For further information:

01244 660 954www.melydmedical.com

© 2014 Allen Medical Systems, Inc. All Rights Reserved D-770732-A1

Distributed By

ALLEN® BOW® FRAME

More Versatile than the Wilson™ Frame,With an INCREASED Patient Weight Capacity

227 kg

Patient Weight

Capacity

• Radiolucent

• Lightweight for easy set-up

• Securely stores in its own cart

• Patient weight capacity: 227 kg (351⁄2 stone)

Bow Frame on

Operating Table

Bow Frame on

Mizuho OSI® Modular

Table System

Bow Frame on

Allen Flex Frame

Bow Frame on

Allen Advance Table

Wilson™ and Mizuho OSI® are trademarks or registered trademarks of Mizuho Orthopedic Systems, Inc.

July 2014 Issue No. 286 ISSN 1747-728XThe Leading Independent Journal For ALL Operating Theatre Staff

ISO 9001 ACCREDITED

TELEPHONE 01652 657200 FAX 01652 657009 WEB www.oakmedicalservices.co.uk EMAIL info@oakmedicalservices.co.uk

Oak Medical Services Ltd Unit 5A, Albert Street, Brigg, North Lincolnshire DN20 8HQ

OAK MEDICALSERVICES LTD

All new TQ electronic tourniquetfrom Oak Medical Services Ltd

* A gimmick free electronic tourniquet - Quick, Quiet & Easy to use!

* The TQ is manufactured by Oak Medical Services Ltd in the UK.

* Dual channel supply for bilateral procedures.

* Back up battery power supply.

* Height Adjustable utility cart with Utility baskets.

* Antistatic castors.

We pride ourselves on quality..Our commitment to quality is an ongoing process con rmed by our ISO13485:2003 status. Even after the product is delivered our aftercare service ensures the machine is kept in good condition.

Prevee-Prep

Dispozee-Cuff

All our products are manufactured in England.

TM

* Display rotary tilt function.

* Push click cuff pressure Rotary knobs for easy preset pressure selection, adjustment and de ation.

* Digital display: Pre-set pressure, cuff pressure, in ation time.

* Range of safety features to maintain cuff in ation pressure.

* Dual channel audio & visual alarms: Cuff check, low battery, service due.

Easily programmable surgical time tracking

List-Cuff

* 10 uses per cuff.

* 100 uses per pack.

* Strike through tags.

* Additional tear off tracker tags.

* Extended size range.

* Free tourniquet machines on usage amounts.

Find out more 02921 680068 • e-mail admin@lawrand.com Issue 286 July 2014 3

The next issue copy deadline, Friday 25th July 2014All enquiries: To the editorial team, The OTJ Lawrand Ltd, PO Box 51, Pontyclun, CF72 9YY Tel: 02921 680068 Email: admin@lawrand.com Website: www.lawrand.comThe Operating Theatre Journal is published twelve times per year. Available in electronic format from the website, www.otjonline.comand in hard copy to hospitals throughout the United Kingdom. Personal copies are available by nominal subscription.Neither the Editor or Directors of Lawrand Ltd are in any way responsible for the statements made or views expressed by the contributors. All communications in respect of advertising quotations, obtaining a rate card and supplying all editorial communications and pictures to the Editor at the PO Box address above. No part of this journal may be reproduced without prior permission from Lawrand Ltd. © 2014

Operating Theatre Journal is printed on paper sourced from Forest Stewardship Council (FSC) approved paper mills and is printed with vegetable based inks. All paper and ink waste is recycled.

Journal Printers: The Warwick Printing Co Ltd, Caswell Road, Leamington Spa, Warwickshire. CV31 1QD

Diabetes patients develop preventable complications in hospital and access to specialist staff is ‘inadequate’

Clinical audit shows patient care improving, but there is ‘a great deal more to do’

Over a fi fth (22.0 per cent) of patients with diabetes in hospital will have experienced a largely avoidable hypoglycaemic episode (6) in hospital within the past seven days (7), according to a national audit report released today. One in ten (9.3 per cent) will have experienced a severe hypoglycaemic episode and one in 50 (2.2 per cent) required injectable treatment due to the severity of the hypoglycaemia.

Th is is despite the fact that only 8.1 per cent of respondents had been admitted for their diabetes or a diabetic complication.

Th e fi ndings are published today in the National Diabetes Inpatient Audit (NaDIA), carried out by the Health and Social Care Information Centre, in collaboration with Diabetes UK. NaDIA is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Programme (3).

Th e report found that over a third of inpatients (37.5 per cent) who should have been referred to a hospital diabetes team did not see a diabetes specialist (8); almost one third (31.7 per cent) of sites in the audit had no diabetes inpatient specialist nurses (DISNs); and over one in 20 (5.3 per cent) had no consultant time for diabetic inpatient care. Almost three quarters (71.2 per cent) of sites had no specialist inpatient dietetic staff time for people with diabetes.

Th is is despite the report’s fi ndings that almost one in six people in a hospital bed has diabetes and that the percentage of hospital beds occupied by people with diabetes has risen each year (from 14.6 per cent in 2010 to 15.8 per cent in 2013).

Th e report also found that the more than a third of patients (37.0 per cent) with diabetes experienced a medication error (9), down from 39.9 per cent in 2011. Patients who had experienced a medication error were more than twice as likely to suff er a severe hypoglycaemic episode (15.3 per cent) compared to those with no error in their medication (6.8 per cent).

Th e National Inpatient Diabetes Audit (NaDIA) examines data about inpatients with diabetes collected by hospital teams in England and Wales on a nominated day in a defi ned week in September. It covers issues such as staffi ng levels, medication errors, patient harm and patient experience. Th e 2013 audit involved 14,198 patients with diabetes in 142 trusts in England and six local health boards in Wales. Th e data also shows:Diabetic Ketoacidosis• 63 patients (0.4 per cent) were

reported to have developed diabetic ketoacidosis (DKA) after their admission. Th is is a life threatening but preventable complication, resulting from a severe shortage of insulin.

Podiatry• All patients with diabetes should

have a foot examination on admission, to detect and prevent foot complications. Th ere happened in 42.4 per cent of cases in 2013, a signifi cant increase from 25.8 per cent in 2011.

• 9.2 per cent of patients were admitted with active diabetic foot disease (10), all of whom should be seen by the multidisciplinary foot care team within 24 hours of admission. Of these, 61.1 per cent were seen by a member of the team within 24 hours, and 69.3 per cent had seen a member of the team within the past seven days.

• Th e proportion of patients developing a foot lesion in hospital has reduced from 2.2 per cent in 2010 to 1.4 per cent in 2013.

Patient satisfaction with timing and content of meals• 14.7 per cent of patients reported

that the hospital did not provide the right kind of food to manage their diabetes.

• 15.1 per cent of patients said that they needed food to be brought into hospital to meet their dietary requirements and/or manage their diabetes.

Audit lead clinician Dr Gerry Rayman said: “Th e purpose of this annual clinical audit is to drive improvements in care for inpatients with diabetes. We are therefore delighted to see year on year improvements including reductions in patient harm. Th is is good news but there is still a great deal more to do.

“Whilst it is welcome to see that the percentage of patients experiencing hypoglycaemia in hospital fell from 25.7 per cent in 2011 to 22.0 per cent in 2013, the number of patients developing this largely preventable complication remains unacceptably high. Additionally, although a 36 per cent reduction in hospital acquired foot ulceration from 2.2 per cent to 1.4 per cent is very impressive, the frequency of this wholly preventable complication remains signifi cantly greater than in those without diabetes.

“Th e role of specialist diabetes staff within hospitals is crucial; it is therefore disappointing that staffi ng levels remain inadequate and it is unacceptable that over 30 per cent of trusts continue to have no diabetes inpatient specialist nurses.

“Diabetes is dependent on the whole of the hospital team working together to deliver safe care: from specialists, to junior medical staff , non-specialist nursing staff , health care assistants, dieticians, podiatrists, pharmacists and even catering staff .

“Were every trust in England and Wales to invest in a fully staff ed inpatient diabetes team, many expensive and avoidable complications could be prevented with considerable savings in bed days. More importantly, there would be a signifi cant improvement in patient satisfaction, and a reduction in morbidity and mortality.“

Source: www. hscic.gov.uk

Bonedoc Mobile App Ranks Highly as a Virtual “First-Person Surgeon”

Game for iOS UsersReleased by Otago Innovation Limited, Bonedoc tries to make all orthopaedic surgeons gamers before stepping into the operating room. Recently rated 4.5 / 5 by iMedical iApps (the leading online publication for medical professionals, patients, and analysts interested in mobile medical technology and health care apps), Bonedoc breaks away from step-by-step instructional apps and gives the user/surgeon greater ability to interact with the surgical procedure.

Th e user enters a virtual operating theatre and goes through the various stages of repairing a hip fracture. From cutting the skin, taking x-rays through to putting the screws in the right position, Bonedoc is bringing fi rst person surgery to medical professionals.

Bonedoc ‘s Project manager Dr Graham Strong said, ““Orthopaedic surgeons - in-training wanting to learn a new technique, and practicing surgeons wanting to help trainees climb the learning curve faster will benefi t from Bonedoc.”

As mobile technology continues to advance, more applications are focusing on simulating virtual surgical and medical techniques before performing them on real patients. Bonedoc gives feedback which has real world meaning and is medically accurate.

Dr. Philip Blyth, the developer of Bonedoc adds, “Th e app allows trainees to ‘warm-up’ before performing real surgery, in much the same way as kicking a football on the side-line before running onto the fi eld.”

Th e app also hooks into the Game Center, so the user can challenge colleagues and friends to see who is the best local or global Bonedoc. It is also easy to share triumphs via Facebook or Twitter.

Bonedoc is released by Otago Innovation Limited, the tech transfer offi ce of the University of Otago, Dunedin, New Zealand. Dr. Philip Blyth is both an academic at the University of Otago as well as an orthopaedic surgeon currently working in emergency medicine. Bonedoc can be downloaded from Apple’s iTunes store.

4 THE OPERATING THEATRE JOURNAL www.otjonline.com

DePuy Synthes introduces new solutions that address clinical and economic needs at EFORT 2014London, UK – 4 June 2014 – DePuy Synthes* showcased its latest orthopaedic solutions that are designed to enhance patient care whilst delivering clinical and economic value to health care professionals today at the 15th European Federation of National Associations of Orthopaedics and Traumatology (EFORT) congress, a combined programme in partnership with the British Orthopaedic Association, held in London, UK. “We are delighted to be able to demonstrate the breadth and depth of our portfolio to the clinical community here at EFORT,” said Davide Visentin, Vice President Marketing, DePuy Synthes Joint Reconstruction EMEA. “Our portfolio provides complete surgical solutions combined with programs and services that aim to create value for the health care system as a whole”.Accompanying the surgical products was DEPUY SYNTHES ADVANTAGE™, a suite of provider-focused solutions that help to address clinical and economic needs with the potential to improve patient satisfaction.New products available for demonstration were:• ATTUNE® Knee System: Designed to improve conformity and stability

throughout the range of motion, the company introduced the ATTUNE Rotating Platform Knee along with the Medialized Anatomic Patella, which is designed to improve patella kinematics.

• RIGIDLOOP™ Cortical Fixation System, RIGIDFIX® Curve Cross Pin System and MILAGRO® ADVANCE Interference Screw; the latest additions to the growing portfolio of products for ACL reconstruction

• PHILOS™ Augmentation and PFNA Augmentation: Innovations to provide additional support for osteoporotic fractures.

• OPERACE: Sterile, single use screw removal instrumentation for multiple manufacturers.

• GLOBAL® UNITE® Anatomic is the newest addition to the next-generation GLOBAL UNITE Platform Shoulder Replacement System that enables surgeons to use the same humeral stem to repair shoulder fractures or perform a total shoulder replacement with the option of later converting to a reverse shoulder that optimizes deltoid function.

• HEALIX ADVANCE™ Anchors: Th e next generation HEALIX suture and knotless anchors providing versatile, easy-to-use solutions for rotator cuff repair.

• FMS VUE™ System: Th e new Fluid Management and Tissue Debridement System off ers a comprehensive pump and shaver system with a simple user friendly set-up

• An extensive range of Power Tools extending across joint replacement (BPL II), trauma (TRS & Colibri II) and hand and foot surgery (SED & EPD)

Th e company also off ered educational symposia on the Anterior Approach to hip replacement, which allows for a smaller incision and less tissue disruption and may shorten the recovery process, knee replacement with the ATTUNE Knee System, and best practices in multidisciplinary fragility fracture management.About DePuy Synthes CompaniesDePuy Synthes Companies of Johnson & Johnson is the largest, most comprehensive orthopaedic and neurological business in the world, built upon the strong legacies of two great companies. DePuy Synthes Companies off er an unparalleled breadth and depth of technology, devices, services and programs in the areas of joint reconstruction, trauma, spine, sports medicine, neurological, cranio-maxillofacial, power tools and biomaterials. Our broad array of inspired, innovative and high-quality off erings help advance the health and wellbeing of people around the world.For more information, please visit: www.depuysynthes.com.

*DePuy Synthes is a trading division of DePuy International Ltd.Th e third party trademarks used herein are the trademarks of their respective owners.

twitter.com/OTJOnline

When responding to articles please quote ‘OTJ’

NICE release Adoption Support for IndithermTh e UK National Institute for Health & Care Excellence (NICE) has published Adoption support information to bring about an increased uptake of Inditherm patient warming in the NHS. http://guidance.nice.org.uk/MTG7/AdoptionSupport.

Active perioperative patient warming reduces the risk of post-operative complications, and a series of NICE guidelines have been published in recent years, encouraging NHS hospitals to adopt active patient warming measures during surgery.

Perioperative patient warming is generally achieved either through the use of what is termed Forced Air Warming, or by means of a conductive warming mattress, such as that manufactured by UK heating technology specialists Inditherm. Forced Air Warming requires the use of disposable blankets, and is the more expensive option. Th e Inditherm patient warming system utilises new carbon polymer materials technology, is completely reusable, and is the only conductive warming mattress patient warming system that has been reviewed by NICE. Data validated by NICE establishes that clinically, the Inditherm system is every bit as eff ective as Forced Warm Air.

Th is latest Adoption support guidance has been prepared by NICE under their Health Technologies Adoption Programme (HTAP) based on consultations with four diff erent NHS Trusts. Th e new NICE Adoption support pack is based on the direct experiences of the Leicester and Pennine Acute Trusts, and Children’s Hospital Trusts in Sheffi eld and in Birmingham. Th e NICE Adoption support highlights:• compliance with NICE clinical guidance (CG65)• clinically eff ective warming • integrated pressure relief • reduced logistics associated with current disposable products• reduced set-up times• signifi cant cost savings.

Commenting on the Adoption support package, Inditherm Chief Executive, Nick Bettles, said: “Th is is a very comprehensive set of documents that should certainly help NHS trusts in their preparations for adoption of Inditherm as their primary perioperative patient warming in place of traditional forced air warming. Th e Adoption support is all based on real life experience in an NHS, carried out with direct input from four independent NHS trusts who have all implemented the change, experienced the issues fi rst hand and realised the benefi ts in practice should give other hospitals confi dence to adopt Inditherm patient warming with all the advantages it clearly delivers.”

For further information contact::Inditherm Medical, Bolton Road, Rotherham S63 7LGTel: 01709 761000Email: tnewton@indithermplc.comWeb: www.inditherm.com When responding to articles please quote ‘OTJ’

Find out more 02921 680068 • e-mail admin@lawrand.com Issue 286 July 2014 5

Rediscover space and movementDiscovery IGS 730

GE Healthcare

The Discovery* IGS 730 angiography system brings both extremely high-quality imaging and complete workspace freedom to the hybrid operating room. Its unique mobile platform brings all the power of a fixed imaging system to the table, yet it can be moved aside, so multi-disciplinary teams can complete procedures comfortably, with unobstructed access to patients. High-end fluoroscopy image guidance, advanced applications, 3D image fusion – it all comes on a sophisticated gantry that travels on predefined paths with laser-guided precision. Now one room accommodates a wide range of endovascular, cardiac, hybrid and open surgical procedures, free of interference from fixed floor or ceiling system structures.

* Trademark of General Electric Company

For further information please contact David Britton at GE Healthcare.e-mail : david.britton@ge.comTel 07831697463

Flexible monitoring with Fukuda Denshi’s newDS-8200 patient monitor

Fukuda Denshi is a leading supplier of advanced patient monitoring and user-confi gurable clinical information management systems, as well as cardiac monitoring and imaging technology. Th e company have recently launched their new transportable and powerful DS-8200 patient monitor.

With a 10” wide colour TFT monitor, the DS-8200 is a modular monitor that uses the same GUI as Fukuda Denshi’s high-end DS-8500. It also off ers continuous monitoring during transportation using the DS-8500 super module and has a battery operation of up to 5 hours.

Compact in design to fi t into any critical care area, the DS-8200 measures just 270mm x 210mm x 201mm and weighs only 3.3kg without battery, making it a highly powerful and transportable monitor for continuous critical care use.

Off ering complete fl exibility, a variety of display confi gurations are available with the DS-8200, including the option of 12 lead ECG.

Other optional extras include Fukuda Denshi’s:

• HR-800 3 channel recorder

• HLX-801 internal telemetry module

• HCP-810 EtCO2 sidestream (Oridion)

• HDP-801 EtCO2 mainstream (Capnostat)

For more information telephone:

Fukuda Denshi on 01483 728065 or visit www.fukuda.co.uk.Fukuda Denshi: Healthcare bound by technology. When responding to articles please quote ‘OTJ’

Laryngoscopy: what’s lurking in your suction?Suction tubes used for scope work can be up to 55cm long and just 2mm wide. Whilst these instruments provide surgeons with the benefi t of aspirating fl uids from as deep as the bronchus, they present a huge challenge for the Sterile Services Team responsible for cleaning them.

Th e long internal cannula is not visible during cleaning or afterwards for inspection.

Researchers at the University of Michigan, USA, who used special microscopes to view inside cannula, found that even when manufacturer’s recommended cleaning methods were followed - and repeated - “fewer than 5% of the suction tips were completely visibly clean at the end of the process.”

Th e blood, bone, tissue and even rust that remains in suctions can pose an infection risk to a patient. Whilst it is diffi cult to link a dirty suction to patient infection, we ask: why take the risk?

Single Use Surgical off ers a range of single use scope suctions that are manufactured in a UK cleanrooms to guarantee that they are perfectly clean for every patient.

Contact Single Use Surgical today to arrange a free trialTel. +44 (0)1226 732 333Fax. +44 (0)1226 785 386Email. info@susl.co.ukwww.susl.co.uk When responding to articles please quote ‘OTJ’

6 THE OPERATING THEATRE JOURNAL www.otjonline.com

Double capacity infusion pump testing with Rigel Medical Multi-Flo Rigel Medical’s Multi-Flo high performance analyser doubles infusion pump test capacity, saving time and delivering productivity improvements through instantaneous high accuracy fl ow measurements.

Available in single or multi-channel confi guration, the Multi-Flo channels can be tested simultaneously across a range of 10 μL (microlitre) to 1,500 mL per hour and the results stored in the instrument’s large internal memory. With a sampling rate of 1Hz, the Multi-Flo can accurately detail any variations in fl ow or pressure, providing a real-time picture of the quality of infusion.

Fast, accurate and instantaneous fl ow measurements are provided, even at low rates, enabling the user to test twice as many infusion devices within the same time period when compared to other volumetric-based analysers.

Th e direct fl ow measurements, are directly comparable with tests using the traditional scales method but without the manual handling and evaporation problems associated with it. Th e Multi-Flo also off ers faster set-up times and improved data recording - tests have shown that on typical low fl ow rates, users can cut testing times by up to 50%, providing signifi cant annual cost savings.

Th e easy-to-use stand-alone analyser enables manufacturer specifi c test routines to be programmed and automatically executed, with readings stored automatically in a large internal memory. Th is removes the need for manual recording of data, reduces duplication of work and cuts the risk of manual data errors.

To meet the requirements of IEC 60601-2-24, the Multi-Flo also provides accurate back pressure simulations, occlusion alarm monitoring and bolus (PCA) measurements. A large colour screen presents the data in both numerical and graphical format, giving the user the fl exibility to monitor acquired volume, fl ow delivery profi les, pressure changes and bolus volumes.

A remote control interface is available via Rigel’s proprietary test solution software Med-eBase, allowing the complete control of the Multi-Flo’s features from the comfort of a PC. Requiring just a single USB connection per Multi-Flo, users can connect as many multi-channel Multi-Flo’s to a PC as they have USB ports, increasing the test capacity in high volume test environments.

Med-eBase software also provides an easy way to create default templates, producing real time and high resolution graphs including trumpet curves, and storage of test data. Th anks to its database structure, the software builds a complete history of each asset including functional and electrical safety test results along with user defi nable visual inspections. Customised PDF test certifi cates can be included to form a corporate identity on each individual certifi cate.

Ideal for testing in the fi eld, thanks to its rugged and compact all-in-one housing, the Multi-Flo is also ideally suited for use in a bench mounted or laboratory environment and is part of a range of advanced analysers, simulators, testers and accessories from Rigel Medical.

More at www.rigelmedical.com/multi-fl o

Th e Multi-Flo from Rigel Medical increases test capacity

When responding to articles please quote ‘OTJ’

Brandon Medical Presents: The Quasar® eLite

Quasar® eLite

Brandon Medical’s fi nest innovation to date, the Quasar® eLite, can now be seen in a high defi nition promotional video on their website www.brandon-medical.com and YouTube channel www.youtube.com/user/brandonmedical

Filmed in their state of the art medical technology centre, the video showcases the world’s most advanced AV operating light highlighting its integration of high intensity illumination and video and audio capabilities.

Th e Quasar® eLite simply has the very best light beam quality of any other product. Th e light boasts the biggest, fattest beam in the business, ranging from 200mm to 420mm; providing a high light intensity across the whole illuminated fi eld without high contrast lighting and visual distractions. Th e video demonstrates the virtually shadow free illumination, full spectrum colour rendition and red balance control to enhance the visualisation of red tissues.

Th e high intensity illumination is combined with the integration of Brandon Medical’s audio-visual Symposia® telemedicine system and embedded HD camera, provides clinicians with a stunningly accurate view of procedures, providing an effi cient system for consultation and sharing of footage with colleagues and medical students.

Th e Quasar® eLite was also designed with the aim of minimising sources of infection; remote controlled, easily cleaned and sealed lamp heads to avoid the ingress of unwanted dirt and liquids.

Once again, for those eager to further discover the capabilities of the Quasar® eLite’s innovative design and capabilities, the promotional video can be viewed at the company website www.brandon-medical.com, more specifi cally Products > Medical Lighting > Operating Th eatre Lights > Quasar® eLite or at their YouTube channel www.youtube.com/user/brandonmedical.

For further information please contact:Tel: 0113 277 7393Email: enquiries@brandon-medical.comWeb: www.brandon-medical.com. When responding to articles please quote ‘OTJ’

NMC - Raising concerns about a nurse or midwife

We have recently produced a leafl et to explain what you can do if you are unhappy about the care or behaviour of a nurse or midwife.

It talks about:• what standards you can expect from nurses and midwives • what you can do if you are unhappy about care • where you can get advice, and • what we can do. Th e document is designed and written with the public in mind and has been certifi ed by the Plain English Campaign for clarity of language and easy reading.

You can fi nd the leafl et on our website. http://www.nmc-uk.org/

Reading this online ?

Click here to watch the video

Find out more 02921 680068 • e-mail admin@lawrand.com Issue 286 July 2014 7

Contact us to organise a trial in your department today!

Tel: 0117 972 8888 Email: sales@p3-medical.comwww.p3medical.com

Distributed by

The world’s rstUltrasound System

with wirelesstranducers

SIEMENS

P3 Medical

New and innovative solution for healthcare establishmentsSpecialist engineering company Medical Air Technology (MAT) recently launched their revolutionary ECO-fl ow range of energy effi cient, ultra-clean ventilation canopies for use in cutting-edge, modern operating theatres. Th is has proved an innovative solution for healthcare establishments. Current projects utilising ECO-fl ow include complete theatre renovations and upgrade programmes including advancement of equipment to comply with existing and pending regulations.

Th e system is designed to meet the ever increasing theatre demand, whilst maximising the ultraclean zone and considerably reducing energy with potential savings of approximately £7,000 per unit per year.Groundbreaking levels of energy effi ciency are achieved owing to extremely speed variable and highly effi cient fans whilst resourceful centrifugal fans reduce signifi cant heat gains needing less cooling from the supply air. As a result ECO-fl ow can work in a full ultraclean mode absorbing less than 1.6kW* of power which can be up to 60% lower than other canopies. Typical running cost per day is considerably less than £1.25**.Another core feature is the user-friendly compact, state of the art PLC control panel with touch screen HMI which provides individual control and monitoring of the fans as well as providing easy integration with existing control systems and theatre controls.As regulations are becoming more stringent it is now more important than ever to be fully compliant. ECO-fl ow ensures total compliance with the requirements of the NHS Health Technical Memorandum, HTM03-01 parts A & B.For a hospital that requires innovative clean air technologies, ECO-fl ow is the perfect solution as it is both cost eff ective and energy effi cient which in turn refl ects the care that a hospital provides their patients.For more information about MAT please visit: http://www.medicalairtechnology.com/ When responding please quote ‘OTJ’

Awareness during surgery may not

leave you stressedPatients with confi rmed episodes of awareness during anaesthesia and surgery do not seem to be at increased risk of post-traumatic stress disorder (PTSD), says a study.“We found no indication that intra-operative awareness with recall had any long-term eff ects on patients’ psychosocial outcome,” said Tanja Laukkala from Centre for Military Medicine in Helsinki, Finland.Th e long-term follow-up study included nine patients with a documented episode of intra-operative awareness during general anaesthesia.All patients had “defi nite awareness with recall” - they accurately described events that occurred during their surgery.A median of 17.2 years after their episode of intra-operative awareness, the patients were evaluated on a battery of tests of psychosocial well-being.Assessment included formal diagnostic interviews for PTSD, along with anxiety, depression, and other psychiatric disorders.Nine patients with similar characteristics - who had undergone surgery without intra-operative awareness - were studied for comparison.Th e results showed no signifi cant diff erence in psychosocial outcomes for the patients with and without intra-operative awareness.In particular, none of the patients with intra-operative awareness were diagnosed with PTSD.In fact, in no patient did the episode of intra-operative awareness meet criteria for being a “potentially traumatic event” of the type leading to PTSD.Other measures of psychosocial well-being, including quality of life ratings, were also similar between groups.A few patients in each group had depression or other psychiatric disorders.Ongoing eff orts needed to prevent intra-operative awareness with recall is an uncommon but documented complication in patients undergoing general anaesthesia.Previous studies have suggested that intra-operative awareness may place patients at risk for PTSD and other mental health conditions, such as depression or alcohol abuse.Th e results suggest that intra-operative awareness does not necessarily increase the risk of PTSD and other mental health problems.Th e study was published in the journal Anaesthesia & Analgesia.

Source: Business Standard

8 THE OPERATING THEATRE JOURNAL www.otjonline.com

DEPUY SYNTHES EXPANDS ANATOMIC ACL RECONSTRUCTION PORTFOLIODePuy Synthes Mitek Sports Medicine*, a leader in orthopaedics sports medicine, announced it has added the RIGIDFIX® Curve Cross Pin System, the fi rst of its kind, designed specifi cally for use with the anteromedial (AM) portal approach to enable a more anatomic ACL (anterior cruciate ligament) reconstruction. Th e company also announced the launch of the RIGIDLOOP™ Cortical Fixation System, which when used with the INTRAFIX® ACL Tibial Fastener System, provides surgeons with a total procedural solution for anatomic soft tissue ACL reconstructions.

Both systems were unveiled at the 15th European Federation of National Associations of Orthopaedics and Traumatology (EFORT) congress, a combined programme in partnership with the British Orthopaedic Association, held in London, UK. In addition, the company announced that, along with the 23mm screw which was released earlier this year, two new sizes of MILAGRO® ADVANCE Interference Screws (30mm and 35mm) were added to Mitek Sports Medicine’s growing portfolio of knee solutions for soft tissue and bone-patellar tendon-bone reconstruction.

RIGIDFIX Curve Cross Pin SystemUsing the AM portal approach, the RIGIDFIX Curve System enables precise placement of two cross pins in the femoral tunnel. Th e cross pins provide strong fi xation and the close to aperture fi xation minimizes intratunnel graft micromotion, small movements of the graft inside the femoral tunnel, that may cause tunnel widening. Th e two cross pins create a compression fi t that further enhances 360-degree graft to bone contact. Th e design of RIGIDFIX Curve is based on the original RIGIDFIX® Cross Pin System, which has been used for ACL reconstruction through a transtibial approach for more than 10 years.

“ Many surgeons are nowadays moving from transtibial drilling to an anteromedial approach, as it may provide a greater rotational stability of the knee due to the more anatomic placement of the graft,” said Peter Reynaert, Consultant Orthopaedic Surgeon, Heilig Hart Hospital, Leuven, Belgium. “For this approach, RIGIDFIX Curve provides a unique fi xation with well known biomechanical advantages and has features that enhance precision and ease-of-use.”

RIGIDLOOP Cortical Fixation SystemTh e RIGIDLOOP system off ers a strong, easy-to-use solution for soft tissue ACL reconstructions. Th e implant consists of a titanium button that comes pre-loaded with a braided suture loop and off ers excellent pull out strength.2 Th e new device is available in sizes 15mm-60mm in 5mm increments, as well as an Extra-Large (XL) button for femoral tunnels greater than 6mm in diameter. Designed with simplicity in mind, the system includes an innovative variable depth gauge that calculates total transosseous length, amount of graft in tunnel, socket reaming depth and implant size. When used in combination with Mitek Sports Medicine’s INTRAFIX ACL Tibial Fastener System, the market’s leading tibial fi xation device, the RIGIDLOOP System provides a complete anatomic soft tissue ACL reconstruction which consists of the strongest cortical device2 (compared to Endobutton) and strongest, clinically proven tibial device.3

Also at EFORT, Mitek Sports Medicine announced that the MILAGRO ADVANCE Interference Screw is now available in larger sizes–30mm and 35mm. MILAGRO ADVANCE Interference Screw is a biocomposite screw designed to off er easier and faster insertion when compared to traditional interference screws.4

“Our portfolio of orthopedic sports medicine solutions continues to grow as we are introducing new innovative products to meet the clinical needs of patients and surgeons,” said Rocco De Bernardis, Marketing Director, Mitek Sports Medicine. “Our new products for ACL reconstruction were designed to accommodate surgeons’ diff erent procedural preferences, but likewise the common need for strong fi xation, procedural simplicity, reproducibility and a more anatomic reconstruction. Among them, RIGIDFIX Curve is not only a new product it is also a “procedural innovation”, introducing new thinking and ideas on how ACL reconstructions can be performed.”

About Mitek Sports MedicineAt Mitek Sports Medicine, we are passionate about getting patients back to their passion. As a global leader in orthopaedic sports medicine, we develop minimally invasive devices and non surgical products used in the treatment of joint injuries related to sports and physical activity, as well as degenerative tissue conditions. Mitek Sports Medicine is part of the DePuy Synthes Companies of Johnson & Johnson, the largest provider of orthopaedic and neurological solutions in the world. For more information, visit www.depuysynthes.com*DePuy Synthes Mitek Sports Medicine is a division of DePuy International Ltd.Th e third party trademarks used herein are the trademarks of their respective owners.1 Joshua A. Baumfeld, etal. Tunnel widening following anterior cruciate ligament reconstruction using hamstring autograft: a

comparison between double cross-pin and suspensory graft fi xation. Knee Surg Sports Traumatol Arthrosc (2008) 16:1108–11132 Internal test data, ref. DHF-102035-MEMO 14 &16 (compared to Endobutton)3 Kousa P, etal. Th e fi xation strength of six hamstring tendon graft fi xation devices in anterior cruciate ligament reconstruction. Part

II: tibial site. Am J Sports Med 20034 Internal test data, ref. DHF-101914-DFTR and DHF-101914-DFTR2

www.depuysynthes.com When responding to articles please quote ‘OTJ’

VIRTUAL PHYSIOLOGICAL HUMAN PROJECT

TRANSCENDS SCI FI AND WILL TRANSFORM HEALTHCARE

Th e University of Sheffi eld-based Insigneo Institute is developing an in silico (computer simulated) model of the human body that will enable simulation of the eff ects of drugs and treatments on the human body

An Institute founded one year ago at the University of Sheffi eld is showcasing the fi rst phase of technology that will lead to the creation of a virtual human body and revolutionise global healthcare.

Th e Insigneo Institute at the University of Sheffi eld has the objective of creating an in silico (computer simulated) replica of the human body that will enable the virtual testing of bespoke treatments. When complete, the Virtual Physiological Human will transform the economics and practicalities of modern medical treatment and medical research.

Th e Virtual Physiological Human (VPH) programme is backed by European Commission funding. Since 2007, approaching 220 million of EC funding has been targeted at collaborative in silico projects across Europe.

Th e VPH will enable collaborative investigation of the human body as a single complex system using integrated computer models of the mechanical, physical and biochemical functions of a living human body. Th e VPH will eventually lead to a better healthcare system, off ering personalised care solutions, a more holistic approach to medicine and a preventative approach to treatment of disease. In time it will lead to treatment that sees the body as a single multi organ system rather than as a collection of individual organs.

Th e showcase recently featured a series of talks and demonstrations that chart progress to date, including:

A presentation on imaging and computational modelling of Pulmonary disease

A look at the emerging potential of the 21st century laboratory

A presentation on VIRTUheart, which will transform the assessment and management of coronary artery disease

A presentation on how the VPH will improve the prediction of fracture risk; and,

A presentation on virtual, physiological and computational neuromuscular models for the predictive treatment of Parkinsons Disease

What we’re working on here will be vital to the future of healthcare, said Dr Keith McCormack, who leads business development at the Institute. Pressures are mounting on health and treatment resources worldwide. Candidly, without in silico medicine, organisations like the NHS will be unable to cope with demand. Th e Virtual Physiological Human will act as a software-based laboratory for experimentation and treatment that will save huge amounts of time and money and lead to vastly superior treatment outcomes.

Th e Insigneo Institute for in silico Medicine is a collaborative initiative between the University of Sheffi eld and Sheffi eld Teaching Hospitals NHS Foundation Trust. It is a multi-disciplinary institute with a membership of more than 120 academics and clinicians who are collaborating to develop computer simulations of the human body and its disease processes. Th ese will be amalgamated eventually to create an holistic in silico model that will be used directly in clinical practice to improve diagnosis and treatment. When complete, the virtual human will be the most sophisticated application of computing technology in healthcare. Sheffi eld is the UKs main centre for this work.

On display at the Showcase was an array of sophisticated 3D simulations of human physiology. Th ere was also updates from scientists and clinicians at the Institute.

Call 01268 297710 for a customised

solution, samples and pricing.

10 reasons why you should choose Timesco’s

single use Laryngoscope systems:

Low cost single use blade and handle systems

from the UK’s No.1 Laryngoscope brand

Low cost, single use solutions.

10 THE OPERATING THEATRE JOURNAL www.otjonline.com

‘Highlighting insuffi ciencies within current training in the NHS during the process of cleaning reusable laryngoscopes’

Th e aim of my article is to critically analyse an area of patient care delivery which I feel is an issue in delivering safe, competent based care. Th e issue which will be addressed is the report of laryngoscope blades in my trust not being cleaned eff ectively. Th e lack of risk assessment and no assessed training in place poses a risk of cross infection. Th is aarticle will examine and critically evaluate current training in practice with regards to cleaning and decontamination methods and guidelines. Review alternative products available, also highlighting the implications cross infection can have in patient care delivery, and propose an action plan needed to improve current daily practice within my department.

Laryngoscopy is a necessary requirement of anaesthetic care delivery in my practice area. A laryngoscope is defi ned as a device used in performing direct laryngoscopy to assist in tracheal intubation (Al-Shaikh & Stacey 2007). As an anaesthetic practitioner I am responsible for the cleaning, decontamination and storage of laryngoscopes. Current practice in my trust involves using reusable laryngoscopes for our theatre lists. At present there is no alternative disposable available.

According to Telang et al (2010), and Ahmed & Musaid (2008) laryngoscopy is an invasive procedure which can present with the problem of cross infection if an adequate high standard of cleaning and decontamination is not applied. It has been indicated by research that if cleaning is not eff ective, this can incur risks to service users, also to the theatre practitioners handling them (Negri de Sousa et al 2013).

At present there is no risk assessment in establishing whether or not the laryngoscope has been cleaned eff ectively enough by the anaesthetic practitioner in removing high risk bacterial or highly infectious pathogens, which as highlighted by Machan (2012) can remain on the scope for several days.

Th e current trust decontamination policy was recently updated in 2011 due to a clinical governance guidance alert which declared a patient’s death resulted from a contaminated laryngoscope handle (Medicines and Healthcare Products Regulatory Agency 2011). Clinical Governance is central to quality improvement strategies within the National Health Service; the document promotes additional use of guidelines within the Assosciation of Anaethetists of Great Britain and Ireland (AAGBI) (2008) with regard to infection control in anaesthesia. Th e policy indicates that anaesthetic practitioners clean the laryngoscope blade with a single use disposable scrub brush using warm water and detergent, rinse with warm water and leave to dry, when dry, wipe with a 70% alcohol wipe. Several studies have suggested that this type of cleaning if not carried out adequately is not suffi cient, one of which was conducted by Miller et al (2001) who indicate that best practice suggest laryngoscope blades should be single use, as inadequate cleaning methods imposes high risks with cross infection. Although this study is quite dated, it is useful to include as it demonstrates that the issue of insuffi cient cleaning and decontamination of reusable blades has been around for a number of years.

It has been further highlighted by Musaid & Ahmed (2012) that occult blood can still be found on the blade following inadequate decontamination which is a high risk for cross infection. Th e blades tested in this study were identifi ed as ready for use on patients.

Risks associated with insuffi cient decontamination of reusable anaesthetic equipment such as laryngoscope blades include, transfer of bacterial pathogens, contamination with blood, micro-organisms and body fl uids (Negri de Sousa et al 2013). Lowman et al (2013) further argue that improper handling of equipment can also be a potential further risk of cross infection via laryngoscope blades, due to inadequate hand washing and handling of equipment without gloves.

In my trust, it is the responsibility of the anaesthetic practitioner to eff ectively clean and decontaminate the reusable laryngoscope blades and handles when used. It has been reported on a number of occasions that the laryngoscope blade was left unclean although it was left as ready for patient use. Training in this area of anaesthetic care is minimal at present, new staff members and students are advised how to clean laryngoscope blades and handles by an experienced anaesthetic practitioner, no assessment of competence is in place at present. Th e issue I am raising through this assignment is how eff ective are these pieces of invasive equipment being cleaned and decontaminated.

Th e trusts current infection control policy was fi rst introduced in 2002, and is based on current guidance from the National Institute for Health and Care Excellence (2012) alongside the Department of Health (2008) clinical guidelines. Th ese bodies govern national standards in healthcare delivery and their guidance is based on best evidence based practice. Th e policy is reviewed and updated annually to be current with new and improveddevelopments in infection control practice. Infection control team within the trust are available to provide support, and training to all staff including assistance with undertaking root cause analysis of possible risk factors. Following discussions with management regarding my fi ndings it was agreed that as a department it would be benefi cial to seek support from the infection control team in order to conduct a risk assessment on current practice.

Currently best practice suggests sending blades to the hospital sterilisation and decontamination unit (HSDU) which would signifi cantly reduce risks of cross infection (Ahmed & Musaid 2008). Sterilisation between patients is further encouraged and recommended by the AAGBI (2008). However, Lewis & Mcindoe (2004) argue that repeated sterilisation of laryngoscope blades can aff ect the function of the laryngoscopes. Taking the above into account, in regards to my trust area, we have a small amount of blades per theatre we do not have enough in order to send blades for sterilisation, also if damage was identifi ed this could incur further costs to the trust. Th erefore at present although evidence would suggest this is best practice, the trust indicates that although our existing methods of decontamination may not be universally accepted as best practice, they are considered by the trust to be a manageable risk through compliance with our current decontamination policy which according to the trust, has been risk assessed prior to implementation by the infection control team. However, as this assignment has highlighted, adequate assessment in this area of care delivery is not in place, so measurement of compliance to policy would be benefi cial in identifying where improvements need to be implemented.Furthermore, since there appears to be many studies and guidance in support of sterilisation, this would suggest that this is an area to be explored further.

In a study conducted by Miller et al (2001) it is suggested in terms of preventing cross infection using the alternative product which is disposable laryngoscope blades however, it is argued that these types of blades are not as reliable as reusable ones in terms of performance (Dos Santos et al 2009). Th e same source highlights that in a study they conducted; a vast majority of intubations were successful on second and third attempt. In a situation where airway management is required urgently, these types of blades are not recommended (Machan et al 2013). However, the AAGBI (2008) propose in their guidelines, that reusable blades are in the high risk category for cross infection and advocate best practice is the use disposable blades, having a reserve of traditional reusable blades available for diffi cult intubations.

On researching this issue in comparison to other trusts, I have found that my trust is one of the few trusts to use solely reusable laryngoscopes as opposed to disposable ones. Other trusts have implemented using disposable blades, having a small reserve of traditional reusable blades available when required as recommended by AAGBI (2008) guidelines. When mentioned in my department it was highlighted from the anaesthetists that the preference was reusable blades in terms of their performance and reliability. Cost was indicated by management as key factor, as the department has a limited amount of spending power, it was also mentioned that as we have a high turnover of patients with a large theatre area, cost would be considerable. However, it has to be mentioned that if a patient acquired an infection from a contaminated laryngoscope blade, the cost would be extremely high for the patient and the hospital in terms of the patient’s health, delay in their recovery, extended stay and litigation (Datta et al 2014). It should also be noted that in the event of changing practice in the future to disposable laryngoscopes, anaesthetic practitioners will still be required to decontaminate the available few reusable laryngoscopes reserved for diffi cult intubations. Th erefore, eff ective training and assessment would continue to be a vital aspect in this type of anaesthetic care delivery.

According to Telang et al (2010) cross infection from inadequately cleaned laryngoscope blades imposes risks and costs to both patients, and the trust as a whole with regards to extended stays in hospital, and prolonged recovery to the patient as mentioned earlier. Lowman et al (2013) highlight that it is diffi cult to prove that cross infection was caused by a contaminated laryngoscope blade. However, one study had conclusive evidence that this was indeed the case. Muscarella (2008) indicated that there was an investigation into the cause of cross infection in a neonatal unit in America resulting in the death of two babies, from investigation, contaminated laryngoscope blades were found to be the cause of death, and the outbreak of infection linked to pseudomonas aeruginosa. Th is study demonstrates the vital importance of ensuring anaesthetic practitioners receive ongoing adequate training and education in the cleaning and decontamination process when dealing with reusable anaesthetic equipment. Th e Trust policies are based on current up to date research and national guidance with regards to infection control, however if staff are not adhering correctly to this policy either through lack of knowledge, or non compliance there is a gap in delivering best practice.

10 THE OPERATING THEATRE JOURNAL www.otjonline.com

Find out more 02921 680068 • e-mail admin@lawrand.com Issue 286 July 2014 11

In order to be competent in eff ectively decontaminating reusable equipment, Chobin (2010) proposes eff ective assessed training methods should be demonstrated within the trust. As mentioned previously, assessed training is lacking in the department. Cleaning methods are demonstrated and explanation is given to the importance of decontaminating equipment. However, the same source highlights that training should be more than just a show and tell system, eff ective training takes time and should be assessed and competency based, as inadequate training places risk on patient safety. Th is is further indicated by Haas (2013) who suggests that training methods within trusts should incorporate formal training as opposed to in house training, which is based on knowledge, skills and is demonstrated in both theory and practice. According to Cobbold & Lord (2012) acquiring, and maintaining knowledge and skills in infection control is viewed as central to the quality of care delivery within service providers.

Salaripour & Perl (2013) further highlight that they have conducted a study into initial training of infection control practice. It was identifi ed in their study that although training enhances knowledge initially, in the long term this knowledge decreases. Th ey propose that eff ective training should be ongoing, conducted annually and be a mandatory requirement in practice. Th ey further conclude that this will contribute to quality improvement strategies for service delivery. Th is would appear to be the way forward in ensuring anaesthetic practitioners are up to date, and assessed annually, as current infection control knowledge is vital to improve this type of service delivery (Cobbold & Lord 2012).

When considering training and assessment within a clinical setting, Sykes et al (2013) suggest that the practice education facilitator (PEF) plays a crucial role in supporting training and education within the clinical setting. Th ey highlight that best practice involves investment in education as part of the ongoing learning and development which is essential in providing safe competent and quality based care. Continuing that staff development empowers individuals in decision making when providing best evidence based care. However, the same source have highlighted that when incorporating cost saving, training is often the fi rst cost cutting area. Th is as mentioned can lead to a reduction of quality care delivery. Th erefore, they propose that a percentage of budgets allocated to the department should incorporate continuing professional development provision within the clinical setting, in order to improve quality of care delivery. Haas (2013) further concludes that the ultimate goal of training is to reduce patient safety risks within the department. In my department we have a PEF who is available to support practitioners in training and education.

When implementing an action plan of change in practice, it is recommended to conduct an audit (Underwood 2011). Th is was further highlighted by Scarparo (2011), who suggest this can be based on risk assessment to indicate risk factors, and assessment of current anaesthetic practitioner knowledge of cross infection. Audit, according to research, enables a review of compliance to current trust policies in infection prevention, data collection, monitoring, and fi nally evaluating eff ectiveness of change in order to improve current practice. Evaluation of audit is a fundamental aspect to determine if changes implemented have improved practice (Evans 2012).

Th erefore, risk assessment and audit appear to be the way forward in order to implement change. In the proposed plan for risk assessment, I intend to seek support from management in the department, the trust infection control team, and microbiology on how to conduct a swab assessment on laryngoscope

blades in each individual anaesthetic room within the department. Th is would indicate eff ectiveness of decontamination in practice also give a quantitative result and highlight non compliance with decontamination practice, the assessment would be based on a period of 12 weeks to give a suffi cient time scale for monitoring (Forsyth et al 2006). Th is could then support my proposal for audit which I intend to seek further support from management, and the trust audit team on how to conduct an audit within the department, my proposal for audit will include interviews to review practitioner’s knowledge on infection control and decontamination methods in the department in order to establish whether improved training would be benefi cial within the trust. Gorrell (2013) highlight that audit supports risk assessment strategies by highlighting areas of non-compliance in clinical practice.

Th ereby, it would appear from evaluating the research in this assignment that reusable laryngoscope blades are a high risk for cross infection if adequate decontamination measures are not in place. It has also been identifi ed that a proposed risk assessment initially will pave the way for audit which can identify current risk factors, seek improvement strategies and review current training within my department. A focus on improved training and education within the department appears to be an area which is an essential aspect of care delivery. Evaluation by way of proposing further audit and risk assessments will enable the department to identify if improvements have been eff ective to current practice. Furthermore, it would appear that by highlighting risk and implementing improved training and education would thereby be benefi cial not only to improve current practice within the department, but to contribute to ongoing professional development for anaesthetic practitioners.

As registered practitioners, we are accountable for our actions and omissions and have a duty of care to our patients to ensure that we deliver safe, competent and evidence based care, (Nursing and Midwifery Council 2008). It is also highlighted by the AAGBI (2008) that service providers have a legal responsibility to implement improved changes to reduce the risk of healthcare associated infections. Th e department are currently reviewing current practice with a view to making improvements to our future practice with reusable laryngoscopes.

Th erefore on conclusion it appears from evaluating the research with regards to decontamination practice in my trust, that collaborating together with management, infection control, the audit team and the PEF, a proposed change in current practice and training is needed if we are to make an improvement in reducing risks associated with reusing laryngoscopes in the department. Adequate education and training which is ongoing appears to be central in making continuous improvements to this type of care delivery. Evaluating the outcome of risk assessment based on swabbing will highlight areas of non compliance and indicate more eff ective training and education is needed. Audit conducted on staff knowledge and current training methods will enable the trust to gain an insight into where improvements to training can be made, and an action plan of change can then be implemented. Evaluation with further audit and risk assessment will determine if changes made have been eff ective. As mentioned eff ective training empowers healthcare practitioners and the trust as a whole in improving our current practice and service delivery to service users in the future.

Rachel Simpson RGNAnaesthetic & Recovery Practitioner

Bibliography:

Ahmed,R. & Musaid, R. (2008) ‘Incidence of visable and occult blood on laryngoscopes of emergency and routine cases’ Middle East Journal of Family Medicine. 10 (8) pp. 39-43.

Al-Shaikh, B. & Stacey, S. (2007) Essentials of Anaesthetic Equipment: Laryngoscopes and tracheal intubation equipment. 3rd ed. Philadelphia: Elsevier Ltd.

Association of Anaesthetists of Great Britain and Ireland (2008) ‘Infection Control in Anaesthesia’ Published Clinical Guidelines. AAGBI. http://www.aagbi.org/sites/default/fi les/infection_control_08.pdf [accessed 21 April 2014].

Chobin, N. (2010) ‘Th e real costs of surgical instrument training in sterile processing revisted’ Association of Perioperative Registered Nurses Journal. 92 (2) pp. 185-193.

Cobbold, A. & Lord, S. (2012) ‘Decontamination of reusable surgical instruments: how up to date are you?’ Journal of Perioperative Practice. 24 (3) pp. 14-15.

Datta, P. , Rani, H., Chauhan, R. Gombar, S. & Chander,J. (2014) ‘Health-care-associated infections: Risk factors and epidemiology from an intensive care unit in Northern India’ Indian Journal of Anaesthesia. 58 (1) pp. 30-35.

Department of Health. (2008) ‘Th e Health and Social Care Act 2008: Code of practice on the prevention and control of infections and related guidance’ Published Clinical Guidelines.DOH. https://www.gov.uk/government/uploads/system/uploads/attachment_data/fi le/216227/dh_123923.pdf [accessed 10 April 2014].

Dos Santos, F.D., Schnakofsky, R., Cascio, A., Liu, J., & Merlin, M.A. (2009) ‘Disposable stainless steel vs plastic laryngoscope blades among paramedics’ Journal of Emergency Medicine. 29 (6) pp. 590-593.

Evans, B. (2012)’How to improve primary care by using signifi cant event audit’ Primary Health Care. 22 (4) pp. 26-29.

Forsyth, R.J. Hartman, J.L. &van Nostrand, V.(2006) ‘Risk-Management Assessment of Visible-Residue Limits in Cleaning Validation’ Pharmaceutical Technology. 30 (9) pp. 104-114.

Gorrell, M. (2013) ‘Preventing Infection transmission in practice’ Practice Nursing. 24 (12) pp. 616-620.

Haas, L. (2013)’Anaesthesia care team risk: considerations to standardize anaesthesia technician training’ American Association of Nurse Anaesthetists. 81 (2) pp. 121-126.

Lewis, S. & Mcindoe, A.K. (2004) ‘Cleaning and sterilization of equipment’ Anaesthesia & Intensive Care Medicine. 5 (11) pp. 360-363.

Lowman, W., Venter, L. & Scribante, J. (2013) ‘Bacterial contamination of re-usable laryngoscope blades during the course of daily anaesthetic practice’ South African Medical Journal. 103 (6) pp. 386-389.

Machan, M.D. (2012) ‘Infection Control practices of laryngoscope blades: A review of the literature’ American Association of Nurse Anaesthetists Journal. 80 (4) pp. 274-278.

Machan, M.D., Monaghan, W.P., Mcdonough, J. & Hogan, G. (2013) ‘Emerging evidence in infection control: Eff ecting change regarding use of disposable laryngoscope blades’ American Association of Nurse Anaesthetists Journal. 81 (2) pp. 103-108.

Medicines and Healthcare Products Regulatory Agency. (2011)’ Medical Device Alert’ Department of Health Clinical Guidance Alert. MHRA. http://www.mhra.gov.uk/home/groups/dts-bs/documents/medicaldevicealert/con129221.pdf [accessed 10 April 2014].

Miller, D. M., Youkahna, I., Karunaratne, W.U. & Pearce, A. (2001) ‘Presence of protein deposits on ‘cleaned’ re-usable anaesthetic equipment’ Anaesthesia. 56 (11) pp. 1069-1072.

Musaid, R. & Ahmed, A. (2012) ‘Incidence of visible blood on laryngoscopes of emergency and routine cases’ Middle East Journal of Family Medicine. 10 (8) pp. 39-43.

Muscarella, L.F. (2008) ‘Reassessment of the risk of healthcare-acquired infection during rigid laryngoscopy’ Journal of Hospital Infection. 68 (2) pp.101-107.

National Institute for Health and Care Excellence (2012)’Infection: Prevention and control of healthcare-associated infections in primary and community care’ Published Clinical Guidelines. http://www.nice.org.uk/nicemedia/live/13684/58656/58656.pdf [accessed 4 May 2014].

Negri de Sousa, A. C. Levy, C.E. & Freitas, M.I.P. (2013) ‘Laryngoscope blades and handles as sources of cross-infection: an integrative review’ Journal of Hospital Infection. 83 (4) pp. 269-275.

Nursing and Midwifery Council (2008) ‘Th e Code: Standards of conduct, perfromance and ethics for nurses and midwives’ Published Guidelines. http://www.nmc-uk.org/Publications/Standards/Th e-code/Introduction/ [accessed 7 May 2014].

Salaripour, M. & Perl, T.M. (2013) ‘Th e eff ectiveness and the retention level of the competency-based training for infection prevention and control practices’ Canadian Journal of Infection Control. 28 (1) pp. 13-17.

Scarparo, S. (2011) ‘Clinical Audit, guidelines and standards: A productive relation for managing clinical practices’ Financial Accountability & Management. 27 (1) pp. 83-101.

Sykes, C. Durham, W. & Kingston, P. (2013) ‘Role of facilitators in delivering high quality practice education’ Nursing Management UK. 19 (9) pp. 16-22.

Telang, R., Patil, V. Ranganathan, P. & Kelkar, R. (2010) ‘Decontamination of laryngoscope blades: Is our practice adequate?’ Journal of Postgraduate Medicine. 56 (4) pp. 257-261.

Underwood, K. (2011) ‘A developing perspective in medical device training’ Technic Th e Journal of Operating Department Practice. 2 (2) pp. 5-7.

Find out more 02921 680068 • e-mail admin@lawrand.com Issue 286 July 2014 11

12 THE OPERATING THEATRE JOURNAL www.otjonline.com

When responding to articles please quote ‘OTJ’

Th e Bill Mapleson Centre – ‘A Trainee Perspective’ Gemma Keightley, ST5 Anaesthetics, University Hospital Wales, Cardiff Anthony Short, ST6 Anaesthetics, University Hospital Wales, Cardiff

As two academic anaesthetic registrars we were asked to assist with opening of ‘Th e Bill Mapleson Centre’. We were to design storyboards on ‘innovation, simulation and Mapleson’, run simulation demonstrations for the media / delegates and coordinate the recording of a short video shown at the launch event. Th e centre, situated in Flexicare® UK headquarters in South Wales, comprises a simulation suite, seminar room and innovation/testing laboratories.

Professor William (Bill) Wellesley Mapleson at the Opening

Cardiff University’s Department of Anaesthetics, Intensive Care and Pain Medicine has been involved in medical simulation training since 2006 and, in 2011, led the design of the state-of-the-art Cochrane Simulation Suite. Th e department hosts postgraduate simulation training for specialist doctors and theatre staff in the ‘Rosen Clinical Skills Room’. Th e new ‘Bill Mapleson Centre’ will also off er high fi delity simulation training sessions for anaesthetists, but also general practitioners, dentists and industry and host engagement activities for schools.Th e Cardiff University and Flexicare® UK collaboration allows a translational research approach to turning scientifi c outputs into products through industry partnerships; reinforcing the Anaesthetic Department’s innovation profi le. Th e academic department focusses on real clinical problems, with device innovation being their forte. Examples include the Cardiff Aldasorber, the ‘Cardiff Palliator’ (the world’s fi rst commercially available patient controlled analgesia machine), the Cardiff Blade and the Hall Lock.Th e centre represents a unique collaboration, as unique as world renowned physicist Bill Mapleson himself. Born in London in 1926, the son of an insurance clerk, Bill attended Durham University. He graduated in Physics in 1947, returning to study for his PhD after National Service in the Royal Air Force.In 1952 Bill was appointed as a research assistant by the Welsh National School of Medicine. He thought ‘it will do for 5 years’ however, those 5 years have stretched to the present day! Over 60 years Bill’s insightful thinking about clinical problems has resulted in many accolades from learned societies. His classic paper (Mapleson, 1954) concerning breathing systems has been continually referenced for six decades. Retiring in 1991, Bill continues to work in the department for two mornings each week pursuing theoretical work, and helping others with study design and statistical analysis. He continues to inspire the lives of countless scientists and anaesthetists. Lecturer posts, during advanced anaesthetic training, are an exciting opportunity to teach and perform research in the Department of Anaesthetics. Th is project gifted us a unique glimpse into the life of Bill himself, a humble and generous man and we would like to personally thank those involved for presenting us with this unexpected and unique opportunity; ‘‘Th is project has been a real challenge. I’ve had to organise my time to attended meetings at the centre alongside my work on other research projects. My fi rst visit to the site was a real eye opener - high quality healthcare equipment being manufactured in the Valleys! I’ve met industry CEO’s, University lawyers, University media and fi lm unit crews and of course, Bill Mapleson himself. I’ve had to ‘ direct’ a video shoot in Day Surgery (the backdrop to a tribute video) and help to design wall art for the centre [3]. Helping the whole launch come together has really tested my management & leadership skills.’’ Anthony Short, ST6‘’My input to the ‘Bill Mapleson Centre’ was both worthwhile and insightful. First and foremost I’ve learnt about the career path and life of a worldwide renowned physicist. Exploring the person behind the circuits has been heart-warming and overwhelming. Th e exposure to innovation has been extraordinary; I’ve seen what can be accomplished through the collaboration of industry, the NHS and universities. I now have insight into the world of business and how collaborations, such as this, require input from a multidisciplinary team, one very diff erent to the multidisciplinary team we are used to as medical professionals. Th is wider professional group involvement has advanced my communication, management and leadership skills. I’ve been lucky enough to experience public engagement during this project, not typical during the current anaesthetic training scheme. It’s expedited my anaesthetic training into that which is well rounded beyond my imagination and I am grateful for this opportunity.’’Gemma Keightley, ST5

http://www.youtube.com/watch?v=hCQ6MrfX5B0http://blogs.cardiff .ac.uk/hallje/2014/05/27/the-bill-mapleson-centre-the-work-of-many-people/

Reading this online ?

Click here to watch the video

14 THE OPERATING THEATRE JOURNAL www.otjonline.com

DEPUY SYNTHES JOINT RECONSTRUCTION INTRODUCES TWO NEW KNEE TECHNOLOGIES FOR THE ATTUNE®KNEE SYSTEMDePuy Synthes Joint Reconstruction*, a global leader in joint replacement, today announced the introduction of two new technologies for the ATTUNE® Knee System—the ATTUNE Rotating Platform and the Medialized Anatomic Patella. Th e announcement was made in conjunction with the 15th European Federation of National Associations of Orthopaedics and Traumatology (EFORT) congress, a combined programme in partnership with the British Orthopaedic Association, held in London, UK.

“Th e new ATTUNE Rotating Platform Knee and the Medialized Anatomic Patella provide additional options for patient care,” said Gary Lancaster, Knee Marketing Director, DePuy Synthes. “Off ering the ATTUNE Knee with both fi xed bearing and rotating platform options is important from the standpoint of surgeon preference and expertise, as well as individual needs of patients.”

Th e advantage of rotating platform knees is that the bearing can rotate as the knee fl exes, which allows for a more natural motion and may also reduce the stress and wear on the implant.1 Th e ATTUNE Rotating Platform Knee builds on DePuy Synthes Joint Reconstruction’s strong leadership in rotating platform knees and combines that expertise with the proven technologies of the ATTUNE Knee, which is designed to enhance stability and motion.

Studies show that between 10-20 percent of knee replacement patients are not completely satisfi ed with their knee replacement.2 A major contributing factor to this is anterior knee pain in the area of the patella.3 Th e Medialized Anatomic Patella was created to help address this need as it is designed to wrap around the knee in a more natural way and improve patellar tracking.

Th e ATTUNE Knee System, the largest research and development project in the history of DePuy Synthes Joint Reconstruction, was designed to provide better range of motion and address the unstable feeling some patients experience during everyday activities, such as stair descent and bending. Th e launch of the ATTUNE Rotating Platform Knee follows last year’s launch of the ATTUNE Fixed Bearing Knee. To date, more than 41,000 ATTUNE Knee implants have been provided for patients worldwide.4

ATTUNE Rotating Platform KneeTh e Rotating Platform design increases the level of conformity to provide stability while delivering freedom of mobility. In addition, the Rotating Platform design gives the tibial insert the freedom to self-align and track with the femoral component throughout the range of motion, allowing surgeons the ability to position the rotating platform tibial base on the proximal tibia for maximum bony coverage. Th e ATTUNE Rotating Platform Knee builds on DePuy Synthes Joint Reconstruction’s heritage, including the LCS® Knee System and the SIGMA® Rotating Platform Knee System. More than one million Rotating Platform knees have been provided for surgeons and patients around the world.5

ATTUNE Medialized Anatomic PatellaTh e Medialized Anatomic Patella works with the ATTUNE Knee femoral components. Th e Medialized Anatomic Patella is unique to DePuy Synthes Joint Reconstruction and is compatible with both ATTUNE Fixed Bearing and Rotating Platform Knees. Th e Medialized Anatomic Patella is designed to have more natural sagittal plane kinematics than traditional dome style patella components. Th ese more natural kinematics are designed to reduce soft tissue interaction with the femoral component and thereby help prevent soft tissue irritation. Also, the unique kinematics of the Medialized Anatomic Patella are designed to increase quadriceps effi ciency in deep fl exion, allowing the knee to more easily fl ex and extend.

About DePuy Synthes Joint ReconstructionDePuy Synthes Joint Reconstruction, a global leader in hip, knee and shoulder replacement, is part of DePuy Synthes Companies of Johnson & Johnson, the largest provider of orthopaedic and neurological solutions in the world. For more information, visit www.depuysynthes.com.

*DePuy Synthes is a trading division of DePuy International Ltd. Th e third party trademarks used herein are the trademarks of their respective owners.

1 McNulty DE, Swope SW, Auger DD, Smith T. Th e eff ect of crosslinking UHMWPE on in vitro wear rates of fi xed and mobile bearing knees. ASTM STP 1445. Gsell, R. et al. American Society for Testing and Materials, West Conshohocken, PA. Available online at www.astm.org (2004).

2 Baker PN, van der Meulen JH, Lewsey J, Gregg PJ. Th e role of pain and function in determining patient satisfaction after total knee replacement. JBJS-Br. 2007; 89-B(7): 893-900.

3 Sensi L, Buzzi R, Giron F, De Luca L, Aglietti P. Patellofemoral function after total knee arthroplasty: gender related diff erences. J Arthroplasty. 2011; 26(8): 1475-1480.

4 Data on fi le at DePuy Orthopaedics, Inc., 20145 Data on fi le at DePuy Orthopaedics, Inc., 2007. When responding to articles please quote ‘OTJ’

SD Healthcare attends Association of Preoperative Practice (AfPP) accredited

course and joins Medical Industry Accredited (MIA) service

Ophthalmic distributor SD Healthcare employees attended a one-day Th eatre Access course – delivered and accredited by the Association of Preoperative Practice (AfPP).

Th e course, developed specifi cally for medical device representatives, ensures delegates leave with an understanding of theatre etiquette, correct protocol and the roles and responsibilities of those within operating theatres.

Paul Chad, Managing Director at SD Healthcare said: “When a member of our team needs to be in the operating theatre, to provide training or support we have a duty to ensure that they are properly qualifi ed for the roles they perform.

Completion of the AfPP accredited training ensures our team has the up-to date knowledge and the understanding required to visit any area of theatre, safely and relatively risk free.

Likewise, the hospitals we visit need assurance that our representatives are properly trained. We have taken additional steps and have signed up to the Medical Industry Accredited (MIA) service’s ID card scheme that is supported by industry bodies including the AfPP and Optic UK. ”

SD Healthcare is committed to employee training and raising industry standards, its representatives also hold the Medical Industry Accredited (MIA) scheme’s ID card. Hospitals can validate card holder’s details on-line via the free to use national database: ensuring safe access by sales staff to NHS premises and sensitive clinical areas. Contact SD Healthcare on +44 (0) 161 776 7626 or Email: info@sdhealthcare.com

When responding to articles please quote ‘OTJ’

National Institute of Academic Anaesthesia

SurveyWhy we need your inputWe want to improve the quality of care for anyone having an operation. Apart from the work of the surgeon, there is a whole team of perioperative professionals, from the main anaesthetist to the recovery and ward nurses, that aims to look after the physical and mental wellbeing of the patient.In addition, there are scientifi c researchers who look into how hospitals function and how to improve care and recovery. From their research, they can feed back to perioperative care teams and help them improve their procedures, services and general care.We want your views because deciding what are the most important ‘treatment uncertainties’ or ‘unanswered questions’ to research in this area comes down to getting all the insights we can from patients, carers and healthcare professionals. We need to put all these ideas together to help see the bigger picture.

For further information and to participate in the survey visit: http://www.niaa.org.uk/psp_survey

Find out more 02921 680068 • e-mail admin@lawrand.com Issue 286 July 2014 15

View the journal online @ www.issuu.com/lawrandOTJ Back issues are also available to view

Registration is Free !www.otjonline.com

ODPs, Theatre, Anaesthetic & Recovery NursesYour Favourite Journal is available ONLINE

(Simple Free Registration)

Jobs, News, Study Days, Books, Clinical Articles

Register Today at: www.otjonline.com

Jobsite:www.operatingtheatrejobs.com

Get Your Personal Copy @

Pre-surgery routines might be doing more harm than good for patientsIf you’ve ever had abdominal surgery, you might remember the routine: no food after midnight, or a liquid diet — maybe even a complete colon cleanse. Th en, after the surgery, IV painkillers and no eating until the doctors say it’s safe.

But doctors at the Mayo Clinic in Minnesota are questioning the necessity and the benefi ts of these protocols.

Dr. Robert Cima, chair of the surgical safety and quality committee at the Mayo Clinic in Minnesota, says there is little science to support this protocol. Patients might even recover more quickly without it.

He says surgeons across the world have been asking, “Why do we do these things? And are they the right thing to do for our patients?”

“When you go into surgery, it’s a trauma, no matter what it is,” Cima says. “It’s a major undertaking for your body; and just like anything else we do in the real world outside of medicine, your body needs to be prepared. It needs to be able to re-energize itself and rebuild itself.”

Many pre- and post-operation procedures were originally put in place for the benefi t of the surgeons. Th e belief was that they were equally benefi cial for the patient.

Dr. Cima thinks surgeons should be looking at it the other way around: “Maybe what’s best for the patient might actually help us. And if we can change our ways of doing things, that benefi ts everybody.”Th is applies to post-surgical treatment as well. “People used to think that you couldn’t feed anyone,” Dr. Cima says. “You had to have a tube in your nose for a day, or two days, to protect the work that the surgeon had done. Well, there’s really been no science behind that at all.” In fact, he says, this practice is associated with other complications.“A lot of the things we’ve done in the past don’t add up to patient benefi t,” Dr. Cima insists. “We should be trying to get the patient back to being who they were beforehand — starting to eat real food, getting up, walking around, avoiding systemic narcotics. We’ve seen real benefi t to this, not just here at the Mayo Clinic, but at other institutions that practice this way.”Dr. Cima does add an important caveat: For this regimen to be eff ective, patient care has to be carefully coordinated — and that is not always the case.“You have to have an integrated care system in which the anesthesiologists, the surgeons and our nursing colleagues are all working together,”

he says. “Th at’s really where it becomes diffi cult to implement such a process.”

At many, if not most, surgical hospitals, patient care is not very well-integrated. Patients are often surprised to learn that, in some instances, surgical teams have never met each other prior to gathering in the operating room. Even Mayo, which is known for its integrated model of patient care, only recently changed this.

“We started here fi ve or six years ago,” Dr. Cima ads. “Now, every morning, outside the OR there’s a briefi ng where everyone meets — anesthesia providers, nurses, surgical assistants, residents. We have our names up on a board outside the door, and we talk. It really is a way of improving communication. I can tell you when I was training 20 years ago that was not the case.”

If integrated care becomes the norm, rather than the exception, does this mean the end of the debilitating and irksome pre-surgical routine? Th at depends.“I think the more you do to disturb the natural body before you go into surgery, the harder it is to recover,” Dr. Cima says. “Now, there’s always a counterbalance to everything in life, and there are some concerns that operating in the fi eld with a lot of stool [in the patient’s system ] could be problematic and increase risk of infections. Th ere are some studies that show that; there are a lot of studies that haven’t.“You have to balance those things. But clearly, you’re better off not disturbing the person, and letting their bodies do what they normally do.”Th is article is based on an interview that originally aired on PRI’s Science Friday. Written by: Adam Wernick

www.Opera ngpera ngTheatreheatreJobs.comobs.comA one-stop resource for ALL your theatre related Career opportuni es

View the latest vacancies online !

or Scan QR Code

DOWNLOADGet our App

for Android

16 THE OPERATING THEATRE JOURNAL www.otjonline.com

Safer And More Accurate Biopsy Device Wins Innovation Voucher Competition

Winning idea: left to right: Chris Armstrong, Marketing Manager, Health Enterprise East, Mr Vincent J Gnanapragasam, Consultant Urological Surgeon, Cambridge University Hospitals NHS Foundation Trust and Sonya Sireau, R&D Clinical Engineer, Cambridge Clinical Innovation (CCI).

A team at Addenbrooke’s Hospital is celebrating winning funding worth £5,000 to help progress its idea for a safer and more accurate device to carry out biopsies of suspected prostate cancer.

Th e Innovation Voucher competition was organised by Health Enterprise East (HEE), the NHS Innovation Hub for the East of England, East Midlands and North London.

Th e winning device is called CAMPROBE (Cambridge Prostate Biopsy Needle), a biopsy device which allows the procedure to be carried out under local anaesthetic as an outpatient, rather than under a general anaesthetic as it is currently performed.

Chris Armstrong, Marketing Manager at HEE said: “We were delighted by the number and high standard of entries in our second Innovation Voucher competition – in total, we received 43 innovations from across our Member Trusts.

“CAMPROBE is an excellent example of an idea from frontline staff which has the potential to improve not only

safety and accuracy, but also reduce the time a patient has to spend in hospital, saving valuable resources and resulting in cost savings.

“Th e team is now planning to use its winning funding to help fi le for a patent on the technology, develop the prototype and use this in a feasibility trial. If successful, this device could be immediately transferred to direct clinical use within the current outpatient structure. Th e technology is simple and cheap but innovative in design and the scope for benefi t is enormous, both in terms of benefi t for patients and the NHS. In Cambridge alone over 400 biopsies are undertaken annually for suspected prostate cancer using the standard routes. If projected nationally, this innovation could majorly improve the diagnostic pathway of the 25,000 men who have prostate biopsies annually in the UK.”

Prostate cancer is the most prevalent male cancer in the UK and its incidence is rising. Th e current method of diagnosing prostate cancer is with a needle biopsy of

the prostate guided by a transrectal ultrasound probe inserted into the rectum which carries a signifi cant risk of bleeding, fever and severe infections. It is also not accurate as 30% of cancers can be missed using this approach. Th e CAMPROBE has been designed to address these

safety and accuracy issues whilst also allowing the procedure to be undertaken in the outpatient clinic using local anaesthesia.

For further information please visit www.hee.org.uk.

When responding to articles please quote ‘OTJ’

www.facebook.com/TheOTJ

A new use for touchless technology in the operating theatre

Feedback sought on Code of Practice for confi dential information

Th e views of health and care policymakers, patient groups, researchers, regulators, and anyone concerned about medical confi dentiality are being sought on a new code which aims to ensure that confi dential health and adult social care information is properly handled by all organisations that handle confi dential information.

Th e HSCIC is inviting feedback on its draft Code of Practice on Confi dential Information (2).

Under the Health and Social Care Act 2012, the HSCIC is required to publish a Code of Practice. Organisations that handle confi dential information about the provision of health and adult social care in England are required to have regard to it, from GP practices and hospital trusts, to commissioners and research organisations.

Th e HSCIC released a Guide to Confi dentiality in Health and Social Care in September 2013 which provided citizens and health and care staff with clear, accessible guidance on the handling of confi dential information3.

Th e Code of Practice aims to complete the picture by providing good practice guidance to those responsible for setting and meeting organisational policies in this arena. It will help organisations to ensure that the right structures and procedures are in place to help all staff follow the confi dentiality rules in the previously published guide.

Th e HSCIC is inviting a wide range of stakeholders to read the draft Code available at www.hscic.gov.uk/cop and provide their feedback by 18 August 2014.

Results of the feedback gathering will be published on our website and used to develop the fi nal Code before its publication at the end of September 2014.

Pioneering work using touchless technology for vascular surgery is now being extended to neurosurgery.

Dr Mark Rouncefi eld and Dr. Gerardo Gonzalez from the School of Computing and Communications at Lancaster University were part of a collaborative team from Microsoft Research, Guy’s Hospital, St Th omas’ NHS Foundation Trust, and King’s College London to pilot the technology in the operating theatre.

Following the successful pilot of the technology in vascular surgery procedures, the team from Lancaster and Microsoft have now partnered with neurosurgeons at Addenbrookes NHS Foundation Trust and Cambridge University to apply the technology to the manipulation of 3D volumetric models of the brain for neurosurgery. Th e new system is currently being piloted in the operating theatres.

Dr Rouncefi eld said: “Th is project on ‘Touchless Interaction’ has successfully combined the skills and knowledge of social and computer scientists with the professional experience of surgeons, to design and develop an application that is already proving of real benefi t in the operating theatre”

Th e pioneering work explores the use of touchless interaction within surgical settings, enabling surgeons to view, control and manipulate medical images without contact.

Surgeons operate in a challenging environment where they are required to maintain sterility at all times. Re-scrubbing is time consuming and therefore surgeons are frequently compelled to instruct others to manipulate visual-aid equipment for them; an often impractical and imprecise method.

Th e new gesture-based systems utilize Kinect for Windows hardware and the Kinect for Windows Software Development Kit to allow the surgery teams to maintain a sterile environment, whilst being able to view and manipulate medical images through a combination of gesture and voice control.

Prof. Kenton O’Hara from Microsoft Research said “Adapting the technology for neurosurgery has allowed us to understand how the system works across diff erent surgical domains. As well as refi ning the gesture set, the new system incorporates enhanced voice control that enables the surgeon to control the system using only voice leaving both hands free to work with surgical instruments.”

Th e touchless interaction software was developed by Gerardo Gonzalez, a post-doctoral researcher at Microsoft Research from Lancaster University.

Source: Phys.org

Reading this online ?

Click here to watch the video

Find out more 02921 680068 • e-mail admin@lawrand.com Issue 286 July 2014 17

Looking to hire state-of-the-art facilities?Contact us.

FIND OUT MORE AND BOOK

www.rcseng.ac.uk/surgeons/education/facilitieseducation@rcseng.ac.uk

020 7869 6300

Cadaveric workshopClinical Skills AreaMIS RoomTeam Skills Training TheatreAnatomy demonstration room

The Royal College of Surgeons of England

Jeremy Hunt: message to NHS staff on strengthening

patient safety - 27th June 2014

Th e Secretary of State for Health talks about a number of new initiatives launched this week to strengthen patient safety in the NHS.

Last week the respected Commonwealth Fund ranked the UK as the best healthcare system in the world. We can all be particularly proud of the fact we moved from seventh place to fi rst for patient-centred care and also came top for safety. Th is is down to the hard work and dedication of everyone who works in the NHS.

But we can do even better. We know from other areas where there is a risk of harm – like the airline industry – that safety depends on staff being confi dent that they can point out problems. Still today too many staff in the NHS feel they can’t speak up or that nothing will happen if they do. So this week I’ve launched a new package of measures to help change things for the better.

First, Sir Robert Francis is leading an independent review into how we can create an open and honest reporting culture in the NHS. As part of that, he will look at what further action is necessary to protect individuals working in the NHS who speak out against unsafe practice or unfair treatment. Sir Robert wants to hear from frontline staff , trade unions and NHS employers amongst others. Information about how you can do this will be made available shortly on the Whistleblowing in the NHS: independent review webpage. I would like to encourage you to get involved with the review: I know that Sir Robert is keen to hear from as many people as possible, and to ensure that a wide range of views and experiences help to shape his conclusions. Th e review would also like to hear from you if you have evidence of good practice regarding concerns raised and action taken to make improvements.

Th is week also saw the launch of the new “Sign up to Safety” campaign, under the leadership of Sir David Dalton, Chief Executive of Salford Royal NHS Foundation Trust. Twelve trusts have already signed up and many more will follow. Find out more about the campaign and how you and your organisation can get involved.

Finally, in a world-leading drive on transparency, the NHS has published a swathe of safety data - including staffi ng levels and ‘open and honest reporting’ - for adult and paediatric hospital wards, including mental health and community hospitals. Th e data has been published on a new safety section on NHS Choices and will give you and your patients the chance to see how well you are doing on some key safety measures.

Focusing on safety is about focusing on things that matter to staff . So I am confi dent that in harnessing the talent and enthusiasm across the NHS, we will help make enduring changes to improve safety, halve avoidable harm and halve the costs of harm. Most importantly it will make a positive diff erence to the people we care for - and potentially save 6,000 lives over the next three years. None of this can happen without you - so I do hope that you will give your support to the important changes announced this week.

Sign up to SafetyOn the 24th June a new patient safety campaign launches across the health care sector. Th e ‘Sign up to Safety’ campaign aims to drive up safety standards in the NHS and save the lives of up to 6,000 people over the next three years.Sign up to Safety wants to create a health care system that is devoted to continuous learning and improvement.It aims to deliver care that is free from harm for every patient, while promoting openness and supporting everyone to improve the safety of patients.Sign up to Safety pledgesIf you sign up to the campaign, you commit to setting out actions in response to the following fi ve pledges.

1. Put safety fi rst. 2. Continually learn.3. Honesty.4. Collaborate.5. Support.

Find out more information at: http://www.england.nhs.uk/signuptosafety/Source: CQC

18 THE OPERATING THEATRE JOURNAL www.otjonline.com

NEW DEPUY SYNTHES ADVANTAGE™ PROVIDES SOLUTIONS FOCUSED ON

IMPROVING CLINICAL AND ECONOMIC OUTCOMES AND PATIENT SATISFACTIONToday DePuy Synthes* introduced DEPUY SYNTHES ADVANTAGE, a suite of provider-focused solutions that are focused on complementing the company’s extensive portfolio of clinically proven products with solutions that assist in driving optimal clinical and economic outcomes while striving to improve patient satisfaction. Th e company unveiled the package of solutions at the 15th European Federation of National Associations of Orthopaedics and Traumatology (EFORT) congress, a combined programme in partnership with the British Orthopaedic Association, held in London, UK.

“Health care providers are striving to reduce costs while improving patient care and satisfaction1” said Andrew Ekdahl, WW President DePuy Synthes Joint Reconstruction. “By providing solutions that aim to save time in the operating room, potentially reduce hospital stay or provide real-time analytics that can lead to improved effi ciency and patient satisfaction, we strive to create value for the health care system as a whole.”

DEPUY SYNTHES ADVANTAGE off ers a suite of fl exible solutions to address the unique and evolving needs of customers around the world:

• Reducing Length of Stay. JOINT PROGRESS®, an integrated patient engagement and management programme, may enable earlier discharge from hospital and faster recovery for patients undergoing treatment by supporting the patient throughout the care pathway.2

• Create surgical effi ciencies. For example, providers can use the DePuy Synthes Advantage Tracker iPad® Application to collect and analyze time spent on each step in joint replacement procedures to help identify pressure points and ineffi cient processes. DEPUY SYNTHES ADVANTAGE Programmes will off er a number of solutions to enhance procedural effi ciency, such as TRUMATCH® Personalized Solutions which can eliminate up to nine steps from the surgical workfl ow.3

When responding to articles please quote ‘OTJ’

Two Thirds of Britons Reluctant to Donate Blood Due to Fear of Needles

• Empower patients through education. Th rough the Real Life Tested Programme; providers have access to a variety of educational materials designed for patients to enable shared decision making with joint replacement patients, manage patient expectations of surgery and provide them with an opportunity to share their experiences with other patients who are considering joint replacement.

By complementing the company’s core product off ering with value-adding solutions, DePuy Synthes is addressing the challenges faced by health care systems around the world.

About DePuy Synthes Companies of Johnson & Johnson DePuy Synthes Companies of Johnson & Johnson is the largest provider of orthopaedic and neurological solutions in the world. Together the companies off er an unparalleled breadth of products, services, programs and research and development capabilities that are designed to advance patient care and deliver clinical and economic value to health care systems throughout the world. DePuy Synthes Companies include eight businesses that focus on joint reconstruction, trauma, neurological, craniomaxillofacial, spinal surgery and sports medicine. For more information visit, www.depuysynthes.com.

*DePuy Synthes is a trading division of DePuy International Ltd.Th e third party trademarks used herein are the trademarks of their respective owners.

1 Independent market research funded by DePuy Synthes2 Husted H. Fast-track hip and knee arthroplasty: clinical and organizational aspects. Acta Orth 2012;

83(Suppl 346):1-39.3 Data on fi le at DePuy, Cat No: 9075-96-000 version 1.

A new study conducted by a leading provider of blood transport bags has revealed that two thirds of Britons who have never given blood have avoided doing so as a result of a phobia of needles.

Th e company is calling for more fl exible hours and locations to donate blood after discovering that almost one tenth of those polled stated that they have previously attempted to give blood but have been turned away as a result of an over booked or crowded blood bank.

To coincide with World Blood Donor Day on June 14th, a team of researchers from a leading supplier of blood transport bags conducted a study aimed at discovering the main reasons as to why Britons do not donate their blood for medical purposes.

www.Versapak.co.uk, which specialises in blood transport bags alongside other tamper evident packaging, polled a group of 1,939 UK adults for the purposes of its research. All respondents were over 18 years old and had indicated to researchers that they had never donated blood before, although they had no pre-existing medical reason which would prevent them from doing so.

Participants were initially asked to select the main reason(s) why they had never given blood before, with the top fi ve answers revealed as follows:1. Fear of needles- (66%)2. Fear of blood – (52%)3. Fear of fainting- (31%)4. I’m too busy to fi nd the time- (18%)5. I don’t want to give my blood- (6%)

Th e participants who indicated that they had a fear which prevented them from giving blood were asked if they would be willing to give blood if they could overcome it, the vast of majority of relevant participants (88%) stated that they would defi nitely do so.

Of respondents taking part in the study, 9% admitted to researchers that they had made an eff ort in the past to donate blood. Of these individuals, 48% claimed they had been turned away due to either a fully booked session or an overcrowded room of people on the day they were available to give blood. A further quarter (24%) claimed that they thought the online registration process was too confusing.

Leon Edwards, Group Managing Director of Versapak, made the following comments regarding the fi ndings of the study:

“I cannot express enough the important and life-changing impact the decision to give blood can have on an individual and their loved ones. With World Blood Donor Day occurring next week, now is the perfect time to donate!

With almost 1 in 10 of our study’s participants complaining that they found it hard to give blood due to overcrowding or confusion, here at Versapak we are calling for a review into the fl exibility and opening times of blood donation banks and locations in the UK.”

He continued:

“Taking into account some of the other reasons given for not donating, the irrational fear of needles and blood is certainly understandable. After people have donated once, they will see that it really isn’t such a traumatic experience and be more likely to visit the blood bank again!”

www.Opera ngpera ngTheatreheatreJobs.comobs.comA one-stop resource for ALL your theatre related Career opportuni es

View the latest vacancies online !

Theatre Practitioners Recovery Nurses Anaesthetic Nurses ODPs Scrub Practitioners Nurse Practitioners Medical Representatives

and Clinical Advisers

Your first choice in anaesthesia

A full range of anaesthetic breathing systems and accessories for use in the operating room, recovery and emergency care.

• Face masks

• Breathing systems

• System accessories

• Emergency care

• CO2 absorbents

The Complete Solutionfrom Patient to Equipment

lnteract with us

www.intersurgical.co.ukQuality, innovation and choice

Find out more about Baggins the Bear: www.intersurgical.co.uk/info/bagginsbear