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Medline's OR Connection Magazine, Volume 7, Issue 1 - FREE CE: In the Heat of the Moment: Malignant Hyperthermia Calls for Action
Citation preview
Malignant HyperthermiaARE YOU PREPARED?
TheAligning practice with policy to improve patient care
Special Breast Cancer Awareness Issue!
Congratulations!Pink Glove Dance photo winners. OR nurses from University Medical Center of Princeton
Volume 7, Issue 2
VOLUME 7, ISSUE 2
THE OR CONN
ECTION w
Ways to Improve Surgical Outcomes5
Get into the Groove! 2012 Pink Glove Dance Competition Page 84
SPEAK UP for OR SAFETY!
Covered Arms Are Compliant ArmsLook what’s new! Long-sleeve scrubs.
The latest AORN and OSHA guidelines recommend that OR nurses who aren’t in gowns should wear long sleeves.
PerforMAX scrubs added an inner sleeve to keep arms covered without dangling cuffs—like on jackets—to contaminate sterile fields.
These sleeves are like the finest athletic undergear: cool, supportive and totally breathable. And because they’re PerforMAX, you get a fashionable layered look that’s comfortable and functional all shift long.
©2012 Medline Industries, Inc. PerforMAX and greensmart are trademarks and Medline is a registered trademark of Medline Industries, Inc.
Talk to your facility’s Medline rep or visit Scrubs123.com to find out more about PerforMAX scrubs.
PerforMAX scrubs
MKT1219116 / LIT139R / 30M / QG5
Standard scrub top
greensmart™ is not a third-party certification. The use of the greensmart™ trademark is deter-mined by Medline Industries, Inc. through an internal review process of environmental claims.
Subscribing to The OR Connection guarantees that you’ll continue to receive this magazine and won’t miss out on our industry updates and articles addressing on-the-job issues and patient safety.
We also welcome any suggestions you might have on how we can continue to improve The OR Connection! Love the content? Want to see something new? Just let us know!
To subscribe, simply go to www.medline.com/education. You will need to provide: Your nameFacility and positionMailing address E-mail address
Never miss an issue of The OR Connection!Subscriptions are FREE!
CoverThis fun group of perioperative nurses from the University Medical Center of Princeton at Plainsboro, in Plainsboro, NJ, took first place in Medline’s Pink Glove Dance Photo Contest at the 2012 AORN Conference in March. From left to right, Lori Mozenter, BSN, CNOR, RNFA, Staff Nurse; Mary Zegarski, RN, CNOR, Staff Nurse and Vice President of AORN Chapter 3109; Fe Moreo BSN,CNOR, Staff Nurse and Patricia Lum, RN, BSHA, CNOR, CMLSO, Perioperative Educator/Interim OR Manager.
Sharps Safety Forms & Tools
Aligning practice with policy to improve patient care 107
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Aligning practice with policy to improve patient care 3
About Medline
Medline, headquartered in Mundelein, IL, manufactures and distributes more than 100,000 products to hospitals, extended
care facilities, surgery centers, home care dealers and agencies and other markets. Medline has more than 800 dedicated
sales representatives nationwide to support its broad product line and cost management services.
©2012 Medline Industries, Inc. The OR Connection is published by Medline Industries, Inc. One Medline Place, Mundelein, IL 60060. 1-800-MEDLINE.
Contents
14
28
24
84
Something Wicked This
Way Comes. Patient safety
expert and author Atul Gawande
comments on the Supreme Court
decision to uphold Obamacare.
In the Heat of the Moment:
Malignant Hyperthermia
Calls for Action. Ways to
make sure your operating room
is prepared to intervene when
patients develop malignant
hyperthermia.
Communication Dynamics
and Patient Safety in the
Operating Room. Solutions
to communication difficulties
and lateral violence among
perioperative personnel.
Pink Glove Dance Video
Competition 2012. Are you
in it to win it? New ways to
promote your Pink Glove
Dance Video.
Editor
Sue MacInnes, RD
Senior Writer
Carla Esser Lake
Creative Director
Michael A. Gotti
Clinical Team
Jayne Barkman, BSN, RN, CNOR
Lorri Downs, BSN, MS, RN, CIC
Margaret Falconio-West, BSN, RN, APN/CNS,
CWOCN, DAPWCA
Joan Ferrara, BA, RN, CNOR
Kimberly Haines, RN, Certified OR Nurse
Rebecca Huff, MSN, RN
Angel Trichak, BSN, RN, CNOR
Perioperative Advisory Board
Garry Crawford, MS, RN, CNOR
Norman Regional Health System, Oklahoma
Evangeline Dennis, RN, BSN, CNOR, CMLSO
Spivey Station Surgery Center, Georgia
Linda Groah, MSN, RN, CNOR, NEA-BD, FAAN
Association of PeriOperative Registered Nurses,
Colorado
Darvina L. Heichemer, BSN, CNOR
Gwinnett Medical Center – Duluth, Georgia
Vivienne P Kaplan, RN
Anaheim Regional Medical Center, California
Colleen Mattioni, MBA, RN, CNOR
Hospital of the University of Pennsylvania,
Pennsylvania
Julieann McIntyre, MSN, RN, CNOR
South Shore Hospital, Massachusetts
Susan A Miller, MSN, RN, CNOR
St. Luke’s Hospital, Missouri
Susan S Phillips, MSH, RN, CNOR
UNC Hospitals, North Carolina
Jo Quetsch, MA, RN, NE-BC
Providence Sacred Heart Medical Center,
Washington
Eleonora Shapiro, BSN, MHA, CNOR
Mount Sinai Medical Center, New York
Pat Thornton, MS, RN, CNOR
Southern Regional Medical Center, Georgia
Judith A. Townsley, MSN, RN, CPAN
Christiana Care Health System, Delaware
Pat Thornton, MS, RN, CNOR
Southern Regional Medical Center, Georgia
Judith A. Townsley, MSN, RN, CPAN
Christiana Care Health System, Delaware
FREE CE!
4 The OR Connection
Page 36
Page 43
Page 76
Page 48
Page 89
Patient Safety
6 Three Important National Initiatives
for Improving Patient Care
24 Communication Dynamics and Patient
Safety in the Operating Room
28 In the Heat of the Moment: Malignant
Hyperthermia Calls for Action
48 Quantification of Anesthesia Providers’ Hand
Hygiene in a Busy Metropolitan Operating
Room: What Would Semmelweis Think?
OR Issues
10 Surgical Safety News
13 Five Ways to Improve Surgical Outcomes
36 Greening the OR
43 Lean Isn’t Just for Diets Anymore
58 Another Article About Safety Scalpels?
Yes, But There’s New Data
70 So You Really Think That Surface Is Clean?
Special Features
9 Medline Acquires Medisiss
11 Communication Between Surgical Services
and Sterile Processing
14 Something Wicked This Way Comes
63 Sterile Processing – A Lifetime Passion:
Q&A with Michele DeMeo
67 The Canvas: Portrait of a Life Well-Lived
80 Emma and SCIP Celebrate Breast Cancer
Awareness Month
84 Pink Glove Dance Video Competition 2012
Caring for Yourself
76 Get Rid of Worry Once and For All
89 Cooking Pink
92 Breast Cancer Myths
98 Healthy Eating: Lillian Stafford’s
Oriental Broccoli
Forms & Tools
101 Now You See It, Now You Don’t
102 Emergency Therapy for Malignant Hyperthermia
103 Malignant Hyperthermia Drill
104 Your 5 Moments for Hand Hygiene
105 Caring for Your Surgical Incision at Home
107 Sharps Safety Begins with You
"The Canvas” by Michelle DeMeo. See page 67.
Aligning practice with policy to improve patient care 5
I was sitting at a table in the front of the room and a friendly
looking woman asked me if she could take the seat beside
me. Her roommate at Congress went to the breakfast,
encouraging her to join in. But my new neighbor said
... ”I just couldn’t get out of bed that early.” Then she said,
something stirred inside her ... her roommate had lost a
friend to breast cancer and she felt she needed to get herself
out of bed and at least make an effort.
Although a bit late (which is probably why she ended up in
the front of the room looking for an empty seat), she was
grateful to be in attendance, and I was the fortunate recipi-
ent of her company. As the choreographer went through
the moves of the “live dance” there was a section where
you needed a dance partner. My “new friend” asked me if I
would be her partner.
We howled with laughter as we went through the moves over
and over again, each time with more animation and energy.
At the conclusion of the dance, my friend asked for my con-
tact info. It wasn’t long before she contacted me to tell me
that she was having a meeting with the staff at her hospital
to show them the dance and talk about the breakfast and
the incredible support of the many attendees.
This was last March. She still stays in contact, and now, her
hospital is doing a video for the Medline 2012 Pink Glove
Dance Video Competition. Recently, she asked if I would visit
her facility and talk to her staff. This from the woman who
wanted to stay in bed but later decided to “get up and get
moving and support something good.”
Several months ago, the perioperative director of a large and
prestigious hospital on the East coast contacted me about
a friend who had a terminal illness. This friend had written a
book, and he was wondering if I could help the friend com-
municate the book to peers. The terminal illness was ALS
(Lou Gehrig’s disease) and the “friend” was Michele Demeo
... who is now my friend also.
You know, “nobody gets out of here alive” ... but the things
we do to save lives and the things we do to support others
through tragedy of loss give us greater meaning than “a job.”
I especially want to recognize the four women on the cover
of this issue of The OR Connection and the many people
who stood in line to have their pictures taken! Each vote you
received was another acknowledgement and show of sup-
port to breast cancer victims and survivors alike.
I support my fabulous table partner at the AORN breakfast, I
am thankful that the perioperative director of that huge acute
care facility took the time to email me about his friend, and
I salute and thank Michele DeMeo, who wants to live the
rest of her days doing meaningful tasks and contributing.
Tragedy is always tragic ... but the spirit and soul of each
healthcare worker is much like a blessing ... nurturing oth-
ers, helping others and delivering care to both patients and
co-workers.
I salute you all,
Sue MacInnes, RD
Editor
The OR Connection
Letter from the Editor
Dear Reader,
Last year, at AORN’s 59th Congress in New Orleans, more than 1,000 OR nurses danced to Pink’s hit
single, “Raise Your Glass” ... at 5:00 in the morning. Picture a ballroom at the Hilton New Orleans filled with
people dancing, laughing, singing ... and even some standing on chairs encouraging their peers to “let their
hair down” and dance ... that was the scene at Medline’s 5th annual Breast Cancer Awareness Breakfast.
6 The OR Connection
Three Important National Initiatives for Improving Patient Care
Achieving better outcomes starts with an understanding of current patient-care initiatives. Here’s what you need to know about national
projects and policies that are driving changes in care.
Origin: Launched by the Institute for Healthcare Improvement (IHI) in January 2009
Purpose: To help hospitals improve patient care by focusing on an essential set of processes needed to
achieve the highest levels of performance in areas that matter most to patients.
Hospitals sign up through IHI and can choose to implement some or all of the recommended interventions.
IHI provides how-to guides and tools for all participating hospitals.
The IHI Improvement Map covers the entire landscape of outstanding hospital care to help hospitals make sense of countless
requirements and focus on high-leverage changes to transform care. There are 73 processes grouped into three domains:
leadership and management, patient care and processes to support care.
Origin: The development and updating of the National Patient Safety Goals (NPSGs)
is overseen by the Patient Safety Advisory Group.
Purpose: The NPSGs were established in 2002 to help accredited organizations address specific
areas of concern regarding patient safety.
Joint Commission-accredited organizations are evaluated for compliance with these goals. The Joint Commission offers
guidance to help organizations meet goal requirements.
Origin: Initiated in 2003 as a national partnership. Steering committee includes the following
organizations: CDC, CMS, ACS, AHRQ, AHA, ASA, AORN, VA, IHI and the
Joint Commission
Purpose: To improve patient safety by reducing postoperative complications
Goal: To reduce nationally by 25 percent the incidence of surgical complications by 2010
SCIP aims to reduce surgical complications in three target areas. Participating hospitals collect data on specific process and
outcome measures. The SCIP committee believes it could prevent 13,000 perioperative deaths and up to 300,000 surgical
complications annually (just in Medicare patients) by getting performance up to benchmark levels.
IHI Improvement Map 1
Joint Commission 2012-2013 National Patient Safety Goals2
Surgical Care Improvement Project (SCIP)3
Aligning practice with policy to improve patient care 7
IHI Improvement Map: 73 Processes to Transform Hospital Care
Surgical Care Improvement Project (SCIP): Target Areas
Joint Commission 2012-2013 National Patient Safety GoalsEffective January 1, 2012:
among caregivers
(decubitus ulcers)
Wrong Procedure, and Wrong Person Surgery.™
- Conduct a pre-procedure verification process.
- Mark the procedure site.
- A time-out is performed before the procedure.
Effective January 1, 2013:
Implement evidence-based practices to prevent
indwelling catheter-associated urinary tract
infections (CAUTI).
To learn more about National Patient Safety Goals, go to www.jointcommission.org.
To learn more about the IHI Improvement Map and the 73 processes to transform hospital care, go to www.ihi.org/imap/tool
1. Surgical infections
temperature management
2. Perioperative cardiac events
3. Venous thromboembolism
The Improvement Map aims to help:
Make care safer
Make patient care transitions smoother
Lead improvement efforts effectively
Reduce costs and increase quality
1. Adverse Drug Events
2. Catheter-Associated Urinary Tract
Infections (CAUTIs)
3. Central Line-Associated Blood-
stream Infections (CLABSIs)
4. Injuries from Falls and Immobility
5. Obstetrical Adverse Events
6. Pressure Ulcers
7. Surgical Site Infections
8. Venous Thromboembolism
9. Ventilator-Associated Pneumonia
Helping hospitals improve in nine core focus
areas identified by Partnership for Patients
Visit www.qualitynet.org
8 The OR Connection
Contributing Writers
Beth Boynton, MS, RN
Beth Boynton is an organizational development consultant specializing in issues that
affect nurses and other healthcare professionals. She is a national speaker, coach,
facilitator and trainer for topics related to communication, conflict management, team-
building and leadership development and author of the book, Confident Voices: The
Nurses’ Guide to Improving Communication & Creating Positive Workplaces.
Wolf Rinke, RD, CSP
Keynote speaker, seminar leader, management consultant, executive coach and editor
of the free electronic newsletter Read and Grow Rich, available at www.easyCPEcred-
its.com. In addition he has authored numerous CDs, DVDs and books including Make
It a Winning Life: Success Strategies for Life, Love and Business, Winning Manage-
ment: 6 Fail-Safe Strategies for Building High-Performance Organizations. Reach him
Atul Gawande, MD
Atul Gawande is a surgeon, writer, and public health researcher. He practices general
and endocrine surgery at Brigham and Women’s Hospital in Boston. He is also Profes-
sor of Surgery at Harvard Medical School and Professor in the Department of Health
Policy and Management at the Harvard School of Public Health. He has written several
books, including The Checklist Manifesto and serves as lead advisor for the World
Health Organization’s Safe Surgery Saves Lives program, which developed the Safe
Surgery Checklist.
Michelle DeMeo
Michele DeMeo is an expert in the sterile processing field who is highly regarded
for her management techniques, product development and contributions to various
healthcare associations and professional publications. She is now tackling another
important role – learning to live well in the face of a terminal illness.
Katie Beam, DNP, RN, ACNS-BC, CWS
Katie Beam is an ANCC Board-Certified Adult Clinical Nurse Specialist and Ameri-
can Academy of Wound Management Certified Wound Care Specialist supporting the
Emergency, Intensive Care, Oncology, Medical Surgical, Pediatric and Maternal Child
departments at Woodland Healthcare. She received her Associate Degree in Nursing
from Shasta College in 1985, her BSN and MSN from California State University, Sac-
ramento, and her Doctorate in Clinical Nursing Practice from the University of Colorado,
Denver. She has been with Dignity Health since 1985.
Joan Ferrara, BA, RN, CNOR
Joan Ferrara has 31 years of experience in various roles in the operating room, including
serving as assistant vice president of surgical services, perioperative services director,
OR nurse manager and OR staff nurse. She has also served as a certified surgical
technologist.
With every customer we strive diligently to:
2 Maintain the highest industry
standards to provide
reprocessed SUDs at half the
cost of new devices without
sacrificing level of performance.
3 Offer you the opportunity to
save operating capital while
reusing devices that would
otherwise be discarded.
4 Continue to demonstrate to
you that reprocessed devices
are as safe and functional as
brand new ones.
5 Assist you in your efforts
as both a conscientious
health provider and a good
steward of the environment.
6 Become one of your
most trusted providers
of SUDs, substantially
improving your bottom
line and overall patient
care in the process.
1 Employ the highest environmental
safeguards to ensure that optimum
infection and decontamination
control processes underscore our
reprocessing of your medical devices.
Medline Acquires Medisiss Surgical Instrument Reprocessing Company
Breaking News
Medline is pleased to announce that we are continuing to expand our
business with the acquisition of Medisiss, a leading surgical instrument
reprocessing company with whom we’ve successfully partnered for the last
two years. With this acquisition, we hope to expand and strengthen our
business with OR teams in both the hospital and surgery center markets.
Medisiss will retain its brand identity and company name and will operate as
a wholly owned subsidiary of Medline headquartered in Redmond, Oregon.
About MEDISISS
Our Commitment to You
greensmart™ is not a third-party certification. The use of the
greensmart™ trademark is determined by Medline Industries, Inc.
through an internal review process of environmental claims.
10 The OR Connection
The Food and Drug Administration (FDA), Centers for Disease
Control and Prevention (CDC), Occupational Safety and Health
Administration (OSHA) and the National Institute of Occupa-
tional Safety and Health (NIOSH), are strongly encouraging
healthcare professionals to use blunt-tip suture needles instead
of standard suture needles to suture fascia and muscle. Using
blunt-tip suture needles decreases the risk of needlestick injury
and exposure to bloodborne pathogens such as hepatitis B,
hepatitis C and HIV.
Published studies show that using blunt-tip suture needles cuts
the risk of needlestick injuries by 69 percent. Although blunt-
tip needles cost about 70 cents more than standard suture
needles, the benefits of reducing bloodborne infections justify
the extra expense.
Surgical Safety News
Safety Organizations
Recommend Blunt-Tip
Suture Needles1
Past Skin Infections
Can Predict SSIs2
A new study by researchers at Johns Hopkins School of Medi-
cine shows that people who have a single skin infection are
three times more likely to develop a surgical site infection.
The increased risk suggests there are underlying biological dif-
ferences in the way individuals respond to skin cuts that need
to be better understood in order to prevent SSIs. Even when all
of the proper procedures known to prevent SSIs are followed
— from administering preoperative antibiotics to using the
correct antiseptic to prepare the skin during surgery — some
patients appear to be much more susceptible than others to
contracting an infection.
Although the research does not establish a cause-and-effect
relationship between a past skin infection and SSI, the research
team says the association between them is strong and should
not be ignored.
In the study, researchers analyzed information before, during
and after surgery for 613 patients, with an average age of 62.
Twenty-four patients developed an SSI within 180 days of sur-
gery, and five of them died from the condition. Another 15 died
from noninfectious causes. Of those who had a history of skin
infection, 6.7 percent got an SSI compared with 3.9 percent of
those without a history of skin disease. It made no difference
whether the skin infection was recent or had occurred years
earlier. Researchers also took into account and adjusted for
other known risk factors for SSI, including the patient’s age, a
diagnosis of diabetes and certain medications they were taking.
References
1. McGraw M. FDA recommends blunt-tip suture needles. Outpatient Surgery
E- Weekly. June 5, 2012. Available at: http://www.outpatientsurgery.net/newsletter/
eweekly/2012/06/05#1. Accessed July 19, 2012.
2. Surgical site infections more likely in patients with history of skin infection [press
release]. Baltimore, MD: Johns Hopkins Medicine; May 29, 2012. Available at: http://
www.hopkinsmedicine.org/news/media/releases/surgical_site_infections_more_likely_
in_patients_with_history_of_skin_infection. Accessed July 19, 2012.
Aligning practice with policy to improve patient care 11
Communication BetweenSurgical Services & Sterile Processingby Michele DeMeo
Sterile Processing Corner
This is especially true when there are barriers in the way, such
as differing educational levels or experience. Communication
can be hampered when we are unable to see the other
person’s perspective for any number of reasons. For example,
miscommunication commonly occurs between surgical
services and the sterile processing department.
If your department has a sound communication system in
place, that’s terrific. If it could use some work or tweaking,
consider making some improvements. Ignoring trouble will
foster more of the same. Implementing even a single change
just might become the impetus for long-lasting, incremental
improvement. And that’s just when successful partnerships
become not just possible, but probable!
This is the first in a series of 8 columns written by Michele
DeMeo, a sterile processing expert with more than 20 years
of experience in this field.
Before reacting, consider for a moment, “What could
the other person have been thinking?” There could
be a very logical reason for their action or statement. It just
may not be logical to you. Allow for the possibility that the
communicator had good intentions, but the outcome was
less than favorable because perception or understanding of
instructions were not clear due to differences in communi-
cation style, experience, education, environment or various
other circumstances.
Mitigate the risk for future communication mishaps by
being proactive now. Invite sterile processing employees to
your morning huddles to give them a real visual and audio
impression of your stress and environment. This can also
serve as a means for members from both teams to ask ques-
tions or convey any impromptu scheduling or case changes.
Consider holding joint educational sessions. The same
type of information isn’t always needed by both units, but it
helps add depth to the other party’s understanding of each
others’ responsibilities and the complexities of their work.
Surgical services staff would benefit from firsthand under-
standing of the conditions, challenges and complex tasks
faced by sterile processing and vice versa.
Consider creating a quarterly newsletter or memo
written jointly by the two department managers. The
newsletter could include tips, congratulations and system
wide initiatives. It might just engage the groups to begin to
help see each other as peers and become a support a
system for collaboration.
Sometimes the most common words and
definitions are the hardest to convey or
apply. The topic of “communication” is
discussed frequently, but often executed
poorly. Many believe they speak, write
or even give direction in the clearest way.
However, people are unique, and as unique
as every person is, so are their styles of
communication. Unfortunately, at some
of the most critical times, breakdowns in
communication make matters worse.
Here are a few tips to consider when
trying to deal with miscommunication
with the sterile processing department:
Editor’s Note:
Join 280,000 other nurses for FREE CE courses at
Medline University
��220 courses��22 curriculum tracks��Interactive competencies��Flexible access: PC, iPhone, iPad��Free registration
©2012 Medline Industries, Inc. Medline and Medline University
are registered trademarks of Medline Industries, Inc.www.medlineuniversity.com
Quiet, please!General surgery residents
made major surgical
errors during eight of 18
simulated procedures
when they were interrupted
by questions or sidebar
conversations in the OR. 2
Use eyewear only onceDisposable protective glasses are a must in the
OR, but they should be discarded after every case.
Wearing glasses a second time raises the risk for
pieces of the glasses flaking off and entering the
sterile field.5 The glasses also may have lingering
pathogens on them from the previous case.
Know your antibiotics Improving the timing and selection of
antibiotics prior to skin incision can reduce the
rate of surgical site infections by up to 50%.4
1. Buxman K. Turn up the tunes in the operating room: studies show that music
improves surgical outcomes. Outpatient Surgery Magazine Online. July 2012: 75.
Available at: www.outpatientsurgery.net/article-archive. Accessed August 14, 2012.
2. Feuerbacher RL, Funk KH, Spight DH, Diggs BS, Hunter JG. Realistic distractions and
interruptions that impair simulated surgical performance by novice surgeons. Archives
of Surgery. 2012 Jul 16:1-5. [Epub ahead of print]. Available at: http://www.ncbi.nlm.
nih.gov/pubmed/22801787. Accessed August 14, 2012.
3. Johns Hopkins Patient Safety Pilot Program slashes colorectal surgical site infections
(SSIs) by 33 percent: researchers estimate similar interventions nationwide could save
more than $100 million annually [press release]. Baltimore, MD: Johns Hopkins
Hospital; July 30, 2012. Available at: http://www.hopkinsmedicine.org/news/media/
releases/johns_hopkins_patient_safety_pilot_program_slashes_colorectal_surgical_
site_infections_ssis_by_33_percent. Accessed August 14, 2012.
4. World Health Organization. 10 Facts on Safe Surgery. Available at: http://www.who.int/
features/factfiles/safe_surgery/en/index.html. Accessed August 15, 2012.
5. DiNobile C. 6 pieces of the barrier protection puzzle. Outpatient Surgery Magazine
Online. January 2012: 26-29. Available at: www.outpatientsurgery.net/article-archive
<http://www.outpatientsurgery.net/article-archive> . Accessed August 16, 2012.
Soothing tunesWhen Frank Sinatra, Vivaldi or
Beethoven were played during surgical
procedures performed under local
anesthesia, patients had less anxiety
and lower respiratory rates.1
Ways to Improve Surgical Outcomes5 Speak up
and reduce SSIs Empowering OR team
members to use a simple safety
checklist and encouraging them
to speak up if something seems
wrong reduced surgical site
infections by one-third.3
References
Aligning practice with policy to improve patient care 13
14 The OR Connection
Aligning practice with policy to improve patient care 15
SOMETHING WICKED THIS WAY COMESby Atul Gawande
June 28, 2012
The New Yorker
A few days ago, while awaiting the Supreme Court’s ruling on President
Obama’s health-care law, I called a few doctor friends around the country.
I asked them if they could tell me about current patients whose health
had been affected by a lack of insurance.
Copyright © 2012 Conde Nast. All rights reserved. Originally published in The New Yorker. Reprinted by permission.
“This falls under the ‘too numerous to count’ sec-
tion,” a New Jersey internist said. A vascular surgeon
in Indianapolis told me about a man in his fi fties
who’d had a large abdominal aortic aneurysm. Doctors
knew for months that it was in danger of ruptur-
ing, but since he wasn’t insured, his local private
hospital wouldn’t fi x it. Finally, it indeed began to
rupture. Rupture is an often fatal development, but
the man—in pain, with the blood fl ow to his legs
gone—made it to an emergency room. Then the
hospital put him in an ambulance to Indiana Uni-
versity, arguing that the patient’s condition was “too
complex.” My friend got him through, but he’s very
lucky to be alive.
Another friend, an oncologist in Marietta, Ohio,
told me about three women in their forties and fi f-
ties whom he was treating for advanced cervical
cancer. A Pap smear would have caught their can-
cers far sooner. But since they didn’t have insur-
ance, their cancers were recognized only when they
caused profuse bleeding. Now the women required
radiation and chemotherapy if they were to have a
chance of surviving.
16 The OR Connection
A colleague who practices family medicine in Las Vegas told me
about his clinic’s cleaning lady, who came to him in desperation
about her uninsured husband. He had a painful rectal fi stula—a
chronically draining infection. Surgery could cure the condition,
but hospitals required him to pay for the procedure in advance,
and, as unskilled laborers, the couple didn’t have the money.
He’d lived in misery for nine months so far. The couple had no-
where to turn. Neither did the doctor.
The litany of misery was as terrible as it was routine. An internist
in my Ohio home town put me on the phone with an uninsured
fi fty-fi ve-year-old tanning-salon owner who’d had a heart attack.
She was now unable to pay the bills for the cardiac stent that
saved her and for the medications that she needs in order to
prevent a second heart attack. Outside Philadelphia, there was
a home-care nurse who’d lost her job when she developed par-
tial paralysis as a result of a rare autoimmune complication from
the fl u shot that her employers required her to get. Then she
lost the insurance that paid for the medications that had been
reversing the condition.
Tens of millions of Americans don’t have access to basic care for
prevention and treatment of illness. For decades, there’s been
wide support for universal health care. Finally, with the passage
of Obamacare, two years ago, we did something about it. The
law would provide coverage for people like those my friends
told me about, either through its expansion of Medicaid eligibil-
ity or through subsidized private insurance. Yet the country has
remained convulsed by battles over whether we should imple-
ment this plan—or any particular plan. Now that the Supreme
Court has largely upheld Obamacare, it’s tempting to imagine
that the battles will subside. There’s reason to think that they
won’t.
In 1973, two social scientists, Horst Rittel and Melvin Webber,
defi ned a class of problems they called “wicked problems.”
Wicked problems are messy, ill-defi ned, more complex than we
fully grasp, and open to multiple interpretations based on one’s
point of view. They are problems such as poverty, obesity, where
to put a new highway—or how to make sure that people have
adequate health care.
They are the opposite of “tame problems,” which can be crisply
defi ned, completely understood, and fi xed through technical so-
lutions. Tame problems are not necessarily simple—they include
putting a man on the moon or devising a cure for diabetes. They
are, however, solvable. Solutions to tame problems either work
or they don’t.
Solutions to wicked problems, by contrast, are only better or
worse. Trade-offs are unavoidable. Unanticipated complica-
tions and benefi ts are both common. And opportunities to learn
by trial and error are limited. You can’t try a new highway over
here and over there; you put it where you put it. But new issues
will arise. Adjustments will be required. No solution to a wicked
problem is ever permanent or wholly satisfying, which leaves
every solution open to easy polemical attack.
Two decades ago, the economist Albert O. Hirschman pub-
lished a historical study of the opposition to basic social
Tens of millions of Americans don’t have access to
basic care for prevention and treatment of illness.
Aligning practice with policy to improve patient care 17
advances; “the rhetoric of intransigence,” as he put it. He
examined the structure of arguments—in the eighteenth cen-
tury, against expansions of basic rights, such as freedom of
speech, thought, and religion; in the nineteenth century, against
widening the range of citizens who could vote and participate in
government; and, in the twentieth century, against government-
assured minimal levels of education, economic well-being, and
security. In each instance, the reforms aimed to address deep,
pressing, and complex societal problems—wicked problems, as
we might call them. The reforms pursued straightforward goals
but required inherently complicated, difficult-to-explain means
of implementation. And, in each instance, Hirschman observed,
reactionary argument took three basic forms: perversity, futility,
and jeopardy.
The perversity thesis is that the change will not just fail but make
the problem worse. The futility thesis is that the change can’t
make a meaningful difference, and therefore won’t be worth
the effort. We hear both of these lines of argument against the
health-care-reform law. By providing coverage for everyone,
it will drive up the system’s costs and make health care unaf-
fordable for even more people. And, some say, people can get
care in emergency rooms and through charity, so the law won’t
do any real good. In fact, a slew of evidence indicates other-
wise—from the many countries that have both universal cover-
age (whether through government or private insurers) and lower
per-capita costs; from the major improvements in health that
uninsured Americans experience when they qualify for Medicare
or Medicaid. The reality is unavoidable for anyone who notices
what it’s like to be a person who develops illness without insurance.
The jeopardy thesis is that the change will impose unaccept-
able costs upon society—that what we lose will be far more
precious than what we gain. This is the sharpest line of attack in
the health-care debate. Obamacare’s critics argue that the law
will destroy our economy, undermine health care for the elderly,
dampen innovation, and infringe on our liberty. Hence their
efforts to persuade governors not to cooperate with the pro-
gram, Congress not to provide the funds authorized under the
law, and the courts to throw it out altogether.
The rhetoric of intransigence favors extreme predictions, which
are seldom borne out. Troubles do arise, but the reforms evolve,
as they must. Adjustments are made. And, when people are
determined to succeed, progress generally happens. The real-
ity of trying to solve a wicked problem is that action of any kind
presents risks and uncertainties. Yet so does inaction. All that
leaders can do is weigh the possibilities as best they can and
find a way forward.
They must want to make the effort, however. That’s a key factor.
The major social advances of the past three centuries have re-
quired widening our sphere of moral inclusion. During the nine-
teenth century, for instance, most American leaders believed in
a right to vote—but not in extending it to women and black
people. Likewise, most American leaders, regardless of their
politics, believe that people’s health-care needs should be met;
they’ve sought to insure that soldiers, the elderly, the disabled,
and children, not to mention themselves, have access to good
care. But many draw their circle of concern narrowly; they con-
tinue to resist the idea that people without adequate insurance
are anything like these deserving others.
And so the fate of the uninsured remains embattled—vulner-
able, in particular, to the maneuvering for political control. The
partisan desire to deny the President success remains powerful.
Many levers of obstruction remain; many hands will be reaching
for them.
For all that, the Court’s ruling keeps alive the prospect that our
society will expand its circle of moral concern to include the
millions who now lack insurance. Beneath the intricacies of the
Affordable Care Act lies a simple truth. We are all born frail and
mortal—and, in the course of our lives, we all need health care.
Americans are on our way to recognizing this. If we actually
do—now, that would be wicked.
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Why are people often afraid to tell the truth in the OR? A compelling discussion on the
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24 The OR Connection
COMMUNICATION
DYNAMICS
Aligning practice with policy to improve patient care 25
Insights for surgeons, nurses, patient advocates and administrative leaders
AND PATIENT SAFETY IN THE OPERATING ROOM
By Beth Boynton, MS, RN
Self-reflection, ownership and respectful communi-
cation are examples of “soft” skills that are extremely
hard to develop and practice. Yet, the surgeon or nurse
manager who can teach the right way of doing some-
thing without humiliating a team member will show
everyone that respect is guaranteed, skills and knowl-
edge are required to work in the OR, and passive ag-
gressive behavior will not be rewarded with alignment.
Not long ago in preparing an interactive workshop on
communication and assertiveness for a chapter for
the Association of periOperative Registered Nurses
(AORN), I asked their educational committee to share
their most common communication challenges so that
we could make our time as meaningful as possible.
They replied with four scenarios.
These scenarios reveal layers of interwoven relationship
patterns that are fraught with horizontal and vertical vio-
lence. Add to that more innocent unawareness about
individual behaviors and their impact on others, along
with lack of skills in self-reflection and expression, and
the complexity of interactions and ramifications begins
to emerge.
Your teammate purposefully holding back
information about a surgery to make you look bad
in front of the surgeon.
Surgeon yelling that s/he wants someone in the
OR who “knows what they are doing.”
Purposeful negative discussion about you in the
operating room by other team members without
including you in the conversation.
Surgeon compromises patient safety either by
surgical technique, not wanting to wait for “Time-
Out” or not wanting to wait for counts at the end
of the procedure (especially when counts are incor-
rect), and ignores or becomes angry when you
request him or her to consider the information
presented.
1
2
3
4
Do these scenes sound familiar?
Continued on page 27
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Consider these questions
Aligning practice with policy to improve patient care 27
Team members vying for approval and leaders who are some-
how gratified by giving or withholding approval are participating
in relationship patterns that contribute to adverse events. With-
holding information, setting up a colleague to work in a position
without appropriate training and experience or using humiliating
language and tone are not in the patients’ best interests.
As human beings, I believe we all want and deserve to feel
respected and have a sense of power. Yet in our culture, some
members and professions are valued more than others. This
imbalance chips away at everyone’s self esteem and contrib-
utes to complex feelings and behaviors involving frustration and
resentment.
In addition, relentless stress, gender, ego and self-esteem fac-
tors help set the stage for such aggressive, passive-aggressive
or passive ways of obtaining power.
I hate to think of my colleagues in the nursing and medical pro-
fessions behaving in these ways, yet I also feel a little defensive.
I know how I feel along the course of a highly stressed shift as a
per diem RN on an Alzheimer’s unit. I can practically watch my
best self disintegrate with relentless alarms, interruptions,
dementia behaviors, changing priorities and chronic understaff-
ing. I’m pretty good at owning and apologizing for any irritability,
but that may be after a sarcastic or short-tempered remark.
Despite the fact that I can empathize with poor conduct, I pas-
sionately believe that individuals and organizations can do better.
Even under pressure, a mistake requiring an immediate substi-
tution of staff can be handled with respect. A statement such as,
“I need trained OR assistance, now!” is quite different from, “Get
someone in here who knows what they are doing!” They both
get the same problem addressed, but the first statement brings
up an organizational responsibility regarding training, while the
second is more blaming of the individual. Making sure the situa-
tion is followed up as soon as possible after surgery by debrief-
ing with the surgeon, nurse manager and staff will identify train-
ing problems, seek solutions and practice giving and receiving
constructive feedback.
Whenever I hear about situations like these, I look for individual
and organizational factors. Solutions that consider less blaming
are more likely to lead to long-term, meaningful change. Admin-
istrative leaders have a responsibility to advocate for resources
required to focus on communication training, opportunities to
practice skills and recognizing learning curves. Individuals have
a responsibility to seek help, acknowledge limitations and de-
velop their skills. Not everyone is cut out to work in the OR, (or
on an Alzheimer’s unit) and career coaching and/or discipline
also may be necessary.
I don’t know exactly what respectful communication looks like
in the operating room, but I suspect there is a unique opportu-
nity for peri-op professionals to define, develop and practice it.
Facilitated discussion among OR staff about the following ques-
tions could be a rich process.
Positive outcomes such as creating new norms, safer sur-
gery, increased collaboration, personal and professional growth
and improved morale are all possible!
Team members vying for approval and leaders who
are somehow gratified by giving or withholding approval
are participating in relationship patterns that contribute
to adverse events.
1
2
3
What does respectful communication look like
in the OR?
What makes it challenging or different here?
What do we need to do to practice it?
28 The OR Connection
Aligning practice with policy to improve patient care 29
Clinicians, particularly nurses, working with patients during or after surgery understand that an emergency situation with a patient who has malignant hyperthermia (MH) instantly can become a matter of life or death. As a result, nurses should be aware of the signs and symptoms that identify malignant hyperthermia and know how to respond immediately and appropriately.1 The challenge for these clinicians, then, is assessing accurately which patients may have or be susceptible for having this rare condition and preparing adequately to handle any case of malignant hyperthermia before it becomes catastrophic for a patient and his or her family.
The information in this article provides an overview of malignant hyperthermia, describes how nurses can prepare an effective malignant hyperthermia cart for use in their facilities and encourages nurses to connect patients and their families with appropriate resources about MH. Familiarity with this type of knowledge is crucial for staff members caring for patients who have received general anesthesia.1
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Malignant Hyperthermia Calls for Action
30 The OR Connection
MANAGING MALIGNANT HYPERTHERMIAFortunately, we have not had a malignant hyperthermia (MH) case at Woodland for more than ten years. Nevertheless, we perform several drills every year and require nurses in the Perioperative, Emergency Department, Maternal Child and Intensive Care Unit (ICU) to complete 90 minutes of an annual MH Competency training that includes hands-on mixing of Dantrolene, and observation of a mock drill video from MHAUS. We also keep one fully stocked MH cart in our surgical services department and another one in our outpatient surgery center, which is located in a separate building adjacent to the hospital. The two carts are set up exactly the same way and each drawer of the MH cart is standardized to provide quick and easy access for needed supplies in an MH emergency. A laminated copy of the cart contents is kept on the top of each MH cart for reference and the drawers are labeled on the outside to assist the staff, and minimizes confusion. This is because many staff float between the surgery center and the main hospital OR. In addition, Dignity Health recently implemented the identical MH cart, educational program, policies, and procedures at their sister hospitals in the greater Sacramento/San Joaquin region of California.
When a malignant hyperthermia (MH) episode occurs, we make an announcement on the overhead page system, “Your attention please, Malignant Hyperthermia Alert (location)” which prompts the nurse supervisor to locate the MH cart and bring it to the patient location within five minutes. Although MH often occurs in the OR, it could also
occur in the emergency department (ED), intensive care unit or in the maternal/child unit in mothers who have Cesarean sections. We recently performed a drill with a mock MH patient in the ED, and the nursing supervisor arrived with the MH cart in two minutes and 45 seconds. Our next drill this year will involve a mock patient in the surgery center. The drill will involve the use of the MH cart for a patient in the recovery area of the surgery center and then test our system of communication and teamwork after stabilization from the initial MH event and transporting the patient to the emergency department at the hospital. From there, the MH patient will be admitted to the ICU for observation because 25 percent of patients who experience MH can have a spontaneous recurrence within 48 hours of the first episode. For this reason, all patients with MH must stay in the ICU for at least 48 hours after being treated and stabilized.
Getting Dantrolene to our patient within the five-minute window, and making certain that our staff feels confident in recognizing and treating MH is a priority to our organization because treating MH is all about speed. MH occurs suddenly and affects multiple body systems simultaneously; the muscles, the heart, the brain, and the kidneys. Knowing how to recognize MH, how to prioritize treatments, understanding their roles in the care of the patient and how important it is to get Dantrolene on board quickly to reverse the hypermetabolic state that initiates the deadly MH cascade, will give our patients their best chance for survival.
at Dignity Health Woodland Healthcare, Woodland, CA
Aligning practice with policy to improve patient care 31
Drawer 1
Drawer 2
Drawer 3
Drawer 4
Drawer 5
Woodland Healthcare MH Cart Contents
3
1
2
5
4
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Aligning practice with policy to improve patient care 33
Recognizing malignant hyperthermia
Malignant hyperthermia is a genetic disorder and a
hypermetabolic, or biochemical chain reaction, response.2,3
Susceptible patients undergoing surgery may exhibit signs of
malignant hyperthermia if they are exposed to the “trigger”
muscle relaxant succinylcholine and select inhalation agents
such as desflurane, enflurane, halothane, isoflurane, and
sevoflurane.2-4
The symptoms of MH can be very specific and include muscle
rigidity, increased CO2 production, and fever escalating to
105 degrees F or higher.3,5 Masseter spasm, which manifests
as jaw muscle rigidity and corresponds with limb muscle
flaccidity after succinylcholine has been given, often is the first
sign of malignant hyperthermia.6 It is important for clinicians
to know that all patients who have had even mildly increased
jaw tension should be observed carefully for signs of MH for
at least 12 hours.6 Non-specific symptoms of MH can include
tachycardia, tachypnea, metabolic and respiratory acidosis
and hyperkalemia.3,5 Severe complications associated with
MH include cardiac arrest, brain damage, internal bleeding or
failure of other body systems, and even death.3
How common is malignant hyperthermia?
It is estimated that for every 5,000 to 50,000 patients who
are given anesthetic gases, one patient may have malignant
hyperthermia.7 Malignant hyperthermia is inherited in an
autosomal dominant pattern,3,7 which means that an affected
person usually inherits the altered gene from a parent who also
is at risk for malignant hyperthermia.7 Carriers of the gene for
MH may be unaware they have this risk unless they are aware
of whether any of their family members has experienced MH
after receiving anesthesia in the past.3
If malignant hyperthermia is suspected, it is essential for the
nurse to get a thorough history of a patient’s experiences with
anesthesia as well as any notable experiences that the patient’s
close family members may have had with anesthesia.8
The Malignant Hyperthermia Cart
Health care facilities that use general anesthesia that could
trigger MH must have a kit or a cart that contains all of
the items needed to manage MH readily available.1,6,9 A
basic MH kit or cart should include the following items1,6:
Dantrolene, sterile water sufficient to dilute Dantrolene,
D50, antiarrythmics, calcium chloride, sodium bicarbonate,
insulin and furosemide.
In addition, the items needed for patient monitoring include
EKG, blood pressure, temperature, pulse oximeter and
capnograph. It is also helpful to have an ice machine, a
refrigerator, cooled intravenous fluids and cool blankets close
at hand so these items can be used quickly to help lower the
patient’s body temperature.1,6,9
To practice how to use the items on the cart efficiently, it can
be helpful for facilities to plan annual staff education to refresh
their knowledge on MH and the procedures for recognizing
and treating MH, and implementing a series of regular,
planned mock “MH drills” that involves many health care
team members. These drills enable all of the team members
to practice providing the urgent care needed for a patient
experiencing MH before an emergency arises.6 Because it can
be difficult to dilute Dantrolene, especially on the first attempt
at doing so, all staff members should be given an opportunity
to practice diluting Dantrolene by using outdated vials of the
drug during an MH drill.6 Staff members should check the MH
cart routinely to remove expired supplies and replace them.1
The Malignant Hyperthermia Association of the United States
(MHAUS) is an organization whose mission is to promote
optimum care and scientific understanding of malignant
hyperthermia and related disorders. MHAUS offers posters
and wallet cards containing concise protocols that can be
disseminated to staff or used during a drill or an educational
session.1
The MH drill could mimic an MH crisis, which would require
the staff to call the MH 24-hour hotline (emergencies only):
1-800-644-9737 (United States) or 00+1+303+389+1647
(outside the United States). Also, the drill could incorporate
practicing the START emergency therapy for MH Acute Phase
Treatment, as recommended by MHAUS.9
34 The OR Connection
Resources for patients and families
affected by malignant hyperthermia
MHAUS has a variety of patient resources that can be
accessed online or by attending a support group or meeting.11
Patients and families who have faced malignant hyperthermia,
or who may recently have learned that they carry the gene
for MH may find helpful information through this organization6
and by reading about and connecting with others who have
experienced situations with MH. MHAUS manages a registry
that keeps records of the family health histories and test
results of patients with MH; the organization uses these data
to conduct relevant research about malignant hyperthermia.11
Today’s techno-savvy patients and family members are
always looking for reliable sources of medical information
online. To help these patients find the type of electronically
engaging yet technically sound information they are seeking,
nurses might want to suggest that patients and family
members view the videos about MH that MHAUS has posted
on its website. 12 By watching these videos, patients and their
families will learn valuable information; also, it is interesting to
note that MHAUS highlights the important role that nurses
play in caring for patients with MH.12
REFERENCES
1. Mitchell-Brown F. Malignant hyperthermia: turn down the heat. Nursing
2012;42(5):39-44.
2. Kaplow R. Care of postanesthesia patients. Crit Care Nurse 2010;30(1):
60-62.
3. Malignant Hyperthermia Association of the United States. What is MH?
www.mhaus.org/mhaus-faqs-healthcare-professionals/what-is-malignant-
hyperthermia/#.UBGhWTFS. Accessed July 28, 2012.
4. Rosenberg H, Sambuughin N, Dirksen R. Malignant hyperthermia
susceptibility. 2003 Dec 19 (updated 2010 Jan 19). In: Pagon RA, Bird
TD, Dolan CR, et al., eds. GeneReviews [Internet]. Seattle: University of
Washington; 1993-. http://www.ncbi.nlm.nih.gov/books/NBK1146/.
Accessed July 27, 2012.
5. Medline Plus, U.S. National Library of Medicine, National Institutes of Health.
Malignant hyperthermia. www.nlm.nih.gov/medlineplus/ency/article/00135.
htm. Accessed July 27, 2012.
6. Greco RJ. Malignant hyperthermia: what are the first signs? The ASF Source;
2008;Summer:1,10.
7. Genetics Home Reference, a service of the U.S. National Library of
Medicine. Malignant hyperthermia. www.ghr.nlm.nih.gov/condition/
malignant-hyperthermia/show/. Accessed July 27, 2012.
8. Rosenberg H, Davis M, James D, Pollock N, Stowell K. Malignant
hyperthermia. Orphanet J Rare Dis 2007;2(1):21.
9. Hutton D. Malignant hyperthermia: part 1. Plast Surg Nurs 2011;31(1):23-26.
10. Malignant Hyperthermia Association of the United States. Healthcare
Professionals: During an MH Crisis. www.mhaus.org/healthcare-
professionals/#.UBS1EEShDkR. Accessed July 28, 2012.
11. Malignant Hyperthermia Association of the United States. Patients and
families. www.mhaus.org/patients-and-families/#.UBLFq0RaPkR. Accessed
July 27, 2012.
12. Malignant Hyperthermia Association of the United States. Videos. www.
mhaus.org/videos/#.UBS17UShDkQ. Accessed July 28, 2012.
Get help. Get Dantrolene. Notify surgeon.
Inject Dantrolene sodium 2.5 milligrams/
kilogram rapidly intravenously through a
large-bore IV, if possible.
Provide a bicarbonate for metabolic acidosis.
Cool the patient.
Address dysrrhythmias: usually respond to
treatment of acidosis and hyperkalemia.
Address hyperkalemia.
Follow this testing sequence: ETOC2,
electrolytes, blood gases, CK, serum
myoglobin, core temperature, urine
output and color, and coagulation studies.
MH Drill Protocols
SCIP #9 SAYS REMOVE THE CATHETER.
INSERTAG TELLS YOU WHEN.
Reference
1 Saint S, Kaufman SR, Thompson M, Rogers MA, Chenoweth CE. A reminder reduces urinary catheterization in
hospitalized patients. Jt Comm J Quality Patient Saf. 2005; 31(8): 455-462
2 Patient Safety Quality Measures for the Surgical Care Improvement Project (SCIP). Health Services Advisory Group.
Available at: http://qualitymeasures.ahrq.gov/content.aspx?f=rss&id=16275. Accessed December 7, 2010.
3 Guideline for Prevention of Catheter-associated Urinary Tract Infections, 2009. Centers for Disease Control and Prevention.
Available at: http://www.cdc.gov/hicpac/cauti/001_cauti.html. Accessed December 7, 2010.
©2012 Medline Industries, Inc. Medline is a registered trademark and InserTag is a trademark of Medline Industries, Inc.
SCIP Measure #9 recommends removal of urinary
catheters in surgical patients by postoperative day one
or two,1 and CDC guidelines advise prompt removal of
catheters.2 However, 74 percent of hospitals do not keep
track of how long patients have catheters in place!3
Medline’s Foley InserTag is a sticker that goes on each
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36 The OR Connection 36 The OR Connection
ORGreening the
Aligning practice with policy to improve patient care 37
By Francesca Olivier
Greening the OR Can Yield Cost Savings and Healthier Communities
Background
Pollution is a serious public health concern that affects every-
one, but it especially affects vulnerable populations such as the
elderly, sick, children and the poor. At Medline we feel that
preserving a healthy planet for future generations is not only the
right thing to do, but it is our responsibility as leaders in the
healthcare industry to do our part.
Going green in the OR is one area of critical importance to Med-
line. We have developed the greensmart™ Program, a unique
environmental training and education initiative designed to help
health care facilities reduce costs, increase patient care and
build healthier communities. A significant component of the
program is a comprehensive roadmap that will help facilities
develop a baseline for OR energy use and waste streams. The
roadmap also provides facilities solutions on how to improve
performance.
The Problem
Operating rooms generate an enormous amount of trash –
about 20-30% of a hospital’s total waste – and account
for 86% of total hospital disposal costs. Since so much of a
hospital’s waste is generated in the OR, it is not a surprise that
many hospital green teams begin with OR nurses. In the chaos
of the OR, packaging and general trash often end up in regu-
lated medical waste (RMW), or red bag waste, even though it
doesn’t need to be there. A Johns Hopkins study found that as
much as 90% of what is thrown in red bag waste does not actu-
ally meet the criteria for regulated medical waste (RMW).
This represents an enormous opportunity not only for
improved environmental impact, but also for cost savings
through reduced RMW. Because of the sheer volume of sup-
plies that pass through the OR, small incremental changes can
add up to significant overall impacts. These impacts are both
environmental and economic. Waste reduction reduces both
immediate and ongoing disposal costs, while it reduces carbon
emissions and the need for landfills and their associated risks.
The Approach
With Medline’s greensmart™ sustainability program health
care facilities have options in addressing sustainability chal-
lenges: facilities can execute the program on their own with the
greensmart™ Roadmap and support of an expert in the field;
they can employ an expert to complete a sustainable OR
assessment; or, facility staff can be trained on how to complete
the assessments and conduct follow-up evaluations. Regard-
less of the path taken, the result of the efforts will be measur-
able, both financial and environmental, and can help gain
support for more sustainability efforts throughout the hospital.
The recommended steps to reduce waste are:
1. Measure your Baseline
To determine the opportunity for waste reduction and cost sav-
ings at your facility, the first step is to measure your baseline.
Work with your housekeeping department to find out the annual
volume of RMW disposed of every year by your hospital and
the cost per pounds for that waste. Next, conduct a waste sort.
Continued on page 39
Program for Healthcare
©2012 Medline Industries, Inc. greensmart is a trademark and
Medline is a registered trademark of Medline Industries, Inc.
greensmart™ is not a third-party certification. The use of the
greensmart™ trademark is determined by Medline Industries, Inc.
through an internal review process of environmental claims.
Measure Your Baseline
From calculations to benchmarking, your
greensmart RoadMAP provides all the tools you
need to green your OR, Housekeeping, Laundry,
Food Services and Patient Rooms.
1
2
4
3Identify Green Products and Strategies
With the help of your Program Manager, you will
identify products, services and education that are
right for your facility.
Receive One-on-one Consultation
You will receive personal assistance from your
dedicated greensmart Program Manager.
Monitor and Promote
You are given the tools to not only monitor your
progress, but to promote your success.
The greensmart approach for reaching your unique goals:
One-on-one sustainability guidance and services
ONE CALL STARTS YOU ON YOUR
WAY TO BECOMING GREENSMART
Francesca Olivier, Medline’s corporate sustainability manager,
is ready to work with you no matter where your facility is
on your sustainability journey. Call her at (847) 643-3821 or
email [email protected]
Aligning practice with policy to improve patient care 39
Green Solutions for the Operating Room
The Problem Green AlternativeEnvironmental Savings for a
Typical 10 OR Suite
Disposable Forced-Air
Patient Warming Blankets
Medline PerfecTemp™ Reusable
Patient Warming Bed
Blue Sterilization Wrap Sterilization Containers
Blue OR Towels Natural OR Towels
and Towel Recycling
40 The OR Connection
A waste sort is a means of cataloging what actually is put
into red bag bins, and the weight of each item. This will tell
you the level of compliance with your hospital’s RMW poli-
cies, as well as the cost savings opportunity through
improved waste segregation practices. Through Medline’s
greensmart™ program you can not only have this assess-
ment completed for you, you can also be trained in the
process so that you can complete your own follow-up evalu-
ations to measure your progress.
2. Implement Environmentally-Friendly
Products and Strategies
There are several strategies that a hospital can take to
reduce the waste generated by the OR. Remember – what
comes into the OR must go out. By eliminating disposables
and moving towards products with a longer life you not only
reduce your contribution to the landfill, but reduce the costs
associated with waste disposal. Here are some examples:
3. Market your Success
Improving performance in health care is a significant accom-
plishment for a facility and should be communicated to
patients, staff and the community. Going green in the OR can
help a facility communicate efforts being made to improve
efficiencies for staff, improve patient care and illustrate how
a facility is reducing their carbon footprint. There are myriad
ways to promote such success through basic communica-
tion efforts including:
to communicate the successes to staff.
resources to communicate the successes to patients.
successes into the facility’s overall public relations plan.
Conclusion
The greensmart™ program is a strategic four-pronged
approach that can help facilities: measure the baseline of
their environmental impact; identify opportunities for environ-
mental cost savings; monitor and report on progress; and,
garner marketing assistance and education. By employing
this comprehensive approach in the OR, hospitals will expe-
rience significant environmental outcomes and look at their
ORs in a whole new light. Going green in the OR will yield
cost savings, increased patient satisfaction and a healthier
community.
About the Author
Francesca Olivier manages Medline’s sustainability program.
She previously worked at the U.S. Environmental Protection
Agency Region 5, in the Office of Enforcement and Compli-
ance Assurance. Francesca received her bachelor’s degree
from Loyola University, New Orleans, and a master’s degree in
Environmental Management and Sustainability from the Illinois
Institute of Technology.
Going green in the OR will yield cost savings, increased patient satisfaction and a healthier community.
greensmart™ is not a third-party certification. The use of the greensmart™ trade-
mark is determined by Medline Industries, Inc. through an internal review process
of environmental claims.
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wood pulp and has all the same great features and
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flush to
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level of green!
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The OR Goes Green
Composition Comparison
wood pulp pulp
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-
of environmental claims.
LEANISN’TJUST FOR DIETS ANYM E
An introduction to the LEAN Process Improvement Methodologyby Joan Ferrara,
RN, BA, CNOR
Aligning practice with policy to improve patient care 43
Lean.
lean
staff, physician and patient satisfaction.
44 The OR Connection
Lean is a process improvement methodology developed by
to providing surgical care? That’s a fair question that has been
answered by many success stories across the country. Health
care is an industry that is undergoing tremendous change.
and the public are holding healthcare providers to a higher
happy? The answer comes from industry. The aviation industry
from automotive factories to hospitals, making small changes
that result in big differences.
What is lean all about?
Just like trimming the fat from your meat, the goal of lean is to
hold on to those things that have value and to get rid of the
cornerstone of Lean. Lean is frequently implemented along with
process, can waste time, steps or supplies.
Leadership training is essential before beginning a lean project.
will become the experts in the lean method. The leader of a lean
team must be familiar with the methodology, and the team should
include front line workers who live with the current practice and
goals are set, and the Lean methodology begins.
How lean can apply to room turnover
teams: room turnover. The value is fairly obvious. Patient and
stretcher get to the room? Who helps move the patient? How
F I V E S T E P S T O L E A N
Flow
Pull
Perfection
Reducing waste is the
cornerstone of lean...
Poorly designed processes,
process, can waste time,
steps or supplies.
Continued on page 46
EMPOWER from Medline shows you how to:
EMPOWER™
Eliminate Waste with Perioperative LEAN Solutions
EDUCATION
ACTIONOUTCOMES
For a no-obligation EMPOWER
review and analysis, contact your
Medline representative or call 1-800-MEDLINE.
46 The OR Connection 46 The OR Connection
place or does the cleaner have to leave the room and disrupt
the work? How are the supplies for the next case gathered?
need to be opened? How does the staff know what the surgeon
The questions are answered and the process is documented in
as much detail as possible. This step requires discussion and
be represented on the team.
supplies may be essential in another. Generally there is room
When a change improves the result it becomes the accepted
have been eliminated and the process is pulled by the customer.
is to follow it.
Then comes Perfection. This doesn’t mean the process is
perfect the process. Little tweaks along the way adjust things
The lean methodology requires continuing attention even after a
is obvious in increased revenue, decreased spending, happy
doesn’t advocate “do more with less.” Lean helps staff work
the sterile core while starting a case, she will be more relaxed
and less distracted from her most important task of taking care
of the patient, less tired at the end of the day, and will feel a
team work together, knowing what to expect of each other, the
work day becomes less stressful and more productive. Who
wouldn’t want that?
the Lean team develops
ideas for doing things
Ask your Medline representative about “Be Free Day”
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48 The OR Connection 48 The OR Connection
By Chuck Biddle CRNA, PhD & Jagdip Shah, MD
Aligning practice with policy to improve patient care 49
QUANTIFICATION of anesthesia
providers’ HAND HYGIENE in a busy
metropolitan OPERATING ROOM:
What would Semmelweis
think?
Background:
care environment representing a major public health
concern. HH compliance is poorly studied in anesthe-
sia providers who contribute extensively to nosocomial
infection. The rate of HH opportunities and compliance
by these providers was studied using embedded, clan-
destine observers. We aimed to quantify HH behaviors
Methods: Following intensive
an academic center, observed the HH of anesthesia
providers over a 4-week period throughout the periop-
HH opportunities and HH failures were recorded and
-
-
sion: HH was very poor among anesthesia providers.
The task density of anesthesia care may conspire with
an intrinsic HH failure rate to create great opportunity
-
-
tional and ergonomic interventions at our facility. Given
the task density of anesthesia care, and the observed
failure rates, novel approaches to HH should be inves-
50 The OR Connection
promote handwashing as the simplest and most effective inter-
representing a true public health crisis, decried in both profes-
sional and lay publications. Whereas many factors contribute
-
ger be viewed as simply a systems problem but rather a matter
of personal accountability.
million occur each year with nearly 100,000 deaths resulting in the
problem because of the perplexing problem of under-reporting.
health care providers. These studies are most often limited by the
positioned in an obvious manner, and even if the providers are not
-
expectancy and the Hawthorne effect.
anesthesia workstation, demonstrating very clearly that patho-
genic, drug-resistant organisms are regularly transmitted to and
from patients via a variety of mechanisms during the technically
challenging and task-dense period associated with anesthetic
administration during surgical procedures. Whereas good HH
is the cornerstone in preventing nosocomial disease transmission
in the hospital setting, a growing body of literature suggests that
anesthesia providers may contribute to the ongoing problem
We executed an observational study of the HH of anesthesia
providers in a major, metropolitan medical center, using embed-
ded, highly trained, clandestine observers that to our knowledge
HH during anesthesia delivery without any potential of observer
-
sia providers during the real-time care of patients over the con-
tinuum of perioperative care.
and assessment inventory and masquerading as surgical nurses
undergoing routine employee orientation to the operating room
the course of a 4-week period. The observers were savvy about
anesthesia providers as well as demonstrations conducted in a
simulation laboratory and then rated the observed HH using the
was achieved on observed HH opportunities and failures, requir-
provider type they would be observing to avoid any clues of their
purpose.
Given the nature of the anesthesia and surgical process where a
single team of surgical and anesthesia providers follows a given
patient through the perioperative process, the study observers
were able to continuously observe the anesthesia providers from
and physical, placing intravenous lines and blood draws, obtain-
recovery period where the provider eventually performed a handoff
to the postanesthesia care unit staff. Throughout this period, the
Recently investigators have focused attention on HAIs in the anesthesia
workstation, demonstrating very clearly that pathogenic, drug-resistant
organisms are regularly transmitted to and from patients via a variety of
mechanisms during the technically challenging and task-dense period
associated with anesthetic administration during surgical procedures.
Continued on page 52
No More Sticky Hands
Sterillium Rub Waterless Surgical Scrub
evaporates quickly for faster OR preparation.
Emollients leave hands feeling soft and silky
— never sticky or tacky — minimizing friction
and skin trauma when donning gloves. It’s
also CHG, latex and non-latex compatible.
For more information on
Sterillium Rub, contact
your Medline representative,
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or call 1-800-MEDLINE.
STERILLIUM®
RUB: FASTER RUB TO GLOVE
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Exceeds FDA Requirements1
Sterillium Rub is the only waterless, brushless
surgical scrub with 80% (w/w) ethyl alcohol —
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antisepsis. Sterillium Rub provides a rapid and
comprehensive kill of transient and resident skin
flora, with a 6 log reduction within two minutes.2
52 The OR Connection
To avoid over penalizing a provider for a HHF, we elected to count
a failure only once in a given sequence, that is, if a provider failed
to perform HH after manipulating the airway or otherwise con-
taminating his/her hands and then began touching the anesthesia
equipment (e.g., agent vaporizer, flowmeters, stethoscope, drug
syringes, warming devices, and others), they were only counted
for 1 HHF (i.e., a “missed opportunity”). This provided the most
consistent and most conservative quantification of HHF rate but
would, however, underestimate the degree of secondary contami-
nation targets.
The ORs at the study institution are typical of any large, metro-
politan academic center providing services over the full range of
surgical procedures with a diverse representation of patient mor-
bidity. The anesthesia care providers include attending anesthesi-
ologists, physician anesthesiology residents, off-service residents
and medical students doing anesthesia rotations (neither were
observed), certified registered nurse anesthetists, and student
registered nurse anesthetists. Attending anesthesiologists provide
medical direction to every surgical case and work in an anesthesia
care team model as they oversee (most commonly) 2 operative
suites with the varied providers.
Throughout the perioperative period, disposable gloves were
available within easy reach of the provider. During the preopera-
tive phase (examination, IV start, and other), sinks with running
water and soap were available within 10 feet of each patient and
were thus accessible to the anesthesia provider. During the intra-
operative phase, sinks with running water and soap were avail-
able immediately outside the OR, and alcohol-based hand scrub
was available within easy reach of the anesthesia provider. During
the immediate postoperative phase, sinks with running water and
soap were available within 10 to 30 feet of each patient, and
alcohol-based hand scrub was available within easy reach of the
anesthesia provider. No signage or verbal “prompts” to perform
HH were used over the course of the perioperative observation
period.
As a condition of the institution’s human subjects committee, the
observed behaviors of the various provider types were recorded in
the aggregate. There was concern by the board that should differ-
ences in rates of failed HH occur between or among groups, that
interdepartmental provider conflict might arise. Therefore, only
descriptive statistics were performed with no inferential statistical
analysis to ascertain provider group differences in HH behavior.
Using a qualitative content analysis, we reduced the HH failures
into mutually exclusive but all-encompassing categories.
RESULTS
Over the course of the 4-week period, 7,976 HH opportunities
among the anesthesia providers actively engaged in clinical prac-
tice were observed, recorded, and electronically archived. Like-
wise, missed opportunities for HH were observed, recorded, and
electronically archived.
Examples of a HH opportunity included, but were not limited to:
Hand cleansing prior to first interacting with the patient;
hand cleansing, gloving prior to arterial or IV line placement or other invasive procedure;
hand cleansing after any invasive procedure;
hand cleansing after manipulation of the airway (e.g.,.artificial airway placement, suctioning);
hand cleansing after hanging a blood product;
hand cleansing after touching the patient for surgical positioning;
gloving before and hand cleansing after suctioning of the airway;
hand cleansing after patient handoff; and
hand cleansing after retrieving a soiled or dropped item off the OR floor.
Continued on page 54
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54 The OR Connection
provider group with a mean aggregate failure rate of 82%.
maintenance, emergence), we found indications occurring
for HH at a rate that averaged 34 to 41 events per hour,
especially at induction and emergence) and at times were
as high as 54 per hour in certain types of cases (e.g.,
extensive blood loss, patients with particularly challenging
airway issues, periods of high task density such as
complicated emergence from anesthesia, and others).
following manner:
1. Moving between/among patients during the preoperative
assessment phase;
2. before, during, and after pain service interventions (e.g.,
placing perioperative nerve blocks);
3. keyboard use with soiled hands when using electronic
medical record keeping;
4. during the placement of IV and blood draws;
5. preparing drugs and equipment for the case to follow
with soiled hands;
6. soiled gloves left on after airway manipulations such as
endotracheal intubation, suctioning of the airway,
laryngeal mask airway insertion, and others;
7. soiled gloves left on after Foley catheter or central or
arterial line manipulation; and
8. other: picking up something off the floor (e.g., pen,
tape roll, tongue blade, suction catheter) and using it.
DISCUSSION
Other researchers in multiple disciplines have demonstrated a
significant failure rate in HH among health care workers using
observational approaches that are likely to significantly influence
provider behavior. The current study is unique in that it quanti-
fied the HH behaviors of anesthesia providers in a busy operating
room in a large, metropolitan medical center using observers who
were embedded in the operating room with easy visual access of
the anesthesia providers throughout the perioperative course of
care and whose intent was totally obscured from those observed.
Table 1
Taxonomy of hand hygiene failures by anesthesia providers
Category of failure Example
Moving among patients during the perioperative
assessment phase
Contacts patient during examination or IV start and goes
on to contact another patient without appropriate HH
Before, during and after pain service Placing a nerve block using “relaxed” aseptic technique.
Failed HH before and after perioperative nerve block
Keyboard use with soiled hands when using electronic
medical record-keeping
Keyboard use with soiled gloves on. Failure to perform HH
before touching keyboard and other charting aides
Placement of IV lines and blood draws Not wearing gloves during procedure. Failed HH before
and after procedures involving vascular access
Preparing drugs and equipment Drawing up drugs, preparing airway devices, IV fluid sets and
other equipment with soiled hands for the next scheduled
case with the case still in progress
Soiled gloves left on after airway access Intubating or otherwise accessing the airway and failing
to remove soiled gloves or perform HH before touching
other items such as keyboard, flowmeters, and others
Soiled gloves left on after Foley catheter or central/arterial
line manipulation
Touching the urinary collection bag or central/arterial line
connection or access site without proper HH
Other Catch-all category for HH behavior such as picking up
something that fell to the floor and using it (e.g., suction
catheter, roll of tape, and others). Touching another room
provider (e.g., shaking hands) with soiled hands. Opening
sterile packages or opening anesthesia cart drawers with
soiled hands.
HH, hand hygiene; IV, intravenous
Continued on page 95
Medline University continues to build its
curriculum of Surgical Tech courses,
available at www.medlineuniversity.com
Visit today to earn free CE credits with the
following courses:
Foreign Objects
Improve Hand-off
Practice Setting
©2012 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
CE Courses for Surgical Techs!
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“
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56 The OR Connection
Medline Hand Hygiene Compliance Program
An intensive educational module developed by an
expert panel of infection control professionals.
a. Testing for skill and competency validation
through the use of Visirub and a UV light box.
b. Patient education pamphlets, facility posters
and a rewards program reinforce positive
behavior change.
HANDHYGIENETools and Resources
a.
b.
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Aligning practice with policy to improve patient care 57
Sterillium Rub
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continuing education for the Certified Surgical
Technologist and Certified First Assistant.
58 The OR Connection
Aligning practice with policy to improve patient care 59
by Natalie J. Mach, RN
How many articles have you read in the last decade about
safety scalpels? How many safety scalpels has your OR trialed
in the last decade? Hospital ORs and surgery centers have
attempted to standardize on safety scalpels – with little success!
There are a vast number of reasons or explanations, especially
from surgeons, such as:
� “I want to continue to use the blade I’m used to using.”
� “It doesn’t feel the same.”
� “I’ve never been stuck. Why should I use a safety
scalpel?” (Note: This is predominantly true. It’s the
surgical techs and nurses who get stuck according
to national statistics.1)
� “The plastic cartridge covering the blade obscures
my vision.”
� “This safety scalpel affects how I perform surgery.”
All that being said, new data strongly suggest an increase in
sharps injuries in surgical settings versus non-surgical settings
since the national Needlestick Safety and Prevention Act was
passed in 2000.
Since the legislation was enacted, injury rates dropped 31.6
percent in non-surgical settings, but increased 6.5 percent in
surgical settings. Most of the injuries were caused by suture
Another Article about
Safety Scalpels?
Yes, but there’s new data
needles (43.4 percent), followed by scalpel blades (17 percent)
and syringes (12 percent). Seventy-five percent of the injuries
occurred during the use or passing of devices. Surgeons and
residents were most often the original users of the injury-causing
devices; nurses and surgical techs were typically injured by
devices originally used by others.1
In addition, the Massachusetts Department of Public Health
(MDPH) surveyed 99 facilities in 2004 specific to sharps injuries
in the operating room. Some of their findings are as follows:
� � Devices without safety features accounted for
more than 78 percent (812) of sharps injuries in
Massachusetts ORs in 2004
� � 32 percent (1,038) of sharps injuries reported by
Massachusetts hospitals occurred in the operating room
� � Three categories of devices: suture needles, scalpels,
and hypodermic needles, accounted for approximately
75 percent of all OR injuries
Based on the Massachusetts data, opportunities exist for
reducing sharps injuries within operating rooms. As sharps data
is presented, it is always important to emphasize that under-
reporting remains a significant issue that varies according to
occupation and facility. It is reasonable to assume, therefore,
that these data underestimate the problem.
60 The OR Connection
The 2010 data is alarming, but what conclusions can be drawn?
In those areas where safety devices have been implemented,
sharps injuries have decreased. In the operating room, where
safety devices/safety scalpels largely have not been implemented,
sharps injuries have risen. Many surgeons are still clinging to
standard scalpels rather than making the conversion to safety
scalpels. OSHA can fine facilities a minimal amount up to fines
as high as $72,000 for “willful” violations.3
What if one of your family members became a sharps injury sta-
tistic? Would you feel any differently about safety products not
being used in the workplace? The answer is obvious.
The evaluation, use and standard practice of safety scalpels is
only one piece of a total program concerning sharps safety. It is
important for operating rooms to implement some, or all of the
following to reduce and/or eliminate sharps injuries:
1. Safety scalpels
2. Passing trays
3. Neutral zones (elimination of hand-to-hand passing
of scalpels or with other sharps)
4. Conscientiousness, consistency and commitment to
reduce sharps injuries by the entire perioperative team.
There are several resources available for employers and employ-
ees with regard to occupational exposures to blood and OPIM.
First, of course, is the OSHA Bloodborne Pathogens Standard
(29 CFR 1910.1030). Also available are “CPL 2-2.69 (November
2001). Enforcement Procedures for the Occupational Exposure
to Bloodborne Pathogens, and many other related documents.
To access this information, as well as information from OSHA’s
Consultation and State Plan State Offices, visit OSHA’s website
at http://www.osha.gov or call 1-800-321-OSHA.
References
surgical settings versus nonsurgical settings after passage of national needlestick legis-
2. Sharps injuries in the operating room. Massachusetts Sharps Injury Surveillance System
Data, 2004. Occupational Health Surveillance Program, Massachusetts Department of
Public Health. April 2008. Available at: http://www.mass.gov/eohhs/docs/dph/occupa-
3. US Labor Department’s OSHA cites Paradise Park Assisted Living in Lake Zurich, Ill.,
with safety and health violations after needle stick injury [news release]. Lake Zurich, Ill:
US Department of Labor Office of Public Affairs: May 3, 2011. Available at: http://
www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=NEWS_RELEASES&p_
SAFER CATHETERIZATION FOR KIDS
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™
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Introducing Medline’s OctylSeal high viscosity
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chance of cracking
adhesive film remains intact
tissue adhesives (0.7 grams versus 0.5 grams)
easier identification on skin
broken glass entering the wound
Indications for use
edges of wounds from surgical incisions, including punc-
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HIGH VISCOSITY TISSUE ADHESIVE
Aligning practice with policy to improve patient care 63
Michele DeMeo
Sterile Processing
Sue MacInnes, editor of The OR Connection, recently had the opportunity to
interview Michele DeMeo, a sterile processing professional who is considered an
expert by her peers and the FDA. She was nominated and approved by the FDA
as the single sterile processing expert on their overarching device committee and
as SGE or special government employee for her work in helping with national
and international standards development. She has also written columns for major
healthcare publications and developed soft goods and statistical tools. She is a
sterile processing consultant, IAHCSMM-approved instructor, course developer
and chair of several national and international committees for major healthcare
associations. Michele has authored over 100 articles, drafted textbook chapters,
and has written three books on topics outside of the sterile processing field.
She also received IAHCSMM’s highest award, Educator of the Year for 2011
and AAMI’s first Shining Star Annual Award. She was listed in Infection Control
Today magazine in 2011 as one of the top 25 Who’s Who to know in Infection
Prevention.
Michele was diagnosed with amyotrophic lateral sclerosis (ALS, also known as
Lou Gehrig’s disease) in 2010, and she readily accepts that the diagnosis is
terminal, giving her only three to five years to live.
Q & Awith
Sue MacInnnes: You have been working in the sterile
Micheele DeeMeo: Twenty years is a long time but, sterile
processing has been my longest love and greatest passion. The
specialty caught my eye about 22 years ago as a technician,
and I still cannot shake my interest in it. Some habits become
so ingrained in us we have no choice but to go along for the
ride. Seriously, there was something missing when I was a
and the OR were much different 20 years ago compared with
I suppose, to better answer your question, the challenge of
changing the world’s perception of what we could provide in
job itself are the things that have kept my interest. My goal has
been to try to chip away misperceptions person by person,
hospital by hospital, and year after year to work toward shared
ownership and peer relationship development between surgical
services and sterile processing.
SM:
MD: The work of many pioneers before me made the greatest
services. I have always been interested in relationship mending
or building right alongside improving both administrative and
for me, I have witnessed and sometimes contributed to clearer
boundaries, more transparency, and better intra-dependency.
each other without something or someone being compromised
in some fashion.
64 The OR Connection
“The challenge of
changing the world’s
perception of what we
could provide in terms
of service and the
complexity of the sterile
processing job itself are
the things that have kept
my interest.”
We owe it to our patients to
encourage and support every
person who touches the very
instruments that can either
help or harm surgeons and
patients.”
“We o
Aligning practice with policy to improve patient care 65
battling silos slowly becoming reverse engineered to the point
an equal peer to surgical services. I also clearly see a stronger
SM:
MD: Yes, without a single doubt. But it is not a simple
respected in facilities. By this I mean that educational funds
or the OR. Resources, in general, are tight, and with a lack of full
put through, change and improvement in skills will have some
road bumps. However, they are not at all insurmountable. In fact, I
believe we can learn many lessons from each other by partnering
more with our surgical units and allowing more personal interface
between the two departments at the staff level.
SM:
MD: Funny you should ask. I helped draft the language of a
sterile processing bill sitting with State Representative Maureen
Healthcare Central Service Materials Management (IAHCSMM)
later was brought in and added considerably to the subsequent
drafts. The bill is now being co-sponsored by the U.S.
Department of Health and Human Services. My hope is that
certification.
SM: How will passage of this bill benefit the OR, especially,
MD: There is plenty of free or low-cost continuing education
available for sterile processing technicians to maintain their
certification. The cost of this education is a fraction of the cost
of a single surgical infection that could be linked to a poorly
person who touches the very instruments that can either help
or harm surgeons and patients. The only sticking point is in
those practices stopped or decreased, then allocation of funds
could be shifted differently to benefit more critical stakeholders.
Sterile processing technicians deserve the same level of funding
for education as any surgical department. They are no less
responsible for outcomes than surgical personal. They simply
elements go hand-in-hand. That means both deserve the same
opportunities for improvement, because they both ultimately
affect each and every surgical patient.
SM: How do you suggest OR managers and directors work
66 The OR Connection
There is no question, in her 39 years, Michele DeMeo has truly lived. In her book,
she shares that in some ways, her life really began when she was diagnosed with
amyotrophic lateral sclerosis (ALS), a terminal disease. Some might question why
a person nearing the end of life would consider spending time writing a book. But
but rather a way to help others learn to live in a more deliberate, thoughtful and
meaningful way.
by her side. Already she’s fading around the edges. It’s okay, because she’s given
The Beauty of a Slow Death is available at amazon.com.
The Beauty of a Slow Death
MD: Allow for more interaction between the units, not just
when an error has been made or in the midst of a crisis. Instead,
understand the type of pressure OR nurses and physicians
and charge nurse and even doctors to ask about schedule
OR’s needs change, and those needs are not communicated,
this as a shared responsibility for open communication to occur
Building better communication and collaborating on projects in
the future, together, will help, too, not just putting out fires in
the moment. Identify risks as a joint effort and mitigate them
together as a team. Neither group, alone, will have the correct
and best practices for both specialties.
SM: I understand that our readers will be hearing more from
MD: Yes, I thought I was retired, but it seems I am not so
ready to relinquish everything. Everyone needs a purpose, and
I pitched an idea for a short column in The OR Connection.
believe people should give all they can give. I am not done yet,
and where else can someone with a love of surgical services
and sterile processing best fit that with you. Turn to page to
read the first article in my new sterile processing column.
Yes, I do have ALS, a terminal disease, but I believe that is all
the more reason for me to write the column. I have lots to say
and likely little time to share all my ideas, hopes and dreams for
the sterile processing profession. I have completed many future
articles to ensure my ideas get printed long after I may be gone.
Every nurse knows you need a contingency plan. They have
taught me well!
Read Michele DeMeo’s Inspiring Book
Proceeds go to the International
Association of Healthcare Central
Service Materiel Management
(IAHCSMM).
Aligning practice with policy to improve patient care 67
Portrait of a Life Well-lived
The Canvas is a painting created by Michele DeMeo, who
believes in passion, improvement and beauty, even in the
darkest times. She’s created The Canvas as a legacy to
her life and her dedication to the sterile processing field.
Aligning practice with policy to improve patient care 67
68 The OR Connection
It began as a blank white stretched canvas to be
abstract rendition of the circle and progression of life
showing that people can build themselves up, make
their own way to find contentment and create a space
literally or figuratively where peace can be found by
sheer determination.
Michele wanted a symbol to outlast her, and so
with brushes taped to her fingers, The Canvas was
born. It is a traveling piece of art on a year long
journey to some of the best and most important
places Michele thought it should be displayed.
Most of the locations along the way are related
to Michele’s lifelong career in sterile processing.
At the end of its journey, The Canvas will reside
permanently at the International Association of
Healthcare Central Service Materiel Management
(IAHCSMM) headquarters in Chicago, where
Michele is donating the piece.
Memorial Hospital
Memorial Hospital was selected because
it shares my values in care and I have the
utmost respect for its mission, vision and
leadership led by an incredible, gifted,
The Food and Drug
Administration (FDA)
Silver Spring, MD
The Food and Drug Administration (FDA) is an
change here in the United States. I accepted
the nomination to be on their team because
I felt it was a duty. I believe it is working
toward complete device improvement and
taking input from surgical services and sterile
Key Surgical
Key Surgical is a great company and a
The Canvas and
pledged enough to earn the opportunity to
choose one of the locations.
The World Health Organization
(WHO)
so many countries and is diverse in its
Gabriel’s at The Ashbrooke Inn
For personal reasons, Gabriel’s was chosen
since it has been my second home for 23
years. It has been my private refuge at
least once a year for a long time. There is
no other place in the world like it and it is
one of the only places I vacation and always
will be. There is a sense of both magic and
peace within the compound. I’ve watched
this 15-year-old inn morph from a work in
progress into an oasis, without losing its soul.
a Journey to Locations
AORN
Denver, CO
The Association of peri-Operative Nurses
because I see sterile processing and surgical
services as a team
Aligning practice with policy to improve patient care 69Aligning practice with policy to improve patient care 69
The Seaver Center
for Autism,
Mount Sinai School
of Medicine
New York, NY
The Seaver Center is a
premier autism facility that
worked closely with me
during my diagnosis and
subsequent studies.
Association for
the Advancement
of Medical
Instrumentation
(AAMI)
Arlington, VA
I could not leave off the
that I had worked with
for years helping to
shape standards, draft
articles and lending
a hand in developing
a useful and needed
tool for the world to
look to as a widely
in best practices for
sterile processing and
utmost faith in AAMI’s
ability, goals, vision and
leadership.
The ALS Clinic at
Hershey Medical
Center
I selected this facility for its
team of professionals with heart
and incredible skill. The team
helped me navigate my way
through the most challenging
news in my life with kindness,
great resources and leadership
Betty Hanna’s Home
Chicago, IL
Betty, well, there are not enough words to say why The Canvas had
to visit Betty Hanna’s home. She leads the International Association of
Healthcare Central Service Materiel Management (IAHCSMM). I look up
to her and I believe in her, and I am proud of what she has accomplished
for our profession with such kindness and a soft approach. Her style of
leadership sings to me, and I believe it reaps longer lasting results.
Home: International Association of Healthcare Central Service Materiel Management (IAHCSMM)
Chicago, IL
I choose to donate The Canvas
The Hospice Foundation of America
The moment I heard the voice of Hospice Foundation CEO Amy Tucci, I knew I had
to include the Hospice Foundation in the year long journey of The Canvas. Hospice
is pivotal to those who are terminal, but not just for the last few days of a person’s
life. Rather, hospice is a program and service that can help ease patients and
families through the sometimes long journey of tough news and death.
Advanced Sterilization
Products (ASP)
Irvine, CA
processing from a job I had as a teen into a
lifelong career. Thank you, Cynthia Spry.
70 The OR Connection
So You Really Think That Surface Is Clean?by Lorri A. Downs RN, BSN, MS, CIC
Healthcare professionals often ask.....
“Is that room or reusable piece of medical equipment clean?”
How do you know? Infection prevention starts with hand
the physician’s office, ambulatory surgery
centers to hospitals and long-term care.
Surface cleaning and disinfection can
help reduce the risks of healthcare-
acquired infections.
Improved hand hygiene and better
limits. A plethora of evidence points to
the importance of proper cleaning
and disinfection. Eight recent
studies have confirmed that
patients occupying rooms
previously occupied by patients
with Vancomycin-resistant
enterococcus (VRE), MRSA,
Clostridium difficile (C. diff.)
and Acinetobacter baumannii
on average a 73 percent increased
risk of acquiring that same pathogen
than patients not occupying such rooms.
improved routine disinfection cleaning
percent decrease in transmission of VRE,
1
Key culprits of healthcare-acquired
infections can survive on dry
surfaces for varying amounts of
time, as shown below.
High touch or high risk objects (side rails, call lights, light
switches, door knobs, toilet handles, telephone, chairs,
commodes, bedside tables, and bedside trays) certainly need
attention due to the repeated contamination from patients or
healthcare workers hands when assisting with patient care.
The term “high risk areas” is not scientifically defined, so it is
important to remember all areas of the environment to effectively
clean and disinfect.
Cleaning and disinfection “best practices” usually involve a one-
step method using a detergent-disinfectant. No pre-cleaning is
necessary unless a spill or gross contamination has occurred.
8 TIPS
OrganismLength of time survives on surfaces
Methicillin resistant Staphyloccocus aureus (MRSA)
1-56 days 2
Clostridium difficile (C diff.) spores 15 mins up to 5 months 3
Vancomycin resistant E. coli (VRE) 7 days to 4 months 4
Acinetobacter baumannii 29 days 5
for Cleaning and Disinfecting Healthcare Settings
■ Perform hand hygiene and apply gloves
■ Place wet floor sign at door
■ Discard disposable items and
remove waste and soiled linen
■ Disinfect (damp wipe) all horizontal,
vertical and contact surfaces with a cotton
(or microfiber) cloth saturated with a
disinfectant-detergent solution
■ Spot clean walls (when visually soiled) with
disinfection-detergent and windows with
glass cleaner
■ Clean and disinfect sink and toilet
■ Stock soap and paper towel dispensers
■ Damp mop floor with disinfectant-detergent
■ Inspect work
■ Remove gloves and wash hands
Best Practices
for Daily
Cleaning and
Disinfection6
1. Purchase EPA-labeled
healthcare grade disinfectant
products and apply per the
manufacturer’s label.
2. Know the “wet contact time,”
which means the amount of time the
surface must remain wet (with the
chemical) to disinfect that surface.
3. More is not better. Use exactly the
amount of cleaning and disinfection
product needed to get the job done.
4. Know how to clean and
disinfect each piece of reusable
medical equipment with the
appropriate product to avoid
damaging the equipment or
voiding the warranty.
5. Always provide and use
appropriate personal protective
equipment prior to performing any
cleaning activities.
6. Maintain a current list of all
approved cleaning and disinfection
products your facility purchases
and prohibit staff from bringing
products from home.
7. Select cleaning products that are
a detergent and disinfectant in one.
8. Set a “regular “ (daily, weekly,
monthly) routine cleaning schedule
(depending on items and areas that
are being cleaned ), and then train
and assign staff to complete.
Continued on page 73
Powerful, Safe and Intelligent
Powerful IRiS emits UV-C rays that produce a 3 to 6 log
reduction in colony-forming units.1
Safe
IRiS has redundant safety features to help prevent
inadvertent exposure to UV-C. IRiS is chemical-free,
so there’s no need to cover windows or seal heating/
ventilation systems. It’s even safe to view from outside
the room.
Intelligent
Dose Assurance – With special sensing technology, IRiS
automatically determines the perfect UV-C dose for any
room size.
Steri-Trak™ Service Documentation –
Advanced patent-pending technology
provides real-time documentation of all
disinfections. Steri-Trak is customizable
and Web-based for maximum
convenience.
©2012 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
A room can look clean, but looks can be deceiving.
IRiS™
Motion Sensors –
on IRiS and for
anging on room-
access door handles.
Intelligent Room Sterilization
Aligning practice with policy to improve patient care 73
Additional Considerations 6
■ Use EPA-registered disinfectant-detergent
(if prepared on site, document correct concentration)
■ Clean surfaces should appear visibly wet and
should be allowed to air dry at least one minute
■ Change mop water containing disinfectant every
three rooms and after every isolation room
■ Change cotton mop heads after isolation room
cleaning and after blood borne pathogen spills
(change microfiber after each room)
■ Clean from the cleanest areas to the dirtiest areas (the
bathroom would be cleaned last followed by the floor)
■ Change cleaning cloths after every room and use at
least three clean cloths per room, but typically five to
seven clean cloths
■ Do not place cleaning cloths back into the disinfectant
solution after using to wipe a surface. Change to a
clean cloth instead.
■ Daily cleaning of certain patient equipment is the
responsibility of other healthcare practitioners
(often nursing)
■ Surfaces should be wiped with a clean cloth
soaked in disinfectant
In today’s healthcare arena the environment
cannot be overlooked. Maintaining a clean and
sanitary environment is the responsibility of
everyone who works in every healthcare setting.
Properties of an
Ideal Disinfectant 6
■ Broad-spectrum antimicrobial
■ Fast acting-should produce a rapid kill
■ Not affected by environmental factors-active in
the presence of organic matter
■ Nontoxic-not irritating to user
■ Surface compatibility-should not corrode
instruments and metallic surfaces
■ Residual effect on treated surface-leave an
antimicrobial film on treated surface
■ Easy to use
■ Pleasant odor or odorless
■ Economical-cost should not be prohibitively high
■ Soluble (in water) and stable
(in concentrate and use dilution)
■ Nonflammable
Now that we have reviewed how to clean, let’s
review how to select the ideal disinfectant.
In 1995 Dr. Rutala published a list of properties in an ideal
disinfectant. Listed in the box are the ideal properties from
their collective research. Consideration of this list will help
you as you evaluate your chemical disinfectants.
Innovation in products and processes to help with surface
disinfection are rapidly entering the marketplace. Three which
have emerged to help facilities ensure consistent and effective
cleaning and disinfection are:
1. Ultra violet (UV) light
2. Microfiber products
3. Adenosine triphosphate (ATP) bioluminescence tests
74 The OR Connection
ATP (adenosine triphosphate)
bioluminescence testsThis technology helps to monitor adequacy of surface
cleaning. ATP testing uses a chemical that gives off light
when it reacts with ATP (adenosine triphosphate). A swabbed
sample is placed in the chemical and inserted into the hand
held unit. The light detector determines the amount of ATP
present in the sample. ATP is found in all animal, plant,
bacterial, yeast and mold cells. Blood and bioburden contain
large amounts of ATP. Microbial contamination contains ATP,
but in smaller amounts. If the surface was cleaned adequately,
then ATP levels should be significantly reduced. This new
testing can help managers measure the effectiveness of the
cleaning and disinfection of reusable medical equipment
throughout the healthcare organization.
MicrofiberMicrofiber is a strong, lint-free and ultra fine material
with a dense matrix. These properties make it an idea
cleaning tool. Microfiber cleaning materials are a blend
of microscopic polyester and polyamide fibers. These
fibers form microscopic “hooks” that scrape up and
hold dust, dirt, and grime. They are 1/16 the thickness
of a human hair and can hold six times their weight
in water.8 The positively charged fibers attract the
negatively charged dirt and dust.
Ultra Violet (UV) Light Irradiation 7
(No touch surface disinfection)
UV light irradiation has been used to control pathogenic
microorganisms in a variety of applications, such as
control of legionellosis, as well as disinfection of air,
surfaces, and instruments. UV light at certain wave lengths
will break the molecular bonds in the DNA, there by
destroying the organism. The efficacy of UV irradiation is a
function of several different parameters, such as intensity,
exposure time, lamp placement, and air movement
patterns. This technology supplements but does not
replace standard cleaning and disinfection because
surfaces must be physically cleaned of dirt and debris
References
1. National Institute for Occupational Safety and Health (NIOSH). How to protect yourself from
needlestick injuries. Available at: http://www.cdc.gov/niosh/docs/2000-135. Accessed March 9, 2012.
2. Pyrek KM. Study raises ongoing issue of passive vs. active safety-engineered sharps devices. November 2, 2010.
Available at: http://www.infectioncontroltoday.com/articles/2010/11/study-raises-ongoing-issue-of-passive-vs-active-
safety-engineered-sharps-devices.aspx. Accessed March 9, 2012.
3. American Nurses Association. 2008 Study of Nurses’ Views on Workplace Safety and Needlestick Injuries.
Available at: http://www.inviromedical.com/Portals/1/PDFs/2008_Fast_Facts.pdf (ANA/Invira)
4. Centers for Disease Control and Prevention. Workbook for Designing, implementing, and Evaluating a Sharps Injury
Prevention Program. Available at: http://www.cdc.gov/sharpssafety/tools.html. Accessed March 9, 2012.
5. O’Connor D. The most dangerous job in surgery? Outpatient Surgery Magazine. March 7, 2012.
Available at: http://www.outpatientsurgery.net/news/2012/03/9-The-Most-Dangerous-Job-in-Surgery. Accessed March 9, 2012.
Safety features so you won’t get stuck
A staggering 74 percent of nurses report being
stuck by a contaminated needle,1 which can
lead to infection with Hepatitis B and C, HIV, and
other dangerous bloodborne pathogens. Avoid
needlesticks with Medline Safety Syringes. After
injection, slide the safety shield forward and simply
twist clockwise. Once you hear a click, the needle
is fully protected and the syringe is ready for safe
and proper disposal.
Medline Safety Syringes also feature:
medication waste and expense
©2012 Medline Industries Inc. Medline is a registered trademark of Medline Industries, Inc.
Protect yourself and patients from needlestick injuries
Medline Safety Syringes
American Nurses Association. 2008 Study of Nurses’ Views
on Workplace Safety and Needlestick Injuries. Available at:
http://nursingworld.org/MainMenuCategories/Workplac-
eSafety/SafeNeedles/2008-Study/2008InviroStudy.pdf.
Accessed March 16, 2012.
Injection Safety is Every Provider’s Responsibility
To Prevent Transmission of Infections in Healthcare
1.
Reference
76 The OR Connection
WOOnce
Wolf J. Rinke, PhD, RD, CSP
To me worrying is like backward goal-setting. Because when
you worry you are vividly imagining all of the things you do not
want to have happen! And boy, do we like to worry. According
to one study four out of five Americans said that they worry.
(That’s 80 percent of us doing the backward goal-setting
thing.) The poll, conducted by Barna Research, asked adults
what are “the most pressing challenges and difficulties you
face.” Among those who worried, 28 percent said that they
worried about finances, 19 percent identified health, 16 percent
mentioned career issues, followed by parenting concerns (11
percent), family relationship issues (seven percent) and goal
accomplishment challenges (seven percent).
Research further indicates that women tend to worry more
than men. For example, in a study of 1,044 women in the
U.S. conducted by Bruskin Audits and Surveys Worldwide, 50
76 The OR Connection
Aligning practice with policy to improve patient care 77
RR and for all
percent reported that they experience anxiety symptoms and
worry for a period of more than six months. In addition, one
out of 10 women describes herself as having “unrealistic” or
“excessive worry.”
What makes these findings startling is that most of us appear
to have little to worry about. In fact, 78 percent of the Barna
Research poll’s respondents rated themselves as completely or
mostly satisfied with their lives.
I find our propensity for worrying particularity perplexing, since
only eight percent of our worries are “legitimate”—that is, they
are under our control. The other 92 percent are “worthless
worries” also known as the coulda, shoulda, woulda syndrome.
That’s when you engage in “catastrophizing” convincing
yourself that a stomachache means that you have an ulcer and
an “angry” look by your spouse means that you are about to get
a divorce. Worthless worry is when we try to solve what can’t be
78 The OR Connection
solved because it has already happened, will never happen or is
simply not under our control.
According to psychiatrist Edward M. Hallowell, worry can
depress us, destroy our relationships, and sap our energy and
joy of living. Struggling with perpetual “what if” scenarios can
make us physically sick with back pain, recurring headaches and
digestive disorders. It may even weaken the immune system,
leading Dr. Hallowell to conclude that chronic, persistent worry
is just as dangerous as high blood pressure.
Of course you can do what I do, and reduce this 8-step
“Worry Buster” process down to 2 steps:
Step 1 What will happen if I worry about this really well? If
the answer is “nothing,” quit worrying. If on the other
hand, you can impact the outcome, go to step 2.
Step 2 Do something—anything—now. Then quit worrying!
If you still need more help, here are seven “Action Steps”
that will help you take getting rid of worries to the
next level:
1. Share Your Worry with Others
When worries seems to go out of control, talk them through
with a trusted friend, a mentor or even your pet — hey, at least
your pet won’t talk back. Be sure to reciprocate so that your
worry support team is there for you when you need them.
2. Realize That Certainty is a Myth
Recognize that the only certainty is death. Given that most of
us are not very interested in that option, make a commitment
to get comfortable with uncertainty. Focus your mental energies
on the joy you get from uncertainty and begin to celebrate it as
part of the unique human experience. Just think, how boring life
would be if everything was certain.
3. Make Worrying a “Snap”
If you find that all of the above still don’t work, start wearing a
rubber band on your left wrist. When you find yourself worrying,
snap the rubber band—it’ll remind you, in a somewhat painful
way, to quit worrying. Another technique that seems to work
real well for one of my coachees is that when she gets stuck
in a serious worry phase she records her worries on an old-
fashioned tape recorder. (Yes they are still around.) Then she
takes the tape out of the recorder, goes to her husband’s
workshop, finds a big hammer and smashes the tape -- getting
rid of those worries once and for all. (Hey, tapes are cheaper
than wasting your precious brain power.)
4. Take a Worry Break
Still not working? Set a timer for a specified time—let’s say 10
minutes—and now worry “real good.” Play the “what if” game
to the max. Get it all out of your system. When the 10 minutes
are up, refocus your energy on something that will disconnect
you from your worries.
Step 1 Clarify what it is that you are worried about. The
best way to do this is to write it down, because it
gets it out of your head.
Step 2 Ask yourself if there is anything you can do to
affect the situation. If not, it’s a worthless worry --
skip to Step 8. If you can affect the situation, go
to the next step.
Step 3 Identify the worst possible outcome.
Step 4 Ask yourself if you can live with the worst possible
outcome. If so, go to Step 6. If not, go to the
next step.
Step 5 Do everything in your power to solve the problem
right now.
Step 6 Make an action plan that will solve the problem
entirely or minimize its bad consequences.
Step 7 Take action.
Step 8 Quit worrying. Either it’s too late or worrying won’t
make a bit of difference.
Not to worry --
pun intended -- I
have delineated an
eight-step process
to help you get rid
of worries once
and for all:
Aligning practice with policy to improve patient care 79
5. Disconnect
Disconnect yourself from worrying by doing something that will
totally absorb you. Try jogging, meditation, yoga, tai chi, getting
a massage, playing a game of tennis, deep breathing, taking a
walk, going to the movies--anything that disconnects you from
your worries and allows you to totally relax.
6. Just Let Go
Done it all, and still worrying? Just say no--I mean just let go.
Let go of the feeling that you have to be in control--you are not!
Realize that the harder you try, the less likely that will happen.
Make a commitment to “go with the flow.” Convince yourself by
re-evaluating prior worries; you may find that ultimately things
do tend to work out for the best.
7. Laugh
If all else fails make yourself laugh. Here is a bit of humor to
make that happen:
Why Worry?There only two things to worry about;
either you are well or you are sick.
If you are well, there is nothing to worry about;
If you are sick, there are only two things to worry about;
either you will get well or you will die.
If you get well, there is nothing to worry about.
If you die, there are only two things to worry about;
either you will go to Heaven or you will go to Hell.
If you go to Heaven, there is nothing to worry about.
If you go to Hell, you will be so busy shaking hands
with friends, you will not have time to worry.
© 2012 Wolf J. Rinke
Dr. Wolf J. Rinke, RD, CSP is a keynote speaker, seminar leader,
management consultant, executive coach and editor of the free
electronic newsletter Read and Grow Rich, available at www.
easyCPEcredits.com. In addition he has authored numerous CDs,
DVDs and popular books including Make It a Winning Life: Success
Strategies for Life, Love and Business, Winning Management: 6
Fail-Safe Strategies for Building High-Performance Organizations;
Don’t Oil the Squeaky Wheel and 19 Other Contrarian Ways to
Improve Your Leadership Effectiveness; and Leadership: Helping
Others to Succeed, available at www.WolfRinke.com. His company
also produces a wide variety of quality pre-approved continuing
professional education (CPE) self-study courses, such as Beat the
Blues--How to Manage Stress and Balance Your Life, (28 CPEUs)
from which this article was excerpted. CPE courses are available
in both print and electronic formats at www.easyCPEcredits.com.
Reach him at [email protected].
Done it all, and still worrying? Just say no -- I mean just let go. Let go of the feeling that you have to be in control -- you are not!”“
80 The OR Connection
Celebrate Breast Cancer Awareness Month
Emma and SCIP
Emma
Aligning practice with policy to improve patient care 81
Schedule a mammogram and remind a friend
to do the same.
Join a breast cancer walk in your local area.
Cook pink! (See page 89)
Wear pink gloves and other pink attire.
Sign up for Medline’s Daily Dance inspirational
emails at www.pinkglovedance.com.
Top 5 Breast Cancer Awareness Activities for October
1
2
3
4
5
Breast cancer awareness fashions available at www.scrubs123.com and www.medline.com
Questions? Call 1-800-MEDLINE or contact your Medline representative
82 The OR Connection
2012 Pink Glove Dance IIVideo Competition
Win a Donation to Your Favorite
Breast Cancer Charity*
First Place: $10,000Second Place: $5,000Third Place: $2,000
Deadline for submissions: September 28Winners announced: November 2
Complete contest instructions are availableat www.pinkglovedance.com.
*Subject to review and approval by Medline Industries, Inc.
PGDVoting beginsOctober 12!
Aligning practice with policy to improve patient care 83pinkglovedance.com
Some of last year’s PGD Video contestants!
Gwinnett Medical Center, Duluth, GA
Lexington Medical Center, West Columbia, SC
� Highland Hospital, Rochester, NY
San Juan Medical Foundation, Farmington, NM
Victoria Hospital, Prince Albert, SK, Canada
Pink Glove Dance COMPETITION
84 The OR Connection
I am very honored that Medline
and Providence St. Vincent Hospital
used my song “Down” to promote and
support Breast Cancer Awareness.
Jay Sean
BY JAYAA SEAN
F ME”
“EVAV CUATAA E THE DANCE FLOOR”
“
BY KAK TAA Y PERRY
BY CASCADA
YY
VIDEO
Aligning practice with policy to improve patient care 85
This year, the competition will embrace old favorites like “Down” by Jay Sean (the song in the
original Pink Glove Dance) and “You Won’t Dance Alone” by The Best Day Ever (the song in
Pink Glove Dance: The Sequel). New tunes include “Part of Me” by Katy Perry, “Evacuate the
Dance Floor” by Cascada, “This One’s for the Girls” by Martina McBride, and “Let Yourself Go”
by Emily, a local artist. Medline is grateful to these artists with heart who are supporting the
cause and providing great dance beats.
The thanks are going both ways. “It’s very cool,” said Tonya Puerto, of Capitol Records, who
is excited about Katy Perry’s music being used for the second year in a row.
Singer Jay Sean said, “I am very honored that Medline and Providence St. Vincent Hospital
used my song “Down” to promote and support Breast Cancer Awareness. I like that such a
fun and light hearted approach was taken to create awareness for a serious disease that can
be cured if caught early. The positive response and reaction that the ‘Pink Gloves’ video has
received has been incredible, and coming from a medical background myself, I hope that we
are able to keep a spotlight on this illness until we reach a cure!”
2012!The 2012 Pink Glove Dance Video Competition is
in full swing, and there’s still time to enter by
the September 28 deadline. Choose from new
songs, new artists and new social media that we
hope will bring the competition to the next level.
BBY THE BEST DAYAA EVER
BY MARTRR INA MMCBRIDE
Aligning practice with policy to improve patient care 85
86 The OR Connection Connection
Emily Rosenberg, of Highland Park, Ill. and a sophomore at
Berklee College of Music in Boston, donated the rights to
use her song the Pink Glove Dance. When asked why, she
responded, “I’m so thrilled to be involved in the Pink Glove
Dance. These videos bring such joy and laughter to the people
who deserve it most. Breast cancer affects so many people —
both the patients and their loved ones. The more awareness
we can raise the better, and we might as well do it in such a
fun way! I’m ecstatic that my music will be used for something
that makes people so happy. That’s the goal of making music:
to improve lives. That’s the dream, and I’m so grateful that the
Pink Glove Dance is helping make it come true.”
Lexington Medical Center, the facility that won the 2011 Pink
Glove Dance Competition, loved dancing pink last year. “The
Pink Glove Dance was a wonderful experience for Lexington
Medical Center,” said Jennifer Wilson, Lexington Medical
Center public relations manager. “We are so grateful to the
people from around our community, country and the world
who viewed our Pink Glove Dance video and voted for us. To
date, our video has received more than 150,000 You Tube
views. The Pink Glove Dance competition was a great way
for Lexington Medical Center to show the world our hospital
and our steadfast commitment to the treatment of breast
cancer, a disease that affects 1 in 8 women in her lifetime.”
The Pink Glove Dance competition was a
great way for Lexington Medical Center to
show the world our hospital and our steadfast
commitment to the treatment of breast cancer.Lexington Medical Center 2011 First Place Pink Glove Dance Winners
87
What started as a crazy fun way to raise awareness about
early detection of breast cancer has become an international
dancing phenomenon, including 21,000 total Pink Glove
Dancers, 13,608,658 (and counting!) views of the original
Pink Glove Dance, and more than one million page views of
www.pinkglovedance.com.
To get the message out there as much as possible, Pink Glove
Dance this year has enhanced its presence on the web through
new social media including Facebook, Twitter, Pinterest, Tumblr
and Flickr. These social media sites are more important than
ever, and not only get the Pink Glove Dance out there, but are a
great resource for competition participants to spread the word
as well.
Medline hopes to keep spreading smiles and awareness by
promoting the Pink Glove Dance as much as possible. Medline
corporate headquarters hosted a Pink Glove Day this year on
Update your family and friends on your project. Your loved ones will love supporting you!
Contact local media (newspaper, tv and radio) and ask for help promoting the campaign.
Create an account on one or more social media sites such as Facebook® or Twitter®. Be sure to “like”
Medline Breast Cancer Awareness on Facebook and “follow” @pinkglovedance on Twitter. Connect
with your friends and remind them to vote.
Email everyone you know with a description of how to vote, and a link to www.pinkglovedance.com.
Get creative to spread the word—our favorite videos featured people dancing their heart out. Host a
bake sale, make flyers, paint your nails pink. Anything and everything you do makes a difference, and
we thank you in advance for your participation!
the launch date of the competition, when Medline employees
enthusiastically donned their best pink clothes, sipped pink
lemonade and tweeted pink to get the word out.
How did last year’s winner do it? Wilson reflected, “Lexington
Medical Center believes that one of the elements that made our
video a winner was the fact that it showcased hundreds of our
employees, emphasizing the commitment of a large number of
people to battling breast cancer. Importantly, the video also used
the lyrics from the Katy Perry song Firework to help tell a story.”
The Pink Glove Dance reflects Medline’s commitment to saving
lives through raising awareness and funds for early detection
of breast cancer. Medline has donated more than $1 million
to date to the National Breast Cancer Foundation to fund free
mammograms from the proceeds of pink gloves and other
Generation Pink™ products.
Aligning practice with policy to improve patient care
Yes, They’re Genuine.
Only Medline’s Pink Pearl™ gloves combine aloe, nitrile and breast cancer awareness.
©2012 Medline Industries, Inc.
Medline is a registered trademark
and Pink Pearl is a trademark of
Medline Industries, Inc.
Scan this QR Code or visit http://pinkglovedance.com/
LEARN MORE ABOUT THE PINK GLOVE DANCE
AND SUPPORT BREAST CANCER AWARENESS
C O O K I N G
PinkThe foods you choose every day are one of the most important
factors in protecting you against cancer. Most Americans eat
a diet that is far too high in meat and calories. Even more
important is what the average diet lacks: a variety of vegetables,
fruits, beans and other plant-based foods.
Plant-based foods give your body not only the nutrients it needs
for good health, but an arsenal of compounds (phytochemicals)
that help protect against naturally-occurring cancer risks you
face every day.
Healthy Pink Foods
� Beets � Cherries � Strawberries
� Raspberries � Red peppers � Pink grapefruit
� Cranberries � Watermelon � Red potatoes
� Salmon � Shrimp � Red beans
BREAST CANCER AWARENESS
Aligning practice with policy to improve patient care 89
90 The OR Connection
What’s in it for you?
����������� ������� �����
Ingredients
Canola oil spray 3 Tbsp. canola oil
2 eggs
1/2 cup sugar 1 tsp. vanilla
1/3 cup unsweetened applesauce
1 cup fresh blueberries 1 cup chopped fresh strawberries 1 cup whole-wheat flour
2 tsp. baking powder 1/4 tsp. salt
1 cup unbleached all-purpose flour
1/2 cup fat-free milk
Directions: Preheat oven to 375 degrees. Spray 12-cup muffin tin with canola oil and set aside.
In medium bowl, whisk together oil, applesauce, sugar and eggs. Add vanilla, blueberries and
strawberries. In separate bowl, blend together flours, baking powder and salt. Fold in half flour
mixture, then half milk. Add remaining flour and milk, folding in just until blended. Scoop batter
into prepared tins. Bake 25-30 minutes or until golden brown and inserted toothpick comes out dry.
Allow muffins to cool for 20 minutes before removing from pan.
Nutrition Information: Per serving (1 muffin), Calories: 165, Fat: 5 grams, Carbohydrates: 25 grams, Protein:
4 grams, Fiber: 2 grams, Sodium: 133 mg
Blueberries are high in soluble fiber. They are an excellent
source of vitamins C and K—all for about 80 calories per cup. In
addition, blueberries contain a family of plant compounds called
anthocyanides, which are among the most potent antioxidants and
may play a role in reducing risk of chronic diseases such as cancer.
Aligning practice with policy to improve patient care 91
Strawberries provide a hearty dose of vitamin C, and
their vibrant color is a sign that they are rich in cancer-
fighting phytochemicals. In addition, strawberries are a
source of ellagic acid, which has shown promising anti-
cancer properties in laboratory studies.
��������������������������� ������������������ ���
����!���"��������#������$�������������%������&��'���������%������(���
Delicious food. Healthy food. They’re one in the same—especially when
the recipes are developed by the American Institute for Cancer Research
(AICR) cookbook team. AICR is proud to announce the publication of its
treasure-trove of 200 recipes, which ravish the palate while helping you
manage your weight and reduce the risk of disease. Available at amazon.
com and Barnes & Noble.
Source: American Institute for Cancer Research
http://www.aicr.org/how-you-can-help/get-involved/pink-on-purpose/pop_pink_recipes.html
92 The OR Connection 92 The OR Connection
Myth #3Having a family history of breast
cancer means you will get it.
FactWhile women who have a family history of breast cancer
are in a higher risk group, most women who have breast
cancer have no family history. If you have a mother,
daughter, sister, or grandmother who had breast cancer,
you should have a mammogram five years before the age
of their diagnosis, or starting at age 35.
Myth #2A mammogram can cause
breast cancer to spread.
FactQuite the contrary. Each year it is estimated that
approximately 1,700 men will be diagnosed with breast
cancer and 450 will die. While this percentage is still
small, men should also give themselves regular breast
self-exams and note any changes to their physicians.
Myth #1Men do not get breast cancer.
FactQuite the contrary. Each year it is estimated that
approximately 1,700 men will be diagnosed with breast
cancer and 450 will die. While this percentage is still
small, men should also give themselves regular breast
self-exams and note any changes to their physicians.
BREAST CANCERMythsDon’t let yourself
be a victim of
misinformation
and myths
generated by fear.
Myth #4Finding a lump in your breast
means you have breast cancer.
FactIf you discover a persistent lump in your breast or any
changes in breast tissue, it is very important that you
see a physician immediately. However, 8 out of 10
breast lumps are benign, or not cancerous. Sometimes
women stay away from medical care because they
fear what they might find. Take charge of your health
by performing routine breast self-exams, establishing
ongoing communication with your doctor, and
scheduling regular mammograms.
Myth #5Breast cancer is contagious.
FactYou cannot catch breast cancer or transfer it to some-
one else’s body. Breast cancer is the result of uncon-
trolled cell growth in your own body. However, you can
protect yourself by being aware of the risk factors and
following an early detection plan.
Myth #7Knowing you have changes in the
BRCA1 or BRCA2 gene can help
you prevent breast cancer.
FactWhile alterations in these genes in men and
women can predispose an individual to an
increased risk of breast cancer, only five to 10
percent of patients actually have this mutation.
This is not an absolute correlation. Like your
age or having a family history of breast cancer,
it’s a factor you just can’t control. But you can
let your physician know, perform regular breast
self-exams, and focus on the fact your chances
of not having this disease are greater than
90 percent.
Myth #6Antiperspirants and deodorants cause
breast cancer.
FactResearchers at the National Cancer Institute (NCI) are
not aware of any conclusive evidence linking the use
of underarm antiperspirants or deodorants and the
subsequent development of breast cancer. For more
information, visit http://www.cancer.gov/cancertopics/
factsheet/Risk/AP-Deo.
Source: National Breast Cancer Foundation. Arm yourself
with knowledge. http://www.nationalbreastcancer.org/
About-Breast-Cancer/Myths.aspx.
Remember...
Get your mammogram.
Visit medline.com
Pink merchandise from Medline
helps support the National Breast
Cancer Foundation.
Aligning practice with policy to improve patient care 95
A high rate of HH failure was observed among anesthesia provid-
ers. The operating room environment is an epicenter of infectious
disease organisms where a large number of patients have active
infectious disease and many who are immunocompromised.
Patients and providers have the opportunity to come into contact
with one another with multiple, ongoing opportunities for both
vertical and horizontal transmission of organisms in such an
environment.
The insular nature of anesthesia care is such that a provider works
without much observation from others because of their generally
being at the patient’s head with surgical drapes obscuring view of
them. This is unlike the surgeon, technicians, and nurses, who are
within view of each other and who subscribe to an intense level of
institutional and peer pressure, as well as tradition in achieving a
powerful culture of asepsis. Furthermore, providing surgical anes-
thesia care can be very challenging because of the high intensity
of psychomotor task density that must be accomplished, often
in a very compressed period of time. The current study revealed
a high rate of HH opportunities that averaged 34 to 41 times per
hour over the phase of care and, in some cases, approached 54
opportunities per hour. Audits performed in the intensive care unit
have found that HH is indicated at an average rate of about 20
times per hour.12 Performing adequate HH in such a setting can
prove daunting if not impossible given the intensity and nature of
the provider-to-patient interactions.
Although health care providers are often primarily concerned
about the transmission of microbes from one patient to anoth-
er, or from patient to provider, it is important to recognize that
patients must be protected both from their own flora as well as
flora from their providers. To illustrate this, consider that Staphy-
lococcus aureus is the most common cause of a surgical site
infection.13 Now consider that one-fifth of health care providers
are persistent carriers of S. aureus in our nares, and fully 30% of
us are intermittent carriers.14 Biofilms are ubiquitous throughout
the hospital; are within and on our bodies; and, because of the
constant shedding of organisms from biofilms, we are constantly
inoculating everything we come into contact with, inclusive of our
patients.15,16 HH is vital to breaking the vector chain.
The intent of the current study was not to seek relationship
between anesthesia provider HH behavior and subsequent
patient outcome as has been done in 2 previous studies, although
both employed methodology where any noted “causal link” could
be readily challenged.9,10 Rather, the goals were (1) quantify the
HH behaviors of a range of anesthesia providers during the real-
time care of patients and (2) determine the rate of indicated HH
for these providers over the continuum of perioperative care. With
respect to the first goal, a very low rate of HH success was
observed with an aggregate failure rate of 82%. With respect to
the second goal, there was a very high rate of HH opportunities
that averaged 34 to 41 times per hour.
The resultant taxonomy of failures (Table 1) may provide organi-
zations with the ability to strategically target educational, facility,
and technologic interventions that are designed to improve HH
in the setting of the anesthesia work station and operating room.
The culture of the anesthesia workstation needs a wake-up call,
having been largely, until recently, outside the intense scrutiny
experienced by other domains in the hospital setting. A recent
editorial17 in a prominent international anesthesia journal ends with
the asking of relevant questions, including the following:
complexities in keeping them germ free?
pathogens wear special masks?
permitted to render care?
equipment including computer keyboards?
iPods, and others) to enter the workstation?
It may be that, given the intense culture of asepsis by the OR
team (surgeon, scrub, circulators, and others) yet the persistence
of a disturbing rate of surgical site infections of at least 5%
despite nearly mandated use of preincisional antibiotics,18 then
perhaps our focused attention should be directed at patient and
anesthesia provider factors. Even the ubiquitous use of stop-
82% Results showed an 82% hand hygiene failure rate among
a range of anesthesia providers
Continued from page 54
96 The OR Connection
cocks in facilitating the IV administration of perioperative drugs
is hampered by difficulties in maintaining good aseptic technique
because of their cumbersome design (Fig 1). Stopcock contami-
nation is extraordinarily common with any associated poor HH
providing direct IV entry of pathogenic material into the
patient.9,10,17 Overall, the HH and aseptic practices of anesthe-
sia providers, revealed in this study, were poor. Whereas criticism
might be directed that this study holds anesthesia providers to
an impossibly high standard, it might also be viewed as a further
opportunity to generate a much needed dialogue on the issue
and to promote novel educational and interventional strategies to
improve practice. Given the demands of anesthesia care and the
high rate of HH opportunities, aggressive strategies for achieving
improved rates of HH should be pursued.
In his day, Dr Ignaz Semmelweis was scorned and literally driven
from practice for his zealotry in urging health care providers to
engage in HH. Semmelweis would likely be greatly disturbed at
the current state of affairs of HH in the US health care institutions.
The current study’s findings further fuel this view. Signage,
immediate availability of gloves, access to HH foam/gel dis-
pensers, aggressive education of providers at grand rounds,
journal clubs, and staff meetings have been instituted in an effort
to improve HH among anesthesia providers. A follow-up study
is planned in this calendar year, using a similar methodology to
determine the efficacy of our multidimensional interventional pro-
gram in improving HH among anesthesia providers.
Address correspondence to Chuck Biddle, CRNA, PhD, Box 980226, Virginia
Commonwealth University Medical Center, Richmond, VA 23298-0226. E-mail address:
[email protected] (C. Biddle).
References
1. Trampuz A, Widmer AF. Hand hygiene: a frequently missed lifesaving oppor¬tunity during
patient care. Mayo Clin Proc 2004;79:109-16.
2. Stone PW, Larson E, Kawar LN. A systematic audit of economic evidence lining
nosocomial infections and infection control interventions: 1900-2000. Am J Infect Control
2002;30:145-52.
3. Lee C. Studies: hospitals could do more to avoid infections. The Washington Post.
November 21, 2006. Section 1; p. A-3.
4. Jarvis W. The United States approach to strategies in the battle against
healthcare-associated infections, 2006: transitioning from benchmarking to zero
tolerance and clinician accountability. J Hosp Infect 2006;65:3-9.
5. Cantrell D, Shamriz O, Cohen MJ, Stern Z, Block C, Brezis M, et al. Hand hygiene
compliance by physicians: Marked heterogeneity due to local culture? Am J Infect Control
2009;27:301-5.
6. Wachter RM, Pronovost PJ. Balancing “no blame” with accountability in patient safety.
N Engl J Med 2009;361:1401-6.
7. Muller MP, Detsky AS. Public reporting of hospital hand hygiene compliance: helpful or
harmful? JAMA 2010;304:1116-7.
8. Klevens RM, Edwards JR, Richards CL Jr, Horan T, Gaynes R, Pollock D, et al.
Estimating health care associated infections and deaths in US hospitals, 2002. Public
Health Rep 2007;122:160-6.
9. Loftus RW, Koff MD, Burchman CC, Schwartzman J, Thorum V, Read M, et al.
Transmission of pathogenic bacterial organisms in the anesthesia work area.
Anesthesiology 2008;109:399-407.
10. Koff MD, Loftus RW, Burchman CC, Schwartzman J, Thorum V, Henry E, et al.
Reductin in intraoperative bacterial contamination of peripheral intravenous tubing
through the use of a novel device. Anesthesiology 2009;110:978-85.
11. Biddle C. Semmelweiss revisited: hand hygiene and nosocomial disease transmission
in the anesthesia workstation. AANA J 2009;77:229-37.
12. Boyce JM, Pitter D. Guideline for hand hygiene in healthcare settings: recommendations
of the Healthcare Infection Control Practices Advisory Committee and the HIPAC/SHEA/
APIC/IDSA Hand Hygiene Task Force. Am J Infect Control 2002;30:S1-46.
13. Kaye KS, Anderson DJ, Sloane R, Chen L, Choi Y, Link K, et al. The effect of surgical
site infection on older operative patients. J Am Geriatr Soc 2009;57: 46-54.
14. van Belkum A, Melles DC, Nouwen J, van Leewen W, van Wamel W, Vos M, et al.
Co-evolutinary aspects of human colonization and infection by Staphylococcus aureus.
Infect Genet Evol 2009;9:32-47.
15. Sheretz RJ, Bassetti S, Bassetti-Wyss B. “Cloud” health care workers. Emerg Infect
Dis 2001;7:241-4.
16. Edmiston CE, Seabrook GR, Cambria RA, Brown K, Lewis B, Sommers J, et al.
Molecular epidemiology of microbial contamination in the operating room: is there a risk
for infection. Surgery 2005;138:573-82.
17. Roy RC, Brull SJ, Eichhorn JH. Surgical site infections and the anesthesia
professionals’ microbiome: We’ve all been slimed! Now what are we going to do about it.
Anesth Analg 2011;112:4-7.
18. Neumayer L, Hosokawa P, Itani K, El-Tamer M, Henderson WG, Khuri SF. Multivariable
predictors of postoperative surgical site infection after general and vascular surgery:
results from the patient safety in surgery study. J Am Coll Surg 2007;204:1178-87.
American Journal of Infection Control. Published online 13 February 2012.
Copyright ©2012 by the Association for Professionals in Infection Control and Epidemiology,
Inc. Published by Elsevier Inc. All rights reserved. Reprinted with permission.
5% Given the intense culture of asepsis by the OR team (surgeon, scrub, circulators,
and others) yet the persistence of a disturbing rate of surgical site infections of at
least 5% ... then perhaps our focused attention should be directed at patient and
anesthesia provider factors.
Aligning practice with policy to improve patient care 97
Promote Correct-Site Surgery
Our Surgical Time Out Procedure (S.T.O.P.™)
safety products alert the surgical team to
perform a time-out verification and help reduce
the risk of wrong-site surgery.
Support Sharps Safety Practices
Transfer trays, scalpel holders and needle
counters with blade guards promote sharps
safety and help make you OSHA compliant.1
Improve Fluid Disposal Safety
The Safety-Splash™ fluid management system
converts biohazardous fluids into a solid,
minimizing the risk of exposure.
©201 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
Safety-Splash and S.T.O.P are trademarks of Medline Industries, Inc.
References: 1. Occupational Safety and Health Standards, Toxic and Hazardous Substances,
Bloodborne pathogens. Regulations (Standards - 29 CFR). Available at: http://
www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_
id=10051#1910.1030(d)(2)(i). Accessed October 13, 2010.
Medline’s Gold Standard safety products stand out against the
sea of blue in the OR to alert the surgical team to focus on safety.
MEDLINE GOLD STANDARD SAFETY COMPONENTS
SAFETY
DESERVES
ATTENTION
Download a QR Code Reader app
Launch the QR app
Scan this QR Code or visit http://
www.medline.com/programs/gold-standard-
safety-program/
1
2
3
LEARN MORE ABOUT MEDLINE’S
GOLD STANDARD SAFETY PRODUCTS
98 The OR Connection
Healthy Eating
Ingredients
1 pkg broccoli cole slaw
1 6-oz pkg slivered almonds
1 7.25-oz jar sunflower seeds
4 green onions, thinly sliced
1 pkg chicken-flavored ramen noodles, crushed
Crush the uncooked ramen noodles and toss all the ingredients
together. Add dressing and toss immediately before serving for
a great crunchy texture. The next day it’s still very good, but the
ramen will have lost its crunch.
Broccoli is a nutrition star. Its resumé of vitamins and miner-
als includes beta carotene, vitamin C, calcium, fiber, and phyto-
chemicals, specifically indoles and aromatic isothiocynates. Some
suggest broccoli other cruciferous vegetables may be responsible
for boosting certain enzymes that help to detoxify the body, even
helping to prevent cancer, diabetes, heart disease, osteoporosis
and high blood pressure.
Ready-to-use broccoli slaw is available in most grocery stores’
packaged salad aisle. It’s long shreds of broccoli stems (and
sometimes some other veggies, too) that you can substitute for
the shredded cabbage in traditional cole slaw, or as the main
ingredient in this delicious salad.
Lillian Stafford’s Oriental Broccoli
Nutrition
Information
Servings: 6
Calories: 391
Fat: 35.8
Sodium: 156mg
Fiber: 3.2g
The Medline employee cookbook
is $10. To purchase your own
copy, please e-mail Judy at
2
Dressing
½ C canola oil (light virgin olive oil works, too)
3 T vinegar
1 T soy sauce
3 T sugar
1 chicken flavor packet (from the ramen noodles)
Whisk or shake to thoroughly mix the ingredients together. Set
aside until ready to serve the salad.
Diane Seminary is a 15-year Medline veteran who works closely
with the manufacturing team in Medcrest. Born here, her family
is originally from Quebec, which she still visits every summer. The
salad’s namesake is the daughter of Bill Stafford from Medline
warehouse B02, who introduced it to Diane’s family. “This salad
is light and carries well for any picnic adventure.” Enjoy.
Forms & Tools
Aligning practice with policy to improve patient care 99
Sharps Safety
Now You See It, Now You Don’t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Sharps Safety Begins with You . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Malignant Hyperthermia
Emergency Therapy for Malignant Hyperthermia . . . . . . . . . . . . . . . . . 102
Malignant Hyperthermia Drill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Hand Hygiene
Your 5 Moments for Hand Hygiene . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Preventing SSIs
Caring for Your Surgical Incision at Home . . . . . . . . . . . . . . . . . . . . . . 105
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NOW YOU DON’T.
NOW YOU SEE IT.
DISCLAIMER: Mention or depiction of any company or product does not constitute endorsement by CDC.
BE PREPARED. Anticipate injury risks and prepare the patient and work area with prevention in mind. Use a sharps device withsafety features whenever it is available.
BE AWARE. Learn how to use the safety features on sharps devices.
DISPOSE WITH CARE. Engage safety features immediately after use anddispose in sharps safety containers.
PROTECT YOURSELF AND OTHERS- USE SHARPS WITH SAFETY FEATURES
Support for printing this poster came from an unrestricted educational grant provided by Safety Institute, Premier, Inc.
Aligning practice with policy to improve patient care 101
Sharps Safety Forms & Tools
102 The OR Connection
EMERGENCY THERAPY FOR
MALIGNANT HYPERTHERMIA
MH Hotline
1-800-644-9737
Outside the US:
1-315-464-7079
DIAGNOSIS vs. ASSOCIATED PROBLEMS
ACUTE PHASE TREATMENT
POST ACUTE PHASE
Signs of MH: Increasing ETCO2
Sudden/Unexpected Cardiac
Arrest in Young Patients:
Trismus or Masseter Spasm with Succinylcholine
Hyperkalemia
pediatric,
adult,
Follow ETCO27
6
Bicarbonate for metabolic acidosis
Cool
Dysrhythmias
except calcium
channel blockers, which may cause
hyperkalemia or cardiac arrest in the
presence of dantrolene.
3
4
5
GET HELP. GET DANTROLENE – Notify Surgeon
2
Dantrolene 2.5 mg/kg rapidly IV through large-bore IV, if possible
1
2
CAUTION: This protocol may not apply to all patients; alter for specific needs.
A D
E
B
C
Non-Emergency Information
MHAUS
Phone
Fax
Website
ORPO 5/08/5K Produced by the Malignant Hyperthermia Association of the United States (MHAUS). MHAUS is a non-profit organization under IRS-Code 501(c)3. It operates solely on contributed funds. All contributions are tax deductible. For more information, go to www.mhaus.org.
Effective May 2008
SSPOST ACUTE PSSSAA
A
channel bAhyperkAAAAM
carbonate fof r m
C
hythmiasM4
PPPic acidosis
LLEE
ERMIA
Eter Spasm with Succinylcho
Forms & Tools Malignant Hyperthermia
Aligning practice with policy to improve patient care 103
Drill Element Met Not Met Notes
Staff member was able to call MH drill appropriately ( called
operator from location and indicated Malignant Hyperthermia
alert and location
Hospital Operator appropriately called MH event overhead
All members of MH team presented to Drill �
medication for administration
Hyperthermia Drill Forms & Tools
Emergency Department
Observers
104 The OR Connection
Forms & Tools Hand Hygiene
Your 5 Moments for Hand Hygiene
12345
WHEN? Clean your hands before touching a patient when approaching him/her.
WHY? To protect the patient against harmful germs carried on your hands.
WHEN? Clean your hands immediately before performing a clean/aseptic procedure.
WHY? To protect the patient against harmful germs, including the patient's own, from entering his/her body.
WHEN? Clean your hands immediately after an exposure risk to body fluids (and after glove removal).
WHY? To protect yourself and the health-care environment from harmful patient germs.
WHEN? Clean your hands after touching a patient and her/his immediate surroundings, when leaving the patient’s side.
WHY? To protect yourself and the health-care environment from harmful patient germs.
WHEN? Clean your hands after touching any object or furniture in the patient’s immediate surroundings, when leaving – even if the patient has not been touched.
WHY? To protect yourself and the health-care environment from harmful patient germs.
BEFORE TOUCHINGA PATIENT
BEFORE CLEAN/ASEPTIC PROCEDURE
AFTER BODY FLUIDEXPOSURE RISK
AFTER TOUCHINGA PATIENT
AFTERTOUCHING PATIENTSURROUNDINGS
12
3
BEFORETOUCHINGA PATIENT 4 AFTER
TOUCHINGA PATIENT
5 AFTERTOUCHING PATIENTSURROUNDINGS
BEFORE
CLEAN/ASEPTIC
PROCEDURE
RISK
FLUID EXPOSUREAFTER BODY
All reasonable precautions have been taken by the World Health Organization to verify the information contained in this document. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.
WHO acknowledges the Hôpitaux Universitaires de Genève (HUG), in particular the members of the Infection Control Programme, for their active participation in developing this material.
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CoverThis fun group of perioperative nurses from the University Medical Center of Princeton at Plainsboro, in Plainsboro, NJ, took first place in Medline’s Pink Glove Dance Photo Contest at the 2012 AORN Conference in March. From left to right, Lori Mozenter, BSN, CNOR, RNFA, Staff Nurse; Mary Zegarski, RN, CNOR, Staff Nurse and Vice President of AORN Chapter 3109; Fe Moreo BSN,CNOR, Staff Nurse and Patricia Lum, RN, BSHA, CNOR, CMLSO, Perioperative Educator/Interim OR Manager.
Sharps Safety Forms & Tools
Aligning practice with policy to improve patient care 107
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SharpsSafety_posterFINAL.qxd 8/8/03 11:13 PM Page 1
Patient Handout Forms & Tools
Caring for Your Surgical Incision at Home
The following are general guidelines. Consult your surgical team for more specific instructions.
Bathing and Showering
Most incisions should be kept dry for several days after surgery, except for incisions closed with surgical glue.
It is usually safe to allow glued incisions to get wet while showering or bathing. It is important, however, to dry
the area around the incision carefully after washing.
Physical Activity and Exercise
Avoid any activity that pulls on the edges of the incision or puts pressure on it. Walking and other light activities
are encouraged to restore normal energy levels and digestive functions. Do not, however, participate in sports,
engage in sexual activity or lift heavy objects until after your postoperative checkup.
Aspirin
Avoid aspirin or over-the-counter medications containing aspirin for a week to 10 days after surgery. Aspirin
interferes with blood clotting and makes it easier for bruises to form near the incision.
Sun Exposure
As an incision heals, the new skin that forms over the cut is very sensitive to sunlight and
will burn more easily than normal skin and lead to worse scarring. Keep the incision area
covered from direct sun exposure for three to nine months in order to prevent burning and
severe scarring.
General Hygiene
Infection is the most common complication of surgical procedures. It is important, therefore, to minimize
the risk of an infection when caring for your incision at home.
Observe the following precautions:
with you
contagious illness
Adapted from www.surgeryencyclopedia.com/Fi-La/Incision-Care.html
Aligning practice with policy to improve patient care 105
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