OR Today Magazine September 2020

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INDUSTRY INSIGHTS NEWS & NOTES

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CE ARTICLE POST-CESAREAN SECTION

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SPOTLIGHT PROFILE SHELIA HOLLERAN

LIFE IN AND OUT OF THE OR

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NUTRITION HABITS

SEPTEMBER 2020

INJURIES REMAIN A STICKING POINT IN 2020 PAGE 36

SPOTLIGHT ON

Shelia Holleran - COVID19 NURSE PAGE 40

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OR TODAY | September 2020

contents features

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COVER STORY: SHARPS SAFETY Despite ongoing efforts, needlestick injuries and sharps safety remain a serious problem in today’s health care environment. At least 600,000 sharps injuries still occur in U.S. health care facilities each year, according to one study. The number of injuries is expected to be even higher as these types of incidents often go unreported.

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CREATING EFFICIENCIES IN THE OR THROUGH THE NEW NORMAL Casey Branham, CMLSO and surgical division vice president at Agiliti, discusses how operating rooms across the country are planning for the weeks and months ahead amid the effects of the COVID-19 pandemic.

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UV-C DISINFECTION ROBOTS MARKET WORTH BILLIONS The global UV-C disinfection robots market is projected to reach $5.57 billion by 2027, growing at a compound annual growth rate of 32.62% from 2020 to 2027.

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HABITS TO CULTIVATE The COVID-19 pandemic means working from home and sheltering in place for millions of Americans. It also means the adoption of some new habits that could be beneficial to maintain even after the pandemic subsides.

(Vol. 20, Issue #9) September 2020 is published monthly by MD Publishing, 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290.

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8 News & Notes 16 IAHCSMM: OR Team: Don’t Forget to Honor Your SPD Teammates 18 Agiliti: Creating Efficiencies in the OR Through the New Normal 21 CCI: Stand by for Heavy Seas 22 Webinar: Webinar Addresses Importance of Communication Tools

24 M arket Analysis: UV-C Disinfection Robots Market Worth Billions 25 Product Focus: Disinfection/UV 30 CE Article: Evidence-Based Care of the Post-Cesarean Section Patient

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news & notes

ValueHealth, ChristianaCare Announce Joint Venture ChristianaCare and ValueHealth LLC have entered into a joint venture partnership that will advance valuebased care in Delaware and the surrounding region. The partnership will create a much-needed, value-based ambulatory and hyperspecialty surgical strategy to lower costs and deliver high-quality care for the communities ChristianaCare serves.

The joint venture will develop future sites in the region encompassing Delaware, Eastern Maryland, Southeast Pennsylvania and Southern New Jersey, with an initial focus on hip- and knee-replacement surgery.

The joint venture was developed to address the needs of the community and commercial payors for value-based health care delivery. In 2019, the Delaware legislature created the state’s first Office of Value-Based Health Care Delivery in the Department of Insurance to reduce health care costs by increasing the availability of high quality, cost-efficient health insurance products that have stable, predictable and affordable rates. Today, as health systems begin to emerge from the peak of the COVID-19 pandemic and seek opportunities to innovate and come back better than before, the need to design new models built on value-based care is more compelling than ever.

“Surgery will never be the same as it was pre-COVID,” said ValueHealth Executive Chairman John R. Palumbo.

“This type of joint venture creates the path forward to better outcomes: financial, clinical and experience. Outmigration of high-cost cases is one of the most strategic challenges health systems face. Combining ChristianaCare’s statewide capabilities with ValueHealth’s proven successes in the hyperspecialty surgical space and partnering with world-class surgeons helps us to achieve the highest level of quality care and patient experience while lowering costs.”

ValueHealth’s payor-led, tech-enabled, data-driven digital surgical platform, currently integrated into more than 30 health systems, includes patient steerage, payor bundles and warranty contracts, as well as its nationally recognized Ambulatory Centers of Excellence (ACE) program, which designates ambulatory surgical centers that not only exceed national accrediting standards, but also meet ValueHealth’s stricter clinical, quality, and financial measures. •

8 | OR TODAY | SEPTEMBER 2020

Dräger Aims to Improve LTAC Outcomes Dräger has leveraged its 100+ years of critical care expertise to develop a new solution designed specifically to address the needs of the long-term acute care (LTAC) environment.

With Dräger’s solution, LTAC facilities can maintain quality throughout the continuum of care with the convenience of a single vendor.

Along with Dräger’s proven critical-care equipment and high-quality accessories and consumables, the company is offering innovative medical headwall systems, a specialized LTAC team, an interactive design center and onsite support to help LTACs address the complexity and costs associated with caring for higher acuity patients outside of the intensive care unit (ICU).

“Administrators and clinical leaders in LTAC facilities often struggle to balance cost and quality given the evolving patient case mix, payer reimbursement restructuring, workflow design complexities and continued vigilance for patient safety,” said Steve Menet, Dräger’s senior vice president of sales for hospital solutions in North America. “With this new solution we are leveraging our extensive expertise in the critical care space to improve outcomes and reduce costs among the rapidly-growing long-term care patient population.”

Dräger’s LTAC solution offers health care organizations the patient care technology, services and solutions they need to support high quality care from admission to discharge, and the convenience and cost savings that comes with the ability to rely on a single vendor. •

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INDUSTRY INDUSTRY INSIGHTS INSIGHTS news & notes

BD Launches New Skin Prep Solution BD (Becton, Dickinson and Company) has announced the availability of BD PurPrep patient preoperative skin preparation with sterile solution, the first and only fully sterile povidoneiodine plus isopropyl alcohol single-use antiseptic skin preparation (PVP-I; 0.83% available iodine and 72.5% isopropyl alcohol) commercially available in the United States.

BD PurPrep joins BD ChloraPrep patient preoperative skin preparation as the only fully sterile skin preparations available on the market that use a single-use applicator specifically designed to prevent cross-contamination and promote aseptic non-touch technique. The BD PurPrep patient preoperative skin preparation is an effective skin preparation alternative when the use of a chlorhexidine gluconate (CHG/IPA) is contraindicated or the patient is sensitive to CHG. “Though progress has been made, health care-associated infections remain a problem,” said Donald E. Fry, M.D., a nationally recognized expert in infection prevention. “Sterile single-use products have been shown to reduce the risk of outbreaks linked to microbial contamination of antiseptic products. By developing fully sterile PurPrep and ChloraPrep, BD is providing health care professionals with a more complete set of tools to reduce the risk of intrinsic contamination in antiseptic solutions.”

The new BD PurPrep formulation includes a fluid-resistant, film-forming polymer developed to facilitate drape adhesion and help create a durable antimicrobial barrier that helps iodine bind to the skin for residual antimicrobial activity. In an irrigation study, mimicking real-world clinical practice, BD PurPrep patient preoperative skin preparation with sterile solution remained on the skin immediately following a saline challenge.

“BD PurPrep strengthens our commitment to health care professionals and patients by providing an alternative fully sterile option to help reduce the risk of intrinsic contamination,” said Michael Cusack, BD, vice president/general manager of infection prevention. “By adding a non-CHG, fully sterile skin preparation option, BD is expanding the number of tools available to help reduce the risk of infection in patients with CHG sensitivities and during procedures when CHG/IPA is not indicated.”

BD PurPrep will replace Prevail and Prevail FX, and is available now through BD and other distribution partners. •

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AAAHC Enhances Standards in New Accreditation Handbook The Accreditation Association for Ambulatory Health Care (AAAHC) is moving forward with enhanced Standards in version 41 of its Accreditation Handbook for Ambulatory Health Care. The new version of the handbook includes new or notably revised Standards and applies to all organizations seeking non-Medicare Deemed Status (non-MDS) accreditation with AAAHC. The v41 Standards reflect comments received from stakeholders, including the AAAHC Standards Development Committee, client organizations, surveyors, partners and staff. Organizations will find the updates contain moderate realignment of a few standards for chapter applicability and cohesion.

Also, elements of compliance have been capped at a maximum of seven for balanced focus within each standard. For ease of review and implementation, the handbook contains a crosswalk identifying changes from the previous version.

“AAAHC anticipates a seamless transition to the v41 Standards that will enhance an organization’s quality improvement efforts,” said AAAHC Board Chair Ira Cheifetz, DMD. “We have prepared educational webinars for AAAHC accredited organizations on Standards updates. Additionally, our upcoming virtual Achieving Accreditation programs will address these changes.”

AAAHC launched the v41 Standards at the ASCA 2020 Virtual Conference & Expo. AAAHC said it plans to release v41 of the Accreditation Handbook for Medicare Deemed Status (MDS) during the summer. •

SEPTEMBER 2020 | OR TODAY |

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INDUSTRY INSIGHTS

news & notes

Servo-air Mechanical Ventilator Receives 510(k) Clearance Getinge has received 510(k) clearance from the U.S. Food & Drug Administration (FDA) for the company’s Servo-air mechanical ventilator, which is part of the Servo family that supports intensive care ventilation ever since the first model was introduced in 1971.

“We are happy to be able to help clinicians in their endeavor to save lives by adding an additional ventilator to our product offering in the U.S. market,” says Elin Frostehav, vice president critical care at Getinge. “This is also an important step for our ventilation business in other parts of the world where 510(k) approval is a prerequisite for governmental tenders.”

Servo-air is a critical care ventilator. Intended for pediatric and adult patients, it includes both invasive and noninvasive (NIV) ventilation modes. Servo-air also features options for high flow therapy and Servo Compass, which

allows lung protective ventilation and makes it easier to follow the ARDSnet protocol.

“The turbine driven Servoair is independent from wall gas. This, in combination with its high battery capacity, makes it suitable for use in intensive care units as well as for intermediate care and intra-hospital transportation,” says Malin Graufelds, global product manager Servo-air.

“Servo-air has the same proven easy-to-use user interface with context based guidance as our high-end ventilator Servo-u, which facilitates both learning and managing a mixed fleet of Servo ventilators,” she adds. •

Medline’s Surgical Center Toolbox Helps ASCs Relaunch Safely Many states have reopened amidst the COVID-19 pandemic, and elective surgeries are starting back up. As ambulatory surgery centers (ASCs) open their doors again, they are now tasked with figuring out how to update all of their infection prevention policies to keep staff and patients safe. A partnership between HOTB and Medline is offering outpatient surgery facilities an online toolkit, the Surgical Center Toolbox (SCT), to help them manage the process digitally.

The Surgical Center Toolbox eliminates manual processes by digitizing logs and creating a central database and document repository. The cloud-based tool simplifies reporting for accrediting bodies, including the Accreditation Association for Ambulatory Healthcare (AAAHC) and The Joint Commission.

“The whole concept of accreditation and compliance is about preventive training and monitoring,” says Andy Firoved, CEO of HOTB Software. “SCT was designed to be able to host any and all regulatory needs a surgery center

10 | OR TODAY | SEPTEMBER 2020

might have, with dynamically auto-populated policies and procedures, logs, credentialing information, all cloud-based and without reliance on dozens of paper logs and binders anymore.”

As COVID-19 began having a major impact on the industry, Medline’s education and training arm, Medline University, began to provide the industry with access to training resources on PPE best practices, including SCT users.

Medline University, in partnership with HealthStream, has a diverse offering of CE compliant courses that are free and available to the public through Sept. 30, 2020. • For a demo of the Surgical Center Toolbox, visit www.sctdemo.com.

For more about Medline’s offerings, visit www.medline.com/ pages/who-we-serve/surgery-center/.

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news & notes

Medtronic, Foxconn Partner to Increase Ventilator Production Medtronic plc and Foxconn Industrial Internet announced that Foxconn has successfully completed Medtronic’s regulatory and quality requirements necessary to begin manufacturing Medtronic Puritan Bennett 560 (PB560) ventilators for Medtronic in the United States. Medtronic and Foxconn are ramping up plans to produce 10,000 PB560 ventilators over the next year at Foxconn’s Wisconn Valley Science and Technology Park in Mount Pleasant, Wisconsin. The ventilators will be marketed and sold by Medtronic.

“No single company can meet the current demands for ventilators that are critical in the fight against COVID-19. Joining together with Foxconn immediately increases our production capacity to meet the increased demand and creates a flexible manufacturing model for us,” said Vafa Jamali, senior vice president and president of the respiratory, gastrointestinal and informatics busi-

ness, which is part of the minimally invasive therapies group at Medtronic. “Together, we can increase ventilator supply and help more patients and clinicians than any one company can do alone.”

The two companies connected after Medtronic publicly shared the design specifications for the PB560 through the Medtronic ventilator open source initiative, which launched earlier this year. This effort allows global participants to evaluate options for rapid ventilator manufacturing at scale to help doctors treat patients fighting COVID-19. To date, there have been more than 200,000 registrations for the design specifications at Medtronic.com/openventilator.

To respond to global demand, if needed, Medtronic and Foxconn can increase their production capability to more than double the current Foxconn ventilator commitment. •

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INDUSTRY INSIGHTS

news & notes

VA Taps Philips for Tele-Critical Care System The U.S. Department of Veterans Affairs (VA) has awarded a contract to Philips to expand VA’s tele-critical care program, creating the world’s largest system to provide veterans remote access to intensive care expertise, regardless of their location. The 10-year contract, which enables VA to invest up to $100 million with Philips for tele-critical care technology and services, leverages Philips history of innovation, including research into technologies that can better support veterans, telehealth, tele-critical care (eICU), diagnostic imaging, sleep solutions and patient monitoring.

VA is the largest integrated health care system in the U.S., consisting of more than 1,700 sites and serving nearly nine million veterans each year. It has become a leader in developing telehealth services in order to improve access to care and federate care delivery.

As part of an overall telehealth program, eICU enables a co-located team of specially trained critical

12 | OR TODAY | SEPTEMBER 2020

care physicians and nurses to remotely monitor patients in the ICU regardless of patient location. With VA managing 1,800 ICU beds nationwide, eICU not only gives patients access to specialists, but also helps them deliver on the Quadruple Aim: optimizing care costs, enhancing clinician and patient satisfaction and improving outcomes. Research has shown that patients in eICU settings spend less time in the ICU and have better outcomes. Moreover, family members can talk to clinicians via integrated audio and video technology to support decision making.

“VA’s relationship with Philips will help to expand and improve our tele-critical care program,” U.S. Secretary of Veterans Affairs Robert Wilkie said. “This is particularly critical to provide Veterans access to quality health care when and where they need it and for improving their health outcomes.” •

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Smiths Medical, HCA Capital Go Live with Smart Pump Programming Smiths Medical announced in late June that smart pump programming of the Medfusion 4000 wireless syringe infusion pumps is live with HCA’s electronic medical records system (EMR) at nine HCA Capital Hospitals. These sites include: Chippenham, Johnston-Willis, Henrico Doctors - Forest, Montgomery, Portsmouth, Reston, Spotsylvania, StoneSprings, and Terre Haute. Combined they have successfully programmed over 1,500 infusions.

Smart pump programming allows clinician order parameters to be sent directly to the pump that will help ensure that the correct medication, concentration, rate and dose be delivered to the patient. This will increase patient safety by reducing possible programming errors.

Smart pump programming is supported by Integrating the Healthcare Enterprise (IHE), an initiative by health care professionals and industry to improve the way computer systems in health care share information. IHE promotes the coordinated use of established standards such as DICOM and HL7 to address specific clinical needs in support of optimal patient care.

Systems developed in accordance with IHE communicate with one another better, are easier to implement and enable care providers to use information more effectively. •

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INDUSTRY INSIGHTS

news & notes

Super Sani-Cloth Wipes Receive Test Results PDI has generated data showing its Super Sani-Cloth wipes are effective against SARS-CoV-2, the virus that causes COVID-19. This is one of several of the company’s hospital-grade disinfecting products being tested for efficacy against SARS-CoV-2 for submission to the EPA for approval. Testing of the additional disinfecting products is still underway and results are expected in the upcoming months.

According to the data, the wipes demonstrated a 3-log reduction against the virus. The wipes were tested in compliance with “Disinfectants for Use on Environmental Surfaces, Guidance for Efficacy Testing,” the EPA’s threshold for deeming a disinfectant effective.

“This was an important step in furthering our mission to protect patients and those on the front lines of preventing the transmission of COVID-19,” said Sean Gallimore, senior vice president and general manager for PDI Healthcare. “We are seeking SARS-CoV-2 EPA label claim approval for Super Sani-Cloth wipes to officially verify that the virus is being inactivated on surfaces, and ultimately protecting caregivers, patients and communities.”

Microbac Laboratories Inc., an independent laboratory that performs environmental, food, and life science testing for businesses, performed the efficacy testing using a multi-step process. First, the lab applied the virus to a surface and let it dry. Then, they wiped the surface with a Super Sani-Cloth wipe, recovered the residual liquid, and applied the liquid to cells in culture. How viable the cells remained told Microbac how effective the cloth was in inactivating the virus.

“This is an important step in understanding how SARS-CoV-2 responds to hospital-grade disinfectants,” said James Clayton, Director of Laboratory Sciences for PDI, after reviewing the data. “The ability to reduce surface transmission of the virus is an important tool in the growing arsenal of preventative measures.”

Other PDI products included on EPA List N are currently being tested by Microbac and results are expected in the coming months. •

14 | OR TODAY | SEPTEMBER 2020

Study: Iodine exposure in the NICU may lead to decrease in thyroid function Exposure to iodine used for medical procedures in a neonatal intensive care unit (NICU) may increase an infant’s risk for congenital hypothyroidism (loss of thyroid function), suggests a study by researchers at the National Institutes of Health and other institutions. The authors found that infants diagnosed with congenital hypothyroidism following a NICU stay had higher blood iodine levels on average than infants who had a NICU stay but had normal thyroid function. Their study appears in The Journal of Nutrition.

“Limiting iodine exposure among this group of infants whenever possible may help lower the risk of losing thyroid function,” said the study’s first author, James L. Mills, M.D. To conduct the study, the researchers analyzed blood spots for their iodine content. They compared blood iodine levels from 907 children diagnosed with congenital hypothyroidism to those of 909 similar children who did not have the condition. This included 183 infants cared for in the NICU — 114 of whom had congenital hypothyroidism and 69 who did not.

Overall, the researchers found no significant difference between blood iodine concentrations in those who had congenital hypothyroidism and those in the control group. Because very high or very low iodine levels increase the risk for congenital hypothyroidism, they also looked at those infants having the highest and lowest iodine levels.

Children with congenital hypothyroidism were more likely to have been admitted to a NICU than those without congenital hypothyroidism. When the researchers considered only those infants with a NICU stay, they found that the group with congenital hypothyroidism had significantly higher iodine levels than those without the condition who also had a NICU stay. Similarly, those with congenital hypothyroidism and a NICU stay tended to have higher blood iodine than children with the condition who did not have a NICU stay.

The researchers were unable to obtain information on the medical procedures the infants may have undergone during their time in the NICU. Iodine solutions are commonly used as disinfectants to prepare the skin for surgical or other procedures. Preterm infants absorb iodine more readily through their skin than older infants. Iodine also is given internally for imaging procedures used in infants.

The researchers said that the higher iodine levels seen among infants with congenital hypothyroidism and a NICU stay may have resulted from exposure to iodine during a medical procedure. Because of this possibility, they cautioned NICU staff to use disinfectants that do not contain iodine whenever possible and to avoid exposing infants to iodine unless absolutely necessary. •

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news & notes

TRICOR Systems Inc. Announces Agreement with SteriView Technologies Inc. TRICOR Systems TRICOR SystemsInc. Inc. has has launched launched thethe SteriView SteriView MICMIC (Modular TRICOR has has beenbeen chosen as (ModularInspection InspectionCamera).

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fected, providing the infection The MIC’s removable inserprevention team the tion tube/camera canability be to imagelevel the internal channels high disinfected, pro- of aviding clean the instrument. infection prevention team the ability to image the more For internal information, channels visit of a clean instrument. www.driscope.com.

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INDUSTRY INSIGHTS

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OR Team: Don’t forget to honor your SPD teammates (International Sterile Processing Week is Oct. 11-17)

By Julie E. Williamson he hard work and contributions of sterile processing (SP) professionals deserve recognition and appreciation every day of the year. After all, without these professionals’ care and handling and delivery of clean, sterile and optimally-functioning surgical instrumentation and equipment, Operating Rooms (ORs) simply could not function, and quality patient care within the surgical suite could not be delivered.

T

Unfortunately, SP professionals often remain the unsung heroes of patient care – working diligently behind the scenes in a fast-paced, challenging and, at times, uncomfortable environment to process instrumentation safely and efficiently to keep a facility’s surgery schedules on track. This year and all that follow, the International Association of Healthcare Central Service Materiel Management (IAHCSMM) urges all OR professionals to take time out of their own busy schedules to honor their teammates in the sterile processing department (SPD) throughout International Sterile Processing Week (this year, it’s being celebrated October 11-17).

Break down barriers One of the best ways for OR professionals to honor their SP colleagues is to spend some quality time within the walls of the busy SPD. This is a valuable move for new and veteran OR professionals alike because only then can SP techni-

16 | OR TODAY | SEPTEMBER 2020

cians’ hard work, dedication and commitment to quality fully be appreciated and understood.

Conversely, inviting new SPD employees or other SP professionals into the OR, so they can view the instruments they process “in action” is equally effective. This allows them to see firsthand how the instruments are used and how essential they are to patient care. Prior to the start of Sterile Processing Week, consider partnering with the SPD on ways to bring the two departments together – and be sure to have OR representation during at least some of the SPD’s celebratory events (which may include departmental tours, educational inservices, standards and guidelines overviews, hands-on demonstrations of proper cleaning technique – all of which can give OR teammates valuable insight into why safe, effective instrument reprocessing takes so much time and should never be rushed).

Kick in on the celebration It’s not uncommon for SPDs to have limited budgets; however, the OR teammates can help them celebrate Sterile Processing Week in impactful, lowmonetary investment ways. Providing baked goods with a heartfelt “Thank You” note attached is always a meaningful gift.

A brief visit to the department during all shifts to deliver a personal message of gratitude can also go a long way toward boosting morale and creating a stronger sense of unity and team-based belonging.

OR professionals may also want to

create a poster for the SPD that highlights some of its many contributions throughout the year (e.g., increased efficiency/productivity, successfully reprocessing new equipment/technology for a newly added specialty, reduced instrument set errors), which can be shared with the SP team and posted in common areas for all other Sterile Processing Week participants/visitors to see. For added impact, have all OR teammates sign their names and/or write a brief personal message on the poster or on individual pieces of paper that can be added to a bulletin board.

The surgical team can also assist the SPD in posting flyers for Sterile Processing Week in common areas of the facility and, perhaps, even consider writing an article for the facility’s internal newsletter that helps demonstrate the importance and value SP professionals deliver to the surgical staff every day. If the SPD is planning a particular event during Sterile Processing Week, offer to help set up or participate in some other way. Again, this helps demonstrate how the two departments really are part of the same team. To add to the education for Sterile Processing Week, volunteer to have a member of the OR provide a brief demonstration on how a new or especially sophisticated instrument or piece of surgical equipment is used during the procedure; then, consider having a member of the SPD team provide a return demonstration on how that instrument/equipment is disassembled, cleaned, high-level disinfected/sterilized, WWW.ORTODAY.COM

inspected and so on. Visual demonstrations deliver high impact. This is also a great time for the SPD to re-educate members of the OR team on proper point-of-use instrument care and how essential it is for keeping devices performing at their best – and helping SP professionals be able to reprocess them more efficiently to keep surgery schedules on track.

Keep up the support SP and OR teammates should work to keep up the positive energy and pursuit for better interdisciplinary partnership throughout the entire year – not just during one another’s dedicated celebratory weeks. Once Sterile Processing Week and Perioperative Nurse Week come to a conclusion in October and November, respectively, the two departments can keep up the momentum by holding frequent (daily, weekly, per-shift or as-needed) joint huddles to address any challenges or concerns, discuss the surgery schedule and specific needs/requests, and answer any questions either department may have. These huddles also provide a perfect opportunity to express gratitude for a job recently well done, or to briefly share how both sides came together to improve service and patient care.

Although the OR and SPD have very different functions, it’s important that both sides recognize they’re very much part of the same team and share a core common goal: ensuring the delivery of the safest, highest quality patient care. Promoting an effective team-based culture that takes time to better understand one another’s needs and roles will go a long way toward helping reach that essential patient safety and customer service goal.

For more Sterile Processing Week ideas, tips and inspiration, visit iahcsmm.org/events/cs-week.html.

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SEPTEMBER 2020 | OR TODAY |

17

INDUSTRY INSIGHTS

SPONSORED CONTENT

Efficiencies

Creating Efficiencies in the OR Through the New Normal Q&A with Casey Branham, CMLSO and surgical division vice president at Agiliti The past several months have shown that the volatility of COVID-19 will likely continue to disrupt patient volumes and revenue at health systems for quite some time.

To get a better sense of how hospitals have evolved their approach to elective surgical procedures, and what they can do to maximize revenue potential, we spoke with Casey Branham, CMLSO and surgical division vice president at Agiliti, to discuss how operating rooms (ORs) across the country are planning for the weeks and months ahead.

Q

hat are some obstacles challenging ORs W from running more efficiently in the current environment?

A: The biggest challenge we’ve seen as COVID has surged across different regions of the country is how ORs manage the variability in case volumes. ORs have seen significant reductions in case volumes this year, and the pressure is on to drive efficiencies by getting patients through the operating room as safely and quickly as possible. But not every OR has taken care of the little things like “case stacking” by grouping together similar cases. This can save hours of valuable time by limiting OR logistics (set up, tear down, equipment in/out).

We’ve also seen some facilities with low patient census try to find hours for their nursing staff by opting to have those nurses cover cases that involve lasers. This can be risky because medical laser operators are required to be certified for every surgical laser model and the procedure in which it is used. If the nurse isn’t properly certified, this is a major compliance risk and a risk to their license.

18 | OR TODAY | SEPTEMBER 2020

Q

ow can ORs navigate H these challenges right now?

A: As elective procedures increase, hospitals and surgery centers need to fill the gap between the equipment to which they currently have access, and the increased amount of equipment that is needed with higher demand.

With financial constraints on many facilities, purchasing new Casey Branham CMLSO and surgical equipment is probably not feadivision vice president sible. Plus, the reality is that the Agiliti delivery and installation of new equipment – coupled with staff training – would likely take too long to get up and running. Renting is cost-effective, giving hospitals flexible access to laser technologies – and trained and certified technologists – to handle the ebbs and flows of surgical volume now and in the coming months. Rental fills the gap until hospitals obtain more information to make a good long-term acquisition decision. We don’t really know what tomorrow brings when it comes to COVID-19, but having flexibility with limited capital budgets is likely going to be very important.

For facilities that have enough lasers but not enough certified technicians for all of their cases, it may be a good time to look into technician-only labor to cover any temporary staffing gaps. This allows hospitals to direct nurses to more critical patient areas and can address the long-term chal-

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INDUSTRY INSIGHTS

Efficiencies

lenges hospitals will face as policies evolve regarding how often staff can come in with mild cold symptoms. In these situations, tech-only supplemental labor can act as a stop-gap when hospitals are short on staff.

Q

How H ow can ORs reduce spend while getting the most out of their surgical lasers and equipment?

A: Understandably, cost savings are top of mind for many OR directors. One of the biggest expenses ORs face when it comes to their surgical lasers and specialized surgical equipment – such as endoscopes, ophthalmic, endo/lap, etc. – is the maintenance and repair of that equipment. Independent service organizations (ISOs) can provide the same quality service as manufacturers while offering meaningful cost savings. Plus, because some original equipment manufacturers (OEMs) have reduced the size

of their service teams due to the pandemic, many facilities are experiencing significant PM backlogs. This is an opportunity for third-party vendors to play a bigger role in servicing these devices at the facility level to fill the gap.

Another way facilities can reduce spend is to ensure their owned medical lasers are being utilized across the entire hospital network. Oftentimes, we see a laser sitting idle at one site, while a sister facility nearby needs that same technology, By utilizing these suggestions and partnering with a quality surgical laser rental and repair provider, hospitals can realize cost savings while meeting the ebbs and flows of variable case demands.

For more information visit www.agilitihealth.com.

.

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INDUSTRY INSIGHTS CCI

Stand by for Heavy Seas

By James X. Stobinski, PhD, RN, CNOR, CSSM(E) recently read an exceptional editorial written by Judy Mathias (2020) about leadership. The editorial was largely a recounting of remarks made by James Mattis in a recent webinar. Although some of you will recognize the name of this retired four star general, it is not often that you find him cited among health care experts. However, Gen. Mattis is a subject matter expert on leadership and during these extraordinary times some wise words on this topic are especially relevant.

I

The content from Gen. Mattis came under the header, “Rough seas make good sailors.” As a U.S. Navy veteran, this phrase rings familiar. The thought is that challenges and trying conditions, such as the current pandemic, force us to respond and rise to another level of performance.

Mattis tells us that the challenges visited upon American health care by the COVID-19 pandemic will exact a toll on those in leadership roles with perioperative nurse leaders not being exempt. He tells us that, “This crisis is applying a very crude and very harsh grading system to our leaders … ” (Mathias, 2020, p. 3). It is disorienting for perioperative nurses accustomed to the security of high demand for surgical care to be displaced to other units, furloughed or lose employment as WWW.ORTODAY.COM

elective surgical caseload plummets.

Unfortunately, even as some regions of the country return to more normal routines in surgery, there remains considerable uncertainty.

Staying with the nautical theme it reminds me of the phrase, “Stand by for heavy seas,” the title of this column. In seafaring, the phrase describes when the water has large waves or breakers in stormy conditions (Mimi Boating, 2020). I have experienced such conditions on a large warship and it is quite disorienting. Under such conditions it is difficult to carry out even the most routine tasks. That description is apt as I predict we will have rough conditions in the OR for the near future. We must address the backload of elective surgeries in the context of severely diminished revenue for one quarter of this year.

At the Competency and Credentialing Institute (CCI), we also have anecdotal reports that many experienced perioperative nurses who were in high-risk groups elected to retire during the pandemic. We have seen unprecedented numbers of our certificants retiring their credentials and applying for emeritus status.

Perioperative nurses tend to have long careers and we have many nurses with 30 and 40 years in the specialty. It seems the changes wrought by the pandemic have proven a tipping point for some to leave the profession.

The pandemic has brought a

distinct set of challenges for CCI. In-person testing volume has shrunken to record lows with very little testing during April and May. Testing is now slowly resuming, but seat capacity for in-person testing remains limited and spotty with distinct variability by state and by region and city within a state. An example of change for CCI, considering limited seating availability, has been the rapid transition to Remote Secure Proctored Exams (RSPE).

That change has not been entirely smooth, and our accreditation bodies have also been forced to pivot quickly to emphasize RSPE. At CCI, we envision remote testing as having a larger future role.

We are working diligently to refine these processes for our nurses. The heavy seas of American health care have forced us to change and adapt and the credentialing specialists at CCI have been instrumental in the startup of remote testing. In our column next month, these frontline staff will relate lessons learned from the CCI transition to RSPE.

References 1. Mathias, JM (2020). Editorial. OR Manager.

36(7). Pp. 3-5.

2. MiMI Boating. (n.d.) Heavy seas: Definition.

Accessed July 2, 2020 at: https://en.mimi.hu/ boating/heavy_seas.html.

SEPTEMBER 2020 | OR TODAY |

21

INDUSTRY INSIGHTS

news & notes webinars

WEBINAR SERIES

Webinar Addresses Importance of Communication Tools Staff report n June 25, OR Today hosted the Healthmark Industries-sponsored webinar “Communication Tools, More Important Than Ever!” eligible for one (1) continuing education (CE) hour by the State of California Board of Registered Nursing and eligible for 1 credit for IAHCSMM and CBSPD.

O

Kevin Anderson, clinical education coordinator for Healthmark Industries, reviewed the important role that labels, signs, symbols and tags play in protecting staff and patients from harm. At the completion of the webinar, attendees had a better understanding of how they all are interconnected with other medical professionals in providing best practices based on the proper use of signs, labels, tags and symbols.

The webinar attracted 152 attendees for the live presentation with more viewing a recording of the presentation online. Two lucky attendees won prizes during the live presentation.

Tracey Young won an OR Today Live! Surprise Pack given away during the live webinar. Fidelia Roster of Halifax Health in Florida won a gift card. According to post-webinar surveys, every attendee was a winner thanks to the quality educational value of the presentation.

“With all the ever-changing regulations and requirements, it was nice to see what we are doing correctly and to know what we need to be looking out

22 | OR TODAY | SEPTEMBER 2020

for,” Director of Surgical Services D. Bonham said.

“I appreciate the opportunity for the OR Today webinar! OR Today is being innovative with providing education in relation to today’s pandemic and it is greatly appreciated by the health care staff,” said T. Young, perioperative education.

“This webinar gave me a lot to think about and what to look for in my facility … What is the best way to display signage and what are the visual cues that most people see in a quick glance?” shared J. Richards, RN. “The webinar was eye-opening. I just looked at a package for pediatric defib electrodes and there were at least 20 symbols and visual instructions,” said G. Koch, BMET III. “I enjoyed the webinar and was reminded that I need to be more aware when autopilot kicks in and make sure I pay attention to visual cues,” Instrument Processor H. Hopkins said.

“I found the presentation interesting and informative. It would be a useful topic at a work or AORN meeting,” said J. Albertson, RN. “The webinar was extremely helpful and relevant in the OR settings.

Presenter was very knowledgeable,” Clinical Supervisor C. Dematteis said.

“The use of signs in Kevin Andersons’s presentation hit the nail on the head. Precise visual communication is key to understanding and creating a safe work environment. Otherwise everyone will have their own interpretation,” Manager MD-CSR L. Otte said.

“This webinar was a great educational tool and a nice refresher to emphasize the importance of communication. It also verifies that communication is still the root of many of our process problems within the health care field,” said F. Roster, vice president chief care continuum officer.

“This was a unique webinar, well presented, clearly stated, great slides and a timely presentation,” Nurse Manager P. Burton said.

“I learned the meaning of some symbols that I wasn’t aware of. The webinar was an eye-opener of the preventable risks without proper and understandable signage,” said S. Sirois, BMET III. “Excellent information into how important signage is when it comes to safety. The speaker was very engaging and insightful,” said T. Fuchs, director of surgical services.

“OR Today’s webinars are consistent, always good, great speakers, always relevant to my role as a perioperative infection prevention consultant and the CEs are a real plus. I try to attend every one or go back and replay,” said P. Segal, president.

For more information, visit ORToday. com/webinars.

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IN THE OR

market analysis

UV-C Disinfection Robots Market Worth Billions Staff report erified Market Research recently published a report, “UV-C Disinfection Robots Market by Type (Portable Type, Stationary Type), by Application (Hospital & Clinic, Biosafety Laboratory, Drug Production Workshop).”

According to the report, the global UV-C disinfection robots market was valued at $172.70 million in 2019 and is projected to reach $5.57 billion by 2027, growing at a compound annual growth rate (CAGR) of 32.62% from 2020 to 2027.

V

The growth of the UV-C disinfection robots market can be attributed to the upsurge in awareness about the harmful effects of hospitalacquired infections (HAIs). Health care facilities are increasingly modifying cleaning protocols and adopting advanced technologies to combat HAIs caused by numerous multi-drug-resistant spores and organisms. These infections can occur during examination, admission, treatment or rehabilitation.

24 | OR TODAY | SEPTEMBER 2020

They can spread from sources, such as visitors, patients, hospital equipment, surroundings as well as the hospital staff. As awareness about HAIs is increasing, emphasis on terminal cleaning at hospitals and improvement in patient care are expected to affect the market growth significantly.

The technological advancements to develop robots for disinfection purposes at health care facilities has increased in recent years. Various robot manufacturers are focusing on creating autonomous models that can navigate through hospitals and other large facilities, supporting human cleaning crews by sanitizing rooms and other surfaces where virus particles can spread among an infected populace. The advancement in technology is allowing more efficient infection control and this is expected to propel the growth of the UV-C disinfection robots market in the coming years.

However, the high cost of disinfection along with the lack of availability of advanced robots for disinfection purposes – mainly in developing and underdeveloped

countries – is expected to hinder market growth substantially.

A report by the research firm Reports and Data included information about the COVID-19 pandemic and its impact on the disinfection market.

“On March 11, 2020, the World Health Organization (WHO) confirmed that an outbreak of the disease COVID-19 had extended to the level of a world pandemic.

Showing worries with ‘the upsetting levels of severity and spread,’ the WHO urged the governments across the globe to take aggressive and urgent action to curb the spread of the deadly virus through the use of products such as ultraviolet disinfection equipment, especially in the hospitals and other places where COVID-19 patients are being treated,” according to Reports and Data.

Some key players in the market are Xenex Disinfection Services LLC, UVD Robots ApS (Blue Ocean Robotics), Tru-D SmartUVC, Purple Sun, Diversey and Dimer UV.

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IN THE OR

product focus

Blue Ocean Robotics UVD Robots

Blue Ocean Robotics develops, produces and sells professional service robots in health care, hospitality, construction, agriculture and other global markets. The portfolio of robots includes the brands: UVD Robots, a mobile robot for disinfection; GoBe Robots, a mobile telepresence robot for communication, social inclusion, and CO2 climate improvements; and PTR Robots, a mobile robot for safe patient handling and rehabilitation. •

Diversey

MoonBeam3 UV-C MoonBeam3 is an ultraviolet-C disinfection device that provides a better angle for disinfection. This portable, powerful solution disinfects quickly, reliably and responsibly. With articulating arms designed to optimally deliver UV-C energy, MoonBeam3 is designed for fast disinfection of patient areas. In independent studies, the system has demonstrated 3+ to 6+-log10 reductions of harmful bacteria, viruses and C. diff spores in just 3 minutes on both horizontal and vertical surfaces. With a compact footprint that makes use, transport and storage easy, the system is affordable to use, with low acquisition and use cost – allowing facilities to create a safer environment. • For more information, visit www.diversey.com.

WWW.ORTODAY.COM

SEPTEMBER 2020 | OR TODAY |

25

IN THE OR

product focus

Tru-D

SmartUVC Tru-D SmartUVC is a portable UVC disinfection device that delivers one automated, measured dose of UVC to consistently disinfect a room, resulting in the ability to document disinfection results after each and every Tru-D room treatment.

Tru-D operates from one placement within the room, ensuring significant pathogen reduction in direct and shadowed areas and reducing the threat of human error in the disinfection process.

Validated by more than 20 independent studies, Tru-D’s combined automated, measured dosing capabilities and real-time usage-tracking features make it one of the most precise and advanced UVC disinfection systems available. •

Xenex

LightStrike Germ-Zapping Robots Xenex’s LightStrike Germ-Zapping Robot helps health care facilities reduce SSIs by quickly destroying the pathogens that can cause infections. Hospitals using LightStrike have published peer-reviewed studies showing 46-100% reductions in Class 1 SSI rates in ORs. The only UV room disinfection technology proven effective at destroying SARS-CoV-2 in two minutes (the virus that causes COVID-19), LightStrike robots use a xenon lamp and generate bursts of high intensity, broad spectrum UV light to quickly deactivate viruses, bacteria and spores where they are most vulnerable without damaging expensive OR equipment. •

26 | OR TODAY | SEPTEMBER 2020

WWW.ORTODAY.COM

IN THE OR

product focus

UltraViolet Devices Inc. UVDI-360 Room Sanitizer

UVDI-360 Room Sanitizer provides Advanced Ultraviolet Disinfection Simplified in the world’s leading hospitals. Proven in published, clinical studies to prevent HAIs and high-risk pathogens and independently tested to inactivate 35 pathogens, including C.difficile, MRSA and coronavirus in 5 minutes at 8 feet; UVDI-360 utilizes four maximum-output lamps for rapid room disinfection and assures complete surface coverage via proprietary UVDI Dose Verify technology. Designed for ease of use – simple operation via the UVDI mobile app and intuitive touchscreen; cloud-based SmartData portal enables data management and device tracking. Safety features include embedded motion sensors, 2-in-1 protective case and it is lightweight for easy navigability. •

Intellego Technologies

UVC Dosimeters UVC Dosimeters by Intellego Technologies are helping health care facilities improve their UV-C disinfection processes with easy-to-use, color-changing dose indicators. Available in two formats (2.5” x 3.5” cards and 1” dots), the dosimeters are placed on or adjacent to equipment and surfaces prior to UV-C disinfection. The yellow indicator reacts to UV-C exposure (254 nm) and changes color so staff can truly see if a desired level of germicidal irradiation has been delivered. UVC Dosimeters provide visible evidence of proper UV-C disinfection protocols, lamp performance and placement, and the confidence that your OR is ready for the next procedure. •

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SEPTEMBER 2020 | OR TODAY |

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IN THE OR

continuing education

Evidence-Based Care of the Post-Cesarean Section Patient

By Diane B. Johnson, BSN, RNC-OB, C-EFM, TNCC any women in our society approach labor with a preconceived idea of how their baby will enter the world.

Women prepare for birth by attending prenatal classes, reading books, and developing a birth plan. Unfortunately, the ideal vaginal birth is not always the outcome. Nurses who have received instruction in how to prepare the patient both emotionally and physically for an alternate birth can provide better care for the patient during one of the most exciting times in her life.

M

The Need for Education In 1996, the rate of cesarean delivery was 20.7%. During the following 13 years, a dramatic increase occurred until 2013, when the number plateaued at 32.7%.1 The cesarean delivery rate decreased to 31.9% in 2016, a decline for the fourth year in a row.2 The American College of Obstetricians and Gynecologists has set practice standards discouraging elective induction before 39 weeks’ gestation. This movement has been supported by many accrediting agencies, including The Joint Commission (TJC), by requiring documentation for any nonmedically indicated induction before 41 weeks.3 Cesarean section is a surgical procedure with potential for complications to both the mother and baby; many adverse effects can occur postpartum, and complications affecting subsequent pregnancies should be considered. Indications can be divided into

30 | OR TODAY | SEPTEMBER 2020

two categories: absolute (cesareans indicated without exception, such as for placenta previa or umbilical cord prolapse) and relative. Relative indications for cesarean delivery are often subjective, with indications that are not clearly defined or are highly variable.4 The most common indications in North America include elective repeat C-section (30%), labor dystocia or failure to progress (30%), fetal malpresentation (11%), and fetal heart rate tracings suggestive of fetal hypoxemia or distress (10%).5 Indications should be based on what is best for, or may save the life of, the mother and infant; an elective C-section without any medical indication, performed solely at the wish of the mother, is a separate indication.4 Because more than one-third of all deliveries occur through surgical intervention, planning and education can help a mother prepare for the physical and emotional impact of a cesarean birth and have the opportunity to set realistic goals for the experience.1 The ability to ambulate or breastfeed her infant after surgery can disrupt the family bonding time in the postpartum period.6 Nurses caring for patients in the prenatal period can help overcome some of the fears of surgical birth as well as prepare patients for what to expect after delivery.

The Surgical Aspect Many complications of a C-section may be mitigated through education and direct interventions before the day of the surgery. Many hospitals use specific standards of care for every patient. These “bundles,” as they are

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

Goal and Objectives The goal of this continuing education course is to provide evidence-based guidelines to nurses who care for patients after a cesarean section. After studying the information presented here, you will be able to: •

Provide presurgical interventions to reduce the risk of infection after surgery.

•

Apply evidence-based, family-centered care to the postpartum patient who has undergone a C-section.

•

Identify common neonatal concerns related to C-section birth.

commonly called, refer to a set of orders that a patient should follow before surgery at home and in the preoperative period. Although initially developed for patients undergoing spine or joint surgery, some facilities have adopted this same practice for their obstetric patients with the hope of reducing post-cesarean infection.

Some segments of a perioperative bundle are dictated by accrediting standards such as TJC surgical site infection prevention. The National Patient Safety Goal recommends the WWW.ORTODAY.COM

IN THE OR

continuing education use of antibiotic prophylaxis before surgery and excellent hand hygiene; removal of hair on the surgical site may be done to facilitate surgery or apply dressings. Shaving with a razor is associated with higher rates of surgical site infection compared to clipping.7,8 Other criteria can be based on research and evidence, including the use of chlorhexidine wipes preoperatively as well as systematic site cleansing immediately before surgery.

� Limitation of the use of razors for the removal of hair at the incision site � Standardization of the preoperative scrub immediately before surgery using a chlorhexidine solution � Administration of antibiotics within one hour of incision time � Patient education for aftercare, including care of the incision site Recommendations from the Centers for Disease Control and Preven-

C-Section Incision: A low-transverse C-section incision involves an abdominal incision and a uterine incision. Care should be taken to prep the entire suprapubic area adequately to decrease the risk of infection. ©2008 A.D.A.M., Inc.

Before Surgery The use of perioperative bundles can help streamline patient care and decrease the risk of infection.7 Perioperative bundles may include components such as: � A surgical infection prevention team, including providers, nurses, and care team assistants � Written education for patients, including instructions on presurgical measures, such as the use of chlorhexidine wipes and bathing WWW.ORTODAY.COM

tion and current research state that all patients should shower with an antiseptic soap or use a chlorhexidine wipe the night before surgery; if possible, use an additional chlorhexidine wipe at the surgical site the morning of surgery.9,10 Chlorhexidine works by disrupting the cell membrane of common organisms, such as Staphylococcus and Lactobacillus, which are often found in cultures of the incision line.

According to the manufacturer, it usually works within 20 seconds of appli-

cation, and because it is not removed before surgery, it provides ongoing protection for up to 48 hours.11 It is not affected by blood or body fluids, which makes it more stable during surgery. It can be supplied to patients in a premoistened cloth or in a bottle.

The patient should be instructed to wash the suprapubic area as directed by the manufacturer.

Hair removal before surgery can be conducted by using a clipper, a razor, or depilatory cream. Patients should be instructed not to shave or wax the pubic and suprapubic hair for at least 24 hours before surgery. Studies have not identified a definitive time frame in which to refrain from shaving, and no statistical difference was found between removing hair on the day of surgery vs. the day before. A Cochrane Review showed that removing hair with a method that creates breaks in the skin, such as waxing or using a razor, should be avoided due to the significant increase in postsurgical infections. Further research is needed to determine the safety of depilatory creams.8,12 Before the introduction of prophylactic antibiotics, the infection rate after surgical birth was around 3% to 15%.8,10 Before 2002, antibiotics were given primarily only if the patient had a prolonged rupture of membrane or became febrile during labor. After the development of several initiatives, including the Centers for Medicare & Medicaid Services Surgical Care Improvement Project, a significant decrease in postsurgical infections was noted with the use of antibiotic prophylaxis when antibiotics were administered before incision time. In 2003, TJC adopted this practice as part of its core measures with the goal of patients’ receiving specific broadspectrum antibiotics within one hour before incision.3 Although the directive has been to administer antibiotics within one hour of incision time, studies have SEPTEMBER 2020 | OR TODAY |

31

IN THE OR

continuing education failed to show whether the greatest benefit occurred from receiving the antibiotics pre-incision or at the time of cord clamping. Maximum benefit from prophylactic antibiotics is obtained when administered 30 to 60 minutes before skin incision; there are also studies that support effectiveness of prophylactic antibiotics after the umbilical cord is clamped. This is most beneficial for patients who undergo an emergent C-section, when there is not time to administer the antibiotics until the surgery is underway.13 The most common antibiotic dosing is 1 g of cefazolin (Kefzol, Ancef), but a higher body mass index may warrant a higher dose. Vaginal preparation with povidone-iodine has also been suggested to reduce the rate of post-cesarean endometritis, particularly in women who have ruptured membranes.8

Emerging Therapies Methicillin-resistant Staphylococcus aureus has been linked directly to serious, soft-tissue infections after surgery. What started as a communityacquired infection has become the most common isolated bacteria in hospital-acquired infections. It is also one of the leading causes of morbidity and mortality. Colonization may occur without subsequent infection, which makes treating the bacteria more of a challenge, as it is not known whether a patient will develop postsurgical complications simply because they are MRSA positive. Some research supports the use of decolonizing patients with known MRSA before surgery, but screening all patients before surgery or using a decolonization method across the board has not proven to be costeffective or able to reduce the number of postsurgical infections.14 The most common method currently available for decolonization of MRSA is the application of topical mupirocin (Bactroban®). Mupirocin 2%, an ointment that is applied in the nares for four to seven days before

32 | OR TODAY | SEPTEMBER 2020

surgery, has shown a 90% decolonization rate at one week post-treatment.

However, ongoing studies are beginning to show evidence of mupirocin resistance, which could directly impact organizations that use this medication routinely.14 Other methods, such as povidone-iodine and tea tree oil, have not been proven to be as effective.

The Perioperative Period During the perioperative period, basic strategies such as good hand hygiene, correct nail care, and proper surgical attire can contribute to an environment that supports a decrease in hospital-acquired infections. One study shows hand hygiene decreases the transmission of multi-drug-resistant organisms by up to 48% and can have a direct impact on the safety of patients. Hands should be washed before and after any invasive procedure.15 Skin prep solutions that use chlorhexidine decrease pathogens on the skin for a longer time than povidone-iodine solutions. In a randomized controlled trial, swabs of the skin incision 18 hours post-surgery in patients who were treated with chlorhexidine were seven times less likely to have a positive culture than women who had been treated with povidone-iodine.

This additional coverage allows more time for the incision to heal before being exposed to external microbes.16 Another important factor in skin prep is to train staff on one specific method of applying the antisepsis before surgery and to continue education through auditing so that staff does not become complacent.

Once the newborn is delivered, every effort should be made to allow the mother to hold her newborn in the same manner as she would have if she’d had a vaginal birth. Skin-to-skin contact has many proven benefits; however, some hospitals are hesitant to create a policy that supports this in the OR. Several studies have disproved many of the concerns regard-

ing thermal regulation of the newborn and skin-to-skin contact (SSC). By placing the newborn directly on the mother’s chest and covering both the mother and baby with a warmed blanket, hypothermia can be avoided.

OR temperatures can be increased to support the family dyad. Most importantly, staff can be trained to assess a newborn while on the mother’s chest, to adjust the equipment in the OR to make room for the infant and staff member, and to promote breastfeeding in the first hour of life.17

Postsurgical Care Women who undergo a C-section have different challenges than a woman who gives birth vaginally. The patient’s ability to care for herself and her newborn may be affected depending on her level of pain and mobility. If the C-section was not elective, the patient may have feelings of disappointment or distress regarding her birth experience that can interfere with bonding; patients experiencing cesarean delivery may be at higher risk for postpartum depression.18 Adequate pain management after surgery is especially important in the postpartum patient. Because of the high fluid shift, postpartum patients are at a much greater risk for developing deep vein thrombosis and pneumonia. Early ambulation significantly reduces that risk, but patients who are experiencing pain may not want to walk. Developing an individualized pain program will help the patient be more comfortable, which will allow her to better meet the needs of her newborn, including the ability to breastfeed and hold her baby. Pain status should be evaluated hourly and rated in a way that is easy to understand, such as a 0-to-10 numeric scale with an ongoing goal of a level less than 3.

Pain relief may be delivered in various ways after surgery. Pain medication can be provided intratheWWW.ORTODAY.COM

IN THE OR

continuing education cally before the surgery, as a patientcontrolled analgesia in oral form or the use of multiple delivery methods, depending on how far out from surgery the patient may be. The most common form of initial pain relief is a one-time injection given intrathecally.

Both morphine and hydromorphone provide excellent coverage for patients and can last up to 24 hours after placement, which decreases the need for additional IV opioids. Common adverse effects for both drugs include nausea or vomiting and pruritus immediately after administration.19 An advantage of intrathecal morphine is that it does not pass into the breast milk, allowing for safe administration in the breastfeeding patient.

Patients who have received opioids intrathecally or with a patient-controlled analgesia are at risk for respiratory depression. The most vulnerable period of time for depression occurs in the first 24-hour post-op period when the effects of general anesthesia, opioid analgesics, sedating antiemetics, and sleep deprivation converge. Lifethreatening respiratory depression can evolve very rapidly. Preventive strategies may require continuous electronic monitoring rather than intermittent patient checks.20 For patients receiving additional narcotics, education should be provided that supports bonding and interaction with the newborn while decreasing the risk for falls. Once patients are tolerating liquids and solids, they should be transitioned to oral narcotics and nonsteroidal anti-inflammatory drugs. Although it has been customary to withhold food and fluids postoperatively for a period of time, evidence is lacking in supporting this practice.

Early feeding after an uncomplicated cesarean delivery is acceptable.5 Postoperative ileus is one postoperative complication, but a combination of chewing gum, early oral hydration, and early mobility have a positive effect on increasing intestinal motility.21,22 WWW.ORTODAY.COM

Women are four times more likely to suffer a postpartum venous thromboembolism after a cesarean birth.23 The highest risk is in women who had a failed vaginal delivery and needed an unplanned cesarean delivery. Pneumatic compression devices and early ambulation should be encouraged. In cases where a woman has additional risk factors for a blood clot, medication such as heparin may be ordered.24 Once a patient is able to ambulate, urinary catheters should be discontinued, and patients should be encouraged to walk throughout the day. Incisional pain often increases with more activity, but it can be controlled with scheduled use of oral medications.

The dressing should be removed after 24 hours and the incision monitored for signs of infection.5 Surgical site infections decreased in 2010 when intervention focused on better patient hygiene pre- and post-operatively.25 Patients may shower when the dressing is removed, wash the incision with soap and water, and dry gently. If patients are at higher risk for infection due to obesity, extra attention should be given to wound care, such as allowing the incision to air dry and placing an absorbent dressing over the incision.

Most wound infections do not become apparent for four to seven days postop, when most women have been discharged home.8 Before discharge, patients should be taught signs and symptoms of infection so they can continue monitoring the incision after discharge. Early recognition of possible infection can decrease the risk of sepsis and help prevent severe complications. Patients should be given expected times to return to their provider’s office for follow-up appointments as well as contact information.

The Family-Centered Gentle Cesarean A new method of supporting familycentered care has been dubbed “the gentle cesarean.” The gentle cesarean

applies the same supportive concepts that happen in the labor and birth room to the OR. This form of care allows the patient and her family to see the birth of their baby through a clear plastic curtain vs. the more common blue shield that many ORs use. When the baby is close to being born, the anesthesia provider slightly lifts the head of the bed. The blue drape is dropped or the window is positioned to ensure that the patient is able to see the birth.

At a minimum, one hand is left free so the patient may hold her newborn.

The newborn is placed on the mother’s chest immediately after birth.

The newborn is dried quickly, assessed by an appropriate staff member, and placed skin-to-skin on the mother’s chest with a warmed blanket covering both the mother and baby. Breastfeeding can be initiated at this time.22 For many women, not being able to see their baby being born is one of the hardest things about not having a vaginal birth. Incorporating the gentle cesarean philosophy supports the family without compromising the sterile field or putting the patient and her family at risk. While the concept is easy to explain, changing the culture in the OR to support this practice will need many champions.

Caring for the Family Caring for the family after a C-section goes far beyond the surgical interventions to prevent infection. Many strides have been made in allowing partners and family members into the labor rooms, but hospitals may still prohibit them from being present during certain stages of surgery. The family-centered care model describes methods needed to provide the most optimal care available to the patient and those who care for her. The family-centered care focuses on sharing information among the patient, family, and healthcare team in an open manner while still respecting the opinions of others on the team. It involves the SEPTEMBER 2020 | OR TODAY |

33

IN THE OR

continuing education patient and her family in the decisions that need to be made throughout their care.26 Family-centered care in the OR involves the partner at many different stages. Education regarding what to expect during surgery and how to care for the patient can be provided to anyone who is involved directly before the surgery. Some hospitals are changing their rules regarding epidural placements and allowing the birth partner to be present, which relaxes the patient. In some cases, SSC by the father or significant other may be advised, if the mother has had general anesthesia or her condition precludes immediate SSC. This may be done outside of the OR if needed. Compared with infants receiving conventional care, infants experiencing SSC with the father show decreased crying and drowsiness, and increased rooting, suckling, and wakefulness.27 One in every three women undergoes a C-section in the United States.

The numbers have continued to climb during the last 10 years. Postpartum complications, including infection, deep vein thrombosis, and delayed maternal-newborn bonding, can impact the family unit significantly.

Developing a surgical site infection bundle that includes pre-, peri-, and postoperative care of the patient can decrease risks and increase patient satisfaction. Evidence-based protocols and guidelines may be used to support the family unit and create a culture of change for families undergoing one of the most exciting times of their lives. •

care units at the University of Colorado Hospital in Aurora, Colorado.

References

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9. Berrios-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for Disease Control and

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nvsr63_06.pdf. Published November 5, 2014.

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10. Witter FR, Lawson P, Ferrell J. Decreasing cesarean section surgical site infec-

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nvsr67_01.pdf. Published January 31, 2018. Accessed September 27, 2019.

11. About chlorhexidine: mechanism of action.

Chlorhexidine Facts Web site. http://www.

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html. Accessed September 27, 2019.

2013;33(11):12-14. http://www.jointcommission. org/assets/1/6/S11.pdf.

12. Tanner J, Norrie P, Melen K. Preoperative hair removal to reduce surgical site

4. Mylonas I, Friese K. Indications for and risks

infection. Cochrane Database Syst Rev.

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13. World Health Organization. WHO recom5. Quinlan JD, Murphy NJ. Cesarean delivery:

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antibiotics prior to skin incision, rather than

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6. Tully KP, Ball HL. Maternal accounts of

childbirth-and-postpartum-care/who-recom-

their breast-feeding intent and early chal-

mendation-administration-prophylactic-an-

lenges after caesarean childbirth. Mid-

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2019.

7. The Joint Commission’s implementation

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guide for NPSG.07.05.01 on surgical site

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EDITOR’S NOTE: Elaine Brown, MS, RNC-OB, EFM-C, the previous author of this CE activity, has not had an opportunity to influence the content of this version.

infections: the SSI Change Project. The Joint

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Diane B. Johnson, BSN, RNC-OB, CEFM, TNCC, is a clinical nurse leader in the high-risk labor and delivery, antepartum, postpartum, and women’s

8. Zuarez-Easton S, Zafran N, Garmi G, Salim

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Guide_for_NPSG_SSI.pdf. Published 2013.

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15. Evidence of hand hygiene to reduce transmission and infections by multi-drug resistant

34 | OR TODAY | SEPTEMBER 2020

WWW.ORTODAY.COM

CE745

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tion? Cochrane Web site. https://

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trial. J Matern Fetal Neonatal

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September 27, 2019.

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23. Elsevier. Cesarean section 17. Stone S, Prater L, Spencer R.

carries increased risk for postpar-

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tum venous thromboembolism

in the operating room after

(VTE). ScienceDaily Web site.

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www.sciencedaily.com/releas-

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24. Norton A. C-section raises

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jpsychores.2017.04.016.

news/20161004/c-section-

1. Read the Continuing Education article.

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If you are an Unlimited CE subscriber, you can take this test at no additional charge. You can sign up for an Unlimited CE membership at https://www.nurse.com/ sign-up for $49.95 per year.

Deadline Courses must be completed by 10/14/2022 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.

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raises-risk-of-blood-clots-after19. Beatty NC, Arendt KW, Niesen

childbirth-review#1. Published

AD, Wittwer ED, Jacob AK. An-

October 4, 2016. Accessed

algesia after Cesarean delivery:

September 27, 2019.

a retrospective comparison of intrathecal hydromorphone

25. Hickson E, Harris J, Brett

and morphine. J Clin Anesth.

D. A journey to zero: reduc-

2013;25(5):379-383. doi: 10.1016/j.

tion of post-operative cesarean

jclinane.2013.01.014.

surgical site infections over a five-year period. Surg Infect.

20. Lee LA, Caplan RA, Ste-

2015;16(2):174-177. doi: 10.1089/

phens LS, et al. Postoperative

sur.2014.145.

opioid-induced respiratory depression: a closed claims

26. Schorn MN, Moore E, Spetal-

analysis. Anesthesiology.

nick BM, Morad A. Implementing

2015;122(3):659-665. doi: 10.1097/

family-centered cesarean birth.

ALN.0000000000000564.

J Midwifery Womens Health.

2015;60(6):682-690. doi: 10.1111/

21. Wen Z, Shen M, Wu C, Ding J,

jmwh.12400.

Mei B. Chewing gum for intestinal

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function recovery after caesarean

27. Cleary E, Cohen M, How-

section: a systematic review and

ard ED. A cry for equity in

meta-analysis. BMC Pregnancy

the operating room: stan-

Childbirth. 2017;17(1):105. doi

dardizing skin-to-skin prac-

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2018;32(2):97-101. doi: 10.1097/ 22. Morais PG, Riera R, Porfirio GJM, et al. Does chewing gum after a caesarean section lead to quicker recovery of bowel funcWWW.ORTODAY.COM

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SEPTEMBER 2020 | OR TODAY |

35

COVER STORY

INJURIES REMAIN A STICKING POINT IN 2020

BY DON SADLER

I

t has been two decades since the Federal Needlestick Safety and Prevention Act of 2000 was passed and revisions were made to the Bloodborne Pathogens Standard.

The Needlestick Safety and Prevention Act covers a wide range of areas related to needlesticks and infections from bloodborne viruses, while all U.S. health care facilities are required by law to comply with the regulations of the Bloodborne Pathogens Standard.

36 | OR TODAY | SEPTEMBER 2020

WWW.ORTODAY.COM

“ I njuries from suture needles and scalpel blades have remained consistent over the years with little to no improvement.”

– Mary J. Ogg, MSN, RN, CNOR

Sharps Safety in 2020 So, where do things stand in 2020 with regard to needlestick injuries and sharps safety? Unfortunately, these injuries remain a serious problem in today’s health care environment.

According to Brian Arndt, MBA, BSN, RN, CNML, a consultant for Keith and Company LLC, at least 600,000 sharps injuries still occur in U.S. health care facilities each year. “One study estimated that as many as 50 percent of sharps injuries go unreported, so the total could be much higher than this,” says Arndt.

“We have made progress, but we’re a long way from eliminating sharps injuries,” Arndt adds.

Mary J. Ogg, MSN, RN, CNOR, senior perioperative practice specialist with the Association of periOperative Registered Nurses (AORN), says that sharps injuries decreased initially after passage of the Needlestick Safety and Prevention Act due to the introduction of sharps injury prevention devices.

“But recent epidemiological data suggests that injuries from sharps injury prevention devices are on the rise,” she says, noting that injuries occur prior to activation of the safety feature. “Injuries from suture needles and scalpel blades have remained consistent over the years with little to no improvement.”

Sharon A. McNamara BSN, MS, RN, CNOR, points to research indicating that a surgeon will sustain a sharps injury during approximately one in every 10 procedures.

“These injuries most often occur when surgeons are using suture needles and scalpels,” she says.

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Emergency physician Michael Sinnott, MBBS, FACEM, FRACP, who is also the co-founder of medical device manufacturer Qlicksmart, cites research indicating that there are 32 sharpsrelated injuries for every 100,000 suture needles purchased, 12.6 sharps-related injuries for every 100,000 scalpel blades purchased and 2.65 sharps-related injuries for every 100,000 needles purchased.

“The real difference I’ve seen over the last few years is that clinical staff are now more willing and eager to admit to having suffered a sharps injury,” says Sinnott. “In the past there was a strong tendency to deny such injuries.”

“While sharps safety has become more recognized as an issue, very little has changed,” says medical device consultant Allan Brack.

“In my CE talks, between five and eight people admit they have had a scalpel blade cut or needle stick.

But when I ask how they changed their practice, I’m met with a ‘deer in the headlights’ look.”

“In short, nothing changed as they believe the hospital will not invest in their safety,” Brack adds.

Preventing Sharps Injuries During his keynote presentation at the World Health Organization’s First Global Patient Safety Day in 2019, Sinnott outlined a five-step safety program for preventing sharps injuries: awareness, regulatory support, safety equipment, administrative actions and management support.

“This five-step program aligns with CDC and WHO advice for hospitals’ bloodborne pathogens exposure controls,” says Sinnott.

Ogg outlines a similar hierarchy SEPTEMBER 2020 | OR TODAY |

37

COVER STORY

MARY J. OGG,

MICHAEL SINNOTT,

BRIAN ARNDT,

MSN, RN, CNOR

MBBS, FACEM, FRACP

MBA, BSN, RN, CNML

of controls for eliminating sharps injuries.

“This hierarchy starts with elimination of the hazard if possible, followed by the use of engineering controls, work practice controls, administrative controls and use of personal protective equipment (PPE),” she says.

While removing sharp objects from the OR might not seem realistic, Ogg says there are ways to avoid the use of sharps devices.

“These include using alternative closure devices such as skin staplers, adhesive strips and glues and using alternative cutting devices such as the electrosurgical device to make the initial incision,” she shares.

When sharp objects can’t be eliminated, safety-engineered devices such as blunt sutures needles, safety scalpels, safety syringes and needles can help eliminate sharps injuries. “Work practice controls – such as using a neutral or safe zone for passing sharp instruments and devices – help minimize the risk of exposure to blood or other potentially infectious materials by changing the way a task is performed,” says Ogg.

38 | OR TODAY | SEPTEMBER 2020

Arndt agrees.

“OSHA recommends isolating hazards using hands-free zones where sharps are placed during handoffs,” he says. “The surgeon would then pick up the sharp instrument instead of being handed a loaded needle driver or scalpel.”

Although it’s at the bottom of the hierarchy, using PPE remains highly effective in reducing sharps injuries.

“It’s also probably the easiest step to implement,” says Ogg. “For example, research has demonstrated that wearing double gloves is highly effective in reducing sharps injuries in the OR.”

Best Practices and Technology Solutions Best practices regarding sharps safety hinge on mechanical safeties and safe handling, according to Arndt.

“Over the last few years the industry has made progress in safety technologies such as self-sheathing needles, needleless connectors, retraction devices and shielding or blunting,” he says.

McNamara says there is a plethora of technology solutions available

to help prevent sharps injuries as well as new ones being developed.

“There are numerous choices with scalpels, for example, such as disposable cartridges for re-useable handles and disposable one-time use scalpels with retractable sheathes,” she says.“The use of passive (or automatic) safety devices can definitely improve sharps safety,” says Sinnott. “For example, a 2019 article from a Scottish anatomy lab named the Qlicksmart BladeFLASK as one of the most important tools in their successful reduction of scalpel injuries, along with a mandatory PPE policy and density of students per cadaver.”

According to Ogg, OSHA can inspect a health care facility at any time for compliance with the Bloodborne Pathogens Standard and impose fines for non-compliance.

“Health care organizations are required to implement appropriate strategies to minimize risk of exposure to sharps injuries,” says Arndt.

“In 2017, the penalty was up to $12,675 per violation. An organization in 2016 was fined over $50,000 related to a high number of needlestick injuries.”

WWW.ORTODAY.COM

McNamara notes that staff participation is crucial to meeting the OSHA requirements.

“Input must be solicited from non-managerial employees responsible for direct patient care to identify, evaluate and select safety engineered sharp devices and work practice controls,” she says. “And safety engineered device product evaluation process must be documented.”

A Simple and Effective Aerosol Barrier

Impact of COVID-19 Ogg notes that the COVID-19 environment has highlighted the importance of worker safety with the use of PPE for respiratory and contact precautions. “To date, there are no published reports of COVID-19 transmission via a blood-borne pathogen exposure.”

Arndt believes that COVID-19 has caused health care leaders to reevaluate everything from basic hand hygiene to supply status and backup equipment.

“The emphasis on health care provider and patient safety is at an all-time high,” he says.

“The simple truth is that the health care industry has known for years that we could do a better job with PPE utilization and hand hygiene, but COVID-19 has provided the extra push to really made a difference.”

AORN has produced a set of online implementation tools to help perioperative team members apply AORN’s evidence-based guidelines for sharps safety in their everyday practice. According to Ogg, the Guideline Essentials for Sharps Safety include: • Gap analysis tools • Case studies • Webinars • Policies and procedures • Competency verification tools • FAQs “The Guideline Essentials also include a quick view of the sharps safety guideline, an implementation roadmap and a power point presentation,” says Ogg.

Visit https://www.aorn.org/essentials to learn how you can obtain a copy of the Guideline Essentials for Sharps Safety.

A clear barrier drape to minimize provider exposure to pathogenic biological airborne particulates.

Designed to tent over patient, providing a barrier between the patient and provider to mitigate risks during aerosol generating procedures A shaped profile to fully encompass the head from behind, forward Allows providers to have full range of movement without restriction of arm movements Aerosolized viral particles contained on product are disposed of after use, no need for additional rigorous cleaning Compliments current PPE to reduce exposure risks Single Use • Disposable • Conveniently Sized Patent Pending

contact us for more information at: 1-800-245-4636 info@encompassgroup.net

For regulatory info: encompassgroup.com/covaire-regulatory

WWW.ORTODAY.COM

SEPTEMBER 2020 | OR TODAY |

39

SPOTLIGHT ON:

Shelia Holleran

OR Clinician Manager at University of Pennsylvania Medical Center (UPMC) in Wellsboro, Pennsylvania

By Matt Skoufalos

I

n March 2020, Pennsylvania Governor Tom Wolf ordered a statewide, temporary freeze on all non-emergency surgeries in an effort to mitigate the impact of the novel coronavirus (COVID-19) pandemic.

At the University of Pennsylvania Medical Center (UPMC) in Wellsboro, Pennsylvania, OR Clinician Manager Shelia Holleran and the crew in her surgical unit found their normal routines put on the shelf for a month-and-a-half. Without their typical roster of mostly elective

40 | OR TODAY | SEPTEMBER 2020

surgical patients – about 200 to 225 cases per month across specialties like general orthopedics, ophthalmology, and obstetrics and gynecology – Holleran and her team were asked to pivot to a new assignment.

They were put in charge of developing a process for collecting COVID-19 specimens in the temporarily shuttered surgical unit. Patients entered the hospital emergency room through a separate, outside entrance, where they were then screened in a negative-pressure room and decontamination room to avoid exposing them to the broader hospital population.

Together with staff nurses Jodi Vandergrift and Sterlynne Young, and same-day surgery nurses Melanie Pierce, Traci Wood and Timothy Mosher, Holleran’s group was tasked with cohorting symptomatic and asymptomatic patients, properly employing personal protective equipment (PPE) for those involved, and safely performing nasal swab exams on those who visited the facility.

They had to do all of it while mitigating their own risk factors and exposure to the virus, which included isolating themselves from friends and family members throughout the process. Over the course of a month WWW.ORTODAY.COM

Shelia Holleran enjoys hiking in her spare time.

and a half, the team tested patients all day, every day, working overtime on weekends, and hoping they were going to be safely isolated from the worst of things.

“It’s a close-knit, small OR,” Holleran said. “We’re all very close with each other. We work well together, and it’s a very happy place to be.”

Even so, operating under those conditions “was kind of stressful,” she said, not least of all because the test for COVID-19 involves a deeply uncomfortable insertion of a specimen collector into the patient’s nasal cavity.

“People hate it,” Holleran said. “I had one lady grabbing my hand and trying to pull my hand out, and in our pre-surgical area where we’re doing patients, we had a few refuse.”

From about April to May, the team at UPMC-Wellsboro collected specimens from 85 patients who were actively symptomatic, had been exposed to COVID-19-positive patients or had traveled to COVID-19 hotspot areas of the world. Fortunately, the small, rural, central Pennsylvania hospital didn’t see a significant number of patients sickened by the virus, and had not suffered a COVID-19-related fatality through early July 2020. Even though the suite is now open to elective surgical procedures again, Holleran is still in charge of pre-surgical specimen collections for its asymptomatic surgical patients.

“Our facility right now is not requiring surgical patients to have the test, so if they opt out, that’s OK as long as they’re not having symptoms and they pass our screening questions,” she said.

Unlike other hospitals in the country, Holleran said her staff never suffered for want of equipment to battle the pandemic, including ventilators and things necessary to create negative-pressure rooms for patients.

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Only one of her staff members was tested for the virus, and only because the staffer suffered from allergy symptoms and had traveled out of the area; and the staffer tested negative. Overall, Tioga County, where UPMC-Wellsboro is situated, only saw 30 COVID-19 infections and two related deaths between March and July 2020.

Despite her unfamiliarity with the virus and the fortunately relatively low risk of contracting it in her area, Holleran counts the specimen collection activity among those circumstances that have shaped her time as an OR professional.

“I had no problem doing it,” she said. “I’m a go-with-the flow, whatever-needs-to-be-done-type person. I learned a lot from it, and it definitely gave me some better experiences.”

“ You get to see patients get through some of the most difficult times of their lives,

and see them

come out better.”

That seems to be par for the course for a woman who began her OR career as a surgical technician and advanced her skills mostly through training while on the job.

After Holleran completed her education to become a medical assistant, she was offered an opportunity to become a registered nurse. She returned again to earn her bachelor’s degree, and then a Certified Registered Nurse First Assistant (CRNFA) that allowed her to assist in surgery. Recently, Holleran was asked whether she would like to step into a leadership role because her supervisor of 20 years, who is the hospital

OR director, will retire in the next four years. So once again, Holleran is preparing for a return to school to earn a master’s degree.

“The three leaders above me have always been very supportive [of my career],” Holleran said. “They’ve pushed me to go back to school when I wanted to give up. I wouldn’t have done it without them and their support.”

“It’s stressful, and many times I want to quit,” she said, “but in the medical field, information is constantly changing. Everything I know expires in five years. Continuing your education constantly is a way to keep on top of the latest and greatest.”

Persisting in her education is one of the things that Holleran has enjoyed about her OR career; so, too is the pace and variety of the job, as well as the impact it offers people who want to make a difference in the lives of others. She’s looking forward to the chance to ascend the ranks in her department, but she wouldn’t ever want to leave the surgical environment completely.

“I love everything about the OR,” she said. “I love the fact that you never have the same day twice. You get to see patients get through some of the most difficult times of their lives, and see them come out better.”

“I have no intentions of leaving the OR,” she said. “I still take calls for some of my staff members if they’re sick. Not everybody is suited for it, but if you enjoy it, it’s definitely something to stick with.”

SEPTEMBER 2020 | OR TODAY |

41

OUT OF THE OR fitness

Discipline Behind at Home Workouts

By Miguel J. Ortiz hen it comes to at home

W workouts, getting yourself motivated can be difficult.

The gym environment and camaraderie can create a more inspired atmosphere.

Whether it’s a personal trainer pushing you to go further or a gym buddy providing encouragement, your surroundings can greatly impact your performance. So, let’s take away the gym. Let’s take away outside motivation? What we are left with?

Our own internal voice telling us we can do this. For a lot of people, that may not be enough. Yet, it’s all you will ever need. The first and most important thing we need to understand is the difference between training and workouts, then we can apply the necessary discipline needed to ensure success.

If you’re training you must have a specific goal,. You will set up a regimen and follow daily behaviors that will ultimately help you reach said goal. It can be exercise, diet or even sport related. The workout is simply just a small or daily portion of the training plan. A workout can be

42 | OR TODAY | SEPTEMBER 2020

anything. For example, I may be on vacation and decide to do a simple workout in the hotel gym. Maybe I decide to run, lift weights or do some stretching. Either way, unless I have a specific regimen or training protocol to follow then what I did was just a workout. Never forget, there is no such thing as a bad workout. The reason why is because it’s just that – a workout. There is no reason to be hard on ourselves for trying to be healthy.

I constantly hear people criticize themselves for not doing enough workouts or saying they didn’t push themselves enough. When instead they could easily just give themselves a pat on the back and be happy they completed it. Keep in mind that something is always better then nothing. This is exactly where you will find your motivation. Enjoy the workout in the moment and be proud that you completed it. Maybe your training goal is to just sweat or move your body 2-3 times a week. The goal may be creating consistent exercise in your life.

The discipline in at home workouts cannot and should not be compared to a training regimen. It should support and compliment your

at home workouts. The discipline is not in the effort, it’s in your attitude.

Every time you complete a workout, you are one step closer to success and your success is only measured by what you determine is important for you. Success could mean feeling good, success could be losing weight, success could mean consistency or really anything.

Maybe you don’t want to have serious goal setting or intense and focused training. Maybe you just want to feel a little better and get moving.

Well, if that’s the case, then do just that. Get moving, enjoy what you learn about yourself in the process, release self-judgment and change your attitude about the workout.

Comparison is the thief of joy and if you constantly compare your at home workouts to training or others programs, you’ll never be happy with the results. Enjoy the workout, never give up and keep moving forward.

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

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OUT OF THE OR health

Should You be Evaluated for ADHD? It’s not just a kid thing

By BPT f you are among the millions of adults in the U.S. who do not know they have attention-deficit/hyperactivity disorder (ADHD), the past several months of social distancing have been a particularly steep battle. Our country was instructed to “sit still,” a command that children with ADHD hear every day in the classroom and at the dinner table.

I

This can be much harder for some than for others. For adults with undiagnosed ADHD, one silver lining to come from social distancing has been the rare opportunity to slow down and realize how easily they can be distracted and how difficult it is to stay on task.

It is a common misperception that ADHD, a neurodevelopmental disorder characterized by developmentally inappropriate levels of inattention, impulsivity and hyperactivity, only affects children. Research shows that nearly 11 million adults have ADHD. Only one in five is properly diagnosed. Symptoms are influenced by age and developmental level. For example, adults experience less hyperactivity and more executive functioning issues in comparison to children.

Raising much-needed awareness about ADHD by sharing information and resources can significantly enhance quality of life for millions of adults who

44 | OR TODAY | SEPTEMBER 2020

were not diagnosed during childhood. It is important to note that 74% of ADHD diagnoses are linked to genetics, so if your child has ADHD, there is a good chance you might, too.

How do I know if I should be evaluated?

Adults with ADHD typically experience substantial challenges in one or more areas of daily living: • Inconsistent performance in jobs or careers; losing or quitting jobs frequently • History of academic and/or career underachievement • Poor ability to manage day-to-day responsibilities, such as completing household chores, maintenance tasks, paying bills or organizing • Relationship problems due to not completing tasks • Forgetting important things • Becoming easily upset over minor things • Chronic stress and worry caused by failure to accomplish goals and meet responsibilities • Chronic and intense feelings of frustration, guilt or blame

How is ADHD diagnosed in adults?

While ADHD begins in childhood, certain individuals can compensate for their symptoms and do not experience issues until high school, college, in pursuit of career aspirations or even in retirement.

In some cases, parents may have provided a highly protective and structured

environment, minimizing the impact of ADHD symptoms in children.

Proper diagnosis requires a comprehensive evaluation by a qualified health care professional who can thoroughly assess signs and symptoms, rule out other causes, and determine the presence or absence of coexisting conditions.

ADHD is often misdiagnosed because it can mimic numerous other conditions, including anxiety, depression, learning disorders, sleep difficulties, side effects from medications and more. Seek out a professional with specific experience in ADHD.

Where do I turn if I think I have ADHD? ADHD is highly manageable with proper identification, diagnosis and treatment. If you have ADHD or think you might, CHADD (Children and Adults with Attention-Deficit/ Hyperactivity Disorder) can help. The nonprofit organization provides support, training, education and advocacy for children and adults with ADHD, their families, educators and health care professionals. As home to the National Resource Center on ADHD, funded by the U.S. Centers for Disease Control and Prevention, CHADD offers reliable, science-based information, and comprehensive programming and support at the national and local levels.

Call the helpline at 866-200-8098 or visit CHADD.org to access resources, including how to find a specialist where you live.

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OUT OF THE OR EQ factor

Commanding and Collaborative Motivations By daniel bobinski o you prefer stepping up and assuming leadership positions, or do you prefer a supporting role?

D

This article is the fifth in a series about the six learned (extrinsic) motivators. The first installment examined the different ways people are motivated by knowledge.

Then we looked at how tangible things – including money – may or may not motivate us. Following that we looked at how we are driven by our surroundings.

Last time we looked at different ways people are motivated to give to others, and in this installment we’ll be looking at how people exercise their power.

The motivational spectrum of power The power spectrum is about how we use our influence. At one end of the scale are people we call commanding, and at the other end are those we call collaborative. Commanding people prefer having control over their choices and freedoms. They prefer being in control, and with that they often seek recognition. Conversely, collaborative people often disperse their power throughout a team, preferring to support a leader or a cause without any need for personal recognition.

All people use power, but they will demonstrate it in different ways.

46 | OR TODAY | SEPTEMBER 2020

Traits of a commanding person People on the commanding side of this spectrum tend to work long and hard to build up their influence and status. They focus on developing winning strategies for whatever project is before them, and they’re often passionate about creating an enduring legacy.

Those with strong tendencies in this area seek authority equal to their responsibility so they can direct and control their own destiny. Advancement and titles can be particularly important to them.

Traits of a collaborative person People with a collaborative motivator are driven to support others, serving as a contributor without much need for personal recognition. They prefer working behind the scenes without fanfare and they don’t need a title. They just want things to get done.

Collaborative people enjoy camaraderie and shared decision making in support of a cause or a leader. They function best when directions and objectives are decided by someone else.

Both motivational styles are easy to identify. Commanding styles usually assert themselves, volunteering to organize and promote activities. Whether it’s a family event like a reunion or a community event like a neighborhood garage

sale, the commanding person will be the “go-to” person to make it happen.

Conversely, collaborative people stay in the background, watching and listening for what’s needed to make a project successful. They will take initiative to get tasks done once they know what the tasks are and work in the background, leveraging the strengths of other people.

They rarely call attention to their own accomplishments, instead giving credit to the team.

As I said, all people have power, but they direct it differently. Both styles are needed to make any organization or project successful; the key is identifying who has which style and letting them shine in their preferred role. With this motivator, you don’t want to put someone in a role that doesn’t fit their style.

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

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OUT OF THE OR nutrition

Habits to Cultivate

By Charlyn Fargo his shelter-in-place time has had me thinking about habits – the things I do on a daily basis to stay healthy. I think it’s because so many habits were changed unexpectedly – driving to work, going to the gym, eating out. My daily commute is now up the stairs to my office; my workout is a two-mile walk in the neighborhood; we eat all our meals at home.

T

To be honest, some of the new habits are refreshing. I love to cook; I love to be outside and walk. There are certain advantages to working at home. I admit I miss personal interaction, and yes, there is Zoom, but it’s not the same.

We can use this time at home more (and even with the lessening of restrictions, I think we’ll be home more) to create some healthier food habits.

I’ve shared before that my mom had breast cancer twice in her life – battled and won both times – only to

48 | OR TODAY | SEPTEMBER 2020

have her heart eventually give out.

Because of my breast cancer history, I’m tuned in to healthy habits to cut my odds of having breast cancer.

When it comes to food, the latest recommendations are tried and true.

Focus on vegetables, fruits and whole grains. The rest of your plate should be filled with lean protein (poultry, fish, lean beef or pork). The goal is to try to eat more plant-forward meals. Veggies, fruits and whole grains offer fiber, which helps us feel full and can help keep our weight at a healthy number.

When it comes to alcohol, less is better. Just two to three servings of wine, beer or liquor a day increase your risk of breast cancer by 20% compared with women who don’t drink at all. A five-ounce glass of wine a day only increases your risk slightly.

And don’t skip working out. Regular physical exercise lowers the risk.

(We knew that, right?) That’s where good habits take over.

Keep making meals at home. Add quinoa to your salads; switch to brown

rice and whole-wheat bread. Check the label to make sure that slice of bread has at least 3 grams of fiber. If you want a glass of wine, have it with a meal. And get some exercise daily.

Make it part of your routine.

Go ahead and schedule that mammogram. The time it takes is well worth the peace of mind it gives you.

Some of us need them yearly; some need scans as well as mammograms.

Listen to your doctor.

We can turn this shelter-at-home time into a benefit.

Like my mom would say, make a list of what you want to accomplish each day, and check it off as you go. Just be sure to add exercise and healthy eating.

Charlyn Fargo is a registered dietitian with SIU Med School in Springfield, Illinois. For comments or questions, contact her at charfarg@aol.com or follow her on Twitter @NutritionRD.

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M132 Rev A

OUT OF THE OR recipe

Creamy One-Pot Spaghetti INGREDIENTS: • 1 tablespoon vegetable oil

Recipe

• 1 pound lean ground turkey or lean ground beef

the

50 | OR TODAY | SEPTEMBER 2020

• 1/2 cup chopped onion • 2 1/2 cups reduced-sodium chicken broth or reduced-sodium beef broth • 2 cups marinara sauce • 1/2 teaspoon crushed fennel seeds • 1/8 teaspoon ground cayenne pepper • 8 ounces spaghetti noodles, broken into 3-4-inch pieces • 1 package (8 ounces) reduced-fat cream cheese, cubed • 1 1/3 cups shredded cheddar cheese, divided • chopped fresh basil or parsley (optional)

By Family Features

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Perfect Pantry Pasta

OUT OF THE OR recipe

A meal made easy with household essentials Creamy One-Pot Spaghetti onstantly seeking out recipe-specific ingredients that may only be used once or twice can be a burden. Instead, keep your home stocked with necessities to simplify dinner prep with dishes made using common household staples.

C

One perfect example: pasta. This recipe for Creamy One-Pot Spaghetti includes easily recognizable seasonings and canned goods for simple dinner solutions. Plus, it includes dairy, an irreplaceable part of a balanced diet as a source of essential nutrients.

Another way to scale back on unnecessary grocery purchases is to give yourself permission to modify. Many recipes can be tweaked for personal preferences, such as using black beans rather than kidney beans or adjusting the amount of a spice used based on your family’s tastes.

Stock your pantry and refrigerator with versatile ingredients like these: • Canned tomatoes • Canned beans • Quick-cook rice • Small whole-grain pasta • Stock, like vegetable, chicken or beef • Fluid milk • Shredded cheese • Plain Greek yogurt For more ideas to simplify family meals, visit milkmeansmore.org.

Creamy One-Pot Spaghetti Prep time: 20 minutes COOK time: 10 minutes Servings: 8 1.

2.

3.

4.

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Using sauté function of pressure cooker, heat oil until hot. Add meat and onion. Cook, uncovered, about 5 minutes, or until meat is browned, stirring to break up. Press cancel.

Stir broth, marinara sauce, fennel seeds and cayenne pepper into meat. Stir in spaghetti, making sure noodle pieces are covered by liquid. Secure lid and set pressure release to sealing function.

Select high pressure and cook 5 minutes. Press cancel.

Allow pressure to release naturally 2 minutes. Move pressure release to venting function to release remaining steam. Remove lid.

Stir spaghetti mixture. Stir in cream cheese and 1 cup cheddar cheese until melted. Ladle into bowls to serve. Sprinkle with remaining cheddar cheese. Garnish with chopped fresh basil or parsley, if desired.

SEPTEMBER 2020 | OR TODAY |

51

OUT OF THE OR pinboard

CHE C K O UT O U R N E W CO N TEST!

OR TODAY

CONTEST The Winner Gets a $25 Gift Card!

THIS M

$25

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ONTH Elaine 'S WINNER Apple Kohan Hill S u Charg rgical Cente e Nurs r e

WORLD HEALTH ORGANIZATION'S

YEAR OF THE NURSE OR Today magazine joins the World Health Organization in celebrating the 200th anniversary of Florence Nightingale’s birth and the Year of the Nurse in 2020. As part of the celebration, OR Today wants to feature nurses in a new contest! Every entry wins a gift card!

To enter the contest, share a time when a nurse served as an inspiration to you or your team. This can be a peer, a mentor, an educator or anyone from the nursing profession. Help us shine a spotlight on these individuals.

Please share your brief (1 to 3 sentences) contest entry at ORToday.com/Contest.

One gift card per individual.

H QUOTE OF THE MONT

people early on g n u yo h ac te to ts “It is time for paren is strength.” e er th d an ty u ea b e is that in diversity ther elou – Maya Ang

52 | OR TODAY | SEPTEMBER 2020

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The News and Photos

OUT OF THE OR

that Caught Our Eye This Month

pinboard

Photo courtesy of Getty Images

NOW’S THE TIME TO TEACH AT-HOME NUTRITION

By Family Features

W

ith a lot of parents facing the challenge of keeping housebound kids happy and healthy, this is the perfect time to teach kids the basics of nutrition and eating right.

Consider these simple suggestions from Melanie Marcus, MA, RD, health and nutrition communications manager for Dole Food Company.

• Healthy Snack Time Taste Tests: Sometimes it feels like kids can snack all day long on easy-to-grab crackers, chips or cookies. Next time they reach into the snack pantry, try incorporating a taste test or food critic activity to encourage something different and more nutritious.

• Purposeful Playtime: Many households have a play kitchen or some kind of play food. Use this as an opportunity to act out how to create a healthy kitchen with activities like making salad, setting the table, peeling bananas and washing dishes. This

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•

•

can help young children become more independent, learn what to expect and grow into little helpers at family mealtime.

Sensory Activity: One idea that can work for school and at home is making a sensory box. Simply place a fruit or two inside a tissue box and have children put their hands inside then try to guess which fruit it is by feeling it.

Recipes for Fun: If you’re preparing a meal, it could be a good time to teach children of reading age how to review a recipe. Evaluating ingredients to learn how food transforms from raw to cooked or how a dish is created can help kids learn kitchen skills.

Find kid-friendly recipe ideas at dole.com plus nutritional tips, free printables and other healthy fun on Facebook, Pinterest, Twitter and Instagram.

SEPTEMBER 2020 | OR TODAY |

53

INDEX

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ALPHABETICAL Action Products, Inc.…………………………………………17 AIV Inc.………………………………………………………………… 4 ALCO Sales & Service Co.……………………………… 47 Augustine Surgical Inc.…………………………………… 49 Capital Medical Resources…………………………………19 Cygnus Medical…………………………………………………IBC Doctors Depot………………………………………………… 20

Encompass Group…………………………………………13,39 GelPro…………………………………………………………………… 11 Healthmark Industries Company, Inc.………… 43 Innovatus Imaging……………………………………………… 5 Jet Medical Electronics Inc………………………………17 MD Technologies Inc.…………………………………………15 OR Today Webinar Series………………………… 19,45

Ruhof Corporation…………………………………………… 2,3 SIPS Consults, Corp.………………………………………… 47 TBJ Incorporated……………………………………………… 23 TIDI………………………………………………………………… 28,29 UVDI…………………………………………………………………… BC

ANESTHESIA

Healthmark Industries Company, Inc.………… 43

REPROCESSING STATIONS

Augustine Surgical Inc.…………………………………… 49

MD Technologies Inc.…………………………………………15

MD Technologies Inc.…………………………………………15

Doctors Depot………………………………………………… 20

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

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

SIPS Consults, Corp.………………………………………… 47

TBJ Incorporated……………………………………………… 23

CATEGORICAL

CARDIAC PRODUCTS Jet Medical Electronics Inc………………………………17

CARTS/CABINETS ALCO Sales & Service Co.……………………………… 47 Cygnus Medical…………………………………………………IBC Healthmark Industries Company, Inc.………… 43 TBJ Incorporated……………………………………………… 23

CS/SPD MD Technologies Inc.…………………………………………15 Ruhof Corporation…………………………………………… 2,3

TBJ Incorporated……………………………………………… 23 TIDI………………………………………………………………… 28,29

INSTRUMENT STORAGE/TRANSPORT Cygnus Medical…………………………………………………IBC Ruhof Corporation…………………………………………… 2,3 TIDI………………………………………………………………… 28,29

MONITORS Doctors Depot………………………………………………… 20

MRI

SAFETY GelPro…………………………………………………………………… 11 Healthmark Industries Company, Inc.………… 43 TIDI………………………………………………………………… 28,29

SINKS Ruhof Corporation…………………………………………… 2,3 TBJ Incorporated……………………………………………… 23

STERILIZATION Cygnus Medical…………………………………………………IBC

Innovatus Imaging……………………………………………… 5

Healthmark Industries Company, Inc.………… 43

Cygnus Medical…………………………………………………IBC

ONLINE RESOURCE

MD Technologies Inc.…………………………………………15

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

MedWrench……………………………………………………… 43

TBJ Incorporated……………………………………………… 23

UVDI…………………………………………………………………… BC

OR Today Webinar Series………………………… 19,45

SURGICAL

DISPOSABLES

OR TABLES/BOOMS/ACCESSORIES

MD Technologies Inc.…………………………………………15

ALCO Sales & Service Co.……………………………… 47

Action Products, Inc.…………………………………………17

ENDOSCOPY

OTHER

Capital Medical Resources…………………………………19

AIV Inc.………………………………………………………………… 4

Cygnus Medical…………………………………………………IBC

OTHER: FLOOR MATS

DISINFECTION

Healthmark Industries Company, Inc.………… 43 MD Technologies Inc.…………………………………………15 Ruhof Corporation…………………………………………… 2,3

FALL PREVENTION ALCO Sales & Service Co.……………………………… 47 Encompass Group…………………………………………13,39

FLUID MANAGEMENT MD Technologies Inc.…………………………………………15

GENERAL AIV Inc.………………………………………………………………… 4 Capital Medical Resources…………………………………19

HOSPITAL BEDS/PARTS ALCO Sales & Service Co.……………………………… 47

INFECTION CONTROL

GelPro…………………………………………………………………… 11

PATIENT MONITORING AIV Inc.………………………………………………………………… 4 Jet Medical Electronics Inc………………………………17

PATIENT WARMING Encompass Group…………………………………………13,39

POSITIONING PRODUCTS Action Products, Inc.…………………………………………17 Cygnus Medical…………………………………………………IBC

PRESSURE ULCER MANAGEMENT Action Products, Inc.…………………………………………17

REPAIR SERVICES Capital Medical Resources…………………………………19

SIPS Consults, Corp.………………………………………… 47 TIDI………………………………………………………………… 28,29

SURGICAL INSTRUMENT/ACCESSORIES Cygnus Medical…………………………………………………IBC Healthmark Industries Company, Inc.………… 43

TELEMETRY AIV Inc.………………………………………………………………… 4

TEMPERATURE MANAGEMENT Augustine Surgical Inc.…………………………………… 49 Encompass Group…………………………………………13,39

ULTRASOUND Innovatus Imaging……………………………………………… 5

ULTRAVIOLET DISINFECTION UVDI…………………………………………………………………… BC

WASTE MANAGEMENT MD Technologies Inc.…………………………………………15 TBJ Incorporated……………………………………………… 23

Cygnus Medical…………………………………………………IBC

X-RAY

ALCO Sales & Service Co.……………………………… 47

Doctors Depot………………………………………………… 20

Innovatus Imaging……………………………………………… 5

Cygnus Medical…………………………………………………IBC

Jet Medical Electronics Inc………………………………17

Encompass Group…………………………………………13,39

54 | OR TODAY | SEPTEMBER 2020

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Contact Cygnus Medical www.cygnusmedical.com 800.990.7489