OR Today March 2022

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Endoscope Cleaning

Infection Prevention

Goalsetting

AAMI

MARKET ANALYSIS

LIFE IN AND OUT OF THE OR

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CORPORATE PROFILE

EQ FACTOR

MARCH 2022

PATIENT PAGE 46

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OR TODAY | March 2022

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features

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features

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VICE PRESIDENT

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Kristin Leavoy

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SPOTLIGHT ON Samantha Pillay

PATIENT SATISFACTION

EDITOR John Wallace

editor@mdpublishing.com

Organizations across all industries are

$25

placing a high priority on measuring patient satisfaction, and the health care

ART DEPARTMENT

Gift C

industry is no different. Hospitals and

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ard

ambulatory surgery centers (ASCs) are

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EVENTS

INDUSTRY INSIGHTS

8 News & Notes 14 Company Showcase: SOMA Tech Intl 16 HSPA: Why SP, OR Staff Should Know True Names and Origins of Surgical Devices 18 AAMI: ST91: Extensive Updates for Endoscope Cleaning, Patient Safety 20 ASCA: Recommitting to Resiliency and Emergency Preparedness in Health Care 22 CCI: The Unique Role of Certification Bodies 25 OR Today Webinars: How to Manage Bullying

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Soma Tech Intl has over 30 years of

“Family-owned, innovative and

I have developed a framework for goal-

experience in providing customers a

responsive” are how Dave Fliss and Tan

setting that includes seven categories.

complete turnkey solution for medical

Jie describe disposable medical products

Feel free to use what I developed, or

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COMPANY SHOWCASE

CORPORATE PROFILE

EQ FACTOR

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ACCOUNTING Diane Costea

WEBINARS Jennifer Godwin

EDITORIAL BOARD Hank Balch, President & Founder, 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

services.

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IN THE OR 27 Market Analysis: Infection Prevention Market Growing 28 Product Focus: Infection Prevention 34 CE Article: Latex Allergy Alert 42 Corporate Profile: Welmed, Inc.

Kristin Leavoy

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OUT OF THE OR 50 Spotlight On: Samantha Pillay 52 Health 54 Fitness 55 EQ Factor 57 Nutrition 58 Recipe 60 Pinboard 62 Index WWW.ORTODAY.COM

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INDUSTRY INSIGHTS

INDUSTRY INDUSTRY INSIGHTS INSIGHTS

news & notes

news & notes

Healthmark Industries Offers New Eye Wash Temperature Check Tag Healthmark Industries has added its Eye Wash Temperature Check Tag to its labeling product line.

Designed for checking the water temperature and logging information of eye wash stations, the white 9l x 5w Inch Eye Wash Temperature Check Tag assists health care workers with verifying that the water of their facility’s eye wash station is within a tepid temperature range. Attached to a 36-inch nickel-plated ball chain to hang from eye wash stations, the front portion of the Eye Wash Temperature Check Tag features a log for individuals to docu-

Corza Medical Announces New Executive Vice President Corza Medical, a global manufacturer of surgical technologies, has announced the expansion of its leadership team with the addition of Dennis Crowley as executive vice president, corporate development. Crowley will lead Corza’s growth and expansion with responsibility for mergers and acquisitions, licensing and strategic planning. He will report to Dan Croteau, CEO, and Gregory Lucier, executive chairman.

Crowley brings nearly 30 years of experience in strategy and business development, driving organic and acquired growth through mergers and acquisitions, joint ventures and strategic affiliations. He has been a leader in over 100 global acquisitions and divestitures. Most recently he served as a senior vice pressident at Baxter Healthcare and previously held executive leadership roles at Tyco International and Medtronic/Covidien, among others.

“I’m thrilled to welcome Dennis to the Corza Medical team, as his industry experience will be a tremendous asset to the ongoing expansion of the business,” said Lucier.

Corza Medical’s priority has been to build a global business and increase value through strategic mergers and acquisition activity, which has included the simultaneous acquisition and merger of Surgical Specialties Corporation and the TachoSil Fibrin Sealant Patch, and the add-on of Katena Products.

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OR TODAY | March 2022

Encompass Group LLC Shares Group One Uniform Apparel Program The Encompass Group’s Group One Staff Uniform Program is an apparel solution designed to reinforce a brand message, create caregiver role identity, deliver style and quality for staff, and provide safety and comfort for patients.

Many facilities are adopting a branded, color-coded staff uniform program to help customers understand the role of each staff member. Encompass offers a wide range of uniform fabrics, colors and sizes, including lab coats and health care kitchen apparel.

“The right apparel can improve both staff and patient satisfaction,” said Deanna Leonard, Encompass vice president and general manager, retail apparel. “We offer a branded, color-coded uniform program supported by management tools and reports, program tracking options, multiple-facility shipping, and optional custom embroidery for logos and personalization. In staff uniforms and apparel, Encompass delivers everything you need for your facility.”

For more information, visit encompassgroup.net

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ment weekly maintenance checks of their facilities eye wash station, which includes a space to note the month, date and initials of the inspector. The back portion of the Eye Wash Temperature Check Tag features a liquid crystal thermometer, along with the recommended water temperature range of 16-38°C (60-100°F).

For more information visit hmark.com.

Lazurite Announces FDA 510(k) Submission Medical device and technology company Lazurite Holdings LLC has submitted a 510(k) premarket notification to the U.S. Food and Drug Administration (FDA) for its ArthroFree wireless camera system for minimally invasive surgery, and that the submission has been accepted for review. The company also announced that early-stage health care investment platform AngelMD named it one of the best startup companies of 2021.

The ArthroFree system is expected to be the world’s first FDA-approved fully wireless, minimally invasive camera system for the operating room. The modular system incorporates the company’s proprietary low-heat, high-intensity Meridiem light engine technology along with advanced camera, battery and wireless transmission technologies. The ArthroFree system is designed to deliver improved operating room productivity, patient safety and economic value through cost-savings, energy efficiency and reduced setup/breakdown times. The system is designed to be fully drop-in compatible with current operating room technology.

“This FDA submission marks an important milestone in our commitment to bring an advanced wireless surgical camera to market,” said Eugene Malinskiy, chief executive officer and co-founder of Lazurite. “During the nearly 50 years since the introduction of the first fiber-optic scope, the industry has seen only a slow evolution in image quality, monitors and usability.

The ArthroFree system is designed to untether the camera from the surgical tower, which is expected to make it safer and

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easier to use, while reducing OR setup and turnover times and delivering exceptional light and image quality during minimally invasive surgery.”

“The ArthroFree system promises to usher in a new era of wireless, minimally invasive camera systems for the operating room,” said Mark Froimson, MD, chair of the board of managers of Lazurite. “Our FDA approval process doesn’t require any human or animal trials, so there is good reason to believe that we will receive FDA clearance for market launch by mid-2022.

Based on the response from surgeons we’ve met at industry trade shows and on visits to leading medical centers across the country, we believe the system will be poised to redefine industry expectations for the use of surgical cameras.”

The ArthroFree wireless surgical camera system has not yet received FDA clearance and is not currently approved for human use. It is not intended for commercial distribution; orders cannot be accepted at this time.

March 2022 | OR TODAY

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INDUSTRY INSIGHTS

INDUSTRY INSIGHTS

news & notes

news & notes

Banner Health, Atlas Healthcare Expand Footprint National Medical Billing Services Acquires mdStrategies VySpine Announces FDA Clearance of the VySpan PCT System VySpine, a spine innovation leader using differentiated materials and designs, has received 510(k) clearance from the FDA for the VySpan Posterior Cervical Thoracic System.

The VySpan PCT System features various screw and hook options, multiple transition rods and revolutionary crosslink versatility. The variety of implant options for the thoracic spine makes the system one of the most versatile on the market.

“The VySpan PCT System is the first of many highly differentiated systems being developed by VySpine,” said Tom McLeer, CEO of VySpine. “Using new materials and creative surgeon input, we are building exceptional quality, flexibility and pricing into all our products. This is just the beginning of the exciting, innovative product launches scheduled for early 2022.”

The VySpan PCT System features fixed and polyaxial head styles, each with a reduction option, that can be paired with either standard or smooth shank bone screws and a variety of hooks and rods.

The VySpan PCT System also offers a unique assortment of rod-to-rod and cross connectors, including a novel head-to-head double joint cross connector, as well as three- and four-point cross connectors for extraordinary versatility. Rod-to-rod connectors allow the VySpan PCT System to connect with larger 05.5mm and 06.0mm rods and includes transition rods, which taper from 03.5mm to either 05.5mm or 06.0mm.

National Medical Billing Services (National Medical), a health care revenue cycle management company serving the ambulatory surgery center market, has acquired mdStrategies, a fullservice medical coding company focused on ASCs. The combination will further bolster the depth and breadth of National Medical’s ASC coding expertise while also enabling it to offer coding-related point solutions to a broader segment of the ASC market. The acquisition marks National Medical’s first transaction since its January 2021 partnership with Aquiline Capital Partners, a private investment firm based in New York and London with $7 billion in assets under management.

“We are thrilled to add mdStrategies to the National Medical family as the two organizations truly complement each other,” National Medical CEO Nader Samii said. “We believe our infrastructure and ongoing technology developments combined with the value-added service offering and deep ASC coding expertise of mdStrategies will allow us to deliver unparalleled revenue cycle and coding results to the ambulatory surgery center market.”

Founded in 2003, mdStrategies provides coding, auditing, transcription, and education and training services to ambulatory surgery centers nationwide. The company’s client base includes some of the most prominent ASC organizations and spans over 40 states, making mdStrategies one of the largest ASC-focused medical coding companies. The company employs an experienced team of certified coders with extensive multi-specialty ASC experience, including orthopedics, spine, urology, pain management, OB/GYN, gastrointestinal, ophthalmology, general surgery and numerous other surgical specialties. Through its web-based software and processoriented employees, mdStrategies ensures accurate, timely deliverables while meeting or exceeding all regulatory and compliance standards.

“At mdStrategies, we have always prided ourselves on providing significant value for our clients,” said Scott Megason, president of mdStrategies. “National Medical’s combination of ASC expertise, analytics, and insightful advice will help continue to elevate our offering, and I look forward to working with them as we enter the next phase of our evolution.”

Atlas Healthcare Partners, in partnership with Banner Health, has announced the addition of new ambulatory surgical centers (ASCs) in Chandler, Tucson and Northern Scottsdale, Arizona. This brings the total to 24 Banner Surgery Centers in Colorado and Arizona for the Banner/Atlas Healthcare Partners Network. The rapid addition of centers has dramatically increased access to high-quality, affordable and convenient health care in the region. The need for such health care is critical given the rapid growth occurring in these metropolitan areas.

“As the industry shifts towards outpatient care, ASCs play a vital role in providing patients with expert care outside of the main hospital setting,” said Banner Health Vice President of Ambulatory Services Joan Thiel. “This growing network increases accessibility for patients to receive expert outpa-

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CAPITAL MEDICAL EQUIPMENTIS NEEDED SOMA IS THERE FOR YOU!

OR TODAY | March 2022

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tient care closer to home. Our unique partnership with Atlas is built on the power of collaboration, with Banner and our physicians working closely every step of the way to create a great culture and working environment.”

“Banner Health and Atlas work hard to create a truly integrated partnership with our physicians to ensure the highest quality care is delivered to every patient through our company-wide focus on the patient and physician experience,” said Atlas Healthcare Partners CEO Aric Burke. “This continued growth and expansion is crucial to implement Banner’s vision for affordable, convenient high-quality care throughout Arizona and Colorado. We are excited to continue our growth into 2022 and beyond.”

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1.800.GET.SOMA March 2022 | OR TODAY

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INDUSTRY INSIGHTS

INDUSTRY INSIGHTS

news & notes

Titan Medical Selects Benchmark to Manufacture Products Titan Medical Inc., a medical technology company focused on the design and development of innovative surgical technologies for robotic single access surgery, announced that it has signed a manufacturing and supply agreement with Benchmark Electronics Inc. to produce Titan’s Enos robotic single access surgical system workstations and patient carts. These Benchmark manufactured solutions will be integrated with Titan’s proprietary patented and patent-pending cameras and multi-articulating instruments planned to be manufactured by Titan at its Chapel Hill, North Carolina facility.

This announcement forms part of Titan’s product development and regulatory plan for the manufacturing of surgeon workstations and patient carts that will be used in human studies expected to begin in 2023.

These studies are expected to support the company’s planned De Novo application to the FDA for marketing clearance. Benchmark was selected as a manufacturing partner for its deep experience and vertical integration in complex medical device engineering, manufacturing and assembly, and its capacity to scale production with demand. Benchmark will leverage its full suite of services for assembly and testing of Titan’s Enos system, from high quality manufacturing and supply chain services, assembly and test tooling development, and packaging and fulfillment to enable Titan’s planned commercialization of its Enos system.

For more information, visit titanmedicalinc.com. .

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news & notes

Johnson & Johnson Medical Devices Companies Announces Microsoft Partnership

Owens & Minor Acquires American Contract Systems Owens & Minor Inc. has completed the acquisition of American Contract Systems (ACS), a Minnesota-based provider of kitting and sterilization services for Custom Procedure Tray (CPT) solutions.

The close of the acquisition represents the first by Owens & Minor since the acquisition of Halyard Health in 2018.

“Bringing into Owens & Minor the capabilities that American Contract Systems offers in the CPT market will further strengthen our ability to meet and exceed our customers’ collective needs for surgical procedure trays,” said Edward A. Pesicka, president and CEO of Owens & Minor.

“Custom procedure trays represent a critical component of medical-surgical supplies. The ACS acquisition expands our existing U.S-based kitting operations, and advances our focus on local solutions and local support for Owens & Minor customers. We are also excited to build upon ACS’s unique local sterilization capabilities. Through its proprietary sterilization process, ACS is able to offer sterilization capabilities without the high-volume use of ethylene oxide that others use for sterilization, making it safer for our communities and our environment.”

“We are pleased to join forces with an industry leader such as Owens & Minor,” said ACS President and CEO David Thomson. “Our two companies have partnered for decades in using HALYARD-branded products for customers’ CPT needs. This acquisition will enhance our combined abilities to serve customers with a stronger CPT offering.”

ACS offers a differentiated CPT solution that will complement existing CPT options within Owens & Minor.

The company provides a proprietary, environmentally sound sterilization process to the CPTs that is easily deployed near the point-of-use. This unique sterilization solution, already deployed in facilities across the U.S., will be combined with Owens & Minor’s Americas-based footprint.

“Empowering our customers to advance health care is in Owens & Minor’s DNA and is the driving force behind every decision we make,” Pesicka said. “We look forward to working with our new ACS teammates in bringing highly innovative solutions to the health care industry.”

INDUSTRY INSIGHTS

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The Johnson & Johnson Medical Devices Companies has announced that it will collaborate with Microsoft to further enable and expand JJMDC’s secure and compliant digital surgery ecosystem. The Microsoft Cloud will help JJMDC realize its vision of driving innovation that advances skills, improves workflow and enhances surgical decision making for a better overall customer experience and improved patient and economic outcomes.

JJMDC’s innovative medical technology exists across an ecosystem that includes next generation robotics, world-class instrumentation, advanced imaging and visualization, data and analytics, artificial intelligence, machine learning and digital solutions. To mobilize the potential of these assets and make a clinical difference for patients, it is imperative to establish robust connectivity with, and between, all elements of the ecosystem with a seamless, interconnected network that meets surgeons where they are in their workflow and patients where they are in their health care journey.

As part of the strategic partnership, Microsoft will serve as JJMDC’s preferred cloud provider for the company’s digital surgery solutions and help JJMDC build out its digital surgery platform and internet of things (IoT) device connectivity. By harnessing the power of the Microsoft Cloud, including Azure, artificial intelligence (AI), and machine learning, Microsoft 365 and Dynamics 365, the companies expect to work together to deliver innovation across the following areas: • Innovating to improve patient outcomes through artificial intelligence, machine learning and data insights.

• Increasing JJMDC device connectivity, insights and intelligence using Azure IoT and edge computing technologies.

• Increasing the pace of digital innovation and transformation across the JJMDC digital surgery ecosystem using Azure capabilities and services.

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March 2022 | OR TODAY

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SPECIAL ADVERTISING SECTION

COMPANY SHOWCASE

Soma Tech Intl

COMPANY SHOWCASE

Soma Tech Intl

COMPANY SHOWCASE oma Tech Intl was founded in 1992 by two young biomedical entrepreneurs that identified a market need for high-quality medical equipment at affordable prices supplied by a local company. The company was first located in a small office in Rocky Hill, Connecticut serving facilities in the area while employing only a handful of dedicated employees.

Q: What are some challenges that your company faced last year? How were you able to overcome them?

S

Within a few years, Soma Tech Intl had expanded its market reach to serve facilities throughout the New England area and developed customer relationships and brand awareness that facilitated its move to a new, larger facility in Cheshire, Connecticut. The move happened in 1996 to accommodate a larger inventory and more team members. The move allowed Soma Tech to continue to expand its product line. By the late 1990s, Soma had become a worldwide supplier of new and refurbished medical equipment setting a high standard for the industry.

To accommodate its resounding success, increasing demand and a growing team, Soma relocated once again. Its headquarters moved to a brand new, state-of-the-art facility in Bloomfield, Connecticut in 2008.

OR Today magazine recently quizzed Soma Tech Intl CEO/President Peter Leonidas about the company.

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Leonidas: Like most companies, we faced supply chain issues and labor shortages. We overcame them by working with smaller niche suppliers of critical components and by expanding our infrastructure and production capacities. We also did more batch processing to continue to meet our customer’s needs.

CEO/President Peter Leonidas

Q: What are some advantages that your company has over the competition?

Leonidas: Soma Tech Intl has over 30 years of experience and reputation in providing customers a complete turnkey solution for capital equipment and medical equipment services. Soma has one of the largest medical equipment inventories nationwide which allows customers to compare equipment among major models and manufacturers. Soma has an in-house biomedical engineering department team that is highly trained to refurbish each piece of equipment according to original manufacturer specifications. Soma guarantees five to seven years of parts availability for every product it sells. Soma also offers the same warranty as new with comprehensive liability insurance.

Q: Can you explain your company’s core competencies and unique selling points?

Leonidas: We are proud of the fact that Soma is an industry-leading refurbished medical equipment provider. Soma is supported by best-in-class products/ services with a diversified “Blue Chip” customer base. We have a long track record of exceptional quality and service verified by an ISO-certified quality management system (QMS). Soma offers trade-in discounts and procurement solutions that save customers money as well as time and effort. Over the last 30 years, we have built a global business with thousands of customers across 50-plus countries.

Q: What are you most excited about right now?

Leonidas: We are most excited about our specialty surgical sales and rental division as well as our parts and accesWWW.ORTODAY.COM

sories business. Those divisions have been growing at double-digit rates for the past couple of years. We expect this growth to continue as we open several regional offices that will be strategically located throughout the U.S.

Q: Can you please share a success story?

Leonidas: There have been so many success stories over the last two years, I am particularly proud of being able to convert a lot of our COVID spike customers to long term capital and rental customers of Soma. By partnering with smaller shipping companies, we were able to navigate through the broken supply chain disruptions and have everything set up and installed in a timely fashion. We have learned and continue to learn so much from the pandemic and believe in making this entire experience educational. We are all proud knowing that our hard work goes directly toward helping frontline health care providers save lives on a daily basis.

Q: Can you describe your company’s facility?

Leonidas: We have multiple facilities.

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Our main facility in Bloomfield, CT is a state-of-the-art medical facility with over 50,000-square-feet of space. This space is largely used for our everyday operations to refurbish, service and repair equipment. It also has an equipment showroom, warehouse and state of the art infrastructure required to work and test medical equipment. Furthermore, we are expanding and adding an additional 60,000-square-feet of engineering and warehouse space in 2022 to accommodate our one-stopshop platform with an unparalleled inventory of medical equipment parts and accessories covering all product categories. We have another four locations that are used for repair operations and equipment warehousing.

Q: Tell us about your employees?

Leonidas: Many of our employees have been with us for decades and all of us adhere to the highest standards of excellence in our dedication to service and the latest quality standards. Combined they have decades of experience with unique skill sets and backgrounds.

The employees and their experience provides Soma with a strong advantage in the med/surg marketplace. The best

thing I can say is that we have dedicated engineering and management teams that truly enjoy and take a lot of pride in their work.

Q: What is most important to you about the way you do business?

Leonidas: We founded Soma 30 years ago to offer affordable solutions in best-of-class products under a one-stop shopping platform. We are proud of the fact, that over the years, we have made and continue to make health care more affordable for all.

Q: Is there anything else you want readers to know about your company?

Leonidas: We are proud of the longterm relationships we have developed with leading GPO, IDN, management companies, equipment planners, health care distributors, and independent health facilities over the last 30 years.

We look forward to building and expanding those relationships.

For more information,visit somatechnology.com

March 2022 | OR TODAY

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INDUSTRY INSIGHTS HSPA

Why SP, OR Staff Should Know True Names, Origins of Surgical Devices

By Tony Thurmond terile processing (SP) professionals must manage the seemingly countless instruments (sometimes, in the thousands) that flow through their departments. These individuals must not only know the proper names of these instruments and how they function, but also be skilled in cleaning, inspecting, testing and assembling them to ensure they are ready for their next use in patient care.

S

SP and operating room (OR) professionals have all experienced instruments with a nickname assigned to them (e.g., a “Joe’s Hoe”).

In my experience as an SP manager and former surgical technologist, using nicknames for instruments is often more common than using the original name. Relying on these nicknames can be a disservice, however – not only for the inventor of the instrument but also for SP and OR professionals because there is significant value in understanding instruments’ proper names and functions. When OR team members use the proper instrument names when putting in requests for the SPD, this can significantly improve efficiencies by eliminating guesswork and ensuring staff members in both departments are on the same page regarding needed instrumenta-

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tion.

What follows are examples of notable surgeon/inventors and the instruments they created: • Dr. John Bookwalter III is responsible for several notable instruments, one of which is the Gelpi retractor (a device OR and SP professionals routinely use and manage). Bookwalter also had a focus on self-retaining retractors, which led him to develop the Bookwalter retractor after a late night in 1964 when he had to hold a retractor during an emergency surgery.

While serving in the U.S. Army, he finalized his self-retaining retractor – a device that would give full exposure and prevent his residents from having to hold retractors for lengthy periods of time. At the time, he was working with Codman and Shurtleff on a pistol-grip needle holder, and he introduced the concept to the manufacturer and the company’s engineers. Although it was a cumbersome device, this creation decreased surgical time for the patient and increased the surgical exposure for the surgeon.

• Dr. Michael Debakey is widely known for many of his innovations in cardiovascular surgery, but his many contributions to medicine are still appreciated decades later. His many awards for his contributions include the Presidential Medal of Freedom, the National Medal

of Science and the Congressional Gold Medal. Additionally, there are numerous institutions named after him. Debakey was the pioneer for the prestigious Baylor School of Medicine. He is known for developing surgical techniques and procedures, including the carotid endarterectomy. He was also among the first to perform an open-heart procedure and was the first to use grafts for vascular procedures designed with Dacron grafts he sewed on his wife’s sewing machine.

Many know Debakey for the forceps designed to assist with the exposure of vessels (without crushing or damaging the walls of the vessel itself). He also developed several clamps, again designed to avoid damaging delicate tissues and vessels. He will also be forever known for his development of the roller pump, which would later be developed into the heart-lung machine used in cardiology procedures. Debakey served in the U.S. Army and was instrumental in developing the mobile Army surgical hospital (M.A.S.H.) units, which would station medical and surgical staff closer to the front lines and increase the survival rate of wounded soldiers in the Korean War. His contributions to the surgical field will be taught and used for decades to come.

• Another notable inventor was

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Dr. Gavriil Ilizarov, an orthopedic surgeon based in Kurgan, Siberia.

During his residency, he developed an external fixation system for the less-invasive treatment of bone fractures. By inserting pins into the proximal and distal portions of the fracture and affixing the pins to an external means of support, the fracture was stabilized and allowed time for healing. He soon discovered that with the gaps at the fracture site, bone healing would occur, creating a healing effect without an internal fixation approach. From this observation, Ilizarov discovered that an external device could help non-unionized fractures heal through surgical intervention. By carefully severing a bone (without severing the periosteum around it), one could separate two halves of a bone slightly and fix them in place; the bone would then fill in the gap. He further discovered that with this approach, the bone could grow in length as the bone matrix intermingled. Ilizarov was able to help patients with traumatic injuries that created improperly aligned bone fracture unions, or patients experiencing bone loss or bone deformities.

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Conclusion Learning about instrumentation used in patient care is valuable and I believe all SP and OR professionals can benefit from learning the history of the inventors and some background of the instruments’ development. I encourage every SP and OR professional to broaden their instrument knowledge, so they can align their requests and expectations and, ultimately, better serve their patients.

Tony Thurmond, CRCST, CIS, CHL, FCS, serves as central service manager for Dayton Children’s Hospital. He is also a past-president of the Healthcare Sterile Processing Association (HSPA) and currently serves as a director for HSPA’s Board of Directors.

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17

INDUSTRY INSIGHTS AAMI

ST91: Extensive Updates for Endoscope Cleaning, Patient Safety fter seven years, the standard for cleaning and storing a long list of medical devices, such as flexible bronchoscopes and various endoscopes, has been updated to reflect the consensus of industry, clinicians and sterilization professionals from around the world. The improved guidance document, ANSI/AAMI ST91:2021, addresses new technologies as well as concerns about medical device cleanliness and patient safety.

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“We really beefed it up,” said Mary Ann Drosnock, director of Clinical Affairs at Healthmark Industries and a member of AAMI’s Endoscope Reprocessing Working Group (ST-WG 84) since its inception.

“We wanted to make sure that everybody’s voices were heard and that all comments were discussed and resolved properly,” she added. “There was no question afterwards. This guidance is about patient safety and we have the data baked in to support it.”

Drosnock was joined by GarlandRhea Grisby, an endoscope service manager for Kaiser Permanente in Northern California, in co-chairing ST-WG 84 and leading the ST91 revision effort.

According to the co-chairs, this updated standard is the fruit of the combined work of medical device manufacturers,

18

OR TODAY | March 2022

sterilization professionals, academics, physicians, nurses, hospital accreditation organizations, the U.S. FDA and other government agencies.

Grisby added that oftentimes, it is the sterilization professionals who are pushing for more stringent regulations and requirements in the interest of safety, even if it means more work within their department.

“When they want to introduce change in their facility that can improve safety, they might get pushback from leadership because there are few guidelines out there that say what they should do or how to do it,” he explained. “That’s why they need this document to back up and outline what needs to be done.”

ANSI/AAMI ST91:2021 includes: • Classification for high-risk scopes, such as bronchoscopes and ureteroscopes • Updated guidance for drying of scopes, as well as proper storage and handling • Recommendations against manual disinfection • Guidance for testing water in automated endoscope re-processors (AERs) to avoid the finalrinse water re-contaminating the scopes • Guidance for determining the length of storage, or “hang time,” that a scope can withstand before needing to be reprocessed

A Change for Everyone According to Drosnock and Grisby, the standard will always need periodic updates to ensure the state-of-the-art of sterile processing is keeping pace with changing technologies. However, an improved understanding of the sciences that drive sterility assurance are also important factors for identifying best practices.

“As an example, we now do not recommend that they disinfect scopes manually at all,” said Drosnock. “It used to be that you soaked the scope in a basin filled with disinfectant, and then you let it sit there. People thought ‘longer is better,’ but this creates fumes that are harmful to staff.”

She explained that this is a practice that is still widely seen in outpatient and office settings, “but we no longer recommend that in any setting,” after peerreviewed studies showed the adverse impacts this practice may have on user health.

The standard, which is widely recognized as the state-of-the-art for hospital sterilization departments, has also been updated to account for outlier settings, such as surgery centers or physician offices. “This is really meant to be used in any health care setting that is reprocessing endoscopes,” said Drosnock.

A Case for Change

and even major purchases,” she added.

However, the working group is confident that responsible health systems and facilities will not hesitate to adopt the changes in the interest of staff and patient safety. After all, the revised standard reflects and expands upon recommendations issued by the FDA this year in the interest of helping health care providers prevent infections caused by or related to reprocessed urological endoscopes.

And that’s no coincidence. The FDA’s representatives have been directly involved in the development of ST91, alongside numerous other stakeholders. In addition to accounting for regulatory concerns, the new standard comes with extensive appendices citing peer-reviewed research and data to support the requirements and recommendations of the document.

“We’re not just throwing out statements just because we wanted people to do this,” said Grisby, adding that the document accounts for scientific discovery, patient safety data and manufacturer instructions for use for medical devices.

Sterilization professionals “now have the fuel to be the spark for the change in their facility to implement more quality processes,” said Drosnock.

– Interested in becoming a spark for change in the standards space? ST-WG 84 is looking for more clinicians and sterilization professionals to represent their profession. Contact standards@ aami.org to ask about joining the AAMI working group.

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INDUSTRY INSIGHTS

INDUSTRY INSIGHTS ASCA

ASCA

Recommitting to Resiliency and Emergency Preparedness in Health Care

By Bill Prentice s we head further into 2022 and the third year of the coronavirus pandemic, I want to take this opportunity to pay tribute to health care providers in every setting who have been working endless hours on the daily challenges this public health emergency presents while continuing to provide great care to patients.

which direction COVID-19 is headed next, 2022 isn’t letting up.

I encourage everyone who reads this, if you need the services an ASC in your community provides, please get the care you need there, and if you know someone who has been working in an ASC – or in any health care facility in your community – through this pandemic, please thank them for their service.

The extraordinary contributions of those providing frontline care to coronavirus patients and the thanks they deserve for their continuing dedication cannot be overstated. At the same time, while their contributions during this time might not be as immediately apparent, ASC physicians, managers and staff across the country have also been providing critical services to patients in need.

The emergence of the coronavirus did not mean the disappearance of patients in pain or with rapidly deteriorating and debilitating conditions that require the safe, highquality outpatient surgery that ASCs provide. As the virus surged, receded and reemerged in some new form, patients due for critical health screenings and other preventive care were also able to get that care safely in an ASC. With staffing shortages nationwide, supply chain disruptions firmly in place around the world and ongoing uncertainty about

Resetting for the Future

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Acknowledging the unknowns we can still expect from this virus and other national and international threats that could erupt at any time, we need to focus now on determining what changes need to be made in the U.S. health care system and what our top priorities will be going forward.

During January, an interview aired by National Public Radio (NPR) affiliate WAMU in Washington, D.C., provided some guidance.

That interview, conducted by NPR reporter Adrian Florido, featured Dr. David Marcozzi, chief clinical officer at the University of Maryland Medical Center. Marcozzi has led the medical center’s COVID response and also serves as a professor of emergency medicine at the University of Maryland.

Marcozzi talked about how, at the time, the U.S. health care system was confronting “a perfect storm.” That storm, he explained, was being created by a frustrated

and tired workforce, large numbers of hospital employees in isolation after being exposed to or infected with COVID and a surge in the number of coronavirus patients coming to the hospital for care following the arrival of the Omicron variant and the large number of people who participated in previously postponed holiday celebrations at the end of 2021. “... this is no longer just a COVID conversation,” Marcozzi added “This affects our ability to deliver care to people who have broken their arms or someone else who requires another emergent condition that is not COVID-related because now – because of so many patients coming through our doors and emergency departments across, certainly, our state and in our hospital – we’re having to figure out and prioritize patients who are needing urgent and emergent care and directing our resources and personnel to those individuals.”

In conclusion, Marcozzi said, “I hope that we are better after this,” and recommended convening a group that will “put everything on the table” and carefully consider how to create a resilient system with improved disaster preparedness built in.

While Marcozzi was speaking through the lens of a hospital administrator, his recommendations are valuable not just for hospitals, but for the entire U.S. health care

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system and deserve to be taken one step further. When groups convene to consider ways to enhance the resiliency and emergency preparedness of a community’s health care providers, all of the providers should be at that table and the most effective ways for them to participate in patient care in the community should be taken into account.

During the pandemic, ASCs were a model of resiliency and emergency preparedness. They adapted quickly to new conditions imposed by the virus and were able to resume providing safe, high-quality outpatient surgery almost immediately after the virus was identified. Additionally, those ASCs that shut down briefly during the earliest days of the pandemic to ensure hospital workers’ access to the protective equipment they needed were able to rely on procedures and policies already in place to re-open quickly and safely once those supplies were available and the ongoing need for outpatient surgical care became clear. Many

ASCs could have provided care to many more patients during the times that hospitals were overwhelmed with coronavirus sufferers and would have welcomed the opportunity to help reduce the serious surgical backlogs that developed. In most cases, however, the systems needed to refer those additional patients to ASCs were not in place.

As the nation’s network of health care providers continues to confront the uncertainties that lie ahead, as Marcozzi suggests, we have an opportunity to become better than ever before. The healthiest communities are likely to be those that put patients first and work collaboratively to address the health care needs of their population.

Bill Prentice is the chief executive officer of the Ambulatory Surgery Center Association (ASCA).

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21

INDUSTRY INSIGHTS

From start...

CCI

The Unique Role of Certification Bodies

By James X. Stobinski

eslie Feinzaig, in a recent issue of Fortune magazine, said that “In times of great disruption, comes great opportunity.” (Heimer, 2021). As I have written recently in this column the credentialing industry has been disrupted during the COVID pandemic. The impact has been far less than what the pandemic has wrought on the American health care system, but there has been disturbance in our workflows. I would like to speak to the unique characteristics of credentialing bodies like the Competency and Credentialing Institute (CCI) which administers the CNOR certification and five other credentials for perioperative nurses. While the pandemic has disrupted credentialing worldwide, CCI believes opportunities are also present.

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The Competency and Credentialing Institute is categorized by the Internal Revenue Service as a 501(C)(6) nonprofit. Generally, our revenue in excess of expenses from our core business is not taxable. To meet the IRS requirements CCI must, “Be an association of people with a common business interest, and its purpose must be to promote this common interest.” (The Balance Small Business, n.d.). And, as a business we cannot be organized for profit. In this respect, CCI is like trade and professional associations with one key difference. That is, CCI does not have members and you cannot join CCI. We are also a missiondriven organization led by a board of di22

OR TODAY | March 2022

rectors elected by our certificants which gives us much flexibility.

These characteristics are an advantage in disruptive times when change must happen quickly. Credentialing and certification processes are being transformed as the pandemic alters the landscape and accelerates change. For CCI, the readiest example of change is the rapid transition to remote secure proctored examinations (RSPE) which allow test takers to test at home versus travelling to a testing center.

This new testing modality now accounts for a quarter of the testing volume for CCI. This transition was completed in about three months to include earning approval from our accreditation bodies.

The move to RSPE was a massive logistical challenge but this transition pales in comparison to the challenges perioperative nurses have faced in the pandemic.

Another example of a rapid change was the transition of the recertification processes for our certifications.

CCI moved from a system centered on continuing education (CE) credits to a professional development points system.

The CSSM and CNAMB credential have only this points system as a method for recertification and the CNOR credential will soon join that group. To make this transition, CCI invested in a proprietary learning management system (LMS) and quickly built up a repository of learning activities vetted for relevancy by certified perioperative nurses. This system has been a resounding success with more than 20,000 learning activities being completed in 2021.

Both the use of RSPE and a LMS give considerable flexibility to certifi-

cants. Remote testing can be done from home at any time during the day or night to include weekends. The LMS can also be accessed 24/7 through a simple login process. Thus, perioperative nurses can log in at their convenience and choose from a diversity of learning activities most of which are available without charge. In uncertain times with tight professional development budgets and with travel being burdensome an LMS can provide great value to certificants. The use of RSPE and the CCI LMS allow certificants far greater control of their professional development and offer considerable cost savings. So, even though the pandemic has been tremendously unsettling it has also presented opportunities and prompted change. In these unsettled times, CCI envisions further growth and transformation in 2022 as we strive to meet the needs of our certificants.

– James X. Stobinski, Ph.D., RN, CNOR, CNAMB, CSSM(E), is CEO of the Competency and Credentialing Institute.

References Heimer, M. (2021, December/2022, January) Investor roundtable. The smart money moves beyond crisis mode.

Forbes, 184(3), 80-88.

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INDUSTRY INSIGHTS

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How to Manage Bullying Staff report

hyllis Quinlan’s recent OR Today webinar “Understanding & Effectively Managing the Disruptive Behaviors of Bullying & Incivility” was sponsored by MFW Consultants to Professionals. It was eligible for 1 CE credit. OR Today is approved and licensed to be a Continuing Education Provider with the California Board of Registered Nurses, License #16623.

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ORTODAYWEBINARS.LIVE WEBINAR ARCHIVES ONLINE OR Today has been approved and is licensed to be a Continuing Education Provider with the California Board of Registered Nurses, License #16623. CBSPD CE credits when applicable.

In this 60-minute webinar, Quinlan raised awareness regarding the impact of disruptive behavior in the workplace. She also offered important assessment tools for distinguishing between someone who is a bully versus someone who is chronically uncivil and offered unique approaches to management.

Her presentation showed that bullying is a shadow behavior that relies on techniques that are often obscure, subtle or disguised as something other than what it is.

Bullies depend on the sense of powerlessness that is often felt by their targets to allow them to thrive.

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The presentation added that bullies also count on the silence of witnesses who fear that they may be the next target. It added that creating the perception of isolation helps bullies to perpetuate a sense of hopelessness in those they target and underscore their (the bully’s) power.

Quinlan also discussed building de-escalation skills.

Some tips for co-workers who see this type of interaction in the workplace include: • D on’t leave the target alone with the bully • Stand up for what is right • Put a witness statement in writing • Testify at a grievance process, including arbitration or mediation Regarding documentation of an incivility/bullying event, Quinlan said to include the five Ws: who, what, when, where, witness.

She also shared that a commitment to creating a healthy work environment and developing emotional intelligence is the real solution.

The webinar had 73 attendees for the live presentation. A recording of the webinar is available for on-demand viewing. Attendees provided valuable feedback via a survey that included a question about the webinar series.

“Today’s webinar was by far the best presentation. Incivility and bullying is such an important organizational virus. Well done,” Senior Director C. Barbiera said.

“Great education on a topic that we all have experienced and worked through. Highly recommend this talk,” said D. Ayala, Quality RN. “Great learning experience! This webinar will contribute to my ability to provide compassionate care to patients,” said K. Wylie, OR RN. “It was an eye opener! Thank you!” said B. Kramarz, RN. For more information, visit ORTodayWebinars.live.

March 2022 | OR TODAY

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INTRODUCING THE NEW SLIM DESIGN

IN THE OR

Non-Telescopic Smoke Evacuation Pencil

market analysis

NON-TELESCOPIC

PenEvac®

Infection Prevention Market Growing

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• Slim Profile for Improved Surgeon Comfort and Visibility • Reduced Cost • Universal Blade Compatibility • Works with all smoke evacuation systems (Neptune, Medtronic, Conmed, Megadyne, etc.)

• On GPO Contracts (GSA, Kaiser, HPG, Premier, etc) • Made in the USA

Staff report

ccording to a recent study

by Future Market Insights (FMI), sales of infection prevention products are expected to top $37.4 billion in 2021, expanding at a compound annual growth rate (CAGR) of over 4.2% during the forecast period (2021-2031).

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Rising cases of infectious diseases caused due to pathogenic organisms such as bacteria, fungi, viruses and other parasitic organism are improving the adoption of infection prevention products.

As reported by the Center for Disease Control and Prevention (CDC) in 2018, infectious disease is the third most leading cause of death in the U.S. followed by other infectious diseases such as tuberculosis (9,025 cases), salmonella (60,99 cases), Lyme disease (33,666 cases), meningococcal disease (327 cases) and parasitic diseases (15.5 Mn cases).

Several other factors such as rising incidence of infections acquired while in a hospital (often called hospitalacquired infections or HAI), large number of surgical procedures, and increasWWW.ORTODAY.COM

ing cases of chronic diseases among the geriatric population have led to a higher emphasis on maintaining proper hygiene and cleanliness.

The COVID-19 pandemic increased the number of patients in hospital during the first quarter of 2020, elevating the risk of viral transmission amongst them.

This, in turn, has increased the demand for infection prevention and controlling options such as the use of hand sanitizers, disinfectants and other such products.

The increase in sales of these infection prevention products is expected to boost the infection prevention market growth in the near future. The market registered spike in demand for infection preventive products, especially in emerging economies such as India.

As per Future Market Insights, the India infection prevention market registered the highest growth across South Asia, reaching $17.29 billion in 2021.

Additionally, companies manufacturing infection prevention products have been focusing on developing eco-friendly and sustainable bio-based products with superior efficacy. A drive toward sustainability is expected to

strengthen the infection prevention market, creating worthwhile opportunities for growth.

An increasing older population worldwide has resulted in a higher focus on proper hygiene and self-care solutions because of the rise in chronic diseases and the onset of COVID-19.

Furthermore, an increase in consumer spending, improved health care infrastructure, rising government and industry investments in research and development activities will create demand for infection prevention products.

Based on the aforementioned factors, Future Market Insights (FMI) estimates that the market will exceed $56.39 billion by the end of 2031.

A report from Mordor Intelligence states that the infection control market is projected to register a CAGR of 6.5% during the forecast period (2021-2026).

ResearchAndMarkets.com reports that the global hospital-acquired infection control market was valued at $19.9 billion in 2020, and is projected to reach $25 billion by 2030, registering a CAGR of 4.6% from 2022 to 2030.

March 2022 | OR TODAY

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IN THE OR

IN THE OR

product focus

product focus

Medline

ReadyPrep Total Prep System The ReadyPrep Total Prep System can help overcome the challenges of pre-operative prep to deliver an antiseptic agent consistently, safely and effectively to the three main sources of bacteria – skin, nose and mouth. The ReadyPrep Total Prep System helps protect patients from surgical site infections (SSIs).This easy-to-use kit can help reduce Staphylococcus aureus (and other dangerous microbes) on the skin, in the nose and in the mouth to help reduce SSIs and shorten hospital stays.

Surfacide

For more information, visit medline.com

Helios UV-C Disinfection System UV-C disinfection products from American-made and manufactured Surfacide remain an option in hospital-grade UV technology for those seeking trusted, scientifically proven, advanced infection prevention measures for their facilities.

Surfacide’s Helios System is the only patented triple emitter robotic system to provide the most efficient and flexible solution in the fight against deadly pathogens (including coronavirus) that cause HAIs. Surfacide’s evidence-based UV-C light solution reaches more surfaces, reduces shadowed areas and requires less labor. The results are better efficacy in less time.

Kinnos

Highlight for Bleach Wipes Highlight colors bleach wipes bright blue, providing instant visual confirmation of coverage, then fades in minutes to remind users of contact time. Proven to quantifiably improve cleaning thoroughness, the color even binds to areas where cleaning was insufficient, indicating that gross contamination remains.

Studies show using Highlight for Bleach Wipes for just a few weeks can improve cleaning scores by 70%. By helping users visualize surface coverage, Highlight retrains users with every wipe and gives you disinfection you can see. Highlight is available for bleach wipes and sprays and is launching a version for quaternary ammonium wipes in May 2022.

For more information, visit surfacide.com.

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March 2022 | OR TODAY

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IN THE OR

IN THE OR

product focus

product focus

BD

HealthSight Infection Advisor with MedMined Insights BD HealthSight Infection Advisor with MedMined Insights, part of BD HealthSight Analytics, is a hosted software solution that combines clinical surveillance of healthcare-associated infections (HAIs) with clinical support and educational tools. This solution aggregates, normalizes and translates disparate data to help optimize workflow, streamline regulatory reporting and provides near real time alerts supporting infection prevention. The solution also identifies clinical patterns in health care data sets by comparing the current incidence of isolates in a facility to a historic baseline to help identify anomalies and emerging clusters including COVID-19 insights.

SC Johnson

Professional Proline Quickview Dispenser System

For more information, visit bd.com/sterilesolutionskinprep.

SC Johnson Professional’s Proline QuickView dispenser systems feature its most up-to-date design with features that drive the unique needs of health care facility environments. The clear 1-liter cartridge is visible from any angle or distance, allowing users and cleaning staff to see soap levels without opening the cover. Available in both manual and touch-free automatic, the hygienically sealed cartridges have unique locking mechanisms preventing unauthorized access, contamination and cross-infection. Sanitizer and soap dispensers are color coded for easy identification in health care units. All SC Johnson Professional manual skin care dispenser buttons are protected with BioCote antimicrobial technology, to provide life-long antimicrobial protection and inhibit the growth of a broad spectrum of bacteria and molds.

Ruhof

Prepzyme Forever Wet Enzymatic Pre-Cleaner Prepzyme Forever Wet with Bio-Clean Technology is a neutral pH, multi-tiered enzymatic humectant spray which promotes the long lasting retention of moisture on soiled instruments and rigid scopes thus helping to prevent the adhesion of bio-burden.

This unique formulation gently coats instruments to maintain moisture making it an ideal pre-cleaner for soiled instruments during transport or when left for an extended period of time.

The non-aerosol product is perfect for use in operating rooms, outpatient surgery, dental and other departments where instruments are transported to decontamination.

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OR TODAY | March 2022

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Xenex

LightStrike Germ-Zapping Robots Quickly reduce bacterial load between surgical procedures with a 2-minute cycle of intense, pulsed xenon UV light emitted by Xenex LightStrike Germ-Zapping Robots. Proven to quickly deactivate pathogens on surfaces, LightStrike robots are the only UV disinfection technology proven effective by more than 45 published, peer-reviewed studies, including multiple studies focused on the OR environment. Emitting UV light across the entire germicidal spectrum, LightStrike robots quickly deactivate pathogens at the wavelengths where they are most susceptible. The robots don’t require warm-up or cool-down time, so they can be used in ORs between surgical cases, at terminal disinfection, and in patient rooms, restrooms and other areas.

For more information, visit xenex.com.

March 2022 | OR TODAY

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IN THE OR

product focus

3M

Hygiena

3M Prevena Therapy Unit and Prevena Plus Therapy Unit manage the environment of closed surgical incisions and remove fluid away from the surgical incision via the application of -125mmHg continuous negative pressure. Available through Henry Schein, Prevena Therapy aids in reducing the incidence of seroma and, in patients at high risk for post-operative infections, aids in reducing the incidence of superficial surgical site infection in Class I and Class II wounds.

A big challenge for hospitals today is maximizing the health and safety of its patients and employees through proper cleaning and monitoring of its effectiveness. This can be accomplished with rapid, accurate ATP testing using Hygiena’s cleaning verification products, EnSURE Touch and UltraSnap. In seconds, results will indicate if a surface was cleaned properly. Since all microbes (bacteria and yeast) contain ATP, results will determine organism presence, reflecting how well the surface was cleaned.

When paired with SureTrend Cloud, the data analysis platform, facilities can track and verify cleanliness and validate surface hygiene across multiple locations or facilities, allowing immediate correct action if necessary.

Prevena Therapy Unit and Prevena Plus Therapy Unit

NOTE: The effectiveness of Prevena Therapy in reducing the incidence of SSIs and seroma in all surgical procedures and populations has not been demonstrated. See full indications for use and limitations at Prevena.com.

AquaMedix

CleanSpray FX Faucet Filter The CleanSpray FX Series 90-day faucet filter by AquaMedix is an FDA-registered medical device for control of waterborne pathogens like legionella, mycobacterium, pseudomonas and other bacteria.

It attaches quickly and easily to faucets with no tools required. Designed with a patented hidden locking mechanism, staff and patients are continuously protected while allowing fast and easy exchanges. The CleanSpray FX is the highest capacity faucet filter on the market and the only platform that can install on low-profile sink faucets and meet plumbing codes.

EnSURE Touch and UltraSnap

PDI

Super Sani-Cloth Wipes-Softpack

The trusted #1 disinfectant wipe in health care,1 Super Sani-Cloth wipes, are now available in an easy-to-use, intuitive and portable design. The new softpack is a convenient format that is more sustainable, containing 80% less plastic and reducing the overall waste footprint,¹ and more flexible, as its compact design offers greater flexibility for disinfection on the go in acute- and nonacute care settings. Super Sani-Cloth wipes are effective against over 30 microorganisms², including Candida auris and SARSCoV-2,³ in a 2-minute contact time.

1 Market leadership claims based on Q3 2021 Clarivate Data 2 In comparison to weight of plastic for similar count canister format; data on file.

3 See Technical Data Bulletin for a complete list of mimicroorganisms.

4 On hard, nonporous surfaces.

For more information, visit aquamedix.net.

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CE570 CE152

IN THE OR

IN THE OR

continuing education

continuing CONTINUING education EDUCATION

Latex Allergy Alert atex hypersensitivity was characterized as a problem in the late 1970s and increased throughout the 1980s and 1990s.

The U.S. Food and Drug Administration (FDA) declared it a serious concern after reports of multiple deaths and over 1,000 documented reactions related to latex (Sussman & Beezhold, 1995). Despite the recognition of natural rubber latex allergy as a serious concern more than 35 years ago, as many as 50% of healthcare providers are unable to recognize the symptoms (Al-Niaimi et al., 2013). This educational activity will discuss differentiating type 1 and 4 allergic responses to latex, sources of exposure, and measures to reduce exposure to latex for sensitive individuals.

The goal of this educational program is to provide nurses and certified medical assistants in acute care settings with knowledge about latex allergy.

5% (Kelly et al., 2011). Recent evidence suggests the prevalence of NRL allergy has declined significantly. (Blaabjerg et al., 2015). The switch from latex exam gloves to powder-free and latex-free alternatives in healthcare settings is credited for this decrease (Saleh et al., 2019).

Latex hypersensitivity became a concern in 1979 and was observed to be increasing throughout the 1980s and 1990s (Nutter, 1979). The FDA declared it a serious health threat after reports of multiple deaths and over 1,000 documented reactions related to latex occurred between 1988 and 1992 (Sussman & Beezhold, 1995).

Increased recognition of latex allergy at many work sites led the National Centers for Disease Control and Prevention (CDC) and the National Institute for Occupational Safety and Health (NIOSH) to issue the following warning in 1997: “Workers exposed to latex gloves and other products containing natural rubber latex may develop allergic reactions such as skin rashes; hives; nasal, eye or sinus symptoms; asthma and (rarely) shock” (1998, p.1)

The Allergy

The Source

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Natural rubber latex (NRL) is found in many products in modern society. It’s used in rubber-based products including balls, erasers, spatulas, and mattresses. Reports about the prevalence of latex allergy vary greatly, probably due to different levels of latex exposure, the sensitivity of testing, and varying methods for estimating prevalence. However, the data does agree that the prevalence of latex allergy among healthcare workers is greater than that of the general population. Three studies have suggested sensitization among healthcare workers was between 5% and 12%, while reactivity in the general population was between 0.5% and 34

OR TODAY | March 2022

NRL is a type of cytosol found in the vascular system of thousands of different plant species. It contains proteins that protect the plant from herbivores. Only one plant species, Hevea brasiliensis, found mainly in Southeast Asia, produces the latex used in the manufacturing of NRL products (Kelly and Sussman, 2017). NRL originates as a milky fluid produced by Hevea brasiliensis trees, sometimes called “rubber trees.”

Two main methods are used to process the fluid into products. More than 85% of the world’s harvested latex is processed using dry rubber sheets and acid coagulation, making products such

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

Goal and Objectives After taking this course, you should be able to: • Distinguish between immediate and delayed allergic responses to latex.

• Identify two sources of latex in the healthcare environment.

• List four ways to reduce risk to those with latex allergies in healthcare settings.

• Name three risk factors for the development of a latex allergy.

as rubber balls or tires. The remaining harvested latex is processed to make flexible rubber products via centrifugation, dipping a mold into liquid latex, heating (vulcanization), drying to retain shape, and coating to prevent the items from sticking to one another. Talc and cornstarch have been used in the past but caused a contact rash or increased the allergenicity of the product. Now latexdipped products are coated in a synthetic polymer to prevent them from sticking to one another. Rubber accelerators are also used in the manufacturing process and have been associated with latex sensitization and allergy (Kelly, 2010).

Dipped latex products like gloves, balloons, and condoms, cause most allergic reactions. Items made from sheet rubber, such as the soles of shoes, rubber balls, and tires, are less likely to be allergenic. Latex paints are made WWW.ORTODAY.COM

with a synthetic substance, not NRL, so do not cause reactions in latex-sensitive individuals (Wu et al., 2016)

Increased Incidence The increase in latex allergy prevalence was related to the rising use of and demand for latex products. In 1987, the CDC introduced universal precautions because of the AIDS epidemic (CDC, 1987). These precautions called for donning latex gloves before any contact with a patient or with bodily fluids of a patient, regardless of the anticipated level or duration of contact. The increased use of latex gloves fueled greater demand and led to faster manufacturing methods, which was hypothesized to have contributed to increased intact allergenic latex proteins on the finished gloves and might have contributed to the rise in latex allergies (Ownby, 2002).

In 1998, the CDC and NIOSH issued the document “Latex Allergy: A Prevention Guide” to provide information on susceptibility, prevention, screening, and management of latex allergy responses.

After the introduction of universal precautions, the sale of latex exam gloves in the U.S. increased by more than 100 times the previous amount over the course of a decade (Kelly & Sussman, 2017). In 2008, the Occupational Safety and Health Administration (OSHA) issued the safety and health information bulletin titled “Potential for Sensitization and Possible Allergic Reaction to Natural Rubber Latex Gloves and Other Natural Rubber Products.”

Summary Natural rubber latex (NRL) is found in many modern products, including many products used in the provision of healthcare. It originates from a fluid produced by the plant Hevea brasiliensis, more commonly known as the rubber tree.

Common products to cause reactions are gloves, balloons, and condoms. Latex allergy has become increasingly common in both healthcare workers and patients WWW.ORTODAY.COM

after prolonged and repeated exposures to items containing latex. The rise of the AIDS epidemic in the 1980s increased demand for latex gloves, which may have contributed to the increase in latex allergies among healthcare providers.

Physiology Latex sensitivity is a type 1, IgE-mediated response involving the formation of systemic antibodies to the proteins in NRL (Kelly et al., 2011).

Many people believe the powder on latex gloves is the culprit in latex allergy.

Although the powder is involved, the allergic response is induced by naturally occurring latex proteins (Wu et al., 2016) NRL contains more than 200 different polypeptides; 15 proteins found in NRL have been accepted by the allergen nomenclature subcommittee of the International Union of Immunological Societies (2019) as latex allergens.

Powder plays a role in NRL protein exposure. Starch or talc was previously added to latex gloves to prevent them from sticking together and make them easier to put on. The powder binds with naturally occurring latex proteins in the gloves. When the powder is dispersed during glove donning or removal, the latex molecules become airborne and may be inhaled or may come in contact with exposed skin (Kelly et al., 2011).

Over time, manufacturers have largely eliminated the powder once added to latex gloves and decreased the allergen content related to latex. As of 2017, the sale of most “powdered medical gloves” has been prohibited in the U.S. (Kelly and Sussman, 2017).

Latex-sensitized people may react to different proteins based on how they were exposed. Patients can absorb latex proteins through the skin, mucous membranes, or the respiratory system, and may absorb latex molecules directly into the circulatory system during invasive procedures (Majed et al., 2009). For example, the necessity for surgical repair exposes infants with spina bifida to NRL

in the gloves worn by surgical personnel; the more surgeries, the more likely it is that repeated exposure will prompt an IgE-mediated (allergic) response (DynaMed, 2018).

For those who wear latex gloves, such as healthcare professionals, any breach in the skin provides an avenue for latex protein molecules to enter the bloodstream, sensitizing the individual and prompting an IgE response that may manifest in a variety of symptoms (Wu et al., 2016).

Any person who frequently wears latex gloves is at risk, including beauticians, police officers, auto mechanics, gardeners, food service workers, day care employees, plumbers, and tollbooth workers. Latex gloves are inexpensive and can be bought in any pharmacy or discount store. Many consumers aren’t aware of the risk of latex allergy, so they continue to choose latex gloves for everyday chores.

Risk Factors People with allergies to latex can be divided into three main groups: healthcare workers, patients who have had a lot of contact with the healthcare system, and the general population (Wu et al., 2016).

The prevalence of allergy within these populations is estimated to be 9.7%, 7.2%, and 4.3% respectively (Wu et al., 2016).

Patients with congenital anomalies requiring multiple surgeries are at very high risk for developing latex allergy. A 2009 study showed the prevalence of latex sensitization in children with spina bifida to be 31% (Majed et al., 2009). However, the American Latex Allergy Association reports that up to 68% of children with spina bifida may be sensitized to latex (American Latex Allergy Association [ALAA], 2014).

Patients with spina bifida are not the only high-risk patient groups prone to latex allergy. Other patient populations at increased risk are those with neurologic and genitourinary anomalies, history of conditions (eczema, asthma, or other allergies), and those who have a history March 2022 | OR TODAY

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continuing education of need for repeated surgeries (Kelly & Sussman, 2017).

Healthcare workers and frequent patients have become sensitized due to repeated contact with latex gloves and latex-containing medical devices. However, people in the general population are also exposed to latex very frequently as it has become difficult to avoid in the modern environment. Latex is found in personal care and food products such as make-up, toothbrushes, chewing gum, and adhesives used in food containers (Wu et al., 2016).

Some people with latex allergies were sensitized via occupational exposure outside of healthcare settings such as scientific research, food service and hospitality, and cosmetology (Wu et al., 2016). Former rubber industry workers are also more prone to the development of latex allergies than people who work in settings where they are not exposed to NRL (Kelly & Sussman, 2017) Risk factors for developing an allergy to latex may include: • A history of recurrent surgical or medical procedures, especially early in life. Examples include people with spina bifida, urological or neurological defects, congenital cardiac or orthopedic anomalies, or severe burns (OSHA, 2008, DynaMed, 2018) • Daily use of latex gloves, e.g., occupational exposure (OSHA, 2008) • Occupational exposure to latex or latex particles, e.g., latex manufacturing workers (OSHA, 2008) • A history of allergic rhinitis, asthma, or eczema (atopic disease) (OSHA, 2008) • A history of allergies to foods such as bananas, avocado, kiwi, mango, chestnut, papaya, and stone fruits (e.g., cherries, peaches), especially if progressive in scope or severity in a person who has ongoing exposure to latex (OSHA, 2008)

Signs and Symptoms Healthcare providers should be able to 36

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continuing education recognize the major allergic reactions to latex. Clinical manifestations range from a local inflammatory response, such as edema, itching, redness, and papules, to potentially life-threatening systemic reactions, such as anaphylaxis.

Irritant contact dermatitis, the most common reaction, results from contact with gloves, glove powder, or another substance that physically or chemically harms the skin. It causes dryness, chapping, or split skin (OSHA, 2008).

Irritant reactions are not immunologically mediated responses but may play a role in immune responses because the skin’s integrity is interrupted, allowing latex proteins and other chemicals used in latex manufacturing to enter the body.

Delayed reactions (i.e., type 4), known as allergic contact dermatitis, are most often confined to the area of the body directly exposed to the allergen.

This can occur 24 to 72 hours after contact. The ensuing erythema, cracking, crusting, vesicles, and oozing lesions may last for days. Chemicals used in latex glove processing or other glove materials are primary culprits in these reactions.

NRL rarely is the cause of these reactions.

People who have experienced this reaction have complained of oral swelling and itching after dental exams during which latex products were used or erythema of the skin touched by latex-containing elastic. Healthcare providers may notice excoriated areas on their hands after using gloves. Multiple incidents may occur before a person begins to suspect latex sensitivity because of the delayed nature of these reactions (OSHA, 2008).

Immediate reactions (i.e., type 1) are mediated via an antibody response to latex proteins. This is an IgE-mediated allergic reaction, which triggers the release of histamines and other chemical mediators that cause physical symptoms.

Repeated exposure to latex proteins through the respiratory tract, skin, or mucosal membranes increases the body’s production of allergen-specific antibodies. After initial antibody production, a

secondary minimal exposure induces a histamine cascade, and a reaction ensues within minutes. No way exists to determine when or whether a person will convert from a type 4 to a type 1 reaction. Type 1 symptoms can range from local complaints (at the site of contact), such as urticaria, rhinitis, pruritus, or angioedema, to generalized (systemic) with severe hypotension, shock, and death.

IgE-mediated reactions may occur within minutes or up to one hour after exposure and can progress rapidly (Kelly, 2010, Wu et al., 2016, OSHA, 2008).

Summary Latex allergy is classified as a type 1, IgE-mediated immune response in which the body forms specific antibodies to NRL proteins. Proteins may be absorbed via the skin, mucous membranes, lungs, or directly into the circulatory system during invasive procedures or surgeries. Powder used in some types of latex gloves is considered to contribute to the problem by causing NRL particles to become airborne during glove donning and removal but is not the origin of the allergy itself. The rise of the AIDS epidemic in the 1980s increased demand for latex gloves, which may have contributed to the increase in latex allergies among healthcare providers.

Diagnosis Diagnosis of latex allergy is based on history, including risk factor analysis and an accurate allergy evaluation. If latex allergy is suspected, the patient should be referred to an allergist for specific testing and diagnosis. In the past, a standardized latex allergen solution for percutaneous skin testing was used in clinical investigations of latex allergy. It was found to be reliable for the diagnosis of latex allergy and was identified as the gold standard in the experimental setting; however, the FDA did not approve the solution for clinical use (Pedersen et al., 2012).

Skin tests are incredibly sensitive and good for diagnosis, but the solutions WWW.ORTODAY.COM

used for this type of testing are still not approved for use in the U.S. Serologic testing is less sensitive, but still useful; other, newer types of tests perform well but are not as widely available (Kelly & Sussman, 2017).

In-vitro (serum) testing for latex allergy is the primary method used to identify specific IgE antibodies to latex in the U.S. (Kelly, 2010). Several in-vitro tests are available to detect IgE antibodies associated with a type 1 reaction to NRL. There are three FDA-cleared assays, (radioallergosorbent test [RAST], AlaSTAT, and Hycor [HYTEC]), and one non-FDA-cleared assay (enzymelinked immunosorbent assay [ELISA]) (Pedersen et al., 2012). In a study of 117 participants reactive to latex and 195 participants not allergic to latex, the RAST and AlaSTAT assays rendered false-negative results in 25% of patients with known latex allergy; the HYTEC identified 27% false-positive results (Hamilton et al., 1999). Due to the high rate of false results, routine screening for latex allergy without a history suspect for latex sensitization is not recommended.

When the blood test matches the patient’s history, the diagnosis of latex allergy is likely, and the patient can take protective measures. Unfortunately, the patient may be in danger if their history indicates they may have an allergy and their blood test is falsely negative (Kelly & Sussman, 2017). The high rate of false-negative testing suggests multiple serologic tests for latex sensitization may help evaluate patients with a history highly suggestive of latex sensitivity (Pedersen et al., 2012).

Prevention and Treatment The primary management method for latex allergy is prevention — avoiding products that contain NRL — and, when needed, medication therapy for latexinduced allergic responses. Premedication prior to anticipated contact with latex in medical settings is a controversial topic, and no clear clinical recommendation or best practice guideline regarding its use WWW.ORTODAY.COM

has been established. (DynaMed, 2018).

Avoiding exposure is difficult for patients and sensitized healthcare workers, who often encounter latex-containing devices during caregiving. People who have significant latex sensitivity must be informed about non-latex alternatives and the need to communicate their sensitivity to others. Also, healthcare facilities have the responsibility to minimize exposure for patients and healthcare personnel to reduce the risk of exposure and subsequent reaction (Majed et al., 2009).

People with a latex allergy should do the following: • Wear a medical alert/condition bracelet identifying specific allergies, such as latex or cross-reactive foods.

• Speak with their allergist or primary care provider about carrying self-injectable epinephrine (i.e., an epinephrine autoinjector), which is the first-line treatment for severe allergic reactions.

• Inform all necessary individuals (family, friends, and healthcare personnel) about the hypersensitivity to latex and what to do in an emergency.

• Carry and refer to a list of latex-containing products and safe, non-latex alternatives.

Supportive medical therapy is the same as for any severe allergy, including antihistamines, corticosteroids, and bronchodilators. For severe responses, epinephrine and IV access for support medications may be necessary while also maintaining a sufficient airway (OSHA, 2008).

Immunotherapy is the most effective treatment of environmental allergies.

However, the FDA has not approved an allergen extract for immunotherapy for latex allergy (Kelly, 2010). Some recent research has indicated that sublingual immunotherapy can improve symptoms of latex allergy, but it is not currently a recommended treatment because of limited clinical data regarding its efficacy (DynaMed, 2018, Nucera et al., 2018).

Limited trials related to latex allergy treatment are being performed, but currently, the FDA has not approved any specific treatment.

Summary People who have a history of recurrent medical or surgical procedures, those who use latex gloves regularly at work, and those with a history of allergies, especially allergies to certain fruits, are at greatest risk for allergic reactions to latex.

The most common sign of a latex allergy is delayed contact dermatitis, which occurs 24 to 72 hours after contact with latex-containing items. Immediate reactions can also occur and cause localized and systemic symptoms ranging from itching to hypotension and shock.

Diagnosis is based on patient history and clinical testing performed by an allergist.

Management of latex allergy primarily consists of avoidance of NRL and treatment of symptoms when exposure occurs. Individuals with a latex allergy should notify healthcare personnel and wear a medical alert bracelet to notify others in case of an emergency. It may be necessary for patients to carry injectable epinephrine for emergency situations.

Providing a Safe Environment Employee and provider education on how to recognize and treat patients and staff who are latex-allergic is vital to maintain patient safety. A 2010 survey about the knowledge about NRL allergy in 156 healthcare workers in the United Kingdom found more than 50% could not recognize a type 1 allergy to NRL, and 84% felt they would benefit from training regarding NRL (Al-Niaimi et al, 2013). The topic of latex allergy should be added to new employees’ orientation and annual mandatory education.

Creating “latex-free” environments for healthcare facilities is nearly impossible. However, recent evidence shows a “latex-safe” environment is ideal, safe, and practical for patients, providers, and healthcare facilities (Kelly, 2010). To deMarch 2022 | OR TODAY

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continuing education velop a “latex-safe” healthcare facility, an interprofessional task force is necessary to evaluate the current state and develop plans for change. This should include allergy specialists, anesthesiologists, respiratory therapists, materials management staff, occupational health, food services, housekeeping, and representatives from patient care units and risk management.

Begin by identifying all latex-containing products in the facility and work to identify suitable latex-free alternatives.

In the past, many commonly used healthcare products and devices were made with NRL. Many of these items are now being made without the use of NRL or have latex-free alternatives readily available, but it is important to be aware of these items’ legacy and carefully check labels, especially in the context of caring for patients with latex allergies. Included in this category of products are exam and surgical gloves, tubing for oxygen, suction, and IV fluids, vital sign equipment and stethoscope tubing, dressing and bandaging supplies, including tape and other adhesives, tourniquets and venipuncture supplies, syringes, vial tops, and urinary catheters (Guignon, 2017). Pediatric care supplies that may contain latex include baby bottles and nipples, toys, and pacifiers (Guignon, 2017). While not always directly associated with patient care, other consumer products that contain latex are found in hospitals. Mattresses can be made of latex, and the elastic bands on clothing, shower caps, and bed linens may contain NRL. Buttons on television remotes may contain latex as well (Guignon, 2017).

Great progress has been made in removing many latex-containing products from hospitals entirely, but unknown hazards persist. Unfortunately, rubber additives are still used in the manufacture of some rubber-containing chemicals in nitrile and vinyl gloves, and these can cause reactions in people with latex allergies (Kelly and Sussman, 2017). Another potential threat in the healthcare environment is vial tops on parenteral medica-

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continuing education tions, which may contain NRL. Repeated punctures of these stoppers on multidose vials could cause reactions in healthcare providers and patients (Kelly and Sussman, 2017). Patients can also react to pens and syringes that contain latex and this has been reported in diabetics who use insulin and psoriasis patients using parenteral biologic medications (Johnson et al., 2018).

Caution should be used when drawing up medications for administration to patients with latex allergy.

The FDA issued regulations in 1998 that required the labeling of latex content in all medical products that use latex, although it didn’t extend to consumer products. In 2014, the FDA released nonbinding recommendations to manufacturers of medical products to replace the use of phrases such as “latex-free,” “does not contain natural rubber latex,” and “does not contain latex” on labels, stating concern that there is no current method to validate the complete absence of latex allergens in a product. The FDA (2014) suggests the use of “not made with natural rubber latex” to convey that NRL wasn’t used in the manufacturing of the product while avoiding an “unsupportable claim” that the product is “free” of NRL. The American Latex Allergy Association (ALAA) has a listing of latex alternative medical and consumer products.

Systems that use color-coding to identify latex-allergic individuals and latex-free products for their use can enhance institution-wide recognition and promote safety. A large warning label can be placed on patients’ charts, and signs should be posted near their rooms, requiring visitors and healthcare providers to seek instructions from the nurse before contact with the patient. A latex-safe product cart should be placed outside latex-allergic patients’ rooms; at a minimum, this cart should contain latexfree gloves, stethoscope, blood pressure cuff, tape, and IV supplies. Latex-free urinary catheters, ECG monitoring electrodes, and emergency airway equipment also are desirable. A process must be

developed that alerts all departments about patients who are allergic to latex so that food handling, diagnostic tests, and transport are safe for them. Each unit may need its own policy for the treatment of latex-allergic patients.

Additional measures that may help reduce the presence of latex and its consequences for allergic individuals include the following: • Ensure that NRL is not used on, near, or around latex-allergic patients. Items that come in contact with the mucous membranes must be latex-free, and a protective barrier, such as a stockinette, should be used between skin and latex articles if they must be used.

• Contact product manufacturers for written documentation of latex content to ensure adequate protection for the allergic patient. Do not make assumptions about which objects contain latex. For example, some black rubber resuscitator bags appear to be made of latex but are not.

• Educate staff regarding the importance of handoff and pre-procedure protocols in preventing patient injury related to allergen exposure.

During handoff and timeout communications, ensure patient allergies, reaction, and manner of exposure when the reaction occurred are documented and that the allergen is removed from the room if possible (Minami et al., 2017) • Remember to involve the dietary department in latex precautions.

The use of latex gloves during food preparation has been linked to allergic reactions (Kelly, 2010).

• Ban NRL balloons, which can be a dangerous source of exposure.

Mylar balloons are an acceptable, risk-free substitute.

• Notify emergency medical system personnel about any precautions or changes that have been made in the delivery of care; for example, the

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added screening for latex allergy in the admissions procedure.

• Encourage latex-allergic individuals to obtain a medical identification bracelet or necklace, to notify family and friends about their allergy, and to have a plan for emergencies.

• Promote the use of synthetic gloves.

This reduces the risk of sensitization and reaction to NRL by eliminating exposure to latex. Research has shown that type 1 latex-sensitized individuals may be able to work in a healthcare setting if sensitized workers use synthetic gloves (Kelly, 2010).

The clinician’s first goal in protecting latex-allergic patients is to minimize exposure in the healthcare environment. Before the latex-sensitive individual undergoes surgical, diagnostic, or therapeutic procedures, the nurse must collaborate with the individual’s primary care provider or allergist to initiate precautions against latex exposure and provide supportive therapy, if necessary. Communication is critical in procedural and surgical environments, and staff must adhere to best practices regarding presurgical checklist or “timeout” procedures to ensure identification of patient allergies and removal of the allergens from the environment when possible.

In a case study presented by JAMA in 2017, a woman getting a cystoscopy and ureteral stent placement prior to surgery for diverticulitis had a urethral catheter placed prior to the procedure start and after the timeout for the procedure was performed. Despite the fact that the patient had a known history of a latex allergy, the urinary catheter was made of latex. (Minami et al., 2017). At the point of discovery of the error, anesthesia had already been initiated. The team opted to immediately replace the catheter with a latex-free device, not knowing the extent of the patient’s past reactions (though this may not have been a reliable predictor WWW.ORTODAY.COM

of the present reaction). Even though the patient had an advanced airway in place for general anesthesia, she became difficult to ventilate and then hypotensive, signs of anaphylaxis. She was eventually transferred to an intensive care unit after treatment with diphenhydramine, methylprednisolone, and epinephrine. She recovered and was able to undergo her planned surgery at a later date (Minami et al., 2017).

Critical mistakes, in this case, include poor communication, problems with equipment management, and a lack of education on the part of the staff. The latex allergy was communicated during the preprocedural timeout, but it was not a complete communication in that it lacked the patient’s past reaction and the manner by which the patient was exposed in the past (Minami et al., 2017). Apparently, the operating room where this incident occurred did not have latex-free urinary catheters stocked, though that was against the institution’s policy, and the staff was unsure which products in the room contained latex and which did not. This led to supply chain changes at the facility, but it is unclear from the article if staff received training to help them determine which products are latexfree (Minami et al., 2017). Analysis of the case also found a general tendency to minimize latex allergy and an assumption among hospital staff that latex allergies were “minor” and “not actual allergies” (Minami et al., 2017, p. 309). This issue was addressed with education and training by the facility, and a new system is now in place where allergy information is communicated prior to patient transfer to the operating room and again during the preoperative timeout (Minami et al., 2017).

The second goal of clinicians and healthcare institutions should be to prevent the new sensitization of other

individuals, especially fellow healthcare providers, by following institutional protocols and policies and staying abreast of new information through in-service education. A stepwise approach to prevention, as it relates to diagnosing and managing a coworker’s suspected latex allergy, will help determine whether an employee may return to work (Kelly, 2010). With healthcare professionals advocating prevention and protection as part of their daily routine in the workplace, the rate of latex sensitization or allergic reactions can be minimized.

Summary Healthcare institutions should strive to create safe environments for patients and staff with latex allergies by establishing processes that promote effective staff communication and management of supplies and equipment. Institutions should also aim to prevent continued sensitization of healthcare workers and patients by reducing the use of products containing latex where possible.

Now that you have finished viewing the course content, you should have learned the following: • Differentiate between immediate and delayed allergic responses to latex.

• Identify two sources of potential latex exposure in the healthcare environment.

• List four measures for reducing risk to latex-allergic individuals in healthcare facilities.

• Name three risk factors for the development of latex allergy.

Latex allergy is a reaction to proteins found in a tropical plant used to make many common products, including gloves and other devices used in healthcare. The prevalence of latex allergy is higher among healthcare workers and patients repeatedly exposed to latex during frequent procedures than among the general population. Nurses and other healthcare workers should be familiar with sources of latex exposure and the March 2022 | OR TODAY

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continuing education clinical presentation and management of latex allergy. They should also know recommended practices to make healthcare institutions safer for people with latex allergies.

The content for this course was revised by Carrie Furberg, BSN, RN, CRN. Carrie Furberg, BSN, RN, CRN, has over 10 years’ experience in radiology nursing, in vascular and interventional radiology as well as all imaging modalities. She is a Certified Radiology Nurse with clinical expertise in procedural sedation, cardiac CT, and radiation safety, and prior experience in critical care, cardiac stepdown, and emergency care. She is a member of the Association for Radiologic and Imaging Nursing (ARIN) and RAD-AID International.

Editor’s Note: Sara A. Lowe, RN, MSN, CPNP, APNP, AE-C was the previous author of this educational activity but has not influenced the content of the current version of this course.

Resources American Academy of Allergy, Asthma, And Immunology: https://www.aaaai.org/ American Association of Nurse Anesthetists: https://www.aana.com/ American College of Allergy, Asthma, and Immunology: https://acaai.org/ Canadian Allergy, Asthma and Immunology Foundation: https://www.allergyfoundation.ca/ World Allergy Organization: https://www.worldallergy.org/ European Academy of Allergy and Clinical Immunology https://www.eaaci.org/ American Society of Anesthesiologists: https://www.asahq.org/

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latex allergy. JAMA, 317(3), 309-310.

AlNiaimi, F., Chiang, Y. Z., Chiang, Y. N., & Williams, J. (2013). Latex allergy: Assessment of knowledge, appropriate use of gloves and prevention practice among hospital healthcare workers. Clinical and Experimental Dermatology: Experimental Dermatology, 38(1), 77-80. doi: 10.1111/j.13652230.2012.04450.x

National Institute for Occupational Safety and Health. (1998). Latex allergy: A prevention guide. [Publication No. 98-113]. https:// www.cdc.gov/niosh/docs/98-113/pdfs/98-113. pdf?id=10.26616/NIOSHPUB98113

American Latex Allergy Association. (2014, February 27). What is latex allergy? https://www. allergyhome.org/blogger/the-american-latexallergy-association-and-latex-allergy/

National Institute for Occupational Safety and Health. (1998, August). Preventing allergic reactions to natural rubber latex in the workplace.

[Publication No. 97-135], 1-11. https://www.cdc.gov/ niosh/docs/97-135/pdfs/97-135.pdf?id=10.26616/ NIOSHPUB97135

Blaabjerg, M. S., Andersen, K. E., Bindslev‐ Jensen, C., & Mortz, C. G. (2015). Decrease in the rate of sensitization and clinical allergy to natural rubber latex. Contact Dermatitis, 73(1), 21-28. doi: 10.1111/cod.12386

Nucera, E., Mezzacappa, S., Buonomo, A., Centrone, M., Rizzi, A., Manicone, P. F., Giampiero, P., Aruanno, A., & Schiavino, D. (2018). Latex immunotherapy: Evidence of effectiveness. Postepy

Centers for Disease Control and Prevention.

(1987). Recommendations for prevention of HIV transmission in health-care settings (Vol. 37).

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Nutter, A. F. (1979). Contact urticaria to rubber. British Journal of Dermatology, 101(5), 597-598.

DynaMed. (2018, November 30). Latex allergy. [Record No. T919790.] EBSCO Information Services.

Guignon, A. (2017, September). An old enemy lurking in the shadows: The problems associated with latex products are still with us. Registered Dental Hygienist, 37(9), 42-44.

Hamilton, R. G., Biagini, R. E., & Krieg, E. F. (1999).

Diagnostic performance of Food and Drug Administration–cleared serologic assays for natural rubber latex–specific IgE antibody. Journal of Allergy and Clinical Immunology, 103(5), 925-930.

Johnson, C., Zumwalt, M., & Anderson, N. (2018).

Latex Hypersensitivity to Injection Devices for Biologic Therapies in Psoriasis Patients. Cutis, 102(2), 116-118.

Kelly, K. J. (2010). Latex allergy. In Leung, D. Y. M., Sampson, H. A., Geha, R., & Szefler, S. J. (Eds.), Pediatric allergy: Principles and practice (2nd ed., pp. 631-639). Mosby.

Kelly, K. J., & Sussman, G. (2017). Latex allergy: Where are we now and how did we get there? The Journal of Allergy and Clinical Immunology: In Practice, 5(5), 1212-1216.

Kelly, K. J., Wang, M. L., Klancnik, M., & Petsonk, E. L. (2011). Prevention of IgE sensitization to latex in health care workers after reduction of antigen exposures. Journal of Occupational and Environmental Medicine, 53(8), 934-940. doi: 10.1097/ JOM.0b013e31822589dc Majed, M., Nejat, F., El Khashab, M., Tajik, P., Gharagozloo, M., Baghban, M., & Sajjadnia, A. (2009). Risk factors for latex sensitization in young children with myelomeningocele. Journal of Neurosurgery: Pediatrics, 4(3), 285-288.

Minami, C. A., Barnard, C., & Bilimoria, K. Y. (2017). Management of a patient with a

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(2008, January 28). Potential for sensitization and possible allergic reaction to natural rubber latex gloves and other natural rubber products. http:// www.osha.gov/dts/shib/shib012808.html Ownby, D. R. (2002). A history of latex allergy. Journal of Allergy and Clinical Immunology, 110(2), S27-S32.

Pedersen, D. J. A., Klancnik, M., Elms, N., Wang, M. L., Hoffmann, R. G., Kurup, V. P., & Kelly, K. J. (2012).

Analysis of available diagnostic tests for latex sensitization in an at-risk population. Annals of Allergy, Asthma & Immunology, 108(2), 94-97. http:// dx.doi.org/10.1016/j.anai.2011.11.009 Saleh, M. M., Forkel, S., Schön, M. P., Fuchs, T., & Buhl, T. (2019). Profile shift in latex sensitization over the last 20 years. International Archives of Allergy and Immunology, 178(1), 83-88.

Sussman, G. L., & Beezhold, D. H. (1995). Allergy to latex rubber. Annals of Internal Medicine, 122(1), 43-46.

U.S. Food and Drug Administration. (2014, December). Recommendations for labeling medical products to inform users that the product or product container is not made with natural rubber latex: Guidance for industry and Food and Drug Administration staff. http://www. fda.gov/downloads/medicaldevices/deviceregulationandguidance/guidancedocuments/ ucm342872.pdf World Health Organization/International Union of Immunological Societies Allergen Nomenclature Sub-Committee. (2019, August 27). Allergen nomenclature database search results: Hevea brasiliensis. http://www.allergen.org/search.php?all ergensource=Hevea+brasiliensis Wu, M., McIntosh, J., & Liu, J. (2016). Current prevalence rate of latex allergy: Why it remains a problem? Journal of Occupational Health, 58 138-144

Clinical VignettE ANSWERS 1. Answer: C. Localized, delayed rashes indicate a type 4 reaction. Continued exposure to NRL increases the body’s production of antibodies, eventually causing an immediate type 1 reaction, such as angioedema or anaphylaxis. 2. Answer: A. Auto-injectable epinephrine (EpiPen® or Adrenaclick®) is the first-line treatment for anaphylaxis. Only epinephrine quickly reverses such allergic reactions as airway constriction, facial swelling, and hypotension. 3. Answer:B. As long as no skin comes in contact with the tubing, any stethoscope may be used. The best way to ensure this is to cover the tubing with a stockinette. 4. Answer: D. The AlaSTAT test has been found to render false-negative results in 25% of patients with a known latex allergy.

IN THE OR

References

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CE152 Clinical Vignette Elaine is a 53-year-old dental hygienist with a history of delayed rashes on her hands after wearing natural rubber latex (NRL) gloves. Her symptoms have never progressed beyond dermatitis, which she has treated with topical corticosteroid creams and hand lotions. Today while working with a patient, Elaine experienced facial swelling, shortness of breath. A colleague brought Elaine to the emergency department for evaluation. She told the emergency physician that the dentist with whom she works was standing next to her when he snapped his gloves while removing them.

Elaine’s vital signs on presentation to the ED are BP 94/50; T 97; HR 88; RR 32. She still has observable angioedema and is leaning forward and pausing frequently to take shallow breaths as she answers questions.

1. Elaine’s new symptoms upon exposure to NRL are due to progression in her allergic reactions from: A. Type 1 to type 4 B. Contact dermatitis to type 1 C. Type 4 to type 1 D. Type 1 to contact dermatitis 2. In the ED, Elaine is given supplemental oxygen, epinephrine, diphenhydramine (Benadryl), and prednisone. Her angioedema begins to resolve, and her respiratory distress improves. Which teaching point should be emphasized?

A. She should speak with her allergist or primary care provider about carrying auto-injectable epinephrine.

B. She should avoid wearing rubber-soled tennis shoes.

C. She must quit her job immediately.

D. She should carry diphenhydramine at all times to treat any future anaphylactic reactions.

3. Elaine’s lung sounds should be auscultated as part of the respiratory assessment, but none of the available stethoscopes can be verified as latexfree. Which is the appropriate action?

A. Skip this part of the respiratory assessment.

B. Cover the stethoscope tubing with a stockinette.

C. Cover the stethoscope tubing with foam rubber.

D. Use any available stethoscope and try not to touch the tubing against Elaine’s skin.

4. Elaine has blood drawn to test for latex allergy.

Which test may be negative even though she has had positive symptoms?

A. Patch test B. Hycor HYTEC test C. Skin prick test D. AlaSTAT test

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

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

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

Deadline Courses must be completed by 3/31/2023 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

March 2022 | OR TODAY

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SPECIAL ADVERTISING SECTION

corporate PROFILE

Welmed Inc.

Welmed Inc.

Strengthen Your Supply Chain Welmed, Your Partner in Disposable Medical Supplies ALL-IN-ONE FRACTURE TABLE HIP DRAPE

ON WELMED

F

amily-owned, innovative and responsive” are three adjectives Dave Fliss and Tan Jie used to describe Welmed, when speaking with John Wallace, editor of OR Today.

Dave Fliss and Tan Jie, the cofounders and partners of Welmed Inc., had much more to say about their privately held, disposable medical products business.

It all goes back to early 2006 when their extensive network of factories, customers and dear friends within the industry offered the idea to form a disposable medical device manufacturing company.

With over 75 years of combined experience within the medical industry, Dave and Tan Jie did not give it a second thought. Welmed quickly became a reality, officially founded in July of 2006.

“It was an exciting time for us, both professionally and personally,” says Dave.

“Our combined talents were a perfect match, with Dave’s business development, entrepreneurial spirit and experience, network of loyal customers and product development along with my experience, in quality, manufacturing and factory management,” says Tan Jie. Welmed continues to be a family, woman-owned organization based in Chicago, manufacturing and selling disposable products to thousands of health care customers including hospitals, surgery centers, distributors, OEMs, sterile kit manufacturers and more.

Dave Fliss and Tan Jie

ON INNOVATION “Disposable medical supplies is an extremely competitive industry and dominated by huge corporations with powerhouse brands, so we needed to find our niche,” explains Dave. “It’s all about the customer, listening and learning and most importantly, effectively and efficiently responding to their unique needs.”

With this simple, customercentric concept, innovation became one of the company’s founding principles and continues to be real at Welmed today. A few innovation examples Dave and Tan Jie described include products such as their fracture table hip drape, GoGreen biodegradable isolation gown and thermal warming products.

One of Welmed‘s lead, on-staff clinicians was in the OR observing a total hip replacement procedure. The patient was positioned on a state-ofthe-art fracture table and Welmed carefully observed the sterile draping procedure. Surprised to see that five unique sterile drapes were used to create the proper sterile field, the ideas started spinning. In partnership with the surgeon, a customer partner and the clinical and product development teams, Welmed’s All-In-One Fracture Table Hip Drape’s first prototype was created. Clinically validated and patented, the sterile drape continues to be used today.

Features of the All-In-One Drape Solution for Use with Fracture Surgical Tables include: • Eliminates the Need to use Multiple Drapes • Designed for Use Across a Variety of Designs and Table Manufacturers • Clear Film for Optimal Visibility & More

GOGREEN BIODEGRADABLE THUMB LOOP ISOLATION GOWNS “With the explosion and continued growth of COVID, just about everyone has seen the blue, plastic gowns donned by health care personnel throughout the pandemic.

Personal protective equipment (or PPE) is now a household name. It’s nearly impossible to not think about the millions of pounds of plastic, blue gowns in our nation’s landfills, even global landfills,” Dave says.

With such a concerning thought, Dave’s ideas started flowing and Welmed’s biodegradable isolation gown was developed. It’s distinctive, bright green color can’t be missed.

The most important facts about the gown include: • Bio-assimilates naturally and fully decomposes in a landfill environment within 6 months without remaining microplastics • Proudly made in the USA with U.S. controlled materials • No special storage, handling or disposal steps required … dispose per standard policy and practices • Environmentally friendly to help achieve customers’ green initiatives

GoGreen Isolation Gown Fracture Table Hip Drape

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OR TODAY | March 2022

CORPORATE PROFILE

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Dave continued on to say, “Thankfully, Welmed’s GoGreen Gowns were available and helped a number of large health systems during the peak of the pandemic.

We are very proud of this innovation and look to serve increasing demand from our customers.”

THERMAL WARMING PRODUCTS “Maintaining normothermia during surgery is critical and studies indicate even a one-degree drop in patient temperature can increase chances of infection, increase recovery times and in some cases result in death. Welmed’s innovative disposable patient warming surgical drapes are designed with integrated warming technology to maintain normothermia while in the operating room for surgical procedures up to 4 hours,” Dave says.

“A warming pad is integrated in the actual disposable surgical drape (patent-pending) and actively warms the patient’s core and large extremity areas with significant arterial circulation,” Dave explains.

Welmed has also developed a line of perioperative warming and thermal products, including thermal and warming drapes and thermal bouffant caps and booties.

In addition, Welmed’s patent-pending product designs are focused on having significant impacts on costs, efficiencies and outcomes.

• The sterile, disposable surgical warming drape is used just like the sterile disposable surgical drapes used today — place the surgical drape on the patient, perform the procedure and dispose of the drape properly post use.

• Welmed patient warming surgical drapes do not require machinery, ongoing maintenance, or laundry costs (like reusable drapes and blankets).

• Welmed’s warming surgical drapes do not require equip-

ment transfer, maintenance or setup, Dave says. Additionally, there is no need to attach tubing, cords, filters or other attachments to a machine or the warming drape.

• Welmed products are designed to help reduce the risk of infection. “By being a disposable item, you’ve greatly reduced the chance of possible acquired infection from one patient to another,” Dave explains. “Most warming machines today use forced warm air through reusable hoses and are used from patient to patient.”

Thermal Warming Jacket

Thermal Warming Products

Warming Surgical Drape with Thermal Bouffant

March 2022 | OR TODAY

43

corporate PROFILE

Welmed Inc.

ON RESPONSIVE SERVICE Welmed prides itself on serving customers personally whether it’s via reachable customer service representatives, sales representatives, management team members or very often, Dave and Tan Jie directly.

“It is not unusual for our customers to just pick up the phone and call us,” says Dave. “We love it, as we learn directly from our customers, often leading to new solutions, quick resolutions on issues and improved service.”

WELMED DELIVERED WHEN OTHERS COULDN'T AND EVEN ADDED A NEW SIZE FOR A CUSTOMER “In one call, we had a large customer who was struggling with chemotherapy gown allocation and needed us to fill their gaps quickly,” says Dave. “We said that we were up to the challenge, and we delivered their first order of 250 cases of chemotherapy gowns within three days. The customer was impressed with the quality of the gowns and told us they were equivalent or better quality than any gown they had purchased previously. We went above and beyond to meet the customer’s quality requirements and delivered the gowns they needed fast.”

“The same customer told us they needed a custom-size chemotherapy gown. We said that we did not make that size, but they asked us if we could. When we said yes, they were impressed with our willingness to help. Our team worked with the customer to design and develop a new product to their required specifications. With the high-quality, fast delivery, and flexibility that we offered, we became one of that customers preferred vendors.”

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OR TODAY | March 2022

CUSTOMERS SHARE FEEDBACK “Thankfully, our customers tell us how they feel with our ongoing, regular customer satisfaction surveys,” says Dave. When asked why they would refer Welmed, a few customer quotes include: • “I like their transparency, open communication, turnaround, and product delivery.

They offered competitive pricing during the pandemic.”

• “They helped us out when no one else had the products.”

• “They were easy to work with and they met my needs.”

• “I like being able to order from them directly.”

• “They were able to give me samples so we could try out products before we bought.”

TRUSTED SUPPLY CHAIN PARTNER “Everyone hears daily, sometimes ad nauseam, about broken supply chains across just about every industry and we all know from the shortages of PPE, health care was no exception,” says Dave. “It is important for our prospective and current customers to know they have a choice and can further strengthen their supply chain by considering new, vetted vendor partners.”

“Beyond working with our customers on a direct basis, we also work with a broad array of distribution partners, offering customers the convenience of ordering via their ‘standard processes and systems.’ Please pick up the phone and call, it is truly that easy and we will see if we can help.”

For more information, contact Dave Fliss or Tan Jie at 847-514-4641 or email: davefliss@welmed.us You can also visit www.welmed.us.

ON QUALITY “On quality, it’s non-negotiable. Especially, as a small business operating in an industry supported by multi-billiondollar organizations. We knew upon founding Welmed that our products had to be better than our competition and were actually clinically designed to improve upon the best within the industry,” says Tan Jie. “The results prove it with Welmed’s quality complaints at 1 in 1 million!”

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COVER STORY

COVER STORY

PATIENT SATISFACTION

BY DON SADLER

rganizations across all industries are placing a high priority on measuring patient satisfaction, and the health care industry is no different.

Hospitals and ambulatory surgery centers (ASCs) are using a variety of tools to gather feedback from patients about their experiences and how well the hospital or ASC staff performed.

O

A Critical Performance Measure “Patient satisfaction is an important measure of a health care organization’s performance, especially in today’s world where this information is publicly available,” says Erin Kyle, DNP, RN, CNOR, NEA-BC, editor in chief, Guidelines for Perioperative Practice with Association of periOperative Registered Nurses (AORN).

“It’s easy for patients to search for this information and use it when making decisions about where to seek health care,” adds Kyle. “We’re seeing in the literature that higher satisfaction scores are associated with better patient outcomes.”

There are several different ways that health care organizations can measure patient satisfaction. The main way is through the Consumer Assessment of Healthcare Providers and Systems survey, or CAHPS. There are separate CAHPS surveys for hospitals and ASCs. The hospital survey is called the HCAHPS while the survey for ASCs and hospital outpatient departments (or HOPDs) is called the Outpatient and Ambulatory Surgery CAHPS, or the OAS CAHPS, survey.

According to Vangie Dennis, MSN, RN, CNOR, CMLSO, assistant vice president, perioperative services at Anmed 46

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Health, the HCAHPS scoring system helps hospitals and its governing bodies evaluate patient satisfaction through quantitative measurements.

“HCAHPS scores are used to enable objective comparisons of hospitals across a variety of metrics,” says Dennis.

“They also inform health care consumers about the relative standard of care at each facility and create incentives for hospitals and health care organizations to compete on patient engagement and satisfaction.”

“All organizations should be accountable to their consumers, and health care organizations are no exception,” Dennis adds. “Patient satisfaction surveys are a means of quantifying patient-centered delivery of quality health care. They measure the effects of clinical outcomes, patient retention and medical malpractice claims and increase the referral base to the hospital or ASC.

History of the OAS CAHPS Survey Development of the OAS CAHPS survey has been underway for the past decade. Before this, there was not a standardized survey instrument to assess patient experiences with the outpatient surgical care they received as ASCs and HOPDs. A field test of the survey was conducted in 2014 to test the reliability of the survey items and implementation procedures and the survey instrument was revised and finalized.

The survey then received accreditation in 2015.

In 2016 the Centers for Medicare & Medicaid Services (CMS) implemented a voluntary national reporting program for the OAS CAHPS survey that was open to any certified HOPD or ASC. CMS-approved survey vendors administer the survey on behalf of HOPDs and ASCs and submit the data to the OAS CAHPS Data Center.

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47

COVER STORY

ERIN KYLE,

DNP, RN, CNOR, NEA-BC

BEVERLY KIRCHNER, BSN, RN, CNOR, CNAMB

VANGIE DENNIS,

MSN, RN, CNOR, CMLSO

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COVER STORY OAS CAHPS survey participation will remain voluntary through 2023 but it will be linked to Medicare reimbursement starting in 2024 for HOPDs and 2025 for ASCs. The OAS CAHPS survey includes questions about the following types of patient experiences: • The level of communication and quality of care provided by health care practitioners and office staff.

• The patient’s preparation for the surgery or procedure.

• The patient’s preparation for discharge and recovery.

According to the OAS CAHPS website, the survey was designed to produce comparable data on the patient’s perspective that allows objective and meaningful comparisons between HOPDs and ASCs on domains that are important to consumers. This will allow consumers to make more informed choices when choosing a HOPD or ASC. The website lists a number of potential benefits to participating in the OAS CAHPS national reporting program, including the following: • Helping provide valuable information to consumers about the quality of care provided nationally by HOPDs and ASCs. • Comparing patient responses against state and national averages, which will be available for download.

• Meeting state or other regulations that require a patient satisfaction survey to be conducted regularly.

HOPDs and ASCs can choose to add supplementary questions to the OAS CAHPS survey, as well as replace their internal patient experience of care surveys with the OAS CAHPS survey, notes the website.

The Ambulatory Surgery Center Association (ASCA) supports quality reporting.

“ASCA has long encouraged CMS to implement a quality reporting program for ASCs and hospital outpatient departments that would

enable patients to make meaningful comparisons among providers,” says ASCA Chief Executive Officer William Prentice.

“The OAS CAHPS survey could be a step in the right direction,” Prentice adds, “but only if certain changes that would encourage patient participation and reduce the administrative and financial burdens on our facilities can be made.”

Preparing for the OAS CAHPS Survey While it might seem a long way off, it’s not too soon to start preparing for how your organization will begin participating in the OAS CAHPS survey when it is linked to Medicare reimbursement in 2024 and 2025.

It starts with researching and interviewing the approved survey vendors, says Bev Kirchner, BSN, RN, CNOR, CNAMB, corporate compliance officer at SurgeryDirect.

“This process could take six to eight weeks to find the right fit for your organization,” she says.

Once you have selected a survey vendor, the next step is to negotiate a contract and begin setting up your organization for success.

“Don’t forget to educate your staff,” adds Kirchner. “Also make sure you and your staff understand the language and terms being used so you can incorporate the terms into your patient communication without telling the patient what will be on the survey.

I’ve heard from several early adopters that the terms confuse the patient so initial scores may be low due to the terms used and the patient’s lack of understanding.”

Kirchner also stresses the importance of reviewing the requirement of the quality indicator and educating staff about it.

“Prepare your quality assurance and performance improvement (QAPI) plan to include the indicator and make sure your policies and procedures cover the indicator,” she says. “Start early and work out the problems before the reporting period starts.”

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A Second Set of Eyes Kirchner has been actively involved recently in helping ASCs improve patient satisfaction.

“Patients are our second set of eyes,” she says. “Along with their family members, they perceive things differently – they see and hear things we miss. With their input, we can improve our communication skills and better understand how to meet our patients’ needs.”

“This is especially important in an ASC because we send patients home within a few hours after surgery,” Kirchner adds. “Our communication must be clear and the education must be delivered in a format the patient learns best.”

Kyle points to research demonstrating a link between patient satisfaction and quality outcomes.

In a 2020 study, researchers evaluated 327 cardiac patients who completed a patient satisfaction survey about their hospital admission and had post-discharge outcomes data. Higher patient satisfaction with the discharge process was associated with fewer readmissions at 90 days post-discharge.

“Higher patient satisfaction with overall assessment of care and hospitalization correlated with a lower mortality rate at six months postdischarge,” says Kyle. “In this population, higher patient satisfaction correlated with better patient outcomes.

Health care organizations can use patient satisfaction data to inform areas for health system improvement.”

And in a 2017 study, researchers evaluated the relationship between patient satisfaction and outcomes for 373,692 patients who underwent major cancer surgery.

“In both unadjusted and adjusted analyses, hospitals with higher proportions of patients reporting excellent satisfaction had lower complication rates, readmissions, mortality and prolonged length of stay,” says Kyle.

“When patients form positive

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relationships and begin to trust their providers, they become more engaged in their own care,” says Dennis. “Great patient experiences often lead to more satisfied patients who tend to comply with treatment and follow recommendations better than dissatisfied patients.”

Higher patient satisfaction also translates into lower malpractice risks.

“And a better patient experience gives hospitals a competitive advantage,” says Dennis.

The higher a hospital’s HCAHPS scores, the higher their reimbursements will be, and vice versa, Dennis adds. “Low HCAHPS scores not only affect a hospital’s reputation, but they also decrease monies received from Medicare.”

There will always be that one patient who you can’t please no matter what you do, notes Kirchner.

“But don’t worry about this,” she says. “Instead, be prepared to address the majority’s needs. And you will find the majority will respond to care positively.”

And remember that reality is not always what the patient satisfaction survey measures. “Instead, it measures patient perception, which is the patient’s reality,” says Kirchner.

Improving Patient Satisfaction Scores To improve patient satisfaction scores, Kirchner recommends analyzing the data, reading the patient comments and doing research based on them. “Then, develop a performance improvement project to make changes that will improve your scores and meet the patients’ needs,” she says.

“The very best strategy to achieve top marks in patient satisfaction is to focus all of your efforts on excellent outcomes by using evidence-based practices for care delivery,” says Kyle.

“And remember that patients are more satisfied when they experience a safe environment of care, have

good outcomes and are encouraged to participate in their care.”

“Patients who witness inefficiencies, a hostile work environment among health care personnel or are not included in their care are likely to be the same patients who have lower satisfaction scores,” Kyle adds.

Dennis lists the following suggestions for improving patient satisfaction scores: • Develop a rapport with your patients • Make it personal and not just about the patient’s condition • Set expectations for your staff and hold them accountable for achieving them • Listen carefully to your patients • Improve patient-provider communication • Improve the physical hospital or ASC environment • Be attentive and strive to reduce unnecessary pain and discomfort “High patient satisfaction scores tell me how well a health care organization’s processes are working,” says Kirchner. “They help organizations meet the value-based care benchmarks and thus will become essential when it comes to Medicare reimbursement and negotiating third-party payor contracts.”

Regardless of the environment, patient care is driven by outcomes.

“If you track patient outcomes and show data that your patients receive the best care using the best processes, your organization will survive today and in the future,” says Kirchner. “If your outcomes are poor, however, you will lose physicians and patients.”

Kirchner believes that going forward, health care will be driven by three main things: compliance, quality and safety.

“These are the future drivers of health care success,” she says. “If you don’t focus on these three aspects of care, you will not thrive in the future.”

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spotlight on:

samantha

pillay

BY Matt Skoufalos er 20-year surgical career has brought Dr. Samantha Pillay of Adelaide, Australia no shortage of milestones.

The first woman in the state of South Australia to train in urology, Pillay further blazed her own trail by specializing in female urology, with a focus on women’s health in incontinence surgery. She built her practice, called Continence Matters, as a first-of-its-kind center of excellence in the subspecialties of female pelvic medicine and reconstructive surgery.

H

“It was unusual for urologists to subspecialize at that time,” Pillay recollects.

“What it meant is there was no script to follow, so I had to forge my own way. I

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had my own vision and my own ideas to create something. That meant I could do what I thought would serve the purpose best.”

The anchor to her career, Pillay said, is a strong sense of belief in herself, her worth and her ability to achieve the dreams she’d envisioned; she believes that lacking that belief “is the fundamental hurdle to success.”

“For people to be able to access and make change in their life, they’ve got to believe in themselves,” Pillay said.

“How strongly adults with healthy habits believe that they can actually succeed is what allows them to put in the work, overcome the obstacles and setbacks, and reach that long-term goal.”

“There’s a lot I can do for someone’s health as a surgeon but it pales into insignificance compared to what they can do for themselves,” she said.

Pillay needed to look no further than her own life for the example of resiliency that has fueled her success. Growing up

in a country where less than 13 percent of all surgeons are female, she had few role models to observe in her chosen career path. More than that, however, Pillay was born with congenital hip dysplasia and struggled with movement throughout her youth.

“I failed to walk, I started school in a wheelchair, and I really struggled with stairs up until I was 18,” Pillay said. “I had significant mobility issues that continued to deteriorate, especially after I had one son; in my 40s, my mobility reduced dramatically to the point that I struggled to shower and get dressed. It was almost to the point where I was going to have to give up work.”

Pillay had even been discouraged from entering a surgical career given the hours of standing that it would require. Urology became a viable prospect because some procedures could be completed while sitting. It wasn’t until she underwent a hip replacement some five years ago that Pillay gained the restriction-free move-

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ment that many of her peers in her field have enjoyed since childhood.

Despite these obstacles, Pillay rose to chair the Female Urology Special Advisory Group for the Urological Society of Australia and New Zealand from February 2007 to June 2013, and was President of the South Australian branch of the Continence Foundation of Australia from February 2011 to November 2014. The momentum that had carried her through schooling and into practice so successfully also sustained her as a single mother and entrepreneur.

As Pillay’s professional career rounded into form, her awareness of the cultural limitations of gender bias and stereotyping that had limited her own opportunities growing up never receded far from her mind. But it wasn’t until she found herself home from work during the novel coronavirus (COVID-19) pandemic that Pillay thought to address those underlying presumptions as an author.

“I’m a single mum, I don’t drink, and like a lot of surgeons, I’m a bit obsessive,” she said. “My thing through COVID has been having a project that I can do alone at home. It’s really important when we have such demanding careers to have some way of escaping that. I like to be productive; writing’s been a blessing in disguise as far as having something else to do.”

Pillay’s first foray into authordom came with “The No-Recipe Cookbook,” an attempt to impart her medical knowledge about the interrelationships among chronic disease, obesity, and mental and financial health into a holistic time- and resource-management cookbook. Her efforts to meal-plan and shop once every two to three weeks helped Pillay half her spending on food, reduce waste and save time. She wrote the book prosaically, with no recipes, and no pictures. “Then I

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was hooked,” Pillay said.

The exercise enabled her to “switch off work” with a hobby that she could pick up on her own schedule, and the positive feedback it generated inspired Pillay to create a second series of books for children. “When I’m a Surgeon” describes the conversations that a young girl might have with herself or her family as she plots a career in medicine. It’s depicted through illustrations that can help a child see what that path might be like, and strengthen her vision (and maybe her resolve) for that future. “When I’m an Entrepreneur” is meant to inspire the next generation of entrepreneurs by highlighting the qualities required for success.

There are companion coloring and activity books for each, and “When I’m an Astronaut” is due for release this year.

“When it comes to careers for women, career gender stereotypes start to form in early childhood,” Pillay said. “Career stereotypes really influence how people see themselves. It’s not about every child being a surgeon, it’s about every child believing that if they wanted to, they could be a surgeon, even for a moment.

Or, that pretending that they were an entrepreneur for a short period of time, instills that self-belief.”

“I can be an author; I can self-publish,” she said. “I didn’t have that self-belief 30 or 40 years ago, but the next generation can because we are slowly lifting all these stereotypes, cultural behaviors and conditioning that acts to reduce people’s self-belief. By lifting these, the next generation will be capable of doing so much more.”

While Pillay acknowledges she didn’t have that same degree of self-belief that her characters (and readers) may enjoy, embracing her hobby has helped her self-publish five titles in a single year.

The books are dedicated “dream big, aim

high,” which, to her thinking, she’s done.

They’ve also helped a surgeon unpack other parts of her brain and find creative applications for her medical career as well.

“This little hobby has benefited my surgical career in many different ways,” Pillay said. “Just the simple things, like challenging yourself outside of your comfort zone, is a good way of exercising your brain. When you’ve been doing the same thing for 20 years, it’s very different putting yourself into an area that you know nothing about.

That learning curve has been very good exercise for my brain and an opportunity to do something creative, which surgery doesn’t really have.”

Samantha Pillary became an author amid the COVID-19 pandemic. Her books include “When I’m a Surgeon”.

March 2022 | OR TODAY

51

OUT OF THE OR

OUT OF THE OR

health

health

muscles, improved mental health and cognitive function and lower risk of depression.

The greatest impacts come from getting the recommended amount of activity: at least 150 minutes of moderate activity, 75 minutes of vigorous activity or a combination of those activities per week. Be sure to discuss with your doctor which activities may be best for you.

Photo courtesy of Getty Images

Take Charge of Risk Factors Impacting Heart Health

risk for heart disease and stroke from high blood pressure, depression or anxiety – stress can lead to unhealthy habits like overeating, physical inactivity and smoking.

Exercise is an effective way to keep your body healthy and release stress. You might also consider incorporating meditation and mindfulness practices into your day to allow yourself a few minutes to distance yourself from daily stress.

Wednesday, Thursday, Friday, Saturday Reduce Stress Research compiled by the American Heart Association June 1-4, 2022 Constant or chronic stress can have real consequences suggests meditation can reduce blood pressure, improve Dallas Marriott City Center on both emotional and physical health. In fact, research sleep, support the immune system and increase your abilThe best of the field converging in Dallas Texas ity to process information. shows chronic stressors like long work hours, financial info@scrubball.org Healthcare Conference & Gala stress and work-life conflict may be as risky for health as www.scrubball.org secondhand smoke, according to a report by the Behavior Learn more about managing your cholesterol and habits to Science and Policy Association. protect your heart health at heart.org/cholesterol.

"To do what nobody else Aside from the toll on your body – including will elevated do, a way that nobody else can do, in spite of all we go through; that is to be a nurse." -Rawsi Williams-

By family features holesterol – a waxy substance created by the liver or consumed from meat, poultry and dairy products – isn’t inherently “bad” for you. In fact, your body needs it to build cells and make vitamins and other hormones. However, too much “bad” LDL cholesterol, or not enough “good” HDL cholesterol, can pose problems.

C

High cholesterol is one of the major controllable risk factors for heart disease and stroke. Because it typically has no symptoms, you may not know you have high cholesterol until it’s causing problems.

Knowing key health numbers like blood sugar, blood pressure and cholesterol, and working closely with your doctor to manage them, are keys to preventing heart disease and stroke.

Those who have already experienced a heart attack or stroke or have family history of cardiovascular disease, chronic inflammatory disease or kidney disease may need to have their cholesterol and other risk factors checked more often and may need medication to manage their conditions to prevent another event. According to the American Heart Association, as many as 1 in 4 survivors will have another heart attack or stroke.

Along with taking medication as prescribed, some life52

OR TODAY | March 2022

style habits can help manage your risk and help you live a longer, healthier life like watching what you eat, getting more exercise and managing stress.

Make Healthy Menu Choices A healthy eating plan is a well-rounded diet with plenty of fruits and vegetables (at least 4-5 servings each day). In fact, researchers at the University of Columbia found each daily serving of fruits or vegetables was associated with a 4% lower risk of coronary heart disease and a 5% lower risk of stroke.

Other smart choices for your menu include nuts and seeds, whole grains, lean proteins and fish. Limit sweets, sugar-sweetened beverages, saturated fat, trans fat, sodium and fatty or processed meats.

Get Moving You likely know exercise is good for you, but an Oxford University study revealed simply swapping 30 minutes of sitting with low-intensity physical activity can reduce your risk of death by 17%. Mortality aside, in its “Physical Activity Guidelines for Americans,” the U.S. Department of Health and Human Services noted physical activity offers numerous benefits to improve health, including a lower risk of diseases, stronger bones and WWW.ORTODAY.COM

Scrub Ball is a dynamic three-day event celebrating, honoring and recognizing YOU, the men and women who have dedicated their professional lives to serving others in the field of health care.

Honoring Unspoken Heroes

After making it through the most th INTENSE years in recent history, Scrub Ball is just what the doctor ordered! An opportunity to get-a-way, unwind, reflect and simply enjoy celebrating people again.

Come and let us celebrate the healthcare workers this summer in Dallas TX, June 1 - 4, 2022 POWERFUL SPEAKERS INCLUDE: Scrub Ball is a dynamic three-day event celebrating, honoring and

The Scrub Ball will have attendees and women who have dedicated their from Perioperative Services, Central professional lives to serving others in the field of health care.

Service, Dental and several other SHARON GREEN GOLDEN healthcare sectors.

Sterile Processing Manager for AHSGMC KAREN CHERRY recognizing YOU, the men The Cherry Foundation, Founder

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"To do what nobo

53 will do, a way tha

else can do, in s we go through; t

OUT OF THE OR

OUT OF THE OR

fitness

EQ Factor

Flow Through Spring Training

Areas For Goalsetting

By Daniel Bobinski

By Miguel J. Ortiz t’s very important to balance out the proper amount of strength and recovery when it comes to putting together a quality training program. If you have a busy schedule or are tight for time, getting the appropriate splits between training and recovery can sometimes be a challenge.

I

What we don’t want to do is favor one over the other. Too much training can lead to heavy fatigue, which could force the body to recover at an inopportune time. Too much recovery and the body can potentially fail to progress through the proper strength requirements. It could even lead to excess soreness when the training kicks back into gear. A great way to keep everything balanced is to utilize “mobility flows” in your training routine. These are similar to yoga poses except you move in and out of the osition instead of holding a stretch. Mobility flows provide great total body core strength and stability during the movement while also adhering to some quality stretching. So, if don’t have enough time to go through a full recovery session and your struggling to balance between strength and flexibility add these mobility flows to your training routine to ensure you stay on track.

Our first movement is a Downward dog, wave unload, cobra flow (youtu.be/ 54

OR TODAY | March 2022

FXlEIH-CBb0). It is important to keep flowing. Instead of holding one position, try to increase your range of motion every rep by utilizing proper strength to make the movement smoother. The strength portion of this exercise is felt during the unloading from the downward dog position and smoothly transition into cobra as your upper body has to stay balanced and your core is responsible for unwinding the spine. This exercise will loosen up your hamstrings, lower back and lats. It will also strength your core and upper body specifically the shoulders.

The second movement is the scorpion stretch (youtu.be/5PULJd89N0c). Don’t let the name fool you, there is a lot more strength in this move than you think. The scorpion stretch activates the posterior system while stretching the anterior (or front of the body) simultaneously. While lying on your stomach place your hands wide making a T. Begin by bending your right knee and lifting your foot off the floor. You’ll then activate your hamstring and glutes in order to lift that right knee off the floor. The strength comes in when you begin to touch your right foot to your left hand, crossing your body over and fully activating your posterior system.

The stretch will occur on the front of the body in your quads, hip flexors and core.

You will only be able to touch your right foot to your left hand if both the strength and flexibility are equal enough to allow

the body to do so.

Lastly, give this weighted OH side bend (youtu.be/1MwQjKwuDI0) a try. I highly recommend keeping the weight very light or even holding a T-shirt overhead. This can be very difficult on your core and back when not done properly. If your unable to sit with your legs wide in a tall position, I recommend sitting with your back against a wall to help keep your back upright. This exercise has a fairly simple set up but challenges your core and inner thighs. By staying upright and leaning to reach for your foot, you’ll be stretching the hamstring of the foot you are leaning towards and your opposite lower back. When unwinding back to the original position is where the strength comes. The same side that gets stretched is the same side that will be strengthen in order to bring you back up.

It provides great flexibility and strength to the hips, core and shoulders. Have fun including these movement flows in your training routine so you can stay balanced when it comes to proper strength and mobility.

Miguel J. Ortiz is a personal trainer in Atlanta, Georgia. He is a Master Trainer for Pain-Free Performance and a Certified Nutritional Consultant with more than a decade of professional experience. He can be found on Instagram at @migueljortiz. You can find his YouTube channel at tinyurl.com/ORTfitness.

WWW.ORTODAY.COM

n last month’s column I spoke about the benefits of knowing your “center.”

A center is the core of what drives your decisions, your sense of self-worth and even your sense of power. Many possible centers exist, but the most powerful is being principle-centered. The reason it’s so powerful? Nobody can take away your principles, so if principles are at the center of who you are, your world cannot collapse.

I

Understanding your center is part of Habit 2 from Stephen Covey’s “7 Habits of Highly Effective People” (Habit 2 is “Begin with the End in Mind”). Before I dig deeper into Habit 2, allow me to point out that Covey’s seventh Habit is “Sharpen the Saw,” which means to take time and tend to all aspects of your life.

Covey’s areas of focus in Habit 7 are physical, mental, spiritual and social-emotional. I would like to suggest those don’t go far enough. A few more are needed.

Thirty-plus years ago my own coach gave me 14 areas for setting goals, but I found that number overwhelming. Subsequently I learned that our brains are capable of managing up to seven things before going into overload. And so, I set out to WWW.ORTODAY.COM

develop a framework for goal-setting that had only seven categories. Feel free to use what I developed, or develop your own. They idea is to have a well-rounded approach to life, otherwise our lives tend to get out of balance.

The seven categories I developed are: Faith. This category is for however you define a spiritual component in your life.

Family & Friends. Pretty selfexplanatory.

Finances. This category is for budgeting, investing and otherwise managing your money.

Fitness. This category has multiple facets. It can include physical fitness or mental fitness. Physical fitness also includes diet. Mental fitness includes taking classes or otherwise improving myself.

Forte. This is whatever I do most during the week. For me, it includes almost all aspects of running my business, but if I were an employee, it would include all aspects of being a good employee. If I were a stay-athome parent or a full-time student, it would include all aspects of that.

Fortress. This is the category for where I live, whether it’s a studio apartment, a duplex or a 77-room mansion. Essentially, this category is for setting goals regarding my living quarters. By the way, I put my

vehicles in this category because they get stored in my “fortress.”

Foundations. This category is for how I participate in my community.

Without a solid community, we don’t have solid society, so whether its participating on a board with my neighbors or helping someone run for public office, it goes in this category.

So you know, I also have an eighth category: Fun. This is where I put plans for vacations or special events in my life.

Feel free to use these categories or make up your own. The idea is to have specific areas for setting goals so your life is well-rounded. In the next issue, I’ll explore the nuts and bolts of setting goals so you can truly begin with the end in mind.

Daniel Bobinski, M.Ed. is a best-selling author and a popular speaker at conferences and retreats. For more than 30 years he’s been working with teams and individuals (1:1 coaching) to help them achieve excellence. He was also teaching Emotional Intelligence since before it was a thing.

Reach Daniel through his website, MyWorkplaceExcellence.com, or his office: (208) 375-7606.

March 2022 | OR TODAY

55

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Let’s explore what that looks like.

If there are foods you need (because of allergy/sensitivity) or want to avoid for health purposes (I’m looking at you sugar), instead of thinking “I cannot have that” reframe that into “I am choosing not to have that.” The first is a restriction/punishment, and the latter is a choice. Choice making is what is really happening anyway. My celiac daughter chooses to not eat gluten because she knows the damage it causes her body.

You may choose to eliminate sugary treats because you know you will feel better.

If you feel like your food choices have gotten boring and limited, reacquaint (or introduce yourself) to the amazing world of food. Americans tend to eat the same 6-8 foods on repeat.

Break free and pay attention to the abundance of food diversity. A fun way to do this is to visit an international grocer. It does not matter what population they cater to because they will certainly have items you are not seeing at your regular market. Buy something weird and enjoy. Look up a new recipe, take a cooking class or try a new dish at

TAKE GOOD CARE: NURSES • SURGICAL TECHS • NURSE MANAGERS

and get a first look at: MAGAZINES • SPECIAL OFFERS WEBINARS • CONFERENCE UPDATES

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56

OR TODAY | March 2022

h, spring! It is the season of potential. As a farmer, I deal in potential. I see bushels of produce when I look at a seed.

Farmers know that potential is nearly limitless. The trendy term for this way of looking at the world is “abundance mindset.” I urge you to apply this lens to the world of food and health.

A

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a restaurant that is new to you. Another great way to broaden your understanding of food diversity is to peruse a seed catalog. A great one is Baker Creek Seeds (rareseeds.com). It’s impossible to look at all that food and not be amazed.

There is an abundance of food in the world and an abundance of ways to prepare it.

If you are facing a health challenge, it is very easy to get stuck in the “why me” mindset and see no way out. What I have learned from my own experience, training and in working with others on their nutrition/health journey is that food is often a powerful solution.

What if you gave your body everything it needs? Your body is an amazing machine with great capacity to heal.

Nutrition is not magic and it is only one of many ways we can impact our health, but I have seen it work miracles. One of the best examples of applying an abundance mindset to nutrition and health is Dr. Terry Wahls. She is an Iowa physician with multiple sclerosis who used nutrition and movement to get out of a tilt-recline wheelchair and reverse most of the symptoms of her disease. Our food choices are a powerful prescription for health and they are abundant.

If you are struggling with eating better because you just do not like vegetables or hate shellfish for example, apply an abundance mindset. Keep trying. Maybe you do not like kale, but you find a brand of kale chips that you love.

Perhaps you grew up hating peas (I am talking about me here), but you discover that you adore eating raw sugar snap

pea pods. Keep trying. Food is abundant and there are an abundance of textures, flavors and preparations. Expect to like something and perhaps you will. I had been repeatedly told that oysters are hands-down the best source of zinc.

Despite knowing better, I avoided a can of tinned oysters in my pantry for years.

I finally took the plunge and found out while I would not say I crave them, I do not hate them. Also know that tastes change. Your palate will change with your diet. Also know that many of the “I do not like vegetables” folks have just not had great, flavorful, fresh ones. My pea hatred was really a hatred of mushy canned peas. I still hate those.

Applying an abundance mindset to health and food has the potential to help you realize your own abundant power over your health. So, when people say to me that they could never eat kale, or how can you eat oysters, or I couldn’t live without x, y, or z; I understand where they are coming from (I really do,) but I wish I could convey to them succinctly that these small investments are the keys by which I own my power. It is an abundance of riches.

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.

March 2022 | OR TODAY

57

OUT OF THE OR recipe

Cheesy Chorizo Nachos

OUT OF THE OR recipe

INGREDIENTS:

A Winning Recipe for March Madness

• 1 package Cacique Pork Chorizo

Recipe

• 1 package Cacique Queso Blanco Queso Dip

the

• 1 can (15 ounces) refried beans • 2 tablespoons water, plus additional, if necessary • 1 bag (12 ounces) tortilla chips • 1 package Cacique Ranchero Queso Fresco • 1/2 cup Cacique Crema Mexicana • 1 large jalapeno, sliced thin

ettling in for an afternoon of March Madness action calls for a variety of food from dips and appetizers to full-blown feasts.

Whether you’re a diehard fan, casual observer or just there for the game time grub, a full day of “homegating” requires flavorful eats to refuel the crowd.

S

• 2 radishes, sliced thin • fresh cilantro leaves, for garnish • guacamole, for serving • Cacique Mild Homestyle Salsa, for serving

One of the easiest ways to take your menu from benchwarmer to MVP status is to add foods from one of the country’s top authentic Mexican food brands, Cacique, to your playbook. For example, flavor-packed, heaping Cheesy Chorizo Nachos can be a

Cheesy chorizo nachos

By Family Features

58

OR TODAY | March 2022

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1.

In large nonstick skillet or wellseasoned cast-iron pan over mediumlow heat, cook pork chorizo, using spoon to break it up. Stir regularly until completely warmed through and deep brown, scraping crispy bits from bottom of pan.

2.

Microwave queso dip 2-3 minutes until heated through.

3.

In medium bowl, thin refried beans with water. Beans should be thick but nearly pourable; add additional water 1 tablespoon at a time, if necessary.

4.

Heat oven to 350 F.

slam dunk at your gathering, even among the pickiest of fans. When the game is on the line, call on this dish to keep your team satisfied from tipoff to the final whistle.

Made with crumbly, creamy, pleasantly milky queso fresco; authentic real cheese queso dip that’s ready in minutes; robust, spicy pork chorizo; fresh-tasting Crema Mexicana; and small-batch homestyle salsa, this shareable dish can feed a houseful of hungry fans. Ready in less than an hour, it’s a perfect solution for pregame baking so it’s ready just before tipoff.

To find more game day recipes, visit CaciqueInc.com.

5.

To assemble nachos, add half the tortilla chips to 13-by-9-inch rectangular baking dish. Use spoon to drizzle half the queso dip and half the refried beans evenly over chips, distributing as evenly as possible. Sprinkle with half the crumbled queso fresco. Repeat with remaining chips, queso dip, beans and crumbled queso fresco. Bake 5-8 minutes until crumbled queso fresco softens and queso dip is creamy.

6.

Remove from oven then drizzle with crema Mexicana and scatter pork chorizo over top. Garnish with sliced jalapenos, radishes and fresh cilantro. Serve with guacamole and salsa.

March 2022 | OR TODAY

59

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