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LIFE IN AND OUT OF THE OR

OCTOBER 2021

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OR TODAY | October 2021

contents features

WHAT’S YOUR STYLE? LEADERSHIP APPROACHES, TEAM BUILDING IN THE OR Leadership and strong teams are important in any organization, but especially in the high-stress, high-stakes setting of the operating room. This makes leadership development and team building critical to perioperative success.

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MARKET ANALYSIS

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CORPORATE PROFILE

OR Today (Vol. 21, Issue #10) October 2021 is published monthly by MD Publishing, 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290. POSTMASTER: Send address changes to OR Today at 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290. For subscription information visit www.ortoday.com. The information and opinions expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher. Reproduction in whole or in part without written permission is prohibited. © 2021

OR TODAY | October 2021

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INDUSTRY INSIGHTS

EVENTS

8 News & Notes 14 Company Showcase: Medline 16 IAHCSMM: Knowledge’s True Power Comes Only When It’s (Properly) Applied 18 TJC: Identifying Vulnerabilities in Standards Compliance, Methods to Improve Performance 20 AAMI: Patient-Focused Research Projects Win AAMI Foundation Grants 22 Company Showcase: ASP 24 CCI: The Demographics of Perioperative Nursing

26 M arket Analysis: Sterilization Market Growth Continues 27 Product Focus: Sterilization 30 CE Article: Safe Labeling Helps Prevent OR Errors 38 Corporate Profile: Healthmark

OUT OF THE OR

62 Index

ACCOUNTING Diane Costea

WEBINARS Jennifer Godwin

EDITORIAL BOARD Hank Balch, President & Founder,

IN THE OR

46 S potlight On: Kristy A. Wheeler, MSN, RN, CNOR 48 Fitness 50 Health 53 EQ Factor 54 Nutrition 56 Recipe 58 Pinboard

Lisa Lisle

Beyond Clean Vangie Dennis, MSN, RN, CNOR, CMLSO, Assistant Vice President, Perioperative Services with AnMed Health System Sharon A. McNamara, Perioperative Consultant, OR Dx + Rx Solutions for Surgical Safety

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INDUSTRY INSIGHTS

news & notes

AORN Launches Surgical Smoke Petition Drive to OSHA As the leading advocate for the safety of perioperative nurses and surgery patients, the Association of periOperative Registered Nurses (AORN) has launched a national petition urging the U.S. Occupational Safety and Health Administration (OSHA) to issue regulations requiring worker and patient protections from harmful surgical smoke. Like cigarette smoke, surgical smoke can be seen and smelled. It is produced during most surgical procedures when lasers and electrocautery devices are used to dissect tissue and stop bleeding. Numerous studies confirm the smoke contains hazardous chemicals, toxins, bacteria and live viruses, and in some cases, carcinogens and agents that cause genetic mutations. The health care consequences for surgical team members – who work long hours in the OR during consecutive procedures – are well documented: from headaches and dizziness to serious respiratory illness, asthma and allergic reactions. Perioperative nurses report twice as many respiratory problems compared to the general population. More recent studies have also associated cancer and reproductive hazards to surgical smoke. In 1988, OSHA, which has authority to enforce workplace safety, issued an alert about the health hazards from surgical smoke, but no regulations. The Joint Commission’s Quick Safety Issue 56: Alleviating the Dangers of Surgical Smoke, describes research findings on the potential harm from surgical smoke. Smoke evacuation technology is now available to capture the smoke generated during these procedures and is in use in some hospitals around the country, but not universally. AORN will deliver the petition to OSHA in November in honor of Perioperative Nurses Week, Nov. 14-20, 2021. This topic will also be discussed at the Georgia Council of PeriOperative Nurses Annual Conference, October 22-23 in Atlanta, Georgia. Visit GaCouncilNurse.org for more information.

OR TODAY | October 2021

Brighthospital Introduces Surgical Forecasting Service Gen3 Brighthospital has introduced its Surgical Forecasting Service Gen3. Since 2015, Brighthospital has provided advanced analytical solutions for hospitals to improve their operational performance, focusing on surgical services, emergency departments and inpatient patient flow. The latest version will expand the forecasting models to surgeon’s clinics, providing a complete view of their surgical pipeline, starting with already scheduled cases, cases to be scheduled from past clinic visits, and reaching in to forecasted number of surgeries based on clinic-to-surgery conversion rate models by surgeon. Surgical services are among the highest margin areas for most hospitals. Yet despite its importance and high costs, the methods and tools available to manage OR capacity have not kept pace with evolving needs and technologies. Surgical Forecasting Service Gen3 enhances forecast accuracy by processing surgeon clinic visit schedule information with the Brighthospital-developed Clinic to Surgery conversion model which is customized for the individual surgeon’s unique practice. With Surgical Forecasting Service Gen3, leadership can right-size OR capacity, work collaboratively with surgeons and their offices to identify additional cases, or market the unused time to other surgeons within timeframes that are not just weeks, but months ahead. Clinic Managers have clear visibility to their surgeons’ surgical pipeline. Senior administration and finance can see the forecasted budget versus actual performance while making insightful strategic plans, operational decisions and financial projections. By starting the forecast with the clinic schedules, hospitals also immediately see the impact of any clinic schedule changes to surgical services. If clinic schedules are impacted by factors such as COVID-19 or surgeon unavailability, the downstream impact is immediately reflected on the forecasts providing unparalleled clarity to hospital leadership. Brighthospital Surgical Forecasting Service Gen3 is a plug and play, fully managed service, and ensures the accuracy of the underlying data and generated forecasts. It can be deployed in less than two weeks with minimal IT staff time required.

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INDUSTRY INSIGHTS

news & notes

Diversey Program Awarded AORN Seal of Recognition Diversey has been awarded the Association of periOperative Registered Nurses’ (AORN) Seal of Recognition for its Operating Room Environmental Hygiene Program. While not an endorsement, the Seal of Recognition is confirmation that the Diversey Operating Room Environmental Hygiene Program education materials align with the AORN Guideline for Environmental Cleaning. The program includes training and education tools for cleaning and disinfection of procedure and operating rooms in both acute and ambulatory care settings. The program includes evidence-based procedures and practices designed to optimize environmental hygiene in the operating room for between-case, terminal/end-of-day, and scheduled interim cleaning and disinfection that will enhance productivity and improve the quality of performance.

“The Diversey education program materials are an important resource for perioperative practice and nurses’ ability to provide a safe environment of care for the surgical patient,” said Lisa Spruce DNP, RN, CNS-CP, CNOR, ACNS, ACNP, FAAN, director of evidence-based perioperative practice at AORN. “It is important that perioperative nurses can rely on education resources that meet AORN guideline recommendations.” To assist the perioperative community in selecting quality training activities that promote safety and optimal outcomes for patients undergoing operative and other invasive procedures, AORN has created a directory of materials and activities that have been awarded the AORN Seal of Recognition: https://www.aorn.org/industrypartners/seal-of-recognition.

Articulating Instruments Receive FDA 510(k) Clearance Asensus Surgical Inc. has received FDA 510(k) clearance for 5 mm diameter articulating instruments, adding to the Senhance Surgical System technology platform. “Articulating instruments offer better access to difficultto-reach areas of the anatomy by providing two additional degrees of freedom. These instruments have previously received CE Mark for use in the European Union,” a news release states. “Bringing the benefits of 5 mm articulating instruments to the Senhance Surgical System in the U.S. will widen the clinical utility and value of our platform,” Asensus Surgical President and CEO Anthony Fernando said. “Combining articulation and haptics with augmented intelligence is a very promising development for Performance-Guided Surgery.” The news release adds that the Asensus Surgical’s technology platform, the Senhance Surgical System, is the first of its kind digital laparoscopic platform that leverages augmented intelligence to provide unmatched performance and patient outcomes through machine learning. “Senhance goes beyond the typical surgical robotic systems, providing surgical assurance through haptic feedback, eyetracking camera control, and 3D visualization, and is the first

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platform to offer 3 mm instruments. Articulating instruments are the latest addition to the Senhance Surgical System in the United States, further enhancing surgical performance with robotic precision,” according to the news release.

October 2021 | OR TODAY

INDUSTRY INSIGHTS

news & notes

Intuitive Plans Expansion

HST Pathways Appoints New CEO

Georgia Governor Brian P. Kemp has announced plans by Intuitive, a pioneer in robotic-assisted surgery and a global leader in minimally invasive care, to invest more than $500 million in its current campus in Gwinnett County, creating approximately 1,200 jobs in Peachtree Corners. The expansion will add to the approximately 180 professionals already based at Intuitive’s offices in Peachtree Corners. Present in Georgia for a decade, the company plans to grow its campus to include more than 750,000 square feet of manufacturing and engineering operations, state-of-the-art training facilities for surgeons and hospital care teams, and administrative offices. Headquartered in Sunnyvale, California, Intuitive is the manufacturer of the da Vinci robotic-assisted surgical systems and Ion bronchoscopy system. Surgeons worldwide have completed more than 8.5 million surgical procedures using Intuitive’s da Vinci systems. Growing demand for robotic-assisted technologies around the world fueled this expansion.

HST Pathways, a leader in cloud-based software for ambulatory surgical centers (ASCs), has appointed David Thawley as chief executive officer (CEO). The appointment follows HST Pathways’ efforts to integrate the best end-to-end ASC software solutions seamlessly under one platform with the mergers of price transparency tool Clariti Health, patient engagement engine SimpleAdmit and case coordination platform Casetabs. “HST Pathways is the most trusted partner to the ASC industry, with innovative, cloud-based SaaS offerings and a sterling reputation of transforming operations, fueling growth and driving a better overall patient experience,” said Thawley. “I’m exceptionally grateful to join HST Pathways and look forward to working with the team to build on that foundation and lead the company into its next phase of growth.”

Healthmark Releases Newest Borescope Healthmark Industries recently introduced the FIS-007 to its ProSys Optical Inspection product line. It is a borescope designed to visually inspect internal channels of potentially soiled or damaged items with enhanced light, vision and magnification. It also offers users the option to document with photos and videos the lumens and crevices not visible to the unaided eye. The FIS-007 features a modular design with interchangeable flexible inspection scope attachments available in diameters of 1.06mm and 1.9mm. These scopes have a working length of 110cm and attach to a 13.3W x 9.9L x 4.7H cm control box, allowing for light level adjustments, image capture and video recording.

OR TODAY | October 2021

The 1.06mm scope is designed to inspect internal channels of 1.1mm in diameter or larger, and the 1.9mm scope is designed to inspect internal channels of 2.0mm in diameter or larger. The image capture and video recording features are only available for the USB control box with FIS-007 software, which is included and installs on Windows 10 PCs. For more information, visit hmark.com.

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INDUSTRY INSIGHTS

news & notes

GP PRO, Mölnlycke Partner to Advance Hand Hygiene GP PRO, a division of Georgia-Pacific and provider of hygienic dispensing systems, and Mölnlycke, a medical products and solutions company, have announced a partnership to create a new hand hygiene standard in health care with the Hibiclens Antimicrobial Hand Soap System by GP PRO. The Hibiclens Antimicrobial Hand Soap System by GP PRO combines the effectiveness of Hibiclens’ FDAapproved chlorhexidine gluconate (CHG) four percent solution with GP PRO’s automated touchless hand soap dispenser. The result is a system that helps improve hand hygiene compli-

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ance across the health care environment, according to a news release. “Our partnership with Mölnlycke is significant because it opens the door for health care professionals in both critical and non-critical areas of patient care to more easily comply with hand hygiene guidelines and, as a result, positively impact patient outcomes,” said Eric Jungslager, vice president, healthcare, with GP PRO. “We are proud to work side-by-side with such a highly respected health care leader to help elevate hand hygiene in health care.” According to Jason Liles, global

marketing manager, antiseptics, with Mölnlycke, “GP PRO is a valuable partner in our quest to provide innovative solutions that allow health care professionals to deliver better patient care. With the GP PRO touchless dispenser, care providers have the opportunity to reap the benefits of Hibiclens throughout the continuum of care.” The Hibiclens Antimicrobial Hand Soap System by GP PRO is scheduled for availability starting Q4 2021. For more information, visit gppro.com/gp/industry/healthcare.

October 2021 | OR TODAY

INDUSTRY INSIGHTS

news & notes

KARL STORZ Upgrades TELE PACK+ KARL STORZ Endoscopy-America Inc. has announced an upgrade to the TELE PACK+ compact endoscopy system. The self-contained, all-in-one device is now compatible with the StreamConnect networking and data-management system. Created for outpatient sites of care, the TELE PACK+ is a portable video system that combines all the essential components (light source, camera control unit and display) needed for endoscopic diagnosis and treatment. Compatible with a wide range of rigid and flexible digital scopes – including single-use versions – it can capture clinical video and HD images for procedures such as stroboscopy that previously would have required far more extensive equipment and specialized expertise. With StreamConnect, outpatient physicians can now attach those videos to the patient’s health record or share them with surgical specialists at other sites within the enterprise. That means fewer visits and less inconvenience for the patient,

greater efficiency and security for providers. “When we introduced the TELE PACK+ last year, compatibility with StreamConnect was not yet possible,” explained Monica Ambrose, executive director, surgical marketing, KARL STORZ. “But because we engineer all of our products for modularity, scalability and forward compatibility, we can continue to make incremental improvements over time. As a result, existing TELE PACK+ users can enjoy this new functionality with a simple and free software update.” With TELE PACK+, health care providers enjoy a universal interface that lets clinicians use the same types of cameras and scopes across all locations and lets administrators standardize across multiple specialties (ENT, urology, gynecology, and more). The enhanced documentation and networking functions made possible with StreamConnect enable multi-tier facilities to seamlessly connect and coordinate all their sites of care.

Morgan Medical Center Deploys LightStrike Germ-Zapping Robots As health care facilities look for new and innovative ways to battle viruses and bacteria that can lurk on high-touch surfaces, Morgan Medical Center (MMC) has taken a leap into the future with two LightStrike Germ-Zapping Robots by Xenex. The robots quickly destroy microscopic pathogens in high-traffic areas, including the emergency department, patient rooms, operating rooms and public restrooms. As part of its commitment to patient safety and quality care, MMC began exploring ultraviolet (UV) technology options for advanced control in 2019. The COVID-19 pandemic reinforced the need for enhanced cleaning protocols in the facility to prevent the spread of the coronavirus and other microorganisms that can cause infections, such as Clostridium difficile (C.diff), methicillin-

OR TODAY | October 2021

resistant Staphylococcus aureus (MRSA), and vancomycinresistant Enterococci (VRE) that often dwell on high-touch surfaces in health care facilities. The LightStrike robot is proven to deactivate Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, on surfaces in two minutes. Named “McSteamy” and “McDreamy” by hospital employees, the robots are already at work disinfecting areas of the hospital. Operated by the Morgan Medical Center environmental services team, the LightStrike robots can disinfect a typical patient room in less than 15 minutes.

LightStrike Germ-Zapping Robots use pulsed xenon to create intense bursts of broad spectrum ultraviolet (UV) light that quickly destroy bacteria and viruses on surfaces without damaging materials in the room. More than 40 peer-reviewed studies have been published by healthcare facilities validating the efficacy of the LightStrike robot disinfection technology.

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MezLight Granted FDA Registration MezLight LLC has launched a surgical lighting system to provide surgeons with a bright, sterile and reusable solution for focused light. Good lighting is an essential element in performing surgical procedures efficiently and accurately to produce the best possible patient outcome. The MezLight was invented by University of Wisconsin transplant surgeon Josh Mezrich in response to his own experience, and that of his colleagues, with the need for better lighting in the operating room (OR). The current standard for bright, focused lighting is the surgeon’s headlight which has numerous downsides including physical discomfort, encouraging poor ergonomic posture, lack of sterility and contribution to physician distraction during a procedure. Perhaps the most serious is the role headlights make to the already physically demanding activity

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of surgery. Holding a poor ergonomic posture to keep the headlight trained on the surgical site can ultimately lead to serious physical injury and chronic pain for the surgeon. MezLight’s surgeon-centric design approach focuses on the wellbeing of the surgeon as a key element in patient outcomes. “I don’t want to change how people operate; I want to help them operate better,” Mezrich said. The MezLight attaches to the OR table rail using a standard Clark socket and delivers the light intensity and illumination performance of a surgeon’s headlight without residing on the surgeon’s head. MezLight’s patent pending flexible neck design allows for use in a wide variety of procedures and provides increased angular cavity illumination not possible with headlights and overhead lights. Because the MezLight is designed

to be sterilized in an autoclave surgeons can control and manipulate their lighting without the need for a towel or sterile sleeve. Interruptions of and distractions to surgical workflow are reduced by the ability of the surgeon to quickly position and reposition the light. The MezLight is FDA registered and available now.

October 2021 | OR TODAY

company showcase Medline

Medline hat happens to HAIs when

Medline understands the importance of incorporating pre-surgical decolonization practices in everyday care and has solutions to help fight against deathly hospital-acquired infections.

Given the wide array of microbial species that can cause an infection, particularly Staphylococcus aureus, coupled with the prevalence of antibiotic resistant pathogens, an antiseptic with broad spectrum antimicrobial activity has the characteristics to be an effective preoperative skin preparation product. An effective skin preoperative antiseptic as described by the U.S. FDA document, “Final Rule for Safety and Effectiveness of Health Care Antiseptics,” is an agent that rapidly reduces the number of organisms in the surgical field before wound incision and suppresses rebound growth for six hours after application3. Chlorhexidine gluconate (CHG) is a broad-spectrum antiseptic with a proven safety record. CHG may have advantages over povidone-iodine, including the fact that increased amount of CHG on the skin leads to enhanced activity, longer residual activity and activity in the presence of blood or serum.4

Pre-surgical Skin Preparation

Nasal Decolonization

SSIs occur in 2% to 4% of all patients undergoing inpatient surgical procedures.1 While advances have been made in infection control practices, SSIs remain a substantial cause of morbidity, prolonged hospitalization, readmissions and death.2 One technique to reduce the likelihood of an SSI is to prep the incision site prior to surgery with an antiseptic in order to reduce the microbial burden on the skin. The goal of preoperative patient skin antisepsis is to reduce the patient’s risk of developing an SSI by removing soil and transient microorganisms at the surgical site.1

In addition to pre-surgical skin preparation, nasal decolonization is proven to be an effective adjunct strategy to assist the medical industry in warding off SSIs and HAP. Multiple studies have demonstrated that eradication of S. aureus nasal colonization results in decreased infections, specifically for those patients undergoing surgery or receiving care in intensive care units.5 The normal flora residing in the nose is wide-ranging such as Staphylococcus aureus, Streptococcus pneumonia and Haemophilus influenza.6 The risk of S. aureus SSI in nasal carriers has been found to be 5.8x greater than in non-

W best practices are used?

They decrease. Medline’s priority is patient safety and this starts with protecting patients against leading hospital-acquired infections (HAIs). Many of these infections, like surgical site infections (SSIs) and hospitalacquired pneumonia (HAP), can be prevented by implementing a comprehensive solution that is both compliance-driven and intuitive to use in every day clinical practices. These practices include preparing the skin, the nares and oral cavity to reduce the risk of bacteria that can lead to extended length of stay, increased costs and increased morbidity rates.

OR TODAY | October 2021

nasal carriers.7 Antiseptic agents such as Medline’s 62% alcohol nasal swabs, will effectively kill potentially dangerous pathogens such as S. aureus within 10 minutes of the first application. Ethyl Alcohol 60-90% is effective against pathogens because it denatures proteins.8 Povidone iodine 10% has broad-spectrum antimicrobial activity against gram-positive, gram-negative bacteria, and fungi if used 1 hour before surgery. The risk of developing resistance to either antiseptic agent is highly unlikely and may contribute to antibiotic stewardship.9 The science behind the practice of nasal decolonization is practical, cost-effective and gives patients one more effective line of defense against SSIs and HAIs.

Oral Decolonization Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) continue to be described as significant causes of illness and death in health care “despite improvements in prevention, antimicrobial therapy, and supportive care”.10 Pneumonia is one of the most common types of HAIs. Multiple health care guidelines include recommendations for the use of oral antiseptics like chlorhexidine gluconate (CHG), 0.12%, and cetylpyridinium chloride (CPC) to reduce risk of hospital-acquired pneumonia and ventilator-associated pneumonia.12,13,14 Oral decolonization with CHG can be considered an important tool in infection prevention and control.15 Good health starts with oral health. Reduce the risk of HAP by WWW.ORTODAY.COM

SPECIAL ADVERTISING SECTION

company showcase

Medline

improvement project measures and postoperative surgical site infections”. Surgical Infection (Larchmt), 13(4): (2012): 234-7 https://www.cdc.gov/nhsn/pdfs/ pscmanual/9pscssicurrent.pdf

providing a comprehensive oral care program for every type of patient care – preoperatively and postoperatively.

Medline’s Total Prep System Preoperative Kit For a one-stop-shop preoperative decolonization solution, Medline has your patient covered with the Total Prep System Preoperative Kit. • Prepare the SKIN with ReadyPrep 2% CHG Cloth • Decolonize the NOSE with 10% Povidone-Iodine Nasal Swabs or 62% Ethyl Alcohol Nasal Swab options • Decolonize the MOUTH with 0.12% CHG Oral Rinse or DuoCare Clinical Oral Rinse (0.1% CPC) Infection prevention is more necessary than ever and the need for proactive pre-surgical decolonization practices is critical. Let Medline provide decolonization solutions for a safer tomorrow.

https://www.fda.gov/media/135559/download

Anderson D.J. et al. (2014). Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update. Healthcare Infection Control Practices Advisory Committee. The Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg published online May 2017. doi:10.1001/ jamasurg.2017.0904

Sievert DM, et al. ICHE 2013;34:1-14 . ICHE 2013;34:1-14

https://www.atsjournals.org/doi/ full/10.1513/pats.201006-038rn

Skrämm I, et al. . Surgical site infections in orthopaedic surgery demonstrate clones similar to those in orthopaedic S. aureus nasal carriers. J Bone Joint Surg Am. 2014. 96(11):882-88

For more information, visit www. medline.com/pages/pre-operative-prepsystem.

REFERENCES 1.

https://psnet.ahrq.gov/primer/surgical-siteinfections

Awad, S.S., “Adherence to surgical care

WWW.ORTODAY.COM

10.

https://cmr.asm.org/ content/29/2/201#sec-2 Septimus EJ, Schweizer ML Decolonization in Prevention of Health Care-Associated Infections. Clinical Microbiology Reviews Jan 2016, 29 (2) 201-222; DOI: 10.1128/CMR.00049-15 T. Poovelikunnel, G. Gethin, H. Humphreys, Mupirocin resistance: clinical implications and potential alternatives for the eradication of MRSA Journal of Antimicrobial Chemotherapy, Volume 70, Issue 10, October 2015, Pages 2681–2692, https:// doi.org/10.1093/jac/dkv169 Published: 03 July 2015 Klompas, M. (2020, July 6). Epidemiology, pathogenesis, microbiology, and diagnosis of hospital-acquired and ventilatorassociated pneumonia in adults. UpToDate.

https://www.uptodate.com/contents/ epidemiology-pathogenesis-microbiologyand-diagnosis-of-hospital-acquired-andventilator-associated-pneumonia-inadults#H1 Accessed July 30, 2021. 11.

Magill SS, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA, Lynfield R, Maloney M, McAllister-Hollod L, Nadle J, Ray SM, Thompson DL, Wilson LE, Fridkin SK; Emerging Infections Program Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey Team. Multistate point-prevalence survey of health care-associated infections. N Engl J Med. 2014 Mar 27;370(13):1198-208. doi: 10.1056/NEJMoa1306801 Accessed July 30, 2021.

12.

Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R. Guidelines for Preventing Health-Care Associated Pneumonia, 2003. Centers for Disease Control and Prevention. https://www.cdc.gov/mmwr/preview/ mmwrhtml/rr5303a1.htm Published March 26, 2004. Accessed July 30, 2021.

13.

Vollman K, Sole ML, Quinn B. Procedure 4 - Endotracheal Tube Care and Oral Care Practices for Ventilated and Non-ventilated Patients. In: AACN Procedure Manual for High Acuity, Progressive, and Critical Care. 7thEdition. Vol 37. 2nd ed. ELSEVIER.

14.

Greene LR, Sposato K. Guide to the Elimination of Ventilator-Associated Pneumonia. Association for Professionals in Infection Control and Epidemiology. 2009:1-47. Page 36. http://dl.icdst.org/pdfs/files3/ b25692879bf1679e1c52f38ca431b94c.pdf. Accessed July 30, 2021.

15.

Weinstein RA, Milstone AM, Passaretti CL, Perl, TM. Chlorhexidne: Expanding the Armamentarium for Infection Control and Prevention, Clinical Infectious Diseases, 46(2): 15 Jan 2008, pp274-281. https://doi. org/10.1086/524736 Accessed August 8, 2021.

October 2021 | OR TODAY

INDUSTRY INSIGHTS

IAHCSMM

Knowledge’s True Power Comes Only When It’s (Properly) Applied By Julie E. Williamson he “knowledge is power” adage is one often relayed by virtually every profession and discipline – but as good as it sounds, some experts question its accuracy. Upon closer examination, it becomes clear why they are dubious.

Although knowledge can certainly be powerful and invaluable to our personal and professional lives, the real power behind it is only unleashed when the knowledge gained is based on standards and best practices, and then properly and consistently applied. In other words, the card catalog of knowledge in our brains becomes wasted until that information is effectively drawn upon and put into appropriate practice. Undeniably, this is a valuable lesson for all health care professionals, including those responsible for the increasingly challenging role of instrument processing. Sterile processing professionals should commit to continuing education and training, and they (and their departments) should also have a plan to apply what they learn. Such commitment is critical to their contribution to customer service quality, patient safety and infection prevention; however, inside the hectic walls of one’s department, it can become easy to lose touch of those primary goals. It seems fair to assume that the vast majority of health care professionals chose their careers out of a sincere desire to positively impact care, 16

OR TODAY | October 2021

and those same professionals likely arrive on the job each day with the intent of doing just that. But when a proverbial wrench gets thrown into the mix, priorities can shift – sometimes, just slightly, but often, the day can spin out of control and lead them to put out fires, as opposed to prevent them. Ringing telephones. Rising tensions. High procedural volume. Requests (and, at times, demands) to rapidly turn over instruments. Staffing and inventory shortages. Challenging instrument design. Each of these can contribute greatly to stressors in the department and up the odds for negative patient outcomes, not the least of which include contaminated instruments and surgical site infections – even if technicians are educated and trained on the correct way of doing things. Although health care is often challenging and unpredictable, the quest for excellence and the commitment to strengthening one’s knowledge base must never waver. The patients on the receiving end of the instrumentation expect (and deserve) clean, sterile, well-functioning devices, and they trust that the professionals responsible for providing those devices are not only knowledgeable about how to manage each task but are also skilled in its proper application. Surely, continuing education and its practical application lie at the heart of effective prioritization and positive outcomes. IAHCSMM understands the challenges impacting sterile processing (SP) professionals and strives

to help them reach their education goals through knowledge advancement and professional growth opportunities – whether through conferences, chapter meetings, lesson plans, textbooks, certifications, e-learning, webinars and more. From there, it’s up to each learner to effectively apply the knowledge attained. What follows are some tried and true tips for making the most of new-found knowledge and ensuring the department is well versed on any changes. � Take good notes during the education/training and then promptly summarize the key takeaway points. This will make it easier to identify areas that may need a closer look or process change within the department. Strong note taking also helps learners retain the information being taught and can keep the knowledge at the forefront of their mind. Note taking is good practice whether one attends a large conference or local chapter meeting, participates in a webinar or podcast or even a seemingly simple inservice, or reads an article pertaining to the profession. � Share any newly gained information with SP leadership and explain why you believe it’s essential to share it with the entire team and put it into practice. Again, detailed notes will be critical because they can highlight standards/regulation/best practice updates or other WWW.ORTODAY.COM

INDUSTRY INSIGHTS

IAHCSMM

resources that can then be further explored and/or compared to the department’s current practices. � SP leaders should encourage department-wide continuing education and information sharing. Also, every employee (regardless of title or experience level) should feel comfortable asking questions, questioning certain aspects of policies or practices if the “why” behind the practice is unclear or potentially inaccurate, and sharing how the new knowledge attained can benefit the department, its customers and patients. � Be aware that some information attained may not be rooted in standards, instructions for use, guidelines or best practice. Social media, for example, can be a great way to network and learn; however, it’s essential that references and data points are carefully explored before putting the information read or heard into practice. Remember: just because someone says something in a public forum does not automatically make it fact. � Follow education with more education and training. If the knowledge gained is supported by standards and best practices and the SP leader determines a new or better practice needs to be adopted, they should have a strategy to ensure all team members have the information they need to effectively put the information into practice. Leaders should explain why the knowledge is important, how it can affect the department and its health care customers, and WWW.ORTODAY.COM

how the department will apply it. If, for example, an SPD wasn’t using a borescope for instrument inspection but will now make its use a requirement, the team members need to not only be taught why borescopes and detailed inspections are so crucial, but they should also receive hands-on training to ensure they know how to use the borescope properly (and are also trained on what to look for during those inspections). � Commit to follow-ups to check competency. Following education and training, the SP leader should ensure every employee understands what was taught and ask for a return demonstration. From there, it will be helpful to conduct random spot checks to verify that employees are still applying the new knowledge effectively and consistently.

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Conclusion Continuing education and hands-on training are crucial for departmental success and employee professionalism – and putting new knowledge into proper practice is even more essential. No professional is too old, skilled or experienced to learn new things and apply it for the department’s greater good. It’s that ongoing commitment to knowledge growth and advancement that gives SP professionals the confidence they need to do their jobs safely and effectively, even when challenges arise and pressure mounts. Julie E. Williamson is IAHCSMM’s director of communications and senior editor.

October 2021 | OR TODAY

INDUSTRY INSIGHTS CCI TJC

Identifying Vulnerabilities in Standards Compliance, Methods to Improve Performance By Laura Gayton nderstanding human factors and compliance go hand-in-hand when it comes to striving for patient safety within health care organizations. Compliance is often based on how an organization lays out its critical safety information, processes and procedures. Establishing a clear set of instructions, standardized language and written procedures allows staff to complete processes and maintain consistency. In addition, such processes provide the greatest opportunity for best practices to be followed and procedures to be successfully completed. However, human factor considerations continue to be leading vulnerabilities affecting performance improvement.

David Mallard from Environment Health and Safety Today explains that understanding the impact of health care safety errors requires understanding human factors, inherent behaviors, characteristics, needs, abilities and limitations. In addition, it requires the study of developing sustainable and 18

OR TODAY | October 2021

safe working cultures. Where there are humans, there inevitably will be human error – it is impossible to eliminate human error entirely. However, by using strategies such as checklists to document and guide tasks helps to limit the occurrence of human error from becoming a real problem at health care organizations. An example of stellar use of checklists can be observed from the airline industry. Use of a pre-flight checklist is imperative to a safe flight. Simply put, a pre-flight checklist consists of tasks that a pilot and/or crew must perform prior to takeoff. The checklist is specific and can be arranged in sequential or segmented order. The concept of pre-flight checklists evolved in 1935 after a fatal crash involving a Boeing test pilot. The investigation revealed that aircrafts require too many complex preparations for a pilot’s memory to recall. It was unrealistic to rely on his or her memory for all flight preparation tasks that must be completed prior to flight. The solution was creating and completing a complete pre-flight checklist. Similarly, in 2007 the World Health Organization (WHO) developed and implemented the WHO Surgical Safe-

ty Checklist. Like the limitations of a pilot’s memory who depends instead on a pre-flight checklist, a perioperative team member would also rely on a pre-operation checklist to complete tasks prior to a surgical procedure. The WHO checklist was developed to enhance communication between a surgical team member, improve outcomes, decrease complications and improve patient safety. Consider the operating room (OR), a complex environment that contains staff, equipment, alarms, computers, and sometimes ringing telephones. Multi-tasking between patient, the surgical team and procedures in the OR (e.g. set-up, counting, specimen management) involves simultaneously meeting a plethora of competing priorities. The effects of distractions during a surgical procedure are physically and cognitively demanding and perioperative team members must maintain a state of constant situational awareness. The attention of the circulating nurse is pulled in various directions. So, it may be challenging for a health care organization to identify these vulnerabilities to maintain safety and compliance. The Surgical Safety Checklist makes it easier to identify WWW.ORTODAY.COM

INDUSTRY INSIGHTS

TJC news & notes

distractions and document procedures. Reviewing how human factors affect the workplace begins with reviewing the task. Consider the timeframe during a surgical wound closure and time allotted for accounting for instruments, sponges and needles. Since there are multiple tasks to be accomplished and a critical need for accuracy, the demand on a health professional’s workload makes him or her vulnerable for error. The working environment of the operating room includes noise and distractions from surgical display alarms and equipment controls. These distractions make clear communication within the surgical field imperative. Communication breakdown may be associated with surgical site infections with this increased movement around the surgical field. So, how can an organization limit vulnerability? It is important to first limit the distractions. A recent Association of PreOperative Registered Nurses (AORN) position statement on managing distractions and noise during perioperative care endorses a multidisciplinary team approach to reducing distractions and creating a safer OR environment. The document explains that while keeping OR noise to a minimum, especially during critical phases of surgical procedures, a surgical team should create a no-interruption zone in which non-essential activities are prohibited. Non-essential activities should be clearly identified prior to surgery, and any intervention needs to be adaptable and practical to the team. By limiting distractions, the human cognitive workload is also reduced. WWW.ORTODAY.COM

Workflow functionality should aim to be seamless and offer few disruptions, supporting the idea that standard work and workflow processes can greatly reduce error. Increasing situational awareness to critical phases and eliminating cognitive biases help staff witness what they are expecting to see. Decreasing or eliminating sources that cause error or enable safety issues helps to reduce human error and vulnerability and makes the environment safer. For example, using unique barcode scanning technology increases the reliability percent accuracy for sponge identification used during surgery. Health care organizations can incorporate identifying human factor vulnerabilities within their commonly used analysis methods. Root cause analysis is a structured analytical tool used to address surgical errors after they occur. Failure mode and effects analysis (FMEA) is a useful process to identify and address potential problems and their effects before an adverse event occurs. By using these methods, health care organizations can evaluate systems and processes with human factor considerations in mind to effectively identify vulnerabilities and implement human factor-based solutions that ultimately promote safety and mitigate risk.

Laura Gayton is the assistant director of the standards interpretation group at The Joint Commission.

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October 2021 | OR TODAY

INDUSTRY INSIGHTS CCI AAMI

Patient-Focused Research Projects Win AAMI Foundation Grants he AAMI Foundation has named the 2021 recipients of the Mary K. Logan Research Award Program. Two grants, totaling $80,000, were awarded to research initiatives that focus on improving patient outcomes by advancing the landscape of clinical alarms and enhancing radiation effects on breast cancer patients.

“The AAMI Foundation is excited to support these important research initiatives,” said Steve Campbell, executive director of the AAMI Foundation. “These projects have the potential to positively impact patient care. We’re anxious to share the results of the researchers’ work and to see the influence they have in health care.” The awards program, which was named in honor of AAMI’s former president and CEO, was established in 2016 with a gift from AAMI. This year, the award will support research from the Children’s Hospital of Philadelphia Research Institute and the Department of Radiation Oncology at Sunnybrook Health Sciences Centre in Toronto, Ontario.

Improving patient outcomes by optimizing alarm technology The AAMI Foundation awarded $40,000 to a research team at 20

OR TODAY | October 2021

Children’s Hospital of Philadelphia Research Institute, led by Halley Ruppel, a core faculty member at the Center for Pediatric Clinical Effectiveness (CPCE). The group will explore ways to actively engage clinical stakeholders in reducing alarm burden on their units. “It’s important that alarms are kept to the minimum necessary to alert nurses to important changes in patient condition. Unfortunately, clinical alarms tend to be excessive and frequently not urgent or actionable.” Ruppel said. “I’m interested in how we can build sustainable processes for evaluating and improving alarms and alarm management in acute care settings.” One way to do this, Ruppel noted, is by giving clinical stakeholders access to up-to-date data analytics on types and frequencies of alarms occurring in their units. This could increase awareness and foster engagement in alarm management efforts. “Clinical stakeholders are already inundated with data, so we are working with clinical stakeholders to define ‘rights’ for alarm data analytics – right information, right recipients, right format, right time – so that the data are actionable and can actually inform meaningful improvements to the system,” she said. Ruppel and her team expect to identify functional specifications

for alarm data analytics which can be used to develop an intervention model to test in future work. Ruppel hopes the project will optimize how technology functions in clinical care. “Our ultimate goal is to develop a sustainable process for evaluating the dynamic clinical alarm system that nurses use while caring for patients. Having this process in place will strengthen collaborations between HTM professionals and clinicians,” she said.

Using microbubble therapy to enhance radiation effects in cancer patients The AAMI Foundation also awarded $40,000 to support the research work of Dr. Gregory Czarnota from the department of radiation oncology at Sunnybrook Health Sciences Centre. It focuses on ultrasound imaging and the spectroscopy of cancer therapy responses. This project seeks to show the enhanced effects of radiation combined with microbubble treatment in ultrasounds on cancer patients. “Radiation has been long thought to cause tumor cell damage and kill cancers by causing DNA damage. About 10 to 15 years ago, there was an interesting idea – and a controversial one – in radiation oncology that we should forget about tumor cell DNA damage. People began to believe that it was damage to the WWW.ORTODAY.COM

INDUSTRY INSIGHTS AAMI

blood vessels in tumors that drove tumor responses,” said Czarnota. “We thought that another way of causing damage to blood in tumors and the cells that line those blood vessels was by using these contrast agents. When you put microbubbles in an ultrasound field, you target that ultrasound field to just the tumor. And all of a sudden, you’ve got all these bubbles just bursting inside the tumor. We found that that was synergistic with radiation effects.” Czarnota and his team have been exploring the effects of ultrasound and microbubbles on radiation for close to 10 years. The Mary K. Logan Grant comes as they are ready to take the next step in their research process. “We started doing work with cells and test tubes first, and then animal models of research,” he said. “Now we’re at the stage where we wish to proceed and evaluate the technology that’s been developed as well as the methodology in human cancer patients.” The team will test the methodology on breast cancer patients. “This really will be the first funded research in terms of testing this in patients,” said Czarnota. “We’d like to demonstrate the safety and feasibility of doing this in patients. We then want to determine the safety profile of this methodology, and be able to show increased efficacy of radiation when it’s combined with this type of ultrasound treatment.” Czarnota hopes that his research will demonstrate that this type of technology can be used to enhance conventional radiotherapy on breast tumors. “I think the impact of our project will be that it’ll drive the ultimate acceptance of this kind of technology as part of standard of care treatments in patients,” he said.

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company showcase ASP

ASP

dvanced Sterilization Products (ASP) is a leader in infection prevention, dedicated to creating the products, solutions and processes needed by practitioners to protect patients during their most critical moments. ASP is committed to continuously advancing infection prevention technologies that health care depends upon.

In addition, ASP is a trusted partner in sterility assurance. The company backs every product it sells with comprehensive support from clinical educational consultants, in-service training and a fullservice warranty.

Terminal sterilization The ASP STERRAD systems continue to be the market leader in hydrogen peroxide based low-temperature sterilization with over 20,000 systems installed globally. Health care institutions around the world have trusted STERRAD systems for decades to safely sterilize medical instruments and materials without leaving toxic residue. Hydrogen peroxide gas plasma sterilization technology helps enhance the safety of patients and sterile processing staff. Gas plasma is documented to actively break down hydrogen peroxide, reducing emissions exposure for sterile processing staff. ASP’s interconnected hydrogen peroxide sterilization and biological indicator monitoring system guides users to help ensure quick and compliant instrument reprocessing. The STERRAD sterilization system’s proprietary gas plasma sterilization offers the largest list of device validations for sterilization in close partnership with medical device manufacturers. The STERRAD VELOCITY System is 22

OR TODAY | October 2021

the first and only all-in-one biological indicator and process challenge device for ensuring sterility assurance. Through ASP ACCESS Technology, ASP systems communicate together to provide an interconnected system of compliance guidance that combines error prevention features with automated audit-ready record keeping and integration with major ITS providers. The STERRAD NX System with ALLClear Technology delivers sterility assurance through an upgradeable platform to help maximize clinical, financial and operational outcomes. It is a compact unit offering from the STERRAD Systems platform. It includes two sterilization cycles – standard and advanced – to sterilize a variety of medical devices, supported by device validations working in close collaboration with medical device manufacturers. The STERRAD 100NX System with ALLClear Technology is one of the latest releases from the STERRAD systems platform, featuring over 25 years of innovation in hydrogen peroxide gas plasma (HPGP) sterilization technology. It currently includes up to four sterilization cycles – standard, express, flex and duo. The ALLClear Technology within the systems increases sterilization productivity by conditioning the load, checking for moisture and running system diagnostics prior to sterilization cycles to maximize successful cycle runs. Featuring an upgradeable platform, the STERRAD NX Systems with ALLClear Technology are designed to adapt to the upcoming demands of sterile processing as medical device designs and guidelines evolve over time.

Endoscopes The ASP AEROFLEX Automatic Endoscope Reprocessor (AER) acceler-

ates workflow and enhances compliance to help maximize clinical, financial and operational outcomes. The ASP AEROFLEX AER is a cost-effective, single-basin system that automates the washing and high-level disinfection cycle of flexible semi-critical endoscopes, increasing productivity and enhancing compliance. It is cleared by the FDA to high-level disinfect flexible, semi-critical endoscopes. Scopes from multiple manufacturers including Olympus, Fuji, Pentax, and others have been qualified on ASP AEROFLEX AER. (For model-specific information or to confirm your scope inventory can be reprocessed with this device, get a consultation and an ASP expert will assist.) ASP AEROFLEX AER features include: • Fast 22-minute cycle time. • Exclusive AUTOSURE MRC Monitor: automated verification of MRC prevents OPA concentration monitoring from being skipped or done incorrectly, delivers a definitive pass/fail result and eliminates a manual step from the workflow • Intuitive user interface: intuitive navigation menu is quick and easy to learn and operate, helping customers to breeze through operation of the system and guiding them through compliant processing steps • Automated record keeping: designed to enhance documentation compliance and simplifies manual record keeping step in the workflow • Small footprint • Easy to install

Case Study In line with environmental standards regulating exposure of hydrogen peroxide, a comparison study was conducted to determine the differences in hydrogen WWW.ORTODAY.COM

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ASP

peroxide emissions for both STERRAD Systems and STERIS V-PRO sterilizers. The study was a simple comparison between four low-temperature sterilization systems – two from each manufacturer. The sterilizers from each brand are clinical in-use sterilizers. The systems tested were the STERRAD 100NX System, the STERRAD NX System, the V-PRO maX and the V-PRO 1 Plus. The study’s conclusion states that in a continuous hydrogen peroxide emissions monitoring test monitors were placed on the tops and fronts of the sterilizers. The two STERRAD system sterilizers ignite a gas plasma phase resulting in fewer measurable hydrogen peroxide emissions – none greater than 0.3 ppm. In contrast, the STERIS V-PRO 1 Plus and V-PRO maX sterilizers each produced significant hydrogen peroxide emissions, ranging

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between 5 and 20 ppm each time the chamber door was opened. The location of the sensor which made these measurements implies hydrogen peroxide clouds were emitted directly into the potential breathing zone of the operator who opens the sterilizer door to remove the load. The test results indicate that when the sterilizer doors were opened at the end of their cycles, STERIS V-PRO sterilizers’ hydrogen peroxide emissions were as much as 27 to 67 times more concentrated than those of STERRAD system sterilizers. The results of the study demonstrate that the STERRAD system, which uses a gas plasma phase to dissociate hydrogen peroxide during the sterilization cycle, had lower hydrogen peroxide emissions compared to STERIS V-PRO sterilizers, which only passes hydrogen peroxide through a catalytic converter. Therefore,

STERRAD systems contribute to a safe working environment. Read the complete case study online at ortoday.com/disinfection-vs-sterilization-understanding-the-differences. Study Disclosures and Acknowledgments The research was designed and executed by Actionable Research, an independent third-party research firm in conjunction with ChemDAQ Inc., a manufacturer of environmental safety monitoring systems. The research sponsor was Advanced Sterilization Products. All data were collected by the ChemDAQ staff. Important Information: Prior to use, refer to the complete instructions for use supplied with the device(s) for proper use, indications, contraindications, warnings and precautions. Capitalized product names are trademarks of ASP Global Manufacturing, GmbH. The third-party trademarks used herein are the properties of their respective owners.

October 2021 | OR TODAY

INDUSTRY INSIGHTS CCI

The Demographics of Perioperative Nursing By Samantha Hendrickson and James X. Stobinski his month we would like to comment on the demographic makeup of perioperative nursing. It may come as a surprise, but the total number of perioperative nurses is not known with any certainty. The information we do have is fragmented and incomplete. It is the nature of voluntary credentials, such as those administered by the Competency and Credentialing Institute (CCI), that there is little connection to licensing and regulatory bodies. It is easier to gather data on roles where credentials are required for employment such as a nurse anesthetist. However, with voluntary credentials there is no consistency among the state boards of nursing in gathering data on nursing specialties such as perioperative or perianesthesia nursing.

At CCI, we have frequent contact with large numbers of perioperative nurses, but these are nurses who are professionally engaged and desire to earn one of our credentials. For those nurses who do not elect to become certified we have little to no information. We have some anecdotal data from the contact we do have that large numbers of perioperative nurses are now leaving the profession. This exodus of seasoned perioperative 24

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nurses has been rumored for some time. The record numbers electing emeritus status for their CCI credentials is one indicator that this forecast is now being realized. With the knowledge that large numbers of perioperative nurses are retiring coupled with a desire to better know our current and future certificants, CCI is gathering data on several fronts. In collaboration with our testing vendor, PSI, we are gathering more information from our test takers in voluntary post-exam surveys. We now have information for the first half of 2021 with nearly 2,000 respondents among CNOR test takers and we were pleasantly surprised with some of the data. We found that 54% of the 2021 CNOR test takers have 2-5 years’ experience as a perioperative nurse. In addition, 74% have baccalaureate level education and 84% have a baccalaureate level or higher education. The largest age block represented are the 25 to 34-year-old nurses who make up 38% of the CNOR test takers this year. We also now have some information on the race and ethnicity of our test takers. The three largest groups being those who identify as white (59%), Asian (19%) and African American/Black (6.2%). To reach all the diversity of perioperative nurses, the CCI Board of Directors is considering a diversity equity and inclusion initiative concentrating on those facilities

which are under-resourced in relation to support for certification. If this initiative is adopted by the CCI Board of Directors, you can expect to hear more in the fourth quarter of 2021. It is likely that the facilities lacking resources may be concentrated in rural areas which have been hard hit during the pandemic. It is also possible that these rural facilities have a different demographic makeup than our current pool of certificants. The tentative plan is to use the assets of the new CFPN credential and our perioperative preceptor job analysis findings to reach a greater diversity of perioperative nurses. This work is part of a larger effort to learn more about the perioperative nursing community to better serve these nurses. As background, CCI is a non-profit, mission driven organization. Our vision is to be part of a growing community of lifelong learners for whom CCI is a catalyst and integral partner. To be an effective partner and to best serve all perioperative nurses we need more accurate information for the community. The DEI initiative and future research will help inform our efforts as we seek to best serve all perioperative nurses. Samantha Hendrickson, AA, AS, is a credentialing coordinator at the Competency and Credentialing Institute. James X. Stobinski, Ph.D., RN, CNOR, CNAMB, CSSM(E), is the CEO of the Competency and Credentialing Institute. WWW.ORTODAY.COM

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October 2021 | OR TODAY

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market analysis

Sterilization Market Growth Continues Staff report he global medical device sterilization market is expected to gain market growth in the forecast period of 2021 to 2028. Data Bridge Market Research analyses that the global medical device sterilization market is expected to reach $7.6 billion by 2028.

The global sterilization equipment market size was valued at $5.52 billion in 2020 and is expected to expand at a compound annual growth rate (CAGR) of 10.3% from 2021 to 2028, according to Grand View Research. Hospital-acquired infections (HAIs), also known as nosocomial infections, are primarily found in patients receiving long-term treatment, mainly surgical treatment. They can occur in surgical centers, clinics, hospitals, ambulatory surgical centers, and long-term care facilities, such as nursing homes and rehabilitation centers. Generally, the geriatric population, children and patients with low immunity are prone to HAIs. Factors such as the use of catheters, lack of proper hygiene in health care settings, and excessive use of antibiotics can increase predisposition to HAIs, the report adds. An increase in the prevalence of HAIs due to the lack of sanitation and preventive measures is a key factor anticipated to propel market growth over the forecast period. According to a report by the Centers for Disease Control and Prevention (CDC) in 2018, around 1.7 million cases of HAIs and around 99,000 associated deaths are reported each year in American hospitals. As per a report published by the European Centre for Disease Prevention and Control (ECDC), in 2018, the prevalence of HAIs in the 26

OR TODAY | October 2021

European countries was around 7.1%. It also reported that around 4.1 million patients suffer from HAIs in Europe each year. Such cases are expected to increase the demand for sterilization equipment. Sterilization equipment is required for sterilization and cleaning of different equipment used in the hospitals as they help in preventing infections and reducing the spread of diseases. An increase in the incidence of chronic diseases, such as diabetes, cancer, and other autoimmune diseases, is anticipated to boost the demand for sterilization equipment, Grand View Research states. Antimicrobial resistance increased adoption of unhealthy and sedentary lifestyles, smoking and alcohol consumption are some of the major factors contributing to the growing prevalence of chronic diseases. According to the National Diabetes Statistics Report 2017, by the CDC, more than 100 million people in the U.S. were living with diabetes or prediabetes. In addition, the WHO reported that in 2015, approximately 1.6 million global deaths were directly caused due to diabetes. Cancer has been a global health care burden. According to the estimates of the WHO, cancer is the leading cause of death globally and almost 1 in 6 deaths can be attributed to this disease. In addition, it reported that over 70% of cancer-related deaths typically occur in middle- and low-income countries. The rising prevalence of chronic conditions has significantly increased the hospital admission rate. Blankets, sterile fluids and equipment are some of the essential requirements in hospitals and clinics. Thus, in such cases, sterilization equipment efficiently serves the purpose as they reduce the risk of infection transmission among patients and improve

care delivery, Grand View Research explains. Thus, the increasing prevalence of chronic diseases is expected to positively impact the market growth during the forecast period. Low-temperature sterilizers held the largest share of 31.97% in 2020, according to Grand View Research. The increasing need for sterilization of heat- and moisture-sensitive medical equipment with complex designs is propelling the need for low-temperature sterilization. This technique involves ethylene oxide (EtO) sterilization, hydrogen peroxide gas plasma and sterilization using other liquid chemical substances. Low-temperature sterilization techniques have been evolving over the decade owing to the changing health care environment and complex innovations. In addition, the use of expensive, complex and delicate medical instruments that are difficult to sterilize is spurring the demand for lowtemperature sterilization. Factors such as increasing surgical procedures, the expanding patient population, rising life expectancy, and the unmet need for sterilization of complex substances are driving the low-temperature sterilizers segment, according to Grand View Research. “There is a constant need for R&D due to the risks associated with various sterilants, which prompts manufacturers to make constant efforts, leading to the launch of new products. Some critical aspects of low-temperature sterilization, such as target specificity and toxicity, create a need for advancements in current chemicals available for sterilization. Therefore, these factors are contributing to the growth of this segment over the forecast period,” the report states.

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product focus

Mobile Medical International Corporation Mobile Sterile Processing System

Mobile Medical International Corporation (mmic) provides temporary sterile processing facilities for hospitals that are undergoing renovations, expansions, experiencing overcapacity issues and/or in cases of natural disaster. The Mobile Sterile Processing System (MSPS) is fully customizable to meet the needs of each facility and is designed to comply with AAMI and FGI guidelines. The MSPS is fully integrated with power, lighting, climate control, plumbing and communications. mmic also offers VERDA, a water quality treatment system engineered to provide onsite water meeting AAMI TIR34 requirements for reprocessing medicals devices. • For more information, visit mmicmedical.com.

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October 2021 | OR TODAY

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product focus

Healthmark

Form-Fitting UnderGuard Tray Liners The Healthmark Form-Fitting UnderGuard Tray Liners are dye-cut so they form a protective barrier for instruments from the bottom and sides of instrument baskets. Produced from pure cellulose ECF wood pulp, manufactured with low chloride and sulfate content and free from optical dyes, these liners can be safely used next to delicate instruments during sterilization to absorb and rapidly disperse condensate. This greatly facilitates the production of dry packs. • For more information, visit hmark.com.

Key Surgical T-EZ Pro

Effective sterilization cannot occur without proper decontamination. Washer-disinfectors used in that process need to be evaluated daily for cleaning effectiveness. The T-EZ Pro from Key Surgical is a new product designed for daily testing of washer-disinfectors in sterile processing. The primary benefit of this product is the use of a true blood soil sample – providing the best representation of the material that washers must remove from surgical instruments during mechanical cleaning in preparation for sterilization. The stainlesssteel indicator is set in a clear plastic process challenge device that can be easily opened after testing, no need to break it. A completely cleaned strip (no residue or tracings of the blood soil sample) indicates a passed test. An easy-to-read pass/fail chart is included in each box of T-EZ Pro. • For more information, visit keysurgical.com.

OR TODAY | October 2021

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product focus

ASP

STERRAD 100NX System with ALLClear Technology STERRAD systems continue to be a leader in hydrogen peroxide based low-temperature sterilization with over 20,000 systems installed globally. Health care institutions around the world have trusted STERRAD systems for decades to safely sterilize medical instruments and materials without leaving toxic residue. STERRAD 100NX System with ALLClear Technology is is the culmination of over 25 years of innovation in hydrogen peroxide gas plasma (HPGP) sterilization technology. The ALLClear Technology within the system increases sterilization productivity by conditioning the load, checking for moisture and running system diagnostics prior to sterilization cycles to maximize successful cycle runs. The system also has integrated quality systems to enhance compliance to guidelines and hospital policies and is ready to integrate with ASP ACCESS Technology and STERRAD VELOCITY Reader to automate the reprocessing experience, making the data audit-ready. • For more information, visit asp.com.

Sterilis Solutions

Regulated Medical Waste (RMW) Autoclave/Grinding System Sterilis Solutions Regulated Medical Waste (RMW) Autoclave/ Grinding System provides on-demand remediation of RMW at the point of use. The Remediator takes sharps containers and red bag waste from biohazardous waste into harmless confetti, to be thrown safely in the solid municipal waste stream. It replaces haulers and incineration, reducing medical waste volume by up to 80%. It’s simple to use, reduces risk and regulatory liability, and eliminates paper reporting, all while decreasing your medical waste costs by up to 50%. •

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October 2021 | OR TODAY

CE435

IN THE OR

continuing education

Safe Labeling Helps Prevent OR Errors By Nancy Bellucci, PhD, RN, CNOR veryone is familiar with the adage, “What you see is what you get.” But can healthcare professionals rely on it when it comes to safe medication administration in the perioperative setting — or should “Looks are deceiving” be their motto?

This course explores patient safety goals and strategies for effective medication and solution labeling on and off the sterile field in the perioperative environment. Perioperative healthcare professionals and pharmacists must be knowledgeable about these concepts, so they can promote patient safety and desirable outcomes.

Safe Patient Care Safe and effective patient care is the core of perioperative practice. The Association of Perioperative Registered Nurses (AORN), the professional organization of perioperative RNs, published the Perioperative Patient Focused Model, which recognizes that “there is nothing more important to the practicing perioperative nurse than his or her patient.”1 Publications such as AORN’s Guidelines for Perioperative Practice, articles in peer-reviewed journals, 30

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research, safe practice guidelines, and tool kits are valuable resources for safe patient care. However, failures in patient care processes and systems still occur and can result in errors in patient care.1 These occurrences and near misses can harm patients. When the error is detected before the care or treatment is administered (a good catch), patient harm is avoided. Sometimes, the care is administered but does not appear to cause patient harm. Unfortunately, sometimes the erroneously administered care, treatment, or medication results in temporary or even long-term harm to the patient. These negative outcomes receive national attention when they become one of The Joint Commission’s (TJC) sentinel events. The Patient Safety Advisory Group (formerly the Sentinel Event Advisory Group), appointed by TJC in 2002, reviews and investigates reported sentinel events by performing root cause analyses.2 Medication errors are reportable sentinel events and made the top 10 in the sentinel events report for 2017.3 Sentinel event data compiled from 2005 to 2017 can be viewed online. The National Academies of Sciences, Engineering, and Medicine’s (NASEM) (formerly The Institute

Relias LLC guarantees this educational program free from bias. The planners and authors have declared no relevant conflicts of interest that relate to this educational activity. See Page 37 to learn how to earn CE credit for this module.

Goal and Objectives The goal of this continuing education program is to provide healthcare professionals with information about the challenges of and effective strategies for medication and solution labeling in the perioperative setting. After studying the information presented here, you will be able to: • Discuss the intent of The Joint Commission’s National Patient Safety Goal NPSG.03.04.01 involving labeling medications and solutions on and off the sterile field. • Identify the challenges for safe medication administration unique to the perioperative environment. • Describe strategies for effective medication and solution labeling on and off the sterile field.

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continuing education

Top 10 Sentinel Events for 20174 Sentinel Event

No. reported

Unintended retention of a foreign body

116

Fall

114

Wrong-patient, wrong-site, wrong-procedure

Suicide

Delay in treatment

Other unanticipated event such as asphyxiation, burn, choking on food, drowning or being found unresponsive

Criminal event

Medication error

Operative/postoperative complication

Self-inflicted injury

of Medicine) 1999 report on medical errors, To Err Is Human: Building a Safer Health System, has made patient safety initiatives a priority for healthcare organizations and government agencies.5 In 2002, AORN launched the Patient Safety First campaign to reduce errors in surgical settings and create resources to help perioperative clinicians provide safe patient care.2 Specific practices include correct patient and surgical site verification and surgical counts, as well as medication safety, which can be found in the AORN Guidelines for Perioperative Practice.1 TJC first established its National Patient Safety Goals (NPSGs) in 2003, with the goal of developing standards and directions for practice, and therefore, creating a national movement for patient safety. The NPSGs continue to influence patient care, and Goal 3 addresses safe medication and solution administration. Perioperative care areas must meet these three specific requirements of Goal 36: WWW.ORTODAY.COM

•

Label any medication that is not in its original container and place it into a syringe, cup, or basin. • Know the medications the patient currently takes, especially blood thinners. • Document and report medications the patient takes at home. The complete list of TJC patient safety goals for 2019 can be found online. 6 NPSG.03.04.01. requires clear labeling for medications and solutions that have been removed from their original containers or packaging and transferred to other containers for use on and off the sterile field by a person other than the preparer.6 This requirement applies to the entire perioperative environment and procedural components of any patient care setting in which operative or invasive procedures are performed, including medications used by anesthesia providers. The practice of using labels on

all cups, basins, and delivery devices has been effective in decreasing the incidence of medication errors in the OR.6,7 Most sterile custom set-up packs contain blank labels and a pen or preprinted labels for use in the sterile field.

Characteristics of Perioperative Settings A healthcare facility is a complex environment with many departments and patient care units and in general, facilities are similar in their management of patient care. However, the OR is a different and separate entity with unique nuances and distinct management processes and methods of delivering patient care. The patient population of the OR spans the age continuum, from neonates to geriatric patients. It is common to care for pediatric and adult patients in one day, whether within one or several surgical specialties. For this reason, age-specific medication information and guidelines should be readily available.8 In many organizations, the perioperative continuum of care is the most involved, with many critical factors, steps, and processes that can influence patient outcomes. Several departments and caregivers hand off the perioperative patient in a short period of time. Communication — whether verbal, written or electronic — lends itself to medication error if nonstandard or easily misinterpreted abbreviations are used. Abbreviations should be avoided in medication orders and documentation.9 The Joint Commission has published a “Do not use” list of abbreviations that can be printed and posted in the patient care divisions.

Common Medication Abbreviation Errors to Avoid10 Abbreviated drug names such as ASA (aspirin), PCN (penicillin), MSO4 October 2021 | OR TODAY

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continuing education

(morphine sulfate) Dosages • Use only metric units (ml, mg, grams, mcg) • Use micrograms or mcg, not µg (can be confused with mg) • Use units, not U or IU Use or misuse of zeros • Zero should be placed before a decimal point (0.9%) • No zero should be placed after a decimal point (5 mL, not 5.0 mL) Daily doses • Write out exactly; QD or qd can be confused with QOD or qod; tid and bid can be confused with each other Eye medication: • Write out eye site(s); OD (right), OS (left), OU (both) can be confused Generally, the medication process in the OR involves the prescribing physician, the preparing and dispensing pharmacy, the circulating nurse, and the scrub person, who is the final check before the medication is administered from the sterile field. Other variables, such as the OR environment, staff availability, and administrative support impact the effectiveness of the medication and the solution safety initiative.7

OR Environmental Conditions Many surgical procedures require that room lights be dimmed or turned off. The X-ray view box, a lamp on the anesthesia cart, surgical spotlights, or a lighted workspace provides alternative or indirect lighting. Visibility is compromised, especially for reading medication labels and preparing and managing medications and solutions on and off the sterile field. The workspace in the circulating nurse’s area can be small and cluttered with equipment and retrofitted computers and keyboards.10 From “patient-in” to “patient-out,” 32

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the OR is a busy area. Conversations take place between team members. Distractions and interruptions are common. During the surgical procedure, the circulating nurse manages multiple priorities of the patient, anesthesia provider, surgeon, and scrub person while still monitoring the sterile field. The circulating nurse works in a constant state of anticipation of who might need what next.10

Staffing Adequate staffing with the appropriate skill mix and assignments is important for safe patient care. The current realities of short staffing, temporary and contract staff, and novice team members create challenges. Complex or multiple specialty procedures, which require additional staff, create further demands.7,10 That said, these procedures typically have several priorities for the patient, anesthesiology provider, and surgeon, so additional staffing is beneficial for the extensive setup and during the initial patient positioning, prepping, and incision time. A second circulating nurse can work exclusively with the scrub person to prepare, dispense, and label the medications or solutions.10 The work schedule should be managed to avoid extended work hours since fatigue contributes to medical errors.

OR Time Management Influences Time is an important indicator when evaluating performance and productivity in the OR. Shorter procedure times, quicker turnover, increased case volume, and total procedure minutes are monitored. Certain eye procedures take little time to perform but use multiple medications in the sterile field.10 Some procedures, such as Dilatation and Curettage (D&Cs) and arthroscopies, can leave the team with the feeling the case is over before it starts. It is an environment of rapid

interventions and the margin for error is great, especially concerning medications and solutions in the OR.

Medication Orders The medication process involves: • Prescribing (a physician’s order) • Processing the order (transcribing and documenting) • Preparing the medication or solution • Dispensing • Administering the medication to the patient • Monitoring and documenting the effect of the medication In the OR, the preference card has long been viewed as the primary source for the physician’s written medication orders and as a “standing order.” As the supplies needed may differ from this, the circulating nurse has the professional responsibility to check the medication needs with the surgeon before each case is set up.10 Medications are sometimes listed on the preference card with options (e.g., if local, use medication “A”; if general, use medication “B”). If preference cards are used, the circulating nurse should update any changes by initialing and dating the revision.10 The relationship of preference cards to medication errors is cause for concern. Information on preference cards can be outdated, incomplete, or inaccurate. Inconsistent nomenclature (e.g., generic vs. brand name), abbreviations, unclear dosage, and concentration calculations should be clarified with the surgeon before the surgical procedure begins.10 Validation of the medications can be incorporated into the time out procedure as part of the available supplies before the incision is made. This process is important in the prevention of medication errors. Medication orders may be given verbally in the preoperative holding area or during an OR procedure. WWW.ORTODAY.COM

IN THE OR

continuing education Medication orders given verbally in the OR are a potential source of error. Masks can muffle speech, the surgeon may have an accent, several conversations are often underway simultaneously, music may be playing, surgical equipment and monitors create ambient noise, and the circulating nurse is usually juggling priorities. Verbal orders should be repeated back and documented as soon as possible, with the physician signing the order (this can be a problem if the surgeon is scrubbed at the time the order is given.) The surgeon must sign the medication order after the surgical procedure is completed.7, 10

Medication Preparation The perioperative setting creates concern about the safe preparation of medication concentrations. Several people handle medications and solutions dispensed to the sterile field before the surgeon administers them. The circulating nurse may need to obtain and reconstitute a drug to a specific concentration before it can be used in the sterile field and the correct type and amount of diluent (sterile saline or sterile water) are as important as the drug itself. This makes the circulating nurse’s knowledge of surgical pharmacology an important factor in preventing medication errors.10 One surgical procedure can require the preparation and mixing of several medications and solutions. Clear, complete, and accurate instructions and conversion charts for the dosage and concentration calculations (including age-specific information) are critical. The pharmacy is responsible for preparing specialty medications and solutions, such as 4% cocaine hydrochloride for otorhinogologic cases. The circulating nurse cannot mix this preparation and must obtain it from the pharmacy. Other drugs are stored in WWW.ORTODAY.COM

stock or in a machine referred to as automated machines, like Pyxis™ dispensers. The dispensing machine is activated by using the ID number of the circulating nurse and the patient’s ID number.9 This is another method of documenting a drug for patient use.

Medication Dispensing and Administration Unique to the OR is the additional team member, the scrub person (who may be an RN or a surgical technologist). After confirming the correct drug, dose, and expiration date, the circulating nurse aseptically dispenses the medication or solution to the sterile field where the scrub person immediately labels the receptacle (cup or basin) and the delivery device (syringe) under sterile conditions. The label should at a minimum include the drug’s name and strength.10 Some facilities require the scrub person’s initials. When the drug is handed to the surgeon, the scrub person repeats the name and strength of the drug. When the surgeon returns the used syringe, as it is pre-marked by the manufacturer with dosage measurement increments, the scrub person can report the amount used to the circulating nurse.10 The nurse documents this amount in the patient’s OR record. All original drug containers from the pharmacy are retained by the circulating nurse until the end of the case as validation of correct medication preparation and usage. The systems in place for drugs used in the sterile field contribute to the safety of medication administration in the OR.

Medication Intensive The OR is medication intensive. It is common for several medications to be used during one surgical procedure and these could include: • topical and local anesthetics

• • • • • •

contrast media dyes gases antibiotics anticoagulants solutions (plain or with additives) Furthermore, the medications can be administered by various routes: topical, injection, infusion, or irrigation.10 These preparations are delivered by the sterile team at the field. Other forms of these drugs are administered by the anesthesia provider in concert with the surgeon. Surgical pharmacology becomes very complicated when determining medication safety and preventing drug interactions. In addition, high-alert medications such as heparin and epinephrine are common in the OR. Once on the sterile field, “look-alike” concerns extend beyond similarities in medications’ names and appearance. Most medications and solutions are clear and look similar, such as irrigation solutions (e.g., saline, sterile water, and lactated ringers) and local anesthetics, whether plain or with additives. Specialty drugs and solutions prepared by the pharmacy may be tinted pale contrast colors for easy identification. Nonetheless, they should be clearly labeled, and these labels checked prior to administration. For example, 4% cocaine hydrochloride is often tinted light green and provided only in 4 to 5 mL increments for topical use in nasal surgery.10

Safety Goals Perioperative nurses assume the role of the patient’s advocate during the perioperative experience and is, therefore, the most significant barrier to adverse events.1,7,10 With patient safety as the priority, the RN critically assesses every activity and intervention as safe practice. Professional responsibilities require the RN to October 2021 | OR TODAY

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continuing education

use best practices and to be aware of changes in practice, as well as knowing the organization’s patient safety initiatives. Patient safety goals provide the RN with an opportunity to be a patient safety leader.

Administrative Support Essential to quality or process improvement is the support and ongoing follow-up from an organization’s leadership. Managers provide leadership for a collaborative, multidisciplinary systems approach to improve processes. They also play an important role in establishing safe practice protocols and identifying necessary core competencies to create highly reliable patient care. This collaborative teamwork fosters mutual respect, with each practitioner knowing his or her role, understanding the roles of fellow caregivers, and having a sense of responsibility and accountability to teammates. Leadership must provide the resources that staff need to ensure this culture of safety.7,10 These resources may include: • Staffing that provides the appropriate number, skill mix, and assignments. • Time for education and training, case setup, and medication preparation. • A safe work environment with reduced distractions and interruptions, as well as appropriate lighting and work areas. • A nonpunitive culture in which reporting of errors is a routine professional responsibility. • Information for increased awareness, quality data, and education and training. • Tools and supplies that support safe practice and adherence to policies, including labels and markers, and alternative lighting for work areas on and off the sterile field. 34

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Label Information Unlabeled medications are unidentifiable. Transferring medications to the sterile field without labeling is an unsafe practice that neglects basic principles of safe medication management. NPSG.03.04.01 mandates labeling for medications on and off the sterile field. Label information must include a medication’s name and strength as well as amount when medications are mixed (as with antibiotic irrigations, tumescent and heparin solutions, and epinephrine). The unit of measure — percent, grams, milliliters, or units — must be recorded along with the date the medication is prepared. An expiration date is applicable when the medication is not used within a certain period designated by the manufacturer or if a specific time limit after reconstitution exists. Original containers and delivery devices must be kept in the OR for verification until the procedure is completed.10 Anything in unlabeled containers must be disposed of immediately. The only exception to labeling is when the medication is immediately used or disposed of, with no intervening steps or functions before administration.

Label Quality Labels are placed on containers, including syringes, medicine cups, pitchers, bulb syringes, and solution bags made of metal, glass, and plastic. The labels are subjected to a wet field for several hours; therefore, labels should be evaluated for the following: • Adhesive durability • Ink that resists smudging when wet or handled often • Adequate size to allow all required information to be legible and clearly visible • Adaptability to fit on a variety of shapes and sizes of containers

•

Cost-effectiveness and availability Several labeling systems are available. Kits and custom packs include pens with permanent ink and labels that are color-coded, preprinted, or custom printed to meet a hospital’s needs.

Transferring to a Sterile Field When two or more qualified people are preparing and administering medications and solutions in the intraoperative setting, they must communicate clearly when transferring the medications and solutions to the sterile field. They must verbally and visually confirm the information on the medication label. To maintain consistency with counting policies, an RN should be one of the people involved. When one person both prepares and administers the medication immediately, the two-person verification is not required.10 If the medication is prepared but not given immediately, labeling is required.

Labeling Medications must be labeled immediately when they are received on the sterile field. Even if only one medication or solution is on the sterile setup, it must be labeled. An effective strategy is the use of preprinted labels, which can be included in the custom pack as well as in separate sterile packaging. Prelabeled containers such as bowls, basins, and syringes are not acceptable since the risk exists for a different medication or solution to be transferred to the container. Label one medication at a time to prevent mislabeling and always double check your work. Consistent labeling protocols must be practiced throughout the department in all specialty services. NPSG.03.04.01 focuses on medications that are removed from their original containers, that are both on WWW.ORTODAY.COM

IN THE OR

continuing education

and off the sterile field, and that are intended to be administered to the patient during the procedure. Solutions with additives, such as electrolytes, antibiotics, and epinephrine, that are delivered from the original container by a device such as an irrigation pump must also be clearly labeled. Labeling is required for “one-person scenarios” (i.e., when one person prepares the medication or solution but does not administer it immediately).

Verification on the field When passing a medication or solution to the surgeon, the scrub person must say the medication or solution name and strength out loud.10 Many times, the surgeon cannot take his or her focus from the immediate surgical field, has asked for several items at a time, or may be continuing a discussion with other team members. The surgeon must confirm the name and strength of the medication or solution as well.

Communication Another unique aspect of patient care in the OR is that the primary scrub person and circulating nurse can transfer responsibilities of direct and indirect patient care activities. Procedures and protocols must be established for communication of medication information during temporary relief for turnover, case setup, and breaks, and during permanent relief for patient handoffs at change of shift and to specialty teams. Information discussed by the entering and exiting team members must include the medication or solution name, strength, concentration, and amount administered. It is important to discuss medications used during the procedure in the post-anesthesia handoff report.11

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Conclusion NPSG.03.04.01 provides a focus for safe medication administration in perioperative practice. A review of the facility’s medication administration process will determine revisions and resources required for safe practice policies and procedures. Having the perioperative team use consistent medication labeling and verification processes as the standard of practice helps reduce medication errors.

The Seven “Rights” of Perioperative Medication Administration10 1. Right Patient • “Time out” for patient identification, allergy confirmation, and surgical procedure verification. • Use of two patient identifiers, such as full name and birth date. 2. Right Medication • Orders: Verify preference card (“written orders”) information with the surgeon; “read back” of verbal orders with surgeon signoff when written. • Dispensing: satellite pharmacy, controlled access dispensing systems, open access storage areas. • Labeling: All medications removed from original container and transferred to secondary containers on and off the sterile field. • Verification: Visual and verbal by two qualified people, one of whom must be an RN, when transferring. • Verbal verification of name and strength by the scrub person when handing to the surgeon. • Review during breaks, change of shift, and specialty handoffs. 3. Right Dose • Pharmacy mixing/preparation. • Age-specific dosage and concentration calculation charts. • Verbal and visual verification by two people.

4. Right Route • Topical, injection, irrigation, infusion, flush. • Competency using delivery equipment (irrigation pumps, specialty syringes, ultrasonic suction, irrigator, aspirators, etc.). 5. Right Time • Medication or solution prepared and transferred to the sterile field at the right stage of procedure. • Expiration time or date for time limits after reconstitution or if not used immediately. 6. Right Reason • Appropriate antibiotic/antimicrobial for known infectious after culture and sensitivity confirmation. • Experimental drugs used only with appropriate process and informed consent. 7. Right Documentation • Signature affirmation by the surgeon for drugs ordered in the perioperative setting. • Delivered dose recorded. Editor’s Note: Nancymarie Phillips, PhD, RN, RNFA, CNOR, previous author of this educational activity, has not had an opportunity to influence the content of this current version. Author: Nancy Bellucci, PhD, RN, CNOR, is a faculty member who teaches for an online RN to BSN program at Galen College of Nursing, an online RN-BSN program for the University of Maryland University College, and an online master’s and undergraduate program for Grand Canyon University. She is the author of articles that have been published by the American Nurses Association, is a peerreviewer for the AORN Journal, and has presented at two national conferences on her work related to strategies that nursing students use to manage the responsibilities associated with balancing work, family, and school. She is a member of the ANA, NLN, AORN, and STTI. October 2021 | OR TODAY

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continuing education

Clinical Vignette

he relief team for the primary ophthalmology group arrives as the surgery concludes and the eye patch is placed on the surgical patient. The relief team asks the primary team to immediately take its break since they have a full relief schedule. The relief RN transfers the patient to the PACU and then completes the next case setup for cataract extraction with lens implantation and trabeculectomy with the relief scrub person. Expected case setup time is seven minutes; the case will take roughly 20 minutes to complete. The medications are prepared and transferred to the sterile field using needle gauge and syringe size combination for identification of the medications and solutions. The balanced saline solution (BBS), an isotonic irrigating solution to maintain pupil dilation and keep the eye moist, is hung on the phacoemulsification unit. Several milliliters of the BSS are flushed through the phacoemulsifier tubing and the hand piece into a glass medicine cup to prime the unit and handpiece. The relief circulating nurse pours 500 mg of vancomycin (Vancocin®) in 10 mL of normal sterile saline into a second glass medicine cup while the scrub person prepares the Mayo stand instrumentation. The relief scrub person prepares the medications and solutions, matching syringe size and needle gauge for identification, including a 3-cc syringe filled with BSS from the glass medicine cup to avoid open-

References

ing another BSS sterile dose bottle (15 mL) at the end of the procedure. This syringe is placed between the medicine cups on the back table. The relief scrub person places the glaucoma drainage device implant into the vancomycin mixture in the second medicine glass until the surgeon is ready to implant the device. The primary team returns from break as the surgical prep is completed. Since the primary team and surgeon have a long-term working relationship, the surgeon rarely needs to ask for the next instrument, medication, or solution during procedures. At the end of the cataract procedure, the surgeon seals the surgical wound and injects the incision with BSS from the 3-cc syringe prepared during the case setup. As the surgeon returns the syringe to the Mayo stand, the primary scrub person realizes it is unclear whether the syringe was filled from the medicine glass containing BSS or the one containing vancomycin. Since antibiotics are toxic when injected into the eye — and vancomycin has a long half-life in normal eyes — a retinal ophthalmologist is called to the OR to perform emergency management with aggressive BSS lavage. The trabeculectomy procedure is not performed because of the emergency situation. Since the patient is at risk for a loss of visual acuity and even blindness, additional postoperative follow-up is required. In addition, the patient requires continued medical management of the glaucoma until it is appropriate to reschedule the trabeculectomy.

quality/10-most-common-sentinel-events-

8. Wallace J, Paauw DS. Appropriate prescrib-

1. Perioperative patient-focused model. In:

of-2017.html. Accessed August 10, 2018.

ing and important drug interactions in older

Guidelines for Perioperative Practice. Denver,

5. The National Academies of Science,

CO: AORN; 2018: 4.

Engineering, and Medicine (NSAEM). To err

2. The Joint Commission (TJC). Facts about

is human: Building a safer health system.

9. Collard B, Royal A. The use of abbrevia-

Published November 1999. http://www.na-

tions in surgical note keeping. Ann Med Surg

tionalacademies.org/hmd/~/media/Files/Re-

(Lond). 2015;4(2):100-102. doi: 10.1016/j.

port%20Files/1999/To-Err-is-Human/To%20

amsu.2015.03.008.

the patient safety advisory group. 2017. https://www.jointcommission.org/assets/1/18/ Summary_4Q_2017.pdf. Accessed August 27, 2019. 3. The Joint Commission (TJC). Summary data of sentinel events reviewed by The Joint Commission. 2018. https://www.jointcommission.org/assets/1/18/Summary_4Q_2017.pdf. Accessed August 27, 2019. 4. Knowles M. Top 10 most common sentinel events of 2017. Becker’s Clinical Leadership & Infection Control. Published July 5, 2018. https://www.beckershospitalreview.com/

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Err%20is%20Human%201999%20%20report%20brief.pdf. Accessed August 27, 2019. 6. The Joint Commission (TJC). 2019 hospital national patient safety goals. 2019. https:// www.jointcommission.org/assets/1/6/NPSG_ Chapter_HAP_Jan2019.pdf. Accessed August 27, 2019.

adults. Med Clin N Am. 2015;99(2):295-310. doi: 10.1016/j.mcna.2014.11.005.

10. Phillips N. Berry and Kohn’s Operating Room Technique. 13th ed. St. Louis, MO: Elsevier; 2017. 11. Petrovic MA, Aboumatar H, Scholl AT, et al. The perioperative handoff protocol: evaluating impacts on handoff defects and provider satisfaction in adult perianesthesia care units.

7. Landers R. Reducing surgical errors: Imple-

J Clin Anesth. 2015;27(2):111-119.

menting a three-hinge approach to success.

doi: 10.1016/j.jclinane.2014.09.007.

AORN J. 2015;101(6):657-665. doi: 10.1016/j. aorn.2015.04.013.

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CE435

How to Earn Continuing Education Credit 1. What is a contributing factor in this medication error? a. L ack of labeling of c. Verbal confirmation of medications transmedications as passed ferred from the original to the surgeon. container to syringes on d. Appropriate handoff the sterile field. between the two OR b. L ong-term specialty teams. team working with the surgeon. 2. Medication errors during surgery resulting from unlabeled secondary containers and syringes on the sterile field are significant for: a. O bligating any future c. M anaging intervensurgical procedures for tions by the anesthesia the patient to be on an provider. inpatient basis. d. They have no sigb. C ausing potentially nificance beyond the long-term harm to the immediate surgical patient. procedure.

3. To avoid future medication errors, the ophthalmology service should implement which strategy? a. Take breaks when c. View the error as a there is a delay or at statistical inevitability. the end of the case d. L abel syringes and schedule. other containers on b. D eny operating the sterile field and privileges to the conduct a handoff surgeon involved. review of medications and amounts given.

Clinical VignettE ANSWERS 1. Answer: A. Lack of labeling of medications transferred from the original container to syringes on the sterile field. 2. Answer: B. Causing potentially long-term harm to the patient. 3. Answer: D. Label syringes and other containers on the sterile field and conduct a handoff review of medications and amounts given. WWW.ORTODAY.COM

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 9/24/2022 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

Questions

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

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

October 2021 | OR TODAY

corporate PROFILE

Healthmark

Healthmark Industries Provides Products, Newsletter & Education or over 50 years Healthmark has provided innovative intelligent solutions to fit the needs of health care facilities. 2021 has been a year of growth, offering new products and providing new educational services.

During 2021 Healthmark announced the acquisition of McGan Technology LLC. One of the most innovative products for the operating room is the Insulation Tester. Designed for electrically testing electrosurgical instruments, the lowfrequency high-voltage Insulation Tester is used to detect and locate defects such as pinholes, cracks and bare spots in the jacket or coating of laparoscopic and bi-polar electrosurgical instruments. The Insulation Tester is a handheld, portable unit that tests the insulation integrity of electrosurgical equipment for flaws in protective coatings applied over conductive instrument surfaces in order to prevent inadvertent tissue burns, which may occur during electrosurgical instrument procedures. Manufactured with a rechargeable battery, the Insulation Tester maintains applied test voltage with constant current source, features full test current at low voltages, limited output current for operational safety, easy-to-read LED indicators 38

OR TODAY | October 2021

as well as the LED display of alarm and battery charge. The Insulation Tester comes with the following reusable and interchangeable accessories: ground wire with alligator clip, ring electrode, tri-hole electrode, brush electrode, saddle and case. The Bi-Polar Fixture accessory that works in conjunction with the saddle, ground wire and brush electrode can be purchased separately. Additionally, an optional Wire Tester accessory used with an HV Red Lead Wire is available for testing wires by locating and identifying defects such as pinholes or cracks in the conductive core. Healthmark Industries is also delighted to introduce the new FIS007 to its ProSys Optical Inspection product line. It is a borescope designed to visually inspect internal channels of potentially soiled or damaged items with enhanced light, vision and magnification. It also offers users the option to document with photos and videos the lumens and crevices not visible to the unaided eye. The FIS-007 features a modular design with interchangeable flexible inspection scope attachments available in diameters of 1.06mm and 1.9mm. These scopes have a working length of 110cm and attach to a 13.3W x 9.9L x 4.7H cm control box, allowing for light level adjust-

ments, image capture1 and video recording. 1 The 1.06mm scope is designed to inspect internal channels of 1.1mm in diameter or larger, and the 1.9mm scope is designed to inspect internal channels of 2.0mm in diameter or larger. Cleaning verification continues to be a critical issue in health care facilities across the country. News headlines often report about complications from surgeries caused by instruments and equipment that have not been properly cleaned. It has affected the health care field over the years. Healthmark’s ProFormance monitoring tools help to ensure surgical instruments and other equipment are reprocessed correctly. AAMI2 and AORN 3 recommend at least weekly testing of the cleaning process. These products are designed to help facilities comply with standards and ensure they are reprocessing equipment and cleaning surgical instruments properly. Researchers have discovered that devices that haven’t been reprocessed correctly can emerge from the cleaning process with bits of bone, blood and tissue from the previous operation. These contaminants can be reservoirs for some potentially lethal bacteria. Proper cleaning and sterilization are essential for ensuring that medical and surgical WWW.ORTODAY.COM

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CORPORATE PROFILE

Healthmark

Healthmark’s growth includes the recent acquisition of McGan Technology LLC.

Healthmark continuously strives to create educational opportunities for health care professionals to earn CEUs. This past year, Healthmark added free bi-weekly webinars hosted by its clinical educators and other professionals around the industry.

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instruments do not transmit infectious pathogens to patients. According to the Centers for Disease Control and Prevention (CDC), multiple studies in many countries have documented lack of compliance with established guidelines for cleaning, disinfection and sterilization. Failure to comply with scientifically based guidelines has led to numerous outbreaks. This year, Healthmark also launched its Vendor Credentialing program. The Clinical Affairs team has created 13 programs for vendors and manufacturer representatives. To gain access to health

care facilities, representatives must fulfill the requirements of various vendor credentialing programs, such as VendorMate (GHX), Intellicentrics and Symplr. This program launched with 13 programs that fulfill the requirements of vendorcredentialing systems. Healthmark continuously strives to create educational opportunities for health care professionals to earn CEUs. This past year, Healthmark added free bi-weekly webinars hosted by its clinical educators and other professionals around the industry. Additionally, it has added a new “Ask the Educator” podcast, October 2021 | OR TODAY

corporate PROFILE

Healthmark

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hosted by Kevin Anderson. Online registration for both is available at http://hmark.com/education.php. In addition to the webinars and podcasts being offered, Healthmark provides a unique free service at Crazy4Clean.com. It’s a website that consists of educational games designed to teach health care professionals about proper reprocessing of instruments/equipment while earning free CEUs. At the end of each game, players receive a free CEU by completing a quiz based on what they’ve learned. StyleYourPPE.com is a site created by Healthmark where health care professionals can purchase PPE and other attire for individual use. Face masks, Cool Aids and other PPE attire are available as well as socks that are creatively designed to add a little fun to a serious dress code.

40 OR TODAY | October 2021

If you are looking for industry news, helpful hints and other information, Healthmark produces a weekly newsletter that is distributed to thousands of readers. Each Healthmarket Digest features a story written by a member of the Healthmark team as well as a weekly coupon.

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COVER STORY

RO P P A P I H S R LEADE

OR TODAY | October 2021

AM E T , S AC H E

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R O E H T N I G N I BUILD

eadership and strong teams are important in any organization, but especially in the high-stress, highstakes setting of the operating room. This makes leadership development and team building critical to perioperative success. “Building a strong perioperative team is essential and contributes to an environment that supports and maintains respect, trust and the dignity of all team members and patients,” says Association of periOperative Registered Nurses (AORN) CEO Linda Groah, MSN, RN, CNOR, NEA-BC, FAAN.

AD NS

D BY

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October 2021 | OR TODAY

COVER STORY “A strong team cultivates a healthy work environment and a culture that encourages innovation in practice,” Groah adds. “It also contributes to team members’ personal and professional well-being and to them finding joy in their work.”

Different Leadership Styles In a landmark study published in 2000, Daniel Goleman and his research team identified six distinct leadership styles exhibited by mid-level managers: • Pacesetting leaders expect and model excellence and self-direction. • Authoritative leaders mobilize the team toward a common vision and focus on end goals. • Affiliative leaders work to create emotional bonds that bring a feeling of bonding and belonging. • Coaching leaders develop people for the future. • Coercive leaders demand immediate compliance. • Democratic leaders build consensus through participation. Lisa Bailey, BSN, BS, RN, CNOR, a member of the AORN Board of Directors, says she has seen some of these leadership styles exhibited in the perioperative setting. She believes the most important leadership characteristics are being honest and open, trustworthy and a good listener. “Leaders also need to be consistent in their words and actions and role model what they expect from their team members,” she says. “Each of these leadership styles has its time and place,” adds Jamie Ridout, RN, MSN, MBA, NEA-BC, CNOR, CASC, the administrator at the Capital City Surgery Center in Raleigh, North Carolina. “That said, leaders must know their audience and use the style that’s most effective and produces the best results. One leadership style won’t work for every situation and every staff member.” Independent perioperative consultant Missi Merlino, MHA, RN-BC, CNOR, CSSM(E), believes that each leadership style can play a part in the OR unless it will harm a patient or

44 OR TODAY | October 2021

violate policies and procedures. “However, the authoritative style is the least effective,” she says. “Collaboration and coaching work best in my opinion. As you develop your team, coaching them through difficult conversations or interactions can have a very positive impact.” Groah adds another leadership style to this list, one that she calls contingency leadership. “In the current age of technology and pivoting expectations of leaders, I believe this is the most effective leadership style,” she says. “This type of leader has command of all the styles of leadership and will use the one that meets the situation and will produce the desired outcome.” Sharon A. McNamara, BSN, MS, RN, CNOR, says she has employed each of these leadership styles at some point during her career, depending on the specific circumstances. “I call this situational leadership,” says McNamara. “These leadership styles are based on components of emotional intelligence, so it’s important to know how these different styles affect performance or results in each situation.” McNamara says she has adopted what she calls the “servant leader paradigm” because she believes the role of a leader is to serve. “As leader I have always worked to develop healthy symbiotic relationships,” she says. “My major focus has always been identifying and meeting the legitimate needs of my people and removing any barriers so we could get results and meet the goal of safe, quality patient care,” says McNamara.

Leadership and Team Building in Action Todd Masten, the founder and COO of SurgeryDirect, has faced a number of leadership and team building challenges since the company was founded in 2015. “As an ASC management company, we have seen it all, from massive staff turnover to failed leadership,” says Masten. “At times we are asked to come in and provide leadership to get the center back on course, so to speak.” According to Masten, stepping into

the multi-license leadership role has required a greater focus on emotional intelligence, or EQ, than on IQ. “In fact, I would argue that in intimate health care settings, EQ is more important than IQ for leaders,” he says. Masten stresses that perioperative leaders must strive to manage their own emotions in difficult situations in order to relieve, not increase, the stress. “How many times have we worked for a leader who acted as accelerant to the problem instead of a suppressant?” he says. “Staff members can only exist in this environment for so long before trust with leadership is broken.” SurgeryDirect’s latest ASC turnaround occurred at a host-center ASC and its four multi-licenses. “It’s by no means easy to manage this complex model, but that makes it even more rewarding when you empower your staff to succeed,” says Masten. They started out by asking openended questions focused more on the individual staff members than on the job roles. “We gave staff an opportunity to get to know us not as a center leader, but as a human,” says Masten “But what they gave us was even more cherished,” he adds. “We learned about their wants and desires, about their families and loved ones, and about what they loved about their profession and why they chose it.” Masten likes to refer to a leadership quote from President Theodore Roosevelt: “People don’t care how much you know until they know how much you care.” “Once the staff knows you care, they will be ready and willing to follow your ideas,” he says. “Staff morale will improve, and turnover will drop drastically.”

Leadership and Team Building Tips Groah offers a number of tips for perioperative leaders when it comes to improving their leadership and team building skills. “Demonstrate empathy, be authentic, recognize positive performance and behavior, and keep your commitments,” she advises. “Also be willing to mentor your team and to apologize

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“My major focus has always been identifying and meeting the legitimate needs of my people and removing any barriers so we could get results and meet the goal

of safe, quality patient care.” – Sharon A. McNamara, BSN, MS, RN, CNOR when appropriate. And do all this while continuously monitoring trends so you are not surprised.” Merlino stresses the importance of acknowledging the contributions, experience and passion of each team member. “Even nurses new to the perioperative setting bring valuable life lessons we all can learn and draw from to improve patient care,” she says. “It’s so important not to stereotype someone without giving them a chance to learn and grow.” Ridout believes that building a strong team begins with setting expectations and vision as a leader. “All perioperative leaders, from the director of nursing to the charge nurse, must have some level of oversight that expectations are being met and staff are bought in to the direction of the organization,” she says. Bailey lists consistency and clear communication as her top leadership and team building tips. “Consistency gives team members a feeling of stability while communicating clear expectations lets them know what is and isn’t allowed and what level of performance is expected,” she says. Having an open and honest rapport with the team is also critical, as is listening to what team members say. “This helps team members feel important and valued by leadership,” says Bailey. For McNamara, ensuring proper work-life balance is a critical characteristic for perioperative team leaders. “The research is out there regarding how working over 10 hours a day or 40 hours a week increases patient risk and perioperative team member safety,” WWW.ORTODAY.COM

she says. “Leaders should take a deep breath and look for ways to inject joy, fun and break times into the workday.” McNamara is also a big believer in teamwork initiatives like TeamSTEPPS and Crew Resource Management. “Research demonstrates that health care organizations that implement these kinds of initiatives have seen a reduction in adverse patient outcomes and ICU stays and a decrease in postoperative sepsis rates,” she says. “One thing I learned many years ago was that the leader must know when to lead and when to follow,” McNamara adds. “There are no effective leaders without effective followers – both are important to successful outcomes.” For example, McNamara says that effective team leaders are comfortable taking a risk and following the unofficial leader. They allow followers to test their ideas and encourage them to challenge the status quo. And they’re stimulated by out-of-the-box discussions, leaving their preconceived solutions at the door and being open to the team’s solutions.

Leadership During a Crisis Nothing tests perioperative leadership skills like a crisis. “The keys to leading in a crisis are remaining calm, using good judgement, trying to stay as informed as possible and making the best decisions you can based on the information you have at the moment,” says Ridout. Merlino spent much of her perioperative career working on cardio-thoracic and vascular teams. “Things can change so quickly during these cases,” she says. “Leaders must stay focused and depend on the training of every-

one in the room. And the emphasis must always be on the patient’s safety, not on anyone getting their feelings hurt.” Groah recommends developing a crisis action plan right away by assessing the situation and identifying the short-term and intermediate needs. “Communicate the plan to all team members and give them the authority they need to do the assignment,” she says. “Then continuously monitor and evaluate the results.” According to Bailey, perioperative team members will have questions and want clarity about what will be expected of them as their environment changes to facilitate the crisis at hand. A good example of this was when COVID-19 entered her facility. “The patient load outnumbered the rest of the patient population requiring care so the number of surgeries being performed was reduced each day to allow space for COVID patients,” says Bailey. “Of course, the perioperative staff was concerned about what that meant for their jobs. Leadership came together to explain how they could help if deployed out to the floors and ICU units.”

Flexible Leadership Masten’s biggest leadership takeaway is simple: Be flexible. “You can’t follow just one leadership style all the time,” he says. “Good leaders get to know their staff members, understand the setting and choose the style that’s best for the situation.” The worst leadership situations Masten has witnessed occured when a leader read an article or book on leadership and immediately tried to use all the different styles. “We’re all human and strive for perfection,” he says. “But being human means we’re all flawed.” Masten concludes: “I believe that when we as leaders understand our flaws, see our blind spots and become more predictable – even boring in that predictability – this allows a team to forget about all the other stuff and just be amazing at completing their role.”

October 2021 | OR TODAY

Spotlight On:

Kristy A. Wheeler

MSN, RN, CNOR

Senior Clinical Nurse II, Acute Care Emergency Surgery Service Line Coordinator University of Maryland Medical Center (UMMC), Baltimore

By Matt Skoufalos

s a teenager, Kristy Wheeler grew up watching “ER,” the 15-season NBC medical drama that followed the lives of emergency room staff at a fictional Chicago hospital. The show resonated with her so much so that Wheeler decided to pursue a career as a surgical technologist. After completing a certificate program and associate’s degree in science at Baltimore County Community College, she landed in the operating room at MedStar Franklin Square Medical Center in Baltimore, Maryland, at just 19 years old. One year in, Wheeler doubled-down on her decision to enter health care, and pursued a bachelor’s degree in nursing. “I really enjoyed being a surgical technologist, and I have maintained my certificate; I’m still scrubbing currently,” Wheeler said. “But being a scrub tech affirmed that I really wanted to do nursing. It definitely gave me an edge becoming a perioperative nurse, because I understand both sides very well; I can scrub and circulate.” Leveraging her work experience, Wheeler was accepted at Coppin State University in Baltimore, Maryland, where she attended classes while working full-time and overnight hours at Franklin Square. (Confusingly, her practical career experience occasionally conflicted with the textbook answers her instructors were seeking.) When all was said and done, Wheeler was hired into a nursing position at Mercy Medical Center in Baltimore. She was the first nurse there ever to finish her orientation ahead of schedule; a clear sign of her command of institutional and applied knowledge.

OR TODAY | October 2021

“Mercy saw me as having a huge advantage of being able to scrub right out of the gate,” Wheeler said. “One of my doctors told me, ‘You already knew how to do the job, you just had to go back and get the degree.’ ” She wasn’t done there, either. While working at the University of Maryland Medical Center (UMMC), an academic hospital, where “the school of nursing was right across the street,” Wheeler achieved her Master of Science in nursing (MSN). In a career where a bachelor’s degree has become entry-level standard, she knew a master’s degree would open up another tier of professional opportunities. Today, Wheeler is a senior clinical nurse and service line coordinator for the acute care emergency surgery service line at UMMC. She oversees a team, leads process improvement projects, and tracks down special supplies for the patients under her care, all mostly on the fly in an emergency care environment. Wheeler credits her involvement with the Association of periOperative Registered Nurses (AORN) as having helped her find the confidence to pursue her master’s degree and the supervisory roles within her institution. “I definitely didn’t set out thinking I would end up being a master’s-degreed nurse,” Wheeler said. “My involvement with AORN opened the door for that for me, and gave me the encouragement that I could get an MSN. I was able to use that to translate into a leadership role.” Wheeler’s initial experience with AORN came at its surgical conference and annual expo. After her local chapter helped subsidize her travel to San Diego, she had the chance to see first-hand all that the organization has to offer. “It affirmed the magnitude of what we are doing, of WWW.ORTODAY.COM

Kristy Wheeler has combined on-the-job lessons with knowledge from the classroom to excel.

our organization and the impact and respect that our organization has worldwide,” Wheeler said. “I came back from the expo and got more involved in the chapter, and ran for a nominating committee. The next year, I ran for president of the chapter, and I’m going to be president for the third time in 2022.” During her first term as chapter president-elect, Wheeler attended a volunteer leadership academy at AORN headquarters, where she met its board of directors and nominating committee. Soaking up the history of the organization deepened her connection to it, but the visit also affirmed for AORN members the value in cultivating a diverse group of voices among its leadership. She ran for – and won – a seat on the national AORN Nominating Leadership Development Committee. “I went to my first meeting, and wanted to just observe,” Wheeler said. “Then they got onto a topic that I’m passionate about, social media, and then I got started talking. I was really worried; I apologized to the chair of the committee at the time. I was 32; she was 62.” “She thought about it, and said, ‘If I didn’t have social media, I wouldn’t know what my kids were doing,’ ” Wheeler said. “I think that was a real unique time for the committee, and I think it kind of opened doors for others in national AORN. I think it started to change their mindset of my age group.” The moment stayed with Wheeler, and strengthened her resolve to find her voice and give truth to her experiences in a professional setting. Her bravery was rewarded: she was added to the AORN national ballot that year. In 2016-17, she chaired the national nominating and leadership development committee just a year after having won

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election to it. The lesson she took away from the experience was one she shared with her colleagues for years to come. “There are institutions where the nurses don’t feel they can speak up; they don’t feel empowered,” she said. “And it’s slowly changing.” “How I ended up where I am is I said ‘yes,’ ” Wheeler said. “Don’t turn down any opportunity, big or small, because you don’t know where it could lead in the future.” “To see how things were 15 years ago compared to now is night and day,” she said. “It gives me great hope that we’ll continue to grow as nursing and hospital administrators and physicians are more focused on care. The value of the nurse is more than it ever has been.” Emboldened and empowered to trust her own intuition and professional judgment, Wheeler also participates in a program at UMMC with her two-year-old “nurse puptitioner,” Sawyer the Goldendoodle, whom she’s trained as a therapy dog. Once a month, Sawyer visits with patients and staff to help them emotionally discharge the energy of their days. His middle name, Adson, is taken from the surgical forceps, and Sawyer finds every opportunity to show he belongs in a hospital environment. Kristy Wheeler’s Goldendoodle, Sawyer, is a therapy dog. He can be found on Instagram @sawyeradson.

OUT OF THE OR fitness

Building Confidence During Uncertain Times By Miguel J. Ortiz e are more than a year into

W the COVID-19 pandemic,

and we still have a lot of uncertainty. Health remains on the forefront of everyone’s mind, and we are all doing our part to stay healthy. I personally think cancers and many other illnesses can be heavily prevented with a quality diet and exercise. It took a pandemic for many people to be health aware. We have known for quite some time that it is important to take care of our health, but we’ve ignored the signs for too long. It’s time to take our power back. One case in point is that a plantbased diet has been shown to be the only diet to reverse cardiovascular disease. So, why don’t more people eat that way? As humans we have a very strong immune system, in many cases we just need to create the right environment for the body to heal appropriately. If we can add a few consistent daily behaviors with quality eating we are going to do a much better job of taking care of others by taking care of ourselves. Let’s make 48

OR TODAY | October 2021

sure we do the following daily to be healthier individuals. First, we need daily sun and activity. The sunlight’s vitamin D and quality air help promote hormone function and clear inflammation, just make sure you stay hydrated. Walking at least 1 hour a day will help the body tremendously. And, for exercise enthusiasts, continue to stay on track and strengthen that heart rate and muscle. Exercise is vital. I also want to note that a compound movement like a push up, pull up, squat, lunge and jogging or running also go a long way in functional training. The ability to continue to do those movements will give the body a quality foundation to build upon. Second, the best way to build confidence is by keeping promises to yourself. Simply put, we need to be more consistent when it comes to trusting the process in order to make appropriate change. Whether it’s an exercise routine or making better food choices, be consistent for at least 2-3 months. Ninety days will make a significant difference as far as feeling and seeing a difference. Third, get more sleep. It helps

regulate brain and hormone function. It also helps with weight loss. Spending more time at home during a pandemic does not necessarily take away stress so make sure you get to bed on time. If you are looking to build muscle, you need sleep. If you want to lose weight, you need sleep. So, let’s go back to the basics and focus on doing the most important things more consistently. Distractions are everywhere, there are fast food joints to the left and right. As you continue to make better choices, don’t be hard on yourself. The more you exercise, the more you’ll want to eat better food. It will slowly force your hand. Being healthy is not a destination, it’s a lifestyle. So, do your part and focus daily on becoming a healthier individual. Together we can build confidence within our communities. Miguel J. Ortiz is a personal trainer in Atlanta, Georgia. He is a member of the National Personal Trainer Institute and a Certified Nutritional Consultant with more than a decade of professional experience. He can be found on Instagram at @migueljortiz. WWW.ORTODAY.COM

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October 2021 | OR TODAY

OUT OUTOF OFTHE THEOR OR recipe health

The Secret Food Club By KIRSTEN Serrano n addition to nutrition work, I am a farmer. One of my big revelations as a farmer is that when it comes to the diversity of food – we’ve been duped. There is a whole world of food that’s probably not on your radar, one that contains a rich diversity of color, flavor, beauty and nutrients. Where is this world hiding? The answer is closer than you may think – small local farms and backyard gardens.

Case in point: Today, I spent my morning harvesting ground cherries You probably have not heard of them. The ground cherry is a member of the nightshade family (tomatoes, peppers and potatoes) that produces a small golden fruit. It tastes mildly of pineapple with a big dose of vanilla. The ground cherry fruit is tucked inside a papery husk. They are versatile, nutritious and yummy. So …. why don’t you already know about them? Why aren’t they at the supermarket? As I harvest, I ask myself the same question. They have many of the features of a successful commercial crop. Ground cherries are easy to grow and produce abundantly. They are relatively free of insect and disease issues. They even store easily (and thus) would ship well. They are snackable and tasty. The only downside I see is that they are tedious to harvest, but so are most small fruits. What they represent to me is the overwhelming ranks of unknown 50 OR TODAY | October 2021

foods. Here’s the scoop – there is a whole world of food only available to those willing to seek it out. That could mean growing it yourself or finding out who does. It is like not being invited to join a club, but you do not even know it exists. We live in strange times. In many ways, we have more access to food than ever, but at the same time our diets have been narrowed. You can have artisanal salami delivered to your door from halfway around the world. Yet, everyday choices in the market may be limited – lacking flavor and nutrition. When shopping at a typical grocery store, you see only a minuscule amount of the diverse foods available in the world. Sure, there may be five or six different tomatoes available, but there are upwards of 15,000 tomato varieties. Trust me, the varieties at the store are not there because they are the most nutritious or flavorful. Anyone who has eaten a homegrown tomato can tell you that. At my farm, I have grown about a hundred different varieties of tomatoes over the years – in all sizes, shapes, colors and flavors. My personal favorite has been the Orange-Fleshed Purple Smudge. (The name says it all!) Tomatoes are just one example of a crop that can have a lot of diversity. Did you know there is pink celery? Red bananas? Green radishes? Tiny cucumbers that look like watermelons? You get my point. Food variety is vast and amazing. If you want to get a better idea of what I

am talking about, take a gander at the website for Baker Creek Seeds (RareSeeds.com), a company that offers a wide array of heirloom seeds. This will give you an idea of some of the vegetable, herb and flower possibilities out there. It does not, of course, stop with plants and produce. What’s offered at the meat counter is just as limited. I could go on and on, but the main point is that there is a world of food that is amazing, diverse and full of all the nutrients we need. Unfortunately, we do not get to tap into these resources on a daily basis and that is a shame. Our grocery stores only offer the illusion of choice. Our sense of unlimited options reflects the limitless processed food combinations available, and that includes produce. In fact, we really eat only a handful of foods on repeat – soy, corn, canola, wheat, dairy, beef, chicken, etc. I urge you to venture out of the grocery store and eat some really delicious and nutritious food. Make yourself a member of the secret food club. 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.

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OUT OF THE OR

EQ factor

Three Tips to Help Relieve Stress By daniel bobinski, M.Ed. f you’re like most people, the past year has added a layer of stress to your life. How one deals with stress can make a huge difference in our health as well as our relationships and our productivity, so allow me to offer a few thoughts on stress management.

The Mayo Clinic outlines some ripple effects of stress: anxiety, headaches, muscle tension and pain, sleep problems, and memory and concentration impairment, among others. It’s been my observation that when people are coping with ongoing stress, their “politeness” factor can wear thin. When that happens, it impacts the attitudes and productivity of those around us. Not good for us, and not good for our families or our workplace. A friend of mine, Dr. Lynn Laird, Psy.D., recently gave a short presentation on managing stress, and I thought that with a stressful 18 months behind us and a stressful holiday season just ahead of us, it might be a good idea to share some of her suggestions.

Start journaling Keeping our thoughts and concerns bottled up can be like putting a lid on a pressure cooker. Journaling allows our brains to process feelings in a way that brings multiple health benefits. A few WWW.ORTODAY.COM

thoughts on journaling include: • Get alone and remove distractions. • If possible, write by hand instead of typing. The neuromuscular process has been shown to improve mood and memory, and even foster creativity and deeper levels of thinking. • Write for at least five minutes. Gratitude journaling (writing about that for which you are thankful) has been shown to have a greater impact on improving happiness and reducing stress. Don’t feel the need to make journaling a daily task – that can add stress! Research shows journaling three times a week can produce better results than writing every day.

Go for a leisurely walk One need not do a full workout to reduce stress. Life’s pace can be hectic, and the Journal of Health Psychology reports that walks which do not noticeably raise heart rates or breathing help lower feelings of stress and depression. Noticing nature, such as paying attention to birds chirping or tree leaves rustling in the wind during a leisurely walk, can add to feelings of well-being.

Turn off social media and open a book Much of what transpires on social media can actually increase stress, but simply turning it off is not a solution in and of itself. Nature abhors a vacuum, so the key

to stress reduction is finding something else to do instead of scrolling. “Page turning” is a viable option and escaping into a good novel is great for reducing stress. According to research at the University of Sussex, stress can be reduced 68 percent just from reading. In fact, people have lower heartbeats and improved relaxation after just six minutes of reading. For those who don’t like novels, historical fiction has been said to be a happy medium. Like anything in life, people can react differently to the same stimuli, and as a good friend used to say, “The same sun that melts butter, hardens clay.” So, if nothing above appeals to you, think back: what has helped you relax in the past? 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.

October 2021 | OR TODAY

OUT OF THE OR pinboard nutrition

Apple pie stuffed pitas FILLING: • 4 green apples, peeled, cored and thinly sliced • 1 teaspoon cinnamon • 1/2 teaspoon nutmeg • 2 tablespoons plantbased butter • 1/3 cup white sugar • 3 tablespoons water • 1 teaspoon cornstarch

OAT CRUMBLE TOPPING:

Go Plant Based for Healthy Meal Options

• 1/2 cup flour • 1/2 cup rolled oats

By FAMILY FEATURES

• 1/4 cup brown sugar

illing the kitchen with plantbased ingredients is an easy way to nudge kids and adults toward nutritious afternoon snacks and make busy weeknight dinners as healthy as they are delicious.

• 1/2 teaspoon cinnamon • 1 tablespoon orange juice • 1 pinch salt • 2 tablespoons plantbased butter • 4 Toufayan Multi-Grain Pita Bread

When you consume foods that boost your energy and give your body the fuel it needs, you can expect to feel healthier, both physically and emotionally. In many cases the foods that deliver are plant-based, and you can create delicious and healthy meals while adhering to a plant-based eating plan.

Make Easy Substitutes Having a vegetarian meal once a day is a great start, or even try “meatless Mondays” at home. Swap out ice cream and instead go for frozen blended bananas as an after-dinner treat. Try a nut- or grain-based milk in place of your normal dairy.

apple pie stuffed pitas Prep time: 10 minutes Cook time: 17 minutes 1. Preheat oven to 350 F. 2. To make filling: In large saute pan over medium heat add apples, cinnamon, nutmeg, butter, white sugar, water and cornstarch. Cook apples down about 10 minutes until they begin to get gooey.

OR TODAY | October 2021

3. To make oat crumble topping: In medium bowl, mix flour, oats, brown sugar, cinnamon, orange juice and salt. Cut in butter and mix until crumbs begin to form. 4. Cut pitas in half and line baking sheet. Fill one pita half with apple filling and lay on its side, being careful to not let apples fall out. Top with oat crumble. Repeat with remaining pitas. 5. Bake about 6 minutes. If desired, broil 1 minute for additional color. WWW.ORTODAY.COM

Roasted chickpea cauliflower sandwiches INGREDIENTS: • 1 can chickpeas, roasted • 1/4 teaspoon salt, plus additional, to taste, divided • 1/8 teaspoon black pepper, plus additional, to taste, divided • garlic salt, to taste • 1 head cauliflower, cut into florets • 1/4 cup plant-based yogurt or sour cream • 1/2 red pepper, diced • 1/3 cup shredded carrots • 1 cup corn kernels (optional) • 1/4 teaspoon dill • 1/2 teaspoon garlic powder • 1/4 teaspoon paprika • 3 Toufayan Bakeries Multi Grain Pitas, halved • parsley, for garnish

Make Gradual Changes Drastically changing your eating habits can be challenging. Small, sustainable changes are easier to manage and simpler to implement. Even one change per day can lead to healthier eating, like swapping the meat in a normal sandwich for a plant-based protein, such as a salad made with chickpeas or lentils, for a quick and easy lunch.

Start Meal Planning Meal planning can reduce the time you spend in the kitchen and cut the cost of your groceries while making plant-based eating easy. When you plan meals in advance, you can buy in bulk and do the prep work ahead of time, which means you can whip up tasty plantbased meals in minutes. Keep healthy staples on hand like vegan, cholesterol-free and trans fat-free Toufayan multi-grain pita bread. The pre-split pita is perfect to keep on hand and fill with your favorite plant-based ingredients for a quick meal or pair with hummus, chickpea salad or apples. Made with quality, wholesome ingredients, each bread is hearth-baked to a golden brown for a tasty, convenient and versatile complement to a wide range of plant-based foods. They’re easy to find in your local grocer’s deli section. Get inspired to create family-friendly, plant-based dishes with these recipes and more at Toufayan.com. WWW.ORTODAY.COM

Roasted Chickpea Cauliflower Sandwiches Prep time: 10 minutes Cook time: 45 minutes Servings: 6 1. Preheat oven to 425 F. 2. Season chickpeas with salt, pepper and garlic salt, to taste. Roast chickpeas 40-45 minutes. 3. In bowl, mix chopped cauliflower; yogurt or sour cream, diced pepper; shredded carrots; corn, if desired; 1/4 teaspoon salt; 1/8 teaspoon pepper; dill; garlic powder and paprika. 4. Once chickpeas are roasted, add to bowl and mix well. Spoon mixture into six pitas and garnish with parsley.

October 2021 | OR TODAY

OUT OF THE OR recipe

Chopped Chicken Taco Salad INGREDIENTS: Dressing: • 1 cup plain Greek yogurt

Recipe

• 1/3 cup buttermilk, plus additional (optional)

the

• 1 tablespoon fresh-squeezed lime juice, plus additional (optional) • 3 tablespoons chopped cilantro • 2 tablespoons taco seasoning Salad: • 2 pounds boneless, skinless chicken breasts • 2 tablespoons taco seasoning • 2 tablespoons olive oil • 1 head leaf lettuce, chopped • 1 avocado, chopped into bite-sized pieces • 1 cup black beans, drained and rinsed • 1 cup corn • 1 pint grape or cherry tomatoes, chopped • 1 cup shredded cheese (Monterey Jack or Mexican) • tortilla strips or crushed tortilla chips, for topping

By Family Features

OR TODAY | October 2021

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Family Meal With Flavor and Nutrition

OUT OF THE OR recipe

By Family features

hildren and parents have busy schedules full of sports, homework and weeknight activities. Building a plan for nutritious and easy meals can be challenging. Piecing together a menu that fuels active minds without spending hours in the kitchen is a common goal for many families.

Chopped Chicken Taco Salad Recipe courtesy of Megan Gundy of “What Megan’s Making” on behalf of Milk Means More

Prep time: 15 minutes Cook time: 15 minutes Servings: 4 1. To make dressing: In small bowl, stir yogurt, buttermilk, lime juice, cilantro and taco seasoning until combined. Taste and adjust lime juice and cilantro as needed. If dressing is too thick, add buttermilk 1 teaspoon at a time until desired consistency is reached. Refrigerate until ready to serve.

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This recipe requires minimal prep and calls for on-hand ingredients like dairy food favorites that provide nutrients people of all ages need to grow and maintain strong bodies and minds. A customizable kid-pleaser is the Chopped Chicken Taco Salad garnished with your family’s favorite toppings. Visit milkmeansmore.org to find more recipes perfect for bringing loved ones together.

2. To make salad: Season chicken on both sides with taco seasoning. Heat large skillet over medium-high heat and add olive oil. Add chicken to pan and cook on both sides until outside is golden brown and chicken is cooked through. Remove to cutting board and slice into strips. 3. On large platter, heap chopped lettuce. Sprinkle chicken over top. Add avocado, beans, corn, tomatoes and shredded cheese. Drizzle dressing on top and sprinkle with tortilla strips or crushed tortilla chips.

October 2021 | OR TODAY

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MAKE NUTRITION A PRIORITY FOR YOUR PET By Family Features

s a dog or cat parent, you are responsible for your pet’s well-being and making good decisions about what’s best for him or her. Providing your cherished companion with a high-quality, nutritionally balanced diet is one of the most important things you can do to ensure your pet lives a happy and healthy life. A balanced pet food recipe formulated with high-quality ingredients provides your pet with the optimal mix of the proteins, fats, carbohydrates, vitamins and minerals he or she needs to thrive. For premium quality, look for recipes that are minimally processed; made with fresh meats, poultry and fish; and contain no artificial preservatives, flavors or colors. While the quality of ingredients is important, it’s also crucial to choose a recipe that is specific to your pet’s life stage and breed size. This helps ensure it contains the right balance of nutrients to meet your pet’s specific needs, including hip and joint support and weight management as he or she gets older. Puppy and kitten recipes are specially formulated with higher levels of protein and essential fats to help support the needs of growing pets. Conversely, adult and senior pets may benefit from diets that are lower in calories and fats to help maintain a healthy weight as their metabolisms and activity levels slow. Large breed dogs may also benefit from ingredients in their diets like glucosamine, chondroitin and green-lipped mussels to support healthy hips and joints as they age. Smaller kibble and breath freshening ingredients like parsley and peppermint are often well-suited for small breed dogs. By choosing carefully balanced pet foods made with premium ingredients, you can take nutrition to another level for your pet. One example is Now Fresh recipes for dogs and cats. Each kibble recipe is made using fresh, de-boned muscle meat and no by-product or meat meals. The recipes also feature more than 20 nutrient-rich superfood ingredients. Consider the important benefits superfoods can provide your pet and look for ingredients such as: • Whole nest-laid eggs: Eggs are a complete protein, containing all the essential amino acids in the optimal amounts dogs and cats need. • Pumpkin: Rich in beta-carotene and prebiotic fiber, pumpkin helps support healthy digestion. • Blueberries: A great source of essential fiber and manga-

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nese, blueberries are also rich in antioxidants that help support healthy immune systems. • Pomegranate: This fruit is rich in antioxidants and a good source of dietary fiber, folate, vitamin C and vitamin K. • Papaya: A tropical fruit, papaya is a natural source of digestive enzymes. • Cranberries: With antioxidants to support immunity and antimicrobial properties, which can help support urinary tract health. • Strawberries: An excellent source of the antioxidant vitamin C, B vitamins, dietary fiber and essential minerals. When selecting the right food for your pet, look for a statement on the packaging that confirms it has been formulated to meet the nutritional levels established by the Association of American Feed Control Officials. An option like Now Fresh also clearly indicates on the package which life stage and breed size the recipe has been formulated for. Learn more about pet nutrition at NowFresh.com. PROPER PUPPY NUTRITION Choosing the right food is an important part of providing your pet with good nutrition, but there are other aspects of feeding that can help ensure your pet is getting the most out of every meal. Puppies need smaller, frequent meals consistently spaced throughout the day. This helps them learn routines while continually replenishing their fast-growing bodies with energy and nutrients. At 6 months, you can consider reducing your puppy’s meals to two per day. You can reinforce routines and help set good bathroom habits by always taking your puppy for a potty break after a meal. Keeping your puppy well hydrated is also important. Always leave a bowl of fresh water where he or she can access it during the day then pick it up a few hours before bedtime to help with house training. Incorporating wet food can also increase water intake, but be sure to balance it out by reducing the dry food you offer so you’re not adding excess calories. – Family Features

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INDEX

advertisers

ALPHABETICAL Action Products, Inc.…………………………………………13

Cygnus Medical………………………………………………… BC

MedWrench……………………………………………………… 52

AIV Inc.………………………………………………………………… 4

FOBI…………………………………………………………………… 49

OR Today Webinar Series…………………………………51

ALCO Sales & Service Co.……………………………… 49

Healthmark Industries Company, Inc.…… 38-41

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

ASP…………………………………………………………… 5, 22-23

MD Technologies Inc.……………………………………… 25

SIPS Consults……………………………………………………… 11

C Change Surgical…………………………………………… 25

Medline……………………………………………………………14-15

TBJ Incorporated……………………………………………… 63

CARDIAC PRODUCTS

Healthmark Industries Company, Inc.…… 38-41

SINKS

C Change Surgical…………………………………………… 25

MD Technologies Inc.……………………………………… 25

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

TBJ Incorporated……………………………………………… 63

CATEGORICAL

CARTS/CABINETS ALCO Sales & Service Co.……………………………… 49 Cygnus Medical………………………………………………… BC

SIPS Consults……………………………………………………… 11 TBJ Incorporated……………………………………………… 63

Healthmark Industries Company, Inc.…… 38-41

INSTRUMENT STORAGE/TRANSPORT

TBJ Incorporated……………………………………………… 63

Cygnus Medical………………………………………………… BC

CS/SPD

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

SKIN PREP Medline……………………………………………………………14-15

STERILIZATION ASP…………………………………………………………… 5, 22-23 Cygnus Medical………………………………………………… BC

MD Technologies Inc.……………………………………… 25

MEDICAL GAS

Healthmark Industries Company, Inc.…… 38-41

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

FOBI…………………………………………………………………… 49

MD Technologies Inc.……………………………………… 25

DISINFECTION

ONLINE RESOURCE

Medline……………………………………………………………14-15

ASP…………………………………………………………… 5, 22-23

MedWrench……………………………………………………… 52

TBJ Incorporated……………………………………………… 63

Cygnus Medical………………………………………………… BC

OR Today Webinar Series…………………………………51

SURGICAL

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

OR TABLES/BOOMS/ACCESSORIES

FOBI…………………………………………………………………… 49

DISPOSABLES

Action Products, Inc.…………………………………………13

MD Technologies Inc.……………………………………… 25

ALCO Sales & Service Co.……………………………… 49

OTHER

ENDOSCOPY

AIV Inc.………………………………………………………………… 4

Cygnus Medical………………………………………………… BC

PATIENT MONITORING

Healthmark Industries Company, Inc.…… 38-41

AIV Inc.………………………………………………………………… 4

MD Technologies Inc.……………………………………… 25 Ruhof Corporation…………………………………………… 2,3

FALL PREVENTION ALCO Sales & Service Co.……………………………… 49

FLUID MANAGEMENT MD Technologies Inc.……………………………………… 25

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

HOSPITAL BEDS/PARTS

POSITIONING PRODUCTS Action Products, Inc.…………………………………………13 Cygnus Medical………………………………………………… BC

PRESSURE ULCER MANAGEMENT Action Products, Inc.…………………………………………13

REPAIR SERVICES Cygnus Medical………………………………………………… BC

REPROCESSING STATIONS MD Technologies Inc.……………………………………… 25

SIPS Consults……………………………………………………… 11

SURGICAL INSTRUMENT/ACCESSORIES C Change Surgical…………………………………………… 25 Cygnus Medical………………………………………………… BC Healthmark Industries Company, Inc.…… 38-41

SURGICAL LAMPS FOBI…………………………………………………………………… 49

SURGICAL TABLE FOBI…………………………………………………………………… 49

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

TEMPERATURE MANAGEMENT C Change Surgical…………………………………………… 25

ALCO Sales & Service Co.……………………………… 49

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

WASTE MANAGEMENT

INFECTION CONTROL

TBJ Incorporated……………………………………………… 63

MD Technologies Inc.……………………………………… 25

ALCO Sales & Service Co.……………………………… 49

SAFETY

ASP…………………………………………………………… 5, 22-23

Healthmark Industries Company, Inc.…… 38-41

TBJ Incorporated……………………………………………… 63

Cygnus Medical………………………………………………… BC

OR TODAY | October 2021

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TBJ

Incorporated

SurgiSonic 1211X ®

Patented cleaning method for cleaning da Vinci instruments. ®

Effective, affordable, versatile, counter-top size, easy to set up, easy to use, easy to maintain.

COUNTER-TOP SIZE

AFFORDABLE

Independently tested for cleaning effectiveness; exceeded AAMI TIR 30.

Cleans all types of submersible surgical instruments. • Specializes in cleaning tubular surgical instruments. Patented method for cleaning robotic instruments: Indenpendent pump and filter for da Vinci® tool end and shaft. Combines ultrasonic action with in-line flushing, suction, and filtration. Filter

Narrow interior and multiple holes creates powerful turbulence to remove debris from jaw/pulley areas.

Suction creates water jet spray to clean jaw

Pump

Filter

Suction flushes shaft clean

Because a tight seal separates the distal jaw/pulley end from the proximal shaft/control box end, a patented dual hook-up method was created for independently cleaning both the distal and the proximal segmented areas of the da Vinci® robotic instrument at the same time. Three “da Vinci® robotic instruments can be cleaned at the same time using this dual hook-up-method and test. *Results sent upon request.

SurgiClean.com for more information TBJ Incorporated Phone: 717-261-9700 • Fax: 717-261-1730 • sales@surgiclean.com