OR Today Magazine June 2020

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PRODUCT FOCUS MEDICAL CARTS AND CABINETS

CE ARTICLE SURGICAL ADHESIONS

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OUT OF THE OR EXERCISE AND MOVE THROUGH COVID-19

LIFE IN AND OUT OF THE OR

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NEW CONTEST SHARE YOUR STORY

JUNE 2020

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OR TODAY | June 2020

contents features

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NEGATIVE PRESSURE WOUND THERAPY Negative pressure wound therapy (NPWT) isn’t new – it was first developed in the 1980s. But it’s becoming more common in clinical practice today as the body of evidence supporting its use in the promotion of wound healing grows.

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MEDICAL CARTS AND CABINETS MARKET ANALYSIS

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The goal of this continuing education course is to provide nurses with information about how surgical adhesions form and how they can be managed and possibly minimized.

After studying the information presented here, you will be able to discuss the pathogenesis of surgical adhesions; describe methods of minimizing the formation of adhesions; and list several patient complications caused by surgical adhesions.

COVID-19 closed gyms across the nation.

So, here are some tips to consider when exercising at home.

CE ARTICLE

The global medical carts market was valued at $1.28 billion in 2016 and is expected to witness a compound annual growth rate (CAGR) of 15.2% through 2025.

FITNESS

OR Today (Vol. 20, Issue #6) June 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. © 2020

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INDUSTRY INSIGHTS 10 News & Notes 16 Surgical Lighting Systems 18 IAHCSMM: Challenging Assumptions, Evaluating Routines Can Aid Quality 20 ASCA: Supports ASC Response to the COVID-19 Pandemic 25 CCI: An Update from the Competency and Credentialing Institute 26 Webinars: OR Today Webinar Sets Attendance Record

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ACCOUNTING Diane Costea

EDITORIAL BOARD Hank Balch, President & Founder,

IN THE OR

Beyond Clean

28 M arket Analysis: Medical Carts and Cabinets Market Growth Predicted 29 Product Focus: Medical Carts and Cabinets 32 CE Article: Surgical Adhesions: The Ties That Bind

Sharon A. McNamara, Perioperative Consultant, OR Dx + Rx Solutions for Surgical Safety Julie Mower, Nurse Manager, Education

OUT OF THE OR 44 Spotlight On 47 Fitness 48 Health 51 EQ Factor 52 Nutrition 54 Recipe 56 Pinboard

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INDUSTRY INSIGHTS

Getinge Increases Production Capacity of Ventilators

news & notes

Healthmark Industries Now Offers SeekNFindTM Tray Tag Tool Healthmark Industries has introduced the SeekNFind to its labeling product line.

The SeekNFind provides a means to locate missing or mislaid trays and other assets. Made from PTFE Teflon, the 240 x 86mm RFID tag is assembled with stainless steel eyelets for attachment to instrument baskets and other assets. The RFID reader is paired with a Bluetooth enabled Android phone. With the SeekNFind app, available for download from the Google Play store, tagged trays and other tagged assets can be more easily found, when missing. •

Getinge announced another ramp-up in production capacity, to 26,000 ventilators in 2020.

The increase equals a growth of 160% compared to 2019, when 10,000 ventilators were produced.

The demand for advanced ventilators for the intensive care units in hospitals continue to increase globally as a result of the COVID-19 pandemic outbreak. Getinge is ramping up the production capacity stepwise at its production facility in Solna, Sweden, and is now increasing production capacity to 26,000 in 2020, compared to the previous planned 16,000 unit level that was communicated on March 17. The ramp up will start immediately and progress in close collaboration with Getinge’s suppliers.

“We continue to ramp up to be able to respond to the increasing demand from our customers,” says Elin Frostehav, vice president critical care at Getinge. “We work closely with our sub-contractors and the ramp up is of course pending availability of supply parts.” •

Cardinal Health Introduces New CFO The Cardinal Health board of directors elected Jason Hollar as chief financial officer, effective May 12. Hollar most recently served as the chief financial officer of Tenneco Inc., a global automotive products and services company.

“We are pleased to welcome Jason to the Cardinal Health family,” said Cardinal Health CEO Mike Kaufmann. “With his deep executive experience, as well as his expertise leading in dynamic environments, Jason will be a strong partner to me and the rest of our team. I’d like to thank Dave Evans for his exceptional contributions and leadership as our interim CFO. Dave will partner with Jason in the coming weeks to ensure a smooth transition and as we continue to create value in a changing marketplace.”

Hollar’s experience spans industries and geographies.

In addition to serving as CFO of Tenneco and previously as CFO of Sears Holding Corporation, Hollar held senior

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finance roles at companies including Delphi and Navistar, demonstrating both breadth and depth across financial disciplines. He also managed regional operations around the globe and led multiple transformative initiatives to drive corporate strategies.

As Cardinal Health CFO, Hollar will lead financial activities across the enterprise, including financial strategy, capital deployment, treasury, tax, investor relations, accounting and reporting. He will report to Kaufmann as a member of the company’s executive committee and will succeed Dave Evans, who will continue to serve as CFO of Cardinal Health through May 11.

“I am excited to join the Cardinal Health team,” said Hollar. “I look forward to partnering with Mike, his leadership team and the finance organization to advance the company’s strategic transformation at this pivotal time in health care.” •

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INDUSTRY INSIGHTS

news & notes

Report: Robotic Surgery Market to Exceed $12 billion by 2030 In its recently published report “Innovations in Robotic Surgery 20202030,” IDTechEx forecasts that the robotic surgery market will exceed $12 billion by 2030. The report breaks down the market landscape and emerging technologies in the field of robotic surgery.

Intuitive Surgical, manufacturer of the da Vinci Surgical System, has been the uncontested market leader in robotic general surgery for the last two decades. With 5,582 systems installed worldwide and over seven million surgeries performed with da Vinci to date, the company is so firmly established that it has practically become synonymous with the term robotic surgery.

Within the last five years, interest in the field of robotic surgery has soared. Investments in companies operating in this space have skyrocketed since 2016, recording an increase of over 300% in three years, and total investment to date has reached $1.36 billion.

Although Intuitive Surgical has long been the only company with a surgical robot cleared for general surgery, the situation could change.

Today, the market pioneer is faced with competition from more than a dozen newcomers that are exploring various configurations and approaches to robotic surgery.

Some companies aim to directly compete with Intuitive Surgical (i.e. operate in the same field, perform the same types of procedures) by developing robotic platforms that are conceptually similar to da Vinci. This means that their robotic platforms include a surgeon console, a vision cart and one

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or more robotic arms. CMR Surgical, for instance, is considered a direct competitor to the da Vinci system as its robot Versius, which became available on the market in late 2019, can perform similar tasks. The Cambridge-based company competes with Intuitive Surgical by making its robot available at a smaller cost. Apart from cost, the distinct advantage of Versius over other robotic surgery platforms is its size and portability. Unlike da Vinci, Versius’ arms are detached from each other and can be transported separately. It is smaller in size (physical footprint of 38cm x 38cm), giving surgical teams access to the patient at all times and facilitating its integration into surgical workflows.

Other companies strive to distinguish themselves from da Vinci through an alternative design, form factor or approach to conduct surgery.

Medrobotics, for example, has created a surgical robot with flexible arms that enables entry into the patient’s body through natural orifices. This circumvents the need for incisions entirely, prevents scarring and helps patients to recover quicker – they are sometimes discharged from hospital the following day. Medrobotics’ Flex Robotic System navigates through complex anatomy using 3D HD visualization capabilities. It is designed to reach challenging surgical targets by creating a 180º path. First, the surgeon navigates a 3D camera to the target destination. Once it is reached, the flexible arms containing miniature surgical instruments are deployed through the same pathway as the camera. The surgeon manually operates the instruments, which look very similar to normal laparoscopy

tools but have flexible arms.

There is also a focus on reducing the size of surgical robots in order to make them less cumbersome and more portable. In an effort to reduce the price of robotic systems, Virtual Incision is developing a miniaturized robotic device that operates entirely inside the body through a single abdominal incision. It features a small, self-contained surgical device that is inserted in the patient’s abdomen. The robot is designed to perform colon resection procedures for colorectal cancer management, meaning that its applications overlap with those of da Vinci and that Virtual Incision is competing in the same market as Intuitive Surgical. Virtual Incision have therefore designed a completely different type of robotic system to distinguish itself from the market leader. Its robot reportedly weighs two pounds, which is hundreds of times lighter than the majority of robotic general surgery platforms on the market. It is therefore portable and easily transportable between operating theatres or even hospitals. In addition, its smaller size means cheaper manufacturing costs.

Virtual Incision has thus stated that its robot will be much cheaper than those of its competitors. The system is still in development and has not yet received regulatory approval.

The robotic general surgery space is in a rapid state of expansion as numerous companies are entering the ring in the hope of seizing a portion of the market share. This is only the beginning as many of the companies’ robotic systems have only been launched in the last two years and others have yet to reach the market. •

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INDUSTRY INSIGHTS

news & notes

Philips Enterprise Monitoring as a Service Model Earns High Marks Royal Philips and Jackson Health System, one of the nation’s largest public health systems, announced new findings from a performance improvement evaluation at Jackson Memorial Hospital. The evaluation looked at the impact of its new Enterprise Monitoring as a Service (EMaaS) model six months after its deployment as part of a groundbreaking Philips partnership. Nursing staff gave the new model a 90% satisfaction rating, up from 8% prior to the new system – an 82% improvement. The hospital also estimates it will save 13,331 staff hours from workflow improvement and automation of manual tasks. Moreover, the new patient transport process has reduced the time it takes to connect a patient to a transport monitor from 5 minutes to 3.9 seconds – saving staff more than 4 minutes and 56 seconds per patient and helping to earn a 94% overall satisfaction rating from nursing staff.

Jackson Memorial Hospital, a nonprofit tertiary care teaching hospital in Miami, is the centerpiece of Jackson Health System. The 1,550 licensed bed hospital is focused on continuous improvement, including standardization of patient monitoring solutions for all acuity levels and settings, as well as improving accuracy of data. By adopting the EMaaS model, Jackson can move away from traditional capital outlay models, which can require buying the monitoring technology, consumption-based engagement or pay-

12 | OR TODAY | JUNE 2020

ing for monitoring capacity per patient. Moreover, it will give the hospital better performance visibility, utilization transparency and other improvements across the enterprise.

“Standardizing Jackson Memorial’s patient monitoring has simplified the staffing and management of our Central Monitoring Unit,” said David Zambrana, the former CEO of Jackson Memorial Hospital and current executive vice president for hospital operations of Jackson Health System.

“It has also simplified the work required to electronically send patient data to our Electronic Medical Records system, managing the network and interfaces over time. Our partnership provides the ongoing support and proactive management we want for a life-critical capability that we rely on 24/7.”

The new Philips patient monitoring solution is also interoperable and automates clinical data sharing, which saves time by quickly making critical information – such as a patient’s vital signs – directly available to staff through the Electronic Medical Record (EMR) system. Moreover, Philips will continue to provide technical support, including helping Jackson to design solutions that seamlessly integrate with core IT systems such as the EMR. Philips will also help Jackson identify clinical workflow optimization opportunities, provide continuing education and assist with asset and data management. •

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Endoscopy Products and Services

FDA Clears Siemens Healthineers RAPIDPoint 500e Blood Gas Analyzer Siemens Healthineers announced that its latest critical care testing solution, the RAPIDPoint 500e Blood Gas Analyzer, has received clearance from the U.S. Food and Drug Administration. The analyzer generates blood gas, electrolyte, metabolite, CO-oximetry and neonatal bilirubin results, which are used to diagnose and monitor critically ill patients in the intensive care unit, operating room or emergency room. Already available in countries requiring the CE mark, the RAPIDPoint 500e Blood Gas Analyzer is now available for critical care testing in the United States.

“Point-of-care teams monitoring respiratory conditions in critical care settings need a blood gas testing solution that delivers fast, accurate results and increases workflow efficiencies. A safe operating environment amid growing concerns about cybersecurity threats in health care is also important,” said Christoph Pedain, PhD, head of point of care diagnostics, Siemens Healthineers. “The RAPIDPoint 500e Blood Gas Analyzer has become a trusted instrument in Europe’s endeavor to combat COVID-19 and to help address an unprecedented demand for blood gas testing in affected respiratory patients.”

The RAPIDPoint 500e Blood Gas Analyzer is an essential instrument supporting COVID-19 response efforts, where blood gas testing plays a critical role in managing infected patients and monitoring their respiratory distress.

Routine blood gas testing is also performed when patients require mechanical ventilation. Arterial blood gas tests provide the status of a patient’s oxygenation levels and enable healthcare providers to determine whether adjustments to ventilator settings or other treatments are required.

The analyzer elevates confidence in patient results with Integri-sense Technology, a comprehensive series of automated functional checks designed to deliver accurate test results at the point-of-care.

Additionally, the RAPIDPoint 500e Blood Gas Analyzer integrates seamlessly into hospital networks with the Siemens Healthineers Point of Care Ecosystem, which offers convenient, remote management of operators and devices located across multiple sites. •

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INDUSTRY INSIGHTS

news & notes

Summit Medical Produces Face Shields In recent months, lives around the globe have been affected by COVID-19. In early March a coalition of Midwest engineers assembled a team to design an open-source medical face shield design. The design is based on shields currently used in hospitals in the Madison, Wisconsin area. Once finalized, the design was released online in an effort to get as many manufacturers involved as possible.

Shortly after the release of the design Summit Medical LLC determined it would join the scores of manufacturers coming together to create the protective equipment desperately needed by the front-line health care community.

On March 19, Summit Medical created its manufacturing plan, timelines and developed a prototype. On March 23, they made adjustments to the second prototype and placed an order for the production materials.

After just one week of collaboration with their existing suppliers, Summit Medical picked up the tooling needed to create the face shield quickly and efficiently.

On March 27, Summit Medical began manufacturing the final design of the face shield in volume. The company is training office staff to assemble face shields during a time when others in the industry are facing massive layoffs.

Summit Medical’s President Kevin McIntosh said, “The collaboration across the world to help fight this pandemic has been truly fantastic.”

In just six days Summit Medical developed the face shield, defined the manufacturing assembly process, ordered significant quantities of raw materials and released the product for manufacturing. Since the first day, Summit Medical has expanded its production capabilities daily, up to the current level around 10,000 units/day with additional refinements being engineered.

With Summit Medical’s shift to face shield production, other Innovia Medical companies have begun implementing their own face shield production. Innovia Medical companies Network Medical and DTR Medical, located in the UK, will soon have the materials needed to start production. Summit Medical plans to continue to elevate care and improve outcomes by making face shields and stocking the world with protective equipment for years to come. •

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UL Grants PurpleSun Mobile Ultraviolet System Certification for LargeScale Health Care Equipment Disinfection UL has announced that PurpleSun, a healthcare technology company providing smart, light-based solutions for infection prevention, has received the first UL Certification for a large-scale mobile ultraviolet disinfection system, the PurpleSun E300 Modular Paneling System.

The PurpleSun E300 was certified to the harmonized Standard, IEC 61010-1, 3rd Edition plus Amendment 1, the standard for general safety requirements for use of electrical equipment used in laboratories and health care facilities. PurpleSun received certification after the E300 Modular Paneling System passed extensive electrical and ultraviolet light emission testing, including risk mitigation analysis.

“Performance and safety testing is critical for successful patient care. That’s why UL prioritizes safety when testing, inspecting and certifying products and technologies,” said Deborah JenningsConner, engineering director, UL. “With this UL Certification, we quickly leveraged our expertise in electrical safety and light emissions while helping PurpleSun rapidly bring to market this solution to help achieve positive patient outcomes.”

PurpleSun’s Ultraviolet Modular Paneling System, which can be deployed to various hospital areas, uses Focused Multivector Ultraviolet (FMUV) light – focused light energy to improve germicidal effectiveness and speed – to quickly kill off organisms on medical and lab equipment.

PurpleSun Founder and CEO Luis F. Romo said, “Health care providers can have the peace of mind that the PurpleSun E300 meets and exceeds the strictest industry standards and helps ensure patient safety in the FMUV rapid treatment of equipment for the purpose of disinfection at the point of care. Our equipment plays a critical role in the fight against COVID-19. The UL Certification helps further complement our vision of sustainable impact to the quality of care for the healthiest patient-ready environments.”

According to the manufacturer, the modular mobile PurpleSun unit can be used to disinfect equipment in an operating room, hallway or patient room while staff continue to work around the system. For example, the unit can be deployed to quickly disinfect a stretcher immediately after patient use, alleviating the need to interrupt critical room and equipment downtime while promoting the health and safety of health care workers and patients.

“We are honored and privileged to be on the cutting edge of technology during this crisis and help our hospital customers on the front lines advance care, all with the help from UL and its engineering teams,” said Romo. “With the Model E300, we can help health care providers enhance safety for patients and caregivers and, ultimately, save lives.” •

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INDUSTRY INSIGHTS

news & notes

KARL STORZ Introduces TELE PACK + Compact Endoscopy System KARL STORZ Endoscopy-America Inc. has announced the launch of the TELE PACK + compact endoscopy system.

The TELE PACK + is a portable video system that combines all of the essential components (light source, camera control unit and display) needed to enable endoscopic diagnosis and treatment, as well as image capture and data management – making this solution ideal for outpatient sites of care.

“Patient volumes continue to transition from the hospital to outpatient sites of care,” said Monica Ambrose, executive director, surgical marketing, KARL STORZ. “The TELE PACK + was developed to effectively keep pace with and enable this procedural migration. It provides a visualization experience similar to what doctors are accustomed to in the OR, in a package designed specifically for outpatient facilities.”

The TELE PACK + enables health care providers to enjoy a single, standardized interface aimed to enable positive

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outcomes, enhance clinician and patient experience, and optimize overall costs. Clinicians benefit from the consistency of being able to use the same types of cameras, videoscopes and instrumentation across all locations. By deploying the TELE PACK +, administrators have the opportunity to standardize across multiple specialties (ENT, urology, gynecology) at multiple outpatient facilities. Patients can also see, firsthand and in real-time, the same endoscopic image that the clinician is seeing. Integrated documentation and networking functionalities, enable health care systems, teaching institutions, and hospitals to seamlessly connect and coordinate outpatient sites of care.

“The TELE PACK + is a perfect addition to any gynecology office,” said Amy Garcia, MD. “The compact design is streamlined and mobile, while the high-definition image provides the quality and visual detail I need to perform hysteroscopy in the office efficiently and safely. This is important for me and my patients.”

JUNE 2020 | OR TODAY |

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SPONSORED CONTENT

INDUSTRY INSIGHTS Avante

Surgical Lighting Systems: What to Consider Before Installing

By Eric Barner urgical lighting is a crucial part of every operating room. While the technology is straightforward, surgical lighting can become tricky when it comes to purchasing and successfully installing a new system in your facility. In this article, learn the importance of proper surgical light installation and how to help make the entire process go as smoothly as possible.

S

When choosing surgical lights, there are three major configuration choices: ceiling mount, wall mount, or portable mount. These are often available in configurations with multiple light heads, allowing you to customize the system so it meets your facility’s illumination requirements.

The Importance of Proper Surgical Light Installation Once you’ve chosen the correct lighting system configuration for your facility, we get to the most important part – installation. In order to get the full use out of your lighting system, not to mention avoid costly building repairs or damage to your equipment, surgical lights must be installed properly.

One of the most common results

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of improper light installation is when light heads drift from their intended location. Not only are the lights incapable of maintaining steady illumination of the operative area, but dual configurations can also knock into one another and cause damage to the light heads. Without adequate planning, lights can also sit too low in the operating room and restrict movement. In absolute worst-case scenarios, faulty lights can cause electrical shock or fall from their ceiling mounts.

Avoid the pitfalls of improper light implementation by purchasing surgical lights from a reputable supplier that also offers installation services. Find a company that has the skilled technicians who have developed processes to ensure safe and effective installation. Though this may mean a substantial price increase upfront, the benefits and peace of mind are worth the investment.

Leave It to the Professionals The most crucial part of surgical light installation is being able to assess the existing support structure, also known as the superstructure, and make needed adjustments. The superstructure will ultimately support the entire lighting system, so it’s vital that the construction is up to the task.

Depending on the state of the exist-

ing superstructure, installation could encompass just a few minor updates or a complete retrofitting process.

All of this must be completed while negotiating around rigid vent ducting, electrical conduits and wires, air handlers, and gas and water piping.

In addition to evaluating and reinforcing the lighting superstructure and handling the electrical installation, professional surgical light installers also use the proper techniques and hardware to ensure that the light heads achieve their full range of motion and don’t drift during use.

Professional installers also adhere to medical facility standards from Infection Control Risk Assessment (ICRA) Best Practices and Interim Life Safety Measures (ILSM).

How to Make the Installation Process Easier To make the surgical light installation at your facility go as smoothly as possible, some preliminary steps are recommended. These set up clear communication and expectations between your facility’s staff and the light installers and helps to make sure everything goes according to plan.

First, assign a point of contact at your facility who will act as the liaison between your team and the surgical WWW.ORTODAY.COM

TREAT YOUR FEET

light installers. The point of contact can help to establish a timeline for construction and determine what kinds of paperwork and facility access permissions are needed to begin the installation process. If an on-site evaluation is needed before construction begins, the point of contact would be present to help answer any questions.

Before installation begins, it’s helpful for the installation team to have a good idea of the operating room’s size and specifications. This information is typically found in building blueprints, and should include the following: Facility specifications, electrical or otherwise Building structure type Wall and/or ceiling material type Distance from the finished floor to the finished ceiling Distance from the finished floor to the existing superstructure Distance between ceiling trusses In addition to these preliminary measurements, photos of the existing support structure and related interstitial space can help light installers to determine implementation strategies.

Before installation begins, the electrical drop for connection should be established. The electrical drop will also need to be on a dedicated circuit. All equipment should be cleared out of the operating room if possible, allowing the installation team full space to work without navigating around valuable surgical equipment. The established point of contact for your facility should be present for the beginning of the installation process and should be easy to connect with for the duration of the project.

Eric Barner is a biomedical engineer for Avante Health Solutions. To learn more about our selection of surgical equipment and related services, visit https://avantehs.com/medical.

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INDUSTRY INSIGHTS

IAHCSMM

Challenging Assumptions, Evaluating Routines Can Aid Quality

NICHOLAS SCHMITZ President, Schmitz Consulting LLC

By Nicholas Schmitz, PMP, LSSBB cross our personal and professional lives, we all fall into many routines; it’s part of how we’re able to perform so many different tasks every day.

Have you ever arrived at work (or home), only to realize you don’t even really remember the drive? That isn’t to say you were unsafe or not paying attention – it’s just that driving has become so routine that we don’t always form a memory of it.

A

The same goes for many other things we routinely do. Sterile Processing and Surgical Services professionals get the job done in their respective disciplines that literally affect patient safety and outcomes; however, the importance of taking a close and honest look at what both disciplines do and how they do it becomes paramount for ongoing quality improvement. If we don’t remember doing something (or don’t recall paying close attention to each step) how can we think to find ways of improving? I’ve found that the best way to overcome that obstacle is to challenge our assumptions. We must strive to experience the familiar in a new way and see it from a different perspective.

What follows are a few exercises

18 | OR TODAY | JUNE 2020

I’ve used with teams over the years to help them see some of their blind spots, identify opportunities and encourage everyone to be receptive to them.

1. Breaking out of the “But I’ve always done it that way” rut This exercise illustrates how easy it is to develop and adopt subconscious habits; it also points out that there are often equally effective, alternative ways to accomplish an objective.

Finally, it helps demonstrate that old ways of doing things may interfere with adopting new (and better!) behaviors. Sometimes, we must un-learn what we have learned.

Procedure Ask one or more participants to stand and remove their coats. Then, ask them to put the coats back on, and take note which arm goes in first. Ask them to remove their coats once more.

This time, ask them to put the coat back on, starting with the other arm.

Discussion Questions How did it feel to reverse or alter one’s normal routine?

Was it difficult or awkward, and why?

What prevents us from adopting

new ways of doing things? How can we make changes without old habits interfering with them?

How can we open ourselves to change within the program and accept that there are equally effective or even better ways to accomplish tasks?

2. Letting go of myths and misconceptions This exercise can illustrate to a group how easy it is to hold onto misconceptions about a process, topic or practice; it can be especially helpful if a specific process or change must occur, but people in the team are resisting.

Procedure Define “myth” for participants, explaining that it is “a fiction or halftruth that appeals to the consciousness of people while expressing some of their deep, commonly felt emotions.”

From there, progressively identify common societal myths, such as: One size fits all You’re only as old as you feel The check is in the mail People hate change It’ll only take a moment to fix this Then, add a myth from your department. For example, one organization I worked with insisted that WWW.ORTODAY.COM

AUGUST 16-18 | DENVER, CO

SPEAKER Spotlight a specific tray must not be opened for inventory because it was vital to surgical procedures. Upon inspection, it was identified that it hadn’t been sterilized in more than 10 years. How vital was this tray if it hadn’t been used in more than a decade and what could have been the outcomes if that tray had been used on a patient?

Discussion Questions Where/how might this myth have originated?

Which factors contributed to the perpetuation of this myth?

How can the myth be dispelled? Is there a metric that would pertain to this?

Is it a myth or is there a large measure of truth to it? Most myths are at least partially rooted in truth.

It’s possible or even likely that an extreme event that occurred long ago triggered a change, but the facts behind the event and the rationale for change became lost or skewed over the years.

3. Releasing the team from the Pike Syndrome This exercise helps illustrate how limits of a person’s training/learning often lie within oneself.

Procedure Relate the story of a large fish called the Northern Pike. It was placed in one-half of a large aquarium with numerous minnows that were visible yet unreachable placed in the other side of the glass-divided tank. The hungry pike makes numerous attempts to get the minnows; however, after learning that the minnows were unreachable, WWW.ORTODAY.COM

the pike eventually gives up. With this learned behavior, even when the glass partition is then removed, the pike does not attack the minnows. The pike’s subsequent behavior is known as Pike Syndrome. Some actions associated with this condition include: Ignoring differences Overgeneralizing reactions Rigidly committing to the past Refusing to consider alternatives Being unable to function well under stress Discussion Questions What are some examples you’ve seen where people seemed to exhibit signs of Pike Syndrome?

How can we help others and ourselves break out of this routine?

Are there any benefits to the Pike Syndrome?

Conclusion It’s important that we keep our minds open to new possibilities. Sometimes, especially with success, it can become increasingly difficult to identify new opportunities for positive change because we might assume that since an issue was already successfully addressed, it no longer deserves our attention. But quality is an ongoing pursuit. Improving our processes should be perpetuated, not the myths that often surround them.

Nicholas Schmitz, PMP, LSSBB, is president of Schmitz Consulting LLC. He holds two master’s degrees in organization development and change management, and project management, and is a certified Project Management Professional and Lean Six Sigma Black Belt.

“

MY HOPE IS THAT OTHERS WILL FIND THEIR OWN PASSION AND FEEL EMPOWERED TO CHALLENGE AND TO BRING INNOVATION TO THEIR PRACTICE.

”

– Sarah Bosserman Matulewicz MSN, RN, CNOR

Sarah is a speaker at OR Today Live!

To learn more, visit www.ortodaylive.com.

JUNE 2020 | OR TODAY |

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INDUSTRY INSIGHTS ASCA

ASCA Supports ASC Response to the COVID-19 Pandemic

By Bill Prentice s I write this message, COVID-19 cases in the U.S. are continuing to rise and health care providers, federal and state officials and private citizens across the country are beginning to come to grips with the magnitude of the response needed to control the spread of the virus and care for those who have been affected.

A

At ASCA, our sincere sympathy goes out to everyone who lost a friend or family member to this invisible enemy and our hopes for a full recovery go out to all who are still suffering the effects of the virus. Many people, in health care and other professions, have been on the frontlines for many weeks leading the national response to the COVID-19 pandemic. They are providing everything from emergency room care to the labor needed to sustain the nation’s food supply, and we want to recognize and thank them all.

The short amount of time it took for COVID-19 to go from a newly discovered virus that was being given a name for the first time to dictating the daily activities of people around the world is staggering. That also means that everyone involved in response efforts had an extremely limited time to plan and react.

Even before the pandemic was declared, ASCA recognized three important ways the association needed to take action to support the ASC community in its response efforts.

First, we knew we needed to be a responsible, reliable source of information to ASCs, sharing important news

20 | OR TODAY | JUNE 2020

and resources as soon as they became available. Second, we knew we had to make sure that ASCs were represented in the conversations that federal, state and local officials were having as they developed their response and recovery plans. Third, we knew we had to be able to provide reliable information about ASCs to those coordinating national, state and local response.

Thanks to a strong network of ASC leaders and deep-rooted advocacy ties to state and federal policymakers – developed over many years through the efforts of our members – that ASCA was able to mobilize quickly, provide essential information and help guide the decisions that were made.

As a fuller picture of the spread of the coronavirus in the U.S. began to emerge, one of the first steps ASCA took was to create an online COVID-19 Resource Center on ASCA’s website (www.ascassociation. org/covid-19). There, we collected information of all kinds that affected or involved the ASC community’s response. At the beginning, ASCA staff worked 24/7 to update those resources several times a day. New information released from sources that included the federal government, specialty societies, accrediting bodies and ASCA itself was generated quickly and posted to the site as soon as it arrived. We continue to update that site regularly today, although the pace that new information has been arriving has slowed considerably.

At the same time we were compiling these resources, we were working with members of the media to try to make certain that the news about

the expanded capacity ASCs could provide and the steps they could take to contribute to the COVID-19 response in the U.S. was being shared in meaningful ways. We also worked with the media to help provide the public with an understanding of what constitutes elective surgery, why ASCs were closing or curtailing operations and the options available for emergent and necessary surgery.

At the same, we were in talks with staff at the White House, the U.S. Department of Health & Human Services and the Centers for Medicare & Medicaid Services, as well as members of Congress and state governors and legislatures across the country. As these officials addressed questions about scope of practice, shared resources and the availability of trained staff, we were able to accurately represent the ASC community’s ability to contribute. When questions arose about financial assistance that might become available, ASCA was there to point to the special needs of ASCs as small businesses and the challenges ASCs will face when they attempt to reopen once the emergency declaration is lifted and operations previously considered normal are once again deemed safe.

All of this time, we were also responding to questions from across the country and around the world from outpatient surgery providers and other health care professionals trying to uncover what was working best, where, when and why? Everyone was trying to anticipate what they needed to prepare for next.

It is still too soon to predict what WWW.ORTODAY.COM

long-term effects the COVID-19 pandemic will have on our nation’s health care system, our economy and our way of life. All of us still have a lot of work to do to manage the effects of COVID-19 and, as some suggest, prepare for the next time, whether that involves the coronavirus or some other unknown agent.

One thing is clear: without a strong network coordinated through ASCA and supported by the state ASC associations, ASCs across the country could not have responded as quickly or had the same opportunity to provide valuable input into the decisions that were made. As we continue to respond and recover from this pandemic, if you work in an ASC, please make sure your facility is an ASCA member.

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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

”

Delores is a speaker at OR Today Live!

To learn more, visit www.ortodaylive.com.

WWW.ORTODAY.COM

JUNE 2020 | OR TODAY |

21

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INDUSTRY INSIGHTS

CCI news & notes

An Update from the Competency and Credentialing Institute

By James X. Stobinski hese are extraordinary times. The COVID-19 virus is having an incredibly disruptive impact on American health care to include perioperative nursing.

At CCI, we have been able to continue uninterrupted service to our nurses, in working from home and practicing social distancing since early March. In the contact we have had through emails, phone conversations and social media we are being told of profound changes for many nurses working in the operating room setting.

T

One pervasive trend we have noted is that elective surgeries have been curtailed severely in many facilities and that overall surgical volume is way down. This presents an interesting dichotomy as surgical suites are underutilized and other work areas such as ICUs and emergency rooms are overcrowded and maxed out to capacity.

We also have heard anecdotal reports of perioperative spaces such as post anesthesia care units being converted to inpatient critical care units. These are jolting changes for perioperative nursing.

As surgical volume has decreased many nurses have reported that they are faced with either using their precious paid time off (PTO) or going unpaid. It is also possible that some perioperative nurses will be furloughed or terminated due to a lack of WWW.ORTODAY.COM

cases. This presents a rapid swing from an overall shortage in the specialty to potentially being out of work.

Some nurses have been offered an alternative in being floated to another work area but that raises other issues (Mathias, 2020). Perioperative nursing is a highly specialized skill set which does not easily transfer to a wide set of other work areas.

Perioperative nurses tend to have long careers in surgery and movement away from the specialty are rare once a nurse has developed a level of proficiency in the setting. It is likely that few perioperative nurses have any recent meaningful experience in other specialties. Simply holding an RN credential cannot guarantee competency in an ICU or med-surg setting. One of our CCI nurses, Julie Mower, opines that a return to team nursing concepts may allow nurses working in surgery to contribute in other units. Flexibility and adaptability are hallmarks of perioperative practice and with some degree of orientation this may be a workable compromise.

We must also realize that there is a rippling effect from rapid decreases to surgical caseloads. Other units and departments will also be affected; consider central processing and the post-surgical units as two examples.

The OR is the economic engine of the hospital and we have now shut down that engine or cut it to a low idle. We must consider that not only have we markedly decreased revenue, but these

same facilities are also incurring great expense in treating resource intensive COVID-19 patients for which reimbursement may be very low or non-existent.

There are some lessons to be learned from these experiences.

Training and preparation, particularly for these worst-case scenarios, is a valuable investment. Maintaining a high state of readiness, as expensive as that may be, is also wise. Ensuring the readiness of critical equipment such as ventilators can also be anticipated as necessary. Recent experience with the SARS and MERS viruses provides valuable lessons here.

At CCI we continue to work with the hope that our country and health care system will eventually get through these incredibly challenging times. Please know that CCI staff are available to you to answer certification and recertification questions. Our intent is to be as flexible as we can in meeting your ongoing professional development needs. As a team, we encourage you to be safe and we are sincerely grateful for your efforts in these extraordinary times.

Reference Mathias, J. (2020). Hospitals redeploy surgical specialists to front lines to fight COVID-19. Accessed April 2, 2020 at: https://www.ormanager.com/briefs/hospitals-redeploy-surgicalspecialists-to-front-lines-to-fight-covid-19/

JUNE 2020 | OR TODAY |

25

INDUSTRY INSIGHTS

WEBINAR SERIES

news & notes webinars

OR Today Webinar Sets Attendance Record Staff report R Today hosted a webinar on April 9 with 373 attendees, the most for a session in 2020! The webinar “COVID-19 Best Practices - Where We Are and Where We Are Heading!” was sponsored by RepScrubs and presented by Dr. John Kutz. It was eligible for one (1) continuing education (CE) hour by the State of California Board of Registered Nursing.

O

In the 60-minute webinar, Kutz, F.A.C.S. Medical Advisor at RepScrubs, discussed COVID-19 best practices. Kutz discussed what is happening on in the front lines right now and how to improve protocols for the future.

More than 700 individuals registered for the webinar with 373 live attendees and more have watched a recording of the session online. Those in attendance for the live presentation shared positive comments and reviews in a post-webinar survey.

“This was about the best COVID-19 webinar I’ve viewed in the past eight weeks! I have passed the link on to several colleagues and recommended it. Our hospital plans to institute several of the best practices discussed,” Infection Control Nurse R. McKanna said.

“An excellent webinar presentation

by Dr. Kutz who provided an outstanding presentation that was clear, engaging, informative and pertinent.

This is my first OR Today webinar experience and it certainly won’t be my

26 | OR TODAY | JUNE 2020

“ This was about the best COVID-19 webinar I’ve viewed in the past eight weeks! I have passed the link on to several colleagues and recommended it. Our hospital plans to institute several of the best practices discussed.” – R. McKanna, infection control nurse last. Thank you for making this service available,” said C. Cerame, president/ owner.

“Always great to get informative information from the best. Thank you for providing these educational sessions for our front-line staff,” shared B. Seider, ANM Surgical Services.

“The presentation was validation that my organization’s COVID-19 prevention efforts are aligned with current best practices for the operating room,” Director of Surgical Services K. Jenkins said.

“This webinar was a clear and concise response for operating room workers to the COVID crisis,” said J. Barber, assistant manager.

“Very relevant webinar, definitely interesting to hear the physician’s side,” Clinical Education Specialist W. Brown said.

“Another outstanding webinar from OR Today. I try not to miss these outstanding educational opportunities,” Clinical Resources Specialist J. Geeary said.

“Enthusiastic, knowledgeable speaker with current information that is both practical and thought provoking. Thank you for offering this webinar on such a timely subject matter,” exclaimed E. Vane, health science

teacher (SPD practicum).

“Speaker is excellent, it is the second time I have attended one of his webinars. I wish I worked with such a level-headed engaged physician. He is an inspiration,” said M. McIntyre, director of nursing/operations.

“Very up-to-date information and a good way of receiving it. I like the OR Today webinar series and think it’s a great way to learn about current issues and responsibilities,” said M. Mortensen, CBET owner.

“It was informative and eye opening. It is always a great experience to hear what others are doing about common issues. Sometimes when you are in it, it is hard to see the solution,” said I. Munoz, director of perioperative services.

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

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market analysis

Medical Carts and Cabinets Market Growth Predicted Staff report he global medical carts market was valued at $1.28 billion in 2016 and is expected to witness a compound annual growth rate (CAGR) of 15.2% through 2025, according to Grand View Research (GVR).

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A rising incidence of musculoskeletal injury (MSI) and the growing adoption of electronic medical records (EMR) in hospitals are key contributors to market growth. Increasing adoption of mobile carts can be attributed to the availability of technologically advanced products that offer better configuration, construction, options and features to meet requirements of consumers.

To offer hassle-free care to patients, a selection of appropriate mobile carts is crucial. For example, demand for small-handled devices is increasing to streamline routine clinical workflows, including medication recording, supplies used for fluid administration and detailed documentation of inpatient admissions, according to GVR. “Growing need to help medical and surgical staff is expected to propel market growth over the forecast

28 | OR TODAY | JUNE 2020

period. On the surgical floor, a secure medication cart coupled with a tablet PC is more convenient than using a separate medication and computer cart. This saves space as well as cost,” according to GVR. “Critical care units have limited floor space and can benefit from such solutions. As a result, demand for medical carts in these units is expected to increase over the forecast period.”

The emergence of telemedicine/ telehealth and availability of technologically advanced medical carts are among factors contributing to market growth. These products improve nursing efficiency, and this helps in better caregiving to patients. Rise in demand for point-of-care diagnostic technology is also a key growth driver.

Mobile computing carts held the dominant revenue share in 2016 owing to high adoption by hospitals.

Technologically advanced mobile computing carts have a battery-operated system consisting of a lithium iron phosphate battery. In addition, changing ergonomics and advanced designs for mobile medical carts are expected to boost demand over the forecast period. Vendors are focusing

on development of easy-to-implement technologies to gain an edge over their competition.

Increasing emphasis on improving nursing efficiency, growing need to curtail hospital costs, and rising importance of quick and easy accessibility to critical medical supplies and equipment in hospitals are some of the factors contributing to the high adoption of mobile computing carts.

Furthermore, supportive government initiatives for the adoption of EMR and telehealth services in hospitals are contributing to the dominance of the segment in the market for medical carts. Increase in adoption of EMR such as Electronic Medication Administration Record (eMAR) and Bar Code Medication Administration (BCMA) to prevent medication errors is anticipated to propel market growth.

Allied Market Research forecasts growth, too.

The global medical carts market is expected to reach at $1.3 billion by 2023 from $571 million in 2016, registering a CAGR of 12.4% from 2017 to 2023, according to Allied Market Research.

WWW.ORTODAY.COM

IN THE OR

product focus

BD

Pyxis Anesthesia Station ES BD Pyxis Anesthesia Station ES offers increased medication safety and anesthesia workflow efficiency in the operating room. This solution helps to control access to medication, standardizes medication management and supports regulatory compliance. The patient-centric workflow gives anesthesia providers quick access to a controlled substance for a patient during a case. Selecting medication directly from the patient case screen reduces workflow interruptions.

The clean user interface highlights patients with the same last name, enabling anesthesia providers to more carefully select the correct patient. In addition, barcode scanning technology helps reduce the risk of medication errors on removal as well as during the replenishment process. •

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The HushKarts are designed for quiet mobility with rubber-cushioned 4-inch sealed bearing casters.

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The one-piece, double-wall polyethylene construction (no creaking bolts and no rattling metal) will not rust, corrode, dent or peel. One-piece seamless construction eliminates hard-to-clean grooves and crevices. Available in three colors, establish a colorcoding system to fit your needs. Choose a color (slate blue, dark brown, coffee beige) to coordinate with the décor. •

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JUNE 2020 | OR TODAY |

29

IN THE OR

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TBJ Inc. offers the finest stainless steel casework, shelving, storage cabinets and custom specialty solutions for hospitals, laboratories and health care facilities. The company fulfills the clinical needs of health care professionals with solutions built from quality materials and expert craftsmanship.

The storage cabinets include stainless steel wall cabinets, base cabinets and tall storage cabinets that are specifically designed for sterile processing departments as well as the operating room area. The goal is to create a new or renovated environment that will satisfy the needs of the facility both now and in the future. TBJ offers a variety of sizing options and can customize products for situations that call for specialization. •

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30 | OR TODAY | JUNE 2020

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IN THE OR

product focus

Total Scope Endocart

The Endocart was created for GI nurses by GI nurses to help solve the challenges they face every day in the procedure room. Endocart is one of only a few brands of endoscopy carts on the market today. Lightweight and durable, these carts have a variety of customizable options, including monitor mounts, shelves, storage baskets, scope hangers and drawers. The company offers three models including a motorized version for increased efficiency and safety while keeping all medical supplies organized during transport. All models come with an 18-month warranty. • For more information, visit www.endocart.com.

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31

CE573

IN THE OR

continuing education

Surgical Adhesions: The Ties That Bind

By Nancy Bellucci, PhD, RN, CNOR dhesions that form in the surgical site create problems ranging from minor discomfort to intense pain. Some patients experience ischemic tissue and obstruction as the adhesive bands become more fibrous with embedded collagen and vascular ingrowth over time.

Repeat admissions for adhesive small bowel obstruction and the resultant surgical procedures cost an estimated $1.3 billion and contribute to 2,000 patient deaths in the U.S. annually.1

A

Adhesions form in 90% of patients who undergo abdominal surgery.2,3 Many pharmacological agents are still in the experimental phase and are not readily available for use in humans. A randomized-control study, performed in 2016, evaluated the use of a pharmacological agent that optimized hemostasis and reduced the formation of fibrin bands at wound bed — the primary elements of adhesion formation.

This study was performed on 68 male rats to identify adhesion-prevention capability pharmacological agents, including agents in powder form that turn into a gel. The results indicated that the use of the powder form of the pharmacologic agents significantly reduced the incidence of adhesions when premixed as a gel.3

32 | OR TODAY | JUNE 2020

The study results indicated that the use of other commonly used agents did not significantly reduce the incidence of adhesion formation in the rats. There is a gap as it relates to human studies that use pharmacological adhesion agents; however, this study did indicate that pharmacological agents have been actively used for both laparoscopic and open surgery.3 A 46-month study of 715 postoperative lower-abdomen surgical patients was conducted. A total of 88% of the participants continued to the end of the study. At the time of the initial surgical procedure, 68% of all patients were found to have some degree of existing adhesions, although 36% had no abdominal surgical history. By the end of the study, 10% of the participants experienced small bowel obstruction caused by surgical adhesions.

The study projected that an additional 6% of the postoperative patients would develop a small bowel obstruction within four years after the study. Perioperative caregivers should understand how adhesions form and how conscientious practice in surgery can help minimize the risk.4 Adhesions can form if breaches occur in the two-layer semipermeable membrane that lines body cavities, such as the pericardium, peritoneum, and pleura. The membrane houses a single layer of flat mesothelial cells in between its two layers: 20% parietal (outer) layer and 80% viscer-

Relias LLC guarantees this educational program free from bias. The planners and authors have declared no relevant conflicts of interest that relate to this educational activity.

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

Goal and objectives The goal of this surgical adhesionscontinuing education course is to provide nurses with information about how surgical adhesions form and how they can be managed and possibly minimized. After studying the information presented here, you will be able to: •

Discuss the pathogenesis of surgical adhesions.

•

Describe methods of minimizing the formation of adhesions.

•

List several patient complications caused by surgical adhesions.

al (inner) layer. The intact mesothelial surface secretes a lubricating transudate over the visceral surface of internal organs. This process prevents the organs from rubbing together and transports leukocytes in response to inflammation. Transudate is a natural lubricating fluid that contains plasminogen, which prevents significant buildup of fibrin (a stringy, sticky natural WWW.ORTODAY.COM

IN THE OR

continuing education protein found in body fluids). The buildup of fibrin is one of the main causes of adhesions, and studies are in process to define natural regulatory processes to inhibit fibrin activity.3 The molecule responsible for fibrin production is transforming growth factor-beta (TGF-beta).3 Breaches in the mesothelial surface with areas of resultant ischemia allow fibrin to accumulate and form strands of dense tissue that encircle and encase surrounding structures. Studies have shown that inhibiting TGF-beta may be a major target for minimizing the risk for adhesions.5,6 Areas that have not been exposed to surgery are often called “virgin territory,” and severe adhesions are not generally found within the tissues unless an infectious or inflammatory process has taken place.5,6 Working in a “virgin abdomen” is less complicated because structures are less distorted by postoperative scarring.

Adhesions (or synechiae) generally form within body spaces and over organs in response to damage to the mesothelium during surgical incision and retraction.7 Other causes of adhesions include extreme inflammation, infection, foreign body reaction, and trauma.6,7

No Clear Way to Predict No blood tests exist to indicate the risk of postoperative adhesions. A patient’s condition, such as a predisposition for intense inflammatory response, can signal an increased risk. In the average patient, no clear way exists to predict adhesion formation. But physiological differences between the sexes place females at increased risk for surgical adhesions. The male pelvis is contained within a closed peritoneal sac with no natural external entry points.

Male reproductive structures are extraperitoneal and isolated from external sources of direct contact with harmful materials in the environment.6 The female system is covered with peritoneum but has direct openings to the external environment through the lumen of the fallopian tubes.

The internal openings of the fallopian tubes open into the peritoneal sac. These openings create direct entry points for WWW.ORTODAY.COM

infection, foreign material, and external contaminants that can damage the mesothelial surface, which may cause adhesions and primary infertility caused by pelvic inflammatory disease.6

caused by extrauterine pregnancies are extreme and often result in retained placental remnants that cannot be removed because of vascular connections.6

An Inflammatory Response While the cause of adhesions in some patients is unknown (idiopathic), one cause may be an excessive inflammatory response, such as that seen in chronic appendicitis or endometriosis. Endometrial implants, or tissue, embedded in the peritoneal cavity bleed in response to the crescendo and decrescendo of hormones every month. Implants can occur on any surface in the peritoneal sac, causing significant disruption in the mesothelium over the small bowel and surface of other intra-abdominal organs.2 Intra-abdominal menstrual flow is shed monthly into the abdomen, which triggers intrinsic inflammation, necessary for the removal of blood cells and endometrial debris via phagocytes. The resorptive properties of the vascular system in the peritoneal sac are overtaxed as inflammation builds and fibrin formation exceeds the mesothelial production of fibrinogen.7 Abdominopelvic organs, such as loops of the small bowel, adhere to each other with fibrous bands. Female reproductive structures, such as ovaries and tubes, commonly fuse together, occluding the lumen of the fallopian tube itself. Ovarian surfaces thicken and sequester clotted blood, causing endometriomas (ovarian cysts caused by endometriosis) that prevent ripe follicles from ejecting mature ova for fertilization.6,7 Released under these circumstances, an ovum often cannot enter or pass through the fallopian tube. In some cases, an ovum enters the fallopian tube and is fertilized, but the lumen entraps the fertilized ovum, causing an ectopic pregnancy.6 Sometimes, a fertilized ovum cannot enter the tube and attaches to an external surface, such as the ovary or the uterine surface. An extrauterine pregnancy creates serious problems for patients and rarely results in a viable fetus. Adhesions

©2008 A.D.A.M., Inc.

Physician-prescribed treatment or therapy sometimes induces adhesions, which are then called iatrogenic adhesions.

Starch peritonitis or granulomas (localized nodular inflammation found in tissue) are common problems in postoperative patients. Cornstarch used as a glove lubricant triggers a foreign-body inflammatory response in the surgical site that stimulates production of fibrin and formation of adhesions. This is particularly a problem for patients with corn allergies. The allergic response augments the inflammatory response and exceeds the body’s natural ability to clear the offending agent by mobilizing white blood cells.6 Foreign body inflammatory reaction results from material introduced into the surgical site, including absorbable sutures and surgical sponges.6 Absorbable sutures often augment the inflammatory processes during the resorptive process. This can be minimized by using fine, inert, synthetic single-fiber sutures. Surgical sponges used as visceral protection during dissection can shed lint particles that cling to tissue.

When laparotomy sponges are placed into a saline irrigation basin to moisten them, lint is visible floating in the solution. The fibers can also be seen floating in the basin under the OR spotlights after wringing out the sponges. Irrigating the patient’s surgical site with lint-laden fluid creates a risk for foreign body inflammatory response, leading to adhesions.6 One way of moistening sponges without dipping JUNE 2020 | OR TODAY |

33

IN THE OR

continuing education them into the basin is to use a bulb syringe to sprinkle the sponges lightly before use.

The solution in the basin remains clear of lint.6 Preventing the transfer of particulate by the scrub person contributes to the well-being of the patient and represents surgical conscience rather than surgical convenience.6 Patients with adhesions may have no symptoms, or they may experience discomfort that ranges from mild to extreme pain with symptoms such as abdominal bloating, nausea, vomiting, loud bowel sounds, constipation, and inability to pass gas or have a bowel movement. Postoperative bowel resection patients may have anastomotic healing problems related to adhesions.6 Some have no complaints until a loop of small bowel becomes entrapped or strangulated in adhesions.7 The main complaint usually begins with acute or chronic pain and can extend into a full-blown bowel obstruction. The small bowel is most often affected.7,8 Some patients have no adhesion-related pain until a clinician manipulates the abdomen during an exam. The exam can reveal location, extent, and severity.

Few Exceptions Almost every surgery is subject to some type of adhesion or scar formation. Adhesions often form in the abdomen, but can also form in joints, intravertebral spaces, the uterine cavity, the bladder or ureter, and in many spaces not usually associated with abnormal scar formation. Scars and adhesions distort the anatomy and vascular structures. This distortion causes difficulty during subsequent dissection because it creates multiple areas of venous oozing that complicate maintenance of hemostasis.

Some surgeons refer to areas of previous surgery as “hostile,” particularly in the abdomen or chest (e.g., “hostile abdomen” or “hostile chest”) because of the scars and ensnared tissues or organs displaced by previous procedures. Anatomic landmarks can be distorted and structures made difficult to differentiate during abdominal dissection.7,8 Surgeons must make

34 | OR TODAY | JUNE 2020

incisions over a “hostile abdomen” with caution because organs and nontarget tissues may be adherent directly under the incised abdominal wall. An unintentional enterotomy (opening a segment of bowel) can ensue if the surgeon accidentally cuts the bowel when making an incision into the abdomen. Sharp dissection is kept to a minimum during the surgical separation of adhesions (adhesiolysis); surgeons commonly use blunt dissection to separate bands between loops of bowel.7,8 Adhesions range from filmy strands attached between organs to thick vascular bands that bind structures tightly to each other and the bordering anatomic wall.

Adhesions are classed as type 1 de novo or type 2 reformed, according to origin. Type 1 de novo adhesions are newly formed strands found on initial intra-abdominal inspection or immediately after first abdominal entry. Type 2 reformed adhesions (scar tissue due to surgery) develop at the site of previous adhesiolysis.8 One study found that up to one in three laparotomy patients were readmitted at least twice for symptoms associated with adhesions.7,8 Most of the initial surgical procedures involved the colon, ovary, fallopian tubes, or uterus. Many surgeons performed adhesiolysis to release adhesions caused by previous surgeries.

Unfortunately, type 2 reformed adhesions developed after the release of the initial adhesive bands. In OB/GYN patients, adhesions are a common cause of secondary infertility (22%) because of fallopian tube involvement with inflammation after laparotomy.

Entering a chest after a previous sternotomy, such as one performed for coronary bypass surgery, is equally as vexing: Adhesions may have formed after the earlier surgery.

Medical records from the previous sternotomy should indicate whether a conduit graft from the saphenous vein or the radial artery was used for revascularization, or if an in-situ right or left internal mammary artery was anastomosed distal to the blockage to bypass the blocked coronary artery.6 Knowing which bypass

vessel was used is important, but often the pericardium is not closed, to minimize the risk of cardiac tamponade postoperatively. Cardiac patients have chest tubes after surgery, which can augment the inflammatory response and stimulate the formation of additional intrathoracic adhesions. The result of opening the thorax and draining it postoperatively is often adhesions of the mediastinal viscera to the chest wall and a “hostile chest” scenario.

Reoperation in an adhesion-laden chest puts grafted aortic conduits at risk and seriously compromises the integrity of internal mammary artery grafts still continuous with the chest wall.6 Surgeons wrestle with postoperative complications, such as visceral ischemia and obstructions caused by surgical adhesions, trying to minimize them by modifying their surgical techniques and using anti-adhesion pharmacologic preparations.6,7 Techniques that minimize complications include wearing powderfree surgical gloves, using minimally invasive endoscopic instruments, reducing the use of monopolar electrosurgical devices that leave charred residue for the body to resorb and trigger inflammatory response, minimizing the interruption of arterial blood supply and venous drainage, promoting meticulous hemostasis, and ensuring copious irrigation of the surgical site with saline preparations before closure.6,7

Laparotomy vs. Laparoscopy One study compared adhesion formation in patients who underwent a laparotomy with patients who underwent a laparoscopy. All surgeries were on “virgin abdomens” (i.e., none of the patients had had previous abdominal surgery).4 This study and others resulted in no clear-cut findings as to whether laparotomy or laparoscopy caused more adhesions. Both approaches caused adhesions to varying degrees depending on the initial preoperative diagnosis and surgical manipulation with resultant inflammatory response.2 Laparotomy-induced adhesions through tissue trauma because of glove powder, sponge lint, tissue dryWWW.ORTODAY.COM

IN THE OR

continuing education ing, reabsorption of sutures, and residual blood or irrigation solution. Laparoscopy-induced adhesions through tissue manipulation, suture resorption, residual blood or irrigation solution, and drying of tissues caused by insufflation of carbon dioxide to create a working space.2,4 The severity of adhesions differed between laparotomy or laparoscopy groups with no recommendation on a preferred surgical approach.2,4,6,7 This was confirmed by peritoneal biopsy.

Both laparotomy and laparoscopy caused postoperative scars to some degree because of the interruption of the mesothelial layer inherent in any incision into the peritoneum.7 Several patients in both groups required adhesiolysis during the second-look procedure to alleviate symptoms.4,6,7 Adhesion pharmacotherapy is based on understanding adhesion pathogenesis and using barriers to separate surfaces until mesothelial layers regain enough integrity to prevent fibrin bonding. Ideally, fluid/solid pharmacological barriers minimize inflammation, prevent fibrin clots, inhibit fibrinoblastic activity, and stimulate fibrinolysis. Fluid barriers employ nonsteroidal anti-inflammatory drugs, anticoagulants, and fibrinolytics in a hydrogel or polymer base. Some additives are time-released for a prolonged effect. Several barrier solutions or gels can be instilled during open or endoscopic procedures. Placement cannot be controlled precisely because of body position changes in the resorptive period.

Adhesion barrier products are membranous sheets positioned and secured with more precision with sutures.2,3,9 Antiadhesion barrier products can be composed of many types of substances, such as bovine (beef) collagen, regenerated cellulose, expanded polytetrafluoroethylene (PTFE), polylactide, or hyaluronic acid/ carboxymethylcellulose, which exhibits antifibrin properties.3,7,9 The barrier products work because they contain chemical components that approximate natural biological compounds and can contain controlled-release drugs.2,3,9 An issue with WWW.ORTODAY.COM

solid adhesion barrier sheets is determining the correct size and exact placement.

Unattached absorbable barrier sheets can shift and leave places for adhesions to form.2,3,9 Adhesion barrier sheets are not used if infection is present; infectious material could sequester and colonize during resorptive time.2,3,9 Any permanent or temporary implant can allow infectious material to grow, requiring implant removal and long-term antibiotic therapy.6 A nonabsorbable PTFE barrier is a synthetic and permanent implant that may need to be removed after a period of time.3 With permanent implants, perioperative RNs record lot numbers.6 In a product recall, lot numbers help staff locate defective batches and notify patients. Other pharmacological antiadhesion materials are treated as any other medication and do not require recording of lot numbers.6 All surgery alters tissues, stimulating fibrin accumulation and adhesions as part of healing.3 Prevention involves minimizing inflammation and preserving native mesothelium. Pharmacologic agents and barrier materials provide hope for preventing this perplexing surgical complication. If not used correctly, they can increase the risk of inflammatory response and cause foreign body reactions and adhesions.6

References 1. Catena F, Di Saverio S, Coccolini F, et al. Adhesive small bowel adhesions obstruction: evolutions in diagnosis, management and prevention. World J Gastrointest Surg. 2016;8(3):222-231. doi: 10.4240/ wjgs.v8.i3.222.

2. Ten Broek RPG, Krielen P, Di Saverio S, et al.

Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg. 2018;13:24. Published 2018 Jun 19. doi:10.1186/s13017-018-0185-2 3. Poehnert D, Grethe L, Maegel L, et al. Evaluation of the Effectiveness of Peritoneal Adhesion Prevention Devices in a Rat Model. Int J Med Sci. 2016;13(7):524–532. Published 2016 Jun 30. doi:10.7150/ijms.15167 4. Strik C, Stommel M, Schipper LJ, et al. Longterm impact of adhesions on bowel obstruction. Surg. 2016;159(5):1351-1359. doi: 10.1016/j. surg.2015.11.016.

5. Sandoval P, Jiménez-Heffernan J, Guerra-Azcona G, et al. Mesothelial-to-mesenchymal transition in the pathogenesis of post-surgical peritoneal adhesions. J Pathol. 2016; 239(1):48-59. doi: 10.1002/ path.4695.

6. Phillips N. Berry and Kohn’s Operating Room Technique. 13th ed. St. Louis, MO: Elsevier; 2017.

EDITOR’S NOTE: Nancymarie Phillips, PhD, RN, RNFA, CNOR, original author of this CE activity, has not had an opportunity to influence this edition.

7. Strik C, Stommel WJ, Schipper LJ, van Goor H, Ten Broek RP. Risk factors for future repeat abdominal surgery. Langenbecks Arch Surg.

2016;401(6):829-837. doi: 10.1007/s00423-016-

Nancy Bellucci, PhD, RN, CNOR, is a faculty member who teaches online for undergraduate and master’s program at Galen College of Nursing, Western Governor’s University, and Grand Canyon University. She is the author of articles published by the American Nurses Association, is a peer-reviewer for the AORN Journal, and has presented at two national conferences on her work related to strategies that nursing students use to manage the responsibilities associated with balancing work, family, and school. She is a member of the ANA, NLN, AORN, and STTI.

1414-3.

8. Ntourakis D, Katsimpoulas M, Tanoglidi A, et al. Adhesions and healing of intestinal anastomoses: the effect of anti-adhesion barriers. Surg Innovation. 2016;23(3):266-276. doi: 10.1177/1553350615610653.

9. Ahmad G, O’Flynn H, Hindocha A, Watson A. Barrier agents for adhesion prevention after gynaecological surgery. Cochrane Database of Syst Rev 2015, Issue 4. Art. No.: CD000475. doi: 10.1002/14651858.CD000475.pub3.

JUNE 2020 | OR TODAY |

35

IN THE OR

continuing education

Adhesion Barriers Product

Chemical Properties

Use

Notes

Precautions

Adept (Baxter)

• 4% icodextrin solution • Starch derivative • Water-soluble glucose polymer • Very similar to peritoneal dialysate • Hydrophilic (attracts fluids)

• Intraperitoneal • Endoscopic use only • IV bag of Adept is connected to scope with a delivery set.

• Warm to body temperature to use as an irrigant during the procedure.

• One additional liter is instilled before removal of endoscope.

• About 40% resorbs in 12 hours.

• Remainder resorbs in three to four days postoperatively.

• 100 mL every 30 minutes as irrigant over target organ during the procedure.

• Evacuate all solution before final retention liter is delivered to cover all organs.

• Do not use for laparotomy. Wound dehiscence may occur.

• Do not use in presence of infection.

• Do not use in presence of intestinal anastomosis or appendectomy.

• Do not use in patients with cornstarch allergy.

• Store at room temperature.

Interceed (Johnson & Johnson)

• Single-layer sheets of oxidized regenerated cellulose • White, knitted fabric • Hydrophilic

• Intraperitoneal laparotomy • Not approved for use in laparoscopy.

• Moisten with 2 mL saline to enhance adherence.

• Adheres to tissue.

• Not sutured • Breaks down into a gel over three to 10 days.

• Resorbs in four weeks.

• Do not use in presence of infection.

• Requires absolute hemostasis.

• Do not fold or use as packing.

Seprafilm (Sanofi SA)

• Single-layer, translucent sheets • Modified sodium hyaluronate carboxymethylcellulose • Hydrophilic

• Intraperitoneal placement of membrane during laparotomy • Applied dry immediately before closure.

• Applied with holder supplied in foil package.

• Do not suture in place.

• Temporary membrane that turns to an adherent gel in 24 to 48 hours that resorbs within one or two weeks

• Do not use to encase an intestinal anastomosis.

• Do not use in combination with other adhesion barriers.

• Do not suture in place.

• No absolute contraindications for use

Preclude surgical membrane (Gore)

• Synthetic material sheet polytetrafluoroethylene (PTFE) • Hydrophobic

• Placed during open procedures in various body sites.

• Sutured or stapled into position.

• Permanent implant • Does not resorb.

• Noninflammatory, but has risk of capsulation.

• Cardiovascular and other site application • Is sutured in place.

• May need to be removed if used in pelvis, and fertility is desired.

DuraGen (Integra)

• Collagen matrix sheet. Bovine (beef) deep tendon derivative • Hydrophilic

• Placed over dura in spinal or cranial procedures to prevent peridural fibrosis.

• Handle with clean powderfree gloves.

• Do not crush • Apply dry or moistened.

• May cut to shape.

• Adheres to surrounding tissue in situ, but may be secured with absorbent tension-free stay sutures or fibrin glue.

• Resorbs • Can be used as only graft to close dural defects in spine or cranium.

• Provides a scaffold for deposition of fibrin and collagen. beginning at postop day four and is complete by day 15.

• In clinical trials in the U.S. • Not used in presence of infection or for primary neural tube defects • Closed wound suction recommended • Not used if piaarachnoid region of meninges is interrupted.

• Not used in patients with a bovine tissue allergy.

Note: For additional information about adhesion prevention products, please see product literature on the manufacturer’s website.

36 | OR TODAY | JUNE 2020

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Clinical Vignette Pam, a 34-year-old woman, underwent a cesarean section several weeks ago. During the procedure, significant amounts of amniotic fluid and meconium entered her peritoneal cavity, which required copious irrigation. She had a low-grade fever for two days. Eight weeks later, she visited her OB/GYN physician for a vague abdominal pain during intercourse. Pam winced when the physician pressed the right lateral aspect of her abdomen. A bimanual exam was uncomfortable. Pam said sexual relations caused pain on her right side. History and physical revealed no bowel, bladder, or menstrual problems. Differential diagnosis revealed a small mass in her right adnexa that could be a cystic ovary, chronic appendicitis, or postoperative adhesions. The physician suggested a diagnostic laparoscopy to examine the right ovary and fallopian tube and rule out other pathology. The surgeon said he would dissect any adhesions and avoid a salpingo-oophorectomy.

The laparoscopy showed adhesions of the right ovary and fallopian tube to the right ascending colon at the level of the cecum. The surgeon dissected the ovary and tube from the adhesions and inserted an anti-adhesion barrier sheet between the adnexa and right colon. Later, he explained that the right ovary and tube were inflamed, but should return to normal within a few weeks. Pam’s fertility was intact from a functional standpoint, but she might experience more adhesions and a higher risk of ectopic pregnancy in her right fallopian tube.

1. P am could have experienced ________ without laparoscopy. a. Primary infertility c. Bladder prolapse b. Secondary infertility d. A repeat cesarean section 2. An issue with anti-adhesion barrier sheets is that: a. They are still in c. U nattached absorbable trial stages. sheets can shift. b. They cause adhesions in d. They cannot be used near some patients. the ascending colon.

3. W hat effect could the laparoscopy have on Pam’s risk of adhesions in the future? a. There is no specific c. S he could develop post-op effect. type 1 adhesions. b. S he would develop d. The barrier sheet type 2 adhesions. prevents all adhesions.

4. Postoperative complications for Pam may include: a. Deep vein thrombosis c. Paralytic ileus b. Atelectasis d. Ectopic pregnancy

Clinical VignettE ANSWERS 1. Answer: B, Adhesions are the most common physiologic cause for secondary infertility. 2. Answer: C, Slippage can occur with barrier sheets. 3. Answer: B, She would probably develop secondary adhesions. 4. Answer: D, Adhesions can form, obstruct the fallopian tube, and possibly lead to an ectopic pregnancy.

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CE573

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 9/3/2022 3. If the course you have chosen to take includes a clinical vignette, you will be asked to review the vignette and answer 3 or 4 questions. You must answer all questions correctly to proceed. If you answer a question incorrectly, we will provide a clue to the correct answer.

4. Once you successfully complete the short test associated with the clinical vignette (if there is one), proceed to the course posttest. To earn contact hours, you must achieve a score of 75%. You may retake the test as many times as necessary to pass the test.

5. All users must complete the evaluation process to complete course. You will be able to view a certificate on screen and print or save it for your records.

Accredited In support of improving patient care, OnCourse Learning (a Relias LLC company) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

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

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BY DON SADLER

40 | OR TODAY | JUNE 2020

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N

egative pressure wound therapy (NPWT) isn’t new – it was first developed in the 1980s. But it’s becoming more common in clinical practice today as the body of

evidence supporting its use in the promotion of wound healing grows.

In particular, two recent studies have demonstrated the effectiveness of using NPWT in reducing surgical site infections (SSIs). In both studies, there were significantly fewer SSIs among the patients who were treated using NPWT than among the patients who were treated using standard closure.

What is NPWT? WoundEducators.com explains that negative pressure wound therapy “uses vacuum therapy in the form of a dressing applied to an acute or chronic wound. The vacuum pressure is controlled at a sub-atmospheric pressure and may be intermittent or constant. The wound is covered by a dressing which is sealed and then connected to a vacuum pump.”

“Negative pressure wound therapy was instrumental in changing soft tissue defect management,” says Julie Cahn, DNP, RN, CNOR, RN-BC, ACNSBC, CNS-CP, perioperative practice specialist with the Association of periOperative Registered Nurses (AORN). “It has a multifocal mechanism of action that promotes wound healing.

“First, the removal of cells and fluid from the wound decreases the local inflammatory response,” Cahn continues. “When fluid is drawn away from the wound surface, this decreases the tissue breakdown that occurs from prolonged exposure to moisture while increasing oxygenation in the wound.”

left open at the end of surgery; and healing by secondary intention, or granulation.

“With granulation, the wound is left open to heal from the bottom up as granulation tissue slowly closes the wound,” says Cahn. “Negative pressure wound therapy is most commonly used for these types of wounds.”

According to WoundEducators.com, NPWT promotes wound healing by removing infectious materials and barriers to cell proliferation/migration, thereby promoting granulation. It also provides a moist, protected wound care bed, promotes tissue perfusion, removes wound exudate and reduces tissue edema.

Revolutionizing Wound Management “Negative pressure wound therapy has revolutionized the way we manage wounds that before were very difficult,” says Richard Schlanger, M.D. PhD, retired associate professor of surgery at the Ohio State University and director of wound care at Select Specialty Hospital East in Columbus, Ohio. “It whisks away excess fluid to allow for better wound healing.”

In addition, NPWT causes angiogenesis, or the creation of new blood vessels in the wound. “This brings cells and nutrients to promote wound healing,” says Schlanger.

Another benefit of NPWT is limited manipulation of the wound by nurses due to dressing changes. “The

“ When fluid is drawn away from the wound surface, this decreases the tissue breakdown that occurs from prolonged exposure to moisture while increasing oxygenation in the wound.” – JULIE CAHN

These actions increase perfusion to the area, which promotes increased fibroblast growth and migration into the wound to form granulation tissue. “This type of dressing can be applied to acute surgical wounds and chronic wounds,” says Cahn.

She explains that there are three different types of wound closure: primary closure (or primary union or intention), typically with suture; delayed primary closure, which occurs when the wound is

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dressing is only changed every two or three days during the first week after surgery, so the wound is better protected,” says Schlanger.

JUNE 2020 | OR TODAY |

41

COVER

STORY WoundEducators.com lists many different types of wounds that can benefit from NPWT, including the following: Traumatic wounds Dehisced wounds Partial-thickness burns Pressure ulcers Diabetic ulcers Grafts and flaps Schlanger says that when wounds aren’t sealed properly like they are when NPWT is used, “there’s a stronger possibility of infection even when the patient’s temperature is normal, oxygenation is good and glucose is under control. These are the factors we usually look for when wounds aren’t healing properly.”

closure. The primary end point of the study was the occurrence of a postoperative SSI. The result: SSI occurred in 31.1% of patients in the standard closure group, but just 9.7% of patients in the negative pressure wound therapy group. This corresponded to a relative risk reduction of 68.8%. What’s more, SSIs were found to independently increase the cost of hospitalization by 23.8%, according to the report.

“The use of negative pressure wound therapy resulted in a significantly lower risk of SSIs,” the report’s authors concluded. “Incorporating this intervention in surgical practice can help reduce a complication that sig-

Are There Drawbacks to NPWT? Schlanger says that cost is probably the biggest drawback to NPWT. “However, new products over the past few years like disposable wound VACs are significantly less expensive than traditional wound VACs.” “I’ve been very happy with these, especially with large patients and those with multiple laparotomies,” Schlanger adds. “I use the wound VAC immediately post-operatively instead of waiting for something to happen.”

In addition, disposable wound VACs are useful for patients who will need to use them at home. “This helps get them through the insurance

“ The dressing is only changed every two or three days during the first week after surgery, so the wound is better protected.” –RICHARD SCHLANGER

“Negative pressure wound therapy is a very eloquent solution to these problems,” says Schlanger. “It also eliminates a lot of post-op headaches because all the excess fluid goes into a canister. It’s a one-way valve, unlike a semi-closed dressing device.

“The integrity of the post-op field is maintained in a semi-sterile condition,” Schlanger adds. “This cuts down on incidents of surgical site infections.”

Studies Evaluate Use of NPWT In 2017, a study was conducted to evaluate the efficacy of negative pressure wound therapy for SSIs after open pancreaticoduodenectomy.

“Despite improvement in infection control, SSIs remain a common cause of morbidity after abdominal surgery,” stated the report’s authors. “SSI has been associated with an increased risk of reoperation, prolonged hospitalization, readmission and higher costs.”

The researchers randomly assigned patients to receive negative pressure wound therapy or a standard wound

42 | OR TODAY | JUNE 2020

nificantly increases patient harm and health care costs.”

Another study conducted in 2017 examined the individual effect of closed surface NPWT on SSI reduction in lower extremity excisions.

About half of the patients received closed surface NPWT and half received standard dressings. Between the groups, there were no major differences in mean age or body mass index, perioperative transfusions, use of prosthetic, reoperative field, dialysis status and presence of diabetes.

The result: There were significantly fewer SSIs among patients who received NPWT dressings (9.8%) compared to patients who received standard dressings (19.0%).

“The use of negative pressure wound therapy devices decreases the incidence of infrainguinal wound infections,” the report’s authors concluded. “This occurs as an independent factor as part of a patient care bundle targeting modifiable variables in perioperative care.”

quagmire so they can go home with it,” Schlanger says.

Cahn says there are “no identifiable obstacles” to the use of NPWT in the OR. “Negative pressure wound therapy dressings may take slightly longer to apply than other types of dressings, but the dressing may stay on longer and reduce the number of dressing changes a patient requires,” she says.

“I believe that the use of negative pressure wound therapy will only increase,” Cahn adds.

Schlanger calls negative pressure wound therapy his “go-to dressing” in certain cases. “It doesn’t take that much more time to apply than standard dressing. If there’s any question about lateral tension on the wound or excess fluid, or concern about keeping dressing on that will be effective, this is the solution on everyone’s mind.”

“Bringing negative pressure wound therapy into mainstream surgery will have a profound effect on better wound closure, fewer wound complications and fewer SSIs,” Schlanger concludes.

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SPOTLIGHT ON:

Vangie Dennis MSN, RN, CNOR, CMLSO

Vangie Dennis is a respected speaker at conferences.

By Matt Skoufalos

A

fter more than 40 years in the field of nursing, Vangie Dennis has earned an armful of educational achievements: she’s a registered, master’s degreed nurse, a certified perioperative nurse, and a certified medical laser safety officer.

Dennis puts all these talents to work as the executive director for perioperative services at WellStar Atlanta Medical Center and WellStar Atlanta Medical Center South, but ask her how she got to where she is today, and she’ll tell you, “I did it all the hard way.”

“Growing up, the first thing they tell you as a female is to be a teacher

Vangie Dennis currently serves as AORN treasurer.

44 | OR TODAY | JUNE 2020

[because] you’ll always have a job,” Dennis said. “I wanted to be an artist, and my mom said, ‘You’ll starve.’ ” But on a visit to the DePaul Medical Center in Norfolk, Virginia, she fell in love with the nursing uniform.

“I remember looking around and seeing the nurses in their starched white medical uniforms and caps and hose,” Dennis said. Not long after that, she enrolled in Gwinnett Community College to earn her practical nursing license.

Dennis worked her way from nursing assistant to LPN to an associate degree at Georgia State University, and then on to her BSN and MSN degrees.

Although she’s worked as a service line coordinator and an ICU nurse, most of her tenure in health care has been in the operating room.

“I can’t think of a time in my life that I’ve ever regretted going into nursing, especially the OR,” Dennis said.

As much as her pursuit of educa-

tion was driven by a desire to excel in her career, Dennis also said she pushed herself to higher and higher degrees because without the weight of her credentials, she felt like her professional perspective was frequently questioned, and her work double-checked by her peers.

“I didn’t take it offensively, but I said, ‘I am what I am,’ ” Dennis said.

“If I want to make a difference in how people respond to me, it means going back to school.”

After earning her BSN, “the world opened up,” Dennis said; that “stamp of credibility” earned respect from her nursing as well as physician colleagues.

“Physicians are scientists by nature,” she said; “to get that respect from your surgeons, they’re going to look at your degree. Unfortunately, it stamps you, whether you want it or not.”

However, even after earning her bachelor’s degrees, Dennis kept having the same experiences at higher levels of employment. That pushed her to earn her MSN and cemented her philosophy that the minimal degree of education any nurse should have is a bachelor’s degree. Today, as the national treasurer of the Association of periOperative Registered Nurses (AORN), her focus on education and career advancement isn’t central only to her career, but also to those of her peers across the United States.

“My passion is really working WWW.ORTODAY.COM

“

I can’t think of a

directly as an educator, but I couldn’t make a difference until I got into management,” Dennis said. “You make recommendations to your director, but that doesn’t necessarily mean it’s implemented. [As a director,] I can do better enforcing the practice than I can recommending the practice.”

Moreover, Dennis said, her clinical background helps inform the decisions she makes from a position of leadership while also bridging the worlds of the clinical and the executive.

“You realize it primarily after you become an educator,” she said. “I couldn’t move the needle if I didn’t have a director that wasn’t involved in clinical practice. Being a director that was once an educator, you’re in touch with clinical; you’re not so far removed that you don’t understand where it goes and how it happens.”

“You can be a leader informally, and then you get so much in return out of respect from your surgeons and your patients when you have that baseline knowledge,” Dennis said.

Nurses “have to define ourselves a little better,” Dennis said, and she believes education is the best way to do it. That doesn’t mean it’s an easy path to success. Many nurses work full-time while pursuing degrees, and Dennis was no exception. However, amid a Vangie Dennis enjoys spending time with her granddaughter and namesake, Evie.

WWW.ORTODAY.COM

time in my life that I’ve ever regretted

”

going into nursing, especially the OR.

Vangie Dennis is seen with her family.

national nursing shortage, and with help from employers, education may be more accessible to today’s nurses than ever before.

“You’ve got grants; you’ve got forgiveness loans,” she said. “My institution pays for you to go back to school, and you can do this very slowly. It’s too accessible today for nurses to not complete their BSN, and there’s some aggressive programs online to bridge them.”

“The generation coming up does have a degree,” Dennis said; “those schools for diploma nurses are going away.”

The advice applies within her own family as well: when Dennis’ daughter, Nicole, finished her BSN, “I told her don’t stop,” Dennis said. Today Nicole has completed her MSN, and has already become a manager within the same hospital where her mother works – a feat that had taken Vangie Dennis another 10 years to achieve in her own career. She’s also keenly aware how difficult the hospital environment can be on staff nurses, both mentally and physically. OR nurses must be technically savvy, clinically capable, and

emotionally sturdy to weather long hours of intense and demanding work.

For those reasons, Dennis says it’s “well important to keep my hand on the pulse with the new nurses coming in,” the better to support them while they’re establishing themselves in the field. The atmosphere in a surgical suite can be intense, and she coaches new additions to draw firm boundaries with their coworkers and not to personalize any of the pointed conversations that may originate there.

Of course, after having worked her way to a position of achievement, now Dennis is asked when she’d like to retire. Her children are grown in addition to Nicole, with whom she works, her son Christian is the drummer and music director for singer Maren Morris, and her daughter Kathryn is a schoolteacher in Portland, Oregon.

Vangie and her husband, Richard, who works as a CFO for an Atlanta furniture company in Atlanta, also busy themselves with three poodles, Gabriel, Chrissy and Luka and a Himalayan cat named Icarus (Ike).

Dennis teaches a lot, works as a consultant, remains very involved in AORN – and yet, none of those things is a substitute for the work she does in the OR. “I don’t think we’re made to retire,” she said. “I think if you enjoy what you do, you feel like you’re relevant in what you do, why do you retire? If you enjoy it and you’re relevant, and you get that personal fulfillment, work when you want to work.”

“Self-fulfillment’s always important,” Dennis said. “You’ve got to love what you do, or no matter what happens in the end, you’ll never be happy.

I love surgery.”

JUNE 2020 | OR TODAY |

45

AUGUST 16-18 | DENVER, CO

SPEAKER Spotlight

“

I STARTED IN THE KITCHEN AT A SMALL FACILITY WHERE I WOULD SEE THE PERIOP STAFF COME THROUGH MY CAFETERIA LINE DAILY. I WOULD TALK TO THEM ABOUT THEIR DAY FROM THEIR TRIUMPHS TO THEIR STRUGGLES AND WANTED SO BADLY TO BE PART OF A TEAM THAT HAD SO MUCH PASSION FOR THEIR PATIENTS.

”

– Cheron Rojo, AA, CRCST, CIS, CER, CFER, CHL Clinical Education Coordinator, Healthmark Industries

Cheron is a speaker at OR Today Live!

To learn more, visit www.ortodaylive.com.

Attend the ASCA 2020 Virtual Conference & Expo to get top-quality ASC education, networking and resources—all from the comfort of your home or office.

THERE’S STILL TIME TO REGISTER! 46 | OR TODAY | JUNE 2020

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OUT OF THE OR fitness

Exercise And Moving

By Miguel J. Ortiz s I write this article, the world is facing a novel coronavirus (COVID-19) pandemic and the majority of the population is in some type of self quarantine. Many people aren’t working or they are working from home. Only “essential” businesses are open are functioning. The virus is a stressor for many and has triggered other stressors including a concern for one’s finances.

A

I want to bring hope and address some opportunities that we can all take advantage of in these difficult times. We are all out of a gym. Your dedication and commitment to exercise has never been this challenged. Being secluded to the inside of your home isn’t the most ideal situation for a lot of people.

So, here are three tips along with some things to consider when exercising at home.

First, find a healthy place within your home to exercise. It be the living room, garage, office or a guest bedroom. Creating a dedicated space WWW.ORTODAY.COM

Through COVID-19 is ideal. The reason this is important is because it mimics the behavior of actually going to a gym. Exercise can be a big stress reliever for people or simply a way to get away and crush a good workout. It is difficult when you literally can’t get away because you’re working out in the same place where you are spending your self quarantine.

This can create more stress. That is why it’s important to create an area of your home dedicated to exercise and movement.

Second, what equipment do you have available? This one can make or break your goals, but only if you let it. Stay positive. Just because you don’t have the specific equipment you want, doesn’t mean your goals are all of a sudden out of reach. There are plenty of ways to adjust acute variables so that when you’re finally able to get back to the gym or outside training you don’t feel so far behind.

If you are training to run a marathon and can’t leave the house, then yes, you’ll need to adjust certain strength and endurance movements so that they A) don’t become to tedious (mental strength) and B) are sustain-

able and appropriate in supporting your goal. You can definitely still take steps forward even though you will need to make some serious adjustments.

Third, create a plan and stick to in.

When you’re constantly at home, it’s easy to relax and not want to exercise.

However, the plan must be executed.

Maybe you don’t complete a full workout or didn’t give it your all – the most important thing you did was keep moving. After some consistency, your body will begin to adjust as you get acclimated to your new in-home routine. If further changes need to be made, or you finally figured out a cool way to lift the couch, then adjust accordingly. But until then continue to move, stick with your plan and be the best motivator you have ever been for yourself.

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.

JUNE 2020 | OR TODAY |

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OUT OF THE OR health

Brain Implant Restores Visual Perception to the Blind lthough he is blind, Jason Esterhuizen is able to follow the sidewalk, thanks to an experimental brain implant that enables him to distinguish light areas from dark.

A

Seven years ago, Jason Esterhuizen was in a horrific car crash that destroyed his eyes, plunging him into total darkness.

Today, he’s regained visual perception and more independence, thanks to an experimental device implanted in his brain by researchers at UCLA Health.

“Now I can do things that I couldn’t do before,” said Esterhuizen, 30, who moved from his native South Africa to participate in the clinical trial at UCLA. “I can sort the laundry, find my way in lighted hallways without using a cane and cross the street more safely. It’s making my life much easier.”

The device is geared to people who used to be able to see but lost their vision to injury or disease. While it doesn’t provide normal sight, it enhances users’ ability to navigate the world by restoring their capacity to detect movement and distinguish light and dark.

“This is the first time we’ve had a completely implantable device that people can use in their own homes without having to be plugged into an external device,” said Nader Pouratian, M.D., Ph.D., a neurosurgeon at UCLA Health and principal investigator of the five-year study. “It helps them recognize, for example, where a doorway is, where the sidewalk begins or ends or where the crosswalk is. These are all extremely meaningful events that can help improve people’s quality of life.”

48 | OR TODAY | JUNE 2020

Designated by the U.S. Food and Drug Administration as a “Breakthrough Device,” the system wirelessly converts images captured by a tiny video camera mounted on sunglasses into a series of electrical pulses. The pulses stimulate a set of 60 electrodes implanted on top of the brain’s visual cortex, which perceives patterns of light and interprets them as visual clues.

“I’ll see little white dots on a black background, like looking up at the stars at night,” said Esterhuizen, the world’s second research subject to receive the device, called Orion. “As a person walks toward me, I might see three little dots.

As they move closer to me, more and more dots light up.”

Along with the glasses, the system includes a belt equipped with a button, which patients can press to amplify dark objects in the sun, and press again to visualize light objects in the dark, such as an oncoming car’s headlights at night.

Six people have received the implant: the first three at UCLA Health, two at Baylor College of Medicine and the sixth at UCLA. Recipients have expressed delight at once again being able to enjoy fireworks and blow out candles on a birthday cake.

“It’s still a blast every time I turn it on,” Esterhuizen said. “After seeing absolutely nothing to all of a sudden seeing little flickers of light move around and figuring out that they mean something.

It’s just amazing to have some form of functional vision again.”

The implant currently stimulates the left side of the patient’s brain. As a result, they perceive visual cues only

from their right-side field of vision.

Ultimately, the goal is to implant both sides of the brain to recover a full field of vision.

“This device has the potential to restore useful vision to patients blinded by glaucoma, diabetic retinopathy, cancer and trauma,” Pouratian said. With research subjects’ input, he and his colleagues hope to one day adapt the device to also assist people who were born blind or have low vision.

Nearly 39 million people worldwide are legally blind. Because the Orion, developed and marketed by Second Sight Medical Products, directly stimulates the visual cortex, it can help people like Esterhuizen who have suffered damage to their retinas and optic nerves.

Esterhuizen, an upbeat athlete and adrenaline junkie who skydives, bungee jumps and recently competed with his team in the 2019 World Series for beep baseball – a form of America’s pastime for people who are visually impaired – credits his accident and the device for changing his life in countless ways.

“The day of my car accident, I was 23 and studying to become an airline pilot,” he wrote in his blog. “Life didn’t end there, it just changed for the better.

I would not have met the love of my life, Sumarie.”

The couple celebrates their first wedding anniversary on Sept. 22.

“Normally when my wife is mad at me, she’ll be quiet, and I’ll be like, ‘Where are you? I want to speak to you,’” he said. “Now I can find her. She can’t hide from me anymore.”

– Courtesy of UCLA Health WWW.ORTODAY.COM

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OUT OF THE OR EQ factor

Money Can Motivate, but Often it Doesn’t

By daniel bobinski ’m guessing you’ve heard it said that people are motivated by money. Sadly, it’s a belief held by too many managers and supervisors.

I say it’s sad is because that statement isn’t true for everyone. In fact, it’s true for less than 40 percent of the population.

I

This article is the second in a series about the six learned (extrinsic) motivators. Last month, I reviewed the different ways people are motivated by knowledge. This month we’ll examine the ways that tangible things – including money – may or may not motivate us.

Why learn this? By studying motivators, we develop better selfawareness, which is the starting point for emotional intelligence. It also helps us understand others, thus improving our relationship management.

The motivational spectrum of utility The utility scale is about the different ways people value the practicality of things, including money. At one end of the scale are those driven by a strong desire to get a return on whatever time or financial investments they make. At the other end of the scale are people more concerned about completing tasks for the sake of comWWW.ORTODAY.COM

pleting tasks. They are not driven by getting something in return for it.

Those that desire a strong return on their investment of time, talent and/ or money are referred to as resourceful. Those that more concerned about completing tasks for the sake of completing tasks are referred to as selfless.

I should point out that no matter one’s preference on the scale, all people value utility. They just value it in different ways.

Traits of a resourceful person People at the resourceful end of the utility spectrum often have an enterprising nature. They are sensitive to the value of time and resources, and often seek measurable and practical results in what they do. Such people do their best when they get rewarded for their efficiency and practicality. Activities that are perceived as wasteful of time or resources tend to be avoided.

Many with this motivational style are driven by the accumulation of wealth and will avoid being in debt.

Traits of a selfless person People concerned about accomplishing tasks and making investments for the greater good – without an eye on a tangible return – are at the selfless end of the utility spectrum. Rather than efficiency or financial gain, the impact value of a project or task is

more important. Put another way, achieving a desired outcome is more important than how fast the outcome was achieved or how much money was made.

This style often chooses work that assists the greater good, without having to consider how much time or how many resources are needed to achieve it.

I should point out that this utility spectrum of motivations is ripe for misunderstandings. All extrinsic motivators are formed by emotional impressions from events in our lives.

Because emotions are powerful drivers, it’s easy to say one motivator is bad while another is good. I always urge people to value the differences among us rather than criticize them. It’s a healthy approach on many levels.

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.

JUNE 2020 | OR TODAY |

51

OUT OF THE OR nutrition

Eat Your Fruits and Veggies

By Charlyn Fargo or those of us spending more time at home, the refrigerator may be a little too accessible, making it easier to snack a little more often.

F

Whether we’re working from home or not, what we put into our bodies counts.

And the little steps we take – or don’t take – toward healthy eating add up to a journey.

To encourage all of us to take better steps, here’s another reason to turn to fruits and vegetables instead of another chocolate chip cookie or a handful of potato chips. With the fruits and vegetables, you’re adding good nutrients called flavonols.

A new study finds that people who eat or drink more foods with flavonols (an antioxidant found in nearly all fruits, vegetables and tea) may be less likely to develop Alzheimer’s dementia years later. The study was published in the journal Neurology.

So, along with doing that jigsaw puzzle or word search to keep your brain active, consider what you’re eating.

Dr. Thomas Holland, lead researcher at Rush University in Chicago, summarizes that eating more fruits and vegetables and drinking more tea could be an easy way for people to stave

52 | OR TODAY | JUNE 2020

off Alzheimer’s dementia. The study involved 921 people with an average age of 81 who had not been diagnosed with Alzheimer’s. The people filled out questionnaires each year on how often they ate certain foods as well as time spent doing other activities. Participants were tested yearly for six years to see whether they had developed Alzheimer’s. Participants were divided into five groups based on how much flavonol they consumed.

The average flavonol intake among American adults is 16 to 20 milligrams per day. In the study, flavonol intake ranged from 5.3 milligrams per day to 15.3 milligrams per day.

The study found those in the highest group were 48% less likely to develop Alzheimer’s than those in the lower group.

The bottom line? While the study doesn’t prove that flavonols directly cause a reduction in disease risk, there’s an association between more fruits and vegetables and less Alzheimer’s risk.

That’s enough to convince me to pass on the chips and cookies for more broccoli, Brussels sprouts and beans. And another glass of tea.

Kicking the Sugar Habit Most of us – despite being around our

kitchens more due to this COVID-19 seclusion – are all about trying to break the sugar habit. It’s not that sugar is banned from a healthy diet; it’s just that it’s easy to overdo sugar consumption.

One of the problems is that sugar wears many disguises on a food label.

It can be called honey, coconut sugar, brown sugar, corn syrup, agave, brown rice syrup or maple syrup. Sugar is added to 68% of packaged foods and drinks in the U.S. Being mindful of products that contain sugar – and how that sugar is labeled – is a way to begin reducing your sugar.

Sugar can be in plant-based milks, nut butters, bacon, ketchup and even chicken stock. Naturally occurring sugars in fruit, veggies and even milk typically don’t need to be on your worry list, as they come bundled with nutrients, fiber, vitamins and antioxidants.

It’s the added sugars that are a problem. The U.S. Department of Agriculture recommends limiting added sugars to 10% of your daily calories. For a 1,600-calorie diet, that means no more than 160 calories, or 10 teaspoons from added sugars per day. The American Heart Association recommends even less – 100 calories from added sugar, or 6 teaspoons a day.

How to break the sugar habit?

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Read ingredient lists, and choose lowsugar options.

Reduce your stress. I know it’s hard in times like these, but a workout, walk, hobby or other diversion will be much more helpful than a sugary snack.

Get enough sleep. We make much better – and healthier – choices when we’re properly rested.

Reduce sugar in baked goods by adding overripe bananas, applesauce or dates instead of sugar.

Rather than cutting the acid in a tomato sauce with sugar, try adding grated carrots, butternut squash or sweet potatoes.

Replace the sweets in your diet with fruit.

Toss fresh or dried fruit into your oatmeal to replace some of the sugar.

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.

WWW.ORTODAY.COM

JUNE 2020 | OR TODAY |

53

OUT OF THE OR recipe

Pasta with Spring Vegetables and Tomato Sauce INGREDIENTS: • 1 pound pencil-thin asparagus, trimmed and cut into 1 1/2-inch lengths

Recipe

• 1 pound dried spaghetti, linguine or angel hair pasta

the

54 | OR TODAY | JUNE 2020

• 3 cups favorite store-bought tomato sauce • 1/2 canned chipotle in adobo, coarsely chopped or bottled chipotle hot sauce • 3 tablespoons finely chopped fresh basil, optional • 1 yellow or orange sweet pepper, cut into 1/4-inch-wide strips, optional • 1 1/2 cups frozen petite peas, defrosted • 1 tablespoon finely chopped parsley • 1/2 cup freshly grated Parmesan cheese

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

Spring Pasta is Easy to Make with Pantry Staples

recipe

his Seriously Simple vegetarian pasta dish celebrates the warm days of the season with common ingredients that should be relatively easy to procure or already in your pantry.

T

Picture a plate of pasta with an array of colors: green asparagus and peas, yellow sweet peppers and red tomato sauce sprinkled with straw-colored freshly grated Parmesan cheese. This is a dish that can deliver some much-needed cheer. Don’t worry if you can’t find some of the ingredients. Just use what is available.

Springtime signals the peak season for asparagus. I love to use it in dishes that show off its unique flavor. The neutrality of pasta provides a perfect backdrop that allows the delicate, slightly grassy flavored asparagus and sweet baby peas to shine through. In this recipe, bottled tomato sauce is accented by the Mexican chipotle chile pepper, which gives the pasta an Italian Mexican fusion style.

This chipotle tomato sauce adds an unexpected touch of smoky heat thanks to half of a chipotle chile. If you prefer a spicier sauce, go ahead and use a whole chile. Use canned chipotles packed in adobo sauce for the best flavor. You can also use a bit of the adobo sauce to add even more heat, but be careful; these chilies can be very hot. If you don’t have access to chipotle or chipotle hot sauce, add a touch of crushed red pepper.

Seared scallops or sliced grilled chicken breasts make this dish a substantial main course. For a pretty presentation serve this in wide, shallow soup bowls. Serve a simple green salad to begin and accompany with a spicy Zinfandel.

Pasta with Spring Vegetables and Tomato Sauce Serves 4 to 6 1. Fill a saucepan with water and bring to a boil over high heat. Place the asparagus pieces in a kitchen strainer basket with a handle, lower into the boiling water, and cook for 2 to 3 minutes, or until crisp-tender. Immediately transfer the asparagus to a bowl of ice water.

2. Bring a large pot of salted water to a boil. Add the pasta and cook according to package instructions, or until al dente.

3. Meanwhile, place the tomato sauce in a saucepan over medium heat. Add the chipotle or a few dashes of chipotle hot sauce and optional basil and bring to a simmer. Add the asparagus, peas, and optional yellow pepper; heat just until sauce is hot and the vegetables are warmed through.

4. Reserve 1/4 cup of the sauce. Drain the pasta well and transfer to the tomato sauce. Use tongs and toss to coat the pasta with the sauce. Place the pasta in a serving bowl. Spoon the reserved sauce on top and sprinkle with the parsley and Parmesan cheese. Serve immediately.

Tasty tips � When blanching the vegetables, use a kitchen strainer with a handle to make it easier to lift the vegetables out of the water. � If you can’t find chipotles in adobo, look for chipotle bottled hot sauce and add a few drops to taste. Crushed red pepper is also a good substitute. � Look for jarred peeled yellow peppers or use a raw yellow pepper, cored, seeded and thinly sliced.

WWW.ORTODAY.COM

JUNE 2020 | OR TODAY |

55

OUT OF THE OR pinboard

CHE C K O U T O U R N E W CO NTE ST!

OR TODAY

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

WORLD HEALTH ORGANIZATION'S

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

do it, is to to y a w e v ti c e ff e st “The mo

do it.”

– Amelia Earhart

56 | OR TODAY | JUNE 2020

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The News and Photos

OUT OF THE OR

that Caught Our Eye This Month

pinboard

MERCURY CAN ATTENUATE THE BENEFICIAL HEALTH EFFECTS OF FISH

H

igher serum long-chain omega-3 fatty acid concentration, a marker for fish consumption, was beneficially associated with cardiac performance in middle-aged and older men from eastern Finland. However, methylmercury exposure, mainly through certain fish species, attenuated these associations, according to a new doctoral thesis from the University of Eastern Finland Coronary heart disease is a major cause of mortality globally. In Finland, despite a sharp decline in the recent decades, coronary heart disease is still one of the main causes of death. It has been suggested that a substantial proportion of this chronic disease could be prevented by a healthy diet, and one the cardioprotective food items is fish. Fish is recommended as a part of a healthy diet in most dietary recommendations.

For example, the Nordic Nutrition Recommendations recommend eating two servings of fish per week.

Epidemiological data provide evidence for an inverse relationship between intake of fish and the longchain omega-3 fatty acids from fish, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and risk of coronary heart disease, but the exact mechanisms for these cardioprotective properties are not completely known. Furthermore, some fish species, especially large predatory fish, may also contain methylmercury, which has been associated with higher risk of coronary heart disease and with attenuation of the cardioprotective effects of the long-chain omega-3 fatty acids.

The thesis investigated whether the serum longchain omega-3 fatty acid and hair mercury concentrations, both objective biomarkers of exposure, were associated with cardiac electrophysiology and performance. The study included 2,199 eastern Finnish men

WWW.ORTODAY.COM

from the Kuopio Ischaemic Heart Disease Risk Factor Study, who were 42-60 years old. The participants’ blood and hair samples were collected at the start of the study in 1984-1989. Cardiac performance was assessed with ECG at rest and during an exercise test.

The study found that higher serum long-chain omega-3 fatty acid concentration was beneficially associated with cardiac repolarization, exercise capacity, resting heart rate and with lower risk of exerciseinduced myocardial ischemia. However, high hair mercury content generally attenuated these cardioprotective associations.

The study provides insight into mechanisms for how intakes of the long-chain omega-3 fatty acids and fish may benefit cardiac health. The findings also suggest that it is best to choose fatty fish that are high in the long-chain omega-3 fatty acids but low in methylmercury. Such fish species include, for example, salmon, trout, anchovy, mackerel, vendace and herring.

The doctoral dissertation of Behnam Tajik, Master of Science in Public Health Nutrition, entitled “Serum long-chain omega-3 polyunsaturated fatty acids, methylmercury and cardiac functions” was examined at the University of Eastern Finland on February 7, 2020. The doctoral dissertation is available for download at: https://epublications.uef.fi/pub/urn_isbn_978952-61-3307-2/urn_isbn_978-952-61-3307-2.pdf. The findings were originally published in European Journal of Nutrition, British Journal of Clinical Nutrition, and Heart.

– Health.com

JUNE 2020 | OR TODAY |

57

INDEX

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Doctors Depot………………………………………………… 24 Soma Technology…………………………………………… 53

ALCO Sales & Service Co.……………………………… 50 Cygnus Medical…………………………………………………… 9 Diversey …………………………………………………………… 49 Healthmark Industries Company, Inc.………… 43 MD Technologies Inc.……………………………………… 27 Ruhof Corporation…………………………………………… 2,3 TBJ Incorporated………………………………………………IBC TIDI………………………………………………………………… 22,23

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

CATEGORICAL

C-ARM Soma Technology…………………………………………… 53

CARDIAC PRODUCTS C Change Surgical……………………………………………… 6

CARTS/CABINETS ALCO Sales & Service Co.……………………………… 50 Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.………… 43 MAC Medical, Inc.……………………………………………… 4 TBJ Incorporated………………………………………………IBC

INSTRUMENT STORAGE/TRANSPORT

CS/SPD

INVENTORY CONTROL

MD Technologies Inc.……………………………………… 27 Ruhof Corporation…………………………………………… 2,3

Key Surgical……………………………………………………… BC

DISINFECTION Cygnus Medical…………………………………………………… 9 Diversey …………………………………………………………… 49 Ruhof Corporation…………………………………………… 2,3

DISPOSABLES ALCO Sales & Service Co.……………………………… 50

ENDOSCOPY Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.………… 43 MD Technologies Inc.……………………………………… 27 Ruhof Corporation…………………………………………… 2,3 Total Scope, Inc.…………………………………………………13

Cygnus Medical…………………………………………………… 9 Key Surgical……………………………………………………… BC Ruhof Corporation…………………………………………… 2,3 TIDI………………………………………………………………… 22,23

MONITORS Doctors Depot………………………………………………… 24 Soma Technology…………………………………………… 53

ONLINE RESOURCE MedWrench……………………………………………………… 39 OR Today Webinar Series……………………………… 38

OR TABLES/BOOMS/ACCESSORIES Action Products, Inc.……………………………………… 53 Soma Technology…………………………………………… 53

OTHER AIV Inc.……………………………………………………………… 50

PATIENT DATA MANAGEMENT

RESPIRATORY Soma Technology…………………………………………… 53

SAFETY Calzuro.com…………………………………………………………17 Healthmark Industries Company, Inc.………… 43 Key Surgical……………………………………………………… BC TIDI………………………………………………………………… 22,23

SINKS Ruhof Corporation…………………………………………… 2,3 TBJ Incorporated………………………………………………IBC

SKIN PREPARATION BD………………………………………………………………………… 5

STERILIZATION Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.………… 43 MD Technologies Inc.……………………………………… 27 TBJ Incorporated………………………………………………IBC

SURGICAL MD Technologies Inc.……………………………………… 27 Soma Technology…………………………………………… 53 TIDI………………………………………………………………… 22,23

SURGICAL INSTRUMENT/ACCESSORIES C Change Surgical……………………………………………… 6 Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.………… 43 Key Surgical……………………………………………………… BC

MAC Medical, Inc.……………………………………………… 4

TELEMETRY

Diversey …………………………………………………………… 49

PATIENT MONITORING

AIV Inc.……………………………………………………………… 50

FALL PREVENTION

AIV Inc.……………………………………………………………… 50

TEMPERATURE MANAGEMENT

ALCO Sales & Service Co.……………………………… 50

POSITIONING PRODUCTS

FLUID MANAGEMENT

Action Products, Inc.……………………………………… 53 Cygnus Medical…………………………………………………… 9

C Change Surgical……………………………………………… 6 MAC Medical, Inc.……………………………………………… 4

ERGONOMIC SOLUTIONS

MD Technologies Inc.……………………………………… 27

FOOTWEAR Calzuro.com…………………………………………………………17

GENERAL AIV Inc.……………………………………………………………… 50

58 | OR TODAY | JUNE 2020

PRESSURE ULCER MANAGEMENT

WARMERS MAC Medical, Inc.……………………………………………… 4

Action Products, Inc.……………………………………… 53

WASTE MANAGEMENT

REPAIR SERVICES

MD Technologies Inc.……………………………………… 27 TBJ Incorporated………………………………………………IBC

Cygnus Medical…………………………………………………… 9 Doctors Depot………………………………………………… 24 Soma Technology…………………………………………… 53

WWW.ORTODAY.COM

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.

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OPTIONAL FEATURES INCLUDE Integrated Ultrasonic System

Air and water pistols

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

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LET US HELP YOU NAVIGATE THE CHALLENGES.

PATIENT SAFETY. AT THE HEART OF ALL YOU (AND WE) DO.

To all healthcare workers on the front lines… we see you. We are inspired by you. You are at the heart of patient care and supporting your dedication and resilience is our promise to you. Preparing to begin again can be challenging and we offer our educational resources for SPD, the O.R., and endoscopy on our website at www.keysurgical.com/education. We are here for you, so you can be there for them.