OR Today October 2023

PATIENT SAFETY TRIFECTA

Prepzyme® Forever Wet creates a long lasting moisture barrier. As seen here, instrument remains wet to the touch for days after application.

Prepzyme® Forever

Wet

INSTRUMENT TRANSPORT HUMECTANT SPRAY

The latest breakthrough in enzymatic pre-cleaning sprays, Prepzyme® Forever Wet’s unique humectant properties form a moist coating over the instruments that lasts for days.

• The humectant formulation creates a moisture retention barrier which keeps soiled instruments and rigid scopes moist for a prolonged period of time – unlike a GEL which HAS NO MOISTURE RETENTION properties

• Operating room safe, non-aerosol, multi-tiered enzymatic spray helps prevent bio-burden from drying on the surface of soiled instruments and scopes

• Ideal for transporting soiled instruments that may sit for an extended period of time

• Reduces tray weight during transport compared to liquid presoaks

• Soiled sharps are visible through humectant

• Decreases spills and potential cross-contamination

Automated Formalin Dispensing System

Eliminate Formalin Exposure

• Reduces formalin spills

• Utilizes high quality specimen buckets

• Standardizes formalin ratio

• Eliminates human error/discrepancies

• Documents fixation time accurately (866) 995-5300 www.milestonemed.com info@milestonemed.com

Let UltraSAFE mitigate the health risks associated with Formalin exposure. UltraSAFE, an innovative instrument for large biospecimens, allows PeriOp nurses to handle patient specimens in complete safety, with no exposure to formalin fumes. UltraSAFE automatically dispenses formalin into specimen buckets in an enclosed and vented chamber that eliminates operator exposure to carcinogenic formalin fumes. The solution is simple. The solution is safe; UltraSAFE.

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MARKET ANALYSIS

The global disposable medical supplies market is expected to reach $429.1 billion by 2030.

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PATIENT SAFETY TRIFECTA

When it comes to safe instrument processing, the operating room, sterile processing department and infection prevention department form a “patient safety trifecta” that must work together to ensure that patient safety remains the top priority.

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CORPORATE PROFILE

Healthmark prides itself as being a leader in providing innovative and cost-effective infection control solutions to health care organizations.

45

EQ FACTOR

One problem that gets in the way of moving forward in building collaborative teams is when someone on the team has little or no concern for other people’s thoughts or feelings.

and not necessarily those of the publisher. Reproduction in whole or in part without written permission is prohibited.

PUBLISHER

John M. Krieg john@mdpublishing.com

VICE PRESIDENT

Kristin Leavoy kristin@mdpublishing.com

VICE PRESIDENT OF SALES

Jayme McKelvey jayme@mdpublishing.com

EDITOR

John Wallace editor@mdpublishing.com

ART DEPARTMENT

Karlee Gower

Taylor Hayes

Kameryn Johnson

ACCOUNT EXECUTIVES

Megan Cabot

Emily Hise

DIGITAL SERVICES

Cindy Galindo

Kennedy Krieg

EVENTS

Kristin Leavoy

ACCOUNTING

Diane Costea

WEBINARS

Linda Hasluem

EDITORIAL BOARD

Justin Fontenot, DNP, RN, NEA-BC, FAADN Assistant Professor of Nursing at UL Lafayette

Natalie Lind, Education Director for the Healthcare Sterile Processing Association, HSPA

Pat Thornton, Periopeartive Consultant

Dawn Whiteside, MSN (Ed), RN, NPD-BC, CNOR, RNFA, Director of Education, CCI

Julie Williamson, BA Director of Communications, HSPA

STARmed Co. Ltd Launches STARmed America in the USA

STARmed Co. Ltd, a leading medical device manufacturer specializing in thermal ablation technology, has announced the launch of its subsidiary, STARmed America, in the USA. This strategic move aims to strengthen direct customer service and foster collaboration with the U.S. market for cutting-edge thermal ablation technology. STARmed America will serve as a vital hub for innovation and collaboration.

STARmed Co. Ltd specializes in radiofrequency ablation generators and electrodes, establishing a strong reputation both domestically and internationally. Working closely with key opinion leaders (KOL) in the medical field has been a primary focus for STARmed, leading to the development of leading-edge

radiofrequency (RF) technology for various clinical applications. STARmed America will further cultivate this culture of innovation, solidifying its commitment to pushing medical advancements through strategic partnerships.

“The mission at STARmed is to maintain the highest levels of innovation, knowledge and technical expertise to provide solutions that enhance patient comfort and improve the quality of their lives,” stated Henry Shin, CEO at STARmed Co. Ltd. “With the launch of STARmed America, we are poised to deliver on this mission by working closely with our USA customers and leveraging potential opportunities to advance thermal ablation technology even further.”

Henry Schein Medical, Medpod Launch Medpac

Henry Schein Medical and Medpod Inc. have announced the launch of Medpac – a lightweight, portable telediagnostic solution that allows health care providers to offer comprehensive professional care regardless of location, helping to bridge the gap between remote telemedicine consultations and in-person office visits. Telemedicine plays a crucial role in improving health care accessibility, reducing barriers, and enhancing patient outcomes, particularly in underserved populations and remote areas, according to a study published in the National Library of Medicine.

A compact, backpack version of Medpod Inc.’s MobileDoc, Medpac houses a set of telediagnostic devices, enabling health care providers to conduct examinations remotely. Equipped with the latest technology, the solution allows for real-time video and audio, as well as clinical and lab data streaming, optimized for both cellular and Wi-Fi networks. Its connectivity capabilities help facilitate continuous patient monitoring and enable access to essential medical data, enhancing the quality of care delivered.

Exclusively distributed by Henry Schein Medical, Medpac is suitable for a range of applications, including ambulatory surgery centers, emergency medical services, expansion of off-site point of care, health professional storage areas, house calls, military, schools and worksites.

“We are excited to join forces with Medpod Inc. to introduce Medpac, which will further our efforts to help health care providers deliver exceptional care to patients in any setting,” said Todd Stack, general manager of medical solutions at Henry Schein. “Medpac features Medpod’s pioneering telediagnostics and supports our commitment to providing innovative health care solutions. Together, we are helping to transform the way care is delivered – enhancing patient outcomes and extending the reach of health care professionals.”

Within Medpac, health care providers will find a selection of medical instruments along with an exam camera, a tablet available in a 12- or 17-inch screen, hot-swappable batteries and a headphone jack for stethoscope monitoring.

“Medpod Inc. is proud to introduce Medpac, a gamechanging and even more portable version of our MobileDoc solution,” said Jack Tawil, chairman and CEO at Medpod Inc. “Medpod’s goal has always been to mobilize health care delivery. Engineered with years of both provider and patient feedback, and following an intense design process, our engineers have managed to pack significant diagnostic capabilities into a backpack that only a few short years ago required a utility truck to transport.”

Olympus Launches Newest Systems Integration Solution

Olympus Corporation has announced U.S. market availability of EASYSUITE ES-IP system, its newest procedure room visualization and integration solution. The EASYSUITE ES-IP system is Olympus’ newest procedure room visualization and integration solution.

The next generation of EASYSUITE, the ES-IP system is a modular, scalable, workflow-based solution. At its core is the new Olympus digital hub, which offers flexibility to run current software applications and potential future Olympus multi-specialty applications (apps).

“We are excited to bring the power of the Olympus Digital Hub and our digital strategy to the core of our flagship EASYSUITE System,” said Shawn LaRocco, vice president, global head customer solutions business unit. “The launch of EASYSUITE ES-IP system represents Olympus’ commitment to delivering intelligent integrated solutions designed to improve patient care pathways and clinical operations. With an increasing reliance on IT, it’s essential that clinicians and nurses have the right data at the right time, allowing them to focus on patient care.”

This platform supports hardware expansion and is built to support software modules added over time, offering an AVoIP solution for the digital OR and catheterization lab.

Benefits of ES-IP include:

• digital hub to power current, potential future

Olympus and third-party apps;

• scalable and small footprint hardware to support growing customer needs;

• vendor neutral and designed to integrate past, present, and future devices;

• seamlessly integrate images and videos with the VaultStream server to many major EHR vendors, MIMPS/PACS and VNAs;

• flexible for multiple specialties and various types of medical procedures to help improve operational efficiencies;

• 4K video routing with IP-based fiber optic video switching;

• interoperability between medical devices enables clinicians to display and capture various visual sources such as live endoscope and vitals;

• a smaller footprint than EASYSUITE ES4K system, requiring less space in the procedure room; and

• IT security.

The launch of the EASYSUITE ES-IP OR integration system is part of Olympus’ larger digital strategy that includes the acquisition of Odin Vision, a cloud-AI endoscopy startup, and subsequent plans to establish a series of digital excellence centers.

ECRI Announces Award Winners

ECRI, the nation’s largest independent patient safety organization, has announced the winners of its 2023 Healthcare Supply Chain Excellence Award. ECRI’s annual award recognizes U.S. health care organizations for achieving excellence in overall spend management and adopting best practice solutions into their supply chain processes.

“We’re proud to award 12 health care systems with our prestigious award this year. These top-performing organizations have successfully navigated ongoing disruptions in the global supply chain market using ECRI’s data-driven, evidence-based services,” says Marcus Schabacker, MD, Ph.D., president and chief executive officer, ECRI. “We are honored to partner with them in delivering high-quality, cost-effective patient care.”

The winners of ECRI’s 2023 Healthcare Supply Chain Excellence Award are (listed in alphabetical order): Adventist Health System/West, Roseville, CA; Broward Health, Fort Lauderdale, FL; Children’s Health, Irving, Texas; Hawai’i Pacific Health, Honolulu, HI; Jackson Health System, Miami, FL; MaineHealth, Portland, ME; MultiCare Health System, Tacoma, WA; Northeast Georgia Health System, Gainesville, GA; Northwell Health, New Hyde Park, NY; RWJBarnabas Health, West

Orange, NJ; University of Miami Health System, Miami, FL; and Wellstar Health System, Marietta, GA.

The Healthcare Supply Chain Excellence Award recognizes members of ECRI’s portfolio of supply chain services who demonstrate exemplary utilization of services across the procurement life cycle, including budgeting, benchmarking, technology assessment and strategic development. As part of the selection process, ECRI evaluated candidates’ 2022 spend management and market analytics efforts for capital medical devices, supplies, physician preference items, service contracts and reagents.

More than 3,000 U.S. hospitals and health systems are members of ECRI’s strategic sourcing and supply chain programs. ECRI has analyzed nearly $60 billion in supply and capital spend over the past year.

“This year’s winners have faced post-COVID supply chain challenges, but their adherence to using data analytics, best practices, and leadership engagement has enabled them to overcome obstacles and make strategic, evidence-based decisions without sacrificing quality or patient care,” says Tim Browne, vice president, supply chain solutions, ECRI. “We are proud to partner with them and contribute to their success.”

Fire Prevention and Response in Surgery

By Richard Parker, MBA, CHFM, CLSS-HC, FASHE, FACHE

H

ow well does your organization prepare for a surgical fire in or on a patient? The oxygen rich environment, flammable preps, combustibles, and sources of ignition all represent specific risks in an operating room that contribute to the potential for a fire.

Processes in the OR are unique and warrant a specific plan to address them and the risk they create.

CMS references the National Fire Protection Association’s (NFPA) Health Care Facility Code (HCFC), NFPA 99: 2012 edition. Chapter 15 of the HCFC titled Features of Fire Protection, includes a section focused on this issue:

15.13 Fire Loss Prevention in Operating Rooms

• Hazard Assessment

• Fire Prevention Procedures

• Germicides and Antiseptics

• Emergency Procedures

• Orientation and Training

ACHC recommends periodically reviewing each of the elements in this resource with the goal of developing an effective surgical fire response plan. This will keep your process top of mind, current and relevant to patient and staff safety should this type of fire occur. As always when planning for an emergency, best practice dictates starting with a risk assessment.

Evaluate the hazards

Your risk assessment must include hazards such as electricity, the operation of surgical equipment, and other conditions associated with the nature of the surgical environment, for example the presence of accelerants and flammable materials and the unique consideration that the fire may be in or on the patient.

Another element to consider when performing the risk assessment is a review of the different types of fire extinguishers. Your risk assessment will have identified the hazards present or anticipated in the environment. When you consider that the fire may be in or on a patient, that is a factor that adds a different consideration as this would directly impact the selection of a fire extinguisher. An ABC extinguisher uses a dry chemical to extinguish a fire but using this on a patient will cause other troubling issues impacting their health. Many organizations will install either a water mist or carbon dioxide (CO2) extinguisher in the procedure room, and an ABC extinguisher accessible in the space outside the procedure rooms.

Recognition that hazards change because of new equipment technology, changes in personnel and different processes demand that the risk assessment is periodically reviewed to identify those changes.

Consider changing conditions

The HCFC section on Fire Loss Prevention in Operating Rooms is the most detailed in the chapter. The requirements related to germicides and antiseptics are explicit, in part, because these materials are a clear contributor to surgical fires and those in use may change over time. Liquid antiseptics or germicides would be identified in your risk assessment. And don’t forget to address alcohol-based hand sanitizers (including those dispensed as aerosols).

Procedures are expected to prevent pooling of flammable liquids and to remove solution-soaked materials from the OR prior to draping.

This section also includes a description of the “time out” process to verify that:

• The application site for germicides and antiseptics is dry prior to draping.

• Pooling has not occurred or has been remedied.

• All solution-soaked materials have been removed from the OR prior to draping or the use of electrosurgery, laser or cautery.

The risk assessment should consider the relationship among these solutions, other combustibles such as drapes, and the ignition sources such as the use of electrosurgery or lasers.

Build your emergency procedure

Your fire response plan for an operating room fire must include:

• Alarm activation.

• Equipment shutdown procedures.

• Provisions for control of emergencies that could occur.

The emergency procedures specific to surgery must also include controlling chemical spills and extinguishing equipment, clothing or drapery fires.

Are you conducting meaningful and relevant training and drills?

The fire response plan and procedures should be documented in writing, then observed and evaluated periodically. This activity begins with orientation and training for all relevant personnel.

New personnel are required to be taught general safety and specific safety procedures for the OR environment. Routine education for existing staff members should be planned and implemented.

Part of the training should include the proper use of the different fire extinguishers.

• Water mist is effective on Class A fires.

• CO2 is effective on Class B and Class C fires.

• Dry chemical (ABC Powder) is effective on Class A, Class B and Class C fires.

NFPA 99-2012 requires at least an annual fire exit drill.

This is separate from the general hospital drills and is based on the surgical fire response plan. Fire drills simulate emergency fire conditions and are a training tool to practice the assigned roles for each member of the OR team. The annual fire drill is not expected to be performed with an actual patient.

Post training, as drills are performed, take a critical approach to identify areas to improve. At minimum, your procedures must be reviewed annually and updated as indicated by changes in the environment or through analysis of drills. On a monthly basis, any actual incidents must be reviewed.

Surgical case fires represent high risk for patients. Using NFPA 99-2012 as a resource for building your plans helps to mitigate risks to your patients and staff with proactive safety in mind.

– Richard L. Parker is associate director, physical environment and life safety at Accreditation Commission for Health Care Inc. where he provides guidance to customers and surveyors in the ASC and hospital programs.

The Crisis in Rural Health Care & Implications for Perioperative Nurse Staffing

By James X. Stobinski

S arah Falcone, in a recent article, described a spate of recent mergers, partnerships and re-structuring of services at rural health care facilities. She explained that 14% of Americans live in rural communities and that 147 rural hospitals have eliminated services or closed in the period 2010-2019. News releases from sources such as Becker’s Healthcare Review inform us that these trends continue unabated into 2023 in the financial reality of postpandemic American health care where labor and supply expenses are rising sharply.

There are many potential benefits to mergers and some rural facilities do successfully re-invent and re-position themselves (Gooch, 2023). But, with these mergers and realignments there is one undeniable fact. It remains difficult to recruit and retain staff in geographically isolated areas with low patient volumes. There is a paucity of research on which incentives are

effective in recruiting health care workers to rural settings (Russell et al, 2021). Many rural facilities are now faced with hard choices from years of decreased revenues and higher current costs which have strained limited financial reserves.

Let’s take a closer look at the connection between rural health care facilities and the makeup of the perioperative nursing workforce which is the subject of this column. Employers who provide the requisite perioperative orientation are the de facto gatekeepers to the profession. Data on the demographics of perioperative nursing are incomplete and no one group has assumed responsibility for gathering those statistics. Recent survey findings illustrate that the makeup of our specialty differs from the overall nursing workforce and the greater American population (Stobinski, Maio & Homme, 2022). Barriers to entry to the perioperative nursing specialty and difficulty in recruiting from all geographic regions contribute to the current demographics of perioperative nursing.

Rural facilities that are struggling

financially may not have the resources for perioperative orientation programs. Secondly, early career nurses working in other specialties such as med-surg nursing are often recruited for perioperative specialty training. Rural facilities, by nature of their size, have fewer candidates in this pool. Thus, there are fewer potential recruits for the perioperative specialty. Finally, we must consider that in rural areas there may be limited options in pre-licensure registered nurse education programs. Likely, there will only be one associate degree (AD) program in the region. Few AD programs offer an introduction to perioperative nursing.

The result for perioperative nursing is then clear. The loss of rural facilities ultimately leads to a less diverse pool of possible accessions to the specialty. A lack of exposure to rural health care and fewer nurses from rural areas will exacerbate the recruiting and retention burden. Cultural competency in caring for rural residents will also be lessened. The loss of employer sites which can facilitate entry to the perioperative nursing specialty will further decrease the opportunity for rural

nurses to become perioperative nurses. The closure and realignment of rural hospitals is one salient aspect of the ongoing consolidation and regionalization of American health care as smaller facilities are forced by a financial imperative to be acquired by a larger health care system. These systems may then be merged into larger systems which may span regions and multiple states. Few rural facilities can approach the range of services and the resources found in a regional collection of diverse health care facilities which include hospitals, ambulatory surgery sites and urgent care centers. The consolidation of American health care and the concomitant loss of con-

trol in smaller facilities will continue. It will take a commitment of resources, a level of innovation and perhaps some entrepreneurial spirit to address this issue relative to the perioperative nursing workforce.

References

Falcone, S. (June 21, 2023). How rural hospital acquisitions are impacting surgical care access. OR Manager. https://www.ormanager.com/how-ruralhospital-acquisitions-are-impactingsurgical-care-access/?oly_enc_ id=0139F0779901C0U

Gooch, K. (June 30, 2023). Texas hospital finds “new identity” as rural emergency hospital. https:// www.beckershospitalreview.com/

finance/texas-hospital-finds-newidentity-as-rural-emergency-hospital. html?utm_medium=email&utm_ content=newsletter

Russell, D., Mathew, S., Fitts, M. et al. Interventions for health workforce retention in rural and remote areas: a systematic review. Hum Resour Health 19, 103 (2021). https://doi.org/10.1186/ s12960-021-00643-7

Stobinski, JX, Maio, S and Homme, C (2022). Select demographics of nationwide sample of OR nurses. OR Manager. Accessed: April 15th, 2022, at: https://www.nxtbook.com/ accessintelligence/ORManager/ormanager-april-2022/index.php

How AORN’s Updated Design & Maintenance Guideline Affects SPDs

By Sue Klacik, BS, CRCST, CIS, CHL, ACE, FCS, Clinical Educator, HSPA

The Association of periOperative Registered Nurses’ (AORN’s) Guideline for Design and Maintenance of the Surgical Suite was updated and released in June 2023. The guideline addresses design layout and equipment used in these areas as well as recommendations for functionality, energy and cost efficiency, workflow and emergencies; physical security measures; considerations and safety measures for new construction or renovation; planning for unintended utility service interruptions; restoration to full functionality; maintenance of structural surfaces; and the design, monitoring, and maintenance of the heating, ventilation and air conditioning [HVAC] system for the perioperative area – and certain sections and additions directly affect sterile processing areas.

In recommendation 3 Designing the Surgical Suite, a new recommendation was added that reflects the ANSI/AAMI ST79:2017 Comprehensive guide to steam sterilization and sterility assurance in health care facilities amendment for Environmental Services/fans/food and drink (regarding sprinkler systems). It is recommended to implement policies and procedures for cleaning, disinfecting, maintaining and repairing the sprinkler system.

Section 11 Sterile Processing Areas provides recommendations for SP design considerations. New recommendations for the design and equipment used in SP have been added, with security systems and oneway workflow now included in this section.

Additions to the section addressing

the decontamination area include:

• space to collect disposable items to be sent to a third-party reprocessor

• space and location for vertical soaking containers

• space for staging dirty case carts if used

• ergonomic work counters of nonporous materials

• source of critical water for final rinsing

• record-keeping area

• instrument air outlet or portable compressed air for drying instruments

• automated testing equipment such as leak testers

• storage for decontamination supplies including medical device decontamination chemicals, cleaning verification supplies, environmental cleaning supplies, safety data sheets, manufacturers’ IFU, linen storage and trash disposal, and PPE

• space for processing patient care equipment

• space for receipt of loaned instrumentation

• space for potential future needs

Additions for SP’s clean side include:

• ergonomic work counters with space to accommodate the volume of equipment assembly (e.g., magnifying lights) for the procedures performed in the facility (e.g., cleaning nonporous material design) and the expected staffing levels

• space for instrument lubrication

• space for monitoring and recordkeeping supplies

• record-keeping area and accessories for computers if used

Note: The complete revised edition has been updated in the AORN eguidelines at

www.aorn.org/eguidelinesplus and will be in the 2024 print version (available for purchase on the AORN website at www.aorn.org).

AAMI Approves Two New Working Groups

The Association for the Advancement of Medical Instrumentation (AAMI) approved two new working groups to provide guidance for processing medical devices in health care facilities: AAMI ST-WG45 Processing of tattoo machines and accessories in health care settings and AAMI ST-WG61 Chemical Sterilants Hospital Practices.

Health care facilities use medical tattoos to treat a condition, communicate information or mark a body location. For example, tattoos are used as fiducial markers to aid in guiding radiotherapy. AAMI ST-WG45 will develop a new technical information report, AAMI TIR117/Ed.1 Guidance for processing tattoo machines and accessories in the health care setting. This document will provide health care personnel with information about pointof-use treatment, transportation, testing (where applicable), cleaning, disinfection, sterilization, packaging, and storage of tattoo machines and accessories used in health care settings.

AAMI ST-WG61 will develop TIR118/Ed.1 Guidance on ultraviolet (UV) disinfection for medical devices in health care facilities to provide recommendations about the use of ultraviolet (UV) disinfection for medical devices and patient care equipment in health care facilities. Specifically, the document will include comprehensive information for health care personnel regarding the processing of reusable devices and accessories to render them safe for patient use.

AAMI Publishes First National Standard on Water Quality for Medical Device Processing

A new standard that establishes the quality of water used to process reusable medical devices heralds “a huge shift for the health care industry,” in the words of Terra Kremer, a microbiological quality expert and co-chair of the AAMI working group that developed the standard.

The first standard of its kind, ANSI/ AAMI ST108:2023, Water for the processing of medical devices, “has garnered an extraordinary amount of interest within the sterile processing, water quality and regulatory communities and we are excited about its publication,” said Matt Williams, AAMI vice president of standards. Nearly 120 subject matter experts and alternates participated in the standard’s development under the auspices of the AAMI Sterilization Standards Committee.

“This document will provide much needed direction on the minimum requirements for water quality necessary to effectively process medical devices intended for patient use,” Williams added.

“Adoption of this standard will position health care organizations to have confidence that the water that they are using in each state of reusable medical device processing is achieving

the prescribed level of cleanliness and sterilization,” said Erin Kyle, editor in chief of Guidelines for Perioperative Practice at the Association of periOperative Registered Nurses and co-chair of the working group that developed the standard. “Health care organizations will be equipped with the information they need to monitor and control their water quality.”

ANSI/AAMI ST108 revises and replaces AAMI TIR:34:2014/(R)2021. Unlike the technical information report, the standard provides clear requirements for every stage of medical device processing. “TIR34 is not a requirement. Elevating its content to a standard will encourage most health care facilities to voluntarily conform with best practices for device processing water quality,” Kremer explained.

Complementing Joint Commission, CMS Requirements

The new standard can be used to avoid the consequences of using water that is of inadequate quality during the cleaning and sterilization of medical devices. Water impurities can have a wide range of adverse effects, the standard notes, such as:

• damage, biofilm buildup and increased microbial load or endotoxin content on medical devices.

• decreased effectiveness of cleaning agents and degradation of the water system or processing equipment.

• infection, toxicity and fever reactions in patients, which can contribute to adverse patient events and outcomes.

• environmental health and safety risks to personnel.

ST108 complements a 2022 water management standard from the Joint Commission and a 2017 requirement by the Centers for Medicare and Medicaid Services for health facilities to have a water management program and staff responsible for overseeing and implementing the program, with requirements for water quality production and a risk assessment.

ANSI/AAMI ST108 specifies the minimum requirements for the water quality and steam purity necessary to effectively process medical devices intended for use on a patient. The new standard:

1. identifies the categories of water quality that should be used during each stage of sterile processing.

2. provides a risk analysis and establishes roles and responsibilities for processing facilities.

3. quantifies water quality given pH, microbial levels, conductivity and

other properties.

4. establishes maintenance, monitoring and quality improvement procedures for water treatment systems.

5. addresses emergency circumstances such as service interruptions and boil water advisories.

“This standard directs the user to qualify the water system and maintain it, so the water quality remains in a state of control,” Kremer said. “For the first time, the points for where water is tested is specified and a cross-functional team is identified as directly responsible for water quality within a health care system.”

Coming to Consensus and Future Plans for Additional Guidance

Given the size and diversity of the team responsible for ANSI/ AAMI ST108, which includes experts from industry, healthcare delivery organizations, regulatory agencies and academia, coming to consensus took time. According to the co-chairs, the working group researched and discussed water quality parameters, values and supporting scientific information to reach meaningful consensus.

“AAMI Sterilization Working Group 95, Water Quality for Reprocessing Medical Devices, consisted of over 170 members that represented industry, regulatory/government, users and

general interest stakeholders,” noted Thomas Kim, director of standards, AAMI, who helped guide the group. “The consensus body brought together a diverse group of stakeholders across the sterilization, water management, medical device and equipment manufacturers, health care practitioners, testing laboratories and regulatory communities.”

“It is always difficult for a committee to align on specific acceptance criteria,” Kremer added. “We did this by utilizing data from the industry to set realistic water quality requirements, where patient safety was our top objective.”

ANSI/AAMI ST108’s novel requirements for water quality provide the foundation for improved patient outcomes and offer clear conformance criteria for organizations involved in processing reusable medical devices in health care facilities.

Following this standard’s publication, the AAMI working group is planning a technical information report to walk healthcare delivery organizations through each step of the water qualification process. This is the “logical next step” to promote adoption of the standard and support patient safety, Kremer said.

Stakeholders and subject matter experts interested in contributing to this work should contact standards@aami.org for more information.

INDUSTRY INSIGHTS Joint Comission

Ambulatory Equipment Maintenance and Safety

By Herman McKenzie

L

ooking back, the COVID-19 pandemic taught ambulatory surgery centers (ASCs), like all health care organizations, many valuable lessons. No lesson was as important as thoroughly understanding the importance of keeping up with timely maintenance of an ASC’s medical and utility equipment.

Proper inspection, testing and maintenance (ITM) of medical and utility equipment is crucial to provide the safest and most efficient patient care. With current advances in medical technology and an increasing emphasis on patient outcomes, maintaining these assets is paramount.

It is also wise to explore benefits, challenges and best practices associated with ASC equipment ITM. Following a regular equipment maintenance routine helps to use most effectively the vital elements of a health care organization’s physical environment. Let’s explore the benefits of keeping up with medical and utility equipment safety.

Benefits of Equipment Maintenance

Patient safety: The primary objective of regular equipment maintenance is to ensure the safety of ASC patients.

Whenever ASC equipment is used, patients, clinicians and other allied health care professionals must feel confident that its analysis, therapy and functionality adhere to the manufacturer guidelines to minimize risk of equipment malfunction. This is imperative to reduce the potential for adverse events and to ultimately enhance patient outcomes.

Equipment reliability: Completing timely maintenance procedures increases the reliability and longevity of medical and utility equipment. Timely and accurate maintenance reduces the likelihood of unexpected breakdowns or disruptions, ensuring that ASCs can operate smoothly and without delays, which ultimately leads to improved patient satisfaction.

Cost efficiency: Well-maintained equipment is more cost-effective in the long run. Routine inspections and proactive maintenance help identify potential issues early, preventing major breakdowns that could eventually require expensive repairs or replacements. Moreover, preventive maintenance extends the lifespan of equipment, delaying the need for costly capital investments.

Challenges in Equipment Maintenance

Technological complexity: Participating in continuous training and education

programs for both equipment users and maintenance staff is vital to keep up with technological advancements and industry best practices. Providing staff with opportunities to enhance their knowledge and skill set ensures they are equipped to manage the maintenance needs of advanced equipment and systems effectively.

Regulatory compliance: Compliance with regulatory standards and guidelines is essential within health care settings. ASCs must ensure that their equipment maintenance practices align with the requirements set forth by accrediting organizations such as The Joint Commission and the Occupational Safety and Health Administration (OSHA). This includes maintaining accurate records of inspections, repairs and equipment history.

Best Practices in Equipment Maintenance

Inspection, testing and maintenance

(ITM): Regularly scheduled preventive maintenance activities — such as calibration, performance testing and routine inspection — are essential to identify and address potential issues before they escalate. A proactive approach minimizes equipment downtime, prevents costly repairs and maximizes the lifespan of the resources. Maintaining comprehensive

and accurate records of equipment and all related ITM activities is crucial for thorough compliance and effective management.

Frequently, the responsibility for managing these systems within ASCs falls upon clinical staff who may not have in-depth technical or regulatory code knowledge to evaluate tasks that are outsourced to vendors to complete. Even when outsourced those managing vendors must make sure that records include such details as maintenance intervals, tasks performed, parts replaced and relevant notes and/or observations. (An example of an important note could be that the manufacturer has stopped providing replacement or repair parts.) This helps health care organizations plan for orderly replacement of an item(s) instead of reacting to a critical failure. Documentation also facilitates traceability, aids in troubleshooting, and supports future planning and decision making.

Conclusion

It is critical for ASCs to be prepared no matter what crisis may lie ahead. ITM of medical and utility equipment and systems within an ASC plays a vital role in ensuring patient safety, operational efficiency and cost-effective management. Proactive maintenance practices, supported by regularly training health care staff, help to prevent equipment failure, minimize downtime and extend the lifespan of assets.

By adhering to regulatory and accreditation guidelines and keeping meticulous records, ASCs can create a culture of excellence in ITM, thereby enhancing patient care and contributing to the overall success of the health care facility.

— Herman McKenzie is the director of engineering for the Standards Interpretation Group at The Joint Commission.

INDUSTRY INSIGHTS

Value of a Public Member on an Organization’s Board

By Sally Irvin & Lisa Rosenfield

The Public Member: Definitions & Descriptions

There are various definitions and descriptions of a public member on a board, but two of the most complete examples are from the Institute of Credentialing Excellence. The definition from their Certification Services Council’s Governing Charter indicates that “the Public Member’s role is to champion the public or consumer interest, bring forward new ideas and goals, contribute an unbiased perspective, encourage consumer-oriented positions, and bring additional public accountability and responsiveness.”1

The definition from their “What is a Public Member” section states that the public member is “a representative of the consumers of services provided by a credentialed population who serves as a voting member on the credentialing body with all rights and privileges, including holding office and serving on committees. The public member should bring a perspective to the decision and policymaking of the organization that is different from that of credentialed individuals and should help to balance the organization’s role in protecting the public while advancing the interests of the profession.”2

The Public Member: Perspectives & Contributions

Although the American Board for Specialty Nursing Certification (ABSNC) and the National Commission for Certifying Agencies (NCCA) accreditation standards require boards to have at

least one public member, accreditation requirements aren’t the only reason for public member inclusion on a board. Since boards are often comprised of individuals within a specific profession, a public member brings additional expertise to a board.

The public perspective outside of the profession is critical for promoting inclusiveness and equity. A public member may have external connections with many different types of people and organizations outside of the profession. A public member can champion public and consumer interest on the board. A public member with expertise in specific areas can also help to fill gaps in expertise among the existing board composition. Reflecting about what a public member might expect from the board can effectively incorporate the varied perspectives of a public member into the board’s decision making. Considering the public impact of the board’s actions can also help a board fully utilize the contributions of a public member. As part of an effort to make public member input a part of their business processes, a board can cultivate, develop, highlight, and sustain public member involvement by engaging in the following activities:

• create bylaws and policies which require a public member on every board committee

• incorporate a “Public Member Report” into each meeting agenda

• host an “Information for the Public” page on the website to keep consumers informed about the

work

of

the board

• post information about the value of the organization’s offerings to the consumer

• incorporate ways to keep the board responsive to the public

• adopt consumer-orientated positions, even if there is resistance within the profession.

The Public Member: The CCI Board of Directors

Since members of the public are both patients and consumers, a public member’s job on the CCI Board of Directors is to champion the publics’ interest. At the Competency & Credentialing Institute (CCI), patient safety is at the heart of the organization’s vision and mission. This commitment is reflected by the inclusion of each public member as a full and equal voting member of the CCI Board of Directors. The CCI Public Member is a non-RN member of the public who brings the consumer’s perspective to the board’s dialogue, deliberations and decision making.

CCI also believes that by meeting a defined set of requirements, a candidate will be able to clearly demonstrate the desired competencies for CCI leaders. Therefore, to be considered for a Public Member position on the CCI Board of Directors, candidates must hold, at minimum, a bachelor’s degree and possess previous experience in senior level business, community or professional leadership role(s). Additionally, in the interest of creating and maintaining a well-balanced board, candidates may be

considered if they have experience in one or more of the following areas:

• experience as national professional committee chair

• experience leading work groups and teams

• membership in community project committee

• governance experience (paid or volunteer) on a private, public or community board

• experience with budgets, business investments or financial planning and statements

• business or entrepreneurial experience, or a background with new business ventures

• experience with health care media, public relations or marketing.

CCI’s Public Members serve an initial three-year term, with an option to renew their board service for an additional three-year term. They are members of a variety of board committees and their committee assignments typically change yearly. They are also required to sign a public member declaration form, along with a conflict of interest form and non-disclosure agreement.

The Public Member: An Essential Viewpoint

Since the public member adds a wealth of value to a board, the board and public member relationship should reflect reciprocity. The board needs the perspective of the public member to identify what the public understands and expects from the profession. And the public member needs the board to provide a platform for input and perspectives.

As the board seeks to advance a profession, it must also seek to balance the perspectives of both the board and the public member. This is particularly important when the product offered by the organization can offer a solution to public issues and concerns.

- Sally Irvin, MA, M.ED, serves as a Public Member of the Board of CCI, the Competency & Credentialing Institute. She is currently Associate Director of Faculty Services for the Wake Forest Law School Law Library and is a Professor of Legal Research.

- Lisa Rosenfield, MA, works in the area of Special Projects and Partnerships at the Competency and Credentialing In stitute. Her scope of work includes designing, implementing, and managing organizational-wide initiatives and signature programs. She also develops, cultivates, and maintains exter nal partnerships. She holds a BS in Human Development and an MA in Educational Administration, Supervision, and Curriculum.

1 https://www.credentialingexcellence.org/Portals/0/Docs/I_C_E_%20Cer tification%20Services%20Council%20Charter_8_25_21.pdf?ver=0oBeXE3 svooi4t0GYY6GKg%3D%3D

2 https://www.credentialingexcellence.org/Membership/Public-Members

Sources https://absnc.org/

https://www.credentialingexcellence.org/About

https://www.cc-institute.org/

Disposable Medical Supplies Market Rising

Staff report

A global disposable medical supplies market report by ResearchAndMarkets.com covers the market from 2022 to 2030.

The global disposable medical supplies market will reach $429.1 billion by 2030, growing by 5.8% annually over 2022-2030. The market is driven by the growing incidence of disease and disorders coupled with aging population, rising incidence of hospital acquired infections (HAIs), impact of COVID-19 outbreak, the growing preference towards the low-cost disposable medical supplies for reducing contamination and HAIs, along with favorable regulations set forth by governments, according to the report.

Grand View Research also issued a report predicting continued growth of this market.

The global medical disposables market size was valued at $318.3 billion in 2020 and is expected to expand at a compound annual growth rate (CAGR) of 16.7% from 2021 to 2028, Grand View Research reports. The growth of the market is attributable to the increasing number of surgical procedures, rising

incidence of hospital acquired infections (HAIs), growing prevalence of chronic diseases leading to longer hospital admission and the impact of COVID-19 outbreaks across the globe.

“The COVID-19 outbreak and increasing hospital admissions across the globe have significantly increased the demand for medical disposables,” according to Grand View research. “The WHO has appealed to industries and governments to increase the manufacturing of personal protective equipment, including hospital gowns, gloves, medical masks, face shields, aprons, respirators and goggles, by 40% to meet the increasing global demand. It also reported that the increase in demand for these accessories has increased their prices to a major extent. For instance, the price of surgical masks has increased six-fold and the price of hospital gowns has increased two-fold. Furthermore, the WHO has shipped around half a million sets of personal protective equipment to around 47 countries. Therefore, the outbreak of COVID-19 has immensely impacted the market and is a highly effective driver for this market.”

Grand View Research also looks at product insights.

“The sterilization supplies segment dominated the market for medical disposables and held the largest revenue share of over 13.0% in 2020. Based on product, the market is segmented into wound management products, drug delivery products, diagnostic and laboratory disposables, dialysis disposables, incontinence products, respiratory supplies, sterilization supplies, nonwoven disposables, disposable masks, disposable eye gear, disposable gloves, hand sanitizers and others,” Grand View Research said.

Mordor Intelligence also predicts growth in the market.

“The disposable medical supplies market is projected to register a CAGR of 9.4% during the forecast period (2022-2027),” Mordor Intelligence reports. “The COVID-19 outbreak significantly impacted the disposable medical supplies market by the sudden increase in the demand for disposable products, such as gowns, masks, antiseptics and disinfectant products. The increase in COVID-19-affected patients led to an increase in hospital admissions across the world, due to which the demand for disposable medical supplies has increased significantly.”

Flagship Surgical Safe Cord Floor Strip

Safe Cord is a durable, disposable safety strip designed to cover cables and cords on operating room floors, thereby reducing the risk of tripping hazards and staff injuries. The adhesive strips on the underside secure the Safe Cord to the floor, with no residue left behind. It is bright yellow for added staff safety and it can be safely walked on or rolled over by equipment without compromising function. It also features simple set-up, removal and disposal.

Isikel Manufacturing Frost Powder-Free Nitrile Exam Gloves

This year, Isikel Manufacturing will begin production of a high quality 100% nitrile non-disposable exam glove for use in the health care sector. Isikel MFG is set to produce hundreds of millions of gloves annually per manufacturing line. The Houstonbased startup is finalizing all FDA 510k submissions for approval to sell to health care partners. The “Frost” gloves are aqua in color, have passed all chemotherapy and fentanyl permeation resistant testing with superior test results compared to ASTM/ISO standards. Isikel MFG will join only a very few domestic nitrile glove manufacturing companies supporting health care resiliency for U.S. health care providers

Cincinnati Surgical Swann Morton Surgical Blades

Swann Morton is the recognized global leader in surgical blade manufacturing, making more than 350 million blades a year. The high-quality British blades are manufactured to ISO 13485 standards with an open edge grinding technology for a better tactile feel. All of the blades go through 200 percent visual inspection, meaning there are no defects in the finished product. Swann Morton surgical blades perform consistently each use and are available in a range of sizes from Cincinnati Surgical or your preferred distributor.

NewGen Surgical Plastic-Free Procedure Kit Packaging Trays

Found in every custom procedure kit, NewGen Surgical Procedure Kit Packaging Trays reduce plastic and allow for industry-sized impact with simple product material substitution. Made entirely with 100% upcycled fiber pulp, known as bagasse (the byproduct of sugarcane production), the NewGen Surgical Procedure Kit Packaging Trays reduce single-use plastic from the health care supply chain by 100% and reduce CO2e by up to 55% in comparison to its plastic counterparts. In one month alone, hospitals and health care systems eliminated nearly 6 tons of single-use plastic with this simple product substitution. NewGen Surgical offers these trays in four sizes, made to fit a variety of procedure kits to cater to each custom kit’s needs. Available in your custom procedure packs through Medline, Cardinal Health and Owens and Minor.

Encompass Group LLC Disposable Medical Supplies

Encompass Group LLC offers a wide variety of single-use apparel for patients, pediatrics, and staff, along with single-use bedding, patient care, personal protective equipment (PPE) and bedside accessories. Every item is developed with high-quality performing materials, and fabrics. Disposable patient apparel features generously sized garments, which help reduce the incidence of cross-contamination, and are available in blue and green nonwoven materials. Encompass Group LLC also offers disposable washcloths, cleaners and bedding in multiple fabrics, colors and styles. All pediatric apparel, safety footwear and bedding items meet the required standards and specifications and are available in a variety of sizes, colors and prints in SBPP or SMS fabrics.

For more information, visit encompassgroup.com

CIVCO Medical Solutions

Disposable TEE Probe Transport Tray

CIVCO’s Disposable TEE Probe Transport Tray offers safe and efficient transportation for delicate transesophageal probes. Made from recyclable materials that are fully disposable, the TEE Transport Tray eliminates the time and resources needed to clean a reusable tray, and the reversable push tab-locked lid is designed to easily convey clean/dirty status. Compliant with national transport standards, the TEE-specific design prevents cross-contamination by separating the high-level disinfected transducer shaft from the low-level disinfected handle, cord and connector and meets probe manufacturer coiling requirements.

For more information, visit civco.com.

Corporate Profile

Healthmark Brings It Home: Reshoring and Reinvigorating Supply

F or over 50 years

Healthmark Industries has provided innovative intelligent solutions to meet the needs of health care facilities. The year 2023 has been a year of growth, offering new products and providing new educational services.

Healthmark announced earlier this year that they have made significant changes to their supply chain efficiency to improve the supply of products to industry partners and increase the manufacturing of major products internally.

The past three years have

proved to be a major challenge to the supply chain of health care products. All industries have experienced supply chain challenges in our personal as well as professional lives.

To rise to the challenge of insecure supply and to dramatically improve the ability of Healthmark to supply critical products to their customers, they undertook a major project to develop new channels of supply, including manufacturing many of these products internally!

As they developed these new and alternative sources of supply, their number one goal has been

to provide products that meet or exceed the specifications of the existing products. The functionality, the intended use, the specifications, and the performance are equivalent to the existing products. So, rest assured these products will meet (or perhaps even exceed) your expectations based upon your prior experience with these Healthmark products.

By bringing production in house. By bringing it closer to home. By developing alternative sources of supply, Healthmark will be an even more reliable supplier of these critical products for your

medical device reprocessing needs.

These product categories include:

• Tray liners

• Tip protectors

• Tray corners

• Cable ties

• Tags and labels

• Bundling, packaging, stringing

• Tray covers

• Wash sleeves

• Protective packaging

• Other related products

Cleaning verification is always a critical issue in health care across the country. News headlines often report about complications from

surgeries caused by instruments and equipment that have not been properly cleaned. It has affected the health care field over the years.

Healthmark’s ProFormance TM monitoring tools to help ensure surgical instruments and other equipment are reprocessed correctly. AAMI 1 and AORN 2 recommend at least weekly testing (preferably daily) of the cleaning process. These products are designed to help facilities comply with standards and ensure they are reprocessing equipment and cleaning surgical instruments effectively.

Researchers have discovered that devices that haven’t been reprocessed correctly can emerge from the cleaning process with bits of bone, blood and tissue from the previous procedure. These contaminants can be reservoirs for some potentially lethal bacteria. Proper cleaning and sterilization are essential for ensuring that medical and surgical devices do not transmit infectious pathogens to patients.

According to the Centers for Disease Control and Prevention (CDC), multiple studies in many countries have

Corporate profile healthmark

documented lack of compliance with established guidelines for cleaning, disinfection and sterilization 3 . Failure to comply with scientifically based guidelines has led to numerous outbreaks.

Healthmark continues to create educational opportunities for health care professionals to earn CEUs. Health care professionals can register directly on the website at https://www.hmark. com/education/

In addition to the webinars offered, Healthmark also provides a unique free service at Crazy4Clean.com. It’s a website that consists of educational games designed to teach health care professionals about proper reprocessing of instruments/ equipment while earning free CEUs. At the end of each game, players receive a free CEU by completing a quiz based on what they’ve learned.

StyleYourPPE.com is a site

created by Healthmark where health care professionals can purchase PPE and other attire for individual use. Face masks, Cool Aids and other PPE attire are available as well as socks that are creatively designed to add a little fun to a serious dress code. If you are looking for industry news, helpful hints and other

information, Healthmark produces a weekly newsletter that is distributed to thousands of readers. Each Healthmarket Digest features a story written by a member of the Healthmark team as well as a weekly feature. You can sign up for the Healthmarket Digest weekly newsletter at Healthmarketdigest.com.

For more information about Healthmark Industries, visit www.hmark.com or call 800-521-6224

1 AAMI (ST79 Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities)

2 AORN Recommended Practices for Cleaning and Care of Surgical Instruments and Powered Equipment

3 https://www.cdc.gov/ infectioncontrol/pdf/guidelines/ environmental-guidelines-P.pdf

By developing alternative sources of supply, Healthmark will be an even more reliable supplier of these critical products for your medical device reprocessing needs.

SAFELY RETRIEVE REUSABLE SHARPS WITH AN SST SYSTEM

A simple & effective way to protect personnel, patients and the environment from contaminated sharps

Cover biohazard symbols on SST Tray Systems with a 4”x 4” Removable Clean Label

2 in 1 removable label for effective communication

PATIENT SAFETY TRIFECTA

By Don Sadler

Safe patient care hinges on solid and productive interdisciplinary relationships between the different departments involved in delivering care. When it comes to safe instrument processing, the operating room, sterile processing department and infection prevention department form a “patient safety trifecta” that must work together to ensure that patient safety remains the top priority.

“These are unique departments that are dependent on one another to ensure that patients receive safe and efficient care,” says Executive Leadership and Management Consultant Ruth Plotkin Shumaker, RN, BSN, CNOR. “No single department can stand alone and function well independently. Instead, they each play a critical role in sustaining a positive culture of patient safety.”

Forming a patient safety trifecta also helps standardize processes between departments. “This lowers the chance for errors, helps eliminate waste and creates optimal workflow, which leads to less fatigue and greater staff satisfaction,” says Karen deKay, MSN, RN, CNOR, CIC, senior perioperative practice specialist with the Association of periOperative Registered Nurses (AORN).

Collaboration is Key

When surveyed, perioperative leaders have identified multiple concerns that have a correlation with the operating room and the sterile processing department. Among them, says Shumaker, are communication, collaboration, cancellation rates, start times and lack of equipment.

Collaboration between departments is especially critical, says Shumaker: “This leads to better problem solving, peer learning, shared purpose and innovative ideas. Department leaders should schedule frequent joint meetings where staff can discuss issues, concerns and successes. The more everyone works together, the easier it is to form good relationships.”

Shumaker believes that many perioperative leaders don’t understand the complexity of sterile processing. “Some are fearful of what they don’t know,” she says. “Leaders should strive for a working knowledge of the areas they lead and be well informed

on the latest work processes in sterile processing, as well as AAMI and AORN standards.”

Early in her career, Shumaker had an opportunity to rotate in SPD and later as a clinical nurse specialist working with ORs and SPDs across the country. “This increased and reinforced my awareness of the importance of collaboration between the OR and SPD,” she says. “However, it also showed a great divide between the two areas.”

“Unfortunately, these departments have a history where a lack of communication and understanding is prevalent,” says Shumaker. “Disrespectful behavior has flourished between the OR and SPD for years, often rationalized because of the high demands and stressful work environments. If leaders are involved in this behavior, it intensifies the divide.”

Instead, perioperative leaders should intervene early and let staff know there will be consequences to creating a hostile work environment. “There’s a clear link between adverse patient outcomes and disrespectful behavior between departments,” says Shumaker.

Another problem at many health care facilities is that the sterile processing department is physically isolated from the operating room. According to Shumaker, this physical separation can create communication problems and inhibit understanding of the critical role each department plays in patient safety.

Marjorie Wall, EDBA ABD, CRCST, CIS, CHL, CSSBB, associate director, sterile processing for the Healthcare Sterile Processing Association and the HSPA’s immediate past president, believes that open communication is critical for creating a collaborative interdisciplinary team.

“This may seem simple, but it’s often the foundation of a successful and productive team dynamic,” says Wall. “Increasing team interactions through activities like huddles and exchange programs is an excellent way to foster a culture of openness and safety. It provides team members with the opportunity to learn from one another, share experiences and gain a deeper understanding of each other’s challenges and perspectives.”

Shadowing programs whereby team members spend time in each other’s environments can be especially valuable.

“Walking a day in each other’s shoes can help break down barriers and encourage empathy and mutual respect,” says Wall. “This allows individuals to witness firsthand the complexities and nuances of different roles, which leads to a greater appreciation for the work each team member contributes to the overall process.”

Wall suggests that SPD team

members reach out to infection control

to see if they would be willing to do an audit of the SPD.

“These often turn educational for both SPD and infection control and can be an excellent way to start building the relationship,” she says.

Spend Time Together

As the manager of the infection prevention department at Emory University Hospital Midtown in Atlanta, Ga., Jill Holdsworth, MS, CIC, FAPIC, NREMT, CRCST, says that infection prevention team members must spend time in the sterile processing department if they want to build a better relationship with them.

“Our IP team members routinely spend time in the sterile processing department to learn from the technicians,” says Holdsworth. “Then, they come back and present an education session to the rest of the IP department. This allows the IP team to partner with SPD, as well as for SPD technicians to feel some ownership

with what they do and their expertise.”

At Emory University Hospital Midtown, an interdisciplinary team looks at all initiatives for SSI prevention.

“Team members from the OR, SPD and IP who are key stakeholders are all present at this meeting,” says Holdsworth. “It’s imperative to have all these representatives together as part of a group that reviews SSIs because we all play an important role in this process.”

The team starts with a risk assessment, or gap analysis, for projects in SPD or the OR.

“We invite all parties to the table who may be involved,” says Holdsworth. “Starting with a risk assessment and working through action items together is a great way to work together, collaborate and track progress to present to senior leaders in an organized way.”

Holdsworth recommends that sterile processing department team members invite infection prevention team members to spend time in the SPD. “Sometimes it just takes an invitation to start a great relationship,” she says. “You could also ask them if they’d be willing to help teach some sessions on microbiology or infection prevention for certification preparation.”

Infection prevention team members, meanwhile, should work their way through the sterilization process alongside a technician, starting with decontamination.

“It’s also helpful for IP team members to follow an instrument set from the OR suite setup through sterilization,” says Holdsworth. “IP staff can learn a great deal from this, especially if the IFU can be pulled ahead of time.”

Shumaker suggests developing a rotation that facilitates OR and SPD staff spending time in each other’s areas. “I recommend that this be done

monthly and be a part of every new employee’s orientation,” she says. “Also, joint staff meetings should be scheduled frequently to allow the departments to meet face to face and share ideas.”

“As infection preventionists, we have to learn the best ways to communicate and engage with various departments and team members,” says Holdsworth. “I have learned that email is usually not the best method to communicate with surgical areas and sterile processing because they are usually in the procedure room or department doing the work.

“Fliers and posters are sometimes effective, but they can easily get overlooked,” says Holdsworth. “Remember that one size doesn’t fit all when communicating with any particular department, so you have to figure out what works best in each situation.”

Addressing the Human Relationship Aspects

Damien Berg, BA, BS, CRCST, AAMIF, vice president of strategic initiatives for HSPA and a past president, believes that to create a more effective interdisciplinary team, one must dive deeply into the human relationship aspects of work and communication.

“Often, we miss the opportunity to create a more collaborative team relationship due to looking from one’s own point of view and what’s in it for one’s own department or career,” says Berg. “When we only look at ourselves and what we do, we will falter.”

“Instead, we must foster a proper understanding of what others do and how we can assist them,” says Berg. “Focusing on others often builds a better team and starts the collaborative approach.”

At AnMed in Anderson, South Carolina, there’s a daily huddle between the SPD supervisor and the OR charge nurse to go over the next

day’s needs. “This helps make sure that everyone is working toward the same goals for the next day,” says Erin Keeney, MSN, RN, CNOR, AnMed’s director of perioperative services.

“OR staff helps out in SPD when there’s downtime while SPD staff comes and shadows in the OR,” says Keeney. “The assistant vice president of perioperative services and I have monthly town halls with the OR and SPD staff. We make rounds on the staff routinely and ensure we are managing up other areas.”

Holdsworth says that when performing rounds and education, frontline workers typically provide insight and answers you won’t usually get from leadership.

“However, to get to the point where frontline team members will trust you and talk to you, you have to spend time in the department, show interest, ask questions and become part of the team,” Holdsworth says.

Independent Healthcare Consultant Deborah L. Mack, RN, BSN, CAIP, CASC, CNOR, also recommends that the OR charge nurse meet daily with the SPD lead to make sure all the required instruments and equipment are ready for the next day’s cases.

“It’s critical to review the next day’s schedule to promote operational efficiencies,” says Mack. “If you have to borrow instrument sets and implants, make sure they arrive the day before surgery so they can be properly sterilized.”

“If the infection preventionist doesn’t have an OR background, he or she should spend time in the sterile processing department to become familiar with all the steps required to properly disinfect, clean and sterilize various instruments and equipment,” Mack adds.

Berg recommends that sterile processing department team members “go where the work is done and not be a mysterious department without

a face, name or personality. SPD leaders or designated liaisons to the OR should visit the OR daily and check on the instruments before the case starts to show they are invested in the case’s success.”

DeKay agrees. “Infection prevention team members should make themselves visible in other departments and ask about their concerns and issues,” she says. “If the facility is having issues with SSIs, form an SSI prevention task force and make sure SPD team members are included.”

The Bugbusters Team

In one facility where she worked, Wall was part of a Six Sigma team called the Bugbusters that included members from infection control, sterile processing, perioperative and a physician. “The team’s goal was to shorten OR turnaround time and reduce SPD errors,” says Berg.

“We had several team meetings with representatives from all the departments to process map, root cause and conduct joint training sessions to promote learning and development,” says Wall. “Through this process, we were able to make a significant clinical impact and build a highfunctioning and collaborative multidisciplinary team.”

DeKay suggests initiating a sterile processing department quality assurance project. “Collaborate with the quality department to develop a plan,” she says. “This may include a Lean Six Sigma Black Belt and robust process improvement methodology.”

“To improve processes or SSI rates, IP leaders could partner with their quality department that can help develop a project improvement plan and obtain buy-in from the OR and SPD,” deKay adds.

Get Everyone on the Same Page

Shumaker sums up the importance of collaboration between the OR, SPD and IP departments this way.

“Without everyone on the same page and working toward a common goal, things will fall apart quickly,” Shumaker says. “The settings are different but the message is the same: Working together rather than in silos creates a positive, inclusive work culture that promotes teamwork, collaboration and respect.”

Keeney acknowledges that some of these steps aren’t always easy for OR, SPD and IP team members.

“You have to step outside of your comfort zone,” she says. “Each department plays a critical role in providing excellent care for patients. Without each other, no department would work well.”

John

W.

Cromwell, MD

Associate Chief Medical Officer and Director of Surgical Quality & Safety University of Iowa Hospitals and Clinics

By Matt Skoufalos

J ohn W. Cromwell’s interest in the technical side of health care was encouraged at a young age. As a high-schooler growing up in Norfolk, Nebraska, he landed a job developing X-rays in a community hospital in the year before he left for college. The work afforded him the opportunity to develop relationships with surgeons there who fostered his enthusiasm for the work through their mentorship, setting him on a path to pursue his own career as a physician.

“I was so interested in what they were doing, and enthusiastic, and they took me under their wing and showed me around,” Cromwell said.

“If you have a good experience with a group of people who are like-minded and enthusiastic and supportive, you gravitate towards those things. I’ve had those a few times in my career and those experiences help.”

Cromwell had a comparable experience in medical school, in which a small and supportive professional community – namely, colorectal surgeons – invited him into their fold while he was working through his residency. Three of the eight years of his surgical education were required to be researchbased, and the invitation to scrub up with the colorectal surgery group led Cromwell to discover that he enjoyed performing the procedures as much as he appreciated the camaraderie.

“No one usually goes

into medical school wanting to be a colorectal surgeon,” Cromwell said. “Surgeons all have slightly different personalities, and I think the colorectal surgery community in general is a smaller subspecialty, which is pretty close-knit. They invited me to join them, and I learned that I liked the technical skills that were required for pelvic surgery.”

The University of Texas Medical Center, where Cromwell completed his residency, was a high-volume environment in which surgeons learned to perform to the best of their abilities through repetition. In the course of a single year, Cromwell estimated that he performed some 1,200 surgeries, honing his technique and approach to patients of all body types.

“That was really the finishing school to learn how to repeat these cases enough that you could learn it really well,” he said.

From Texas, Cromwell then joined the Moffitt Cancer Center at the University of South Florida campus in Tampa, where he spent four years in an academic colorectal surgery program. Cromwell was subsequently recruited by the University of Tennessee to establish a colorectal program at its Memphis campus; he worked there for nearly three years until the family relocated to the Midwest after the birth of their daughter.

Through 13 years at the University of Iowa Hospitals and Clinics, Cromwell has risen to the position of associate chief medical officer (ACMO) and director of surgical quality and safety. Most of his day-to-day work is spent addressing issues of surgical quality and safety, the better to improve the quality of outcomes and case volume in the surgical environment – especially in a post-COVID-19 (novel coronavirus) climate where health care resources are stretched in many ways.

“Prior to the pandemic, there’s been lots of staffing challenges for hospitals, including closures of critical-access hospitals across the

country,” Cromwell said, “and that’s changed how academic medical centers have functioned.

“People are living longer, but they’re not necessarily living healthier lives,” he said. “A lot of our patients are sicker, which changes your safety approach, and changes decision-making. We’re trying to be more data-driven about how we treat our patients, and develop optimization for that.”

For the last several years, Cromwell has worked to establish an interdisciplinary structure that integrates the perspectives of teams involved with surgical safety and operations, the better to improve patient outcomes. Much of its work involves analyzing safety events that happen in surgical spaces, and trying to be proactive about preventing them in the future. It’s common for the group to revisit basic routines, review responsibilities and establish pipelines for addressing concerns, all in the service of team-building.

“We have people from all parts of the country – trainees, new nurses, new faculty – and we’re constantly trying to align people on their responsibilities, and what we’re trying to achieve on a daily basis,” Cromwell said. “Our goal is to keep our team members around, and engaged, and focused on creating the best outcomes for our patients. When you create friction because you have inexperienced team members who don’t work together and aren’t aligned on who’s doing what, that’s a problem.”

To that end, Cromwell said his facility has begun working with a surgical data platform developer called Caresyntax, which leverages data collected in the operating room to inform strategies and benchmarking used in staff training and professional development.

“Now we’re able to improve onboarding by creating this robust library of how we do things in this program in various specialties, and

measure resident performance in a very objective, systematic way, so we can monitor how those skills are changing from year one to the time they go out,” Cromwell said.

In addition to Cromwell’s surgical leadership roles, he also heads up a research laboratory at the University of Iowa that’s commercializing new technologies in the field of computational health, all of which are geared toward preventing adverse surgical events. Among the projects that it’s spinning out are a process to

identify acoustic biomarkers related to post-operative ileus (Cromwell was inspired by Cornell researchers working to reducing bird strikes at airports by charting their songs) and a screening device for hospital delirium, which he said can affect 20 to 50 percent of patients aged 60 and older. The lab is also building an AI-based platform that will process health records data in an attempt to identify patients at the highest risk of contracting a surgical infection.

“I’ve tried to keep it aligned with things that I do every day,” he said.

When he’s not at work, Cromwell enjoys travel, cycling and cooking meals with his family. .

“We have people from all parts of the country – trainees, new nurses, new faculty –and we’re constantly trying to align people on their responsibilities, and what we’re trying to achieve on a daily basis. Our goal is to keep our team members around, and engaged , and focused on creating the best outcomes for our patients.”

Enjoy A Workday Reset

7 Ways to Break Away From Work and Boost Morale

By Family Features

When the sun is shining and comfortable weather is calling you outdoors, focusing on tasks at work can become a challenge. Workdays are often long and strenuous, making that blue sky and fresh air all the more tempting.

Don’t let a full to-do list bog you down. In fact, taking a break from your desk and averting your eyes from work may actually help you mentally reset and increase efficiency through the remainder of the day.

Consider these popular ways to disconnect for a short while so you can take on busy days without feeling overwhelmed.

1. Stretch – After hours of sitting, stretching from head to toe can be a good way to get physically active if you’re short on time and stuck at your desk. Neck, shoulder, arm, back and leg stretches are all easy ways to stand up and disengage from the computer. Another trick: practice wrist exercises to avoid injury or strain from typing.

2. Go for a Walk – If you have a few minutes to spare, leave the office or your desk at home entirely and head outside for a walk. A stroll through your neighborhood or the city sidewalks can provide the fresh air and physical activity your body craves.

3. Take Five Outside – On hot days when a midworkday walk might not be the right refresh, skip it and simply find a shady spot to sit down. You can enjoy the benefits of fresh air and sunlight without getting too hot.

4. Rest Your Eyes – Follow the rule of 20s. If you’re

working a computer job, eyestrain may be a serious concern. Give them a break by looking 20 feet away for 20 seconds every 20 minutes.

5. Enjoy a Favorite Snack – Push that office chair away from the computer and treat yourself to a bite of something you enjoy. For example, Nestlé rallies nut butter bombs are a perfect cure. Available in three craveable flavors – raspberry peanut butter, brownie almond butter and salted cashew butter – the chilled delights combine decadent chocolate and smooth nut butter for a rich burst of flavor with no preservatives, artificial flavors or artificial colors.

6. Check in with Friends – Squeeze in a midday chat to catch up with a friend or coworker. Socializing is a feel-good way to take your mind off work even for just a few minutes.

7. Sip an Afternoon Coffee – If caffeine gives you that much-needed jolt to finish out the workday, head to your favorite local shop for a refreshing iced beverage. Pair it with a chilled snack like Nestlé rallies nut butter bombs for a perfect sweet and savory afternoon pick-me-up.

Find more delicious ways to rally through the day by visiting nestlerallies.com.

Photo courtesy of Getty Images

A Better Warm Up for a Better Workout

By Miguel J. Ortiz

Most people usually do a quick warm up routine when it comes to training and exercise. Maybe it’s a couple of stretches combined with some light calisthenics to get the heart rate up. It usually is not very intentional. If it is intentional it can drastically improve results and effort over a long period of time.

Most people recognize that warming up is good for the body. They don’t understand how vital it is from a neuromuscular and strength stand point. Your body has a fight-or-flight system, and when we start to warm up we gradually start getting into the flight mode. In the flight mode we may not want to jump into more vigorous exercise – but that’s exactly what the warm up is there to do. It should prep us for getting into fight mode. We want the body to be ready to go to battle. We want it to prepare to endure the work ahead. The following are a couple of warm-up ideas that may be used in a training programs.

Let’s start with some endurance. If you’re in this phase, a quality warm up would look like the following. If it is for running then maybe start with doing 3-5 minutes of specific foam rolling or

SMR (self-myofascial release), targeting calfs, quads and glutes. Once you have some light blood flow add some general stretching then gradually add more intense movement. So, we can do 3 rounds of the following. Jump rope for 1 minute, this is to get the ankles and joints prepped for bounding work to help with absorption during the run. It also drives the heart rate up. Next, we will perform an elevated single leg glute bridge. Do 3 sets of 8 to help strengthen the hip and prep the legs for running. Lastly, we can do a shinbox extension (3 sets of 8). This compliments the bridge as it helps with hip activation and adds an element of core work which is required for quality running.

For overall strength training individuals, we want to keep that same general foam rolling for 3-5 minutes on the specific areas you’re going to train. For example, if you’re hitting the back and core, then foam roll your back and arms. The main pattern you should notice with an endurance and strength training warm up protocol is that I suggest lengthening before strengthening. For a back and core day, start with general activation like a Prone Shoulder CAR snow angel (3 sets of 8). This will help with activation and prep the shoulder for stronger work. Then, we can move

to more specific activation exercises. Be sure to turn the weight down so it’s not intense since this is for warming up. DB Hinge & Row (3 sets of 10), this exercise targets the back and core.

Lastly, if you are training for power, then you’ll need to lengthen and do joint prep. More importantly, whatever workout you are about to get into needs work with much lighter weight with a strong intention toward moving faster. Let’s say you’re about to do a powerful 3 rep deadlift. Your warm up might have some of the same moves as above except you’re going to prep your body by actually doing deadlifts, just doing it with lighter weight and a high concentration on form.

Regardless, never skip your warm up. Make sure your body is always prepped to endure the workout. Have fun with your movements and stay active.

– 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 videos of the exercises mentioned in this column on his YouTube channel at tinyurl.com/ORTfitness.

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Creating a Safe Work Environment

By Daniel Bobinski

ne problem that gets in the way of moving forward in building collaborative teams is when someone on the team has little or no concern for other people’s thoughts or feelings. Many reasons can exist for a lack of caring, but one common reason is the existence of an emotional wall, which usually formed because of a significant event in a person’s past.

I will not play psychotherapist here, but as co-workers and as fellow human beings, we can strive to create environments in which people feel safe enough to move past the obstacles living in their brains – and hearts.

Modeling what we want

I’m assuming you’ve heard the golden rule: treat others the way you want to be treated. If we want others to understand and care about others, then we need to show our understanding and display our caring. What follows are some ways to do that. Granted, you may look at this list and say, “Yes, I already know those things,” but my response will be, “That’s great, but how well are you doing them?” As another saying goes, there’s always room for improvement.

• Active Listening: Hearing is perceiving a sound by ear. We can hear things but that doesn’t mean we’re listening, and people instinctively

know which they’re getting from you. To actively listen, we need to pay full attention to what’s being said. That means pushing away from a cellphone or computer or whatever else we were working on and look at the person speaking. A great way to actively listen is to ask yourself in your own head, “What is this person thinking or feeling?” If you can use your own words to articulate the thoughts or feelings of what’s being conveyed, then that’s an excellent indicator that you are actively listening.

• Respect Different Styles: This is an area that is often overlooked. If we want respect to be a core value on our team, then we need to practice it in everything we do, including listening. One big area is decision making. More than half the population have personality styles that need time to think things through. It is disrespectful to demand fast answers or fast decisions from them. This doesn’t mean we can’t have deadlines and expectations, but we create a safer and often more productive environment when those goals and deadlines are mutually established. One could spend years studying styles and, frankly, the time invested in learning them pays off.

• Personal Beliefs: Our society has become polarized on many issues, and our opinions do not fall off

once we walk through the workplace door. It’s OK to disagree with others, the key is to do it agreeably. In many situations, we can simply nod and move on, without having to debate who’s right and who’s wrong. After all, such an approach does not create safe environments, as walls are likely to remain up. In fact, they often get reinforced. When discussing emotional intelligence with others, I often say that the shorthand definition is that people want to feel safe – and if we work to create environment in which people are likely to feel safe, then we create the foundation for good collaborative bridges to be built.

Daniel Bobinski, who has a doctorate in theology, is a bestselling author and a popular speaker at conferences and retreats. For more than 30 years he’s been working with teams and individuals (1:1 coaching) to help them achieve excellence. He was also teaching Emotional Intelligence since before it was a thing. Reach him by email at DanielBobinski@ protonmail.com or 208-375-7606.

Howdy! Meet the Delicious Superfoods of the Southwest

by Grace O

When we think of the Southwest, what do we picture? Beautiful red rock landscapes. A saguaro cactus silhouetted against a perfect sunset. A bright blue sky with fluffy clouds. A pitcher of Margaritas?

Super healthy, age-defying foods probably don’t come to mind. Most of us think of Tex-Mex cuisine – lots of cheesy, spicey, tomato-y dishes wrapped in tortillas. Delicious, yes, but good for you? Not so much. But if you dig a little deeper and explore what indigenous people grew and ate in the Southwest, you’ll find there are plenty of foods that are tasty, healthful and typical of the region.

Here’s my list of some top Southwestern superfoods that provide plenty of nutrients that help us age better.

ent properties! They’re low in fat but high in protein and fiber, which can keep blood sugar stable. Deeply colored black and red kidney beans are high in antioxidants. Beans provide generous amounts of vitamins and minerals including thiamin, riboflavin, niacin, vitamins B6, A, C and K, calcium, iron, magnesium, phosphorus, potassium, folate, manganese and copper.

Beans – There’s almost never a Southwestern meal without them. Generally thought of as a low-cost, low-status food, beans are rich in so many FoodTri-

Avocados – True, avocados contain 77 percent fat, but it’s healthy unsaturated fat that the body uses for slow-burning energy and maintaining moisture and elasticity of the skin. Avocados are also loaded with vitamin E and antioxidant carotenoids that help protect skin from the aging effects of the sun. They provide 18 essential amino acids necessary for the body to form a complete protein while the oleic acid they contain helps reduce inflammation. A 3.5-ounce serving of avocado contains 7 grams of fiber, which is 27 percent of the recommended daily amount. Then there’s their delicious, buttery taste!

Tomatoes – Technically a fruit, but used as a vegetable, tomatoes are in the nightshade family with eggplants, chilies and potatoes. Tomatoes cooked in oil are especially rich in a carotenoid called lycopene, which is associated with reducing prostate cancer. The deep red color of tomatoes is due to the presence of lutein, which is important for maintaining eye health. The anti-cancer properties of tomatoes are enhanced when consumed with fat-rich foods such as avocados, so enjoy!

Chia seeds – Like many Southwestern foods, chia seeds came north with Spanish explorers and descendants of indigenous Mexican people. The tiny

black seeds of the chia plant contain an easily digestible protein and a good dose of heart-healthy Omega 3 fatty acids – eight times as much as wild salmon. They also reduce cholesterol, help maintain beneficial blood sugar levels, and are great for detoxing your whole system. Two tablespoons of chia seeds provide as much calcium as half a cup of milk without the fat or lactose. Finally, chia seeds help to metabolize fat and reduce levels of stress hormones that promote fat storage.

Chilies – These are the heart and soul of Southwestern cuisine. From sweet and mild to fiery hot, the heat factor in chilies comes from a substance called capsaicin. Chilies are a good source of vitamin C as well as A, K, B6 and folate. They also provide good amounts of potassium, fiber and beta-carotene. Research has linked eating hot peppers with reduced blood pressure and cholesterol.

Nopales – These are the paddles of the cactus plant. You can find them fresh in Latin markets or online. One cup is a generous source of vitamins A and C, and provides significant amounts of manganese, magnesium, calcium and potas -

OUT OF THE OR nutrition

sium. It’s also an excellent source of dietary fiber while extremely low in calories and carbohydrates.

To serve, nopales are usually cut into strips and simmered for about 20 minutes to make them tender. They can also be roasted or grilled, then cut into strips once cooled. The strips are delicious in scrambled eggs, soups, stews, salsas or in salads. I like to add them to ceviche right before I serve it to my guests.

Cilantro – This is the green, leafy version of coriander with a bright, fresh taste. Cilantro is high in vitamins and fiber and it’s a good source of vitamins A, C, E, K, calcium, iron, potassium and magnesium. Just ¼ cup of fresh cilantro provides 270 IU of Vitamin A, and 16 percent of the daily value recommended of vitamin K, which is important for heart health, bone density and brain function. This herb contains antioxidants that help prevent cellular damage caused by free radicals that are linked to degenerative diseases like cancer, heart disease, arthritis and Alzheimer’s disease. As if that weren’t enough, chewing on a few leaves of cilantro will freshen breath and can be a digestive aid.

Squash and pumpkin – Pumpkin is, of course, a squash and you find them in Southwestern recipes. The orange color of pumpkins, acorn and butternut squash means they’re loaded with the antioxidant beta-carotene, which is one of the plant carotenoids your body converts to Vitamin A, which is essential for healthy skin, sharp eyesight and boosting the immune system. All of these squashes are low-calorie, yet filling. They’re good sources of fiber, healthy fats, rich in beta-carotene and high in anti-inflammatory beta-cryptoxanthin.

– Grace O is the creator of FoodTrients, a unique program for optimizing wellness and longevity. Sheis the author of three award-winning cookbooks. Her latest cookbook is “AntiAging Dishes from Around the World.” Learn more at FoodTrients.com

OUT OF THE OR recipe

Recipe the

Heart-Healthy Pita Pizzas

INGREDIENTS:

• 4 whole-wheat pitas (6 1/2 inches each)

• 1 cup chunky tomato sauce

• 1 cup grilled boneless, skinless chicken breast, diced (about 2 small breasts)

• 1 cup broccoli, rinsed, chopped and cooked

• 2 tablespoons grated Parmesan cheese

• 1 tablespoon fresh basil, rinsed, dried and chopped (or 1 teaspoon dried)

By Family Features

5 Steps Toward Heart-Healthy Eating

As the leading cause of death among Americans, according to the Centers for Disease Control and Prevention, heart disease often results from uncontrolled high blood pressure, high cholesterol, diabetes, overweight and obesity. However, a heart-healthy eating plan can help lower or control these risk factors and put you and your family on a path toward better heart health.

It’s important for families to make time for healthy eating decisions. Consider these five steps recommended by The Heart Truth program of the National Heart, Lung and Blood Institute (NHLBI):

Eat Smart

One way to get started on a path toward hearthealthy eating is to change your way of thinking about how and what you eat. For example, use smaller plates to help limit portion sizes. Chew food slowly and consider the textures and flavors of different food as you eat.

Plan to Eat Heart Healthy

Put together an eating plan that offers a balance of calories and nutrients including vegetables, fruits, whole grains and low-fat or fat-free dairy. Consider make-at-home favorites like Heart-Healthy Pita Pizzas, which include grilled chicken as a betterfor-you alternative to methods such as frying.

Choose Healthy Snacks

After a full day of learning or working, it’s tempting for children and adults to grab a quick snack that may not be healthy. Swap out sugary or salty snacks and instead enjoy lower-calorie after-school treats that fit into your daily eating plan. Try options like a cup of seedless grapes, small banana, cup of cherry tomatoes, handful of unsalted nuts or half cup of low-fat or fat-free yogurt.

Find Heart-Healthy Menus

How you eat day after day can make a difference in your heart health over time. Developed through research by NHLBI, the Dietary Approaches to Stop Hypertension (DASH) eating plan emphasizes vegetables, fruits, whole grains, fish, poultry, beans, nuts, low-fat dairy and healthy oils to help keep your blood pressure in a healthy range. DASH focuses on lowering sodium and limiting foods that are high in saturated fat, including fatty meats, full-fat dairy and tropical oils.

Stay On Track When Dining Out

It is possible to eat healthy foods in restaurants. To control portion sizes, try tactics like eating half your entree and taking leftovers home for another meal. Choose foods that are broiled, baked or roasted to limit calories. Ask for low-sodium menu options and request butter, gravy, sauces and salad dressings on the side or leave them off completely.

Visit hearttruth.gov to find more healthy eating inspiration and find DASH-friendly recipes at healthyeating.nhlbi.nih.gov.

Heart-Healthy Pita Pizzas

Prep time: 10 minutes

Cook time: 8 minutes

Servings: 4

1. Preheat oven or toaster oven to 450 F.

2. On each pita, spread 1/4 cup tomato sauce and top with 1/4 cup chicken, 1/4 cup broccoli, 1/2 tablespoon Parmesan cheese and 1/4 tablespoon chopped basil.

3. Place pitas on nonstick baking sheet and bake 5-8 minutes until pitas are golden brown and chicken is heated through.

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