OR Today Magazine November 2020 by MD Publishing

INDUSTRY INSIGHTS TJC REVOKES PRIOR POSITION STATEMENT

PRODUCT FOCUS PATIENT POSITIONING SYSTEMS

EQ FACTOR THE POWER OF CHOICE

LIFE IN AND OUT OF THE OR

VERTICAL VIOLENCE & WORKPLACE

BULLYING PAGE 40

CORPORATE PROFILE

NOVEMBER 2020

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contents features

t us treat you...

ative Nurses Week is November 8-14 and

erve to be celebrated more than ever!

VERTICAL VIOLENCE AND WORKPLACE BULLYING Bullying and "incivility" has been an issue in the health care environment in the past and remains one today â&#x20AC;&#x201C; especially during the ongoing COVID-19 pandemic.

operative Nurses Week focuses attention on the meaningful work of thousands of

urses in the United States. OR Today joins the celebration with a new contest for our readers!

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The latest industry news of interest to perioperative and central sterile professionals.

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NEWS & NOTES

ORToday.com

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CORPORATE PROFILE: INNOVATIVE MEDICAL PRODUCTS Innovative Medical Products (IMP) continues to serve customers and grow in 2020 despite the challenges of the COVID crisis.

OR Today (Vol. 20, Issue #11) November 2020 is published monthly by MD Publishing, 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290. POSTMASTER: Send address changes to OR Today at 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290. For subscription information visit www.ortoday.com. The information and opinions expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher. Reproduction in whole or in part without written permission is prohibited. ÂŠ 2020

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INDUSTRY INSIGHTS 10 News & Notes 18 IAHCSMM: TJC Revokes Prior Position Statement Due to COVID-19 Resurgence 21 Avante: How to Maximize the Efficiency of Your Patient Monitor Fleet 22 CCI: The Challenges of Remote Secure Testing 25 OR Today Webinars Deliver Continuing Education

26 M arket Analysis: Patient Positioning Market Continues Advance 27 Product Focus: Patient Positioning Systems 30 CE Article: Perioperative Nurses Lead the Way in Managing Surgical Patients' Skin Integrity 36 Corporate Profile: Innovative Medical Products

OUT OF THE OR

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Hank Balch, President & Founder, Beyond Clean Sharon A. McNamara, Perioperative Consultant, OR Dx + Rx Solutions for Surgical Safety Julie Mower, Nurse Manager, Education Development, Competency and Credentialing Institute

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INDUSTRY INSIGHTS

news & notes

OR Today Celebrates Perioperative Nurses Week Every year, Perioperative Nurses Week (November 8-14) focuses attention on the meaningful work of thousands of perioperative nurses in the United States. OR Today joins the celebration with a new contest for readers! Visit us on Instagram at @or_today, like our page and tag someone for a chance to win a $75 Massage Envy gift card! See page 20 for details. •

Healthmark Offers Wellness Screens Healthmark has announced the addition of Wellness Screens to its Personal Protection Equipment (PPE) product line. These easy-to-build Wellness Screens provide a layer of protection and act as a physical barrier between individuals while allowing complete visibility, as well as pass-through access to the other side. Manufactured from clear acrylic, the chemically resistant Wellness Screens are equipped with acrylic feet that allow them to stand on their own and can be used in various locations throughout a facility. The Wellness Screens are offered in two sizes and are available for individual purchase. •

Medline Expands Respiratory Care Portfolio Medline and Hospitech Respiration Ltd. have announced an agreement to distribute AG Cuffill, a compact and intuitive syringe-like device that provides an accurate solution for measuring both pressure and volume of airway cuffs in all clinical settings. Effective October 2, 2020, Medline will be the exclusive distributor of AG Cuffill in all health care markets across the United States. “Working with Hospitech strengthens Medline’s portfolio of respiratory solutions designed to improve care, reduce risk and manage costs,” says Tim Finnigan, respiratory division president at Medline. “AG Cuffill allows clinicians to make monitoring cuff pressure a standard of care while reducing the risks and costs associated with pressures above or below the recommended range.” Measuring and adjusting cuff pressure is critical for

10 | OR TODAY | NOVEMBER 2020

patients intubated with a cuffed endotracheal (ET) tube, trach tube or LMA. Cuff pressures can change rapidly, especially during transport or as patients change position, such as proning. The AG Cuffill is a device that enhances patient safety while diminishing the risk of cross contamination. The device can be used by all medical professionals, including respiratory, anesthesia, first responders and home providers to reduce potential for aspirations with an under-inflated cuff or ischemic injury that can result from over-inflation. This new partnership will leverage more than 400 acute and surgery center Medline sales reps to help expand the product’s presence in hospitals and surgery centers across the country. •

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New AAAHC Accreditation Handbook Enhances Medicare Deemed Status Standards With its mission to improve health care quality through accreditation, the Accreditation Association for Ambulatory Health Care (AAAHC) has published version 41 of the Accreditation Handbook for Medicare Deemed Status. Released September 1, the revised edition provides the most current information and guidance for organizations seeking AAAHC Medicare Deemed Status (MDS) accreditation and promotes best practice for the safety and care of patients and staff within the ambulatory setting. “As we begin our fifth decade of service to ambulatory health care centers, the updated handbook reflects refinements in our standards and delivery of improved tools to provide guidance for facility quality improvement efforts,” said AAAHC Board Chair Ira Cheifetz, DMD. “The revised standards uphold the AAAHC 1095 Strong, quality everyday philosophy by driving excellence and relevance and survey readiness throughout the 1,095 days of the accreditation term.” Following an extensive review process and multiple public comment periods with accredited organizations, partner associations, committees, surveyors, and staff, the moderate revisions in v41 reflect realignment of standards for improved clarity of requirements. For ease of review and implementation, the handbook contains a crosswalk identifying changes from the previous version. In addition, reformatted v41 of the Accreditation Handbook for Medicare Deemed Status includes “elements of compliance” and compliance ratings charts. These additions to the MDS handbook increase transparency about how surveyors will evaluate compliance and allow organizations to easily conduct self-assessments that may more closely align with onsite surveys. “While the revised 2020 version of the handbook includes only moderate changes, it presents the expectations for demonstrating compliance in a more concise, cohesive format,” said Noel Adachi, MBA, president and CEO of AAAHC. “We anticipate a seamless transition for organizations to integrate policies, procedures, or programs to be compliant with the v41 changes.” • For more information, visit www.aaahc.org.

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INDUSTRY INSIGHTS

news & notes

FDA Clears Neurosurgical Access Platform Minnetronix Medical, a company known for developing and manufacturing products for medical device companies throughout the world, has received FDA clearance for its first platform product: the MindsEye Expandable Port for neurosurgical procedures. This clearance represents an expansion of the company’s traditional offerings to include market-ready platforms. The MindsEye Port is the first minimally invasive, expandable port designed for use in the treatment of stroke, cancer and other conditions. The device’s dynamic retraction creates a custom-sized channel allowing surgeons to reach target areas deep within the brain. “This is next-generation deep brain access technology,” said Dr. Mario Zuccarello, professor of neurosurgery, University of Cincinnati Medical Center. “Minimizing invasiveness as much as possible is important to respect the eloquence of brain tissue. The MindsEye Expandable Port allows surgeons to work without unnecessary distractions, which ultimately improves quality of life for the patient.” “Given its unique features, the port has already attracted interest among neurosurgeons and potential distribution partners. They’re excited to get their hands on it,” says Matt Adams, vice president and general manager at Minnetronix Medical. “The MindsEye Port is an exciting example of how Minnetronix Medical is expanding its offerings by developing market-ready products.” He adds that the port represents an entire platform for the company, as it has additional applications and complimentary product opportunities in the neuro market and beyond. •

NOVEMBER 2020 | OR TODAY |

INDUSTRY INSIGHTS

news & notes

ValueHealth Hires New COO ValueHealth President Don Bisbee has announced the hiring of John Gresham as chief operating officer of ValueHealth, a nationally recognized digital health care services company with a tech-enabled surgical platform. Gresham will focus on the expansion of ValueHealth’s consumer strategies along with scaling the company’s clinical, financial and technology operations across ValueHealth’s Provider Network. Gresham brings over 20 years of healthcare IT experience, creating new business innovations, scaled operations and improved

clinical outcomes for major health systems. ValueHealth provides health systems, provider groups and employers a stateof-the-art surgical John Gresham platform to deliver value-based care and accelerate the surgical road forward post-COVID-19, expanding safe capacity for urgent and non-urgent surgery. ValueHealth’s digital surgical platform is currently integrated into over 46 systems. Along with patient steerage, payor bundles,

and warranty contracts, the platform empowers ValueHealth’s nationally recognized Ambulatory Centers of Excellence (ACE) program, which designates ambulatory surgery centers that not only exceed national accrediting standards, but also meet ValueHealth’s stricter clinical, quality and financial measures. Gresham comes to ValueHealth from Cerner Corporation, where he held several senior executive roles for the company launching dozens of firstof-a-kind enterprise partnerships and innovative growth solutions. •

Web-based App Reduces Sepsis Mortality The Joint Commission Center for Transforming Healthcare is introducing its Reducing Sepsis Mortality Targeted Solutions Tool (TST), a web-based application to help providers reduce sepsis mortality and increase sepsis protocol compliance in pursuit of zero harm. Sepsis is a top cause of death in hospitalized patients that costs the health care system at least $41 billion each year. Early recognition and effective treatment of sepsis not only saves lives, but it also frees up scarce resources and dollars that hospitals need for staff or to rebuild services and infrastructure. Sepsis, a severe reaction in response to an infection, was already among the leading causes of death for hospital patients in the United States when the COVID-19 pandemic hit in early 2020. In the United States alone, it typically affects 1.7 million patients every year, with about 270,000 of those cases resulting in death. The Global Sepsis Alliance has confirmed that COVID-19 can cause sepsis, and that signs of multiorgan injury typical in sepsis cases occur in approximately 2% to 5% of COVID-19 cases. Although it is still early in the pandemic and data is continuously being collected and analyzed, some studies indicate sepsis may be the

12 | OR TODAY | NOVEMBER 2020

second leading cause of death among COVID-19 patients. “With sepsis, time is life,” said Barbara Ihnen-Carlson, quality nurse analyst for the U.S. Department of Veterans Affairs at the Omaha VA Medical Center. “Our goal was to improve the sepsis care delivered to veterans, and the Sepsis TST cohort gave us the ability to identify and improve opportunities or barriers. Sepsis is a universal concern, and this intuitive tool will be a benefit to any organization.” The center’s release of the Reducing Sepsis Mortality TST follows a comprehensive quality improvement project that decreased mortality among the cohort by nearly 25% and a subsequent multihospital pilot that reduced mortality from nearly 20% to over 50%. In addition to the Sepsis TST, the center offers other TSTs that help reduce injuries from falls, handoff communication failures and errors within the surgical process. When an organization has isolated its most significant causes of failure, it can then implement solutions that target the problem. • For more information, visit www.centerfortransforminghealthcare.org.

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3M Introduces New Sterilization Solutions 3M now offers a lineup of new 3M Attest sterilization offerings that will help teams safely standardize, simplify and streamline workflows. Using the 3M Attest system across modalities provides consistent equipment, interfaces, workflows, processes and training across a department, potentially reducing the risk of human error and helping teams work more effectively. “We are thrilled to offer even more solutions to CSSD managers and technicians with our new steam and vaporized hydrogen peroxide systems,” said Adam Wilt, global business director, 3M medical solutions division. “Our new solutions help make the job easier for our partners who are essential to making sure safe instruments are used on patients. We strive to help raise the standard of care through monitoring every load while standardizing workflows and streamlining the critical sterilization process. As the first and only VH2O2 chemical indicator in the FDA’s new multivariable product category for chemical vapor sterilization, the 3M Attest Vaporized Hydrogen Peroxide (VH202) Tri-Metric Chemical Indicator independently monitors the three critical variables of time, temperature and VH202 concentration. This will allow sterile processing departments to elevate the standard of care in VH2O2 to the level they currently expect in steam sterilization. The 3M Attest Tri-Metric Chemical Indicator helps ensure heat and moisture sensitive instruments such as robotic scopes and batteries are properly exposed to the critical variables of VH202 sterilization. With easy-to-read “accept” and “reject” zones, the indicator will clearly change from blue to pink to indicate results. The redesigned 3M Attest Steam Chemical Integrator, Type 5 utilizes moving front technology which eliminates time spent interpreting color changes. Further enhancements improve readability and make it easy to find in operating room case trays. The CI enhances efficiency by streamlining the tracking process as its barcode can be scanned into a hospital’s instrument tracking system. The 3M Attest Steam Chemical Integrator is made with thick aluminum foil for added durability and is designed to withstand the temperature extremes that come with extreme sterility conditions. The new 3M Attest Mini Auto-reader 490M, provides 24-minute sterilization monitoring results in a smaller, four-indicator well footprint. This makes it ideal for smaller clinics, operating rooms and ambulatory surgery center settings. This easy to use Auto-reader is designed to incubate and read both steam and vaporized hydrogen peroxide 3M Attest Rapid Readout Biological Indicators 1491, 1492V and 1295 for a final fluorescent result in 24 minutes. Routine monitoring with the Attest Mini Auto-reader 490M can reduce the risk of patient exposure to contaminated medical instruments. “At 3M, we are continually working with the health care community to understand their pain points and bring innovative solutions to the table. We are excited to continue to expand our 3M Attest suite of products to better meet the needs of health care professionals,” said Wilt. • For more information, visit go.3M.com/sterilization.

A Simple and Effective Aerosol Barrier

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

For regulatory info: encompassgroup.com/covaire-regulatory WWW.ORTODAY.COM

NOVEMBER 2020 | OR TODAY |

INDUSTRY INSIGHTS

news & notes

Hologic Acquires Acessa Health Hologic Inc. has acquired Acessa Health Inc., a privately held innovator in minimally invasive treatment for fibroids, for approximately $80 million in cash plus contingent payments based on future revenue growth. “Acquiring Acessa Health strengthens our leadership position in the GYN surgical space and broadens our fibroid treatment portfolio with a highly complementary new product,” said Essex Mitchell, Hologic’s newly appointed division president, GYN surgical solutions. “Together with the Acessa team, we can leverage our core women’s health expertise, commercial infrastructure and physician relationships to accelerate our

growth strategy and offer superior technology that translates into better clinical outcomes for women.” Acessa Health markets the Acessa ProVu system, a fully integrated laparoscopic system that combines radiofrequency ablation with advanced intraabdominal ultrasound visualization and guidance mapping, enabling physicians to effectively and safely treat women with symptomatic, benign uterine fibroids. Clinical studies have shown that the Acessa ProVu system is a safe and minimally invasive alternative to hysterectomy and myomectomy. The system is indicated for treatment of benign uterine fibroids and is designed to detect more

fibroids as compared to current imaging modalities. Radiofrequency treatment of fibroids is supported by clinical data demonstrating less blood loss and faster recovery times as compared to standard treatments currently available. “The Acessa Health team is exceedingly passionate about providing women with more options to address their symptomatic uterine fibroids,” said Kim Rodriguez, Acessa Health president, chief executive officer and co-founder. “Now, under Hologic’s leadership and with their commercial presence, the Acessa ProVu system can more rapidly become the standard of care and greatly benefit more women.” •

Ambu Inc. Awarded Premier Inc. Contract Ambu Inc. has been awarded a single-use endoscopy contract in the category of surgical disposable scopes with Premier Inc. In addition, Ambu was the only supplier of single-use endoscopes designated to participate in Premier’s SURPASS and ASCEND purchasing programs. The three-year agreement creates a single-use endoscopy category specifically for the Premier membership, and was signed in late August, effective November 1, 2020. The partnership with Premier – whose members represent 4,100 hospital and health systems in the U.S. and 200,000 other providers – will further accelerate Ambu’s rapidly expanding share of the single-use endoscope market by giving those accounts pre-negotiated pricing and terms for Ambu’s full suite of endoscopy products. Premier’s SURPASS program represents $8.4 billion in

14 | OR TODAY | NOVEMBER 2020

annual supply chain purchasing, with more than 30,000 acute care beds across 24 states and two U.S. territories. The ASCEND group purchasing program, meanwhile, is one of the nation’s largest committed purchasing programs with more than 120,000 acute care beds and combined purchasing volume of more than $18 billion. “The agreement allows Ambu to tap into a vast market of hospitals, health systems and health care providers across the U.S. with our single-use endoscopes,” said Juan Jose Gonzalez, CEO of Ambu A/S. “It strengthens our position in the U.S. and demonstrates the value of our portfolio in improving workflows and increasing patient safety. Premier is an exceptional company that we have known for years and we look forward to continue building our relationship with a company that is transforming the health care industry.” •

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INDUSTRY INSIGHTS

Flow-e and Flow-c Anesthesia Systems Receive 510(k) Clearance The U.S. Food & Drug Administration (FDA) recently cleared Getinge’s Flow-e and Flow-c anesthesia systems. The Flow family is Getinge’s line up of anesthesia machines conceived to cover the needs of all types of surgeries and patients. Developed together with clinicians, these machines are designed to facilitate personalization with patient safety in mind. With an intuitive interface, emphasis on ease of use, smart design, and a high level of automation, the Flow Family brings personalized anesthesia delivery and smooth workflow to the clinician. “Every detail of this machine has been designed in collaboration with clinicians to ensure optimal care with high efficiency. Flow-e has a smart workspace that makes work easier in the busy OR environment,” explains Lena Evander, director product management anesthesia at Getinge. “The tools are right where you would want them to be, which makes it possible to work in an ergonomic and comfortable position.”

news & notes

The Flow Family core technology includes gas modules that are common with Servo ICU ventilators, allowing lung-protective ventilation and the optional Lung Recruitment Maneuvers tool, which is available on Flow-e and Flow-i models. Lung Recruitment Maneuvers have become the tool of choice to counter atelectasis, improve oxygenation, and help prevent postoperative complications. What was once considered complex and time consuming is now seamlessly integrated so that anesthesiologists can focus on high-acuity patients while monitoring their vital signs. The Flow-e and Flow-c will be launched with upgraded software, version 4.7, which includes the MAC Brain indicator, a unique tool that visualizes the difference in agent concentration between the lungs and target organ, the brain. The reliability of the data places anesthesiologists in control, which allows planning and delivery of more efficient agent dosing. The other members of the Flow family will have access to the software upgrade soon. •

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NOVEMBER 2020 | OR TODAY |

INDUSTRY INSIGHTS

news & notes

Philips Unveils OmniWire Royal Philips has introduced OmniWire, the world’s first solid core pressure wire for coronary artery interventional procedures. With its breakthrough solid core construction, physicians can more easily maneuver the wire in the patient’s circulatory system to measure blood pressure along the vessel and guide the delivery of catheters and stents. The new wire supports instant wave-Free Ratio (iFR) measurements, the only resting index supported by randomized controlled outcome trials, as well as fractional flow reserve (FFR) measurements. It also integrates with the Philips IntraSight interventional applications platform, which can co-register iFR data onto the angiogram (interventional X-ray image) to precisely identify the parts of vessels requiring treatment. Traditional pressure wires use a hollow metal tube (hypotube) to house the wiring that transmits the pressure information. Due to their thin walls, these wires can be challenging to maneuver and can sometimes kink, potentially becoming damaged during the procedure. OmniWire is the world’s first solid core pressure guidewire, using advanced conductive ribbons embedded in its outer polymer layer to communicate pressure

16 | OR TODAY | NOVEMBER 2020

information. The front (distal) part of the wire is made from Nitinol, a super-elastic, durable material that is commonly used in non-diagnostic, interventional ‘workhorse’ guide wires. The back (proximal) part of the wire is constructed from a high-strength cobalt alloy that provides the high durability required for complex and multi-vessel cases. “I have been very impressed with the handling of OmniWire, the new solid core design performed beautifully, and I was able to navigate the difficult case easily,” said Dr. Jasvindar Singh, director of the catheterization lab at Barnes Jewish Hospital and associate professor at Washington University in St. Louis, U.S., who performed the first human case with OmniWire in the country. “We used iFR co-registration and found that the patient needed a stent. I was then able to perform the whole procedure working over OmniWire. This is truly an innovation in percutaneous coronary interventions.” The new wire supports both iFR and FFR indices. iFR continues to be

adopted into clinical practice and has been validated in clinical outcomes studies with data from over 4,500 patients as well as being recognized by the European Society of Cardiology (ESC), the Society for Cardiovascular Angiography and Interventions (SCAI) and the American College of Cardiology (ACC). OmniWire integrates with IntraSight, Philips’ secure interventional applications platform that integrates a comprehensive suite of clinically proven modalities including iFR, FFR, intravascular ultrasound (IVUS) and co-registration to simplify complex interventions and speed routine procedures. With iFR pullback and co-registration, physicians can identify the precise locations causing ischemia, plan stent length and placement with a virtual stent, and predict physiologic improvement. OmniWire is now available in the U.S. and Japan and has received clearance from the U.S. Food and Drug Administration (FDA) and approval from the Japan Pharmaceuticals and Medical Devices Agency. •

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Carestream Enters PPE Market Carestream Health has entered the personal protection equipment (PPE) market with the launch of the Carestream Shield, solving problems of discomfort and difficulty of use commonly associated with personal face shields. Carestream has a proven track record in disciplined development of digital medical imaging systems. The company has applied this expertise in developing its new face shield, which will help frontline health care workers protect themselves from risky exposure to fluids. Designed to be used as supplemental protection in conjunction with a face mask, goggles and other PPE, the 9 x16-inch shield aims to protect health care workers from exposure to infection. The face shield safeguards a user’s eyes, nose and mouth from acutely expelled aerosols of bodily fluid. A breathable and lightweight system with an adjustable visor, the shield has flexible baseball-cap style straps for a personalized fit. Its forehead cushion provides a soft and slip-resistant contact point eliminating the need to adjust the system during a patient visit. The face shield reduces the buildup of fog and sweat – a too common occurrence with the use of face masks – through an

opening at the top, allowing hot air from the body to ventilate away from the face. While these new reusable shields are easy to disassemble, carry, store and disinfect, they are also replaceable to maintain visibility and help limit the spread of infection. The Carestream supplemental PPE face shield is available in two distancefrom-face options. The standard model, nearly two inches from the forehead, provides excellent protection without sacrificing mobility. The extended model, 2.5 inches from the forehead, allows even more space between the face and the shield to fit bulky eyewear or PPE like dental loupes, glasses, goggles and larger respirators. Carestream will make its new face shield available for purchase in the United States and will expand to other worldwide geographies over the next few months.

YOU WOULDN’T WANT THIS IN YOUR OPERATING ROOM WHY ARE YOU SETTLING FOR FORCED AIR? IMAGINE EFFECTIVE PATIENT WARMING WITH NO NOISE, AIR MOVEMENT OR EXCESSIVE HEAT

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NOVEMBER 2020 | OR TODAY |

INDUSTRY INSIGHTS

IAHCSMM

TJC Revokes Prior Position Statement Due to COVID-19 Resurgence FDA addresses methanol hand sanitizer risks, revises EUA for respirator decontamination By Susan Klacik, BS, CRCST, CIS, CHL, ACE, FCS n August 14, 2020, the Joint Commission (TJC) removed its position statement, Preventing Nosocomial COVID-19 Infections as Organizations Resume Regular Care Delivery. As the accreditation agency noted, the guidance document was originally written in May when COVID-19 cases in the U.S. were declining, health care organizations were rapidly working to resume elective procedures and ambulatory care, and TJC was receiving many questions regarding reopening.

“We are now in a very different situation,” the agency noted in a prepared statement. “Health care organizations are trying to balance providing safe, routine care while combatting the continuing epidemic amidst persistent shortages of personal protective equipment (PPE).” The agency also acknowledged it heard from some professional societies and health care organizations that section of the TJC position statement were “problem-

18 | OR TODAY | NOVEMBER 2020

atic” due to changes in the pandemic and the agency’s understanding of the science surrounding COVID-19 transmission. Additionally, TJC stated that the Centers for Disease Control and Prevention updated its guidance to address some of the issues outlined in TJC’s position statement, including definitions of contingency strategies and crisis standards of care for PPE conservation and when they should be applied – which led TJC to deem its own position statement “no longer useful.” To read the full statement, visit: https://www.jointcommission. org/-/media/tjc/documents/covid19/ removal-of-position-statement.pdf.

FDA list grows for dangerous methanol-containing hand sanitizers Hand hygiene is a part of a sterile processing technician’s daily responsibilities. When the COVID-19 pandemic began, routinely used hand hygiene products were, at times, in short supply and replaced with other hand hygiene products. In July, the U.S. Food and Drug Administration (FDA) issued a warning to consumers and

health care professionals about hand sanitizer products containing methanol, or wood alcohol; this substance, which is often used to create fuel and antifreeze, is not an acceptable active ingredient for hand sanitizer products and can be toxic when absorbed through the skin (and life-threatening when ingested). The FDA has seen an increase in hand sanitizer products that are labeled to contain ethanol (also known as ethyl alcohol), but that have tested positive for methanol contamination. Methanol exposure can result in nausea, vomiting, headache, blurred vision, permanent blindness, seizures, coma and/or permanent damage to the nervous system, or death. Consumers who have been exposed to hand sanitizer containing methanol and are experiencing symptoms should seek immediate medical treatment for potential reversal of toxic effects of methanol poisoning. The FDA recommends that if using these products to immediately stop using them and dispose of the bottle in a hazardous waste container, WWW.ORTODAY.COM

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if available, or dispose of as recommended by local waste management and recycling centers. These products should not be flushed or poured down the drain or mixed with other liquids. The FDA has and will continue to quality test hand sanitizers, including testing products entering the country through the U.S. border. The agency maintains a list of FDA-tested and -recalled hand sanitizers on its website, which is being continually updated as dangerous products are discovered. To access the information, visit: www.fda. gov/drugs/drug-safety-and-availability/ fda-updates-hand-sanitzers-methanol.

Changes to types of respirators that can be decontaminated for reuse Shortly after the COVID-19 pandemic began, the FDA issued emergency use authorizations (EUAs) to specify which respirators are appropriate for decontamination. During continued reviews and research, the FDA has ascertained from the Centers for Disease Control and Prevention’s (CDC’s) National Institute for Occupational Safety and Health (NIOSH) testing that authorized respirators manufactured in China may vary in their design and performance. Based on that information, the FDA has concluded that the available information does not support the decontamination of these respirators and, for that reason, the agency has revised the relevant EUAs. WWW.ORTODAY.COM

In addition, the FDA is also revising relevant EUAs to no longer authorize decontamination or reuse of respirators that have exhalation valves. In an effort to ensure health care personnel are adequately protected, the FDA has announced it has revised and reissued a number of EUAs to amend which respirators are authorized to be decontaminated. According to the CDC’s recommendations, decontaminated respirators should only be used when new FDA-cleared N95 respirators, NIOSH-approved N95 respirators or other FDA authorized respirators are not available. The decontamination systems are only authorized to decontaminate noncellulose compatible N95 respirators. Health care facilities should not reuse a respirator that is incompatible with an authorized decontamination system. It is important to note that users of any respirator (whether or not decontaminated) should always assess for proper fit after placement. Respirators with poor fit, visible soiling or damage should not be used. Susan Klacik, BS, CRCST, CIS, CHL, ACE, FCS, serves as a clinical educator for the International Association of Healthcare Central Service Materiel Management (IAHCSMM) and has served as the IAHCSMM representative to the Association for the Advancement of Medical Instrumentation since 1997.

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INDUSTRY INSIGHTS Avante

How to Maximize the Efficiency of Your Patient Monitor Fleet By Mai Sumlut, Technician Supervisor s a key component in almost any medical setting, patient monitors come in many varieties and sizes. Throughout the course of patient treatment, clinicians can use a combination of bedside and portable monitors. Keeping an entire fleet of patient monitors in good working order in any facility, especially a large hospital, requires expertise, time and money.

Facilities can manage their patient monitors more efficiently while increasing cost savings by partnering with an equipment provider to help them source the monitors they need, and make sure they’re up and running with comprehensive service, repair and parts. In this article, learn what to look for in a patient monitoring equipment provider in order to maximize your facility’s efficiency and its budget.

Cost-Effective Patient Monitor Sourcing When choosing a patient monitor provider, it makes sense to work with a company that offers a large inventory of refurbished monitors in various types, brands and models. Look for a company that can offer monitors from all the top manufacturers including GE, Philips, Draeger and more. While the biggest, most straight forward benefit of refurbished monitors is the cost savings, professionally refurbished medical equipment can also provide facilities with other benefits. A late-model, refurbished patient monitor can integrate more seamlessly WWW.ORTODAY.COM

Mai Sumlut Technician Supervisor into an existing fleet, reducing staff training. Avante Health Solutions is wellknown for its wide selection of patient monitors. Avante can offer facilities professionally refurbished monitors from top manufacturers, helping facilities find the equipment they need at a cost-effective price point.

Simple, Fast Service and Repair In addition to sourcing the right models, a true equipment partner can offer facilities flexible, simple service on their patient monitors with a quick turnaround. Be sure to ask a prospective equipment provider what their repair process entails. A reputable company will have simple, easy-to-use services that allow facilities to easily communicate equipment errors and send in their equipment for repair. When choosing a patient monitor repair partner, be sure the company has the skills and expertise to be able to handle a variety of repairs on all major brands. The company should have thorough processes for repair and documentation, and this com-

municated effectively to customers. An easy way to determine whether a company is quality-focused is to ask if their processes have been certified by a regulatory agency. Avante offers patient monitoring repairs at component level. Repair technicians at Avante understand how time consuming the repair process can be for facilities, so they have streamlined to process to be quick, simple and easy to use. Avante’s patient monitoring repair processes have been certified with ISO 13485:2016.

In-Demand Patient Monitor Parts Beyond equipment sourcing and repair, a patient monitoring equipment partner can also give facilities access to component parts. Being able to easily order and receive patient monitoring parts allows hospital biomedical technicians to perform maintenance and minor repairs in-house, allowing them to quickly get the equipment back on the floor. Avante has one of the largest selections of patient monitor component parts in the industry today. With an inventory of both OEM- and Avantebrand replacement parts, Avante empowers the biomedical community with the parts they need in their facilities. Avante offers discounts and free shipping for large orders, helping to save valuable budget space. Mai Sumlut is a technician supervisor at Avante Health Solutions’ San Clemente Center for Excellence. For more information on patient monitor equipment sourcing, service and parts from Avante, please visit avantehs.com/monitoring. NOVEMBER 2020 | OR TODAY |

INDUSTRY INSIGHTS CCI

The Challenges of Remote Secure Testing By Samantha Hendrickson and Lindsey McNorton n March of 2020, secondary to the pandemic, all inperson certification testing was temporarily halted in the United States. Certification examinations are essential for the Competency and Credentialing Institute (CCI). Cessation of testing was intensely disruptive, as there was very limited testing availability from the beginning of this shutdown until June. In this brief article, we would like to share some of the lessons learned and how CCI began to adapt to this problem through Remote Secure Proctored Examinations (RSPE).

The shut down of certification examination testing was widespread throughout the industry and impacted all testing vendors and all nursing certification examinations. The accreditation agencies for nursing certification programs were quick to respond to the shutdown and allowed the use of RSPE in lieu of in-person testing. CCI was required to submit detailed requests to the accreditation agencies before beginning the use of RSPE. Prior to candidates testing, the CCI credentialing team tested the check-in process to launch the exam to better understand the user experience. We then had pilot testing with three nurses; two military nurses stationed in Afghanistan and a nurse from Nebraska. Upon completion of

22 | OR TODAY | NOVEMBER 2020

those tests, and reviewing the feedback from these nurses, we began a gradual, measured ramp up of the use of RSPE. At present, RSPE is in use for the CNOR and CSSM certification examinations and was used for the initial testing for the CNAMB credential in September. The RSPE process is much different than traditional in-person testing. A short video from our testing partner Prometric explains the process and can be found at https://www. prometric.com/proproctorcandidate. Remote testing allows nurses to take an exam in their home using an available computer with audio and a web cam. Not every test taker is comfortable or receptive to the unique process of remote testing. Admittedly, the start-up has not been flawless. We would like to share the pros and cons for remote testing and some of the lessons learned. We had very high hopes for RSPE as we began the process. We had hoped this alternative would take the place of inperson testing and CCI would quickly return to near normal levels of testing. Our optimistic forecasts did not materialize, and we have learned RSPE is not a panacea for all testing issues. Remote testing allows a candidate considerable choice in their testing experience. Distractions are minimized since you just need a quiet room that can be isolated for roughly 4 hours. Most candidates test from their home using their laptop. Scheduling is very flexible with proctors available 24/7 versus the daytime hours of test-

ing centers. Remote testing not only removes infection and travel risks, but also accommodates the irregular hours worked by perioperative nurses. Many candidates have chosen to test in the evening and on weekends. There are also some drawbacks to RSPE. Although system checks are required prior to testing, technical issues do happen. A good Internet connection for both the proctor and the test takers is needed. Even though Macs and PCs can be used, not all computers meet the security requirements for testing and exams cannot be done with smartphones or tablet devices. RSPE has been a useful adjunct in these extraordinary times and dozens of nurses have successfully used this method. Remote testing will likely be commonplace in the future. CCI has learned valuable lessons from early use of these systems. The use of RSPE is a viable and useful option at present and we will continue to refine and strengthen our use of this cuttingedge technology to meet the needs of perioperative nurses. Samantha Hendrickson is a Credentialing Associate and holds an Associate of Art Degree and Associate of Science in PreEngineering. Lindsey McNorton is a Credentialing Associate and holds a Bachelor of Science in Event Management.

References Prometric (2020) ProProctor. [webpage]. Accessed August 31, 2020 at: https://www. prometric.com/ProProctor. WWW.ORTODAY.COM

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newswebinars & notes

OR Today Webinars Deliver Continuing Education By John Wallace

ebinars are an even more important venue for acquiring continuing education credits and hours amid the COVID-19 pandemic. Travel bans, virtual conferences and other changes caused by the novel coronavirus outbreak created a need for additional avenues for pursuing continuing education opportunities. The OR Today Webinar Series is one of those venues!

Vendor Management The recent OR Today webinar “Vendor Management: A Historical Perspective of Chaos Coordination” was sponsored by RepScrubs and eligible for one (1) continuing education (CE) hour by the State of California Board of Registered Nursing. This 60-minute webinar featured Will Kahn, vendor management facilitator at VCU Health. He presented successful strategies for implementing a vendor management program. During the webinar, attendees heard more details regarding challenges with vendor management, predictable outcomes, evolution of vendor management, creative opportunities and a COVID-19 response. Attendees shared positive feedback in a post-webinar survey. “This was very good to open my thoughts up about how we are managing our vendors in the OR and hospital. Thanks for the many suggestions in how to better handle them,” Director of Surgical Services T. Lafoon said. “The presentation was very well WWW.ORTODAY.COM

thought out. Ideas and actual implementation were shared,” said J. Dumser, VP. “I love the online webinars. They fit into daily life perfect and are very informational. You can learn a lot in just a very short period of time,” said R. Messina, charge sterile processing tech.

IFU and EAU The recent OR Today webinar presentation “Hyperventilating Through the Pandemic, Don’t Get a Brown Bag … Know Your IFUs and the Importance of EUAs” was popular and highly rated. It was sponsored by oneSOURCE and eligible for one (1) continuing education (CE) hour by the State of California Board of Registered Nursing. The webinar was presented by Sharon Greene-Golden, manager, sterile processing at Adventist HealthCare Shady Grove Medical Center. “Managing our way as sterile processors through a pandemic has been stressful. We need to remember our basics from the importance of Instructions for Use to compliance. We are an instrumental part to our facilities reopening for elective surgeries, keeping ourselves, our patients and facility personnel safe and healthy,” is how an email described the session. In the webinar, Greene-Golden reviewed the things patients are depending on nurses to do correctly every single day. More than 100 individuals logged on for the live presentation that tied for the highest-rated webinar of the year with a 4.4 rating on a 5-point scale. Attendees praised the session in a survey.

“Speaker was very insightful in problem solving during the COVID-19 pandemic. Enjoyed her style of the presentation,” Clinical Educator J. Arnold said. “Sharon Greene-Golden was great! She put it all in perspective. You have already been dealing with all these other disease processes and this is no different in the decontamination of instruments. Great speaker,” said C. Edmonds, vascular/transplant OR coordinator. “I try to never miss one of OR Today’s webinars, they are excellent! I truly enjoyed her webinar. The information she reviewed regarding EUAs was superb and the guidance she gave about not following the IFUs was spot on! She truly is a subject matter expert and I appreciate listening to true and honest daily challenges we face in health care when it comes to sterilization processes, etc.,” said Vice President Chief Care Continuum Officer F. Roster. The OR Today Webinar Series continues to grow. Almost 2,000 attendees have viewed a live presentation in 2020 with even more watching recorded sessions via the on-demand option. For more information, visit ORToday.com and click on the “Webinars” tab. Thank you to our sponsors:

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IN THE OR

market analysis

Patient Positioning Market Continues Advance Staff report he patient positioning system market is expected to gain market growth in the forecast period of 2020 to 2027. Data Bridge Market Research predicts the market will reach $992.3 million by 2027 growing at a CAGR of 4.8% during the forecast period.

Grand View Research reports that the global patient positioning systems market size was valued at $942.8 million in 2016 and is expected to expand at a CAGR of 4.7% through 2025. The growing geriatric population, increasing prevalence of cancer, rising awareness among the patient population and surging expenditure on diagnostic procedures are expected to boost the patient positioning systems market during the forecast period. Technological advancements in sensors, such as optic fiber technology, cancer tracking sensors and MEMS sensors are expected to fuel market growth. These systems help keep

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patients in a comfortable and stable position during radiotherapy as well as treatment delivery. The growth of this market is further supplemented by the increasing prevalence of cancer. By end-use, the market for patient positioning systems is categorized into hospitals, ambulatory centers and others. Hospitals are identified as the largest segment owing to increasing health care expenditure globally. Additionally, increasing the number of hospitals across the globe is anticipated to drive demand in this market. However, the ambulatory segment is expected to grow at a faster rate. As the number of these centers soars in developed as well as developing countries, they help alleviate the pressure on hospitals and clinics. There are approximately 5,229 Ambulatory Surgical Centers (ASCs) certified by Medicare in the U.S. North America held a dominant market share of 34.2% in 2016 owing to the rising prevalence of chronic and lifestyle-related diseases and the pres-

ence of sophisticated health care infrastructure. In addition, the local presence of major market players in the U.S., such as Hill-Rom Holdings, Inc.; Stryker Corporation; Medline Industries; Skytron, LLC; and SchureMed, is expected to boost the growth of the market for patient positioning systems in North America. Europe is also expected to hold a lucrative share during the forecast period due to a flourishing medical device industry in U.K., France and Germany, in addition to rising avenues for market participants in this region. Asia Pacific is expected to register a higher CAGR as compared to other regions over the forecast period, which can be attributed to the increasing geriatric population and increasing health care expenditure in this region. Some of the major players in this space are Medtronic; Hill-Rom Holdings, Inc.; Stryker Corporation; Medline Industries; Skytron LLC; OPT SurgiSystems Srl; SchureMed; Smith & Nephew; STERIS plc; and Leoni. WWW.ORTODAY.COM

AliMed

AliLite Prone Positioning Set

IN THE OR

product focus

The AliLite Prone Positioning Set includes essential components for pressure redistribution and nerve protection for vulnerable areas during prone procedures. The AliLite Prone Headrest offloads pressure and maintains neutral position. The AliLite Prone Positioning Set includes a prone headrest, knee support, prone positioner, heel pads and armboard pads. The AliLite Precontoured Positioners reduce pressure by distributing weight over a larger surface area. Up to 50% lighter than comparable gel-only products, AliLite gel-foam positioners are easier to handle, impervious to fluids, naturally bacteriostatic and feature a stable, nonskid base. AliLite gel is made of dry viscoelastic polymers. •

Encompass Group PDQ Slider Patient Positioner System

The PDQ Slider Positioner Draw Sheet and Knitted Fitted Bottom Sheet add a repositioning system to everyday bed protocols. The two-sided slider draw sheet will be used mostly by itself. Its patient-facing surface is soft 100% woven microfiber. Its breathable taffeta backing reduces heat and moisture and helps facilitate repositioning. For more difficult-to-reposition patients, it can be used in conjunction with the knitted bottom sheet. It’s 100% polyester with a central panel of staticdissipative taffeta facing toward the patient. The system can be laundered with other bed linens. Available in standard 40” x 72” and 50” deep for bariatric use. • For more information, visit www.encompassgroup.com.

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IN THE OR

product focus

Hillrom

Yellofins Apex Stirrups The Yellofins Stirrups line from Hillrom represent enhanced safety, with a dual-rod design that prevents medial leg drop, and automatic positionlocking technology to safely position the patient while protecting both the patient and the surgical team. In addition, Yellofins Apex stirrups offers greater ease-of-use with single-point boot release capabilities, alleviating the need for heavy lifting. To help enhance infection control, Yellofins Apex stirrups include welded pads and removable silicon straps that are easy to clean and reduce the surface area accessible to potential contaminants. •

D. A. Surgical

TrenGuard Trendelenburg Patient Restraint Sliding in Trendelenburg can cause post-operative pain or even serious injury. The TrenGuard “Speed Bump” bolster is proven to prevent patient sliding in steep Trendelenburg, without the use of shoulder braces or chest straps. It is designed to improve OR efficiencies. TrenGuard sets up in less than two minutes and simplifies patient repositioning. • For more information, visit www.da-surgical.com.

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IN THE OR

product focus

IMP

De Mayo Exact-Fit Lateral Positioner The De Mayo Exact-Fit Lateral positioner is an improved version of the original De Mayo Hip positioner in many respects. It is a self-contained unit that accommodates all patients without the need to change components, regardless of patient size. It is the only positioner on the market that connects both OR table rails into a rigid mechanical construct, offering maximum patient stability. The positioner stores fully assembled and is ready to apply as soon as the patient is placed on the operating room table. The single-use protective pads, utilizing a proprietary gel-infused slow recovery foam, ensure that the patient is safely positioned. For more information, visit IMPmedical.com.

Medline

Single-Use Disposable Foam Adult Head Positioners Medline’s Single-Use Disposable Foam Adult Head Positioners provide comfort and support for the patient’s head and neck while in the prone, supine or lateral positions. The positioner is able to accommodate an endotracheal tube on either side of the positioner to help ensure proper positioning. Compressed packaging saves storage space and the positioner is single-use to reduce cross-contamination. It is available in standard highly resilient foam or low-density economy foam. •

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CE541

IN THE OR

continuing education

Perioperative Nurses Lead the Way in Managing Surgical Patients’ Skin Integrity By Nancy Bellucci, Ph.D., RN, CNOR lder patients show a reduction in subcutaneous fat, which will cause a decrease in protection from pressure effects.1

In addition to older adults, pressure injuries affect those with a major injury or comorbid disease the most. Others affected include patients with conditions such as vascular disease, diabetes, and obesity. Patients with pressure injuries stay in the hospital longer, are at a higher risk for mortality, and pay more money for treatment ($36,000 vs. $17,200 per patient) than patients without pressure injuires.2 In 2008, The Joint Commission listed preventing pressure injuries as one of its patient safety goals because of their high rate of occurrence.3 The Centers for Medicare and Medicaid Services (CMS) will not reimburse hospitals for pressure injuries incurred during hospitalization. Pressure injury is a localized response to either external pressure or a combination of external pressure and shearing force. Shearing force occurs when underlying tissue is stressed and stretched while external tissue remains under pressure.1-7 Pressure injury may not be noticed until up to four days after surgery. To floor personnel, the injury may appear as a burn area. In the OR, the injured area may look reddish-maroon, which is caused by reperfusion after prolonged ischemia. Patients with darker pigmented skin are often later diagnosed when tissue begins to necrose.1-7 According to the National Pressure Ulcer Advisory Panel (NPUAP), a multi-

30 | OR TODAY | NOVEMBER 2020

disciplinary group of experts in pressure injury research that sets the standard for describing and defining pressure injury, 2.5 million patients develop pressure injuries during their hospital stays. NPUAP research shows that 45% of these tissue injuries originate in the OR.8 NPUAP defines pressure injury as localized damage to skin and/or underlying tissue over a bony prominence or related to a medical or another device. The complete staging criteria list is available at www.npuap.org. The European Pressure Ulcer Advisory Panel, in concert with NPUAP, provides additional information. As of 2016, newer nomenclature has discontinued the use of the terminology “pressure ulcer” in favor of the term “pressure injury.”6 ,8, 9 The perioperative nurse’s focus should be not only on the color of the skin itself but also on the potential deep internal tissue damage that likely has already occurred, especially if the discoloration is over a bony prominence. In other words, the external reddish color is, in all likelihood, not the injury.1-7 The injury is on the deep internal tissue; the surface color is only a manifestation of the deep tissue ischemic injury.4 In the OR, it is important to grasp the concepts of pressure, duration, and the location of the pressure on various parts of the body (i.e., “pressure points”).4 In the OR, management of a patient’s skin integrity is a challenge. Anesthetized patients cannot adjust their position in response to physiological discomfort and lack of sensation. The state of anesthesia (general, local, block, or sedation) and anesthetic agents may

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 purpose of this program is to discuss evidence-based practice changes that will promote RNs’ management of skin integrity in the OR. After studying the information presented here, you will be able to: •

Describe intraoperative skin integrity within a model of patient care outcomes.

•

Discuss intraoperative skin integrity in relation to the position of a surgical patient.

•

Discuss managing skin integrity in relation to the intraoperative care team.

compromise physiological response to ischemic tissue under pressure.8 Protective reflexes are lost or diminished by anesthetic agents.5 Perioperative nurses need to accept managing patients’ skin integrity during the intraoperative phase as it relates to assuming accountability as determined by the American Nurses Association and AORN.5, 6, 7, 8 Skin integrity is a nursing practice concept. “Skin is the first line of defense” is a mantra in nursing education programs. Nursing standards of practice WWW.ORTODAY.COM

IN THE OR

continuing education support that principle. Traditionally, nursing literature did not strongly support “padded pressure points” (PPP) in nursing care plans or in intraoperative nursing notes.1 The benefits of different support surfaces in the OR have been studied, but it remains difficult to verify the best and most effective means to prevent pressure injuries.1, 4 Padding considerations must be patient-specific. The average 70 kg patient may require standard pressure-relieving padding; however, a bariatric patient needs thicker alternating pressure pads to compensate for larger dispersal of body weight.4 Research on pressure injuries in nonOR settings showed that using standardissue hospital linen, cotton blankets, and rolled towels as PPP to position patients compromised skin integrity rather than promoted it.1, 4 Once compressed, blankets and linen become hard, immobile surfaces and do not alternate the pressure against the patient’s tissue.1, 4 Investigators have focused on egg crate foam “paddings” and stabilizers, such as heel and elbow protectors and headrests. They recommend perioperative nurses use alternating pressure surfaces that incorporate gel-filled padding. However, the previously used standard devices increased pressure, especially with obese patients, and did more harm than good for skin integrity.4, 5, 10 One inch of gel padding material is especially important to focus on when preventing the formation of skin breakdown in older adults. Thicker padding may be indicated for obese patients to allow for 1 inch of alternating pressure gel padding between the patient and the OR bed surface.1, 4 Today, nursing research is more sophisticated and supported by performance improvement projects in clinical practice.4 Research has elevated awareness; thus, accrediting agencies, public and private payers, and evidence-based practice have mandated skin assessment and the management of skin integrity to increase positive patient care outcomes.4 The concepts of pressure injury preWWW.ORTODAY.COM

vention and skin integrity management include improved pressure-reducing surfaces and pressure-relieving devices.5 There is a more critical need for nurses to focus on managing skin integrity by integrating OR-specific risk factors with knowledge about pressure-reducing and pressure-relieving devices.1 The change in practice is based on knowledge and two patient outcomes: freedom from injury and freedom from infection. The change is evidence-based practice, not just a rationale.1

Research Findings on Positioning 3, 5, 6 Research on positioning on various OR bed surfaces indicates that the lateral position creates the greatest potential for deep-tissue injury and surface skin injury. The dependent, or “down” side, of a patient in the lateral position creates a potential for deep-tissue injury and shear caused by the pressure between the patient’s skin and the surface of the OR bed. The “up” side of the patient in the lateral position creates a potential for skin surface injury caused by the physiological compromise at the capillary level because of the stretch of tissue over the femoral process and resultant tissue ischemia.

Preventing Injury and Infection Patient outcomes are observable, measurable physiologic and psychologic responses to any nursing intervention. A patient-based outcomes model focuses practice on the high risks that patients in need of surgery or other invasive procedures may encounter.1, 5, 6 In the OR, the high risks are injury and infection. The focus for care team practice is based on freedom from infection and freedom from injury. All perioperative team members, regardless of license or title, contribute to these two patient outcomes. The environmental service staff contributes when they use disinfectant to clean all horizontal

surfaces in the OR. The sterile processing staff contributes when they decontaminate instruments as the first step in the sterilization process. Surgical technologists contribute when they establish and manage sterile fields. All activities of perioperative nurses contribute to keeping a patient free from injury and infection. The RN circulator performs the preoperative assessment, noting patient needs and risk factors; organizes and manages the OR care environment to promote freedom from infection and injury; and evaluates care based on outcomes.1, 5, 6 The AORN guidelines for perioperative practice emphasize the patient’s skin integrity in the discussion of outcomes of freedom from infection and injury.5 The relationship between AORN standards and a patient’s intraoperative position is a baseline skin assessment. Without a preoperative baseline skin assessment, the perioperative nurse cannot accurately evaluate skin integrity postoperatively.5 As a result, compromise to skin integrity from PPP or pressure-reduction and pressurerelieving surfaces will be difficult to determine. A clear “before and after” comparison of the skin is the best way to determine whether any injury to skin integrity is related to pressure-reduction and pressure-relieving surfaces, which are part of patient positioning, according to AORN evidence-based standards.5, 6, 4 The perioperative nurse should observe and document any potential pressure points before positioning is performed. The same potential pressure points should be observed and documented before the patient leaves the OR for the post-anesthesia care area. During the handoff report, the perioperative nurse should include the pressure point findings for the post-anesthesia nurse.3, 8, 11 In addition, during the baseline assessment, the perioperative nurse assesses the patient’s risk factors and can be an advocate for the patient if special intraoperative pressure-relieving devices are required.5-7 With such nursNOVEMBER 2020 | OR TODAY |

IN THE OR

continuing education ing interventions, intraoperative-related iatrogenic injuries, such as burns, nerve damage, deep-pressure tissue injury, and skin surface trauma, should decrease, as should hospital-acquired infections. The perioperative nurse should take into consideration that some more complex surgical procedures require the patient to be repositioned intraoperatively. Examples include prone to supine positioning during colorectal surgery, anterior-posterior liposuction, and belt lipectomy for redundant skin reduction after extreme weight loss. Additional positioning devices and pressure reduction methods must be readily available.4 Intraoperative tissue injury related to intraoperative positioning is a physiologic effect at the capillary interface level. The pressure gradient at that level is normally in the range of 23 to 32 mmHg relative to the thousands of capillary interface levels in the body. Physical tissue injury occurs when the tissue is compromised at the capillary interface level, causing ischemia.4-6 Compromise is caused by one or a combination of these factors:1, 4-6 � Unrelieved pressure (or intensity) � Pressure over time (duration) � The location of pressure that is unrelieved for any length of time on the patient’s body If any pressure exceeds a capillary’s normal pressure, regardless of the length of time, it is enough to restrict the normal blood-to-tissue interface at the capillary level. Deep tissue deprived of oxygen-enriched blood begins to break down at this microscopic capillary interface level. As pressure time (duration) increases, the rate of the tissue breakdown increases. As the density between deep tissue and skin surface decreases, the intensity of breakdown from microscopic to deep tissue to surface tissue to skin increases, leading to skin-surface injury. Breakdown can occur when tissue is stretched or compressed over a bony prominence. As a result, capillary interface pressures are exceeded or diminished. Patients undergoing

32 | OR TODAY | NOVEMBER 2020

procedures lasting more than four hours or cardiac procedures are at greater risk for skin breakdown, nerve damage, and compartment syndrome. Neither pressure nor duration alone can cause deep-tissue ischemia. High capillary pressure for a short duration and low capillary pressure for a long duration are equally compromising to deep tissue. Conceptually, tissue tolerance is an actual or potential closed pressure injury. If intensity and duration continue, a skin surface injury will manifest.1, 4-6 Skin integrity is complicated further by moisture on the surface, resulting in maceration of the surface tissue. If skin breakdown is found on the coccyx area, heels, or elbows, it may become an open pressure injury due to the small surface area and thinner tissue layers.1, 4-6

What Endangers Skin Integrity? Patients who undergo an operative or other invasive procedure are at a higher risk for impaired skin integrity because of three variables: surface pressure, immobility, and the length of time that the pressure and immobility are exerted on the body.1 In a retrospective study of 25,300 procedures, investigators observed that 2,093 procedures exceeded three hours and pressure injury rate reached 8.5%.12 Postoperatively, it is not unusual to observe reddened areas (hyperemia) on patients’ skin surfaces. Not all hyperemia is related to “poor” positioning.1, 4 Skin injury also may be the result of tissue trauma during surgery; manipulation of internal organs and a homeostatic response to injury; thermal or chemical surface-skin reaction to an agent used to prepare the surgical site; placement of retractors during the procedure; iatrogenic factors, such as staff’s leaning against the draped patient; and the patient’s own hemodynamics during the procedure.1, 4 Additional factors that may contribute to skin injury, but to a lesser extent, include irrigating solutions and fluid overload. Vasopressors are an example of drug-mediated peripheral

circulatory compromise.4 Although coronary flow accelerates, vasomotor flow to peripheral circulation decelerates.4 The patient also may be genetically or medically predisposed for impaired skin integrity. (See sidebar for intrinsic risk factors.) The skin integrity of such patients is insulted a second time because of OR-specific risk factors.3, 5

Predisposing Patient Risk Factors4, 5, 6 � Age in relation to skin health � Comorbidities: diabetes, hypertension, respiratory disease, vascular disease, immunocompromised disease processes, and diastolic blood pressure � Nutritional status at the cellular level: hemoglobin levels, hematocrit levels, serum albumin, and total protein counts � Body size � Mobility � Body temperature

Important extrinsic factors that are gaining attention are the interfaces between the patient’s body and the bed surface; and also between the patient’s body and the positioning supplies and equipment used for intraoperative positioning.1, 4 For example, heel pressure is difficult to relieve or reduce because of the heel’s small surface area. Standard foam heel pads increase heel pressure; hyperemia may be expected if such pads are used. (Suspending heels over a gel “bump” is more effective.) A recent report on foam headrests suggests that they, too, are more likely to cause occipital pressure injuries and alopecia than to maintain skin integrity.4-6 Intraoperative extrinsic risk factors include pooled liquids from skin preps, shearing of skin and skin friction during positioning, intraoperative hypotension caused by anesthetic agents and manipulation of the patient’s body, alterations WWW.ORTODAY.COM

IN THE OR

continuing education in hemodynamic and circulatory status related to the patient’s intraoperative position, and the layering of material between the patient and the pressurereducing or pressure-relieving surfaces.4-6 Wrinkles in the OR bed sheets or pressure pad covers can appear as linear pressure injuries of varying depths.4

The Key Role of the Perioperative Nurse Perioperative nurses use evidence-based, patient outcomes-focused principles when a patient requires intraoperative positioning. The ability of perioperative nurses to manage skin integrity is part of the perioperative patient care model and involves directing the OR team toward optimal patient outcomes. The outcomes are the result of all OR caregivers working to prevent skin surface injury and deep tissue injury. Therefore, positioning is a responsibility that all OR caregivers share. Perioperative nurses usually initiate evidence-based care because of their knowledge of the patient, the patient’s risk factors, and the OR supplies and equipment available for intraoperative positioning. The surgical procedure, the surgeon’s preference for exposure, and the patient’s physiologic condition are variables to consider when choosing the type of equipment for positioning.4, 10, 12 The surgical position affects the patient’s physiology. All members of the OR team have their own interests in positioning and contributing to optimal outcomes by safe and appropriate positioning. The interests include: � Optimal exposure of the surgical site (surgeon) � Airway management, ventilation, and the monitoring access (anesthesia care provider) � Physiologic safety for the patient (team) � Maintenance of patient dignity (perioperative nurse) Providing positioning devices that relieve and reduce pressure is part of the advocacy role and duty of the perioperative nurse.3, 4, 5, 11 Pressure-reduction WWW.ORTODAY.COM

devices reduce pressure to a level better than what a patient would experience on a standard-issue hospital mattress. An OR bed mattress-gel overlay is popular in OR skin integrity management. It is efficient, effective, and supported by evidence.3, 4, 5, 11 Most overlays are gel-filled pads used to cover the entire OR bed mattress. Air- and fluid-filled overlays also are available, including accessories (e.g., “bumps,” “rolls,” and supports). An accessory molds to the body, distributing and supporting weight-bearing body surfaces that are in contact with the pressurereducing overlay. The pressure alternates under the weight of the patient’s body and does not remain constant. The pressure at patient capillary interface levels is reduced (intensity), and the duration and location of pressure on the patient’s body surfaces are relieved.3, 4, 5, 11 Research has shown that a gel or an air overlay is an effective barrier between deep tissue and skin surface (pressure potential), the traditional OR bed mattress (intensity potential), and the patient. All these surfaces and devices help in managing a patient’s intraoperative skin integrity.5, 6, 8

Adjusting Positioning to Patient Needs Preoperative assessment includes factors such as skin surface, condition of the skin, wasting of tissue, age, cleanliness of environment, patient nutrition and hydration, and evidence of skin breakdown.2 The assessment is part of the OR duty because care must be individualized. As an example, if a patient’s musculoskeletal system is compromised by physiologic deformity, safe and appropriate positioning may not be possible because of anatomic limitations. In this case, the perioperative nurse will need to adjust the type of position and positioning devices in consultation with the surgeon and the anesthesia provider. Other preoperative assessments include a baseline assessment of skin, specifically in areas on which the safety straps and patient return electrodes are placed.

One type of commercial gel mattress overlay can serve as the return electrode when electrosurgical machinery is used.1, 2 In the OR, positioning devices should be available in a variety of sizes and shapes. The devices should be durable, allergen-free, fire- and moisture-resistant, and easily cleaned and disinfected.4-6 They should slow microbial growth, be handled hygenically, and be stored in a way that makes access easy. All patients should be evaluated for special needs required for positioning. Positioning injuries are especially costly to hospitals because CMS does not reimburse for the cost of hospital-acquired injuries.1, 2 AORN does not recommend specific policies and procedures or nursing protocols for various intraoperative positions because it would be difficult to encompass all variables and scenarios. However, facilities should institute and follow practice guidelines premised on evidence-based principles and patientoutcomes standards.11, 13 AORN has developed a toolkit for the prevention of pressure injuries. The toolkit follows NPUAP guidelines for the prevention of pressure injury in the OR.5 At a minimum, intraoperative documentation should include the perioperative nurse’s preoperative assessment, the type and location of positioning devices, the names and titles of people positioning the patient, and an evaluation of outcomes, such as the appearance of the skin before and after the procedure. Also, when the patient is repositioned on the OR bed or the positioning devices are moved, the perioperative nurse should reassess the patient. Postoperatively, while the patient is still in the OR, the perioperative nurse should reassess the patient, noting hyperemia before applying a dressing.4-6 Some of the one-step, alcohol-based iodophor preps are designed as a lasting antiseptic barrier on the skin’s surface postoperatively and should not be removed. If they must be removed, a special cleanser NOVEMBER 2020 | OR TODAY |

IN THE OR

continuing education should be used to prevent skin injury or irritation. The presence of this layer of prep solution can mask pressure injury indicators.4-6 Directing four OR team members to help with transferring the patient from the OR bed to the gurney helps avoid shearing injury, friction injury, physical patient injury, and injury to OR personnel themselves. AORN provides guidelines on preventing shearing and friction as well as moving patients in the guidelines for perioperative practice.6, 4, 9 During hand-off communication, the post-anesthesia nurse incorporates effective communication with the perioperative nurse by reporting skin condition, performing a follow-up skin assessment, and noting when any reactive hyperemic areas begin to fade. The nurse reports to the surgeon any reddish or purple-colored areas that do not regain blanch or diminish in time.

RN Research Sets the Stage Perioperative nurses can assess the risks of deep-tissue and skin surface injury in their own care setting to compare incidence and prevalence. The data are available from an institution’s quality and outcomes department. By identifying the risks of injury in an OR and calculating their incidence vs. prevalence, perioperative nurses can support changes in positioning practices that are focused on prevention.4-6 Cost savings in the OR, based on evidence-based research, can contribute to success with reimbursement, best practices, and shorter hospital stays. This viewpoint represents a change from the traditional view of intraoperative patient positioning as a skill to that of positioning as an outcomes-based practice based on nursing knowledge and nursing evidence. The integration of this viewpoint may require a culture change in some ORs. It is an opportunity to help control the problem of perioperative compromise of skin integrity, which is debilitating to patients through injury and infection. These extra injuries and infections can

34 | OR TODAY | NOVEMBER 2020

lead to more challenges for the healthcare industry, including longer hospital stays and lack of reimbursement for hospital-acquired injuries.4-6

Technique. 13th ed. 2017. St. Louis, MO: Elsevier; 2016: 479-513. 5. Association for periOperative Registered Nurses. Prevention of perioperative pressure ulcers tool kit.

EDITOR’S NOTE: Sophia Mikos-Schild, EdD, MSN, RN, MAM/HROB, CNOR, and Nancymarie Phillips, Ph.D., RN, RNFA, CNOR, previous authors of this educational activity, have not had an opportunity to influence the content of this current version.

Available at: https://www.aorn.org/guidelines/clinical-resources/tool-kits/prevention-of-perioperativepressure-injury-tool-kit. Accessed April 2, 2019. 6. Association for periOperative Registered Nurses. Guideline for positioning the patient. In: Guidelines for Perioperative Practice. 2018. Denver, CO: AORN

Relias LLC guarantees this educational activity is free from bias.

Inc; 2016:649-668. 7. McKenzie RJ. Ramirez C. Preventing pressure

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

References

injuries in the operating room: Be proactive to avoid perioperative pressure and peripheral nerve injuries. American Nurse Today, May 2018: 19-21. Available at: https://www.americannursetoday.com/wp-content/ uploads/2018/05/DabirSupplement_May2018. pdf#page=21. Accessed April 2, 2019. 8. Engels D, Austin M, McNichol L, et al. Pressure ulcers: Factors contributing to their development in the OR. AORN J 2016;103:271-279. doi: 10.1016/j. aorn.2016.01.008. 9. National Presure Ulcer Advisory Panel. Pressure ulcer staging illustrations. Available at: http://www.

1. Kalowes P. Preventing pressure injuries in critically

npuap.org/resources/educational-and-clinical-

ill patients: Evidence-based care bundles improve

resources/pressure-injury-staging-illustrations/.

patient safety and prevent pressure injuries.

Accessed April 2, 2019.

American Nurse Today, May 2018:14-16. Available at: https://www.americannursetoday.com/wp-content/

10. Scott SM. Creating a strategic plan for

uploads/2018/05/DabirSupplement_May2018.

perioperative pressure ulcer prevention. AORN J

pdf#page=21. Accessed April 2, 2019.

2016;103:P13-P14. doi: http://dx.doi.org/10.1016/ S0001-2092(16)30017-5.

2. Powers J, Ames C. Take action to solve causes of pressure injuries. American Nurse Today, May

11. Bauer K, Rock K, Nazzal M, et al. Pressure ulcers

2018:4-7. Available at: https://www.american-

in the United States’ inpatient population from

nursetoday.com/wp-content/uploads/2018/05/

2008 to 2012: Results of a retrospective nationwide

DabirSupplement_May2018.pdf# page=21. Ac-

study. Ostomy Wound Manage 2016;62:30-38.

cessed April 2, 2019. 12. Putnam K. Minimizing pressure ulcer risk for sur3. The Joint Commission. Preventing pressure

gical patients. AORN J 2016;103:P7-P9. doi: http://

injuries. The Joint Commission Quick Safety: Issue

dx.doi.org/10.1016/S0001-2092(16)30009-6.

24;2016:1-4. Available at: https://www.jointcommission.org/assets/1/23/Quick_Safety_Issue_25_

13. Agency for Healthcare Research and Quality.

July_20161.PDF. Accessed April 2, 2019.

Preventing pressure ulcers in hospitals: A toolkit for improving quality of care. Available at: https://www.

4. Phillips NM. Foundations of perioperative care

ahrq.gov/sites/default/files/publications/files/put-

standards. In Berry and Kohn’s Operating Room

oolkit.pdf. Accessed April 2, 2019. WWW.ORTODAY.COM

Clinical Vignette Mary Jasperson, age 76, is admitted for surgery to repair a fractured right hip after falling in her house. She is diagnosed with mild dehydration and has an IV inserted before going to the OR. The anesthesia provider administers spinal anesthesia. A Foley catheter is placed to monitor her output. Ms. Jasperson is positioned on a fracture table by four OR members. Her surgeon guides the fractured right hip during the positioning. The procedure is estimated to last two hours. The perioperative nurse, Kim Yu, provides preoperative education and assesses Ms. Jasperson. Kim discusses the intraoperative plan for positioning the patient with the surgeon and the team. As an advocate for the patient, Kim is concerned about managing the integrity of the patient’s skin, knowing that older adult patients have special needs to prevent pressure injuries. 1. When Ms. Jasperson arrives in the OR, Kim’s initial assessment would include: a. The condition of skin, color, turgor, warmth, abrasions, bruises, or any other abnormalities, such as anemia, the potential for blood loss, and length and tolerance of procedure b. Blood pressure c. K nowledge of surgical procedure d. K nowledge of the risks, benefits, and alternatives to surgery 2. Kim’s role as a patient advocate in the perioperative setting would include: a. N oting the belongings of Ms. Jasperson and her family b. O rganizing and managing supplies needed for the case c. M aintaining an environment that prevents infections and pressure injuries based on evidence-based practice d. E valuating the need for X-ray 3. After positioning, Kim reassesses Ms. Jasperson, including the following systems: a. R espiratory, circulatory, neurological, musculoskeletal, and integumentary b. Circulatory only c. N eurological and respiratory d. Respiratory 4. Kim realizes that Ms. Jasperson’s susceptibility to pressure injuries while on a fracture table can be caused by factors such as: a. Humidity in the OR b. The patient not being in proper alignment for an extended period with less than an inch of support material between a body part and the hard surface or the fracture table. c. The cold environment in the OR. d. The extreme care taken when positioning.

Clinical VignettE ANSWERS 1. Answer: A, Initially, an assessment by the OR nurse includes the condition of skin to include color, turgor, warmth, abrasions, and bruises. In addition, anemia, potential blood loss, and length and tolerance of the procedure are assessed to form a baseline for comparison with the postoperative condition. 2. Answer: C, Nurses acting as advocates manage the environment to prevent infection and pressure injuries based on evidence-based practice. The perioperative nurse can assess the patient from the nonsterile side of the fracture table and observe for breaches in technique or obvious changes in the patient’s physiology. 3. Answer: A, The respiratory, circulatory, neurological, musculoskeletal, and integumentary systems are important to assess when a patient is positioned for a surgical procedure. The fracture table is layered with a smaller gel pad for the torso and a perineal gel peg between the patient’s legs. The nonoperative leg is secured on the nonsterile segment of the frame and is observed for pulses periodically. 4. Answer: B, One inch of gel padding material is especially important to focus on when preventing the formation of pressure injuries in older adults. Thicker padding may be indicated for obese patients to allow for 1 inch of alternating pressure gel padding between the patient and the OR bed surface.

WWW.ORTODAY.COM

CE541

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

Deadline Courses must be completed by 8/30/2022 3. If the course you have chosen to take includes a clinical vignette, you will be asked to review the vignette and answer 3 or 4 questions. You must answer all questions correctly to proceed. If you answer a question incorrectly, we will provide a clue to the correct answer. 4. Once you successfully complete the short test associated with the clinical vignette (if there is one), proceed to the course posttest. To earn contact hours, you must achieve a score of 75%. You may retake the test as many times as necessary to pass the test. 5. All users must complete the evaluation process to complete course. You will be able to view a certificate on screen and print or save it for your records.

Accredited In support of improving patient care, OnCourse Learning (a Relias LLC company) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. OnCourse Learning is also an approved provider by the Florida Board of Nursing, the District of Columbia Board of Nursing, and the South Carolina Board of Nursing (provider #50-1489). OnCourse Learning’s continuing education courses are accepted by the Georgia Board of Nursing. Relias LLC is approved by the California Board of Registered Nursing, provider # CEP13791.

ONLINE

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

Questions or for a complete listing of our courses Phone: 877-843-8374 Email: nursesupport@relias.com

NOVEMBER 2020 | OR TODAY |

CORPORATE INDUSTRY INSIGHTS PROFILE

news & notes IMP

Innovative Medical Products Re-Invents Itself Among the COVID Crisis.

ince its early beginnings in 1983, Innovative Medical Products (IMP) has grown to become a world leader in surgical patient positioning. Never before has IMP experienced a year like this. The year 2020 will go down in history as the most challenging year ever for many health care companies. Innovative Medical Products Inc. (IMP) has kept its employees working while restructuring its manufacturing and is proud to have been able to improve its processes during the COVID-19 pandemic. The COVID-19 pandemic has demonstrated that a virus can overwhelm a hospital and, in turn, put a halt on all elective procedures. As hospitals and ASCs reopened for elective surgeries, most discovered that they were not properly equipped to handle the sudden increase in short-term business. IMP responded with a new customer rental program to help ASCs with short-term equipment needs. These programs enable hospitals and ASCs to acquire the products they need when capital funding may not be available. “IMP also launched two upgrade programs that have helped hospitals and ASCs improve their positioning experience. Our trade-in program

36 | OR TODAY | NOVEMBER 2020

provides up to a $1,000 credit for upgrading older, outdated De Mayo Knee Positioners to the new De Mayo D2 with extended terms. Facilities were also offered an option to update outdated De Mayo Knee Positioners by returning them to the IMP service center for incremental upgrades,” says Tim Walker, Manager of Sales & Marketing. “During this uncertain time, IMP made an investment in itself. The owners, managers and employees all did their part to ensure that everyone could come to work and so that our organization would come out stronger during this international crisis,” Bailey shared. “We are proud of everyone's efforts, and when the world markets

open up 100%, we have no doubt we will return to setting record sales.”

Utilizing Downtime to Deliver More Value and Expand Markets The vision of the company’s success has always been to design, manufacture and distribute unique, innovative products to a surgical world where patient positioning has been problematic. This year, among all it's challenges, Rich Larkin, Director of Operations and his quality management team dedicated their time to earning IMP's ISO 13485 registration. ISO 13485 is an international quality management system for medical device manufacturers. “This ISO 13485 registration is one of the most important events to happen to IMP in its history, ensuring that its products will be available to all markets,” says Rich. IMP’s solutions to universal positioning problems come from years of communication with the best surgeons, the best orthopedic companies and the best hands-on med/surg supWWW.ORTODAY.COM

CORPORATE INDUSTRY INSIGHTS PROFILE

news & notes IMP port teams that have ideas for surgical improvements and perceptive opinions on how to improve the patient experience and patient outcomes. Hospitals, ambulatory surgical centers and surgical clinics have seen many changes in the way they operate, bundle services and improve products to become more efficient and costeffective. Toward that goal, IMP has invested in the latest manufacturing equipment, increased personnel, improved data processing and expanded territory coverage nationally and internationally. “While continuously improving our product line, we also strive to create innovative methods for performing surgery, while supporting robotic advancements, and developing products to fit into the new realm of ambulatory surgical centers,” Bailey said.

Two New Products for 2020, Amid the Challenges “IMP listens to our customers and is a surgical positioning company that offers products that have been codesigned by orthopedic surgeons. We are a small, agile company that can respond more quickly to customers' needs, and that has made us the goldstandard for surgical positioners for over 30 years,” Bailey explained. IMP founders and managing partners work directly with engineering, design and field reps to establish a clear expectation of performance, evaluating progress to ensure that customers’ product expectations will be met, from concept to early prototype to finished product. “Product improvements made to our core products as a goal of continuous product improvement has been a hallmark of IMP products. They just keep getting better,” says Tamas Kovacs, Engineering Manager. “One example of how the IMP team can quickly respond to customers’ needs will soon be seen in a new De Mayo Knee Positioner, which will redefine our market in terms of OR WWW.ORTODAY.COM

The unique unfolding design of the De Mayo ExactFit Hip Positioner offers un-paralleled rigidity, assures no issues with an operative range of motion during a procedure or checking a patient's position.

turnover,” Bailey said. “After conducting field consultations with several of our key ASC customers, IMP began developing a new product that could address the challenges of space, storage and SPD limitations that ASCs face. The new positioner incorporates everything we've learned from two decades in the field and has a unique solution that will make it unlike any other positioner on the market. Be on the lookout for an official announcement toward the end of 2020.” IMP actually has two exciting new products coming to market that will accelerate setup, simplify training, improve stability, reduce turnover times and improve overall profitability for our customers doing total knee and hip replacements. “We are incredibly proud of our newest hip positioner, the De Mayo Exact-Fit Hip Positioner. This product went from thought to completion during the COVID pandemic and will usher in a new era in patient stability for hip replacements in the lateral position.” Bailey said. “The IMP engineering team lead by Tamas and with input from Dr. Ed De Mayo, made a stellar product with innovative engineering.”

IMP established the gold-standard in hip positioners in 1984 with the original IMP McGuire Hip Positioner. In 2001, IMP partnered with orthopedic surgeon Dr. Ed De Mayo to design the De Mayo Hip Positioner, that met surgeons' demands for a system to accommodate bariatric patients. “From establishing the position and securing the patient, to performing procedures and testing range of motion, we created a system that's faster and easier while also giving doctors completely unrestricted access to the surgical field” says Dr. Ed De Mayo. In 2020, IMP is re-inventing the market again, with the new De Mayo Exact-Fit Lateral Positioner. “Surgeons needed a lateral positioner that was easier to setup, simpler to use and adapts to the patient anatomy while achieving a rigid fixation of the pelvis. No matter how significant the BMI of the patient, the Exact-Fit worked. The unique unfolding design, which offers un-paralleled rigidity, assures no issues with an operative range of motion during a procedure or checking a patient's position,” Bailey said. “Our goal is to have the product available in the first quarter of 2021.” NOVEMBER 2020 | OR TODAY |

Top: Early Exact Fit Prototype Below: Pre-production model shown

IMP's Commitment to Clean, Sterile and Safe Medical Devices Recent events in the knee positioner marketplace have put a strong light on the processes for cleaning and sterilization. As processes and requirements change, materials, methods and designs must also change to meet those requirements. IMP is fully committed to ensuring its products meet these standards. IMP takes this commitment seriously and has heavily invested in its designs, Instructions For Use (IFUs) as well as cleaning and sterilization validations. IMP’s cleaning and sterilization validations are performed by independent testing facilities using the latest standards. IMP also has relationships with nationally recognized individuals and organizations, which are experts, in the sterile processing and certification testing professions. IMP understands that not all sterile processing departments are built the same. Equipment handling, personnel, education and hospital environment are just some of the factors that influence the performance of a department. IMP is willing to work with its customers to assist them in overcoming some of these challenges to ensure the IMP products they are processing meet the set standards. Dave Jagrosse, CHL CRCST of David Jagrosse Consulting says “Lint and particulates are as much an enemy as are microorganisms within the SPD department. I urge all who reprocess linens in any capacity to obtain a copy and follow these critical guidelines to do it properly or consider a single-use alternative in the name of patient safety.”

38 | OR TODAY | NOVEMBER 2020

IMP welcomes readers to browse its website at IMPMedical.com. It offers a surplus of useful information that can be viewed and downloaded. The website also showcases some of IMP’s latest products that feature instructional videos.

IMP’s World-Wide Reach In the ever-changing environment of regulatory compliance, Innovative Medical Products continues to meet national and international standards for its positioning systems and accessories. IMP is proud of its commitment to meet these stringent requirements while the company continues to make outstanding products that achieve or exceed the user’s expectations. Supporting IMP’s global reach is a highly qualified network of independent distributors and product representatives that span across the United States, Europe, Japan, Canada, Australia, Russia and Israel. IMP’s Made-in-America products are supported by an unflagging resolve to change with the times and adapt to new technologies and industry regulations.

Innovative Medical Products: Growth and Success Innovative Medical Products has been focused on developing and marketing innovative products to benefit and improve efficiency in the operating room and hospital clinics where patient stability and positioning are required. IMP’s products are designed to provide accuracy for the surgeon, ensure patient safety, save time for

OR personnel and benefit the overall patient surgical experience. Advancements in minimally invasive surgical (MIS) procedures and robotic navigation through computerassisted orthopedic surgery (CAOS) also bring opportunities for IMP to partner with leading surgeons and orthopedic companies committed to improving surgical techniques. In addition to supporting customers via continued education, surgical time efficiencies, product bundling and superior products, IMP offers its Value Added Commitment (VAC) Program. The VAC Program infuses qualified organizations with true value to markedly improve overall performance. In other words: “Every customer’s business and outcomes are important to IMP.” “IMP has always believed in the continuous improvement of existing products and constant innovation. Whether ideas come from in-house engineering or surgical experts in the medical field, the process has always been to create quality products, improve setup and surgical times, while giving the best value for long-lasting products that meet or exceed regulatory requirements,” Bailey said. For more information, please visit www.IMPmedical.com. WWW.ORTODAY.COM

THE FUTURE IS ABOUT TO UNFOLD

Coming soon!

ONE SIZE FITS ALL WITH UNEQUALED STABILITY

NO ASSEMBLY REQUIRED. SIMPLY UNFOLD AND MOUNT TO OR TABLE

UNIQUE ENHANCED LUMBAR ADJUSTABILITY

The operative word in surgical patient positioning

www.impmedical.com • 800.467.4944 *Proper sterile setup may not be represented. Please consult IFU for proper setup. Sterile drape moved to reveal product. Image shown may be different from actual product. Design subject to change without notice. imp® products are protected by patent & patent pending rights. Visit impmedical.com/patents. All Rights Reserved. ©2020 IMP

VERTICAL VIOLENCE & WORKPLACE

BULLYING By Don Sadler

40 | OR TODAY | NOVEMBER 2020

WWW.ORTODAY.COM

orkplace bullying is a common problem in many organizations today and, unfortunately, the health care setting is no exception. According to the American Nurses Association’s (ANA) 2019-2020 Healthy Nurse, Healthy Nation (HNHN) Survey, nearly a quarter (23%) of nurses said they have experienced bullying from those in authority (or vertical violence) while nearly a third (31%) have experienced bullying from a peer (or horizontal violence).

Health Care Isn’t Immune “Unfortunately, health care is not immune to workplace drama,” says Joseph Grenny, a cofounder of VitalSmarts and coauthor of the bestselling book Crucial Conversations. “The problem of bullying among nurses is chronic and pervasive.” “If anything, the stress and complexities of long and difficult hours and power differentials among colleagues ensure that health care professionals will face interpersonal strain and frustration at every turn,” Grenny adds. Research performed by VitalSmarts indicates that more than three-fourths of caregivers regularly work with doctors or nurses who are condescending, insulting or rude. Meanwhile, one-third say they’ve experienced behavior that’s even worse than this, such as namecalling, yelling and swearing.

[

“Perhaps the biggest challenge isn’t so much that bullying exists, but that it’s perceived by many as unsolvable,” says Grenny. “According to our latest study, 79% of nurses said solving the problem of vertical violence from a difficult peer was barely or not at all solvable.” According to Ruth Francis, MPH, MCHES, senior policy advisor at the ANA, bullying can be covert or overt. “Covert acts include withholding information, exclusion, unfair assignments, sighs and annoyed glances,” she says. “Overt acts incude openly criticizing and purposely embarrassing peers in front of others, blaming others and ethnic jokes or slurs.” Sharon A. McNamara, BSN, MS, RN, CNOR, agrees that vertical violence has been an issue in the health care environment in the past and remains one today. “This problem is one of the major issues in health care and perioperative practice because it breaks down effective communication and teamwork and places both the practitioner and the patient in unsafe conditions,” she says. McNamara prefers to discuss workplace bullying within the context of the term ‘incivility,’ which she defines as rude, disruptive, intimidating and undesirable

behaviors that are directed toward another person. “Behaviors I have seen include intimidation through actions intended to frighten or coerce, threats to cause physical or mental harm, physical attacks, property damage (like shoes filled with water and family pictures on lockers defaced) and even sexual harassment,” says McNamara. “I also have observed that because the perioperative team functions with a small team in an isolated room behind the closed doors of the operating room, the practice is more frequent,” McNamara adds. “Working in these teams creates unique relationships that may foster tolerance of the inappropriate behavior, which is often rationalized as humor or ‘just his or her personality.’”

Factors Leading to Bullying There are many factors unique to the perioperative environment that can lead to workplace bullying, whether it’s vertical or horizontal violence. “In the operating room, some of the unique stressors are the time pressures of the surgical environment and the patient being under anesthesia,” says Renae Battié, MN, RN, CNOR, vice president of nurs-

“ According to our latest study, 79% of nurses said solving the problem of vertical violence from a difficult peer was barely or not at all solvable.” – Joseph Grenny

WWW.ORTODAY.COM

]

NOVEMBER 2020 | OR TODAY |

ARTICLE CONTRIBUTORS

[

Joseph Grenny, a cofounder of VitalSmarts and coauthor of the bestselling book “Crucial Conversations.”

ing with the Association of periOperative Registered Nurses (AORN). “These pressures can lead to impatience among less experienced team members who aren’t as efficient with tasks and responses,” Battié adds. “Of course, stress, fatigue and fear also contribute to negative behaviors.” Francis notes that in the HNHN Survey, 77% of nurses said that workplace stress is a work hazard and concern for them. “Perioperative work has long shifts, is crisisoriented and is high pressure,” she says. “Not that this is an excuse, but stress can cause a breakdown in the teamwork and incite anger and hostility, which creates a breeding ground for bullying.” Not surprisingly, the coronavirus pandemic appears to have made the problem of bullying in the OR worse. “While the current pandemic has created stress for everyone, this is even more true for nurses and other health care professionals who are concerned about maintaining their own health, keeping their families safe and also taking care of potentially high-risk patients,” says Francis. “When stress increases like it has during the pandemic, those with greater perceived power often express more aggression and those who perceive themselves as less powerful often believe their only option is to submit,” adds Grenny. However, McNamara points out that many health care workers are at their best while in crisis mode. “Everyone fires on all cylinders, teamwork kicks in and we are more aware of the needs of the patient and each other,” she says. “Granted this cannot be main-

42 | OR TODAY | NOVEMBER 2020

Sharon A. McNamara, BSN, MS, RN, CNOR

tained indefinitely, which may add to the breakdown in individuals’ behavior,” McNamara adds. “We must be alert for the aftermath and its effects – which may be far more reaching as nurses struggle to recoup physically, emotionally and psychologically while expected to carry on.”

Zero Tolerance for Bullying Addressing the problem of workplace bullying starts with creating a culture of safety and a zero-tolerance policy throughout the organization, says Francis. “The ANA’s Incivility, Bullying, and Workplace Violence Prevention Position Statement provides guidelines for nurses and their employers,” Francis says. “Employers should increase the awareness of staff to the statement by providing training to recognize behaviors and know what actions to take.” Specifically, nurses should know what the facility policies are and should not be afraid to speak up when an incident occurs. “Reporting inappropriate behavior should never have repercussions,” says Francis. The ANA’s #EndNurseAbuse website (https://www.nursingworld. org/practice-policy/work-environment/end-nurse-abuse) contains educational materials, an issues brief, legislative information and flyers for nurses to learn more about protecting themselves and others from abuse, as well as prevention strategies to keep the workplace safe. “Our research confirms that if you can talk about bullying, you can solve it,” says Grenny. “Within most health care teams, however, few people feel comfortable speaking up and addressing it.

Renae Battié, MN, RN, CNOR, vice president of nursing with the Association of periOperative Registered Nurses (AORN)

]

“But there is hope,” Grenny adds. “Specifically, when managers are trained in the skills to engage in crucial conversations and hold people accountable, organizations experienced less bullying. And when bullying did occur, it was both discussable and solvable.” In research conducted by VitalSmarts, hospitals staffed with leaders who have created a culture of open dialog where honest conversation is the norm when problems arise scored: � 16% higher on patient safety � 18% higher on quality of care � 19% higher on patient experience � 37% higher on staff engagement “The key to overcoming workplace bullying is to create strong norms that prohibit it,” says Grenny. “This type of behavior stops when norms change.”

The Importance of Mentoring In this environment, Battié stresses the importance of older and more experienced perioperative nurses mentoring younger and newer nurses. “The effective communication and conflict management skills that more experienced nurses have are a very important element of the mentoring that is needed for younger nurses,” she says. McNamara agrees. “Now is the time for action when these master perioperative nurses must share with younger nurses their knowledge, skills and personal bag of tricks that have allowed them to provide safe, quality care,” she says. “I challenge experienced nurses to adopt a novice nurse with the intention of making her or him a firestorm for patients and future practitioners.”

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NOVEMBER 2020 | OR TODAY |

SPOTLIGHT ON:

DEBORAH

DUNN Graduate School Dean and Center for Research Director, Madonna University By Matt Skoufalos

hen Deborah Dunn first began to consider a career in nursing, the path many young professionals pursued involved getting an LPN certificate or job-specific associate degree. At the same time, the increasing integration of technology into hospital practices was driving a shift in the field; to meet the higher threshold of these new demands, young nurses were encouraged to pursue advanced degrees in order to keep up. “The career paths were not as broad as they are today,” Dunn said. “I always had a huge interest in health and helping people, and that developed throughout high school.” “The nursing profession itself was pushing four-year degrees at that time, and I was really fortunate that I got wind of that,” she said. “I didn’t have anybody in the family who was a nurse; I didn’t have anyone other than a high-school counselor who informed me of that.” Upon graduating from Eastern Michigan University with her BSN in 1974, Dunn took a midnight shift on the medical-surgical unit at St. Mary Mercy Hospital in Livonia, Michigan – the first hospital with which she interviewed, and a community hospital that afforded her exposure to a variety of patient needs. After a year, she switched to day shift, and then was offered an opportunity to rotate to pediatrics. It was a departure from what she’d known thus far

44 | OR TODAY | NOVEMBER 2020

in her fledgling career, but she took it. Today, Dunn reflects back on this moment as the one that “starts my story of saying yes.” “When someone is mentoring you or trying to give you opportunities, it’s a good idea to trust them and say ‘yes,’ if you feel that you have the ability to do it,” she said. “We always have imposter syndrome – [fearing] ‘that’s going to be too hard for me’ – but you have to trust your mentor. People pushing me a little bit helped me expand my skills and get more experience in nursing.” Dunn learned a lot about pediatrics on that rotation, but spending half her time in adult care, she also learned a lot about caring for medically complex patients, and concluded that she needed more education. That carried into her enrollment in the MSN program at Wayne State University, in downtown Detroit. Rewarding her curiosity and commitment to advancing her skill set, Dunn’s supervisor offered her an opening in the cardiac care unit, which also included rotations in the ICU and medical ICU. Just a few years removed from her college career, the young nurse found herself again at the cusp of another institutional shift toward higher education. “There was a big push in the ’80s for clinical nurse specialists and advanced nurses who worked in the hospital and fulfilled an advanced patient care role, a managerial role, to teach other nurses,” Dunn said. “I was attracted to that. I was especially attracted to teaching because you were often a preceptor for new nurses.” While expanding her knowledge base and bringing along the next group of new nursing recruits, Dunn continued to work at the hospital, even as she married and began building her home life. After giving birth to her first daughter, WWW.ORTODAY.COM

Deborah Dunn addresses attendees at the annual GAPNA conference.

and while completing her MSN, Dunn was encouraged throughout her graduate studies to come work at the university by her thesis advisor. So, in keeping with her culture of “yes,” Dunn, took a job teaching medical-surgical nursing at Wayne State, an opportunity she also leveraged into earning a critical-care certification. On rotation, she would visit different hospitals in the Detroit area with her students, gaining exposure to a variety of clinical education settings. Throughout the 1980s, as prophetically as her early education had foretold, technological advancements began to shape her career even more. First came the expansion of electronic health records, and then, when the HIV/ AIDS epidemic hit, a focus on palliative care for patients for whom other treatments weren’t available. It was a time when Dunn also relied on her skills as a bedside nurse in helping patients survive the physical and mental aspects of the disease and its attendant traumas; for her, it remains a period to which the novel coronavirus (COVID-19) pandemic of today hearkens. Dunn continued working as an adjunct professor and as a nurse, and eventually was invited to take a full-time job teaching medical-surgical nursing at Madonna University of Livonia, Michigan, which is affiliated with the St. Mary Mercy Hospital. The position has afforded her access to several different hospitals for clinical rotation, “and I’m learning right along with them because I’m nursing in all these different environments,” Dunn said. Throughout it, she continued her education, earning a nurse practitioner degree and a second master’s in gerontological nursing. “Saying yes, you never know what these experiences will bring,” Dunn said. “I decided I really liked taking care WWW.ORTODAY.COM

of people in long-term care environments, and did a lot of clinical rotations. So I’m teaching full-time and working part-time in clinical practice at several nursing homes in the area; flash-forward and I’m sitting on the board of directors at Marywood Nursing Care Centers.” Dunn also continued to help develop the nurse practitioner program at Madonna University, taking it from the ground floor to an acute care and NP track, and then a dual track merging hospice and adult acute or primary care. “It all kept jelling and coming together,” Dunn said. Her advice for working nurses who want to find the same degree of synchrony in their own careers? “Stay curious,” she said. “Keep learning. Say yes to opportunities. You’ve got to be internally driven. Find what is calling to your gifts and your talents and your special interests, and be open to criticism.” “We’ve got a social contract that we’re fulfilling,” Dunn said; “we’ve got a role to play in society. It demands our highest behavior, it demands trust and honesty. We’ve got to be good team players, and we’ve got to remember we don’t know it all. We need to call on each other, call on our colleagues, call on our friends, and not be so tentative.” “Work with your team members and you’re going to feel much more confident in your practice, and you’re going to learn a lot,” she said. “Rugged individualism only stands to the point where you’ve got to accept your responsibilities. You’re also proud to be a good team member and team player.” “How can we perfect a just society if we don’t practice from that position?” she asked. NOVEMBER 2020 | OR TODAY |

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OUT OUTOF OFTHE THEOR OR fitness

fitness

Learning From the Soreness of Exercise By Miguel J. Ortiz ven in our childhood we learn a great deal from the pain of soreness and movement. Learning to walk just about requires that you fall as well as improve muscular development. So, it’s easy to see how we must learn to adapt to make progress. When we were young and learning to walk, falling wasn’t so bad when stand barely two feet tall, but how does that learning curve change as we get older? Well, we already understand that as we get older the body changes, especially muscular atrophy, however we also know that consistent activity or exercise throughout one’s life can drastically slow that down. So, what are the best ways to combat and learn from the inevitable muscular soreness that progress can bring?

The natural process of how muscles develop requires a form of stress adaptation. This means that in order for us to get stronger, faster or whatever the exercise goal may be, we are forced to create some consistent change or stress in order for that to happen. For example, if you want to be able to do more push-ups, then a more consistent or weekly planned regiment of push-ups WWW.ORTODAY.COM

is required for your chest or muscles to develop the ability to change. This goes off the S.A.I.D. principle, which means Specific Adaptation to Imposed Demand. So whatever imposed demand you force onto the body you will receive a specific adaption. This may sound simple, but it’s the process of that imposed demand that becomes challenging. And in that process is where we learn, develop and ultimately make change. Now that we understand a little more about how the body changes in regards to stress, here are my top two tips on learning from soreness. First, we must start to pay closer attention to our general awareness of how the body is moving to provide proper recovery. Let’s use the push-up example again and say that the person has never done a push-up. The person needs to learn how to do a push-up and create a plan or routine to develop their chest and other assisting muscles that help make that movement easier. Through the inevitable soreness that one develops from doing push-ups also comes recovery, this is where the awareness comes in. So, if you’re doing pushups and your sore in your chest then you can conclude you’re doing them right, so some stretching and recovery for your chest and you are back at it. But what if you’re doing push-ups and your shoulders start to hurt. This would

mean that compensation took place. You may have been doing push-ups, but not with good form. So, how do we learn to fix it? Second, by failing forward you can adjust programming, schedule or daily routine without being discouraged. So, your shoulder is hurting from the pushups and you need to adjust. Great, you have just learned that for some reason you are sorer in one or both shoulders after doing push-ups and that generally doesn’t happen. Well you are already ahead of the curve, just by having the awareness that something doesn’t “feel” right you are now able to make the necessary changes to ensure proper muscular activation. Maybe you take an extra rest day to recover or have someone check on your form. Recognizing that something is wrong gives you the power to change it. The smartest decision you can make is to not push through the pain, but to learn from it and then make a decision on how you will move forward. Trust me, your body will thank you. 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. NOVEMBER 2020 | OR TODAY |

OUT OF THE OR health

Links Found Between Diabetes Blood Markers, Alzheimer’s Disease Pathology study published in the Journal of Alzheimer’s Disease provides insight into the association of blood markers of diabetes with brain betaamyloid accumulation among older people at risk of dementia. The results suggest a link between Alzheimer’s pathology, lower levels of insulin and lower insulin resistance.

The deposition of beta-amyloid plaques in the brain is known to be one of the key elements of Alzheimer’s disease and can begin years or even decades before the disease progresses to the dementia stage. Amyloid accumulation in the brain can be detected by PET scans. Type 2 diabetes is a known risk factor for cognitive impairment and Alzheimer’s disease, but the underlying mechanisms are still unknown. Autopsy studies have found that diabetes is associated with small vessel pathology typical of vascular dementia, but not specifically of Alzheimer’s

48 | OR TODAY | NOVEMBER 2020

disease. Insulin resistance, an indicator of a pre-diabetic state, has been associated with amyloid accumulation in cognitively normal middle-aged and late middle-aged individuals, but not in the older age groups. In the present study, researchers from the University of Eastern Finland investigated the association of blood markers of diabetes with beta-amyloid accumulation detected in PET scans in older people at risk of dementia. The study population included 41 participants from the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER). FINGER has investigated the cognitive benefits of a multidomain lifestyle intervention for people over 60, who are at risk of cognitive decline. Results from the study indicate slightly better insulin homeostasis in amyloid positive older individuals at risk of dementia. The findings contrast with earlier findings, possibly due to the fact that this study population was at high risk of cognitive decline. “The results could also suggest that

in people with diabetes and vascular pathology, less amyloid accumulation in the brain may be needed to trigger the onset of Alzheimer’s dementia,” Associate Professor Alina Solomon from the University of Eastern Finland says. “Interestingly, no association was found for amyloid deposition with fasting glucose levels or HbA1c, which measures the average level of blood sugar.” This study adds to the growing amount of data on the associations of insulin resistance and diabetes with Alzheimer’s disease pathology. Due to its promising results, the FINGER study has expanded around the globe as part of the World Wide FINGERS research network, which has been set up to help execute lifestyle interventions for, and research into, cognitive impairment and dementia prevention. In the future, this will enable the replication of the results obtained in this study with larger populations and help gain further insight into the connections between diabetes and Alzheimer’s disease. WWW.ORTODAY.COM

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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.

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so, others and fail to do lp he to ce an ch a “If you have e on this earth.” m ti ur yo ng ti as w e you ar te – Roberto Clemen

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NOVEMBER 2020 | OR TODAY |

OUT OF THE OR pinboard

The News and Photos

that Caught Our Eye This Month

SMALLER PIECES HELP WITH EATING MORE VEGGIES By Alan Flurry

ot eating your fruits and vegetables can have serious health consequences, from obesity to macular degeneration. And many Americans, even those who have easy access to these healthy foods, stubbornly resist eating them. Now, researchers at the University of Georgia have examined the psychology of how vegetables are presented and served, and how this affects consumption. Previous research shows that people consume less of a particular food if it’s packaged separately in a smaller portion. For example, serving separately wrapped chocolates generally reduces consumption by making the eater more aware of the amount. “For chocolates, people need to inhibit the desire to eat more. Each decision point offers a reminder that they should stop, and so increasing the decision points actually decreases consumption,” said Michelle vanDellen, associate professor in the Franklin College of Arts and Sciences department of psychology and lead author on the paper. However, researchers posited that offering relatively less-appealing foods (like vegetables and other low-fat, low-sugar foods) in separate units might have the opposite effect and increase consumption. “People need to initiate self-control to consume vegetables. More decision points might require more initiation. Separating food into a unit might reduce decision points. Because people also have an intrinsic desire for completion, they may be more likely to finish a unit or serving, even if these are made of relatively unappealing options,” vanDellen said. The team conducted experiments in which they randomly presented cauliflower both in whole presentation formats (all pieces on one plate) or a partitioned presentation format and measured consumption. Overall, people didn’t eat different total amounts of cauliflower across the conditions. But they did find

50 | OR TODAY | NOVEMBER 2020

that the presentation format affected consumption. In the whole presentation format, most participants only ate one piece of cauliflower. In the partitioned format, participants were less likely to stop at one piece and more likely to eat a whole serving (either four or six pieces depending on the study). Co-authors on the study include Janani Rajbhandari-Thapa, assistant professor of health policy and management in the UGA College of Public Health, and Julio Sevilla, associate professor in the UGA Terry College of Business department of marketing. “While past findings have shown that partitions can help curve the consumption of highly tempting, unhealthy foods, as a result of enhanced self-monitoring, our work provides support for another benefit of using partitions,” Sevilla said. “Interestingly, partitions can help increase the consumption of healthy items, such as vegetables, as they nudge consumers to finish what they started.” “This study is a true outcome of interdisciplinary collaboration,” said Rajbhandari-Thapa. “The findings inform how a subtle change in vegetable presentation can influence consumption behavior. The result can inform nudging and choice architecture intervention in cafeteria settings to encourage vegetable consumption.” The paper is published in the journal Food Quality and Preference.

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OUT OF THE OR EQ factor

The Power of Choice

By daniel bobinski, M.Ed. o matter what happens in the nation, our state, our city or our workplace, there’s one thing over which we have complete control, and that’s our response. We can choose to be proactive or reactive, and those choices will have positive or negative ripple effects; but our choices are always in our control.

Let’s talk about the arena of choices and where we have control. One book that radically changed my life more than 35 years ago was “Control Theory,” by William Glasser, M.D. He later re-wrote the book, calling it “Choice Theory,” but the principles remained: We have more and better control over our lives if we make healthy choices. The four arenas identified by Glasser are our physiology, our feelings, our thoughts and our actions. In Glasser’s “Choice Theory,” he postulates that other than food and exercise, we have little control over our physiology. Our heart wants to beat no matter what and our lungs want to draw air no matter what. Our body knows how to process chemicals to help us digest food and respond to physical injury, and our body does this all on its own. No choices are needed WWW.ORTODAY.COM

for any of that to happen. We also have emotions. We have some control over our emotional state, but not much. I’m oversimplifying, but emotions simply tend to occur. Beyond that is our thoughts. We have a lot more control over our thoughts than we do our emotions, but still, some thoughts just happen whether we want them or not. Finally, the one thing we have total control over is our behavior. Outside of reflexes, our actions occur because of our choices. We choose to stand up. We choose to shower. We choose to brush our teeth. We choose to answer the phone. One important thing to know is that a chain of impact occurs within these four arenas. Our actions affect our thoughts, our thoughts affect our feelings and our feelings affect our physiology. For example, you might notice that when you’re feeling bad, that feeling might be hard to change. But since our thoughts affect our feelings, we can impact our feelings if we change our thoughts. But if you’ll remember, we don’t have total control over our thoughts. What we do have control over is our actions. And, since our actions affect our thoughts and our thoughts affect

our feelings, if we choose to proactively change our behavior in a positive way, we will have better thoughts, which, in turn, helps us have better feelings. The key to success in all of that? Making wise choices. By proactively thinking through the ripple effects of your choices, you can identify actions that will lead to better thoughts which then lead to better feelings. Why is that important? Because feeling bad will affect your physiology in a bad way, too. Let me close with a quote from the late Stephen Covey: “We are not a product of what has happened to us in our past. We have the power of choice.” Daniel Bobinski, M.Ed. is a best-selling author and a popular speaker at conferences and retreats. For more than 30 years he’s been working with teams and individuals (1:1 coaching) to help them achieve excellence. He was also teaching Emotional Intelligence since before it was a thing. Reach Daniel through his website, MyWorkplaceExcellence.com, or his office at 208-375-7606.

NOVEMBER 2020 | OR TODAY |

OUT OF THE OR nutrition

Let’s Beat the Odds By Charlyn Fargo new report finds that less than 7% of adults in the U.S. practice all five of the healthy behaviors recommended by public health organizations, including the Centers for Disease Control and Prevention and the American Cancer Society.

So, what are those behaviors? � Exercising regularly (150 minutes per week) � Eating a healthy diet � Maintaining a healthy weight � Avoiding smoking � Avoiding excessive alcohol consumption Researchers looked at data from a national survey of over 26,000 adults ages 20 to 79. Only 1 in 5 surveyed adopt four or more of the healthy behaviors, and nearly half participate in fewer than three. The study was published in the American Journal of Preventative Medicine in April 2020. Why do these behaviors matter? The better your habits (and the more of these five habits you accomplish), the more your quality of life can be improved and the less likely you will be to develop a chronic disease. Just what does a healthy diet entail? Let’s go back to the U.S. Department of Agriculture’s MyPlate. It’s an easy-to-understand plan that doesn’t require counting calories. Fill half your plate with fruits and vegetables, a fourth of your plate with lean protein (it can be from plants or lean meats) and a fourth of your plate with whole

52 | OR TODAY | NOVEMBER 2020

grains (quinoa, brown rice, teff, wholewheat pasta or bread). Have a side of low-fat dairy. That plan can be more challenging at breakfast, but think of a wholegrain, high-protein cereal with skim milk and berries, or whole-wheat toast with peanut butter and a banana. Add a glass of low-sodium vegetable juice for a balanced meal. You could also add spinach, onions and mushrooms to an omelet or scrambled eggs with a side of fruit or a smoothie with protein powder and spinach or kale. The bottom line? It would be good for all of us to add as many of these healthy habits to our daily routines as we can.

Healthy Eating Checkup Every so often, we need a checkup. When you visit the doctor for almost any appointment, it’s common to answer some questions about your health. They can range from the medications you’re taking to whether or not you’re feeling sad or depressed. As 2021 approaches, it’s a good time to have a healthy eating checkup. There are two questions that can help assess how you’re doing. � No. 1: How often do you eat five or more servings of fruits and vegetables a day? � No. 2: How often do you consume sugary foods and drinks? It seems too simple that healthy eating can be assessed with those two questions. But they tell a lot about where you’re at on the U.S. Depart-

ment of Agriculture’s MyPlate and Food Guide Pyramid. That’s because if your daily plate is filled with cookies and soda, it often means you aren’t consuming more nutrient-dense foods such as fruits, vegetables, whole grains and water or milk. And on the flip side, if you’re consistently eating five servings of fruits and vegetables every day, you aren’t hungry for other empty-calorie foods. Many of us plan our meals beginning with the meat or protein. Try instead planning around a salad, vegetable or fruit. MyPlate recommends that half your plate is filled with fruits and vegetables. Five a day means at least two meals need a fruit and vegetable, or you can have a fruit or vegetable for a snack. Fruit can offer a great ending to a meal as well, to replace that sugary dessert. Why focus on fruits and vegetables? They, along with whole grains, contain many of the nutrients your body needs. When it comes to sugary foods, think about having a glass of water before you reach for a soda or energy drink (yep, most of them have sugar). Try a baked apple or grilled peach for dessert instead of a cookie or cupcake. You’ll be surprised at how you can turn unhealthy eating into healthy eating with just these two goals. Charlyn Fargo is a registered dietitian with SIU Med School in Springfield, Illinois. For comments or questions, contact her at charfarg@aol.com. WWW.ORTODAY.COM

Recipe the

OUT OF THE OR recipe

A Cheesy, Creamy, Kid-Friendly Meal

Skillet Macaroni and cheese INGREDIENTS: • 1 cup dried elbow macaroni • 2 tablespoons olive oil • 1 pound boneless, skinless chicken breast, cut into 1-inch pieces • 1/2 cup onion, finely chopped • 1 package (5 ounces) semisoft cheese with garlic and fine herbs • 1 1/2 cups fat-free milk • 1 tablespoon flour • 1 teaspoon hot sauce • 1/2 cup shredded cheddar cheese • 2 cups fresh baby spinach

By Family Features

urning to easy recipes that require minimal cooking time can help your loved ones take the stress out of busy school nights while increasing the opportunities for sharing family moments together.

Skip the long cook times of complicated dishes and instead turn to an option like this Skillet Macaroni and Cheese, a kidfriendly and parent-approved meal to turn hectic school nights into happy time with family. With a slight twist on the childhood classic, this version calls for chicken to add protein along with spinach and cherry tomatoes for increased veggie intake. Plus, it’s made with milk and cheese as part of an important daily intake of dairy, an irreplaceable part of a balanced diet as a source of essential nutrients. Find more kid-friendly meals at milkmeansmore.org. WWW.ORTODAY.COM

• 1 cup quartered cherry tomatoes

Skillet Macaroni and Cheese Recipe courtesy of Katie Serbinski of “Mom to Mom Nutrition” on behalf of Milk Means More Prep time: 5 minutes Cook time: 25 minutes Servings: 4-6 1. Cook macaroni according to package directions; drain. 2. Heat large skillet over medium-high heat. Add olive oil, chicken and onion. Cook 6-8 minutes, or until chicken is no longer pink. 3. Reduce heat to medium. Stir in semisoft cheese. Gradually add milk and flour. Continue stirring and cooking until mixture is thickened and bubbly. 4. Reduce heat to low. Add hot sauce, cheddar cheese and cooked macaroni. Cook and stir 1-2 minutes until cheese is melted. Stir in spinach. 5. Top with cherry tomatoes and serve. NOVEMBER 2020 | OR TODAY |

INDEX

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ALPHABETICAL Action Products, Inc.…………………………… 23 AIV Inc.……………………………………………………… 4 ALCO Sales & Service Co.…………………… 43 Augustine Temperature Management… 9 Cygnus Medical……………………………………… 56

Encompass Group………………………………13, 17 GelPro………………………………………………………… 15 Healthmark Industries Company, Inc.… 6 Innovative Medical Products……………… 39 Jet Medical Electronics Inc.………………… 46

MD Technologies Inc.…………………………… 43 MedWrench…………………………………………… 55 OR Today Webinar Series…………………… 24 SIPS Consults………………………………………… 23 TBJ Incorporated……………………………………… 5

ANESTHESIA

INFECTION CONTROL

REPAIR SERVICES

Augustine Temperature Management… 9

ALCO Sales & Service Co.…………………… 43 Cygnus Medical……………………………………… 56 Encompass Group………………………………13, 17 Healthmark Industries Company, Inc.… 6 MD Technologies Inc.…………………………… 43 SIPS Consults………………………………………… 23 TBJ Incorporated……………………………………… 5

Cygnus Medical……………………………………… 56 Jet Medical Electronics Inc………………… 46

CATEGORICAL

CARDIAC PRODUCTS Jet Medical Electronics Inc………………… 46

CARTS/CABINETS ALCO Sales & Service Co.…………………… 43 Cygnus Medical……………………………………… 56 Healthmark Industries Company, Inc.… 6 TBJ Incorporated……………………………………… 5

CS/SPD MD Technologies Inc.…………………………… 43

DISINFECTION Cygnus Medical……………………………………… 56

DISPOSABLES ALCO Sales & Service Co.…………………… 43

ENDOSCOPY Cygnus Medical……………………………………… 56 Healthmark Industries Company, Inc.… 6 MD Technologies Inc.…………………………… 43

FALL PREVENTION ALCO Sales & Service Co.…………………… 43 Encompass Group………………………………13, 17

FLUID MANAGEMENT MD Technologies Inc.…………………………… 43

GENERAL AIV Inc.……………………………………………………… 4

HOSPITAL BEDS/PARTS ALCO Sales & Service Co.…………………… 43

INSTRUMENT STORAGE/TRANSPORT Cygnus Medical……………………………………… 56

ONLINE RESOURCE MedWrench…………………………………………… 55 OR Today Webinar Series…………………… 24

OR TABLES/BOOMS/ACCESSORIES Action Products, Inc.…………………………… 23 Innovative Medical Products……………… 39

OTHER AIV Inc.……………………………………………………… 4

REPROCESSING STATIONS MD Technologies Inc.…………………………… 43 TBJ Incorporated……………………………………… 5

SAFETY GelPro………………………………………………………… 15 Healthmark Industries Company, Inc.… 6

SINKS TBJ Incorporated……………………………………… 5

STERILIZATION Cygnus Medical……………………………………… 56 Healthmark Industries Company, Inc.… 6 MD Technologies Inc.…………………………… 43 TBJ Incorporated……………………………………… 5

SURGICAL

OTHER: FLOOR MATS

MD Technologies Inc.…………………………… 43 SIPS Consults………………………………………… 23

GelPro………………………………………………………… 15

SURGICAL INSTRUMENT/ACCESSORIES

PATIENT MONITORING AIV Inc.……………………………………………………… 4 Jet Medical Electronics Inc………………… 46

PATIENT WARMING Encompass Group………………………………13, 17

POSITIONING PRODUCTS Action Products, Inc.…………………………… 23 Cygnus Medical……………………………………… 56 Innovative Medical Products……………… 39

PRESSURE ULCER MANAGEMENT

Cygnus Medical……………………………………… 56 Healthmark Industries Company, Inc.… 6

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

TEMPERATURE MANAGEMENT Augustine Temperature Management… 9 Encompass Group………………………………13, 17

WASTE MANAGEMENT MD Technologies Inc.…………………………… 43 TBJ Incorporated……………………………………… 5

Action Products, Inc.…………………………… 23

54 | OR TODAY | NOVEMBER 2020

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