation…………………………………………… 2,3 TBJ Incorporated………………………………… 20-21, BC

SAFETY Calzuro.com…………………………………………………………17 GelPro……………………………………………………………………13 Healthmark Industries Company, Inc.………… 28 TIDI……………………………………………………………………18-19

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

MEDICAL IMAGING TABLES

TBJ Incorporated………………………………… 20-21, BC

International X-Ray Brokers…………………………… 27

SKIN PREPARATION

Cygnus Medical…………………………………………………… 9

MONITORS

BD……………………………………………………………………… 35

Diversey ……………………………………………………………… 4

Doctors Depot………………………………………………… 22

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

STERILIZATION

ONLINE RESOURCE

Cygnus Medical…………………………………………………… 9

DISPOSABLES

MedWrench……………………………………………………… 52

Healthmark Industries Company, Inc.………… 28

ALCO Sales & Service Co.…………………………………51

OR Today Webinar Series……………………………… 43

MD Technologies Inc.………………………………………IBC

ENDOSCOPY

OR TABLES

TBJ Incorporated………………………………… 20-21, BC

Cygnus Medical…………………………………………………… 9

International X-Ray Brokers…………………………… 27

SURGICAL

Healthmark Industries Company, Inc.………… 28

OR TABLES/BOOMS/ACCESSORIES

MD Technologies Inc.………………………………………IBC

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

DISINFECTION

MD Technologies Inc.………………………………………IBC

Action Products, Inc.……………………………………… 47

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

Innovative Medical Products…………………………… 5

ERGONOMIC SOLUTIONS

OTHER

Diversey ……………………………………………………………… 4

FALL PREVENTION ALCO Sales & Service Co.…………………………………51

FLUID MANAGEMENT MD Technologies Inc.………………………………………IBC

AIV Inc.……………………………………………………………… 55

OTHER: FLOOR MATS GelPro……………………………………………………………………13

PATIENT MONITORING AIV Inc.……………………………………………………………… 55

FOOTWEAR

Jet Medical Electronics Inc…………………………… 27

Calzuro.com…………………………………………………………17

POSITIONING PRODUCTS

GENERAL

Action Products, Inc.……………………………………… 47

AIV Inc.……………………………………………………………… 55

Cygnus Medical…………………………………………………… 9

HOSPITAL BEDS/PARTS ALCO Sales & Service Co.…………………………………51

INFECTION CONTROL

Innovative Medical Products…………………………… 5

PRESSURE ULCER MANAGEMENT Action Products, Inc.……………………………………… 47

ALCO Sales & Service Co.…………………………………51

REPAIR SERVICES

Cygnus Medical…………………………………………………… 9

Diversey ……………………………………………………………… 4

Doctors Depot………………………………………………… 22

62 | OR TODAY | MAY 2020

SIPS Consults…………………………………………………… 47 TIDI……………………………………………………………………18-19

SURGICAL INSTRUMENT/ACCESSORIES C Change Surgical……………………………………………… 6 Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.………… 28

TELEMETRY AIV Inc.……………………………………………………………… 55

TEMPERATURE MANAGEMENT C Change Surgical……………………………………………… 6

WASTE MANAGEMENT MD Technologies Inc.………………………………………IBC TBJ Incorporated………………………………… 20-21, BC

X-RAY International X-Ray Brokers…………………………… 27

WWW.ORTODAY.COM

ENVIRON-MATE

DM6000 SERIES

DM6000-2A Arthroscopy Urology

Optional Fluid Totalizer

DM6000 Utility/SPD

DM6000-2 Endoscopy FM99

Pays for itself in one year!

No more canisters! • Eliminate staff exposure • Reduce turnaround time

• Save canister & solidifier costs • Check cost saving on our website

Use the DM6000 for your project! • Surgery, endoscopy, SPD • Requires vacuum, electrical & drain

unlimited fluid capacity!

FILTER/MANIFOLD PROVIDES 4 CONNECTIONS FOR SCOPE, SHAVER AND FLUID COLLECTORS. 500CC CAPACITY!

ELIMINATE THESE!

46”

PROMETHEAN ISLAND® 4400 FLOOR MAT

30”

• Collect fluids before they reach the floor • Accurately measure spilled irrigation fluids • Reduce post-op clean-up/turnaround time Screw toptop minimizes risk ofrisk C. Diff. Screw minimizes of C. Diff.

Systems require plumbing most conveniently installed during new construction or remodeling.

CALL US BEFORE YOU BUILD OR REMODEL! 800-201-3060

NEW FEATURED PRODUCT

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

TBJ’s SurgiSonic® 1211X features a patented dual hook up method for pre-cleaning da Vinci® instruments utilizing a filtered, independent flushing system combined with ultrasonic action. The unit is independently tested for cleaning effectiveness and exceeded AAMI TIR 30. Three instruments can be pre-cleaned simultaneously.

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

The system is also ideal for other types of non-robotic submersible tubular instruments as six instruments can be pre-cleaned simultaneously. Available in an economical counter top unit or floor standing unit with automatic water filling and automatic drain control.

OPTIONAL FEATURES INCLUDE Integrated Ultrasonic System

Air and water pistols

Auto Fill System

Automated Lumen and Scope Flushing

717.261.9700 sales@tbjinc.com www.tbjinc.com