OR Today July 2021

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PRODUCT FOCUS TEMPERATURE MANAGEMENT

WEBINARS STERILE PROCESSING

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CE ARTICLE RNs SHELTER VICTIMS OF DISASTER

RECIPE FRIED LOBSTER PO BOY BURGERS

LIFE IN AND OUT OF THE OR

JULY 2021

U P D A T E

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SURGICAL SMOKE L E G I S L A T I O N

GUIDE TO PAGE 54

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OR TODAY | JULY 2021

contents features

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UPDATE ON SURGICAL SMOKE LEGISLATION Politics continue to hamper efforts to pass legislation that will protect health care professionals from the effects of surgical smoke. At least eight states will consider new legislation through next year.

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The temperature management market is

This CE article shares how nurses work

The 2021 AORN Global Surgical

projected to reach $3.2 billion by 2025.

with other team members in American

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Red Cross shelters in the aftermath of a

reenergize, regroup and recommit at the

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MARKET ANALYSIS

CONTINUING EDUCATION

GUIDE TO AORN

of the Guidelines for Perioperative Practice.

OR Today (Vol. 21, Issue #7) July 2021 is published monthly by MD Publishing, 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290.

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SPOTLIGHT ON

EDITOR

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OR TODAY CONTEST

RECIPE OF THE MONTH

DIGITAL SERVICES Cindy Galindo Kennedy Krieg Erin Register

EVENTS Lisa Lisle

INDUSTRY INSIGHTS

10 News & Notes 16 CCI: New CFPN Credential Creates Bridge to Certification 18 IAHCSMM: Collaboration Crucial to Interdisciplinary Team Success 20 AAMI: Sterile Barrier Initiative Earns First-Ever Kilmer Research Grant 22 ASCA: Despite COVID-19’s Continuing Impact, ASCs Are Moving On 25 Webinar Explores Sterile Processing

27 M arket Analysis: Temperature Management Market Weathers COVID-19 28 Product Focus: Temperature Management 32 CE Article: RNs Shelter Victims of Disaster

OR TODAY | July 2021

EDITORIAL BOARD Beyond Clean Sharon A. McNamara, Perioperative Consultant, OR Dx + Rx Solutions

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WEBINARS Jennifer Godwin

for Surgical Safety

OUT OF THE OR

58 Index

Diane Costea

Hank Balch, President & Founder,

IN THE OR

44 S potlight On: Leticia Ramirez, Director of Nursing 46 Fitness 47 Health 48 EQ Factor 49 Nutrition 50 Recipe 52 Pinboard

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INDUSTRY INSIGHTS

news & notes

Getinge Expands Servo Ventilator Platform Getinge announced clearance from the U.S. FDA of several new software options for the Servo-u and Servo-n ventilators. In addition to the latest software upgrades, Getinge also received clearance for the new Servo-u MR ventilator for the MRI room.

“The COVID-19 pandemic and the heightened awareness of respiratory health has driven the need for personalized ventilation solutions for critically ill patients. Now more than ever, options for personalized lung protection and personalized weaning solutions are at the forefront of respiratory patient health. Getinge strives to support clinicians and patients by optimizing lung protection and delivering solutions for personalized ventilation,” said Eric Honroth, president, Getinge North America.

With this software upgrade for the

Servo-u and Servo-n combined, Getinge adds several new functionalities and options across all patient categories – adult, pediatric and neonatal. Getinge broadens its portfolio of lung-protective tools, including Automatic Stepwise Recruitment maneuver (Auto SRM), a standardized and automated workflow that guides lung recruitment and helps clinicians identify a personalized PEEP that provides the lowest driving pressure, which is a variable strongly associated with patient survival in ARDS. Stress index and transpulmonary pressure monitoring, including key parameters for assessment of lung stress during controlled and spontaneous ventilation, complements the lung protective toolkit, which was designed to optimally divide the cognitive workload between the clinician and the ventilator.

Additionally, the clearance includes

heliox therapy. Heliox is a mixture of helium and oxygen that facilitates laminar flow and minimizes airway pressure due to its low density. This helps reduce the work of breathing (WoB) of patients suffering from obstructive lung diseases.

Getinge also received clearance to introduce the Servo-u MR to the U.S. market, a complement to the Servo Family, expanding Getinge’s platform of ventilators into the MRI room.

Designed to guide the ventilator into a safe position, the Servo-u MR includes a magnetic field indicator with visual and audible alerts and an auto-lock handle that locks all four wheels as soon as the clinician releases the ventilator.

The new options and the Servou MR ventilator are expected to be available in the U.S. in July 2021.

AAAHC Unveils New Website The Accreditation Association for Ambulatory Health Care (AAAHC) now offers a fresh digital experience for ambulatory health care organizations. The completely redesigned website (AAAHC.org) enhances user experience and facilitates access to essential tools and resources. AAAHC puts forth this digital technology, enabling organizations to stay accreditation ready all 1,095 days of the accreditation term. Users will find comprehensive login portals for accreditation and certification applications, as well as for AAAHC governance and surveyors.

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OR TODAY | July 2021

The new AAAHC gateway also features a brand-new eCommerce experience showcasing the latest AAAHC products and convenient purchase process.

The website features intuitive navigation, modern design and provides 24/7, on-demand access to resources through the AAAHC learning management system, 1095 Learn, for accelerated readiness and AAAHC Standards compliance.

Users will find a seamless experience which guides health care providers toward essential accreditation and certification news, information, and updates and creates a clear and efficient path to achieve 1095 Strong, quality every day.

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INDUSTRY INSIGHTS

news & notes

Now offering Beard Net, the newest item in the PPE accessory line.

Healthmark Industries Adds Staff, Achieves ISO Certification, Offers New Products Healthmark Industries announced that it has received ISO 13485:2016 certification. ISO 13485:2016 is designed to support medical device manufacturers in designing quality management systems that establish and maintain the effectiveness of their processes. It ensures the consistent design, development, production, installation and delivery of medical devices that are safe for their intended purpose.

In other news, Malinda Elammari is a new clinical education specialist for Healthmark Industries. She will provide clinical expertise on medical device processing, SPD education and standards.

Elammari is a Certified Sterile Processing Manager, a Certified Endoscope Reprocessor, currently serves as a president of an IAHCSMM local chapter, SSGB-Lean six sigma green belt and serves on numerous AAMI Committees.

Healthmark Industries also has introduced two new products.

One new product is an Anti-Fatigue Mat that the company has added to its Personal Protection Equipment (PPE) product line. Manufactured from energyreturn polyurethane foam, the black 0.75-inch thick

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Anti-Fatigue Mat is designed for health care workers in reprocessing areas to help reduce fatigue and discomfort from standing for long hours. Eco-friendly and providing ergonomic comfort, the Anti-Fatigue Mat has a stain and puncture-resistant surface to prevent absorption of dirt and water, a beveled edge at 18 degrees to reduce tripping potential, matte textured top surface to provide optimum friction and anti-microbial properties for added protection.

The easy-to-clean slip-resistant Anti-Fatigue Mat is equipped with a high-traction bottom surface certified by the National Floor Safety Institute and is offered in three sizes: 20 x 32 inches, 24 x 36 inches, and 20 x 48 inches.

Healthmark Industries has also recently added a Beard Net to its personal protection equipment accessory line. Manufactured from polypropylene, the single-use Beard Net is latex-free and designed to cover beards to limit as a source of possible contamination.

The Beard Net is a one size fits most, colored white and available for purchase in a pack of 100.

For more information, visit www.hmark.com.

July 2021 | OR TODAY

11

INDUSTRY INSIGHTS

news & notes

Lexington Medical Achieves Milestone Lexington Medical, a U.S.-based medical device company delivering minimally invasive surgical stapling solutions, announced that the company has achieved over 10,000 successful surgeries with the AEON Endostapler in multiple countries.

“We are pleased to reach this exciting milestone for our AEON surgical stapling devices,” said Leon Amariglio, founder and chief executive officer, Lexington Medical. “As Lexington Medical is dedicated to providing surgeons with high-quality stapling solutions, we look forward to further expanding our global reach and benefiting more patients across the world. We thank all of the surgeons and partners who have traveled this journey with us and helped achieve this significant milestone.”

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OR TODAY | July 2021

Companies Aim to Revolutionize Infusion Management Smiths Medical has formed an exclusive partnership with Ivenix Inc. that positions the companies as the first in the U.S. to offer a comprehensive suite of infusion management solutions to meet health care needs across the continuum of care. The long-term partnership, which includes a strategic investment from Smiths Medical, unites two innovators under a common goal of revolutionizing infusion management to improve patient safety and meet the needs of health care providers today and into the future.

Ivenix, a medical technology company dedicated to eliminating infusionrelated patient harm, developed the first and only large-volume infusion pump from the ground up to meet the latest U.S. Food and Drug Administration infusion pump guidelines addressing recurring safety issues with pumps. Ensuring patient safety and clinical efficiency are critical components of successful life-saving infusion management. Today, infusion-related errors account for more than 50% of the 1.5 million adverse drug events reported annually to the FDA, and infusion-related adverse drug events cost the health care system billions of dollars annually.

Smiths Medical’s complementary portfolio of market-leading infusion systems CADD-Solis and Medfusion include syringe and ambulatory pumps that serve adult and neonatal critical care, operating rooms and pain management in both the hospital and home. By adding the Ivenix Infusion System to its U.S. product portfolio, Smiths Medical will accelerate its offering into the large-volume infusion device segment, which is estimated to be over $2 billion.

“As a researcher focused on large volume IV smart pumps, I am well aware of the many safety and usability issues that exist with current products,” said Karen K. Giuliano, Ph.D., RN, FAAN, MBA, an associate professor and co-director of the Nursing-Engineering Center for Innovation at the University of Massachusetts Amherst. “Innovation in IV smart pumps is long overdue, and I am happy to see new options for acute care clinicians to consider for the delivery of life-saving fluids and medications in this very important area of patient safety.”

“The long-term partnership between Smiths Medical and Ivenix will ensure that we are bringing the next generation of infusion management solutions to hospitals across the U.S. and fulfills our commitment to helping connect patients to life-saving therapies and insights to providers,” said JehanZeb Noor, Smiths Medical CEO. “Our investment in Ivenix will help spur the research and development needed to continue building on this critical resource and provide holistic solutions for hospitals and health systems.”

The Ivenix Infusion System includes a large-volume infusion pump with administration sets, infusion management tools and analytics to inform care and advance efficiency. The system received 510(k) clearance in 2019 and sets a new standard in infusion delivery by rethinking safety, simplicity and interoperability. The system is centered around both the patient and clinician and designed to reduce infusion-related errors and drive down the total cost of ownership.

Smiths Medical will launch the Ivenix infusion System as part of its infusion portfolio in the summer of 2021.

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CoolOR® KEEP YOUR OR STAFF COOL The lightweight CoolOR® Circulating Water System is a proven solution for keeping surgeons and staff cool and comfortable.

CONVENIENT, EASY-TO-USE AND PORTABLE DESIGN VEST STYLE CHOICES Adjustable and fitted cooling vests cool by circulating cold water through a series of tubes sewn into the vest.

PENTAX Medical Announces New President PENTAX Medical recently announced the appointment of Ojas A. Buch as president of the Americas. Buch assumed the role of president April of this year and leads the PENTAX Medical team in its continued mission to improve patient outcomes; and enriching patient and provider’s experience by empowering every member of the care team to achieve optimal outcomes.

Throughout his career in the medical device industry, Buch has developed an in-depth understanding of leading diverse teams that are empowered and aligned towards a common goal of keeping the customer at the core of all activities. Leadership roles at GE Healthcare, St. Jude Medical (Abbott), CareFusion (Yvaire) and most recently Philips have provided Buch with a keen understanding of the industry and its key players. As vice president of Philips, Buch commanded customer-driven organizational transformations, advanced the company’s growth strategy and led strong teams around him for several global health care businesses, which resulted in innovation and revenue growth.

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INDUSTRY INSIGHTS

news & notes

Medtronic Partners, Surgical Theater Provide Augmented Reality Platform Medtronic and Surgical Theater have announced a partnership to interface Surgical Theater’s SyncAR augmented reality (AR) technology with Medtronic’s StealthStation S8 surgical navigation system. This collaboration will enable neurosurgeons to use AR technology in real-time to enhance visualization during complex cranial procedures.

Using fighter-jet simulation technology, the SyncAR platform allows surgeons to visualize structures in the brain, test virtual surgical tools and plan surgeries before entering the operating room. By integrating this technology with the StealthStation S8 cranial solution, surgeons can expand the benefits of AR and, for the first time, see a 360-degree AR rendering overlaid onto the live surgical site during brain surgeries.

“SyncAR offers important benefits in planning and practicing how to approach complex cases, and now being able to actually use AR during procedures to see where instruments are in relation to critical structures while never losing focus on the patient is a significant advance,” said Thomas Steineke, M.D., chairman, JFK Neurosciences Institute, Edison, N.J. “In neurosurgery, it’s paramount to correctly identify and navigate critical brain structures. AR-enhanced visualization interfacing with the StealthStation will help me achieve the best possible outcomes for my patients.”

Surgical Theater’s SyncAR technology synchronizes with Medtronic’s StealthStation S8 navigation system and microscope optics to provide tools that may help surgeons accomplish complicated procedures with increased precision and efficiency. The combination of the StealthStation S8 and

SyncAR technology is designed to give surgeons the ability to see otherwise hidden anatomical and vascular structures, pathologies, and Diffusion Tensor Imaging (DTI) white matter tracts synchronized and aligned to the surgeon’s operative view. A 360° AR rendering, created from the patient’s scans, is overlaid onto the live image viewed through the oculars of the microscope as they track the positioning of their surgical tools, allowing surgeons to keep their eyes focused on the patient.

The StealthStation S8 navigation system combines hardware and clinical software with tracking and image dataset merging algorithms, to precisely track surgical instruments and help guide the user during surgical procedures. Surgical Theater’s SyncAR 360° Visualization Hub offers surgeons live and synchronized augmentation including vascular structures, pathology, and white matter tracts aligned to their surgical field of view.

Olympus Announces Single-Use Bronchoscopes Olympus has announced the addition to its U.S. bronchoscopy portfolio of the 510(k)-cleared H-SteriScope Single-Use Bronchoscopes, a line of five premium endoscopes for use in advanced diagnostic and therapeutic procedures. The introduction of the H-SteriScope portfolio has been a collaboration between Veran Medi-

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OR TODAY | July 2021

cal Technologies Inc., a wholly owned Olympus subsidiary, and Hunan Vathin Medical Instrument Co. Ltd. “We are very excited to launch our first line of single-use bronchoscopes,” said Lynn Ray, vice president and general manager of the global respiratory business unit for Olympus Corporation. “These premium disposable bron-

choscopes give physicians flexibility and choice when convenience and portability are critical factors in care.

Adding them to our already robust bronchoscopy portfolio aids physicians in achieving faster transitions to diagnosis and treatment for patients.”

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IT’S NOT MAGIC, IT’S CARBON.

Imagine effective patient warming with no noise, air movement or excessive heat.

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Purdue Adds Externship Program Purdue University is pairing its online courses to prepare health care professionals for the Certified Registered Central Service Technician exam with an externship program that gets them the 400 hours of experiential learning they must have to take the exam and become certified.

The externships are now available through a partnership between Purdue Online and the College of Biomedical Equipment Technology (CBET). CBET, based in San Antonio, is a 13-year-old accredited private college offering biomedical equipment and health care technology and management training aimed at meeting demand for trained personnel in the health care industry.

“Purdue well understands how partnerships with professional institutions and organizations like CBET can add value to our non-degree offerings for professionals,” said Gerry McCartney, executive vice president of Purdue Online.

CBET will work with its large network of health care organizations to place individuals in an externship site convenient for them, with a qualified externship supervisor and personal live support throughout the program. The externships give central service, operating room, infection control and material management employees on-site experience at an approved facility.

Nova’s unique heating element uses a novel carbon veil technology.

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OPERATING ROOM SOLUTIONS Surgical Table Pads, Casters, Mayo Stands and more!

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July 2021 | OR TODAY

15

INDUSTRY INSIGHTS CCI

New CFPN Credential Creates Bridge to Certification

By Benjamin Dennis, A.S., and Sarah Bosserman Matulewicz, MSN, RN, CNOR n July 1, the Competency and Credentialing Institute (CCI) will launch a new credential, Certified Foundational Perioperative Nurse (CFPN). The new, voluntary credential establishes a standard of baseline competency for nurses new to the perioperative profession.

One of CCI’s strategic goals is to engage perioperative nurses in professional certification earlier in their career. CFPN meets this goal. This new credential is fundamentally different than current CCI credentials.

O

Previously, perioperative nurses needed to wait a minimum of two years and gain 2,400 hours of experience before being eligible to attain the CNOR certification.

However, with this new credential, perioperative nurses who have completed an orientation to perioperative nursing at their home hospital or surgery center are now eligible to test for CFPN certification, well in advance of CNOR eligibility. Giving newly oriented perioperative nurses the opportunity to obtain a certification earlier in their career will promote increased skill and continued education in this unique profession.

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OR TODAY | July 2021

To earn the CFPN credential, applicants must first pass a 100-item knowledge-based test (KBT). Those who pass the test, must then complete a self-assessment of perioperative nursing competency, a personality trait (soft skills) assessment and, finally, a reflective learning exercise.

CCI has partnered with Dr. Brigid Gillespie to adapt the Perceived Perioperative Competence Scale-Revised (PPCS-R) for use with American nurses. This instrument will serve as the initial competency assessment. The 16PF assessment is provided through CCI’s testing partner, PSI Assessments, and enables nurses to increase their self-awareness through a personality factor assessment. After completion, each nurse receives a detailed and personalized report which provides them with information about their areas of strengths, as well as opportunities for improvement. Each domain explains personality traits associated with an individual nurse and provides tips and suggestions which can be implemented for their career development.

The last component of the CFPN is a reflective learning exercise. In allowing nurses the opportunity to outline a personalized plan for professional development and continued learning, the reflective exercise enables nurses to

contemplate their own journey toward perioperative certification.

The sum of these four components gives a perioperative nurse, early in their career, a true measure of the three components of competency – knowledge, skills and aptitude.

During development, each part of the CFPN credential received input and feedback from perioperative nurses at the University of Rochester Medical Center, and a special CCI-appointed committee, the Emerging Professionals Advisory Committee (EPAC). CFPN is unique in that it not only allows new nurses to validate basic knowledge of perioperative practice, but the certification also includes additional elements to help develop those who are new to the perioperative nursing profession. Nurses who choose to continue their certification journey and acquire CNOR will also receive a testing discount, further encouraging them to obtain the certification. Nurses who hold CFPN will become eligible to take their CNOR exam after holding the credential for 18 months if they have 2,400 hours of perioperative nursing practice.CCI began testing for the new credential in June, and applications are now open for CFPN. With the CFPN credential, CCI is continuing to define what it means to be a perioperative nurse and opening the door to certification for newly oriented operating room nurses.

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INDUSTRY INSIGHTS

IAHCSMM

Collaboration Crucial to Interdisciplinary Team Success

By Tony Thurmond, CRCST, CIS, CHL ealth care organizations – and the departments that comprise them – don’t become successful through a single idea or individual effort. Instead, optimal results come from a collective effort of a team, with all members working toward a common goal.

H

Collaboration, when used in the context of business, allows people to work together in achieving a defined, common business purpose. Collaboration in the workplace is when two or more people (often groups) work together through idea sharing and thinking to accomplish a common goal. Put simply, it’s teamwork taken to a higher level.

Too often, we look to complete tasks or ventures on our own, either not seeking help from others due to the fear of asking or the fear of relinquishing control. Sometimes, we see ourselves as the experts and don’t want anyone telling us how to do our job; however, this mindset can prove damaging to ourselves, our departments and facilities, our customers and, especially, our patients.

If you aren’t currently working collaboratively with others, you’re missing out on some big opportunities for growth and success. Even more importantly, you may not be doing your best to protect the patients who visit your facility.

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OR TODAY | July 2021

Putting best practices in the spotlight The best changes in our departments often come from reaching out to another department (or, in many cases, multiple departments) and putting our minds together to drive best results.

Many departments can help our department achieve best results, beginning with the health care customers we serve.

Let’s explore how collaborating with with the following departments/ professionals can help deliver better outcomes for all parties involved.

Surgery: Numerous collaborative opportunities await between sterile processing (SP) and the operating room (OR), and those opportunities often lie within the challenges.

Often, it appears these challenges lead to finger pointing between the two departments, but it’s important to remember we’re all on the same team and seek the same outcomes: quality service and safe patient care.

Designating a champion in the OR who will work with SP – and, perhaps, assigning an SP liaison to the OR – is a great way to foster greater teamwork.

When looking to improve point-of-use instrument care at a previous facility, I recruited the help of an assistant manager in the OR. I gave him examples of how instruments arrived in decontamination in such disarray and were dangerous and difficult for our staff to handle. I showed him pictures of heavy items placed on top of delicate

equipment and provided examples of soiled instruments with dried-on soil and explained how dried-on bioburden makes cleaning more difficult and can impede the sterilization process. I also showed how point-of-use care is a practice recommended by the Association for the Advancement of Medical Instrumentation, the Association of periOperative Registered Nurses and the Association of Surgical Technologists; this provided documented proof of what is universally recommended and expected.

What resulted was a collaborative effort to educate all OR staff to begin treating instruments at the point of use (moistening soiled instruments with an approved spray prior to their being sent to the decontamination area). We also began monitoring trays sent to decontamination and recorded in our instrument tracking system whether or not they were sprayed.

Our compliance rate jumped from 15% to over 64% in just over five months.

Another collaborative approach we took was having our SP staff witness a surgical procedure. This allowed our staff to see firsthand how the instruments are used and how the OR staff expect to receive them in order to provide proper care. One of our technicians reported back to me that the experience helped her learn the importance of having the right instrument in the tray and she better WWW.ORTODAY.COM

INDUSTRY INSIGHTS

IAHCSMM

Tony Thurmond, CRCST, CIS, CHL

understood the frustrations and challenges in having to call for another instrument or tray.

Infection Prevention: Sometimes, there’s an impression that infection preventionists (IPs) are only there to look over SP professionals’ shoulders to ensure we are following documented practices. The truth, though, is IPs are eager to learn as much as they can from those in the sterile processing department (SPD). Accreditation organizations will look to IPs to ensure they have a full understanding of the facility’s sterilization practices. SP professionals should ask IPs to come and work with or observe in the department for a day or two. Most will be eager to learn the processes and will serve as another set of eyes on your practices that might even shed light on some process improvement opportunities. Working closely with IPs can also help ensure that SP has the tools and resources needed to work safety, effectively and in accordance with standards.

Biomedical Engineering/Equipment vendors: Collaborating with biomedical engineers and equipment WWW.ORTODAY.COM

vendors provides an opportunity to have them see how SP equipment is being used, which will help drive positive results. After a recent visit by both groups in our department, it was identified how an ultrasonic could be moved closer to a workstation to save steps and help deliver optimal results.

We also were able to identify highuse equipment and rotate equipment cycles for improved utilization.

Environmental Services: Collaborating with Environmental Services (EVS) can help the SPD determine an optimal cleaning schedule for the best outcomes. If EVS does not know the SPD’s needs and understand the reasoning behind those needs and requests, the service may not be viewed as a top priority. Working together builds a stronger relationship that helps set proper expectations to improve patient and employee safety.

Units/Clinics: Often, point-ofuse instrument care is not taught or demonstrated, so employees from user departments may not have the information and tools to complete the important function effectively and consistently. They may even falsely assume instrument care is the sole responsibility of SP. A good example is when flexible bronchoscopes or other endoscopes are brought to the floors for procedures; often, endoscopy professionals don’t understand they have a responsibility for point-of-use treatment of the device following its use. If this point-of-care step is skipped, most endoscope instructions for use call for an extended cleaning process, which can add many more hours to the reprocessing of the device. Obviously, such a situation negatively impacts SP and endoscopy professionals – and the patient. Effective collaboration and targeted education on the importance of point-of-use instrument care will

help eliminate these (and other) challenges.

Hospital Administration: The hospital administrator will likely not know the needs and challenges of the SPD (including insufficient staffing, limited instrumentation inventories, old or outdated equipment that can no longer meet the needs of the department and its health care customers, and lack of current industry standards, for example). This is why it is essential that the SPD communicates clearly and regularly with those at the administrative level. The more they know, the better they can help you (and, often, the more they will recognize the value of what takes place in the department).

Conclusion To help ensure effective collaboration, all parties should come prepared to offer solutions to issues and have difficult discussions. Everyone should be prepared to disagree at times but be open to accept suggestions and constructive criticism. A collective willingness to do what is necessary as a team to bring success to the organization and to our departments is a great starting point that will continue serving us in any situation. Many efforts will start small and move gradually, and there is no failure in that as long as we’re all working together toward positive improvements. Remember: the goal of collaborative change is better production, improved communication and greater compliance – all of which leads to improved patient safety and satisfaction.

Tony Thurmond, CRCST, CIS, CHL, is an IAHCSMM Past-President who serves as Central Service Manager at Dayton Children’s Hospital.

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INDUSTRY INSIGHTS CCI AAMI

Sterile Barrier Initiative Earns First-Ever Kilmer Research Grant

by Erin Clancy he AAMI Foundation’s new Kilmer Fund has awarded its first research grant to a team that will seek to reduce the need for stability testing of common sterile barrier material systems.

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The winning research grant, awarded to Project Wicked Stability, in the amount of $9,500, was awarded by the Kilmer Fund Committee, which supports research projects seeking to advance the science of microbiological quality and sterility assurance.

Project Wicked Stability is a subgroup of the recently formed industry group Kilmer Innovations in Packaging (KIiP), which is dedicated to improving patient outcomes and clinician delight through the science and engineering of sustainable packaging.

“The Kilmer Research Grant will allow Wicked Stability to focus on advancing the project much more expediently (and keep the team invigorated!) than if we’d also had to fundraise for donations prior to moving the project along,” said Rod Patch, of Johnson & Johnson, leader of the Wicked Stability project group. “The funds awarded will greatly help to move the needle forward in executing the critical testing we need to conduct to assess and prove our theory.”

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Creating a Science-Based Assessment of Material Stability for Medical Packaging Project Wicked Stability is driven by the team’s concern that the industry has performed repetitive, time consuming and expensive stability testing of well-known sterile barrier materials.

“Numerous organizations have raised concerns of wasted resources and the extensive, redundant testing utilized to establish sterile barrier shelf life in accordance with current requirements,” the group noted. “For many material combinations, there is no concern with actual stability with respect to customary conditions of use; it ends up being more of a documentation exercise. The problem is that current methodology consumes resources and can potentially delay the implementation of innovative and life-saving medical devices.”

In order to address these issues, Wicked Stability hopes to create a predictive stability model for common sterile barrier materials of construction (MOC).

Generating Openly Sourced, IndustryWide Data While there is strong evidence that common MOC maintain sterile barrier integrity far beyond their labeled expiration dates, such data

is exclusive to singular organizations and thus not readily available for compiling standard shelf-life claims.

Project Wicked Stability hopes to change that.

“This baseline testing will result in open-source data and that can be assessed by a panel of industry experts, leading to the results being published for independent peerreview,” the group said.

Findings will be broadly available to industry, with details on how to verify, challenge and substantiate assessments of common MOC shelf-life.

Making Lasting Impacts in the Industry The Project Wicked Stability team hopes that its research will lead to more efficient industry guidelines and, ultimately, that it will facilitate speedy access to the right medical devices and the improvement of patient outcomes.

“We believe the evidence coming out of our study will be able to support medical device manufacturer’s requirements to place products on markets globally in an equally safe, yet accelerated, timeline,” the team said.

Members of the team are eager to see where their research takes them. “In a short period of time, Project Wicked Stability has initiated baseline testing and continues WWW.ORTODAY.COM

to tackle complex undertakings during each exchange we have. When this project started, the path we would follow was unclear. We asked questions, we gathered information, we discovered unknowns, we gained knowledge ... and still continue to ask more and more questions!”

Project Wicked Stability is grateful to the AAMI Foundation for making this groundbreaking research possible.

“We are humbled, excited and proud to be awarded the very first grant from AAMI Foundation’s Kilmer Fund,” said Patch.

“This award is an excellent way to promote not only the AAMI Foundation and Kilmer Fund, but also exhibits the spirit of Kilmer Conference through collaboration and innovation. We’re grateful for the trust, confidence and recognition that the AAMI Foundation has placed in us by awarding the first Kilmer Research Grant to the Wicked Stability project. We are quite eager to use these funds to accelerate access to medical devices!”

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INDUSTRY INSIGHTS

news & notes ASCA

Despite COVID-19’s Continuing Impact, ASCs Are Moving On

By Bill Prentice ast April, U.S. Department of Health & Human Services (HHS) Secretary Xavier Becerra extended the COVID-19 public health emergency (PHE) through July 19, 2021. Based on a letter HHS sent state governors earlier in the year, many health officials are expecting to see additional extensions issued, as needed, to keep the PHE in place through at least the remainder of 2021.

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Extension of the PHE ensures the continuation of numerous regulatory flexibilities for health care providers, including waivers for expanded access to care, increases in Medicaid matching funds and emergency use authorizations for diagnostic services and treatments.

As the U.S. continues to respond to and recover from the COVID-19 pandemic, these expanded services continue to help patients across the U.S. access the care they need.

Where do ASCs fit in?

With COVID-19 still on everyone’s mind, the PHE still in place and more vaccinations being delivered daily, we cannot rely on past patterns to project exactly what caseloads will look like inside ASCs through the rest of the year or even through the end of summer. We could see some of the summer slow downs we have seen in the past as patients begin to feel safe to travel more widely and staff take vacations 22

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they have been postponing for some time. Or, we could see some ASCs get even busier as more patients feel comfortable scheduling care they delayed earlier.

In either case, ASCs are prepared to respond and, as usual, do what is best for their patients. As I have discussed in this column previously, surveys demonstrate that, thanks to the infection prevention policies they already had in place and the additional precautions they implemented once COVID-19 was identified, ASCs have been able to provide outpatient surgery safely and deliver high-quality results throughout the pandemic. If they find that patients are ready to schedule procedures they postponed previously, ASCs are prepared to provide the care they need.

If, on the other hand, ASCs find themselves with less demanding schedules this summer, they will put that time to good use. In the past, ASC administrators have told us that when they get extra time, they use it to carefully review their policies and procedures to make sure they are compliant with any recent changes, take a closer look at their billing and collections to ensure they are capturing all the income they are earning and help staff complete training or earn continuing education credit they need.

With nearly all our educational resources available online this year, ASCA is a great partner for anyone

who works in an ASC and wants to earn some CE or get help tackling a specific concern inside their facility.

ASCA’s Online Training Series, for example, covers topics ranging from managing latex allergies and administering medications safely to monitoring ambulatory surgery patients during moderate sedation, responding to a malignant hyperthermia event and preventing operating room fires. Our 2021 on-demand webinar series, which still has a few presentations set to be released live this year, has tracks for materials managers, clinical directors, infection preventionists and administrators. You don’t have to hold one of those titles to be able to use the content you will find there, but if you do fill one of those positions in your ASC, you are likely to find some valuable information there. Both of these programs allow users to proceed at their own pace and earn CE credit.

Participants in ASCA’s virtual programs this year tell us that we really knocked it out of the park. I am not sure when we will be able to post as much new, high-quality digital education online in one year again. This year, even if you haven’t already registered for the original programs online, you can register now for two that received rave reviews: “Management Essentials for ASC Administrators” and “Infection Prevention for ASCs.” You will get access to all the sessions and be able to earn CE credit for both programs.

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Infusion Pump Support & Power Solutions Also, although you can no longer earn CE credit from ASCA 2021, you can still register for the full conference, view all the sessions and visit the exhibit hall. While we presented the entire ASCA 2021 conference virtually this year, we did not compromise on the quality of the content or the faculty. The program contains a wealth of information on topics ranging from communicating more effectively with the members of your board and adding new procedures to your ASC to laser safety, credentialing and recruiting non-investor physicians. Using the on-demand format, you can study in the comfort of your own home or surgery center and select only the sessions that interest you most.

All our programs and resources were created with ASCs in mind, so you never need to wonder if the material applies or is important in the ASC setting. If it doesn’t or isn’t, we don’t cover it. You can find out more about all these opportunities on the homepage of ASCA’s website (www.ascassociation.org) under the Education and Surveys tab.

While ASCs will be spending their time caring for patients, finetuning their operations and exploring new ways to take their facilities and customer service to the next level, ASCA will be continuing our conversations with White House staff, members of Congress and policymakers across the country on behalf of ASCs. During July, we typically spend time reviewing Medicare’s proposed ASC payment rule for the coming year and preparing comments to submit to the Centers for Medicare & Medicaid Services to improve the final rule.

We expect that to remain a part of our summer plans this year as well.

If you work in an ASC, I encourage you to consider ASCA your partner and use the resources ASCA provides to support you in the work you are doing this year. If you do manage to find time for a vacation, please do what is needed to stay healthy and safe.

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INDUSTRY INSIGHTS

webinars WEBINAR SERIES

Webinar Explores Sterile Processing Staff report

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he OR Today webinar “Sterile Processing: An Honest Look at What is Happening Behind Closed Doors” was sponsored by Resolute Advisory Group LLC and eligible for (1) CE credit.

The webinar was presented by David L. Taylor III, MSN, RN, CNOR, principal of Resolute Advisory Group LLC. He shared his experiences of consulting with numerous facilities.

He led attendees to examine their own practices and make necessary changes to improve quality and keep patient safety a top priority. Taylor has more than 35 years of experience working in surgical services.

Surgical instruments, endoscopes and durable medical equipment that are of subpar quality place patients at risk every day. Through this presentation, attendees were able to gain a better perspective of issues plaguing CSPD, review failures to follow recommended practices and identify the impact of negative publicity.

Attendees were also able to explore the positive impacts of following standard practices.

Taylor opened the floor to webinar attendees during a Q&A portion of the webinar. One question was “If WWW.ORTODAY.COM

storage space at an ASC is very limited, how do you avoid storing trays on top of one another?”

“Yeah, that’s a hard question to answer, because for me, I’m a visual person,” Taylor said. “When I do my lean processes, I look at all of the spaces to identify where we can potentially go with that. So, it depends how you’re storing them.

Now, if you’re storing them with the Medline wire mesh shelving what I would first look at is one, how is that shelving organized? Is it flat against the wall? Are you using it like an accordion where you have one shelf that’s fixed and 5 or 6 shelves that are on wheels so that you can move the shelves right or left? That’ll save you square footage and allow you to add more shelving. There is a metal panel system that you can apply to your walls and in there you can place plastic bins and they clip in place. That’ll also save you a lot of space without having to require new construction.”

“The additional spaces that I would look at is what’s between your instrument set and the shelf,” Taylor added. “So, on the top measure, from the top of your instrument tray to the next shelf, if you have any inches there, you can

lower that top shelf and add some space. And if you do that in enough shelves, you can sometimes add 30% more storage capacity. The Rotomat is another great example because it sits where you visualize the opening. But, where most of the Rotomat sits is maybe 20 or 30 feet above you. Behind or underneath that dropped ceiling or it can go down into the floor into your basement because it’s very elongated and you can put thousands of instrument sets in there.”

The webinar was a popular session with 170 attendees for the live presentation. Attendees provided feedback via a post-webinar survey that included the question, “Give us 3 words to describe today’s webinar?”

“Enlightening, informative, frightening,” said H. Herritt, clinical development manager, surgical and ambulatory services.

“Illuminating, informative, compelling,” Director of Infection Prevention M. Eichelberger said.

“Concise, relevant, real,” said D. Braendle, Sr. market manager/USA. For more information, visit ORTodayWebinars.live.

July 2021 | OR TODAY

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Temperature Management Market Weathers COVID-19 Staff report

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he temperature management market is projected to reach $3.2 billion by 2025, according to a report from MarketsandMarkets.

Factors promoting market growth include an increasing global incidence of chronic conditions and the subsequent increase in the number of surgical procedures.

Globally, there has been an increase in the incidence of chronic conditions, such as strokes, cardiac arrests and neurological diseases such as traumatic brain injury. Several research studies indicate that survivors of cardiac arrests can suffer from devastating neurological impairments. Temperature management devices are widely used in the prevention of neurological damage after cardiac arrests. The use of mild therapeutic hypothermia is considered to improve neurological outcomes after cardiopulmonary resuscitation. Thus, the increasing incidence of chronic diseases is expected to drive the demand for temperature management systems.

The growing number of contracts and agreements between market players is also expected to offer a wide range of growth opportunities for market players during the forecast period.

Over the years, the number of companies offering temperature management systems has increased globally.

Major market players are focusing on strengthening their product offerings, distribution networks, and geographic presence by entering into contracts and agreements with other established and emerging players in the market. This provides growth opportunities for emerging companies in the market.

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However, the high cost of intravascular temperature management systems is restraining the growth of this market.

Intravascular temperature management systems provide rapid, safe, and effective management of the core body temperature of patients. However, the cost of these systems and accessories is significantly higher than that of noninvasive systems and accessories. This can restrain market growth.

The COVID-19 pandemic has resulted in significant disruption to business and economic activity globally and is expected to show short-term impacts on the temperature management product business, according to MarketsandMarkets. Temperature management products for perioperative care are expected to be impacted to some extent because of the postponement of elective surgeries caused

by COVID-19 in 2020.

By type, the patient warming systems segment is divided into surface warming systems, intravascular warming systems, and warming accessories. The surface warming systems segment accounted for the largest share of the patient warming systems market in 2019, according to MarketsandMarkets.

Grand View Research reports that, “The global patient temperature management market size was valued at $2.64 billion in 2018 and is expected to witness attractive CAGR of 8.5% over the forecast period (through 2026).”

Patient cooling systems are anticipated to showcase lucrative growth over the forecast period, due to the rising number of cardiac surgeries and requirement of low temperature for eliminating the adverse neurologic outcomes and related brain trauma injuries, according to Grand View Research.

July 2021 | OR TODAY

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market analysis

HotDog Patient Warming System

Augustine Surgical Inc. The newest (air-free) HotDog Patient Warming System is so advanced it’s almost magic.

The HotDog Temperature Management Controller smartly manages the system’s patented conductive fabric technology that warms above and below the patient to improve normothermia outcomes. Air-free warming enhances patient and staff safety. The Normothermia Partnership Plan overcomes capital constraints and reduces warming costs. Trendelenburg patients are kept warm and secure with WaffleGrip the integrated securement technology that optimizes surgical efficiency and safety. Contact the normothermia experts at Augustine Surgical Inc. for a free demo.

CenTrak

Automated Temperature Monitoring

CenTrak’s Automated Temperature Monitoring solution offers a reliable and cost-effective way to meet regulatory requirements and ensure the safe use of blood, tissue and other critical items. Leveraging wireless networks, the sensor is easily installed to measure temperatures within a refrigerator or freezer. The sensor triggers customizable alerts such as emails, text messages or audible/visual alarms when temperatures fall outside of pre-set parameters. Automated monitoring and configurable reports eliminate the need for manual data collection and reduces the risk of human error. The solution uses NIST-certified probes to accurately log temperatures between -200 °C and 200 °C within +/-0.5 °C.

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product focus

Attune Medical ensoETM

Attune Medical’s ensoETM modulates and controls patient temperature through a single-use silicone tube inserted into the esophagus, similar to a standard gastric tube, and connected to an external heat exchange unit. Positioned in the esophagus, next to the heart and great vessels, water circulates inside the closed-loop system to efficiently warm or cool a patient. Unlike surface devices, the ensoETM’s internal placement won’t impede patient access during procedures in the OR, ER, ICU or electrophysiology lab for various temperature management applications. The ensoETM works with existing heat exchangers and is the only device cleared for use in the esophagus for patient temperature modulation.

Getinge

Combination Warming Cabinets

Getinge offers combination warming cabinets with separate, independently controlled chambers. Separate controls ensure that blankets and fluids are safely and accurately heated to recommended temperatures. The Getinge GET1850BL, GET1350BL and GET1350BL/PT (with pass-through cabinet) are designed to warm injection or irrigation fluids in the top chamber, and blankets in the bottom chamber.

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product focus

C Change Surgical SurgiSLUSH

Automate expert slush and simplify your sterile field. Outside of the sterile field, one-touch freezers automatically produce and maintain atraumatic slush in sealed, 24-hour containers. Efficient slush is ready when needed. You can add focus for priorities with no more fussing with slush during complex cases. The SurgiSLUSH closed-system slush technology automatically advances infection prevention efforts. It erases troublesome sterile barrier failures and ends prolonged, ambient exposure. Sealed containers verify sterility before every use. You can supply more slush with less equipment. Just slush, store and make more. You can auto-produce slush at the time you choose for maximum efficiency. A closed system delivers important clinical, economic and practical advantages.

For more information, visit cchangesurgical.com.

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product focus

Ecolab

CoreTemp Fluid Management System The Ecolab CoreTemp Fluid Management System advances fluid warming technology through innovation to help surgical staff with fluid management in the OR and to help mitigate fluid-related surgical risks and associated patient complications. This open basin fluid warming system is designed to accelerate surgical readiness by heating fluids to a safe and controlled temperature up to three times faster than other systems, enabling its use in urgent situations, such as trauma or labor and delivery. In addition, its basin acts as a scale with real-time, automated fluid volume tracking displays to replace guesswork with solid data, while push button height-adjustment enables easy alignment with back table heights or nurse preferences.

Encompass

Nova Patient Warming Blanket Since its introduction last fall, the Encompass Group LLC Nova Next-Generation Patient Warming Blanket has been favorably reviewed for efficacy, ease of use, clinician and patient satisfaction. Nova warms patients without air movement, reducing infection risks associated with forced air. With no moving parts, the Nova system is silent, creating no additional noise in the OR. The Nova blanket is easy to apply and to keep on a patient. The controller unit is intuitive and simple to operate. Nova banks a patient’s heat before surgery and maintains normothermia throughout the surgical process. The Nova blanket doesn’t emit excess heat, so patients stay warm while clinicians remain cool during surgery. Nova was designed with both the caregiver and patient in mind. Upper and lower body products are available.

For more information, visit www.encompassgroup.com.

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continuing education

RNs SHELTER VICTIMS OF DISASTER

By Nancy Mannion Bonalumi, DNP, RN, CEN, FAEN magine that 5 hours ago, a magnitude 6.8 earthquake struck a California community.

Even before the American Red Cross shelter is ready, people start streaming in. One young man has lacerations and burns on both arms from a broken water heater.

A woman who is 8 months pregnant is worried about her toddler, whose asthma medication is in the damaged apartment they abandoned. An older man lost his glasses and hearing aid in the confusion after the quake. A family sitting in the corner is just recovering from the flu, and 2 children have bronchitis.

A man with diabetes is worried about missing a podiatrist appointment to treat his ingrown toenails. A teenage girl wanders in crying uncontrollably.

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Welcome to the world of American Red Cross Disaster Health Services (DHS).

The Red Cross is a humanitarian organization whose goal is to help relieve human suffering during and after a disaster.1 The Red Cross has thousands of volunteer nurses in hundreds of chapters across the United States, 32

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many of whom are involved in DHS.1 But many more are needed to respond to future local and national disasters.

This course will help nurses better understand the role of Red Cross nurses during major disasters and help nurses decide whether DHS nursing may be where they can best contribute their time and talents to help their fellow citizens.

Defining a Disaster The Red Cross defines a disaster as “a sudden, calamitous event that seriously disrupts the functioning of a community or society, and causes human, material, and economic or environmental losses that exceed the community’s or society’s ability to cope using its own resources.”2 (Level C) Never in the history of the U.S. has disaster preparation and response been as vital as it is today. Disasters are classified frequently as man-made or from natural causes. In addition to the threat of manmade disasters, such as terrorist attacks, and natural disasters, such as fires, floods, storms, and earthquakes, the focus of disaster preparation has grown to include emerging infectious diseases, such as severe acute respiratory syndrome and avian influenza. In 2014, a number of people

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

Goal and Objectives The goal of this nursing continuing education program is to educate nurses about how nurses work with other team members in American Red Cross shelters to prevent injury and illness and to promote health in the aftermath of a major disaster. After studying the information presented here, you will be able to: • State at least 2 emergency support functions of the National Response Framework that the American Red Cross supports.

• Describe 5 functions a nurse performs under the American Red Cross Disaster Health Services.

• Discuss the professional and personal characteristics beneficial to caring for clients in a shelter.

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continuing education infected with Ebola entered the U.S. after serving as healthcare providers in western Africa. Once they became sick and entered the healthcare system, concerns about an outbreak began to surface. Many states began quarantinetype activities by enforcing a shelterin-place policy for people even thought to have been exposed. During the 21day incubation period, public health nurses conducted wellness checks on patients who were required to be isolated from the public.3 In the past several years, the effects of natural disasters such as major earthquakes, tsunamis, and hurricanes/cyclones have affected millions of people worldwide. Earthquakes that occurred in Nepal in 2015 and in Mexico in 2017 required a response from the International Red Cross as well as other relief agencies worldwide.4 The massive destruction from U.S. hurricanes in 2017 and 2018 imperiled community health.

The record-breaking snowstorm in January 2016 on the East Coast of the U.S. resulted in deaths, thousands of stranded travelers and commuters, and mass stoppages of public transportation, including air travel. Other natural disasters and possible large-scale terrorist attacks could do the same in the future.

An emergency is an event that requires a rapid response using available community resources. These are common occurrences that are generally handled on a local level. A disaster, however, poses a much more serious and immediate threat to the public’s health.5 Disasters quickly overwhelm local response ability and resources.

Major disasters may result in many deaths and injuries and can overwhelm a community’s healthcare system and public health infrastructure quickly.5 Occurring less than 1 month apart in 2017, hurricanes Irma and Maria: • Overwhelmed public service personnel • Destroyed buildings WWW.ORTODAY.COM

•

Depleted water, food, and medical supplies • Disrupted essential communication, utility, and sanitation services6 In a disaster, people may not have time to prepare logistically or emotionally. During a slow-rising flood or an approaching hurricane, evacuees may have time to gather essential medications and supplies and to anticipate the stresses of dislocation. However, in an earthquake or a tornado, people must seek safety on the spur of the moment and have no time to prepare emotionally for the disaster.7 Preparing for and responding to community emergencies is the responsibility of local and regional agencies.

When disaster strikes, a much larger response is necessary from state agencies.7 When the effects of a disaster exceed the capacity of state resources, states call on the federal government for help. The National Response Framework provides a structure for national disaster assistance.8 When emergencies and disasters occur, they are always immediately addressed by local first responders. As resources are overwhelmed, the National Response Framework identifies a chain of events that must take place. These steps are followed to ensure a rapid response from federal agencies: 1. Local first responders become overwhelmed and request assistance.

2. Elected/appointed officials through the local Emergency Operation Center contact the governor’s office to request state assets. The governor may enact a “State Declared Disaster.”

3. The governor’s office though the State Emergency Operation Center requests a presidential declaration.

4. The Federal Emergency Management Agency (FEMA)

region is contacted.

5. The President declares a federal disaster.

6. FEMA response teams deploy.

Emergency Operation Centers on local, state, and federal levels operate under an organizational structure that consists of 14 Emergency Support Functions (ESFs).8 These ESFs are identified in the National Response Framework as: • Transportation • Communications • Public works and engineering • Firefighting • Information and planning • Mass care, emergency assistance, temporary housing, and human services • Logistics • Public health and medical services • Search and rescue • Oil and hazardous materials response • Agriculture and natural resources • Energy • Public safety and security • External affairs

The Red Cross’s Role The primary responsibility for each ESF falls to a specific agency.9 The Red Cross, the only nongovernmental agency the National Response Framework specifically names, is the primary supporting agency for mass care, emergency assistance, temporary housing, and human services (ESF No. 6). The Red Cross also acts as a support agency for several other functions, including ESF No. 8 (public health and medical services).1 The Red Cross serves on local, state, and federal levels during disasters in the United States.

The Red Cross, founded by Clara Barton in 1881, is an independent organization supported by public contributions.1 In 1905, the U.S. Congress chartered the Red Cross to operate a program of national and international July 2021 | OR TODAY

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relief in times of peace and to help relieve suffering caused by natural and man-made disasters.1 As part of the Red Cross disaster relief response, DHS provides emergency and preventive health services to victims of disasters and to Red Cross staff assigned to a disaster relief operation.1 The year 2017 was marked with record-breaking disasters, and the American Red Cross mobilized quickly to deliver more food, relief supplies, and shelter stays than all of the previous 4 years combined.10 In just 45 days in the fall of 2017, the Red Cross responded to 6 large and complex disasters. These included hurricanes Harvey, Irma, Maria, and Nate; deadly wildfires in California; and the deadliest mass shooting in U.S. history in Las Vegas. Over 56,000 Red Cross workers, 92% of them volunteers, were deployed in 2017 to provide:

• • • •

Shelter Meals Comfort Health and mental health consultations10

Each year, the Red Cross provides relief to millions of victims of emergencies and disasters in the U.S.11 The majority of these events are house and apartment fires, to which a local Red Cross chapter disaster action team responds quickly. Team members are on call 24 hours a day to meet the immediate health and family service needs of victims. Typically, people displaced by local emergencies, such as apartment fires, are housed in local motels or hotels. The Red Cross has agreements for discounted housing rates with these lodging facilities.

When disasters affect large numbers of people who cannot remain in their own homes or find alternative housing, the Red Cross opens community shelters. Red Cross shelters may be opened in facilities such as schools that have large spaces for dormitory living, sanitary facilities, and kitchens 34

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for food preparation and distribution.

The Red Cross and local facilities establish agreements as part of disaster preparation so that the facilities can be used quickly when disaster strikes.

Shelters must follow state and local health standards for: • Food storage, preparation, and service • Sanitary facilities • Congregate dormitories • Emergency aid stations • Healthcare areas7 If compliance with local health regulations is not realistic given the extent of a disaster, DHS is responsible for obtaining waivers from public health officials or for seeking alternative arrangements.7 The Red Cross model for DHS is an RN-led model of care delivery that provides supportive and assistive care, but not direct medical care, to those affected by a disaster. The goal of DHS is to maintain the client’s level of health through assessment and monitoring, and to refer those clients requiring definitive medical care to appropriate resources.12 The Red Cross assigns DHS staff members to mass-care shelters based on their professional education and experience in conjunction with state practice acts. RNs must have active licenses.

Vocational nurses, emergency medical technicians, paramedics, and physician assistants also must have active licenses or certifications and work under the supervision of an RN or a physician.13 Preventive care and health promotion are provided according to Red Cross protocols. Each DHS protocol contains directions about: • Desired health outcomes • Client history and assessment • Points of emphasis • Management • Physician referral Red Cross general liability insurance covers professional medical personnel while they volunteer under

the supervision of authorized Red Cross staff and if they practice using expected professional judgment and management skills.

In 2009, the World Health Organization and the International Council of Nurses (ICN) published “ICN Framework of Disaster Nursing Competencies,” which defines the necessary competencies for a generalist nurse acting within the 4 phases of a disaster (prevention/mitigation, preparedness, response, and recovery/rehabilitation).14 The 2010 report issued by the Institute of Medicine (IOM), “The Future of Nursing: Leading Change, Advancing Health,” states that nurses should practice to the fullest extent of their scope of practice.15 The National Nursing Committee of the Red Cross has adopted several IOM recommendations. While recommendations from the ICN and IOM have not been fully implemented by the Red Cross, work continues on developing a competency-based model for disaster nursing.

To protect clients’ health, shelter nurses must be proactive, making regular rounds to assess clients’ physical and emotional needs continually.

Establishing and monitoring minimum standards for food and water safety, sanitation, and personal hygiene are critical for maintaining health and preventing disease.1 Disasters frequently cause power outages, water and food shortages, and damage to vital community functions.12 As a result, it is critical to prevent and control infectious diseases. Essential components of an infection prevention and control program are: • Education • Monitoring • Surveillance • Reporting Among the educational resource guides available from the Association for Professionals in Infection Control and Epidemiology website are the Infection Prevention and Control for WWW.ORTODAY.COM

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continuing education

Shelters During Disasters and the FEMA Interim Emergency Management Planning Guide for Special Needs Populations, which provides practical information about preventing an infectious disease outbreak in special needs populations. Adequate and frequent handwashing provides essential protection from the illnesses transmitted when people congregate.1 Staff uses standard precautions in shelters to prevent transmission of bloodborne infections, such as HIV and hepatitis B. DHS works closely with the Centers for Disease Control and Prevention and other organizations to prevent or minimize hazards and injuries caused by disasters.9

What to Expect After training, DHS staff may be deployed for up to 3 weeks for national disasters. To gain the most satisfaction from a disaster relief assignment, nurses should have realistic expectations about how they will care for people in a shelter. Twenty-four-hour nursing coverage and medical supervision are essential to maintain health standards and prevent further illness or injury. Nurses work 10- to 12-hour shifts and, depending on resources, may have 1 day off a week. Physical hardships can be overwhelming, even for those in excellent condition.1 Nursing staff may sleep in the shelter along with residents. Food is nutritious, but food choices may be limited.

Air conditioning and heating may not work. To provide nursing care in a shelter, nurses must be able to work effectively with many volunteers and with limited technology.1 Essential competencies are: • Assessment skills • Adaptability • Flexibility • Creativity • Good communication skills • The ability to work as a part of a team WWW.ORTODAY.COM

Effective shelter nurses combine the ingenuity of community nurses, the focus of public health nurses, and the practicality of occupational health nurses to meet the needs of people in crisis.

Although nearly everyone in a major disaster experiences stress, some people are more vulnerable than others. Those at greater risk for adverse reactions include people who: • Live alone • Lack coping skills or are mentally ill • Have limited financial and social support resources • Do not speak the local language • Abuse drugs or alcohol In the aftermath of a disaster, mental health professionals provide invaluable services to disaster victims and volunteer workers alike by supporting expressions of normal coping, treating those with coping problems, and identifying people who may be at risk for psychiatric disorders.16 DHS nurses work closely with Disaster Mental Health Services to ensure that the emotional needs of clients and volunteers are met. Nurses can refer clients to Disaster Mental Health Services when they have problems coping with the emotional aspects of the disaster or have preexisting mental health conditions that have been exacerbated by the disaster.1 People with chronic conditions, such as hypertension, cardiac and respiratory problems, and diabetes mellitus, are also vulnerable to adverse health outcomes because of the stress of the disaster itself and interruptions in their health maintenance practices.

Special needs populations, such as nursing home residents and people with developmental disabilities, are at special risk after a disaster.

After Hurricane Katrina in 2005, 34 residents of a nursing home in Violet, Louisiana, died. The owners were charged with negligent homicide

for failing to follow their own evacuation plans. This tragedy has led to an extensive review of healthcare facility evacuation plans and sheltering strategies.17 New rules require that longterm care facilities have emergency and stand-by power systems, on par with hospitals. Also, they must track patients and on-duty staff during and after an emergency.

Maslow’s hierarchy of needs is a model that can help DHS nurses work with survivors of disaster to regain physical and emotional equilibrium.18 The most basic level in the hierarchy involves physiological and safety needs. Physiological needs can be met by providing survivors of disaster with water, food, and shelter from the elements. Safety needs can be met by ensuring that the shelter is a haven from additional threats to health and survival.18 Personal and physical safety of loved ones is a major concern for survivors of disaster. Some people may need to talk repeatedly about events and feelings associated with the disaster.18 Many feel a need to be part of the recovery efforts; DHS workers can help meet this need by enlisting appropriate shelter residents to help with daily tasks.

Nurses should assess shelter residents to determine which residents should be relocated to protect their own health or the health of other residents. Such people may include: • Those who are immunocompromised • Those with a communicable disease that requires isolation • People whose physical or emotional problems prevent them from being safely sheltered • Substance abusers Nurses make and document health histories and clinical assessments for all people seen for treatment in a shelter. The history includes information such as: • The time of an injury or onset July 2021 | OR TODAY

35

IN THE OR

continuing education

of symptoms • Subjective complaints • How an injury occurred • Self-treatment and results A medical history documents the person’s: • General state of health • Previous health problems • Prescription and over-thecounter (OTC) medications • Allergies • Personal physician’s name and telephone number • The date and reason for the person’s most recent hospitalization Clinical assessment includes the person’s: • General appearance • Age • Sex • Weight • Vital signs • Objective signs, such as level of consciousness, pupil status, and skin temperature and color After assessment, clients are assigned to a treatment classification, ranging from life-threatening conditions that require immediate transport to minor conditions that can be managed in the shelter.

Starting to Recover DHS nurses provide a variety of services to meet client emergency health needs, including:1,12 • Immediate care for disastercaused or aggravated illnesses or injuries • Referrals for emergency medical care • Help in obtaining medical supplies for health maintenance • Purchase of OTC medications for disaster-related health conditions or losses • Purchase of disaster-related urgent medications and approval of payment by the Red Cross 36

OR TODAY | July 2021

or other agencies Purchase of eyeglasses, contact lenses, dentures, prosthetic devices, hearing aids and other health-related equipment required because of disaster-related health problems or losses Red Cross DHS nurses who work in a shelter are part of a team that must collaborate to meet clients’ needs. DHS volunteers come from all parts of the country, bringing with them a variety of backgrounds and experiences. No matter what their background or role, DHS volunteers have common values, among them: • Using resources wisely • Respecting clients’ confidentiality • Honoring the International Red Cross principles of humanity, impartiality, neutrality, independence, unity, universality, and voluntary service1 In addition to frequent collaboration with their mental health colleagues, nurses work closely with client caseworkers to help clients who need: • Food • Clothing • Household furnishings • Work supplies and equipment • Transportation • Help with home repairs or rent payments1,2 A shelter manager, or in a large disaster relief operation, a client services administrator, has administrative responsibility for all shelter operations.

In addition to DHS functions, key shelter functions include: • Client registration • Feeding • Mental health services • Communications • Dormitory management • Material support services • Recruitment and placement of shelter staff7 •

The nurse reports directly to the shelter manager or client services administrator. A DHS medical consultant is always available for consultation on unusual health issues.

Ready to Volunteer?

Throughout U.S. history, nurses have provided health services in response to epidemics and disasters. There are nearly 3 million RNs with active licenses in the U.S.19 Nurses have excellent assessment skills, are critical thinkers and problem solvers, and come from a variety of specialty practice areas. The Society for the Advancement of Disaster Nursing believes that all nurses should possess a basic level of knowledge and skill to respond to disasters with mass casualities.20 To be most effective in responding to a local or national disaster, nursing leaders recommend that RNs become involved with disaster relief organizations before disaster strikes.9 Nurses who want to help the Red Cross as members of a local disaster action team or as mass care shelter nurses can contact their local Red Cross chapter.

Nurses can become credentialed in disaster care by successfully completing the National Healthcare Disaster Certification examination, an American Nurses Credentialing Center-accredited interprofessional certification.

The examination provides a valid and reliable assessment of the knowledge, skills, and competencies of healthcare professionals relevant to all phases of the disaster preparedness, mitigation, response, and recovery cycles.21 Whether the next major disaster is a hurricane, pandemic influenza, an earthquake, or a terrorist attack, nurses will be called upon to contribute their expertise and energy to protect the health of the people in the U.S. Nurses need to assess how they can best contribute during a disaster. Some nurses WWW.ORTODAY.COM

IN THE OR

continuing education

may find that volunteering for specific disaster relief efforts is the best use of their knowledge and skills. Others may best contribute when they keep their organizations running during a disaster by working extra shifts and cheerfully taking on additional duties.

All nurses in the U.S. should learn more about their own organizations’ and communities’ disaster response plans and decide where they will fit in. Make disaster preparation the focus of your continuing education efforts this year.

NANCY MANNION BONALUMI, DNP, RN, CEN, FAEN, has more than 35 years of experience in emergency nursing as a clinician, an educator, and a nurse leader. She was the 2006 president of the Emergency Nurses Association. She is the president of NMB Global Leadership, LLC. Relias LLC guarantees this educational activity is free from bias.

References 1. Casey-Lockyer M, MacIntyre LM, Rodgers JC, Cole V. American Red Cross Disaster Health Services and Disaster Nursing: National Capability-Local Community Impact. In: Veenema TG, ed. Disaster Nursing and Emergency Preparedness for Chemical, Biological, and Radiological Terrorism and other Hazards. 4th ed. New York, NY: Springer Publishing Company; 2018.

2. Loke AY, Fung OW. Nurses’ competencies in disaster nursing: implications for curriculum development and public health. Int J Environ Res Public Health.

2014;11(3):3289-3303. doi: 10.3390/ ijerph110303289.

3. Drazen JM, Kanapathipillai R, Campion EW, et al. Ebola and quarantine. N Engl J Med. 2014;371(21):2029-2030. doi: 10.1056/NEJMe1413139.

4. International disasters and crises. American Red Cross Web site. https://www.redcross.org/aboutus/our-work/internationalservices/international-disasters-and-crises.

WWW.ORTODAY.COM

html. Accessed July 10, 2019.

5. Furin MA. Disaster planning. Medscape Web site. https://emedicine.medscape. com/article/765495overview. Updated July 30, 2018. Accessed July 10, 2019.

6. One year after hurricanes Irma and Maria, recovery has progressed slowly in Puerto Rico and the U.S. Virgin Islands and health care challenges remain, particularly in mental health. Henry J Kaiser Family Foundation Web site. https://www.kff.org/ medicaid/press-release/one-year-after-hurricanes-irma-andmaria-recovery-has-progressed-slowly-in-puerto-rico-and-the-u-svirgin-islands-and-health-carechallengesremain-particularly-in-mental-health.

Published September 19, 2018. Accessed July 10, 2019.

7. American Red Cross. Disaster Services: Shelter Operations Participant’s Workbook. Washington, DC: American Red Cross; 2005:1-81. https://prepareiowa. trainingsource.org/sites/default/files/ u2/10%20ARC%20Shelter%20Ops%20 Participants%20Workbook.pdf. Accessed July 10, 2019.

8. National Response Framework, Third Edition. June 2016. Department of Homeland Security. https://www.fema. gov/media-library-data/14660146829829bcf8245ba4c60c120aa915abe74e15d/ National_Response_Framework3rd.pdf.

Accessed July 22, 2019.

9. Slepski L, Couig MP, Lavin R, Orsega SM, Veenema TG. Leadership and coordination in disaster healthcare systems: the U.S. national preparedness system. In: Veenema TG, ed. Disaster Nursing and Emergency Preparedness for Chemical, Biological, and Radiological Terrorism and other Hazards. 4th ed. New York, NY: Springer Publishing Company; 2018.

10. 2017 year in review: Red Cross delivers more food, relief items and shelter stays than last 4 years combined. American Red Cross Web site. https://www. redcross.org/about-us/news-and-events/ pressrelease/2017-Year-in-Review-RedCross-Delivers-More-Food-Relief-Itemsand-Shelter-Stays-than-Last4-Years-Combined.html. Published December 7, 2017.

Accessed July 10, 2019.

11. Disaster relief. American Red Cross Web site. https://www.redcross.org/about-us/ our-work/disasterrelief.html. Accessed July 10, 2019.

12. American Red Cross. Disaster Health Services Standards and Procedures. V.1.0

Washington, DC: American Red Cross; 2017.

13. Eligibility criteria for new disaster health services volunteers. American Red Cross Web site. https://www.redcross.org/ content/dam/redcross/volunteer/pdfs/ Eligibility-Criteria-for-Disaster-HealthServices-Volunteers.pdf. Accessed July 10, 2019.

14. Dorsey DM. World Health Organization and International Council of Nurses. ICN Framework of Disaster Nursing Competencies. Geneva, Switzerland: WHO and ICN; 2009. http://www.wpro.who.int/hrh/ documents/icn_framework.pdf. Accessed July 10, 2019.

15. Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health.

Washington, DC: The National Academies Press; 2011.

16. Carlson MS, Plum KC, Meeker EC. Understanding the psychosocial impact of disasters. In: Veenema TG, ed. Disaster Nursing and Emergency Preparedness for Chemical, Biological, and Radiological Terrorism and other Hazards. 4th ed. New York, NY: Springer Publishing Company; 2018.

17. Emergency preparedness rule. Centers for Medicare & Medicaid Services Web site. https://www.cms.gov/Medicare/ProviderEnrollment-and-Certification/SurveyCertEmergPrep/EmergencyPrep-Rule.html.

Updated May 8, 2019. Accessed July 10, 2019.

18. Maslow AH. Motivation and Personality.

2nd ed. New York, NY: Harper & Row; 1970.

19. Agazio JBG, Slepski LA, Lavin RP, Couig MP, Strauss-Riggs K, Ricciardi R. Directions for disaster nursing research and development. In: Veenema TG, ed. Disaster Nursing and Emergency Preparedness for Chemical, Biological, and Radiological Terrorism and other Hazards. 4th ed. New York, NY: Springer Publishing Company; 2018.

20. About. Society for the Advancement of Disaster Nursing Web site. https://disasternursing.org/about. Accessed July 11, 2019.

21. National healthcare disaster certification (NHDP-BC). American Nurses Credentialing Center Web site. https:// www.nursingworld.org/our-certifications/ national-healthcare-disaster. Accessed July 11, 2019.

July 2021 | OR TODAY

37

IN THE OR

continuing education Clinical Vignette About 170 people are housed in an American Red Cross shelter because of extensive local flooding.

Tiffany Edwards, a Red Cross volunteer nurse, has been assigned to care for people in the shelter. Among the shelter residents is 38-year-old Janie Jackson, the sole caregiver for her 72-year-old mother with schizophrenia. Ms. Jackson has asthma and lost her inhaler in the flood. She has no acute respiratory symptoms, although she appears anxious. She states that her mother’s medications, which are essential for behavioral control, were left behind during the evacuation. George Lopez, age 54, is a Red Cross volunteer asking for treatment of a cut he sustained while helping unload shelter equipment.

1. An appropriate referral for Ms. Jackson and her mother is to: a. The shelter manager c. An on-call MD consultant b. A Disaster Mental Health d. Local EMS Services volunteer 2. After determining that Ms. Jackson’s mother would be most safely housed in a nonshelter environment, with whom should Tiffany make arrangements for alternative housing? a. A local MD consultant c. The shelter manager b. A local motel d. Another Red Cross volunteer 3. In deciding how to care for Mr. Lopez, which strategy should Tiffany follow? a. Educate Mr. Lopez about the Red Cross protocol for asimportance of wearing work sessment and treatment of gloves. skin injuries. b. Advise the shelter manager d. Consult with other volunthat Mr. Lopez will be unable teers about which action to to volunteer. take. c. F ollow instructions in the 4. Which health practice would be most effective in helping to prevent the spread of infection in a shelter? a. F requent and thorough handwashing b. Advising clients to wear disposable gloves c. K eeping cots at least 25 feet apart d. C ontacting the local health department to distribute hygiene brochures

Clinical VignettE ANSWERS 1. Answer: B, A Disaster Mental Health Services volunteer 2. Answer: C, The shelter manager 3. Answer: C, Follow instructions in the Red Cross protocol for assessment and treatment of skin injuries. 4. Answer: A, Frequent and thorough handwashing 38

OR TODAY | July 2021

CE409-60

How to Earn Continuing Education Credit 1. Read the Continuing Education article.

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

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

Deadline Courses must be completed by 9/6/2022 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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Questions or for a complete listing of our courses Phone: 877-843-8374 Email: nursesupport@relias.com

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July 2021 | OR TODAY

39

U P D A T E

O N

SURGICAL SMOKE L E G I S L A T I O N

By Don Sadler

40 OR TODAY | July 2021

WWW.ORTODAY.COM

T

he dangers of surgical smoke in the operating room have long been apparent.

Nearly four decades ago, it was first documented that particulate matter in

surgical smoke can be inhaled and deposited in the lungs of OR personnel.

The health care profession has unfortunately been slow to deal with this problem. But this is finally starting to change: A growing number of states are introducing and passing legislation requiring hospitals and ambulatory surgery centers (ASCs) to use smoke evacuation systems to prevent human exposure to surgical smoke.

Three states have passed such legislation so far: Rhode Island, Colorado and, most recently, Kentucky, whose surgical smoke law passed in March of this year. In addition, surgical smoke legislation has been introduced in Connecticut, Georgia, Illinois, Iowa, New Jersey, Ohio, Oregon and Texas.

What is Surgical Smoke?

Surgical smoke is a byproduct created by the thermal destruction of tissue when using lasers, electrosurgical systems, radio frequency devices, hyfrecators, ultrasonic scalpels, power tools and other heat destructive devices in the OR, says Laura Gayton, MHCA, RN, CNOR, CSSM, associate director, standards interpretation for The Joint Commission.

“Research studies confirm that the surgical smoke plume can contain toxic gases and vapors such as benzene, hydrogen cyanide, formaldehyde, bioaerosols, dead and live cellular material (including blood fragments) and viruses,” says Gayton. “In some fields, it’s also possible to generate particulates and metal fumes.”

Gayton says that patient exposure to surgical smoke is short-term and relatively low risk. “However, surgeons, perioperative nurses and other OR staff are exposed to surgical smoke daily,” she says. “At high conWWW.ORTODAY.COM

centrations, the surgical smoke causes ocular and upper respiratory tract irritation and creates visual problems for the surgeon.”

“Most of what’s in surgical plume is 1.1 microns in size or smaller,” says Kay Ball, Ph.D, RN, CNOR, CMLSO, FAAN, a perioperative consultant and adjunct professor at Otterbein University in Westerville, Ohio.

“Any particles less than 10 microns can be irritating to lung tissue, and ultrafine particles can settle in alveoli, causing lung and air exchange problems,” says Ball. “Some of these particles may contain viable pathogens that can be transmitted in plume.”

Ball first performed research into the effects of surgical smoke on OR personnel in 2010 and then repeated parts of the research in 2020. “The results of the first study repeated 10 years later, which demonstrates a profile for perioperative nurses,” she says.

When asked if they had respiratory disorders or diseases, OR nurses in Ball’s study reported twice the incidences of respiratory problems compared to the general population.

For example: • 22.9% of OR nurses reported sinus infections and sinus problems compared to 11% of the general population • 10.9% of OR nurses reported asthma compared to 7.6% of the general population • 9% of OR nurses reported bronchitis compared to 3.4% in the general population • 24.2% of OR nurses reported allergies compared to 15% in the general population “There are many research studies that have shown the dangers of surgical smoke,” says Ball. “In AORN’s

‘Guideline for Surgical Smoke Safety,’ there are 223 references that help document the hazards of surgical smoke.”

In a study reported in the Journal of Clinical Nursing in 2016, 49% of nurses and 58% of surgeons reported experiencing headaches, 40% of nurses and 42% of surgeons reported watery eyes, and 49% of nurses and 28% of surgeons reported coughing due to exposure to surgical smoke.

Sore throat, nausea, drowsiness, dizziness, sneezing, rhinitis and bad odors absorbed in the hair were also attributed to surgical smoke by nurses and surgeons in this study.

Status of State Legislative Efforts Brenda C. Ulmer, RN, MN, CNOR, has been spearheading efforts to get surgical smoke legislation passed in Georgia for more than two years.

“Nurses and technicians who are tired of breathing smoke in the workplace are taking matters into their own hands by telling their story to legislators and asking for help through the political system,” she says.

Ulmer says she began her efforts after learning at the AORN Surgical Conference and Expo in 2019 that two states had passed surgical smoke laws.

“That’s when I decided Georgia should be the next state to pass legislation to protect patients and health care workers from surgical smoke,” says Ulmer, who was named the Georgia Council Legislative Chair in 2019. “It has been a seesaw journey since then.”

Due to the efforts of Ulmer and several others – including Vangie Dennis, MSN, RN, CNOR, CMLSO, assistant vice president, perioperative July 2021 | OR TODAY

41

KAY BALL

Ph.D, RN, CNOR, CMLSO, FAAN, a perioperative consultant and adjunct professor at Otterbein University in Westerville, Ohio

services with AnMed Health – two surgical smoke bills will be active on the first legislative day of 2022 in Georgia.

“Georgia is in a two-year legislative cycle so this puts us in a good position for getting legislation passed next year,” says Ulmer. “Georgia could be one of the next states to adopt surgical smoke legislation – hopefully by the spring of 2022, which is our goal.”

Unfortunately, surgical smoke legislation in Texas suffered a setback recently when legislation was pulled just before testimony was scheduled

by Beverly Kirchner, president of the Texas Collaboration of periOperative Registered Nurses (TCORN), and J.D. Buchert, MSN, M.Ed., MS, RN, president of the Dallas Association of Perioperative Nurses.

“As perioperative nurses, we want to help save lives and not be put in danger while doing it.”

– J.D. Buchert, MSN, M.Ed., MS, RN, president of the Dallas Association of Perioperative Nurses

“We still have Senate Bill 429, but we were told that it would not make it to the committee this session,” says Kirchner. “We will now go the regulatory route instead of waiting 18 months to introduce the bill again. If we’re unsuccessful with the regulatory pathway, we will plan to come back and introduce the bill again in 2023.”

“As the president of TCORN, I plan to lead the effort to work with the Texas Health and Human Services and obtain a regulatory rule to ensure smoke evacuation is used to protect the perioperative team and the patient,” Kirchner adds.

Buchert points out that there is now four decades of knowledge and research when it comes to the dangers of surgical smoke. “With knowledge of people who have passed away and gone through cancer treatment due to inhaling surgical smoke, I believe our bill is important and needs to be passed to support the health of OR workers,” he says.

“My biggest reason for advocating so heavily on this topic is simple: Because it’s the right thing to do,” Buchert adds. “As perioperative nurses, we want to help save lives and not be put in danger while doing it.”

Ball says that her home state of Ohio introduced a smoke evacuation bill this spring. “The state bills are all very similar,” she says. “Most simply state that in hospital ORs or ambulatory surgery centers, a policy must exist on how to remove surgical smoke and the policy must be followed.”

Keys to Legislative Success According to Jennifer Pennock, senior 42

OR TODAY | July 2021

BEVERLY KIRCHNER President of the Texas Collaboration of periOperative Registered Nurses (TCORN)

manager, government affairs, for the Association of periOperative Registered Nurses (AORN), surgical smoke evacuation legislation tends to be most successful in states with a strong group of grassroots advocates committed to working on policy advocacy for multiple years and through legislative sessions.

“To lay the groundwork for successful legislation, it is important for AORN and the advocates to engage with stakeholders early in the process,” says Pennock. “It’s also important to identify a strong bill sponsor in the House or Senate who will throw their political influence into the success of the bill.”

Support from state nurses’ associations and state hospital associations also contributes to the success of legislation, Pennock adds. “A strong bill sponsor can help all the stakeholders involved see the merits of the legislation,” she says.

Despite some setbacks and what might appear to be a slow pace, Ulmer believes that trying to get surgical smoke legislation passed at the state level is a smart strategy. “We have tried for many years to get some sort of national mandate on surgical smoke, but without success,” she says.

Often, the biggest obstacle to getting surgical smoke legislation passed by states is good old-fashioned politics.

“Georgia has been especially contentious with opposition from the hospital association and one particular surgeon,” says Ulmer.

“Not to mention the political divide between Democrats and Republicans in the Georgia state legislature. We have learned as we’ve tried to work through the political system.”

In addition to legislation, there are WWW.ORTODAY.COM

JENNIFER PENNOCK Senior manager, government affairs, for the Association of periOperative Registered Nurses (AORN)

also recommendations and guidance regarding surgical smoke from regulatory bodies. For example, NIOSH recommends that a smoke evacuator be on at all times when airborne particles are produced during all surgical or other procedures.

“Unfortunately, this is simply a recommendation and does not require compliance,” says Pennock.

“State laws requiring surgical smoke evacuation policies provide a pathway for the accrediting organizations to enforce facility adherence to their own policies on surgical smoke evacuation through the organization’s accreditation processes,” Pennock adds.

Steps to Reduce Surgical Smoke It could obviously be quite some time before surgical smoke legislation is passed in all 50 states. So, what can hospitals and ASCs do in the meantime to reduce the risks of surgical smoke to OR personnel? Gayton recommends the following steps: • Implement standard procedures for the removal of surgical smoke and plume through the use of engineering controls, such as smoke evacuators and high filtration masks.

“Use specific insufflators for patients undergoing laparoscopic procedures that lessen the accumulation of methemoglobin buildup in the intra-abdominal cavity,” says Gayton.

“For example, a lapro-shield smoke evacuation device helps clear the field inside the abdomen.”

• During laser procedures, use standard precautions to prevent exposure to the aerosolized blood, blood byproducts and pathogens contained in surgical smoke plumes. “These include WWW.ORTODAY.COM

those promulgated by the Blood-Borne Pathogen Standard and the CDC’s Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings,” says Gayton.

• Establish and periodically review policies and procedures for surgical smoke safety and control.

“Make these policies and procedures available to staff in all areas where surgical smoke is generated,” says Gayton.

• Provide surgical team members with initial and ongoing education and competency verification on surgical smoke safety, including the organization’s policies and procedures.

• Conduct periodic training exercises to assess surgical smoke precautions and consistent evacuation for the surgical suite or procedural area.

Gayton recommends reading The Joint Commission Quick Safety Issue 56 (http://tinyurl.com/4a7y937v) for more detailed guidance in alleviating the dangers of surgical smoke.

“Awareness of the dangers of surgical smoke has certainly increased when we consider the impact of The Joint Commission’s Quick Safety Alert, along with the growing interest in states to enact legislation,” says Pennock. “AORN also provides ongoing education about surgical smoke to our membership and the larger perioperative community.”

Pennock mentions the AORN Go Clear program specifically. “This is a comprehensive approach to protecting patient and worker safety by promoting a smoke-free environment

LAURA GAYTON MHCA, RN, CNOR, CSSM, associate director, standards interpretation for The Joint Commission.

“Nurses and technicians who are tired of breathing smoke in the workplace are taking matters into their own hands by telling their story to legislators and asking for help through the political system.”

– Brenda C. Ulmer, RN, MN, CNOR

wherever surgical smoke is generated,” she says. It includes all the tools and protocols needed to start or enhance smoke evacuation practices.

Since the AORN Go Clear program was first implemented, more than 1,200 facilities have registered for the program and 129 facilities have received the Go Clear award. “In addition, more than 19,000 facility staff are enrolled in the education portal,” says Pennock.

For more information about the AORN Go Clear program, visit https://www. aorn.org/member_apps/Product/ Detail?productID=9709.

July 2021 | OR TODAY

43

SPOTLIGHT ON:

LETICIA

RAMIREZ

Director of Nursing at Illinois Sports Medicine and Orthopedic Surgery Center of Morton Grove, Illinois

BY MATT SKOUFALOS n 2001, Leticia Ramirez was working in customer service for Commonwealth Edison, the largest electricity provider in Illinois. She’d felt pushed to embrace a more meaningful career, and knew she needed to make a change in her current path if that was to happen. The terrorist attacks of September 11

I

simply catalyzed her resolve.

you have to work that much harder,” Ramirez said. “You have to have a strong foundation and be dedicated.”

Her dedication to her studies and her son never wavered. Ramirez recollects working 38 hours in a given weekend to free up her

weekdays for study and attending to his needs as a room mom, Little League coach, and youth football volunteer.

By the time she graduated in 2007, Ramirez was already prepared for the long hours of working in the surgical unit of a Level One trauma center, Advocate Christ Medical Center in Oak Lawn, Illinois.

Its proximity to the south

“It was something that was a wakeup call,” Ramirez said. “Whether it was 9/11 itself, or the way that the company was changing, or the economy and different things, I knew I needed to do something a lot more meaningful.”

“I’ve been on my own since I was 17; I had my son very young,” she said.

“When my son started kindergarten, I started nursing school.”

The experience was intense.

Nursing school on its own is a challenge; for a single, working mother of a school-aged child, there were some added hurdles. Ramirez didn’t shy away from any of them. “It was hard,” she said.

“I wouldn’t wish nursing school on my worst enemy.”

“I had a great professor who told us our first semester, ‘You will have no life, and you need to be OK with it,’ ” Ramirez recalled. “‘Nursing school will ‘de-A’ you’ — we’re all pretty much A students — and you have to be OK with it,’ ” her professor told them.

“You can’t let it crush you; 44 OR TODAY | July 2021

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side of Chicago meant that the facility saw the effects of 50 to 60 shootings on any given weekend. Ramirez fielded trauma calls while putting her stamp on the orthopedic surgery team, where she quickly rose to become a critical player during her five-year career there.

“It was exactly what I wanted to do,” Ramirez said. “I loved it, loved the people, and loved helping people.

Every day is different, kind of wild, but I enjoyed it very much. I got the best foundation in nursing there.”

She described the experience of working in her first operating room as “totally baptism by fire,” and credits her generally calm demeanor with endearing her to surgeons who “were very highadrenaline.”

“They used to kick other people out and ask for me in really tense situations,” Ramirez said.

In addition to supporting the emergency department, Ramirez found that she enjoyed working orthopedic cases quite a bit. That feeling stuck with her as she ramped up to 80-hour work weeks in the years that followed. But as her son was approaching high school, Ramirez decided to slow down the pace of things so that she could be more available for him.

She gave up the hospital environment for an office environment, running a private-practice orthopedic group for four years while spending more time with her son. The change also gave her a fuller picture of the patient experience, including pre- and post-surgery.

“In surgery, you only see the patients

able to put the pieces of the puzzle together is awesome.”

As her career progressed, Ramirez also discovered an interest in osteoporosis care, which had been highlighted by the World Health Organization as an area of concern given the mortality related to hip fractures. She wanted to bring awareness to the condition, and was pulled into a different care setting at Mid-America Orthopedics, where Ramirez helped to start a bone health program; eventually, she ran the surgery scheduling department, was active in marketing and business development at the facility, and became its surgery center administrator.

In November 2020, Ramirez left that position to join the Illinois Sports Medicine and Orthopedic Surgery Center, where she is the director of nursing. She’s also going back to school to complete her MBA at Purdue University, and even though she’s working as a director of nursing, she still scrubs in for procedures when staff are shorthanded.

“You can do a new job every year in a nursing role and never do the same thing twice,” Ramirez said. “There are so many different avenues.”

“My advice is live out your dreams and do what you want to do,” she said.

“It’s one thing at a time; you never know which turn you’re going to take, or when it will turn.”

As a nursing leader, Ramirez said she is motivated to make her institution a great place to work, making sure staff are motivated to care for their

– Leticia Ramirez when they’re asleep,” Ramirez said. “You never know what it took to get them there, or what their outcomes are. Being WWW.ORTODAY.COM

patients, themselves and to help the center thrive. In an ambulatory setting, the environment is smaller and more

controlled, which Ramirez believes offers a better work-life balance for everyone.

“I am very much into orthopedics and creating a great place for people to have a career,” she said. “But even before I graduated, working as a nurse extern, it’s gratifying knowing that you’re helping patients and helping them reach their goals.”

“In administration, I’ve been able to be exposed to more of the economics of health care, and, by being able to control costs in an ambulatory center, we are able to provide the same care with a much more cost-efficient model,” Ramirez said. “That’s not only helping the patients with their problems but this country in general.”

When she’s not working, Ramirez enjoys exercising on her Peloton, traveling and restoring her home.

Today, her son is an adult as well, working full-time and househunting himself. She takes pride at having been able to raise him as a working mother in a career that has made a meaningful difference in her community.

“There are a lot of admirable nurses in society,” Ramirez said.

“It’s a good way to give back, and to be able to take care of patients is an honor.

You feel it on the very first day.”

July 2021 | OR TODAY

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OUT OF THE OR fitness

Can I Get A Good Workout in 20 Minutes?

By Miguel J. Ortiz ealth and wellness are on everyone’s mind.

The COVID-19 pandemic has forced many people to make incredible changes. Sitting in front of a computer has become even more normal than before. Which is why I’m here to tell you that you can make some serious changes with just 20 minutes a day.

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There’s no better time than now to take your exercise program seriously.

The key is consistency. I want you to get to a point where you are exercising daily. So, for all my regular exercise fans, thank you for being consistent in your routine and keeping yourselves healthy. For my folks who don’t have a consistent regimen, lets step it up and start with this daily 20-minute workout routine. It will give you a solid foundation to build upon.

Some of you may be saying, well I have a friend that works out a lot and even they have rest days. Well yes, their routine is consistent and already planned out. I’m talking to two types 46

OR TODAY | July 2021

of people right now. The ones who are not exercising regularly and those who want a solid 20-minute workout to keep themselves moving when they are having a busy day.

So, let’s jump right into it.

First, we are trying to establish a baseline of endurance. So, a couple key rules. No breaks, your time to rest is your transition in and out of exercise.

No water until the end of the workout.

All you need to start is your body, a mat and a timer. We will be performing a two-minute warmup to start. The warmup will involve 10 reps of four exercises for as many rounds as possible in two minutes with a slow pace (besides the jumping jacks). The four exercises are hamstring sweeps, quad stretches, high knee pulls and jumping jacks.

The workout will consist of the following exercises. We want to perform all movements with a consistent flow in order to assist cardiovascular function. For strength and flexibility we want to perform all movements as best as possible with a full range of motion. Also,

during the strength portion, we will only be keeping time so we don’t need to worry about rushing through reps. Consistency and tempo control are the goals. You will do these four movements, for one minute each for 4 rounds (16 minutes total).

• Prisoner squats • Push up to alternating full plank rotation • Glute raise marches • Alternating lunges For the two-minute cool down, we are going to perform some of the exercises from the warmup. The difference is that we will do them slower and hold the stretch for a couple seconds longer to let the body know we are slowing down. Have fun progressing your workout as you get stronger and more consistent. The cool down exercises are hamstring sweeps, quad stretches, high knee pulls and alternating rear deltoid/arm cross over stretch.

Editor’s Note: Videos on how to perform the exercises mentioned can be found on YouTube.

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OUT OF THE OR health

Better Post-Surgical Care Would Boost Cancer Survival Chances atients’ chances of survival after cancer surgery is strongly linked with the standard of post-operation hospital care, a major international study suggests.

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Patients in low- and lower-middleincome countries were up to six times more likely to die from complications within 30 days of surgery compared with those in high-income countries, the report said.

Hospitals in these countries were found to be less likely to have postsurgical facilities or care plans in place.

Investing in appropriate recovery and ward space, trained staff, early warning systems and critical care facilities would result in much improved surgical care and reduce the number of deaths, experts said.

In the largest study of its kind, researchers from the Universities of Birmingham and Edinburgh examined data for nearly 16,000 patients in 428 hospitals across 82 countries who underwent surgery for breast, bowel and stomach cancer between April 2018 WWW.ORTODAY.COM

and January 2019.

Surgery is an important part of cancer treatment with 80 percent of cancer patients undergoing a procedure.

Stomach cancer patients who underwent surgery were three times more likely to die in low and lowermiddle income countries than those in high-income countries. It was four times more likely for bowel cancer patients in low and lower-middleincome countries to die than those in high-income countries. There was no difference in deaths between countries for patients who underwent breast cancer surgery.

Complications following surgery are common, but hospitals that provide a high standard of post-operative care had the best outcomes, even when treating late-stage cancers, the study found.

Collaborative lead Dr. Aneel Bhangu, from the NIHR Global Health Research Unit on Global Surgery, at the University of Birmingham, commented, “Our findings demonstrate major variation between countries in

delivering post-operative care. There is a clear benefit to global expansion and standardization of the care that patients receive after surgery. We urge care providers to examine and, where necessary, improve the standard of post-surgical care for all patients.”

Low- and lower-middle-incomecountries that had post-operative care facilities in place were associated with seven to 10 fewer deaths per 100 complications.

The research, published in The Lancet, has been funded through the NIHR Global Health Unit on Global Surgery. The team only looked at early outcomes following surgery, but, in future, they plan to study longer-term outcomes and other cancers.

Professor Ewen Harrison, professor of surgery and data science, University of Edinburgh, said, “Rich and poor countries alike have talented surgeons and anesthesiologists, but low resource countries do not have the infrastructure to support the complications that occur during surgery. We now know this can have a major impact on whether or not a patient survives.”

July 2021 | OR TODAY

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OUT OF THE OR EQ factor

The Value of Empathy By daniel bobinski, M.Ed. n my last column I presented 10 reasons people leave their jobs, and how a boss’s lack of empathy was a major factor in creating the conditions for people to leave. Replacing employees is expensive. You can use a person’s annual salary as a reliable estimate of “cost to replace.” Therefore, bosses who fail to develop empathy can cost their companies a lot of money.

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Empathy is a not usually an innate skill. It comes easier to some than others, but for most it requires a conscious decision. That said, if one wants to learn it, it’s certainly learnable.

In the Emotional Intelligence model, empathy is something that works in concert with a solid base of self-awareness and self-management.

In other words, without a solid foundation from which to operate, empathy easily gets misdirected.

Self-awareness encompasses many facets, and a great place to start is with behavioral styles. I always recommend DISC assessments for understanding your preferences in responding to problems, influencing others, your preferred workday pace and how you respond to rules and procedures.

Other assessments to use to increase self-awareness are the Driving Forces assessment, which identifies your learned motivations, and the 48

OR TODAY | July 2021

Myers-Briggs Type Indicator, which identifies your cognitive style preferences, such as perceiving, processing and making decisions.

The other half of the foundation is self-management. This means being able to manage yourself in light of your strengths and weaknesses.

Now that I’ve briefly reviewed the need for a self-awareness/self-management foundation, let’s talk about empathy. Empathy is generally defined as the ability to understand the thoughts and feelings of others based on their current state of mind. This is essential in the arena of emotional intelligence.

We can examine three different aspects of empathy. First is the “thoughts,” or cognitive facet. This is being able to genuinely understand someone else’s perspective on matters, without having to agree or disagree. This can be tough for some people. I’ve had workshop attendees tell me they would not acknowledge an alternative point of view because, according to them, it would indicate agreement. Nothing is further from the truth.

The second aspect is “feelings,” or the emotional facet. This is being able to understand the impact someone’s emotions have on their current mindset, without judging the feelings to be good or bad. It doesn’t mean assimilating the same feelings. Empathy in this context means being able to ascertain someone’s feelings.

Third is the aspect of compassion.

Again, this does not mean you must agree with someone’s thoughts or feelings, but rather creating what I call a “safe” environment. Let people think their thoughts and feel their feelings.

People are wired to be a certain way, and to deny their perspectives or feelings about a matter is to create an atmosphere of rejection. That’s not an atmosphere conducive to cooperation and productivity.

By the way, the reason the skill of empathy is aided by a solid foundation of self-awareness and self-management ability is because you end up becoming a student of your own human nature as a subset of the different ways people do things. With that broader understanding it is easier to practice empathy.

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 him through his website at MyWorkplaceExcellence.com or call his office at 208-375-7606.

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OUT OF THE OR nutrition

Embracing Beets for Heart Health

By KIRSTEN Serrano bet if I say stress eating, you think of a pint of ice cream or your favorite nachos. Stress can certainly drive you to make less than ideal food choices, but you can also eat to counteract its effects.

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I love an underdog and when it comes to vegetables, my favorite is the beet.

It is undervalued and all too absent from our plates. Beets have a lot of great health properties but let’s focus on beets and heart health. They truly help keep your heart “beeting.” Pun intended. Beets lower blood pressure, lower homocysteine levels (more on that below) and help regulate blood lipids (your cholesterol profile.)

Homocysteine is a byproduct protein that is released when the amino acid methionine is broken down in your body. If you are eating a nutrientrich diet (and one notably high in B vitamins), your body can quickly break down the homocysteine into other substances the body needs. Your blood should have low levels of homocysteine. Unfortunately, higher than normal levels are a common occurrence. High levels are toxic and inflammatory. If present, that inflammation is damaging your blood vessels. Beets can come to the rescue. The high levels of betaine in beets are excellent at helping the body detox homocysteine. Consuming beets can reduce your homocysteine levels and cool inflammation.

There is more good news about WWW.ORTODAY.COM

beets and your cardiovascular system.

Your body uses the plentiful nitrates in beets to make nitric oxide. The nitric oxide then works to relax blood vessels and improve blood flow. The results are so dramatic and important that athletes use beet juice to improve stamina and nitroglycerine is given during heart attacks. Better blood flow even improves brain performance and helps erectile dysfunction!

Finally, the high amounts of fiber in beets help regulate your cholesterol levels. They absorb dietary cholesterol in the digestive system and shuttle it out of the body.

So, is there a best way to eat beets?

All ways! They are tasty steamed, pickled, roasted and raw. Here are a few considerations when consuming beets: Do not boil them. You are boiling away nutrients and then dumping them down the drain.

Betalains are one of the phytonutrients that give beets their beautiful color and make them antioxidant, antiinflammatory and detoxifying powerhouses. Betalains are richer in beets than other plant foods. Betalains are steadily degraded while being heated.

Steam beets for 15 minutes or less and keep roasting times to under one hour.

Eat them raw! Beets are high in carbohydrates and will spike blood sugar more than non-starchy vegetables. When you eat beets raw, they have less of an impact on blood sugar levels which may be important for

you. While I do not recommend eating them like an apple (that would be a chore and you would be a mess,) they can be grated, cut into thin noodles or very thinly shaved for all kinds of uses.

Beets are popular for juicing, but the whole vegetable is a better option.

When you juice them (or anything for that matter) you get the natural sugars and some of the nutrients, but you lose the fiber. You probably need more fiber in your life, so do not toss it away. Fiber helps to control blood sugar rise as well as being essential for digestive health.

If you have a powerful blender you can add beets to smoothies and give them a beautiful hue.

Beets are in season year-round for most of us and they store well, so stock up. Beets greens are not trash! Use the greens in the same way you would use chard and kale. They are also nutrientdense powerhouses.

If you think beets are not for you, I encourage you to keep trying them in new ways. They are worth it and your heart will thank you.

Kirsten Serrano is a nutrition consultant, chef, farmer, food literacy educator and the best-selling author of “Eat to Your Advantage.”

You can find out more about her work at SmallWonderFood.com.

July 2021 | OR TODAY

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OUT OF THE OR recipe

Fried Lobster po boy burgers with pimento remoulade INGREDIENTS: Pimento Remoulade: • 1/2 cup mayonnaise • 1 1/2 tablespoons minced pimentos

Recipe

• 1 tablespoon Dijon mustard

the

• 1 tablespoon minced bread and butter pickles • 1 pepperoncino (seeded and minced) • 1/4 teaspoon smoked paprika • 1/4 teaspoon garlic powder • 1/4 teaspoon freshly ground black pepper • 1 tablespoon freshly squeezed lemon juice • 3 dashes hot sauce • kosher salt, to taste

Fried Lobster Tails: • Vegetable oil, for frying • 1/2 cup all-purpose flour • 1/2 teaspoon kosher salt, divided • 1/2 teaspoon freshly ground black pepper, divided • 1/4 teaspoon garlic powder • 1/4 teaspoon smoked paprika • 1 large egg • 1 tablespoon water • 2 dashes hot pepper sauce • 1/4 cup potato chips, finely blended in food processor • 1/3 cup panko breadcrumbs • 1 tablespoon minced flat leaf Italian parsley • 2 Omaha Steaks lobster tails (5 ounces each)

Cheeseburger: • 1 pound Omaha Steaks premium ground beef • salt, to taste • freshly ground black pepper, to taste • 2 tablespoons unsalted butter, at room temperature • 2 brioche buns • 2 slices yellow cheddar cheese • 3 leaves romaine lettuce, shredded

By Family Features

50 OR TODAY | July 2021

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OUT OF THE OR

A Sizzling Summer Meal

recipe

By Family Features ummertime, for many, represents an opportunity to enjoy freshly cooked meals while enjoying time outdoors. Taking your dishes from ordinary to extraordinary starts with chef-inspired recipes that call to mind the flavors of the season.

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If you’re a summer burger connoisseur looking for a fresh twist on tradition, this recipe calls for high-quality beef from Omaha Steaks. Created by Omaha Steaks Executive Chef David Rose, these Fried Lobster Po Boy Burgers with pimento remoulade sauce are a tempting way to combine two summertime favorites – seafood and burgers.

Visit OmahaSteaks.com for more summer meal inspiration.

fried lobster po boy burgers: Prep time: about 20 minutes Cook time: about 20 minutes Servings: 2 1. To make pimento remoulade: In small bowl, mix mayonnaise, pimentos, mustard, pickles, pepperoncino, paprika, garlic powder, black pepper, lemon juice and hot sauce until well incorporated.

Season with salt, to taste.

2. Preheat grill to 400 F and add oil to 10-inch cast-iron pan about 1/2-inch deep.

3. In medium bowl, whisk flour, 1/4 teaspoon salt, 1/4 teaspoon pepper, garlic powder and smoked paprika until well incorporated. Set aside.

4. In separate medium bowl, whisk egg, water and hot pepper sauce. Set aside.

5. In third medium bowl, whisk potato chips, panko breadcrumbs and parsley until well incorporated. Set aside.

6. Cut lobster tails in half lengthwise, remove meat from shell and season with remaining kosher salt and black pepper.

7. Toss halved lobster tails in flour mixture first, egg mixture second then potato chip mixture third, coating thoroughly.

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8. Fry lobster tails 3-4 minutes on each side until golden brown and cooked through. Close grill lid between flipping.

9. Preheat grill to 450 F using direct heat. Form ground beef into two 1/2 pound patties, each about 1/2-inch thick.

10. Using thumb, make dimple in center of each patty to help cook evenly.

11. Season both sides of burger with salt and pepper, to taste. Spread butter on each cut side of buns.

12. Grill burgers 4-5 minutes per side for medium doneness.

13. Add one slice cheddar cheese on each burger, close lid and grill about 30 seconds to melt cheese. Remove patties from grill to clean plate. Place buns cut sides down on grill grates and toast 2030 seconds, or until well toasted, being careful to avoid burning.

14. To assemble: Place desired remoulade on buns. Place cheeseburgers on bottom buns. Top each with two fried lobster tail halves. Place handful shredded lettuce on lobster tails. Top with buns.

Recipe courtesy of Omaha Steaks Executive Chef David Rose July 2021 | OR TODAY

51

OUT OF THE OR pinboard

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Up-to-date and informational on recommended guidelines and practices.”

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Instructor- Perioperative

H QUOTE OF THE MONT

bow, you in ra e th t n a w u o y “The way I see it, if e rain.” gotta put up with th — Dolly Parton

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OR TODAY | July 2021

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The News and Photos

OUT OF THE OR

that Caught Our Eye This Month

pinboard

EXERCISE REDUCES RISK OF AIRWAY DISEASE

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xercise appears to reduce the long-term risk of bronchiecta-

year 25. Preservation

sis, a potentially serious disease of the airways, according to

of cardiorespiratory

a study published in the journal Radiology.

Bronchiectasis is characterized by repeated cycles of inflammation and exacerbations that damage the airways, leaving them enlarged, scarred and less effective at clearing mucus.

fitness reduced the odds of bronchiectasis on CT at year 25.

“In an adjusted

This creates an environment ripe for infections. Risk increases

model, one minute longer treadmill duration between year zero

with age and the presence of underlying conditions like cystic

and year 20 was associated with 12% lower odds of bronchiec-

fibrosis. There is no cure.

tasis on CT at year 25,” Diaz said. “Having preserved fitness at

Computed tomography (CT) is used to confirm or rule out the disease in patients with symptoms like shortness of breath

middle age is associated with lower chances of bronchiectasis.”

The researchers pointed to several possible explanations for

and coughing up mucus. Bronchiectasis has also been found on

the relationship between cardiorespiratory fitness and bronchi-

CT in asymptomatic and mildly symptomatic individuals.

ectasis. For one, a high level of cardiorespiratory fitness is linked

Little is known about factors that can reduce the risk of

with lower levels of systemic inflammation, which might help

bronchiectasis. While some studies have tied higher levels of

preserve the health of the airway. Good cardiorespiratory fitness

cardiorespiratory fitness to a reduced risk of declining lung func-

also reduces the risk of certain diseases associated with bron-

tion and airway diseases, such as chronic obstructive pulmonary

chiectasis, such as asthma and pneumonia. Finally, high fitness

disease, its benefits in reducing the risk of bronchiectasis are

levels may improve the ability of the airway to clear mucus.

unknown.

To examine the association between cardiorespiratory fitness

The researchers observed a higher prevalence of bronchiectasis than found in previous studies. The difference may be

and bronchiectasis, researchers analyzed data from the long-

explained by the use of CT for detecting bronchiectasis in the

running Coronary Artery Disease in Young Adults (CARDIA)

new study rather than the physician-based diagnosis used in

study. CARDIA was launched in 1984 across the U.S. to examine

previous studies.

the risk factors for coronary artery disease in young adults.

The researchers looked at 2,177 healthy adults who were ages

“This study suggests that bronchiectasis on CT scans might be more frequent than previously thought,” Diaz said. “However,

18 to 30 years at the beginning of the study period. The study

the clinical implications of finding bronchiectasis on CT scans in

participants were followed up over a 30-year period with fitness

people with no or mild symptoms remain to be determined.”

tests and CT. “We used year zero and year 20 cardiorespiratory fitness measured as exercise duration on a treadmill and ascertained bronchiectasis on chest CT at year 25,” said study lead author

The researchers are studying bronchiectasis in other populations like smokers to look for features of the airways and lung tissue associated with bronchiectasis flare-ups.

“These results amplify the benefits of fitness to human

Alejandro A. Diaz, M.D., M.P.H., assistant professor of medicine

health when a sedentary lifestyle is a concerning world

at Harvard Medical School and associate scientist at Division of

epidemic,” Diaz said. “It also highlights that fitness might be

Pulmonary and Critical Care Medicine at Brigham and Women’s

a tool to preserve lung health. The airways are challenged

Hospital in Boston. “We assessed whether differences in tread-

by what we breathe in every minute, and fitness may help to

mill duration between year zero and 20 were associated with

preserve lung health from injuries.”

bronchiectasis on CT at year 25.”

Of the 2,177 participants, 209, or 9.6%, had bronchiectasis at

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July 2021 | OR TODAY

53

guide INDUSTRY INSIGHTS to

news & notes AORN

Guide to the 2021 AORN

Global Surgical Conference & Expo Perioperative Professionals Invited to In-Person Event

ake plans to join the best and brightest in perioperative nursing for four days of inspiration and education in the Sunshine State. By investing a few days in your professional development, you’ll gain new insights, capabilities and spark your passion for perioperative nursing.

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Celebrating its 68th annual conference, AORN is a trusted resource and the only conference presented by the authors of the Guidelines for Perioperative Practice.

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OR TODAY | July 2021

The 2021 AORN Global Surgical Conference & Expo is set for August 7-10 in Orlando, Florida. The theme is “Our Shared Purpose: Safe Surgery Together.” AORN is excited to once again be able to get together. Members are encouraged to attend to reenergize, regroup and recommit.

“Make plans to join us for four days of inspiration and education in sunny Orlando, Florida – at the #1 perioperative nursing conference in the world,” the website states.

The in-person event will have added COVID-19 safety measures in place as well as a “virtual pass” option for the

conference and expo.

“Members are very eager to reconnect in-person. They want to discuss the work they’ve been doing, their challenges and solutions over the past year and reconnect with their peers from across the country,” an AORN spokesperson said. “So many of our perioperative nurses return to the AORN Expo year after year and because the conference was canceled in 2020, they have a lot to talk about.

They are also looking forward to meeting the industry reps face to face – due to COVID-19 facility restrictions, it’s been a year since they have been able WWW.ORTODAY.COM

INDUSTRY guide INSIGHTS to

news &AORN notes to see what is new for the operating room. There are more than 800 exhibitors presenting products in the expo hall.”

Education is one aspect of the annual conference, and the 2021 version boasts top-notch presentations and a variety of tracks for health care professionals.

“Attend the most revered perioperative nursing conference in the United States that meets you where you are in your career with a customizable learning experience,” the website states. “With 13 education tracks, you can choose from over 100 sessions that align specifically to your professional role and topics that interest you most. Presented by industry experts, esteemed researchers, and worldrenowned speakers, this is the place to learn the latest information about the perioperative specialty and re-energize your passion for practice … and have a lot of fun while you’re at it.”

AORN promises education for the entire team with more than 200 continuing education contact hours offered in tons of learning options, formats and tracks. The educational tracks offered include ambulatory, evidence-based practice/research, educator, global, infection control and prevention, informatics, leadership/management,

WWW.ORTODAY.COM

professional development, risk management and sterile processing.

“More than ever, we know the importance of coming together to talk over and understand new perioperative standards and practices,” the spokesperson said. “The conference is designed to ensure we can gather safely. For those unable to travel, AORN is offering a virtual registration option – an alternative way to take part in select conference sessions and experiences. Select sessions will be live streamed during the four-day event including our first virtual general session speaker – making it a truly hybrid event. Dr. David Williams, MD, will present the Jerry G. Peers Lectureship virtually to the online and onsite audience on August 8 at 2:45 p.m. ET.” In addition to education, virtual attendees will get access to an online vendor solution center, poster gallery and networking lounges.

Registration for the virtual pass will open in July.

Along with regular registration and the virtual pass, AORN offers a Leadership Summit option in 2021. The Leadership Summit registration is a full access pass. Individuals who select this option can attend sessions, meal symposia and activities happening at the Leadership Summit, plus all benefits

included in the full conference pass.

“The Leadership Summit registration is the conference’s full access pass that is designed for emerging leaders and experienced executives,” the spokesperson added. “It is a smaller group within the larger conference where they will attend education sessions that are focused on the management and business side of perioperative nursing. The flexible pass option means leadership summit attendees can move between Leadership Summit sessions and sessions at the main conference.

We will record all sessions that will then be available on-demand for 45 days after the event, so attendees can get caught up on sessions they missed after returning home.”

The conference experience will not be complete without a visit to the expo hall – one of the largest surgical trade shows in the U.S. Hundreds of leading medical companies will be sharing their newest innovations. Attendees will be able to connect with recruiters from top health care systems, participate in education workshops, hands-on simulation trainings and more.

The expo hall will be open Sunday, August 8 through Tuesday, August 10.

New in 2021, the expo hall will feature an Innovation Zone and Theater where attendees can experience

July 2021 | OR TODAY

55

guide INDUSTRY INSIGHTS to

news & notes AORN

presentations around the latest surgical innovations and connect with industry representatives who are leading the way in OR technology advancements.

They also have the benefit of learning from the AORN Guidelines authors on best practices, participate in demos and engage in lively Q&As. “In a typical year, we have 5,000 to 6,000 nurse attendees and about the same number of vendor reps. We are expecting approximately 50% of a typical year, which complies with CDCmandated reduced occupancy of rooms and social distancing,” the spokesperson said.

Perioperative professionals are

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OR TODAY | July 2021

invited to come for the conference and stay for a vacation.

Take a well-earned break and experience all Orlando has to offer before, during and after the conference, including Universal Studios and Disney Parks, expansive resorts with incredible pools and world-class dining and shopping.

“In 2021, we’re looking forward to gathering once again – to enjoy the company of our colleagues and friends in settings we’ve been unable to visit for so long,” AORN states on the conference website. “What better place to do this than in a big city with countless adventures and unforgettable experiences? Orlando is an extraordinary

place to unwind and renew your spirit.

See world-renowned attractions, visit classic theme parks, listen to live music, play golf or take a daytrip to the beach.

Whatever re-energizes you, Orlando has it.”

For more information about the AORN Global Surgical Conference and Expo, visit aorn.org/surgicalexpo.

Editor’s Note: All photos are from the 2019 AORN Global Surgical Conference & Expo held in Nashville, Tennessee.

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INDUSTRY guide INSIGHTS to

news &AORN notes DON’T MISS THESE OR TODAY ADVERTISERS!

Action Products, Inc. Booth: 17007 www.actionproducts.com Action Products, Inc. manufactures the full range of ACTION brand support surfaces and patient positioning devices for pressure injury protection, including pediatric and bariatric sizes. Products feature proprietary AKTON® polymer gel.

Cygnus Medical Booth: 15013 www.cygnusmedical.com Cygnus Medical has developed several innovative products that target some of the surgical instrument handling problems that plague hospitals. The Single Cycle Tray, the first disposable, sterilizable transport tray for clean and soiled instruments.

BD Booth: 24023 www.bd.com BD is one of the largest global medical technology companies in the world and is advancing the world of health by improving medical discovery, diagnostics and the delivery of care.

Encompass Group, LLC Booth: 25069 www.encompassgroup.com Encompass is one of the world’s leading manufacturers of reusable healthcare textiles, apparel, therapeutic support surfaces, and single-use medical products. Visit #730 to learn more about our award-winning alternative to forcedair patient warming.

C Change Surgical Booth: 30008 www.cchangesurgical.com SurgiSLUSH™ Works for You. As your staff gets things done, SurgiSLUSH™ programmable freezers automatically produce & maintain optimal sterile slush inside sealed and protected containers.

Confirmed Sterility. Increased Utility.

Smarter Use. Compare!

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Healthmark Industries Booth: 19015 www.hmark.com Healthmark offers infection control solutions and tools to manage the proper reprocessing of surgical instruments in compliance with AORN and AAMI guidelines. Healthmark has products to support every step of the reprocessing cycle of a surgical instrument, including

safe transport of soiled instrumentation, cleaning and cleaning verification, visual inspection, packaging, labeling and sterilization. Visit our booth for in-booth CEU education and to see our line of custom PPE accessories!

OR TODAY Booth: 29062 www.ortoday.com For nearly 20 years OR Today has provided perioperative professionals with news and information about their profession. Stop by our booth to signup for your free subscription and learn how to earn FREE CE credits with our monthly webinar series!

TBJ, Inc. Booth: 30027 www.tbjinc.com TBJ manufactures stainless steel precleaning sinks for surgical instruments, robotic instruments, endoscopes and accessories. TBJ also offers stainless steel casework, tables, ultrasonic cleaners, PPE equipment, scrub sinks and warming cabinets.

July 2021 | OR TODAY

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INDEX

advertisers

ALPHABETICAL Action Products, Inc.……………………………………… 26

Calzuro.com…………………………………………………………21

MedWrench……………………………………………………… 24

AIV Inc.……………………………………………………………… 23

Cygnus Medical………………………………………………… BC

OR Today Webinar Series…………………………… 6, 17

ALCO Sales & Service Co.…………………………………15

Encompass Group………………………………………………15

Polar Products……………………………………………………13

ASCA………………………………………………………………… 39

Healthmark Industries Company, Inc.…………… 5

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

BD………………………………………………………………………… 9

Jet Medical Electronics Inc………………………………21

Sympliant………………………………………………………………17

C Change Surgical…………………………………………… 26

MD Technologies Inc.………………………………………… 4

TBJ Incorporated……………………………………………… 59

ASSOCIATION

HOSPITAL BEDS/PARTS

REPROCESSING STATIONS

ASCA………………………………………………………………… 39

ALCO Sales & Service Co.…………………………………15

MD Technologies Inc.………………………………………… 4

CARDIAC PRODUCTS

INFECTION CONTROL

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

C Change Surgical…………………………………………… 26

ALCO Sales & Service Co.…………………………………15

Jet Medical Electronics Inc………………………………21

Cygnus Medical………………………………………………… BC

SAFETY

CARTS/CABINETS

Encompass Group………………………………………………15

Calzuro.com…………………………………………………………21

Healthmark Industries Company, Inc.…………… 5

Healthmark Industries Company, Inc.…………… 5

MD Technologies Inc.………………………………………… 4

SINKS

CATEGORICAL

ALCO Sales & Service Co.…………………………………15 Cygnus Medical………………………………………………… BC Healthmark Industries Company, Inc.…………… 5 TBJ Incorporated……………………………………………… 59

CS/SPD MD Technologies Inc.………………………………………… 4 Ruhof Corporation…………………………………………… 2,3

DISINFECTION Cygnus Medical………………………………………………… BC Ruhof Corporation…………………………………………… 2,3

Ruhof Corporation…………………………………………… 2,3 TBJ Incorporated……………………………………………… 59

INSTRUMENT STORAGE/TRANSPORT Cygnus Medical………………………………………………… BC Ruhof Corporation…………………………………………… 2,3

ONLINE RESOURCE MedWrench……………………………………………………… 24 OR Today Webinar Series…………………………… 6, 17

TBJ Incorporated……………………………………………… 59

Ruhof Corporation…………………………………………… 2,3 TBJ Incorporated……………………………………………… 59

SKIN PREPARATION BD………………………………………………………………………… 9

STERILIZATION Cygnus Medical………………………………………………… BC Healthmark Industries Company, Inc.…………… 5 MD Technologies Inc.………………………………………… 4

OR TABLES/BOOMS/ACCESSORIES

TBJ Incorporated……………………………………………… 59

Action Products, Inc.……………………………………… 26

SURGICAL

OTHER

MD Technologies Inc.………………………………………… 4

AIV Inc.……………………………………………………………… 23

SURGICAL INSTRUMENT/ACCESSORIES

Healthmark Industries Company, Inc.…………… 5

PATIENT MONITORING

C Change Surgical…………………………………………… 26

MD Technologies Inc.………………………………………… 4

AIV Inc.……………………………………………………………… 23

Cygnus Medical………………………………………………… BC

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

Jet Medical Electronics Inc………………………………21

Healthmark Industries Company, Inc.…………… 5

Sympliant………………………………………………………………17

PATIENT WARMING

TELEMETRY

FALL PREVENTION

Encompass Group………………………………………………15

AIV Inc.……………………………………………………………… 23

ALCO Sales & Service Co.…………………………………15

POSITIONING PRODUCTS

TEMPERATURE MANAGEMENT

Action Products, Inc.……………………………………… 26

C Change Surgical…………………………………………… 26

FLUID MANAGEMENT

Cygnus Medical………………………………………………… BC

Encompass Group………………………………………………15

MD Technologies Inc.………………………………………… 4

PRESSURE ULCER MANAGEMENT

Polar Products……………………………………………………13

FOOTWEAR

Action Products, Inc.……………………………………… 26

WASTE MANAGEMENT

Calzuro.com…………………………………………………………21

REPAIR SERVICES

MD Technologies Inc.………………………………………… 4

GENERAL

Cygnus Medical………………………………………………… BC

AIV Inc.……………………………………………………………… 23

Jet Medical Electronics Inc………………………………21

DISPOSABLES ALCO Sales & Service Co.…………………………………15

ENDOSCOPY Cygnus Medical………………………………………………… BC

Encompass Group………………………………………………15

58

OR TODAY | July 2021

TBJ Incorporated……………………………………………… 59

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

The system is also ideal for other types of non-robotic submersible tubular instruments as six instruments can be pre-cleaned simultaneously.

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Air and water pistols

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Automated Lumen and Scope Flushing

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