Printed on 100 per cent recycled paper MARCH 2016 | IN TOUCH | 1

By Rebecca Goss

Big changes are coming to the Medical Device Reprocessing Department this spring as part of St. Michael’s 3.0 redevelopment project.

The MDRD, located in the B1 level of the Cardinal Carter Wing, is the hospital’s only medical device reprocessing and issuing centre. It cleans and sterilizes medical devices and equipment from all areas of the hospital, from the operating room to the catheterization lab, and ensures each item processed meets all infection prevention and control,

occupational health and safety and CSA standards.

After a medical procedure, soiled medical devices and equipment are transported to the MDRD by the hospital’s Environmental Services team, where they are first decontaminated. In this part of the department, negative air pressure is used to prevent airborne contamination from flowing to the clean and sterile areas. Staff must also wear personal protective equipment that meets CSA and IPAC standards.

All medical devices and equipment are then inspected, tested for functionality Continued on page 2

INTOUCHMARCH 2016

Relocation for renovation: a makeover for the hospital’s reprocessing department

and wear and tear, assembled into sets and trays and sterilized. Rigorous protocols are in place to ensure these items leave the MDRD sterile, including ensuring that temperature and humidity are monitored in the department at all times.

Given how crucial the MDRD is to hospital operations, it’s imperative the department runs smoothly. This spring the department will begin a 12-month renovation to improve work flow and ensure the area meets all building codes and standards. Some autoclaves, which

Joy Allen, an MDRD technician, assembles a small surgical set for ophthalmology. (Photo by Yuri Markarov, Medical Media Centre)

MARCH 2016 | IN TOUCH | 2

St. Michael’s is in the midst of transformation. As you can see around you every day, construction of our new 17-storey Peter Gilgan Patient Care Tower is advancing rapidly and renovations are taking place in multiple locations across the hospital. Each day we are getting closer to becoming Canada’s premier critical care hospital.

Our Inspire 2018 campaign will give you the up-to-date environment and tools you need to continue to provide great care. We’ll soon have new inpatient facilities for flagship programs that will double the number of single rooms in the hospital. We’ll have more elevators – I know everyone will be pleased about that – and an easily recognizable front door. We’ll have a new, twice-

Alayne Metrick, President, St. Michael’s Foundation

as-large Emergency Department for our ever-expanding volumes, and other crucial renovations and improvements. We’ll have funds for new research and education projects to advance care – all to treat patients whose lives hang in the balance.

The end of our campaign is in sight, but we need your support to complete our ambitious $210 million goal. You may have seen “The Final Piece” poster campaign that rolled out across the hospital in January. In that image, one piece remains to finish the puzzle – that final piece is your support. We are so close.

On March 10, we are holding a one-day staff fundraising blitz to give you the opportunity to join our campaign. Watch for foundation staff at hospital entrances and support Inspire 2018 with a one-time gift of any amount, or sign up for monthly giving. We also encourage you to stop by our foundation office at 30 Bond St. to make a gift any day. All gifts are great!

We are very fortunate to have dedicated staff members like you who support this

hospital by your generous commitments and the work you do here every day. We hear it again and again: Your compassionate care is what drives our donors to give back. Help make St. Michael’s Canada’s premier critical care hospital. Your support is crucial in completing this campaign. You are the final piece.

OPEN MIKE with

Follow St. Michael’s on Twitter: @StMikesHospital

use steam to sterilize medical devices and equipment, are more than 40 years old and will also be replaced as part of the upgrade.

During the renovation, the MDRD will be relocated temporarily above ground in the courtyard north of the historic Bond Street entrance in a mobile reprocessing centre – basically, an MDRD on wheels. The trailer, built specifically for St. Michael’s, will connect to the hospital and allow MDRD staff to continue to provide sterile medical devices and equipment for the hospital’s clinical needs. The trailer will arrive in April and following two weeks of training for staff, will be used as the hospital’s sole reprocessing centre until renovations are complete in early 2017.

“We are optimistic,” said Stephenie Naugler, manager of the MDRD. “It will be worth the wait.”

Relocation for renovation story continued from page 1

“Every piece adds to the picture.”

•Reprocesses250,000 medical devices and equipment annually

•39 full-time technicians, nine part-time/casual technicians and six administrative staff

•Thedepartmentisopen24-7

•Onesurgicaltraytakesabout10 to 15 minutes toassemble

•Multi-layeredsetofmedicaldevicescanweigh up to 10kilograms

FactsabouttheMDRD:

THE FINAL PIECE

PLEASE INVEST TODAY416.864.5000stmichaelsfoundation.com

Your support will complete our $210 million campaignto become Canada’s Premier Critical Care Hospital.

MARCH 2016 | IN TOUCH | 3St. Michael’s is an RNAO Best Practice Spotlight Organization

The first time medical student Mei Wen saw a human lung it reminded her of a tree.

So she did what she usually does when she learns something interesting: she painted.

For Wen, a first-year University of Toronto medical student who attends her Arts and Science in Clinical Medicine class at the Li Ka Shing Knowledge Institute, painting is a way to both decompress and bring to life concepts she’s learned in class. She makes an effort to set aside at least one weekend per month to paint and she tries to connect her paintings to her medical studies.

Her most recent piece, a 50-centimetre by 60-centimetre acrylic painting titled Pulmonary Tree, was inspired by a lung she saw in anatomy class.

By Rebecca Goss

Medical student’s painting shows similarities between humans and nature

“The first time I saw a real lung all I could think was how much it reminded me of a tree,” Wen said. “There are so many similarities between our bodies and nature. I like making those connections through my art.”

The painting depicts the trachea and bronchi of the lungs as a tree. The trunk represents the trachea, the branches represent the bronchi and green leaves represent the lobes.

The parrots in the painting symbolize the connections humans have to nature around them. The flowers near the top of the painting are foxgloves, which produce the poisonous compound digoxin, often used as a cardiac stimulant.

“It goes full circle,” said Wen.

“Notonlyisthehumanbodyconnectedtonature,everythingweputintoourbodies,allofourmedicine,istoo.”-MeiWen,first-yearmedicalstudent

Wen said Pulmonary Tree was purposefully eye-popping and colourful to contrast anatomical drawings in her textbooks.

The painting hangs in her study space at home as inspiration to paint and to keep exploring medicine. Another painting of an external carotid artery in a skull hangs nearby. Wen has submitted both pieces to be considered for Synesthesia, the University of Toronto Faculty of Medicine art show in March.

Medical student Mei Wen shows her painting of lungs. (Photo by Rebecca Goss)

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CODEBROWNEmergency Codes are St. Michael’s Hospital’s organized response to situations that require immediate action. They involve many areas of the hospital working together, often after hours, to minimize the impact of an event.

Code Brown is a response to a flood or hazardous spill. The hospital has responded to many Code Browns in recent months as a result of aging plumbing infrastructure in some areas of the hospital and, in one case, human error during construction.

OnDec.2, 2015, at 4:48 p.m., aCodeBrownwascalledon5Donnelly.

Asixth-floorpipewasleaking.

A Perioperative Services staff member noticed that there was water leaking from the ceiling tile.

By 5:02, the Code Brown was escalated to Stage Two. The Command Centre was activated and key personnel were assigned roles to ensure hospital operations continued and minimize impact to patients, visitors, staff and volunteers. When the Command Centre opened, the Code Brown was affecting:

20PLUMBINGSTACKS (sets of pipes that move hot, cold and waste water

through the hospital) are being replaced in the Donnelly Wing as part of the St. Michael’s 3.0

redevelopment project.

47OUTDATEDRADIATORS are being replaced with radiant panels in the areas

that are being renovated. Radiant panels are a more efficient and quieter method of heating.

HERE’SANEXAMPLEOFWHYTHISMATTERS:

MARCH 2016 | IN TOUCH | 5

A Perioperative Services staff member noticed that there was water leaking from the ceiling tile.

By 5:02, the Code Brown was escalated to Stage Two. The Command Centre was activated and key personnel were assigned roles to ensure hospital operations continued and minimize impact to patients, visitors, staff and volunteers. When the Command Centre opened, the Code Brown was affecting:

And to everyone at St. Michael’s for their patience during the necessary changes to service; for stepping up to mitigate the impact of this event; and for providing the best possible care for our patients each and every day…

1BIGTHANKYOU!

23BATHTUBS could have been filled by the water coming from the leak

43DAYS passed between the Dec. 2 flood and the reopening of the first

ambulatory OR on Jan. 14

TOOMANYTOCOUNTinfection control tests, equipment inspections and other safety checks

46KILOMETRES (a marathon and then some) walked by one member of the

Planning team moving equipment into the OR on Jan. 14 and 15, 2016

MORETHAN100STAFFwere directly involved in the Code Brown response.

2EXAMROOMS on 3 Donnelly in Electromyography (EMG)

2PATIENTBEDS in a palliative care room on 4 Donnelly

6AMBULATORYORSon 5 Donnelly

MARCH 2016 | IN TOUCH | 6

Developing emergency medicine from scratch in Ethiopia

By Greg Winson

Ethiopia, Africa’s fastest-growing country, has ambitions to become a middle-income country by 2025. However, a virtually non-existent emergency medicine infrastructure keeps many of the country’s poorest citizens from matching the ambitions of their leaders.

“The people who are the poorest are the sickest,” explained Dr. James Maskalyk, an emergency room physician at St. Michael’s Hospital and a visiting professor of emergency medicine at Ethiopia’s Addis Ababa University. “Many families live day to day with little savings. If someone gets sick, or injured, they will spend what they have, even if it was for school fees or better housing. Often, because there are few places to treat such emergencies, the family member dies, and their savings are wiped out, perpetuating the vicious cycle of poverty and sickness.”

Soon after returning from a six-month tour with Médecins Sans Frontières in Sudan in 2007, Dr. Maskalyk was

tasked with setting up an emergency medicine training program in Ethiopia.

There was some precedent for this type of program. Dr. Clare Pain of Mount Sinai Hospital developed the first residency program for psychiatry in 2003 in collaboration with Addis Ababa University.

Establishing a similar program for emergency medicine would be even more challenging, as there were no emergency doctors in the country and no well-resourced emergency rooms to train them.

“No one was doing a program like the one Ethiopia wanted to embark on, not in the country nor anywhere nearby,” said Dr. Maskalyk. “Too often, this type of engagement sees a well-resourced partner bring in supplies and training intermittently, for a short time. The merits of that seemed transient. We wanted this to stick, so we took a different approach. We brought teachers.”

Forty doctors from the Toronto area have participated during the first five years of the program, along with 20 senior residents from the University of Toronto. Each residency lasts three to four months.

The program, which commenced in 2010, has graduated 15 doctors over three groups. A fourth and fifth group is being trained. Notably all graduates of the program have continued to practise medicine in Ethiopia.

The surprise benefit of this project has been the positive reaction of the doctors and residents who have participated in the program.

“Almost 100 per cent of participants want to go back once we take them there,” said Dr. Maskalyk. “Their inspiration is most often not the medicine, but the resolve of the doctors and nurses who work there.”

Dr. James Maskalyk speaks to a class of residents in the emergency medicine program at Ethiopia’s Addis Ababa University. (Photo courtesy of Dr. James Maskalyk)

Dr. James Maskalyk has written two books – “Six Months in Sudan,” which was published in 2009, and “Life onthe Ground Floor” is due this year.

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At some point in their lives, roughly 11 per cent of the world’s population will experience depression. Despite being extremely common, depression remains one of the most difficult health conditions to successfully treat – but St. Michael’s Dr. Sakina Rizvi is determined to try.

Dr. Rizvi’s research focuses on treatment-resistant depression, where typical medications or therapies have not been effective in individuals with Major Depressive Disorder, or MDD. Specifically, her research has found a direct link between patients who have treatment-resistant depression and “anhedonia,” the inability to feel pleasure or experience reward.

“When we talk about depression, the common symptoms people identify are feeling sad, hopeless or worthless,” said Dr. Rizvi, who has a PhD in neuroscience. “These symptoms are linked to low serotonin levels, which most anti-depressant medications target. However, anhedonia symptoms are not always improved by targeting serotonin because other neurotransmitters, like dopamine, are involved in feelings of pleasure.”

To assess the relationship between anhedonia and treatment-resistant depression, Dr. Rizvi needed a screening tool for patients experiencing anhedonia to use in clinical settings. With limitations of existing options, she created and validated her own tool: the Dimensional Anhedonia Rating Scale, or DARS.

The simple self-reporting questionnaire allows patients to measure their experience with anhedonia. Patients identify various activities they previously sought out or enjoyed. They then answer a series of questions relating to pleasure, interest, effort and motivation to participate in these activities on a scale of “not at all” to

By Kendra Stephenson

Treating the other side of depression

Dr. Sakina Rizvi explains the areas of the brain involved in experiencing symptoms of anhedonia, the inability to feel enjoyment or pleasure. (Photo by Yuri Markarov, Medical Media Centre)

“very much.” With a total possible score of 68, average scores of people without MDD fall within 44 and 68 on the DARS scale, whereas patients with MDD score within one and 40.

“I wanted to develop a good clinical tool as a proxy for the biological impairment that occurs in the brain when a person experiences anhedonia,” said Dr. Rizvi. “I looked at anhedonia symptoms in depressed patients in relation to dopamine receptors in the brain.”

This mapping of brain biology activity with symptoms could also eliminate the need for PET scans or MRIs when someone’s treatment isn’t working. Scans are expensive, with PET scans costing about $2,000 and MRIs around $500.

The DARS is highly accessible for patients and practitioners and can be used in real-time. Dr. Rizvi’s self-assessment questionnaire is free, fast and unique to the individual’s personal experience with depression.

The DARS tool is already being used by practitioners in clinical settings, with Dr. Rizvi’s research on anhedonia expanding to examine other areas of mental health, such as suicide risk and traumatic brain injuries.

Didyouknow?MentalhealthdisordersareNo.5ontheglobalburdenof diseases, just after cancer.

INTOUCH MARCH 2016

In Touch is an employee newsletter published by Communications and Public Affairs. Please send story ideas to In Touch editor Leslie Shepherd at shepherdl@smh.ca.

Design by Lauren Gatti

By Melissa Di Costanzo

Kidney transplant recipient Dave McComiskey shares a smile with his hero: Renal Transplant Nurse Co-ordinator Galo Meliton. (Photo by Yuri Markarov, Medical Media Centre)

Renal Transplant Nurse Co-ordinator Galo Meliton stumbled on nursing as a career after his family moved to Canada from the Philippines. One of 12 (his father said the family’s riches would be in children), Meliton has worked at St. Michael’s for almost 37 years. In honour of Kidney Month, Meliton shares some insight into his role.

Q:WhathaskeptyouatSt.Michael’s?

The culture and the camaraderie. It’s a friendly atmosphere, and I have the best manager, Jonathan Fetros.

Q:Whatisatypicaldaylikeforyou?

I help determine if potential kidney recipients are able to receive a donation. I work with their referring centres in ensuring their required testing is done. I run a pre-transplant class to help patients and their families learn more about kidney transplants. I was a urology nurse in a past life, so I have some urology-related roles, too (I teach men how to self-catheterize or to retrain their “lazy bladders” and I give injections to patients with prostate cancer). I organize events like a symposium every other year for renal transplant nurses and allied health

disciplines. I organize travelling road shows, talking to the public about kidney transplantation. I am a steering committee member for the Transplant Companions Program, an educational tool for patients and their families considering transplantation, and I am the St. Michael’s lead for a high-school outreach initiative, talking about the importance of organ and kidney transplantation. I usually present with an organ recipient. The hair on the back of my neck still rises when I hear heart recipients talk about their experiences. They are amazing stories.

Q.Whatisthemostrewardingpartofyourrole?

Truly being able to help people the best way I can whatever small way I can. This is my dream job. I feel good that I will be able to be part of something good. I’ve been so lucky over the years, especially having had some great mentors.

Q:Youarethe2005recipientoftheKarolSteinhouseMemorialAwardfromtheKidneyFoundationofCanadaandpastpresidentoftheOntariochapteroftheInternationalTransplantNursesSociety.Whatarethreethingsmostpeopledon’tknowaboutyou?

I like ballroom dancing with my wife, Cecilia. I sing my heart out while I wait for the bus. I was a barboy (I opened up the bar and cut up limes) when I first came to Canada in 1977.

Q & A GALO MELITON