Journal of Perioperative Practice
PROCUREMENT GUIDE March 2014 2014 Volume 03 Issue 01 03 July/August l Volume 03 Issue l 01423 01423881300 881300 lwww.afpp.org.uk www.afpp.ord.uk
SURGICAL
PROTECTING THE PATIENT FROM
SCRUB-UP TO CLEAN-DOWN Surgical Site Infections (SSIs) pose a very serious risk to patient safety and can result in significant additional costs to the hospital. An effective theatre infection prevention programme needs to address each source to minimise the threat of SSIs.
Infection Prevention Solutions for the Operating Theatre Ecolab’s clinical team can assist and advise on integrated solutions from preoperative body washing through to sterile equipment draping and hygiene monitoring. After gaining an understanding of existing products and processes, we can help to improve productivity, increase efficiency and realise significant cost savings, whilst improving patient safety during surgical care.
EQUIPMENT PROTECTION
ENVIRONMENTAL CLEANING
TRAINING AND MONITORING
PRE-OPERATIVE SKIN ANTISEPSIS
SURGICAL HAND PREPARATION
CALL881300 ALISON ON 0113 232 2480 FOR FURTHER INFORMATION 01423 www.afpp.org.uk ECOLAB HEALTHCARE Lotherton Way, Garforth, Leeds LS25 2JY, UK +44 (0) 2920 854 390 © Ecolab 2014 6401/06.14
www.ecolab.co.uk
Enzymatic foam spray The PREPZYME速 XF will aid the implementation of the new CFPP 01-01 Guidance by maintaining your surgical instruments and scopes in a moist environment. PREPZYME速 XF Xtreme Foam is a pH neutral multi-tiered enzymatic foam spray with a built in rust inhibitor that prevents the adhesion of soil to the surface and lumen of all surgical instruments and scopes. This specially designed product covers the instruments with thick foam that penetrates all the nooks and crannies of the instrument or scope and begins breaking down blood, fat, protein and carbohydrates on contact, starting the cleaning process immediately. Its special applicator allows the effective cleaning of the majority of cannulated instruments and scopes, preventing contaminated soil from drying during transportation. Q Thick long lasting foam Q Eliminates dried on soil Q No messy spills or splashing Q Speeds up turn-around time Q Contains a rust inhibitor Q Neutral pH, non-abrasive Q Free-rinsing and 100% biodegradable Q Special applicator tip for deeper penetration of cannulated instruments and scopes
For a Free Sample, please contact the office... Tel: 01323 511038 Fax: 01323 503247 Email: support@ruhof.co.uk Website: www.ruhof.co.uk
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Journal of Perioperative Practice l PROCUREMENT GUIDE July/August 2014 Volume 03 Issue 03 www.afpp.org.uk
Contents
Welcome to July/August 2014 Guide 04
09
07
11
Day surgery a continually evolving speciality
Product news: The saving benefits of single-use instruments - time, life and cost
08
Product news: Protecting the patient from scrub-up to clean down
Product news: A new, simple non-invasive device to facilitate uniform alignment of the divided sternum following median sternotomy
Enhanced recovery in day care surgery
Journal of Perioperative Practice Procurement Guide information In print within the AfPP Journal of Perioperative Practice covering national AfPP members, but also with a dedicated print and e-distribution to supplies and purchasing managers. Key Sectors: NHS Supply Chain, Independent Hospitals, Higher Education. Medical Device Companies. Published 6 times a year we will focus on procurement issues in every edition as well as specialist subjects which for the following year include:
Contact Information: September 2014 Airway Management November 2014 Safety January 2015 Recovery/Patient Warming March 2015 Medical Devices/Instruments May 2015 Infection Prevention/Control
Advertising, Sponsorship & Partner Packages. Frances Murphy Account Manager Open Box M&C T: 0121 200 7820 E: francesmurphy60@yahoo.com Editorial Chris Wiles Head of Publishing / Editorial AfPP T: 01423 882950 E: chris.wiles@afpp.org.uk
PR & press material. All press releases welcome and we will feature as many as we can in each issue, all press releases need to be submitted to: Frances Murphy Account Manager Open Box M&C T: 0121 200 7820 E: francesmurphy60@yahoo.com
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Journal of Perioperative Practice l PROCUREMENT GUIDE July/August 2014 Volume 03 Issue 03 www.afpp.org.uk
Day surgery
Day surgery - a continually evolving speciality Day surgery is when selected patients for selected surgical procedures are admitted into a day care unit and return home on the same day. They will usually require full operating theatre facilities with a general anaesthetic. The NHS continually strives to improve efficiencies and where and how a patient receives care can sometimes shift from the traditional setting when commissioners redesign the care provision. For example minor procedures may shift to the day care setting to improve efficiency and access for patients. Through these changes the NHS can experience huge cost savings and release of beds required for more complex cases. Generally day case patients arrive early in the morning and following surgery, if observations are acceptable, they are discharged home on the same day. Patients attending for day case surgery do need some focused postoperative monitoring for a few hours prior to discharge. Advancements in surgical and anaesthetic technology mean a range of surgeries can be safely performed as a day case. This makes the surgery more convenient for patients; however, not all patients are suitable for day surgery. Their physical health and home circumstances will need to be assessed by a healthcare professional before surgery, this will determine if day surgery is the best option for them. A consensus document (Verma et al 2011) produced by a working party established by the Association of Anaesthetists of Great Britain and Ireland (AAGBI) and British Association of Day
4.
As in other patient care environments, the benefit of a day surgery care pathway ensures consistent management of conditions and provides best practice guidelines for multi-disciplinary teams.
Surgery (BADS) developed the following summary in relation to day case surgery: 1. Day surgery is a continually evolving speciality performed in a range of ways across different units. 2. In recent years the complexity of procedures has increased with a wider range of patients now considered suitable for day surgery. 3. Effective preoperative
5.
6.
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preparation and protocol driven, nurse led discharge are fundamental to safe and effective day and short stay surgery. Fitness for a procedure should relate to the patient’s health as determined at preoperative preparation and not limited by arbitrary limits such as ASA status, age or body mass index. Patients presenting with acute conditions requiring urgent surgery can be efficiently and effectively treated as day cases via a semi-elective pathway. Central nuraxial blockade and a range of regional anaesthetic techniques, including brachial plexus and paravertebral blocks, can be used effectively for day surgery. Each anaesthetist should develop techniques that permit the patient to undergo the surgical procedure with minimum stress and maximum comfort, and optimise his⠄her chance of early discharge. Every day surgery unit must have a clinical lead with specific interest in day surgery and whose remit includes the development of local policies, guidelines and clinical governance. Good quality advice leaflets, assessment forms and protocols are in use in many centres and are available to other units.
10. Effective audit is an essential component of good care in all aspects of day and short stay surgery. 11. Enhanced recovery is based on established day surgery principles and is aimed at improving the quality of recovery after inpatient surgery such that the patient is well enough to go home earlier and healthier.
The benefits of care pathways
As in other patient care environments, the benefit of a day surgery care pathway ensures consistent management of conditions and provides best practice guidelines for multidisciplinary teams. Pathways provide plans and expectations for the patients and the facility providing the care. The patient can plan their home requirements and the hospital/day care team know what needs to be done and when. Working to a planned structure provides the opportunity to evaluate the care and audit against planned outcomes.
Conclusion
In 1999 the Government predicted that 75% of invasive procedures would take place in a day care setting and the statistics provided by the National Audit Offices shows that by 2007 52% of procedures were being undertaken in day care settings, however, these statistics included diagnostics which is not, therefore, a true reflection of the outcomes. If the NHS is to save money and time and free up beds for more complex cases then a more structured and rigid approach to day case procedures will need to be adopted.
Peskett Solutions Ltd would like to introduce two recently acquired endoscopy products called Eco Ez Cleanse™ and Valvesafe™
Eco EZ Cleanse™ Bedside Kit Eco EZ Cleanse™ - An endoscope ultra pre-cleaner designed for the initial flush and wipe of an endoscope immediately post-procedure. It brings together all the necessary components to undertake the pre-clean stage in one easy-to use single-use kit. By including a sachet of concentrated endoscopic detergent we are not packaging water, this means Eco EZ Cleanse™ is significantly more cost-effective than other bedside cleansers, shipping costs are greatly reduced and only takes up a quarter of the space of competitive products thus freeing up storage space.
With Liquiclean S ECO-Pac Concentrated Detergent
Valvesafe™ Disposable Valve Cage Valvesafe™ is a single-use solution for keeping endoscope valves with the parent endoscope during the entire cleaning, disinfection and storage process. Valvesafe™ is designed to take up to 4 valves. As you may be aware, BSG and JAG Guidelines for Decontamination of Equipment for Gastrointestinal Endoscopy states: “ Valves (including rinsing valves) should stay with a named endoscope as a set to prevent cross-infection and enable full traceability.”
For free samples for evaluation, please contact our office. For information on special offers and how we can help save you money on your bedside cleaning, please contact Matthew. Email: support@pekettsolutions.com
Peskett Solutions Ltd Unit 4-5 Brampton Business Park 55 Brampton Road, Eastbourne, East Sussex, BN22 9AF Tel: 01323 511038 Fax: 01323 503247 E Mail: support@ruhof.co.uk Web: www.ruhof.co.uk
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Day surgery References and further information Association of Anaesthetists of Great Britain & Ireland (AAGBI) http://www.aagbi.org British Association of Day Surgery (BADS) http:// daysurgeryuk.net/en/home Department of Health 2002 Day surgery: operational guide [online] Available from: http:// webarchive.nationalarchives. gov.uk/+/www.dh.gov.uk/en/ Publicationsandstatistics/ Publications/ PublicationsPolicyAndGuidance/ DH_4005487 [Accessed April 2014] National Audit Office www.nao. org.uk
AT4 Tourniquet System Ideal for single or bi-lateral orthopaedic surgery and pain management • Available as an electronic or pneumatic version • Dual channel tourniquet system • Colour coded channels • Automatic self-diagnostic checks • Precision controlled regulators • Independent displays • Visual and audible warnings • Automatic LCD timers • IVRA (Bier’ss block) guidance feature • Self-c compensating • Cuff hooks k for ease of storag ge Innovative Te T chnology – Practically Applied
01943 878647 sales@aneticaid.com Queensway, y Guiseley, y We W st Yo Y rks k hire, LS20 9JE UK.
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MADE IN THE UK
QUALITY ASSURED GLOBAL DISTRIBUTION
NHS Better Care Better Value www.productivity.nhs.uk NHS England Improving Quality: www.england.nhs.uk/ ourwork/qual-clin-lead/nhsiq NHS Scotland 2006 The planned care improvement programme. Day surgery in Scotland [online] Available from http:// www.scotland.gov.uk/Resource/ Doc/154924/0041643.pdf [Accessed June 2014] Verma R, Alladi R, Jackson I, et al. 2011 Day case and short stay surgery: 2 Anaesthesia 2011; 66: pp 417-434 Available from: http://onlinelibrary.wiley. com/doi/10.1111/j.13652044.2011.06651.x/pdf [Accessed April 2014]
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Journal of Perioperative Practice l PROCUREMENT GUIDE July/August 2014 Volume 03 Issue 03 www.afpp.org.uk
Product news
The savings benefits of single-use instruments – time, life and cost In this tough economic climate realising savings is vital. Evidence suggests that purchasing high quality, singleuse surgical instruments, can save considerable time, cost and possibly even lives. Time-saving
The complexity of reprocessing medical instruments is often underestimated, where regular reprocessing and repair work, which is time consuming and often creates supply shortages that delay theatre lists.
Life-saving
Traditional sterilisation processes may not completely remove some proteins that are resistant to reprocessing cleaning methods, which can be passed onto the patient with potentially adverse effects.
In one recent study, 35% of nurses said they faced daily shortages of medical supplies1, causing unnecessary disruption to workflows.
With single-use products cross-contamination is avoided, significantly reducing the risk to patients’ lives and providing them with a greater standard of care.
According to the GS1 UK Healthcare Report, research involving 861 UK hospital nurses found that each nurse spends an average of four hours a week for medical items, including instruments – equivalent to 23 days per year (per nurse).
By disposing of an instrument after one use, many instances of infection are prevented, thereby minimising costs, potential litigation, and mortality rates.
About 17 minutes per day of this time is for medical devices, costing the NHS over £350 million per annum.2
Cost-saving
More than initial purchasing costs should be considered when buying surgical instruments. The table below compares the potential costs of reusable vs. single-use:
Reusable
Single-use
Initial purchasing costs
Purchasing costs – buy in bulk = economies of scale
Cost of transport to off site location
None
Cost of man power to reprocess the instrument
None
Cost of transport back to healthcare facility
None
Cost of reprocessing resources – energy to make steam, use of chemicals, use of machinery
None
Cost of staff used to arrange for reprocessing to take place – collection and reassembling of instruments
None
For more information about the benefits of single use please download DTR Medical’s TLC: the savings benefits of single-use catalogue at www.dtrmedical. com/catalogues. info@dtrmedical.com +44 (0) 1792 79 79 10 www.dtrmedical.com
(Endnotes) 1 GS1 & Nursing Standard, May 2010, Survey of 861 UK Hospital Nurses 2 GS1 Healthcare report (2010)
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Journal of Perioperative Practice l PROCUREMENT GUIDE July/August 2014 Volume 03 Issue 03 www.afpp.org.uk
Day surgery
Enhanced recovery in day care surgery In recent years the complexity of procedures has increased to involve a wider range of patients that are now considered suitable for day surgery. This has posed a challenge to provide safe, efficient and effective recovery discharge after a surgical procedure. The provision of a range of local and regional anesthetic techniques such as brachial plexus and paravertebral blocks can be helpful in providing a pain free discharge from the recovery room and from the hospital at the end of the day. The development of enhanced recovery is based on established day surgery principles, and is aimed at improving the quality of recovery to enable patients to go home earlier and healthier. The recent drive to reduce the length of stay and improve the quality of postoperative recovery has ensured that day surgery is fundamental to modern patient care.
These shortened hospital stays along with early mobilisation also reduce the risk of hospital acquired infections and venous thromboembolism.
These shortened hospital stays along with early mobilisation also reduce the risk of hospital acquired infections and venous thromboembolism. Recovery from anesthesia in the day surgery setting is classed as first stage recovery. This stage lasts until the patient is awake, protective reflexes have returned and pain is well controlled. The use of modern drugs and techniques may allow early recovery to be complete by the time the patient leaves the
operating theatre, thus allowing some patients to bypass the first stage recovery room process. Most patients undergoing surgery with local anesthetic block can be fast tracked in this manner. The most recent of changes and developments I have noticed are in the area of podiatry,
where patients have their local anaesthetic blocks administered in the ward area before being transferred to theatre. After surgery they return directly to the ward, where early mobilisation is encouraged and discharge is complete just a couple of hours after surgery. This allows patients to be efficiently discharged in a safe manner. The principles of enhanced recovery can also be successfully used for patients following major surgery such as hip or knee replacements. Correct patient selection is of paramount importance to ensure successful hospital discharge. The enhanced recovery phase is based on the following principles; Planned mobilization • Rapid hydration and nourishment • Appropriate hydration and nourishment • No wound drains • No bowel surgery or nasogastric tubes • Catheters removed early • Regular oral analgesia • Paracetamol and NSAIDS • Avoidance of systemic opiate based analgesia where possible or administered topically. Enhanced recovery is the outcome of applying a range of strategies that are designed to prepare and optimise patients before, during and after surgery, ensuring prompt recovery and discharge. Most of these principles are already well established in day surgery, which
can be considered the ultimate example of enhanced recovery. As patient hospital stays become shorter and recovery times are greatly improved, the boundaries for day case surgery are changing and progressing at what sometimes feels like the speed of light.
Amanda Tudor Senior RODP/SFA Ilkeston Community Hospital
Bibliography British Association of Day Surgery 2011 Day case and short stay surgery 2nd edition Available from: www.aagbi. org/publications/publicationsguidelines/D/D Lubarsky DA 1996 Fast track in the post-anaesthesia care unit: unlimited possibilities? Journal of Clinical Anaesthesia 8 (3) Supplement S70-72 NHS Enhanced Recovery Partnership Programme 2010 Delivering enhanced recovery. Helping patients to get better sooner after surgery Available from: http:// webarchive.nationalarchives.gov. uk/20130107105354/http://www. dh.gov.uk/prod_consum_dh/ groups/dh_digitalassets/ documents/digitalasset/ dh_119382.pdf
Product news
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We’ll tailor the most effective surgical textile solution for you
Protecting the patient from scrub-up to clean down Surgical site infections may account for 16% of all Healthcare Associated Infections (1) and can double the length of time a patient stays in hospital. Effective infection control in operating theatres saves time, saves money and most importantly, saves lives. Ecolab have launched a new comprehensive programme for operating theatres to improve productivity, efficiency and realising significant cost savings for the hospital. Concentrating on a holistic approach that incorporates a system of hygiene products, services and training, the programme addresses all aspects of contamination risk right along the surgical pathway. From pre-operative skin antisepsis to surgical hand hygiene, equipment protection and environmental cleaning, patient safety is maximised at every step of the journey. One example is Ecolab’s unique monitoring system for environmental hygiene,
EnCompass, which addresses contamination risk in this specialised environment and improves cleaning standards in the operating theatre. Ecolab’s clinical team, which includes a microbiologist and practising ODP, are fully trained in best practice and are therefore able to aid product selection, deliver training and offer advice on cost efficiencies, giving the theatre team more time to focus on what they do best. For further information on how Ecolab can support and improve your theatre hygiene protocols, call Alison on 0113 232 2480 or email info.healthcare@ecolab. com 1. Health Protection Agency (2011) English National Point Prevalence Survey on Healthcareassociated Infections and Antimicrobial Use.
WHY COMPROMISE?
As a unique provider of Single and Multi use gowns, drape packs and tray wraps, at Guardian we understand that, whilst protection is paramount for patients and staff, comfort is also a critical factor. Our high-tec materials offer excellent levels of protection whilst alleviating uncomfortable heat retention.
Explore our comprehensive range now.
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Visit: www.guardiansurgical.com Email: info@guardiansurgical.com
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Journal of Perioperative Practice l PROCUREMENT GUIDE July/August 2014 Volume 03 Issue 03 www.afpp.org.uk
Day surgery
AfPP’s Theatre access course Who’s it for? This course has been tailored specifically for medical device representatives but may also be suitable for students wanting to get a ‘taste’ of theatres. What do you get out of it? - An understanding of theatre etiquette, correct protocol and the roles and responsibilities of those within theatres. - A certificate and theatre access course ID pass card. How long does it last? The course is valid for two years, after which you will be required to complete a refresher module.
Where is it held? Either at AfPP HQ in Harrogate or onsite at your offices (a minimum of 10 delegates are required for onsite courses). What does it cost? - £250+VAT for medical device representatives - £150+VAT for students The course can also be ‘tailor made’ to your specifications. To book your place or for further information, please call Pauline Thompson on 01423 882969 or visit www.afpp.org.uk/events/theatreaccess
JPP_138x188_sharps 06/02/2013 15:07 Page 1
safety
in mind first time, everytime In response to the New EU Sharps Directive 2010/32/EU Swann-Morton have extended their Retractable Safety Scalpel range to include the large size blades 20-25A. Whilst supporting existing safe passing and disposal protocols the sliders are colour coded to assist with blade shape recognition. For those preferring a metal handled scalpel then the Cygnetic range offers an “easy attach and detach” function for the attending Nurses. Swann-Morton can offer in house sharps safety training in line with the new Directive so contact us on sharpssafety@ swann-morton.com for more information. For more information on the complete range of surgical blades, handles, scalpels, disposable, fine and retractable scalpels please go to our website.
All medical devices are CE marked in accordance with the Medical Device Directive (93/42/EEC)
Owlerton Green, Sheffield S6 2BJ Telephone: 0114 2344231, Sales: 0114 2344223, Fax: 0114 2314966 uksales@swann-morton.com, exportsales@swann-morton.com www.swann-morton.com ‘Swann-Morton’ and the ‘Ring Pattern Logo’ are the registered trade marks of Swann-Morton Limited and related companies.
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Journal of Perioperative Practice l PROCUREMENT GUIDE July/August 2014 Volume 03 Issue 03 www.afpp.org.uk
Product news
ThorAcc® - A new, simple non-invasive device to facilitate uniform alignment of the divided sternum following median sternotomy In January 2014, G+N (Griffiths and Nielsen Ltd, UK) launched ThorAcc®, a device specifically developed to assist surgeons in closing the sternum following cardiac surgery. Traditionally, closing the sternum has required manual handling from surgical assistants which is particularly challenging in obese patients.
For more information about the product or to see a demonstration please email us at chris.gilpin@ gandn.com or call us on 0845 263 8908. www.gandn.com
Clinically developed by leading Cardiac centres in the UK and USA, ThorAcc® aims to facilitate uniform alignment of the sternum during closure, reducing the incidence of sternum instability, lowering the manual handing risks for staff and minimising the risk of the ‘cheese wire’ effect.
Controlled inflation of sectioned air cells allows the shoulders and sides to be pushed upwards and inwards which helps to reduce the force required when tightening wires to bring the sternal edges together and ensures a more controlled and uniform alignment.
ThorAcc® consists of three parts; a four chamber inflatable to assist in sternum closure, a hand controller which connects to the surgical air supply to control the inflation/deflation of the device and tubing which connects the inflatable to the hand controller.
Mediastinitis occurs in 1% to 3% of patients following median sternotomy1 and studies have shown a 59% higher mortality risk compared to patients without mediastinitis2. However, with adherence to perioperative aseptic technique, attention to
Have you any ‘New Products’ to launch or ‘Established Products’ you wish to push to the forefront of the ‘NHS Supply Chain & Private Sector’?
haemostasis and precise sternal closure, a very low incidence of mediastinitis can be achieved3. ThorAcc® helps to facilitate better alignment of the sternum which could help to reduce incidence of postoperative mediastinitis and may potentially reduce critical care hospital stay. First experiences of the device have been very positive showing that ThorAcc® is a safe and simple device which can reduce complications such as postoperative bleeding, pain and sternum instability, particularly in obese or frail patients4.
References 1. 1. Eklund, A et al. (2006). Mediastinitis after more than 10,000 cardiac surgical procedures. Ann Thorac Surg. 82 (5), 1784-1789 2. Risnes, l et al. (2010). Mediastinitis after coronary artery bypass grafting risk factors and long term survival. Ann Thorac Surg. 89 (5), 1502-10 3. Baskett, R et al. (1999). Is Mediastinitis a preventable complication? A 10 year review. Ann Thorac Surg. 67 (2), 462-599 4. King’s College Hospital, evaluation report 2012.
Call our sales contact, Frances, to discuss including them in our upcoming editions
Frances Murphy +44 (0)121 200 7820
The Association for Perioperative Practice is a registered charity (number 1118444) and a company limited by guarantee, registered in England (number 6035633). AfPP Ltd is its wholly owned subsidiary company, registered in England (number 3102102). The registered office for both companies is Daisy Ayris House, 42 Freemans Way, Harrogate, HG3 1DH.