OR Connection Volume 7 Issue 2

Malignant HyperthermiaARE YOU PREPARED?

TheAligning practice with policy to improve patient care

Special Breast Cancer Awareness Issue!

Congratulations!Pink Glove Dance photo winners. OR nurses from University Medical Center of Princeton

Volume 7, Issue 2

VOLUME 7, ISSUE 2

THE OR CONN

ECTION w

Ways to Improve Surgical Outcomes5

Get into the Groove! 2012 Pink Glove Dance Competition Page 84

SPEAK UP for OR SAFETY!

Covered Arms Are Compliant ArmsLook what’s new! Long-sleeve scrubs.

The latest AORN and OSHA guidelines recommend that OR nurses who aren’t in gowns should wear long sleeves.

PerforMAX scrubs added an inner sleeve to keep arms covered without dangling cuffs—like on jackets—to contaminate sterile fields.

These sleeves are like the finest athletic undergear: cool, supportive and totally breathable. And because they’re PerforMAX, you get a fashionable layered look that’s comfortable and functional all shift long.

©2012 Medline Industries, Inc. PerforMAX and greensmart are trademarks and Medline is a registered trademark of Medline Industries, Inc.

Talk to your facility’s Medline rep or visit Scrubs123.com to find out more about PerforMAX scrubs.

PerforMAX scrubs

MKT1219116 / LIT139R / 30M / QG5

Standard scrub top

greensmart™ is not a third-party certification. The use of the greensmart™ trademark is deter-mined by Medline Industries, Inc. through an internal review process of environmental claims.

Subscribing to The OR Connection guarantees that you’ll continue to receive this magazine and won’t miss out on our industry updates and articles addressing on-the-job issues and patient safety.

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CoverThis fun group of perioperative nurses from the University Medical Center of Princeton at Plainsboro, in Plainsboro, NJ, took first place in Medline’s Pink Glove Dance Photo Contest at the 2012 AORN Conference in March. From left to right, Lori Mozenter, BSN, CNOR, RNFA, Staff Nurse; Mary Zegarski, RN, CNOR, Staff Nurse and Vice President of AORN Chapter 3109; Fe Moreo BSN,CNOR, Staff Nurse and Patricia Lum, RN, BSHA, CNOR, CMLSO, Perioperative Educator/Interim OR Manager.

Sharps Safety Forms & Tools

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About Medline

Medline, headquartered in Mundelein, IL, manufactures and distributes more than 100,000 products to hospitals, extended

care facilities, surgery centers, home care dealers and agencies and other markets. Medline has more than 800 dedicated

sales representatives nationwide to support its broad product line and cost management services.

©2012 Medline Industries, Inc. The OR Connection is published by Medline Industries, Inc. One Medline Place, Mundelein, IL 60060. 1-800-MEDLINE.

Contents

14

28

24

84

Something Wicked This

Way Comes. Patient safety

expert and author Atul Gawande

comments on the Supreme Court

decision to uphold Obamacare.

In the Heat of the Moment:

Malignant Hyperthermia

Calls for Action. Ways to

make sure your operating room

is prepared to intervene when

patients develop malignant

hyperthermia.

Communication Dynamics

and Patient Safety in the

Operating Room. Solutions

to communication difficulties

and lateral violence among

perioperative personnel.

Pink Glove Dance Video

Competition 2012. Are you

in it to win it? New ways to

promote your Pink Glove

Dance Video.

Editor

Sue MacInnes, RD

Senior Writer

Carla Esser Lake

Creative Director

Michael A. Gotti

Clinical Team

Jayne Barkman, BSN, RN, CNOR

Lorri Downs, BSN, MS, RN, CIC

Margaret Falconio-West, BSN, RN, APN/CNS,

CWOCN, DAPWCA

Joan Ferrara, BA, RN, CNOR

Kimberly Haines, RN, Certified OR Nurse

Rebecca Huff, MSN, RN

Angel Trichak, BSN, RN, CNOR

Perioperative Advisory Board

Garry Crawford, MS, RN, CNOR

Norman Regional Health System, Oklahoma

Evangeline Dennis, RN, BSN, CNOR, CMLSO

Spivey Station Surgery Center, Georgia

Linda Groah, MSN, RN, CNOR, NEA-BD, FAAN

Association of PeriOperative Registered Nurses,

Colorado

Darvina L. Heichemer, BSN, CNOR

Gwinnett Medical Center – Duluth, Georgia

Vivienne P Kaplan, RN

Anaheim Regional Medical Center, California

Colleen Mattioni, MBA, RN, CNOR

Hospital of the University of Pennsylvania,

Pennsylvania

Julieann McIntyre, MSN, RN, CNOR

South Shore Hospital, Massachusetts

Susan A Miller, MSN, RN, CNOR

St. Luke’s Hospital, Missouri

Susan S Phillips, MSH, RN, CNOR

UNC Hospitals, North Carolina

Jo Quetsch, MA, RN, NE-BC

Providence Sacred Heart Medical Center,

Washington

Eleonora Shapiro, BSN, MHA, CNOR

Mount Sinai Medical Center, New York

Pat Thornton, MS, RN, CNOR

Southern Regional Medical Center, Georgia

Judith A. Townsley, MSN, RN, CPAN

Christiana Care Health System, Delaware

Pat Thornton, MS, RN, CNOR

Southern Regional Medical Center, Georgia

Judith A. Townsley, MSN, RN, CPAN

Christiana Care Health System, Delaware

FREE CE!

4 The OR Connection

Page 36

Page 43

Page 76

Page 48

Page 89

Patient Safety

6 Three Important National Initiatives

for Improving Patient Care

24 Communication Dynamics and Patient

Safety in the Operating Room

28 In the Heat of the Moment: Malignant

Hyperthermia Calls for Action

48 Quantification of Anesthesia Providers’ Hand

Hygiene in a Busy Metropolitan Operating

Room: What Would Semmelweis Think?

OR Issues

10 Surgical Safety News

13 Five Ways to Improve Surgical Outcomes

36 Greening the OR

43 Lean Isn’t Just for Diets Anymore

58 Another Article About Safety Scalpels?

Yes, But There’s New Data

70 So You Really Think That Surface Is Clean?

Special Features

9 Medline Acquires Medisiss

11 Communication Between Surgical Services

and Sterile Processing

14 Something Wicked This Way Comes

63 Sterile Processing – A Lifetime Passion:

Q&A with Michele DeMeo

67 The Canvas: Portrait of a Life Well-Lived

80 Emma and SCIP Celebrate Breast Cancer

Awareness Month

84 Pink Glove Dance Video Competition 2012

Caring for Yourself

76 Get Rid of Worry Once and For All

89 Cooking Pink

92 Breast Cancer Myths

98 Healthy Eating: Lillian Stafford’s

Oriental Broccoli

Forms & Tools

101 Now You See It, Now You Don’t

102 Emergency Therapy for Malignant Hyperthermia

103 Malignant Hyperthermia Drill

104 Your 5 Moments for Hand Hygiene

105 Caring for Your Surgical Incision at Home

107 Sharps Safety Begins with You

"The Canvas” by Michelle DeMeo. See page 67.


I was sitting at a table in the front of the room and a friendly

looking woman asked me if she could take the seat beside

me. Her roommate at Congress went to the breakfast,

encouraging her to join in. But my new neighbor said

... ”I just couldn’t get out of bed that early.” Then she said,

something stirred inside her ... her roommate had lost a

friend to breast cancer and she felt she needed to get herself

out of bed and at least make an effort.

Although a bit late (which is probably why she ended up in

the front of the room looking for an empty seat), she was

grateful to be in attendance, and I was the fortunate recipi-

ent of her company. As the choreographer went through

the moves of the “live dance” there was a section where

you needed a dance partner. My “new friend” asked me if I

would be her partner.

We howled with laughter as we went through the moves over

and over again, each time with more animation and energy.

At the conclusion of the dance, my friend asked for my con-

tact info. It wasn’t long before she contacted me to tell me

that she was having a meeting with the staff at her hospital

to show them the dance and talk about the breakfast and

the incredible support of the many attendees.

This was last March. She still stays in contact, and now, her

hospital is doing a video for the Medline 2012 Pink Glove

Dance Video Competition. Recently, she asked if I would visit

her facility and talk to her staff. This from the woman who

wanted to stay in bed but later decided to “get up and get

moving and support something good.”

Several months ago, the perioperative director of a large and

prestigious hospital on the East coast contacted me about

a friend who had a terminal illness. This friend had written a

book, and he was wondering if I could help the friend com-

municate the book to peers. The terminal illness was ALS

(Lou Gehrig’s disease) and the “friend” was Michele Demeo

... who is now my friend also.

You know, “nobody gets out of here alive” ... but the things

we do to save lives and the things we do to support others

through tragedy of loss give us greater meaning than “a job.”

I especially want to recognize the four women on the cover

of this issue of The OR Connection and the many people

who stood in line to have their pictures taken! Each vote you

received was another acknowledgement and show of sup-

port to breast cancer victims and survivors alike.

I support my fabulous table partner at the AORN breakfast, I

am thankful that the perioperative director of that huge acute

care facility took the time to email me about his friend, and

I salute and thank Michele DeMeo, who wants to live the

rest of her days doing meaningful tasks and contributing.

Tragedy is always tragic ... but the spirit and soul of each

healthcare worker is much like a blessing ... nurturing oth-

ers, helping others and delivering care to both patients and

co-workers.

I salute you all,

Sue MacInnes, RD

Editor

The OR Connection

Letter from the Editor

Dear Reader,

Last year, at AORN’s 59th Congress in New Orleans, more than 1,000 OR nurses danced to Pink’s hit

single, “Raise Your Glass” ... at 5:00 in the morning. Picture a ballroom at the Hilton New Orleans filled with

people dancing, laughing, singing ... and even some standing on chairs encouraging their peers to “let their

hair down” and dance ... that was the scene at Medline’s 5th annual Breast Cancer Awareness Breakfast.

6 The OR Connection

Three Important National Initiatives for Improving Patient Care

Achieving better outcomes starts with an understanding of current patient-care initiatives. Here’s what you need to know about national

projects and policies that are driving changes in care.

Origin: Launched by the Institute for Healthcare Improvement (IHI) in January 2009

Purpose: To help hospitals improve patient care by focusing on an essential set of processes needed to

achieve the highest levels of performance in areas that matter most to patients.

Hospitals sign up through IHI and can choose to implement some or all of the recommended interventions.

IHI provides how-to guides and tools for all participating hospitals.

The IHI Improvement Map covers the entire landscape of outstanding hospital care to help hospitals make sense of countless

requirements and focus on high-leverage changes to transform care. There are 73 processes grouped into three domains:

leadership and management, patient care and processes to support care.

Origin: The development and updating of the National Patient Safety Goals (NPSGs)

is overseen by the Patient Safety Advisory Group.

Purpose: The NPSGs were established in 2002 to help accredited organizations address specific

areas of concern regarding patient safety.

Joint Commission-accredited organizations are evaluated for compliance with these goals. The Joint Commission offers

guidance to help organizations meet goal requirements.

Origin: Initiated in 2003 as a national partnership. Steering committee includes the following

organizations: CDC, CMS, ACS, AHRQ, AHA, ASA, AORN, VA, IHI and the

Joint Commission

Purpose: To improve patient safety by reducing postoperative complications

Goal: To reduce nationally by 25 percent the incidence of surgical complications by 2010

SCIP aims to reduce surgical complications in three target areas. Participating hospitals collect data on specific process and

outcome measures. The SCIP committee believes it could prevent 13,000 perioperative deaths and up to 300,000 surgical

complications annually (just in Medicare patients) by getting performance up to benchmark levels.

IHI Improvement Map 1

Joint Commission 2012-2013 National Patient Safety Goals2

Surgical Care Improvement Project (SCIP)3


IHI Improvement Map: 73 Processes to Transform Hospital Care

Surgical Care Improvement Project (SCIP): Target Areas

Joint Commission 2012-2013 National Patient Safety GoalsEffective January 1, 2012:

among caregivers

(decubitus ulcers)

Wrong Procedure, and Wrong Person Surgery.™

- Conduct a pre-procedure verification process.

- Mark the procedure site.

- A time-out is performed before the procedure.

Effective January 1, 2013:

Implement evidence-based practices to prevent

indwelling catheter-associated urinary tract

infections (CAUTI).

To learn more about National Patient Safety Goals, go to www.jointcommission.org.

To learn more about the IHI Improvement Map and the 73 processes to transform hospital care, go to www.ihi.org/imap/tool

1. Surgical infections

temperature management

2. Perioperative cardiac events

3. Venous thromboembolism

The Improvement Map aims to help:

Make care safer

Make patient care transitions smoother

Lead improvement efforts effectively

Reduce costs and increase quality

1. Adverse Drug Events

2. Catheter-Associated Urinary Tract

Infections (CAUTIs)

3. Central Line-Associated Blood-

stream Infections (CLABSIs)

4. Injuries from Falls and Immobility

5. Obstetrical Adverse Events

6. Pressure Ulcers

7. Surgical Site Infections

8. Venous Thromboembolism

9. Ventilator-Associated Pneumonia

Helping hospitals improve in nine core focus

areas identified by Partnership for Patients

Visit www.qualitynet.org

8 The OR Connection

Contributing Writers

Beth Boynton, MS, RN

Beth Boynton is an organizational development consultant specializing in issues that

affect nurses and other healthcare professionals. She is a national speaker, coach,

facilitator and trainer for topics related to communication, conflict management, team-

building and leadership development and author of the book, Confident Voices: The

Nurses’ Guide to Improving Communication & Creating Positive Workplaces.

Wolf Rinke, RD, CSP

Keynote speaker, seminar leader, management consultant, executive coach and editor

of the free electronic newsletter Read and Grow Rich, available at www.easyCPEcred-

its.com. In addition he has authored numerous CDs, DVDs and books including Make

It a Winning Life: Success Strategies for Life, Love and Business, Winning Manage-

ment: 6 Fail-Safe Strategies for Building High-Performance Organizations. Reach him

at [email protected].

Atul Gawande, MD

Atul Gawande is a surgeon, writer, and public health researcher. He practices general

and endocrine surgery at Brigham and Women’s Hospital in Boston. He is also Profes-

sor of Surgery at Harvard Medical School and Professor in the Department of Health

Policy and Management at the Harvard School of Public Health. He has written several

books, including The Checklist Manifesto and serves as lead advisor for the World

Health Organization’s Safe Surgery Saves Lives program, which developed the Safe

Surgery Checklist.

Michelle DeMeo

Michele DeMeo is an expert in the sterile processing field who is highly regarded

for her management techniques, product development and contributions to various

healthcare associations and professional publications. She is now tackling another

important role – learning to live well in the face of a terminal illness.

Katie Beam, DNP, RN, ACNS-BC, CWS

Katie Beam is an ANCC Board-Certified Adult Clinical Nurse Specialist and Ameri-

can Academy of Wound Management Certified Wound Care Specialist supporting the

Emergency, Intensive Care, Oncology, Medical Surgical, Pediatric and Maternal Child

departments at Woodland Healthcare. She received her Associate Degree in Nursing

from Shasta College in 1985, her BSN and MSN from California State University, Sac-

ramento, and her Doctorate in Clinical Nursing Practice from the University of Colorado,

Denver. She has been with Dignity Health since 1985.

Joan Ferrara, BA, RN, CNOR

Joan Ferrara has 31 years of experience in various roles in the operating room, including

serving as assistant vice president of surgical services, perioperative services director,

OR nurse manager and OR staff nurse. She has also served as a certified surgical

technologist.

With every customer we strive diligently to:

2 Maintain the highest industry

standards to provide

reprocessed SUDs at half the

cost of new devices without

sacrificing level of performance.

3 Offer you the opportunity to

save operating capital while

reusing devices that would

otherwise be discarded.

4 Continue to demonstrate to

you that reprocessed devices

are as safe and functional as

brand new ones.

5 Assist you in your efforts

as both a conscientious

health provider and a good

steward of the environment.

6 Become one of your

most trusted providers

of SUDs, substantially

improving your bottom

line and overall patient

care in the process.

1 Employ the highest environmental

safeguards to ensure that optimum

infection and decontamination

control processes underscore our

reprocessing of your medical devices.

Medline Acquires Medisiss Surgical Instrument Reprocessing Company

Breaking News

Medline is pleased to announce that we are continuing to expand our

business with the acquisition of Medisiss, a leading surgical instrument

reprocessing company with whom we’ve successfully partnered for the last

two years. With this acquisition, we hope to expand and strengthen our

business with OR teams in both the hospital and surgery center markets.

Medisiss will retain its brand identity and company name and will operate as

a wholly owned subsidiary of Medline headquartered in Redmond, Oregon.

About MEDISISS

Our Commitment to You

greensmart™ is not a third-party certification. The use of the

greensmart™ trademark is determined by Medline Industries, Inc.

through an internal review process of environmental claims.

10 The OR Connection

The Food and Drug Administration (FDA), Centers for Disease

Control and Prevention (CDC), Occupational Safety and Health

Administration (OSHA) and the National Institute of Occupa-

tional Safety and Health (NIOSH), are strongly encouraging

healthcare professionals to use blunt-tip suture needles instead

of standard suture needles to suture fascia and muscle. Using

blunt-tip suture needles decreases the risk of needlestick injury

and exposure to bloodborne pathogens such as hepatitis B,

hepatitis C and HIV.

Published studies show that using blunt-tip suture needles cuts

the risk of needlestick injuries by 69 percent. Although blunt-

tip needles cost about 70 cents more than standard suture

needles, the benefits of reducing bloodborne infections justify

the extra expense.

Surgical Safety News

Safety Organizations

Recommend Blunt-Tip

Suture Needles1

Past Skin Infections

Can Predict SSIs2

A new study by researchers at Johns Hopkins School of Medi-

cine shows that people who have a single skin infection are

three times more likely to develop a surgical site infection.

The increased risk suggests there are underlying biological dif-

ferences in the way individuals respond to skin cuts that need

to be better understood in order to prevent SSIs. Even when all

of the proper procedures known to prevent SSIs are followed

— from administering preoperative antibiotics to using the

correct antiseptic to prepare the skin during surgery — some

patients appear to be much more susceptible than others to

contracting an infection.

Although the research does not establish a cause-and-effect

relationship between a past skin infection and SSI, the research

team says the association between them is strong and should

not be ignored.

In the study, researchers analyzed information before, during

and after surgery for 613 patients, with an average age of 62.

Twenty-four patients developed an SSI within 180 days of sur-

gery, and five of them died from the condition. Another 15 died

from noninfectious causes. Of those who had a history of skin

infection, 6.7 percent got an SSI compared with 3.9 percent of

those without a history of skin disease. It made no difference

whether the skin infection was recent or had occurred years

earlier. Researchers also took into account and adjusted for

other known risk factors for SSI, including the patient’s age, a

diagnosis of diabetes and certain medications they were taking.

References

1. McGraw M. FDA recommends blunt-tip suture needles. Outpatient Surgery

E- Weekly. June 5, 2012. Available at: http://www.outpatientsurgery.net/newsletter/

eweekly/2012/06/05#1. Accessed July 19, 2012.

2. Surgical site infections more likely in patients with history of skin infection [press

release]. Baltimore, MD: Johns Hopkins Medicine; May 29, 2012. Available at: http://

www.hopkinsmedicine.org/news/media/releases/surgical_site_infections_more_likely_

in_patients_with_history_of_skin_infection. Accessed July 19, 2012.


Communication BetweenSurgical Services & Sterile Processingby Michele DeMeo

Sterile Processing Corner

This is especially true when there are barriers in the way, such

as differing educational levels or experience. Communication

can be hampered when we are unable to see the other

person’s perspective for any number of reasons. For example,

miscommunication commonly occurs between surgical

services and the sterile processing department.

If your department has a sound communication system in

place, that’s terrific. If it could use some work or tweaking,

consider making some improvements. Ignoring trouble will

foster more of the same. Implementing even a single change

just might become the impetus for long-lasting, incremental

improvement. And that’s just when successful partnerships

become not just possible, but probable!

This is the first in a series of 8 columns written by Michele

DeMeo, a sterile processing expert with more than 20 years

of experience in this field.

Before reacting, consider for a moment, “What could

the other person have been thinking?” There could

be a very logical reason for their action or statement. It just

may not be logical to you. Allow for the possibility that the

communicator had good intentions, but the outcome was

less than favorable because perception or understanding of

instructions were not clear due to differences in communi-

cation style, experience, education, environment or various

other circumstances.

Mitigate the risk for future communication mishaps by

being proactive now. Invite sterile processing employees to

your morning huddles to give them a real visual and audio

impression of your stress and environment. This can also

serve as a means for members from both teams to ask ques-

tions or convey any impromptu scheduling or case changes.

Consider holding joint educational sessions. The same

type of information isn’t always needed by both units, but it

helps add depth to the other party’s understanding of each

others’ responsibilities and the complexities of their work.

Surgical services staff would benefit from firsthand under-

standing of the conditions, challenges and complex tasks

faced by sterile processing and vice versa.

Consider creating a quarterly newsletter or memo

written jointly by the two department managers. The

newsletter could include tips, congratulations and system

wide initiatives. It might just engage the groups to begin to

help see each other as peers and become a support a

system for collaboration.

Sometimes the most common words and

definitions are the hardest to convey or

apply. The topic of “communication” is

discussed frequently, but often executed

poorly. Many believe they speak, write

or even give direction in the clearest way.

However, people are unique, and as unique

as every person is, so are their styles of

communication. Unfortunately, at some

of the most critical times, breakdowns in

communication make matters worse.

Here are a few tips to consider when

trying to deal with miscommunication

with the sterile processing department:

Editor’s Note:

Join 280,000 other nurses for FREE CE courses at

Medline University

��220 courses��22 curriculum tracks��Interactive competencies��Flexible access: PC, iPhone, iPad��Free registration

©2012 Medline Industries, Inc. Medline and Medline University

are registered trademarks of Medline Industries, Inc.www.medlineuniversity.com

Quiet, please!General surgery residents

made major surgical

errors during eight of 18

simulated procedures

when they were interrupted

by questions or sidebar

conversations in the OR. 2

Use eyewear only onceDisposable protective glasses are a must in the

OR, but they should be discarded after every case.

Wearing glasses a second time raises the risk for

pieces of the glasses flaking off and entering the

sterile field.5 The glasses also may have lingering

pathogens on them from the previous case.

Know your antibiotics Improving the timing and selection of

antibiotics prior to skin incision can reduce the

rate of surgical site infections by up to 50%.4

1. Buxman K. Turn up the tunes in the operating room: studies show that music

improves surgical outcomes. Outpatient Surgery Magazine Online. July 2012: 75.

Available at: www.outpatientsurgery.net/article-archive. Accessed August 14, 2012.

2. Feuerbacher RL, Funk KH, Spight DH, Diggs BS, Hunter JG. Realistic distractions and

interruptions that impair simulated surgical performance by novice surgeons. Archives

of Surgery. 2012 Jul 16:1-5. [Epub ahead of print]. Available at: http://www.ncbi.nlm.

nih.gov/pubmed/22801787. Accessed August 14, 2012.

3. Johns Hopkins Patient Safety Pilot Program slashes colorectal surgical site infections

(SSIs) by 33 percent: researchers estimate similar interventions nationwide could save

more than $100 million annually [press release]. Baltimore, MD: Johns Hopkins

Hospital; July 30, 2012. Available at: http://www.hopkinsmedicine.org/news/media/

releases/johns_hopkins_patient_safety_pilot_program_slashes_colorectal_surgical_

site_infections_ssis_by_33_percent. Accessed August 14, 2012.

4. World Health Organization. 10 Facts on Safe Surgery. Available at: http://www.who.int/

features/factfiles/safe_surgery/en/index.html. Accessed August 15, 2012.

5. DiNobile C. 6 pieces of the barrier protection puzzle. Outpatient Surgery Magazine

Online. January 2012: 26-29. Available at: www.outpatientsurgery.net/article-archive

<http://www.outpatientsurgery.net/article-archive> . Accessed August 16, 2012.

Soothing tunesWhen Frank Sinatra, Vivaldi or

Beethoven were played during surgical

procedures performed under local

anesthesia, patients had less anxiety

and lower respiratory rates.1

Ways to Improve Surgical Outcomes5 Speak up

and reduce SSIs Empowering OR team

members to use a simple safety

checklist and encouraging them

to speak up if something seems

wrong reduced surgical site

infections by one-third.3

References




SOMETHING WICKED THIS WAY COMESby Atul Gawande

June 28, 2012

The New Yorker

A few days ago, while awaiting the Supreme Court’s ruling on President

Obama’s health-care law, I called a few doctor friends around the country.

I asked them if they could tell me about current patients whose health

had been affected by a lack of insurance.

Copyright © 2012 Conde Nast. All rights reserved. Originally published in The New Yorker. Reprinted by permission.

“This falls under the ‘too numerous to count’ sec-

tion,” a New Jersey internist said. A vascular surgeon

in Indianapolis told me about a man in his fi fties

who’d had a large abdominal aortic aneurysm. Doctors

knew for months that it was in danger of ruptur-

ing, but since he wasn’t insured, his local private

hospital wouldn’t fi x it. Finally, it indeed began to

rupture. Rupture is an often fatal development, but

the man—in pain, with the blood fl ow to his legs

gone—made it to an emergency room. Then the

hospital put him in an ambulance to Indiana Uni-

versity, arguing that the patient’s condition was “too

complex.” My friend got him through, but he’s very

lucky to be alive.

Another friend, an oncologist in Marietta, Ohio,

told me about three women in their forties and fi f-

ties whom he was treating for advanced cervical

cancer. A Pap smear would have caught their can-

cers far sooner. But since they didn’t have insur-

ance, their cancers were recognized only when they

caused profuse bleeding. Now the women required

radiation and chemotherapy if they were to have a

chance of surviving.


A colleague who practices family medicine in Las Vegas told me

about his clinic’s cleaning lady, who came to him in desperation

about her uninsured husband. He had a painful rectal fi stula—a

chronically draining infection. Surgery could cure the condition,

but hospitals required him to pay for the procedure in advance,

and, as unskilled laborers, the couple didn’t have the money.

He’d lived in misery for nine months so far. The couple had no-

where to turn. Neither did the doctor.

The litany of misery was as terrible as it was routine. An internist

in my Ohio home town put me on the phone with an uninsured

fi fty-fi ve-year-old tanning-salon owner who’d had a heart attack.

She was now unable to pay the bills for the cardiac stent that

saved her and for the medications that she needs in order to

prevent a second heart attack. Outside Philadelphia, there was

a home-care nurse who’d lost her job when she developed par-

tial paralysis as a result of a rare autoimmune complication from

the fl u shot that her employers required her to get. Then she

lost the insurance that paid for the medications that had been

reversing the condition.

Tens of millions of Americans don’t have access to basic care for

prevention and treatment of illness. For decades, there’s been

wide support for universal health care. Finally, with the passage

of Obamacare, two years ago, we did something about it. The

law would provide coverage for people like those my friends

told me about, either through its expansion of Medicaid eligibil-

ity or through subsidized private insurance. Yet the country has

remained convulsed by battles over whether we should imple-

ment this plan—or any particular plan. Now that the Supreme

Court has largely upheld Obamacare, it’s tempting to imagine

that the battles will subside. There’s reason to think that they

won’t.

In 1973, two social scientists, Horst Rittel and Melvin Webber,

defi ned a class of problems they called “wicked problems.”

Wicked problems are messy, ill-defi ned, more complex than we

fully grasp, and open to multiple interpretations based on one’s

point of view. They are problems such as poverty, obesity, where

to put a new highway—or how to make sure that people have

adequate health care.

They are the opposite of “tame problems,” which can be crisply

defi ned, completely understood, and fi xed through technical so-

lutions. Tame problems are not necessarily simple—they include

putting a man on the moon or devising a cure for diabetes. They

are, however, solvable. Solutions to tame problems either work

or they don’t.

Solutions to wicked problems, by contrast, are only better or

worse. Trade-offs are unavoidable. Unanticipated complica-

tions and benefi ts are both common. And opportunities to learn

by trial and error are limited. You can’t try a new highway over

here and over there; you put it where you put it. But new issues

will arise. Adjustments will be required. No solution to a wicked

problem is ever permanent or wholly satisfying, which leaves

every solution open to easy polemical attack.

Two decades ago, the economist Albert O. Hirschman pub-

lished a historical study of the opposition to basic social

Tens of millions of Americans don’t have access to

basic care for prevention and treatment of illness.


advances; “the rhetoric of intransigence,” as he put it. He

examined the structure of arguments—in the eighteenth cen-

tury, against expansions of basic rights, such as freedom of

speech, thought, and religion; in the nineteenth century, against

widening the range of citizens who could vote and participate in

government; and, in the twentieth century, against government-

assured minimal levels of education, economic well-being, and

security. In each instance, the reforms aimed to address deep,

pressing, and complex societal problems—wicked problems, as

we might call them. The reforms pursued straightforward goals

but required inherently complicated, difficult-to-explain means

of implementation. And, in each instance, Hirschman observed,

reactionary argument took three basic forms: perversity, futility,

and jeopardy.

The perversity thesis is that the change will not just fail but make

the problem worse. The futility thesis is that the change can’t

make a meaningful difference, and therefore won’t be worth

the effort. We hear both of these lines of argument against the

health-care-reform law. By providing coverage for everyone,

it will drive up the system’s costs and make health care unaf-

fordable for even more people. And, some say, people can get

care in emergency rooms and through charity, so the law won’t

do any real good. In fact, a slew of evidence indicates other-

wise—from the many countries that have both universal cover-

age (whether through government or private insurers) and lower

per-capita costs; from the major improvements in health that

uninsured Americans experience when they qualify for Medicare

or Medicaid. The reality is unavoidable for anyone who notices

what it’s like to be a person who develops illness without insurance.

The jeopardy thesis is that the change will impose unaccept-

able costs upon society—that what we lose will be far more

precious than what we gain. This is the sharpest line of attack in

the health-care debate. Obamacare’s critics argue that the law

will destroy our economy, undermine health care for the elderly,

dampen innovation, and infringe on our liberty. Hence their

efforts to persuade governors not to cooperate with the pro-

gram, Congress not to provide the funds authorized under the

law, and the courts to throw it out altogether.

The rhetoric of intransigence favors extreme predictions, which

are seldom borne out. Troubles do arise, but the reforms evolve,

as they must. Adjustments are made. And, when people are

determined to succeed, progress generally happens. The real-

ity of trying to solve a wicked problem is that action of any kind

presents risks and uncertainties. Yet so does inaction. All that

leaders can do is weigh the possibilities as best they can and

find a way forward.

They must want to make the effort, however. That’s a key factor.

The major social advances of the past three centuries have re-

quired widening our sphere of moral inclusion. During the nine-

teenth century, for instance, most American leaders believed in

a right to vote—but not in extending it to women and black

people. Likewise, most American leaders, regardless of their

politics, believe that people’s health-care needs should be met;

they’ve sought to insure that soldiers, the elderly, the disabled,

and children, not to mention themselves, have access to good

care. But many draw their circle of concern narrowly; they con-

tinue to resist the idea that people without adequate insurance

are anything like these deserving others.

And so the fate of the uninsured remains embattled—vulner-

able, in particular, to the maneuvering for political control. The

partisan desire to deny the President success remains powerful.

Many levers of obstruction remain; many hands will be reaching

for them.

For all that, the Court’s ruling keeps alive the prospect that our

society will expand its circle of moral concern to include the

millions who now lack insurance. Beneath the intricacies of the

Affordable Care Act lies a simple truth. We are all born frail and

mortal—and, in the course of our lives, we all need health care.

Americans are on our way to recognizing this. If we actually

do—now, that would be wicked.

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Introducing

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Speak Your Truth I

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communication tools surgical staff can employ to openly communicate with colleagues

and leadership in the OR.

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Kathleen Bartholomew, RN, MN

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Learn new ways to effectively communicate with colleagues, how to build an effective

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Adverse events occur more often in surgery than in any other specialty. A staff that feels confident

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New! Culture of Safety in the Operating Room

Martie Moore, R.N., MAOM, CPHQ, Chief Nursing Officer,

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Rick Waller, MD, Chief of Surgery (retired)

Cyndi Owens, RN, MA, CNOR, Director of Surgical Services

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Martie Moore (far right) and colleagues, Providence

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COMMUNICATION

DYNAMICS


Insights for surgeons, nurses, patient advocates and administrative leaders

AND PATIENT SAFETY IN THE OPERATING ROOM

By Beth Boynton, MS, RN

Self-reflection, ownership and respectful communi-

cation are examples of “soft” skills that are extremely

hard to develop and practice. Yet, the surgeon or nurse

manager who can teach the right way of doing some-

thing without humiliating a team member will show

everyone that respect is guaranteed, skills and knowl-

edge are required to work in the OR, and passive ag-

gressive behavior will not be rewarded with alignment.

Not long ago in preparing an interactive workshop on

communication and assertiveness for a chapter for

the Association of periOperative Registered Nurses

(AORN), I asked their educational committee to share

their most common communication challenges so that

we could make our time as meaningful as possible.

They replied with four scenarios.

These scenarios reveal layers of interwoven relationship

patterns that are fraught with horizontal and vertical vio-

lence. Add to that more innocent unawareness about

individual behaviors and their impact on others, along

with lack of skills in self-reflection and expression, and

the complexity of interactions and ramifications begins

to emerge.

Your teammate purposefully holding back

information about a surgery to make you look bad

in front of the surgeon.

Surgeon yelling that s/he wants someone in the

OR who “knows what they are doing.”

Purposeful negative discussion about you in the

operating room by other team members without

including you in the conversation.

Surgeon compromises patient safety either by

surgical technique, not wanting to wait for “Time-

Out” or not wanting to wait for counts at the end

of the procedure (especially when counts are incor-

rect), and ignores or becomes angry when you

request him or her to consider the information

presented.

1

2

3

4

Do these scenes sound familiar?

Continued on page 27

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Consider these questions


Team members vying for approval and leaders who are some-

how gratified by giving or withholding approval are participating

in relationship patterns that contribute to adverse events. With-

holding information, setting up a colleague to work in a position

without appropriate training and experience or using humiliating

language and tone are not in the patients’ best interests.

As human beings, I believe we all want and deserve to feel

respected and have a sense of power. Yet in our culture, some

members and professions are valued more than others. This

imbalance chips away at everyone’s self esteem and contrib-

utes to complex feelings and behaviors involving frustration and

resentment.

In addition, relentless stress, gender, ego and self-esteem fac-

tors help set the stage for such aggressive, passive-aggressive

or passive ways of obtaining power.

I hate to think of my colleagues in the nursing and medical pro-

fessions behaving in these ways, yet I also feel a little defensive.

I know how I feel along the course of a highly stressed shift as a

per diem RN on an Alzheimer’s unit. I can practically watch my

best self disintegrate with relentless alarms, interruptions,

dementia behaviors, changing priorities and chronic understaff-

ing. I’m pretty good at owning and apologizing for any irritability,

but that may be after a sarcastic or short-tempered remark.

Despite the fact that I can empathize with poor conduct, I pas-

sionately believe that individuals and organizations can do better.

Even under pressure, a mistake requiring an immediate substi-

tution of staff can be handled with respect. A statement such as,

“I need trained OR assistance, now!” is quite different from, “Get

someone in here who knows what they are doing!” They both

get the same problem addressed, but the first statement brings

up an organizational responsibility regarding training, while the

second is more blaming of the individual. Making sure the situa-

tion is followed up as soon as possible after surgery by debrief-

ing with the surgeon, nurse manager and staff will identify train-

ing problems, seek solutions and practice giving and receiving

constructive feedback.

Whenever I hear about situations like these, I look for individual

and organizational factors. Solutions that consider less blaming

are more likely to lead to long-term, meaningful change. Admin-

istrative leaders have a responsibility to advocate for resources

required to focus on communication training, opportunities to

practice skills and recognizing learning curves. Individuals have

a responsibility to seek help, acknowledge limitations and de-

velop their skills. Not everyone is cut out to work in the OR, (or

on an Alzheimer’s unit) and career coaching and/or discipline

also may be necessary.

I don’t know exactly what respectful communication looks like

in the operating room, but I suspect there is a unique opportu-

nity for peri-op professionals to define, develop and practice it.

Facilitated discussion among OR staff about the following ques-

tions could be a rich process.

Positive outcomes such as creating new norms, safer sur-

gery, increased collaboration, personal and professional growth

and improved morale are all possible!

Team members vying for approval and leaders who

are somehow gratified by giving or withholding approval

are participating in relationship patterns that contribute

to adverse events.

1

2

3

What does respectful communication look like

in the OR?

What makes it challenging or different here?

What do we need to do to practice it?



Clinicians, particularly nurses, working with patients during or after surgery understand that an emergency situation with a patient who has malignant hyperthermia (MH) instantly can become a matter of life or death. As a result, nurses should be aware of the signs and symptoms that identify malignant hyperthermia and know how to respond immediately and appropriately.1 The challenge for these clinicians, then, is assessing accurately which patients may have or be susceptible for having this rare condition and preparing adequately to handle any case of malignant hyperthermia before it becomes catastrophic for a patient and his or her family.

The information in this article provides an overview of malignant hyperthermia, describes how nurses can prepare an effective malignant hyperthermia cart for use in their facilities and encourages nurses to connect patients and their families with appropriate resources about MH. Familiarity with this type of knowledge is crucial for staff members caring for patients who have received general anesthesia.1

IN THE HEAT OF THE MOMENT by Katie Beam, DNP, RN, ACNS-BC, CWS

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Malignant Hyperthermia Calls for Action


MANAGING MALIGNANT HYPERTHERMIAFortunately, we have not had a malignant hyperthermia (MH) case at Woodland for more than ten years. Nevertheless, we perform several drills every year and require nurses in the Perioperative, Emergency Department, Maternal Child and Intensive Care Unit (ICU) to complete 90 minutes of an annual MH Competency training that includes hands-on mixing of Dantrolene, and observation of a mock drill video from MHAUS. We also keep one fully stocked MH cart in our surgical services department and another one in our outpatient surgery center, which is located in a separate building adjacent to the hospital. The two carts are set up exactly the same way and each drawer of the MH cart is standardized to provide quick and easy access for needed supplies in an MH emergency. A laminated copy of the cart contents is kept on the top of each MH cart for reference and the drawers are labeled on the outside to assist the staff, and minimizes confusion. This is because many staff float between the surgery center and the main hospital OR. In addition, Dignity Health recently implemented the identical MH cart, educational program, policies, and procedures at their sister hospitals in the greater Sacramento/San Joaquin region of California.

When a malignant hyperthermia (MH) episode occurs, we make an announcement on the overhead page system, “Your attention please, Malignant Hyperthermia Alert (location)” which prompts the nurse supervisor to locate the MH cart and bring it to the patient location within five minutes. Although MH often occurs in the OR, it could also

occur in the emergency department (ED), intensive care unit or in the maternal/child unit in mothers who have Cesarean sections. We recently performed a drill with a mock MH patient in the ED, and the nursing supervisor arrived with the MH cart in two minutes and 45 seconds. Our next drill this year will involve a mock patient in the surgery center. The drill will involve the use of the MH cart for a patient in the recovery area of the surgery center and then test our system of communication and teamwork after stabilization from the initial MH event and transporting the patient to the emergency department at the hospital. From there, the MH patient will be admitted to the ICU for observation because 25 percent of patients who experience MH can have a spontaneous recurrence within 48 hours of the first episode. For this reason, all patients with MH must stay in the ICU for at least 48 hours after being treated and stabilized.

Getting Dantrolene to our patient within the five-minute window, and making certain that our staff feels confident in recognizing and treating MH is a priority to our organization because treating MH is all about speed. MH occurs suddenly and affects multiple body systems simultaneously; the muscles, the heart, the brain, and the kidneys. Knowing how to recognize MH, how to prioritize treatments, understanding their roles in the care of the patient and how important it is to get Dantrolene on board quickly to reverse the hypermetabolic state that initiates the deadly MH cascade, will give our patients their best chance for survival.

at Dignity Health Woodland Healthcare, Woodland, CA


Drawer 1

Drawer 2

Drawer 3

Drawer 4

Drawer 5

Woodland Healthcare MH Cart Contents

3

1

2

5

4

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Recognizing malignant hyperthermia

Malignant hyperthermia is a genetic disorder and a

hypermetabolic, or biochemical chain reaction, response.2,3

Susceptible patients undergoing surgery may exhibit signs of

malignant hyperthermia if they are exposed to the “trigger”

muscle relaxant succinylcholine and select inhalation agents

such as desflurane, enflurane, halothane, isoflurane, and

sevoflurane.2-4

The symptoms of MH can be very specific and include muscle

rigidity, increased CO2 production, and fever escalating to

105 degrees F or higher.3,5 Masseter spasm, which manifests

as jaw muscle rigidity and corresponds with limb muscle

flaccidity after succinylcholine has been given, often is the first

sign of malignant hyperthermia.6 It is important for clinicians

to know that all patients who have had even mildly increased

jaw tension should be observed carefully for signs of MH for

at least 12 hours.6 Non-specific symptoms of MH can include

tachycardia, tachypnea, metabolic and respiratory acidosis

and hyperkalemia.3,5 Severe complications associated with

MH include cardiac arrest, brain damage, internal bleeding or

failure of other body systems, and even death.3

How common is malignant hyperthermia?

It is estimated that for every 5,000 to 50,000 patients who

are given anesthetic gases, one patient may have malignant

hyperthermia.7 Malignant hyperthermia is inherited in an

autosomal dominant pattern,3,7 which means that an affected

person usually inherits the altered gene from a parent who also

is at risk for malignant hyperthermia.7 Carriers of the gene for

MH may be unaware they have this risk unless they are aware

of whether any of their family members has experienced MH

after receiving anesthesia in the past.3

If malignant hyperthermia is suspected, it is essential for the

nurse to get a thorough history of a patient’s experiences with

anesthesia as well as any notable experiences that the patient’s

close family members may have had with anesthesia.8

The Malignant Hyperthermia Cart

Health care facilities that use general anesthesia that could

trigger MH must have a kit or a cart that contains all of

the items needed to manage MH readily available.1,6,9 A

basic MH kit or cart should include the following items1,6:

Dantrolene, sterile water sufficient to dilute Dantrolene,

D50, antiarrythmics, calcium chloride, sodium bicarbonate,

insulin and furosemide.

In addition, the items needed for patient monitoring include

EKG, blood pressure, temperature, pulse oximeter and

capnograph. It is also helpful to have an ice machine, a

refrigerator, cooled intravenous fluids and cool blankets close

at hand so these items can be used quickly to help lower the

patient’s body temperature.1,6,9

To practice how to use the items on the cart efficiently, it can

be helpful for facilities to plan annual staff education to refresh

their knowledge on MH and the procedures for recognizing

and treating MH, and implementing a series of regular,

planned mock “MH drills” that involves many health care

team members. These drills enable all of the team members

to practice providing the urgent care needed for a patient

experiencing MH before an emergency arises.6 Because it can

be difficult to dilute Dantrolene, especially on the first attempt

at doing so, all staff members should be given an opportunity

to practice diluting Dantrolene by using outdated vials of the

drug during an MH drill.6 Staff members should check the MH

cart routinely to remove expired supplies and replace them.1

The Malignant Hyperthermia Association of the United States

(MHAUS) is an organization whose mission is to promote

optimum care and scientific understanding of malignant

hyperthermia and related disorders. MHAUS offers posters

and wallet cards containing concise protocols that can be

disseminated to staff or used during a drill or an educational

session.1

The MH drill could mimic an MH crisis, which would require

the staff to call the MH 24-hour hotline (emergencies only):

1-800-644-9737 (United States) or 00+1+303+389+1647

(outside the United States). Also, the drill could incorporate

practicing the START emergency therapy for MH Acute Phase

Treatment, as recommended by MHAUS.9


Resources for patients and families

affected by malignant hyperthermia

MHAUS has a variety of patient resources that can be

accessed online or by attending a support group or meeting.11

Patients and families who have faced malignant hyperthermia,

or who may recently have learned that they carry the gene

for MH may find helpful information through this organization6

and by reading about and connecting with others who have

experienced situations with MH. MHAUS manages a registry

that keeps records of the family health histories and test

results of patients with MH; the organization uses these data

to conduct relevant research about malignant hyperthermia.11

Today’s techno-savvy patients and family members are

always looking for reliable sources of medical information

online. To help these patients find the type of electronically

engaging yet technically sound information they are seeking,

nurses might want to suggest that patients and family

members view the videos about MH that MHAUS has posted

on its website. 12 By watching these videos, patients and their

families will learn valuable information; also, it is interesting to

note that MHAUS highlights the important role that nurses

play in caring for patients with MH.12

REFERENCES

1. Mitchell-Brown F. Malignant hyperthermia: turn down the heat. Nursing

2012;42(5):39-44.

2. Kaplow R. Care of postanesthesia patients. Crit Care Nurse 2010;30(1):

60-62.

3. Malignant Hyperthermia Association of the United States. What is MH?

www.mhaus.org/mhaus-faqs-healthcare-professionals/what-is-malignant-

hyperthermia/#.UBGhWTFS. Accessed July 28, 2012.

4. Rosenberg H, Sambuughin N, Dirksen R. Malignant hyperthermia

susceptibility. 2003 Dec 19 (updated 2010 Jan 19). In: Pagon RA, Bird

TD, Dolan CR, et al., eds. GeneReviews [Internet]. Seattle: University of

Washington; 1993-. http://www.ncbi.nlm.nih.gov/books/NBK1146/.

Accessed July 27, 2012.

5. Medline Plus, U.S. National Library of Medicine, National Institutes of Health.

Malignant hyperthermia. www.nlm.nih.gov/medlineplus/ency/article/00135.

htm. Accessed July 27, 2012.

6. Greco RJ. Malignant hyperthermia: what are the first signs? The ASF Source;

2008;Summer:1,10.

7. Genetics Home Reference, a service of the U.S. National Library of

Medicine. Malignant hyperthermia. www.ghr.nlm.nih.gov/condition/

malignant-hyperthermia/show/. Accessed July 27, 2012.

8. Rosenberg H, Davis M, James D, Pollock N, Stowell K. Malignant

hyperthermia. Orphanet J Rare Dis 2007;2(1):21.

9. Hutton D. Malignant hyperthermia: part 1. Plast Surg Nurs 2011;31(1):23-26.

10. Malignant Hyperthermia Association of the United States. Healthcare

Professionals: During an MH Crisis. www.mhaus.org/healthcare-

professionals/#.UBS1EEShDkR. Accessed July 28, 2012.

11. Malignant Hyperthermia Association of the United States. Patients and

families. www.mhaus.org/patients-and-families/#.UBLFq0RaPkR. Accessed

July 27, 2012.

12. Malignant Hyperthermia Association of the United States. Videos. www.

mhaus.org/videos/#.UBS17UShDkQ. Accessed July 28, 2012.

Get help. Get Dantrolene. Notify surgeon.

Inject Dantrolene sodium 2.5 milligrams/

kilogram rapidly intravenously through a

large-bore IV, if possible.

Provide a bicarbonate for metabolic acidosis.

Cool the patient.

Address dysrrhythmias: usually respond to

treatment of acidosis and hyperkalemia.

Address hyperkalemia.

Follow this testing sequence: ETOC2,

electrolytes, blood gases, CK, serum

myoglobin, core temperature, urine

output and color, and coagulation studies.

MH Drill Protocols

SCIP #9 SAYS REMOVE THE CATHETER.

INSERTAG TELLS YOU WHEN.

Reference

1 Saint S, Kaufman SR, Thompson M, Rogers MA, Chenoweth CE. A reminder reduces urinary catheterization in

hospitalized patients. Jt Comm J Quality Patient Saf. 2005; 31(8): 455-462

2 Patient Safety Quality Measures for the Surgical Care Improvement Project (SCIP). Health Services Advisory Group.

Available at: http://qualitymeasures.ahrq.gov/content.aspx?f=rss&id=16275. Accessed December 7, 2010.

3 Guideline for Prevention of Catheter-associated Urinary Tract Infections, 2009. Centers for Disease Control and Prevention.

Available at: http://www.cdc.gov/hicpac/cauti/001_cauti.html. Accessed December 7, 2010.

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36 The OR Connection 36 The OR Connection

ORGreening the


By Francesca Olivier

Greening the OR Can Yield Cost Savings and Healthier Communities

Background

Pollution is a serious public health concern that affects every-

one, but it especially affects vulnerable populations such as the

elderly, sick, children and the poor. At Medline we feel that

preserving a healthy planet for future generations is not only the

right thing to do, but it is our responsibility as leaders in the

healthcare industry to do our part.

Going green in the OR is one area of critical importance to Med-

line. We have developed the greensmart™ Program, a unique

environmental training and education initiative designed to help

health care facilities reduce costs, increase patient care and

build healthier communities. A significant component of the

program is a comprehensive roadmap that will help facilities

develop a baseline for OR energy use and waste streams. The

roadmap also provides facilities solutions on how to improve

performance.

The Problem

Operating rooms generate an enormous amount of trash –

about 20-30% of a hospital’s total waste – and account

for 86% of total hospital disposal costs. Since so much of a

hospital’s waste is generated in the OR, it is not a surprise that

many hospital green teams begin with OR nurses. In the chaos

of the OR, packaging and general trash often end up in regu-

lated medical waste (RMW), or red bag waste, even though it

doesn’t need to be there. A Johns Hopkins study found that as

much as 90% of what is thrown in red bag waste does not actu-

ally meet the criteria for regulated medical waste (RMW).

This represents an enormous opportunity not only for

improved environmental impact, but also for cost savings

through reduced RMW. Because of the sheer volume of sup-

plies that pass through the OR, small incremental changes can

add up to significant overall impacts. These impacts are both

environmental and economic. Waste reduction reduces both

immediate and ongoing disposal costs, while it reduces carbon

emissions and the need for landfills and their associated risks.

The Approach

With Medline’s greensmart™ sustainability program health

care facilities have options in addressing sustainability chal-

lenges: facilities can execute the program on their own with the

greensmart™ Roadmap and support of an expert in the field;

they can employ an expert to complete a sustainable OR

assessment; or, facility staff can be trained on how to complete

the assessments and conduct follow-up evaluations. Regard-

less of the path taken, the result of the efforts will be measur-

able, both financial and environmental, and can help gain

support for more sustainability efforts throughout the hospital.

The recommended steps to reduce waste are:

1. Measure your Baseline

To determine the opportunity for waste reduction and cost sav-

ings at your facility, the first step is to measure your baseline.

Work with your housekeeping department to find out the annual

volume of RMW disposed of every year by your hospital and

the cost per pounds for that waste. Next, conduct a waste sort.


Program for Healthcare

©2012 Medline Industries, Inc. greensmart is a trademark and

Medline is a registered trademark of Medline Industries, Inc.

greensmart™ is not a third-party certification. The use of the

greensmart™ trademark is determined by Medline Industries, Inc.

through an internal review process of environmental claims.

Measure Your Baseline

From calculations to benchmarking, your

greensmart RoadMAP provides all the tools you

need to green your OR, Housekeeping, Laundry,

Food Services and Patient Rooms.

1

2

4

3Identify Green Products and Strategies

With the help of your Program Manager, you will

identify products, services and education that are

right for your facility.

Receive One-on-one Consultation

You will receive personal assistance from your

dedicated greensmart Program Manager.

Monitor and Promote

You are given the tools to not only monitor your

progress, but to promote your success.

The greensmart approach for reaching your unique goals:

One-on-one sustainability guidance and services

ONE CALL STARTS YOU ON YOUR

WAY TO BECOMING GREENSMART

Francesca Olivier, Medline’s corporate sustainability manager,

is ready to work with you no matter where your facility is

on your sustainability journey. Call her at (847) 643-3821 or

email [email protected]


Green Solutions for the Operating Room

The Problem Green AlternativeEnvironmental Savings for a

Typical 10 OR Suite

Disposable Forced-Air

Patient Warming Blankets

Medline PerfecTemp™ Reusable

Patient Warming Bed

Blue Sterilization Wrap Sterilization Containers

Blue OR Towels Natural OR Towels

and Towel Recycling


A waste sort is a means of cataloging what actually is put

into red bag bins, and the weight of each item. This will tell

you the level of compliance with your hospital’s RMW poli-

cies, as well as the cost savings opportunity through

improved waste segregation practices. Through Medline’s

greensmart™ program you can not only have this assess-

ment completed for you, you can also be trained in the

process so that you can complete your own follow-up evalu-

ations to measure your progress.

2. Implement Environmentally-Friendly

Products and Strategies

There are several strategies that a hospital can take to

reduce the waste generated by the OR. Remember – what

comes into the OR must go out. By eliminating disposables

and moving towards products with a longer life you not only

reduce your contribution to the landfill, but reduce the costs

associated with waste disposal. Here are some examples:

3. Market your Success

Improving performance in health care is a significant accom-

plishment for a facility and should be communicated to

patients, staff and the community. Going green in the OR can

help a facility communicate efforts being made to improve

efficiencies for staff, improve patient care and illustrate how

a facility is reducing their carbon footprint. There are myriad

ways to promote such success through basic communica-

tion efforts including:

to communicate the successes to staff.

resources to communicate the successes to patients.

successes into the facility’s overall public relations plan.

Conclusion

The greensmart™ program is a strategic four-pronged

approach that can help facilities: measure the baseline of

their environmental impact; identify opportunities for environ-

mental cost savings; monitor and report on progress; and,

garner marketing assistance and education. By employing

this comprehensive approach in the OR, hospitals will expe-

rience significant environmental outcomes and look at their

ORs in a whole new light. Going green in the OR will yield

cost savings, increased patient satisfaction and a healthier

community.

About the Author

Francesca Olivier manages Medline’s sustainability program.

She previously worked at the U.S. Environmental Protection

Agency Region 5, in the Office of Enforcement and Compli-

ance Assurance. Francesca received her bachelor’s degree

from Loyola University, New Orleans, and a master’s degree in

Environmental Management and Sustainability from the Illinois

Institute of Technology.

Going green in the OR will yield cost savings, increased patient satisfaction and a healthier community.

greensmart™ is not a third-party certification. The use of the greensmart™ trade-

mark is determined by Medline Industries, Inc. through an internal review process

of environmental claims.

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wood pulp and has all the same great features and

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-


LEANISN’TJUST FOR DIETS ANYM E

An introduction to the LEAN Process Improvement Methodologyby Joan Ferrara,

RN, BA, CNOR


Lean.

lean

staff, physician and patient satisfaction.


Lean is a process improvement methodology developed by

to providing surgical care? That’s a fair question that has been

answered by many success stories across the country. Health

care is an industry that is undergoing tremendous change.

and the public are holding healthcare providers to a higher

happy? The answer comes from industry. The aviation industry

from automotive factories to hospitals, making small changes

that result in big differences.

What is lean all about?

Just like trimming the fat from your meat, the goal of lean is to

hold on to those things that have value and to get rid of the

cornerstone of Lean. Lean is frequently implemented along with

process, can waste time, steps or supplies.

Leadership training is essential before beginning a lean project.

will become the experts in the lean method. The leader of a lean

team must be familiar with the methodology, and the team should

include front line workers who live with the current practice and

goals are set, and the Lean methodology begins.

How lean can apply to room turnover

teams: room turnover. The value is fairly obvious. Patient and

stretcher get to the room? Who helps move the patient? How

F I V E S T E P S T O L E A N

Flow

Pull

Perfection

Reducing waste is the

cornerstone of lean...

Poorly designed processes,

process, can waste time,

steps or supplies.


EMPOWER from Medline shows you how to:

EMPOWER™

Eliminate Waste with Perioperative LEAN Solutions

EDUCATION

ACTIONOUTCOMES

For a no-obligation EMPOWER

review and analysis, contact your

Medline representative or call 1-800-MEDLINE.


place or does the cleaner have to leave the room and disrupt

the work? How are the supplies for the next case gathered?

need to be opened? How does the staff know what the surgeon

The questions are answered and the process is documented in

as much detail as possible. This step requires discussion and

be represented on the team.

supplies may be essential in another. Generally there is room

When a change improves the result it becomes the accepted

have been eliminated and the process is pulled by the customer.

is to follow it.

Then comes Perfection. This doesn’t mean the process is

perfect the process. Little tweaks along the way adjust things

The lean methodology requires continuing attention even after a

is obvious in increased revenue, decreased spending, happy

doesn’t advocate “do more with less.” Lean helps staff work

the sterile core while starting a case, she will be more relaxed

and less distracted from her most important task of taking care

of the patient, less tired at the end of the day, and will feel a

team work together, knowing what to expect of each other, the

work day becomes less stressful and more productive. Who

wouldn’t want that?

the Lean team develops

ideas for doing things

Ask your Medline representative about “Be Free Day”

staff to the newest latex free technology.

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By Chuck Biddle CRNA, PhD & Jagdip Shah, MD


QUANTIFICATION of anesthesia

providers’ HAND HYGIENE in a busy

metropolitan OPERATING ROOM:

What would Semmelweis

think?

Background:

care environment representing a major public health

concern. HH compliance is poorly studied in anesthe-

sia providers who contribute extensively to nosocomial

infection. The rate of HH opportunities and compliance

by these providers was studied using embedded, clan-

destine observers. We aimed to quantify HH behaviors

Methods: Following intensive

an academic center, observed the HH of anesthesia

providers over a 4-week period throughout the periop-

HH opportunities and HH failures were recorded and

-

-

sion: HH was very poor among anesthesia providers.

The task density of anesthesia care may conspire with

an intrinsic HH failure rate to create great opportunity

-

-

tional and ergonomic interventions at our facility. Given

the task density of anesthesia care, and the observed

failure rates, novel approaches to HH should be inves-


promote handwashing as the simplest and most effective inter-

representing a true public health crisis, decried in both profes-

sional and lay publications. Whereas many factors contribute

-

ger be viewed as simply a systems problem but rather a matter

of personal accountability.

million occur each year with nearly 100,000 deaths resulting in the

problem because of the perplexing problem of under-reporting.

health care providers. These studies are most often limited by the

positioned in an obvious manner, and even if the providers are not

-

expectancy and the Hawthorne effect.

anesthesia workstation, demonstrating very clearly that patho-

genic, drug-resistant organisms are regularly transmitted to and

from patients via a variety of mechanisms during the technically

challenging and task-dense period associated with anesthetic

administration during surgical procedures. Whereas good HH

is the cornerstone in preventing nosocomial disease transmission

in the hospital setting, a growing body of literature suggests that

anesthesia providers may contribute to the ongoing problem

We executed an observational study of the HH of anesthesia

providers in a major, metropolitan medical center, using embed-

ded, highly trained, clandestine observers that to our knowledge

HH during anesthesia delivery without any potential of observer

-

sia providers during the real-time care of patients over the con-

tinuum of perioperative care.

and assessment inventory and masquerading as surgical nurses

undergoing routine employee orientation to the operating room

the course of a 4-week period. The observers were savvy about

anesthesia providers as well as demonstrations conducted in a

simulation laboratory and then rated the observed HH using the

was achieved on observed HH opportunities and failures, requir-

provider type they would be observing to avoid any clues of their

purpose.

Given the nature of the anesthesia and surgical process where a

single team of surgical and anesthesia providers follows a given

patient through the perioperative process, the study observers

were able to continuously observe the anesthesia providers from

and physical, placing intravenous lines and blood draws, obtain-

recovery period where the provider eventually performed a handoff

to the postanesthesia care unit staff. Throughout this period, the

Recently investigators have focused attention on HAIs in the anesthesia

workstation, demonstrating very clearly that pathogenic, drug-resistant

organisms are regularly transmitted to and from patients via a variety of

mechanisms during the technically challenging and task-dense period

associated with anesthetic administration during surgical procedures.


No More Sticky Hands

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and skin trauma when donning gloves. It’s

also CHG, latex and non-latex compatible.

For more information on

Sterillium Rub, contact

your Medline representative,

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or call 1-800-MEDLINE.

STERILLIUM®

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Exceeds FDA Requirements1

Sterillium Rub is the only waterless, brushless

surgical scrub with 80% (w/w) ethyl alcohol —

the highest alcohol concentration of any surgical

rub available in the US. Its long-lasting, persistent

effect exceeds FDA requirements for surgical hand

antisepsis. Sterillium Rub provides a rapid and

comprehensive kill of transient and resident skin

flora, with a 6 log reduction within two minutes.2


To avoid over penalizing a provider for a HHF, we elected to count

a failure only once in a given sequence, that is, if a provider failed

to perform HH after manipulating the airway or otherwise con-

taminating his/her hands and then began touching the anesthesia

equipment (e.g., agent vaporizer, flowmeters, stethoscope, drug

syringes, warming devices, and others), they were only counted

for 1 HHF (i.e., a “missed opportunity”). This provided the most

consistent and most conservative quantification of HHF rate but

would, however, underestimate the degree of secondary contami-

nation targets.

The ORs at the study institution are typical of any large, metro-

politan academic center providing services over the full range of

surgical procedures with a diverse representation of patient mor-

bidity. The anesthesia care providers include attending anesthesi-

ologists, physician anesthesiology residents, off-service residents

and medical students doing anesthesia rotations (neither were

observed), certified registered nurse anesthetists, and student

registered nurse anesthetists. Attending anesthesiologists provide

medical direction to every surgical case and work in an anesthesia

care team model as they oversee (most commonly) 2 operative

suites with the varied providers.

Throughout the perioperative period, disposable gloves were

available within easy reach of the provider. During the preopera-

tive phase (examination, IV start, and other), sinks with running

water and soap were available within 10 feet of each patient and

were thus accessible to the anesthesia provider. During the intra-

operative phase, sinks with running water and soap were avail-

able immediately outside the OR, and alcohol-based hand scrub

was available within easy reach of the anesthesia provider. During

the immediate postoperative phase, sinks with running water and

soap were available within 10 to 30 feet of each patient, and

alcohol-based hand scrub was available within easy reach of the

anesthesia provider. No signage or verbal “prompts” to perform

HH were used over the course of the perioperative observation

period.

As a condition of the institution’s human subjects committee, the

observed behaviors of the various provider types were recorded in

the aggregate. There was concern by the board that should differ-

ences in rates of failed HH occur between or among groups, that

interdepartmental provider conflict might arise. Therefore, only

descriptive statistics were performed with no inferential statistical

analysis to ascertain provider group differences in HH behavior.

Using a qualitative content analysis, we reduced the HH failures

into mutually exclusive but all-encompassing categories.

RESULTS

Over the course of the 4-week period, 7,976 HH opportunities

among the anesthesia providers actively engaged in clinical prac-

tice were observed, recorded, and electronically archived. Like-

wise, missed opportunities for HH were observed, recorded, and

electronically archived.

Examples of a HH opportunity included, but were not limited to:

Hand cleansing prior to first interacting with the patient;

hand cleansing, gloving prior to arterial or IV line placement or other invasive procedure;

hand cleansing after any invasive procedure;

hand cleansing after manipulation of the airway (e.g.,.artificial airway placement, suctioning);

hand cleansing after hanging a blood product;

hand cleansing after touching the patient for surgical positioning;

gloving before and hand cleansing after suctioning of the airway;

hand cleansing after patient handoff; and

hand cleansing after retrieving a soiled or dropped item off the OR floor.


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provider group with a mean aggregate failure rate of 82%.

maintenance, emergence), we found indications occurring

for HH at a rate that averaged 34 to 41 events per hour,

especially at induction and emergence) and at times were

as high as 54 per hour in certain types of cases (e.g.,

extensive blood loss, patients with particularly challenging

airway issues, periods of high task density such as

complicated emergence from anesthesia, and others).

following manner:

1. Moving between/among patients during the preoperative

assessment phase;

2. before, during, and after pain service interventions (e.g.,

placing perioperative nerve blocks);

3. keyboard use with soiled hands when using electronic

medical record keeping;

4. during the placement of IV and blood draws;

5. preparing drugs and equipment for the case to follow

with soiled hands;

6. soiled gloves left on after airway manipulations such as

endotracheal intubation, suctioning of the airway,

laryngeal mask airway insertion, and others;

7. soiled gloves left on after Foley catheter or central or

arterial line manipulation; and

8. other: picking up something off the floor (e.g., pen,

tape roll, tongue blade, suction catheter) and using it.

DISCUSSION

Other researchers in multiple disciplines have demonstrated a

significant failure rate in HH among health care workers using

observational approaches that are likely to significantly influence

provider behavior. The current study is unique in that it quanti-

fied the HH behaviors of anesthesia providers in a busy operating

room in a large, metropolitan medical center using observers who

were embedded in the operating room with easy visual access of

the anesthesia providers throughout the perioperative course of

care and whose intent was totally obscured from those observed.

Table 1

Taxonomy of hand hygiene failures by anesthesia providers

Category of failure Example

Moving among patients during the perioperative

assessment phase

Contacts patient during examination or IV start and goes

on to contact another patient without appropriate HH

Before, during and after pain service Placing a nerve block using “relaxed” aseptic technique.

Failed HH before and after perioperative nerve block

Keyboard use with soiled hands when using electronic

medical record-keeping

Keyboard use with soiled gloves on. Failure to perform HH

before touching keyboard and other charting aides

Placement of IV lines and blood draws Not wearing gloves during procedure. Failed HH before

and after procedures involving vascular access

Preparing drugs and equipment Drawing up drugs, preparing airway devices, IV fluid sets and

other equipment with soiled hands for the next scheduled

case with the case still in progress

Soiled gloves left on after airway access Intubating or otherwise accessing the airway and failing

to remove soiled gloves or perform HH before touching

other items such as keyboard, flowmeters, and others

Soiled gloves left on after Foley catheter or central/arterial

line manipulation

Touching the urinary collection bag or central/arterial line

connection or access site without proper HH

Other Catch-all category for HH behavior such as picking up

something that fell to the floor and using it (e.g., suction

catheter, roll of tape, and others). Touching another room

provider (e.g., shaking hands) with soiled hands. Opening

sterile packages or opening anesthesia cart drawers with

soiled hands.

HH, hand hygiene; IV, intravenous


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Medline Hand Hygiene Compliance Program

An intensive educational module developed by an

expert panel of infection control professionals.

a. Testing for skill and competency validation

through the use of Visirub and a UV light box.

b. Patient education pamphlets, facility posters

and a rewards program reinforce positive

behavior change.

HANDHYGIENETools and Resources

a.

b.

Nurses can earn up to four continuing education credits by completing the program. Approved for continuing education by the Florida

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continuing education for the Certified Surgical

Technologist and Certified First Assistant.



by Natalie J. Mach, RN

How many articles have you read in the last decade about

safety scalpels? How many safety scalpels has your OR trialed

in the last decade? Hospital ORs and surgery centers have

attempted to standardize on safety scalpels – with little success!

There are a vast number of reasons or explanations, especially

from surgeons, such as:

� “I want to continue to use the blade I’m used to using.”

� “It doesn’t feel the same.”

� “I’ve never been stuck. Why should I use a safety

scalpel?” (Note: This is predominantly true. It’s the

surgical techs and nurses who get stuck according

to national statistics.1)

� “The plastic cartridge covering the blade obscures

my vision.”

� “This safety scalpel affects how I perform surgery.”

All that being said, new data strongly suggest an increase in

sharps injuries in surgical settings versus non-surgical settings

since the national Needlestick Safety and Prevention Act was

passed in 2000.

Since the legislation was enacted, injury rates dropped 31.6

percent in non-surgical settings, but increased 6.5 percent in

surgical settings. Most of the injuries were caused by suture

Another Article about

Safety Scalpels?

Yes, but there’s new data

needles (43.4 percent), followed by scalpel blades (17 percent)

and syringes (12 percent). Seventy-five percent of the injuries

occurred during the use or passing of devices. Surgeons and

residents were most often the original users of the injury-causing

devices; nurses and surgical techs were typically injured by

devices originally used by others.1

In addition, the Massachusetts Department of Public Health

(MDPH) surveyed 99 facilities in 2004 specific to sharps injuries

in the operating room. Some of their findings are as follows:

� � Devices without safety features accounted for

more than 78 percent (812) of sharps injuries in

Massachusetts ORs in 2004

� � 32 percent (1,038) of sharps injuries reported by

Massachusetts hospitals occurred in the operating room

� � Three categories of devices: suture needles, scalpels,

and hypodermic needles, accounted for approximately

75 percent of all OR injuries

Based on the Massachusetts data, opportunities exist for

reducing sharps injuries within operating rooms. As sharps data

is presented, it is always important to emphasize that under-

reporting remains a significant issue that varies according to

occupation and facility. It is reasonable to assume, therefore,

that these data underestimate the problem.


The 2010 data is alarming, but what conclusions can be drawn?

In those areas where safety devices have been implemented,

sharps injuries have decreased. In the operating room, where

safety devices/safety scalpels largely have not been implemented,

sharps injuries have risen. Many surgeons are still clinging to

standard scalpels rather than making the conversion to safety

scalpels. OSHA can fine facilities a minimal amount up to fines

as high as $72,000 for “willful” violations.3

What if one of your family members became a sharps injury sta-

tistic? Would you feel any differently about safety products not

being used in the workplace? The answer is obvious.

The evaluation, use and standard practice of safety scalpels is

only one piece of a total program concerning sharps safety. It is

important for operating rooms to implement some, or all of the

following to reduce and/or eliminate sharps injuries:

1. Safety scalpels

2. Passing trays

3. Neutral zones (elimination of hand-to-hand passing

of scalpels or with other sharps)

4. Conscientiousness, consistency and commitment to

reduce sharps injuries by the entire perioperative team.

There are several resources available for employers and employ-

ees with regard to occupational exposures to blood and OPIM.

First, of course, is the OSHA Bloodborne Pathogens Standard

(29 CFR 1910.1030). Also available are “CPL 2-2.69 (November

2001). Enforcement Procedures for the Occupational Exposure

to Bloodborne Pathogens, and many other related documents.

To access this information, as well as information from OSHA’s

Consultation and State Plan State Offices, visit OSHA’s website

at http://www.osha.gov or call 1-800-321-OSHA.

References

surgical settings versus nonsurgical settings after passage of national needlestick legis-

2. Sharps injuries in the operating room. Massachusetts Sharps Injury Surveillance System

Data, 2004. Occupational Health Surveillance Program, Massachusetts Department of

Public Health. April 2008. Available at: http://www.mass.gov/eohhs/docs/dph/occupa-

3. US Labor Department’s OSHA cites Paradise Park Assisted Living in Lake Zurich, Ill.,

with safety and health violations after needle stick injury [news release]. Lake Zurich, Ill:

US Department of Labor Office of Public Affairs: May 3, 2011. Available at: http://

www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=NEWS_RELEASES&p_

SAFER CATHETERIZATION FOR KIDS

Sometimes, you just need a buddy. Buddy

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catheter patients. Along with some serious patient

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But it’s more than just fun. There’s published evidence

that distraction helps children tolerate unpleasant

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You trust Medline for clinical innovations, such as our

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™

©2012 Medline Industries, Inc. Medline is a registered trademark and OctylSeal is a trademark of Medline Industries, Inc.

Introducing Medline’s OctylSeal high viscosity

tissue adhesive for closure of simple wounds

chance of cracking

adhesive film remains intact

tissue adhesives (0.7 grams versus 0.5 grams)

easier identification on skin

broken glass entering the wound

Indications for use

edges of wounds from surgical incisions, including punc-

tures from minimally invasive surgery and simple, thoroughly

cleansed trauma-induced lacerations. OctylSeal may be

used in conjunction with, but not in place of deep dermal

sutures. Available by prescription only.

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HIGH VISCOSITY TISSUE ADHESIVE


Michele DeMeo

Sterile Processing

Sue MacInnes, editor of The OR Connection, recently had the opportunity to

interview Michele DeMeo, a sterile processing professional who is considered an

expert by her peers and the FDA. She was nominated and approved by the FDA

as the single sterile processing expert on their overarching device committee and

as SGE or special government employee for her work in helping with national

and international standards development. She has also written columns for major

healthcare publications and developed soft goods and statistical tools. She is a

sterile processing consultant, IAHCSMM-approved instructor, course developer

and chair of several national and international committees for major healthcare

associations. Michele has authored over 100 articles, drafted textbook chapters,

and has written three books on topics outside of the sterile processing field.

She also received IAHCSMM’s highest award, Educator of the Year for 2011

and AAMI’s first Shining Star Annual Award. She was listed in Infection Control

Today magazine in 2011 as one of the top 25 Who’s Who to know in Infection

Prevention.

Michele was diagnosed with amyotrophic lateral sclerosis (ALS, also known as

Lou Gehrig’s disease) in 2010, and she readily accepts that the diagnosis is

terminal, giving her only three to five years to live.

Q & Awith

Sue MacInnnes: You have been working in the sterile

Micheele DeeMeo: Twenty years is a long time but, sterile

processing has been my longest love and greatest passion. The

specialty caught my eye about 22 years ago as a technician,

and I still cannot shake my interest in it. Some habits become

so ingrained in us we have no choice but to go along for the

ride. Seriously, there was something missing when I was a

and the OR were much different 20 years ago compared with

I suppose, to better answer your question, the challenge of

changing the world’s perception of what we could provide in

job itself are the things that have kept my interest. My goal has

been to try to chip away misperceptions person by person,

hospital by hospital, and year after year to work toward shared

ownership and peer relationship development between surgical

services and sterile processing.

SM:

MD: The work of many pioneers before me made the greatest

services. I have always been interested in relationship mending

or building right alongside improving both administrative and

for me, I have witnessed and sometimes contributed to clearer

boundaries, more transparency, and better intra-dependency.

each other without something or someone being compromised

in some fashion.


“The challenge of

changing the world’s

perception of what we

could provide in terms

of service and the

complexity of the sterile

processing job itself are

the things that have kept

my interest.”

We owe it to our patients to

encourage and support every

person who touches the very

instruments that can either

help or harm surgeons and

patients.”

“We o


battling silos slowly becoming reverse engineered to the point

an equal peer to surgical services. I also clearly see a stronger

SM:

MD: Yes, without a single doubt. But it is not a simple

respected in facilities. By this I mean that educational funds

or the OR. Resources, in general, are tight, and with a lack of full

put through, change and improvement in skills will have some

road bumps. However, they are not at all insurmountable. In fact, I

believe we can learn many lessons from each other by partnering

more with our surgical units and allowing more personal interface

between the two departments at the staff level.

SM:

MD: Funny you should ask. I helped draft the language of a

sterile processing bill sitting with State Representative Maureen

Healthcare Central Service Materials Management (IAHCSMM)

later was brought in and added considerably to the subsequent

drafts. The bill is now being co-sponsored by the U.S.

Department of Health and Human Services. My hope is that

certification.

SM: How will passage of this bill benefit the OR, especially,

MD: There is plenty of free or low-cost continuing education

available for sterile processing technicians to maintain their

certification. The cost of this education is a fraction of the cost

of a single surgical infection that could be linked to a poorly

person who touches the very instruments that can either help

or harm surgeons and patients. The only sticking point is in

those practices stopped or decreased, then allocation of funds

could be shifted differently to benefit more critical stakeholders.

Sterile processing technicians deserve the same level of funding

for education as any surgical department. They are no less

responsible for outcomes than surgical personal. They simply

elements go hand-in-hand. That means both deserve the same

opportunities for improvement, because they both ultimately

affect each and every surgical patient.

SM: How do you suggest OR managers and directors work


There is no question, in her 39 years, Michele DeMeo has truly lived. In her book,

she shares that in some ways, her life really began when she was diagnosed with

amyotrophic lateral sclerosis (ALS), a terminal disease. Some might question why

a person nearing the end of life would consider spending time writing a book. But

but rather a way to help others learn to live in a more deliberate, thoughtful and

meaningful way.

by her side. Already she’s fading around the edges. It’s okay, because she’s given

The Beauty of a Slow Death is available at amazon.com.

The Beauty of a Slow Death

MD: Allow for more interaction between the units, not just

when an error has been made or in the midst of a crisis. Instead,

understand the type of pressure OR nurses and physicians

and charge nurse and even doctors to ask about schedule

OR’s needs change, and those needs are not communicated,

this as a shared responsibility for open communication to occur

Building better communication and collaborating on projects in

the future, together, will help, too, not just putting out fires in

the moment. Identify risks as a joint effort and mitigate them

together as a team. Neither group, alone, will have the correct

and best practices for both specialties.

SM: I understand that our readers will be hearing more from

MD: Yes, I thought I was retired, but it seems I am not so

ready to relinquish everything. Everyone needs a purpose, and

I pitched an idea for a short column in The OR Connection.

believe people should give all they can give. I am not done yet,

and where else can someone with a love of surgical services

and sterile processing best fit that with you. Turn to page to

read the first article in my new sterile processing column.

Yes, I do have ALS, a terminal disease, but I believe that is all

the more reason for me to write the column. I have lots to say

and likely little time to share all my ideas, hopes and dreams for

the sterile processing profession. I have completed many future

articles to ensure my ideas get printed long after I may be gone.

Every nurse knows you need a contingency plan. They have

taught me well!

Read Michele DeMeo’s Inspiring Book

Proceeds go to the International

Association of Healthcare Central

Service Materiel Management

(IAHCSMM).


Portrait of a Life Well-lived

The Canvas is a painting created by Michele DeMeo, who

believes in passion, improvement and beauty, even in the

darkest times. She’s created The Canvas as a legacy to

her life and her dedication to the sterile processing field.



It began as a blank white stretched canvas to be

abstract rendition of the circle and progression of life

showing that people can build themselves up, make

their own way to find contentment and create a space

literally or figuratively where peace can be found by

sheer determination.

Michele wanted a symbol to outlast her, and so

with brushes taped to her fingers, The Canvas was

born. It is a traveling piece of art on a year long

journey to some of the best and most important

places Michele thought it should be displayed.

Most of the locations along the way are related

to Michele’s lifelong career in sterile processing.

At the end of its journey, The Canvas will reside

permanently at the International Association of

Healthcare Central Service Materiel Management

(IAHCSMM) headquarters in Chicago, where

Michele is donating the piece.

Memorial Hospital

Memorial Hospital was selected because

it shares my values in care and I have the

utmost respect for its mission, vision and

leadership led by an incredible, gifted,

The Food and Drug

Administration (FDA)

Silver Spring, MD

The Food and Drug Administration (FDA) is an

change here in the United States. I accepted

the nomination to be on their team because

I felt it was a duty. I believe it is working

toward complete device improvement and

taking input from surgical services and sterile

Key Surgical

Key Surgical is a great company and a

The Canvas and

pledged enough to earn the opportunity to

choose one of the locations.

The World Health Organization

(WHO)

so many countries and is diverse in its

Gabriel’s at The Ashbrooke Inn

For personal reasons, Gabriel’s was chosen

since it has been my second home for 23

years. It has been my private refuge at

least once a year for a long time. There is

no other place in the world like it and it is

one of the only places I vacation and always

will be. There is a sense of both magic and

peace within the compound. I’ve watched

this 15-year-old inn morph from a work in

progress into an oasis, without losing its soul.

a Journey to Locations

AORN

Denver, CO

The Association of peri-Operative Nurses

because I see sterile processing and surgical

services as a team

Aligning practice with policy to improve patient care 69Aligning practice with policy to improve patient care 69

The Seaver Center

for Autism,

Mount Sinai School

of Medicine

New York, NY

The Seaver Center is a

premier autism facility that

worked closely with me

during my diagnosis and

subsequent studies.

Association for

the Advancement

of Medical

Instrumentation

(AAMI)

Arlington, VA

I could not leave off the

that I had worked with

for years helping to

shape standards, draft

articles and lending

a hand in developing

a useful and needed

tool for the world to

look to as a widely

in best practices for

sterile processing and

utmost faith in AAMI’s

ability, goals, vision and

leadership.

The ALS Clinic at

Hershey Medical

Center

I selected this facility for its

team of professionals with heart

and incredible skill. The team

helped me navigate my way

through the most challenging

news in my life with kindness,

great resources and leadership

Betty Hanna’s Home

Chicago, IL

Betty, well, there are not enough words to say why The Canvas had

to visit Betty Hanna’s home. She leads the International Association of

Healthcare Central Service Materiel Management (IAHCSMM). I look up

to her and I believe in her, and I am proud of what she has accomplished

for our profession with such kindness and a soft approach. Her style of

leadership sings to me, and I believe it reaps longer lasting results.

Home: International Association of Healthcare Central Service Materiel Management (IAHCSMM)

Chicago, IL

I choose to donate The Canvas

The Hospice Foundation of America

The moment I heard the voice of Hospice Foundation CEO Amy Tucci, I knew I had

to include the Hospice Foundation in the year long journey of The Canvas. Hospice

is pivotal to those who are terminal, but not just for the last few days of a person’s

life. Rather, hospice is a program and service that can help ease patients and

families through the sometimes long journey of tough news and death.

Advanced Sterilization

Products (ASP)

Irvine, CA

processing from a job I had as a teen into a

lifelong career. Thank you, Cynthia Spry.


So You Really Think That Surface Is Clean?by Lorri A. Downs RN, BSN, MS, CIC

Healthcare professionals often ask.....

“Is that room or reusable piece of medical equipment clean?”

How do you know? Infection prevention starts with hand

the physician’s office, ambulatory surgery

centers to hospitals and long-term care.

Surface cleaning and disinfection can

help reduce the risks of healthcare-

acquired infections.

Improved hand hygiene and better

limits. A plethora of evidence points to

the importance of proper cleaning

and disinfection. Eight recent

studies have confirmed that

patients occupying rooms

previously occupied by patients

with Vancomycin-resistant

enterococcus (VRE), MRSA,

Clostridium difficile (C. diff.)

and Acinetobacter baumannii

on average a 73 percent increased

risk of acquiring that same pathogen

than patients not occupying such rooms.

improved routine disinfection cleaning

percent decrease in transmission of VRE,

1

Key culprits of healthcare-acquired

infections can survive on dry

surfaces for varying amounts of

time, as shown below.

High touch or high risk objects (side rails, call lights, light

switches, door knobs, toilet handles, telephone, chairs,

commodes, bedside tables, and bedside trays) certainly need

attention due to the repeated contamination from patients or

healthcare workers hands when assisting with patient care.

The term “high risk areas” is not scientifically defined, so it is

important to remember all areas of the environment to effectively

clean and disinfect.

Cleaning and disinfection “best practices” usually involve a one-

step method using a detergent-disinfectant. No pre-cleaning is

necessary unless a spill or gross contamination has occurred.

8 TIPS

OrganismLength of time survives on surfaces

Methicillin resistant Staphyloccocus aureus (MRSA)

1-56 days 2

Clostridium difficile (C diff.) spores 15 mins up to 5 months 3

Vancomycin resistant E. coli (VRE) 7 days to 4 months 4

Acinetobacter baumannii 29 days 5

for Cleaning and Disinfecting Healthcare Settings

■ Perform hand hygiene and apply gloves

■ Place wet floor sign at door

■ Discard disposable items and

remove waste and soiled linen

■ Disinfect (damp wipe) all horizontal,

vertical and contact surfaces with a cotton

(or microfiber) cloth saturated with a

disinfectant-detergent solution

■ Spot clean walls (when visually soiled) with

disinfection-detergent and windows with

glass cleaner

■ Clean and disinfect sink and toilet

■ Stock soap and paper towel dispensers

■ Damp mop floor with disinfectant-detergent

■ Inspect work

■ Remove gloves and wash hands

Best Practices

for Daily

Cleaning and

Disinfection6

1. Purchase EPA-labeled

healthcare grade disinfectant

products and apply per the

manufacturer’s label.

2. Know the “wet contact time,”

which means the amount of time the

surface must remain wet (with the

chemical) to disinfect that surface.

3. More is not better. Use exactly the

amount of cleaning and disinfection

product needed to get the job done.

4. Know how to clean and

disinfect each piece of reusable

medical equipment with the

appropriate product to avoid

damaging the equipment or

voiding the warranty.

5. Always provide and use

appropriate personal protective

equipment prior to performing any

cleaning activities.

6. Maintain a current list of all

approved cleaning and disinfection

products your facility purchases

and prohibit staff from bringing

products from home.

7. Select cleaning products that are

a detergent and disinfectant in one.

8. Set a “regular “ (daily, weekly,

monthly) routine cleaning schedule

(depending on items and areas that

are being cleaned ), and then train

and assign staff to complete.


Powerful, Safe and Intelligent

Powerful IRiS emits UV-C rays that produce a 3 to 6 log

reduction in colony-forming units.1

Safe

IRiS has redundant safety features to help prevent

inadvertent exposure to UV-C. IRiS is chemical-free,

so there’s no need to cover windows or seal heating/

ventilation systems. It’s even safe to view from outside

the room.

Intelligent

Dose Assurance – With special sensing technology, IRiS

automatically determines the perfect UV-C dose for any

room size.

Steri-Trak™ Service Documentation –

Advanced patent-pending technology

provides real-time documentation of all

disinfections. Steri-Trak is customizable

and Web-based for maximum

convenience.


A room can look clean, but looks can be deceiving.

IRiS™

Motion Sensors –

on IRiS and for

anging on room-

access door handles.

Intelligent Room Sterilization


Additional Considerations 6

■ Use EPA-registered disinfectant-detergent

(if prepared on site, document correct concentration)

■ Clean surfaces should appear visibly wet and

should be allowed to air dry at least one minute

■ Change mop water containing disinfectant every

three rooms and after every isolation room

■ Change cotton mop heads after isolation room

cleaning and after blood borne pathogen spills

(change microfiber after each room)

■ Clean from the cleanest areas to the dirtiest areas (the

bathroom would be cleaned last followed by the floor)

■ Change cleaning cloths after every room and use at

least three clean cloths per room, but typically five to

seven clean cloths

■ Do not place cleaning cloths back into the disinfectant

solution after using to wipe a surface. Change to a

clean cloth instead.

■ Daily cleaning of certain patient equipment is the

responsibility of other healthcare practitioners

(often nursing)

■ Surfaces should be wiped with a clean cloth

soaked in disinfectant

In today’s healthcare arena the environment

cannot be overlooked. Maintaining a clean and

sanitary environment is the responsibility of

everyone who works in every healthcare setting.

Properties of an

Ideal Disinfectant 6

■ Broad-spectrum antimicrobial

■ Fast acting-should produce a rapid kill

■ Not affected by environmental factors-active in

the presence of organic matter

■ Nontoxic-not irritating to user

■ Surface compatibility-should not corrode

instruments and metallic surfaces

■ Residual effect on treated surface-leave an

antimicrobial film on treated surface

■ Easy to use

■ Pleasant odor or odorless

■ Economical-cost should not be prohibitively high

■ Soluble (in water) and stable

(in concentrate and use dilution)

■ Nonflammable

Now that we have reviewed how to clean, let’s

review how to select the ideal disinfectant.

In 1995 Dr. Rutala published a list of properties in an ideal

disinfectant. Listed in the box are the ideal properties from

their collective research. Consideration of this list will help

you as you evaluate your chemical disinfectants.

Innovation in products and processes to help with surface

disinfection are rapidly entering the marketplace. Three which

have emerged to help facilities ensure consistent and effective

cleaning and disinfection are:

1. Ultra violet (UV) light

2. Microfiber products

3. Adenosine triphosphate (ATP) bioluminescence tests


ATP (adenosine triphosphate)

bioluminescence testsThis technology helps to monitor adequacy of surface

cleaning. ATP testing uses a chemical that gives off light

when it reacts with ATP (adenosine triphosphate). A swabbed

sample is placed in the chemical and inserted into the hand

held unit. The light detector determines the amount of ATP

present in the sample. ATP is found in all animal, plant,

bacterial, yeast and mold cells. Blood and bioburden contain

large amounts of ATP. Microbial contamination contains ATP,

but in smaller amounts. If the surface was cleaned adequately,

then ATP levels should be significantly reduced. This new

testing can help managers measure the effectiveness of the

cleaning and disinfection of reusable medical equipment

throughout the healthcare organization.

MicrofiberMicrofiber is a strong, lint-free and ultra fine material

with a dense matrix. These properties make it an idea

cleaning tool. Microfiber cleaning materials are a blend

of microscopic polyester and polyamide fibers. These

fibers form microscopic “hooks” that scrape up and

hold dust, dirt, and grime. They are 1/16 the thickness

of a human hair and can hold six times their weight

in water.8 The positively charged fibers attract the

negatively charged dirt and dust.

Ultra Violet (UV) Light Irradiation 7

(No touch surface disinfection)

UV light irradiation has been used to control pathogenic

microorganisms in a variety of applications, such as

control of legionellosis, as well as disinfection of air,

surfaces, and instruments. UV light at certain wave lengths

will break the molecular bonds in the DNA, there by

destroying the organism. The efficacy of UV irradiation is a

function of several different parameters, such as intensity,

exposure time, lamp placement, and air movement

patterns. This technology supplements but does not

replace standard cleaning and disinfection because

surfaces must be physically cleaned of dirt and debris

References

1. National Institute for Occupational Safety and Health (NIOSH). How to protect yourself from

needlestick injuries. Available at: http://www.cdc.gov/niosh/docs/2000-135. Accessed March 9, 2012.

2. Pyrek KM. Study raises ongoing issue of passive vs. active safety-engineered sharps devices. November 2, 2010.

Available at: http://www.infectioncontroltoday.com/articles/2010/11/study-raises-ongoing-issue-of-passive-vs-active-

safety-engineered-sharps-devices.aspx. Accessed March 9, 2012.

3. American Nurses Association. 2008 Study of Nurses’ Views on Workplace Safety and Needlestick Injuries.

Available at: http://www.inviromedical.com/Portals/1/PDFs/2008_Fast_Facts.pdf (ANA/Invira)

4. Centers for Disease Control and Prevention. Workbook for Designing, implementing, and Evaluating a Sharps Injury

Prevention Program. Available at: http://www.cdc.gov/sharpssafety/tools.html. Accessed March 9, 2012.

5. O’Connor D. The most dangerous job in surgery? Outpatient Surgery Magazine. March 7, 2012.

Available at: http://www.outpatientsurgery.net/news/2012/03/9-The-Most-Dangerous-Job-in-Surgery. Accessed March 9, 2012.

Safety features so you won’t get stuck

A staggering 74 percent of nurses report being

stuck by a contaminated needle,1 which can

lead to infection with Hepatitis B and C, HIV, and

other dangerous bloodborne pathogens. Avoid

needlesticks with Medline Safety Syringes. After

injection, slide the safety shield forward and simply

twist clockwise. Once you hear a click, the needle

is fully protected and the syringe is ready for safe

and proper disposal.

Medline Safety Syringes also feature:

medication waste and expense

©2012 Medline Industries Inc. Medline is a registered trademark of Medline Industries, Inc.

Protect yourself and patients from needlestick injuries

Medline Safety Syringes

American Nurses Association. 2008 Study of Nurses’ Views

on Workplace Safety and Needlestick Injuries. Available at:

http://nursingworld.org/MainMenuCategories/Workplac-

eSafety/SafeNeedles/2008-Study/2008InviroStudy.pdf.

Accessed March 16, 2012.

Injection Safety is Every Provider’s Responsibility

To Prevent Transmission of Infections in Healthcare

1.

Reference


WOOnce

Wolf J. Rinke, PhD, RD, CSP

To me worrying is like backward goal-setting. Because when

you worry you are vividly imagining all of the things you do not

want to have happen! And boy, do we like to worry. According

to one study four out of five Americans said that they worry.

(That’s 80 percent of us doing the backward goal-setting

thing.) The poll, conducted by Barna Research, asked adults

what are “the most pressing challenges and difficulties you

face.” Among those who worried, 28 percent said that they

worried about finances, 19 percent identified health, 16 percent

mentioned career issues, followed by parenting concerns (11

percent), family relationship issues (seven percent) and goal

accomplishment challenges (seven percent).

Research further indicates that women tend to worry more

than men. For example, in a study of 1,044 women in the

U.S. conducted by Bruskin Audits and Surveys Worldwide, 50



RR and for all

percent reported that they experience anxiety symptoms and

worry for a period of more than six months. In addition, one

out of 10 women describes herself as having “unrealistic” or

“excessive worry.”

What makes these findings startling is that most of us appear

to have little to worry about. In fact, 78 percent of the Barna

Research poll’s respondents rated themselves as completely or

mostly satisfied with their lives.

I find our propensity for worrying particularity perplexing, since

only eight percent of our worries are “legitimate”—that is, they

are under our control. The other 92 percent are “worthless

worries” also known as the coulda, shoulda, woulda syndrome.

That’s when you engage in “catastrophizing” convincing

yourself that a stomachache means that you have an ulcer and

an “angry” look by your spouse means that you are about to get

a divorce. Worthless worry is when we try to solve what can’t be


solved because it has already happened, will never happen or is

simply not under our control.

According to psychiatrist Edward M. Hallowell, worry can

depress us, destroy our relationships, and sap our energy and

joy of living. Struggling with perpetual “what if” scenarios can

make us physically sick with back pain, recurring headaches and

digestive disorders. It may even weaken the immune system,

leading Dr. Hallowell to conclude that chronic, persistent worry

is just as dangerous as high blood pressure.

Of course you can do what I do, and reduce this 8-step

“Worry Buster” process down to 2 steps:

Step 1 What will happen if I worry about this really well? If

the answer is “nothing,” quit worrying. If on the other

hand, you can impact the outcome, go to step 2.

Step 2 Do something—anything—now. Then quit worrying!

If you still need more help, here are seven “Action Steps”

that will help you take getting rid of worries to the

next level:

1. Share Your Worry with Others

When worries seems to go out of control, talk them through

with a trusted friend, a mentor or even your pet — hey, at least

your pet won’t talk back. Be sure to reciprocate so that your

worry support team is there for you when you need them.

2. Realize That Certainty is a Myth

Recognize that the only certainty is death. Given that most of

us are not very interested in that option, make a commitment

to get comfortable with uncertainty. Focus your mental energies

on the joy you get from uncertainty and begin to celebrate it as

part of the unique human experience. Just think, how boring life

would be if everything was certain.

3. Make Worrying a “Snap”

If you find that all of the above still don’t work, start wearing a

rubber band on your left wrist. When you find yourself worrying,

snap the rubber band—it’ll remind you, in a somewhat painful

way, to quit worrying. Another technique that seems to work

real well for one of my coachees is that when she gets stuck

in a serious worry phase she records her worries on an old-

fashioned tape recorder. (Yes they are still around.) Then she

takes the tape out of the recorder, goes to her husband’s

workshop, finds a big hammer and smashes the tape -- getting

rid of those worries once and for all. (Hey, tapes are cheaper

than wasting your precious brain power.)

4. Take a Worry Break

Still not working? Set a timer for a specified time—let’s say 10

minutes—and now worry “real good.” Play the “what if” game

to the max. Get it all out of your system. When the 10 minutes

are up, refocus your energy on something that will disconnect

you from your worries.

Step 1 Clarify what it is that you are worried about. The

best way to do this is to write it down, because it

gets it out of your head.

Step 2 Ask yourself if there is anything you can do to

affect the situation. If not, it’s a worthless worry --

skip to Step 8. If you can affect the situation, go

to the next step.

Step 3 Identify the worst possible outcome.

Step 4 Ask yourself if you can live with the worst possible

outcome. If so, go to Step 6. If not, go to the

next step.

Step 5 Do everything in your power to solve the problem

right now.

Step 6 Make an action plan that will solve the problem

entirely or minimize its bad consequences.

Step 7 Take action.

Step 8 Quit worrying. Either it’s too late or worrying won’t

make a bit of difference.

Not to worry --

pun intended -- I

have delineated an

eight-step process

to help you get rid

of worries once

and for all:


5. Disconnect

Disconnect yourself from worrying by doing something that will

totally absorb you. Try jogging, meditation, yoga, tai chi, getting

a massage, playing a game of tennis, deep breathing, taking a

walk, going to the movies--anything that disconnects you from

your worries and allows you to totally relax.

6. Just Let Go

Done it all, and still worrying? Just say no--I mean just let go.

Let go of the feeling that you have to be in control--you are not!

Realize that the harder you try, the less likely that will happen.

Make a commitment to “go with the flow.” Convince yourself by

re-evaluating prior worries; you may find that ultimately things

do tend to work out for the best.

7. Laugh

If all else fails make yourself laugh. Here is a bit of humor to

make that happen:

Why Worry?There only two things to worry about;

either you are well or you are sick.

If you are well, there is nothing to worry about;

If you are sick, there are only two things to worry about;

either you will get well or you will die.

If you get well, there is nothing to worry about.

If you die, there are only two things to worry about;

either you will go to Heaven or you will go to Hell.

If you go to Heaven, there is nothing to worry about.

If you go to Hell, you will be so busy shaking hands

with friends, you will not have time to worry.

© 2012 Wolf J. Rinke

Dr. Wolf J. Rinke, RD, CSP is a keynote speaker, seminar leader,

management consultant, executive coach and editor of the free

electronic newsletter Read and Grow Rich, available at www.

easyCPEcredits.com. In addition he has authored numerous CDs,

DVDs and popular books including Make It a Winning Life: Success

Strategies for Life, Love and Business, Winning Management: 6

Fail-Safe Strategies for Building High-Performance Organizations;

Don’t Oil the Squeaky Wheel and 19 Other Contrarian Ways to

Improve Your Leadership Effectiveness; and Leadership: Helping

Others to Succeed, available at www.WolfRinke.com. His company

also produces a wide variety of quality pre-approved continuing

professional education (CPE) self-study courses, such as Beat the

Blues--How to Manage Stress and Balance Your Life, (28 CPEUs)

from which this article was excerpted. CPE courses are available

in both print and electronic formats at www.easyCPEcredits.com.

Reach him at [email protected].

Done it all, and still worrying? Just say no -- I mean just let go. Let go of the feeling that you have to be in control -- you are not!”“


Celebrate Breast Cancer Awareness Month

Emma and SCIP

Emma


Schedule a mammogram and remind a friend

to do the same.

Join a breast cancer walk in your local area.

Cook pink! (See page 89)

Wear pink gloves and other pink attire.

Sign up for Medline’s Daily Dance inspirational

emails at www.pinkglovedance.com.

Top 5 Breast Cancer Awareness Activities for October

1

2

3

4

5

Breast cancer awareness fashions available at www.scrubs123.com and www.medline.com

Questions? Call 1-800-MEDLINE or contact your Medline representative


2012 Pink Glove Dance IIVideo Competition

Win a Donation to Your Favorite

Breast Cancer Charity*

First Place: $10,000Second Place: $5,000Third Place: $2,000

Deadline for submissions: September 28Winners announced: November 2

Complete contest instructions are availableat www.pinkglovedance.com.

*Subject to review and approval by Medline Industries, Inc.

PGDVoting beginsOctober 12!

Aligning practice with policy to improve patient care 83pinkglovedance.com

Some of last year’s PGD Video contestants!

Gwinnett Medical Center, Duluth, GA

Lexington Medical Center, West Columbia, SC

� Highland Hospital, Rochester, NY

San Juan Medical Foundation, Farmington, NM

Victoria Hospital, Prince Albert, SK, Canada

Pink Glove Dance COMPETITION


I am very honored that Medline

and Providence St. Vincent Hospital

used my song “Down” to promote and

support Breast Cancer Awareness.

Jay Sean

BY JAYAA SEAN

F ME”

“EVAV CUATAA E THE DANCE FLOOR”

“

BY KAK TAA Y PERRY

BY CASCADA

YY

VIDEO


This year, the competition will embrace old favorites like “Down” by Jay Sean (the song in the

original Pink Glove Dance) and “You Won’t Dance Alone” by The Best Day Ever (the song in

Pink Glove Dance: The Sequel). New tunes include “Part of Me” by Katy Perry, “Evacuate the

Dance Floor” by Cascada, “This One’s for the Girls” by Martina McBride, and “Let Yourself Go”

by Emily, a local artist. Medline is grateful to these artists with heart who are supporting the

cause and providing great dance beats.

The thanks are going both ways. “It’s very cool,” said Tonya Puerto, of Capitol Records, who

is excited about Katy Perry’s music being used for the second year in a row.

Singer Jay Sean said, “I am very honored that Medline and Providence St. Vincent Hospital

used my song “Down” to promote and support Breast Cancer Awareness. I like that such a

fun and light hearted approach was taken to create awareness for a serious disease that can

be cured if caught early. The positive response and reaction that the ‘Pink Gloves’ video has

received has been incredible, and coming from a medical background myself, I hope that we

are able to keep a spotlight on this illness until we reach a cure!”

2012!The 2012 Pink Glove Dance Video Competition is

in full swing, and there’s still time to enter by

the September 28 deadline. Choose from new

songs, new artists and new social media that we

hope will bring the competition to the next level.

BBY THE BEST DAYAA EVER

BY MARTRR INA MMCBRIDE


86 The OR Connection Connection

Emily Rosenberg, of Highland Park, Ill. and a sophomore at

Berklee College of Music in Boston, donated the rights to

use her song the Pink Glove Dance. When asked why, she

responded, “I’m so thrilled to be involved in the Pink Glove

Dance. These videos bring such joy and laughter to the people

who deserve it most. Breast cancer affects so many people —

both the patients and their loved ones. The more awareness

we can raise the better, and we might as well do it in such a

fun way! I’m ecstatic that my music will be used for something

that makes people so happy. That’s the goal of making music:

to improve lives. That’s the dream, and I’m so grateful that the

Pink Glove Dance is helping make it come true.”

Lexington Medical Center, the facility that won the 2011 Pink

Glove Dance Competition, loved dancing pink last year. “The

Pink Glove Dance was a wonderful experience for Lexington

Medical Center,” said Jennifer Wilson, Lexington Medical

Center public relations manager. “We are so grateful to the

people from around our community, country and the world

who viewed our Pink Glove Dance video and voted for us. To

date, our video has received more than 150,000 You Tube

views. The Pink Glove Dance competition was a great way

for Lexington Medical Center to show the world our hospital

and our steadfast commitment to the treatment of breast

cancer, a disease that affects 1 in 8 women in her lifetime.”

The Pink Glove Dance competition was a

great way for Lexington Medical Center to

show the world our hospital and our steadfast

commitment to the treatment of breast cancer.Lexington Medical Center 2011 First Place Pink Glove Dance Winners

87

What started as a crazy fun way to raise awareness about

early detection of breast cancer has become an international

dancing phenomenon, including 21,000 total Pink Glove

Dancers, 13,608,658 (and counting!) views of the original

Pink Glove Dance, and more than one million page views of

www.pinkglovedance.com.

To get the message out there as much as possible, Pink Glove

Dance this year has enhanced its presence on the web through

new social media including Facebook, Twitter, Pinterest, Tumblr

and Flickr. These social media sites are more important than

ever, and not only get the Pink Glove Dance out there, but are a

great resource for competition participants to spread the word

as well.

Medline hopes to keep spreading smiles and awareness by

promoting the Pink Glove Dance as much as possible. Medline

corporate headquarters hosted a Pink Glove Day this year on

Update your family and friends on your project. Your loved ones will love supporting you!

Contact local media (newspaper, tv and radio) and ask for help promoting the campaign.

Create an account on one or more social media sites such as Facebook® or Twitter®. Be sure to “like”

Medline Breast Cancer Awareness on Facebook and “follow” @pinkglovedance on Twitter. Connect

with your friends and remind them to vote.

Email everyone you know with a description of how to vote, and a link to www.pinkglovedance.com.

Get creative to spread the word—our favorite videos featured people dancing their heart out. Host a

bake sale, make flyers, paint your nails pink. Anything and everything you do makes a difference, and

we thank you in advance for your participation!

the launch date of the competition, when Medline employees

enthusiastically donned their best pink clothes, sipped pink

lemonade and tweeted pink to get the word out.

How did last year’s winner do it? Wilson reflected, “Lexington

Medical Center believes that one of the elements that made our

video a winner was the fact that it showcased hundreds of our

employees, emphasizing the commitment of a large number of

people to battling breast cancer. Importantly, the video also used

the lyrics from the Katy Perry song Firework to help tell a story.”

The Pink Glove Dance reflects Medline’s commitment to saving

lives through raising awareness and funds for early detection

of breast cancer. Medline has donated more than $1 million

to date to the National Breast Cancer Foundation to fund free

mammograms from the proceeds of pink gloves and other

Generation Pink™ products.

Aligning practice with policy to improve patient care

Yes, They’re Genuine.

Only Medline’s Pink Pearl™ gloves combine aloe, nitrile and breast cancer awareness.

©2012 Medline Industries, Inc.

Medline is a registered trademark

and Pink Pearl is a trademark of

Medline Industries, Inc.

Scan this QR Code or visit http://pinkglovedance.com/

LEARN MORE ABOUT THE PINK GLOVE DANCE

AND SUPPORT BREAST CANCER AWARENESS

C O O K I N G

PinkThe foods you choose every day are one of the most important

factors in protecting you against cancer. Most Americans eat

a diet that is far too high in meat and calories. Even more

important is what the average diet lacks: a variety of vegetables,

fruits, beans and other plant-based foods.

Plant-based foods give your body not only the nutrients it needs

for good health, but an arsenal of compounds (phytochemicals)

that help protect against naturally-occurring cancer risks you

face every day.

Healthy Pink Foods

� Beets � Cherries � Strawberries

� Raspberries � Red peppers � Pink grapefruit

� Cranberries � Watermelon � Red potatoes

� Salmon � Shrimp � Red beans

BREAST CANCER AWARENESS



What’s in it for you?

��

Ingredients

Canola oil spray 3 Tbsp. canola oil

2 eggs

1/2 cup sugar 1 tsp. vanilla

1/3 cup unsweetened applesauce

1 cup fresh blueberries 1 cup chopped fresh strawberries 1 cup whole-wheat flour

2 tsp. baking powder 1/4 tsp. salt

1 cup unbleached all-purpose flour

1/2 cup fat-free milk

Directions: Preheat oven to 375 degrees. Spray 12-cup muffin tin with canola oil and set aside.

In medium bowl, whisk together oil, applesauce, sugar and eggs. Add vanilla, blueberries and

strawberries. In separate bowl, blend together flours, baking powder and salt. Fold in half flour

mixture, then half milk. Add remaining flour and milk, folding in just until blended. Scoop batter

into prepared tins. Bake 25-30 minutes or until golden brown and inserted toothpick comes out dry.

Allow muffins to cool for 20 minutes before removing from pan.

Nutrition Information: Per serving (1 muffin), Calories: 165, Fat: 5 grams, Carbohydrates: 25 grams, Protein:

4 grams, Fiber: 2 grams, Sodium: 133 mg

Blueberries are high in soluble fiber. They are an excellent

source of vitamins C and K—all for about 80 calories per cup. In

addition, blueberries contain a family of plant compounds called

anthocyanides, which are among the most potent antioxidants and

may play a role in reducing risk of chronic diseases such as cancer.


Strawberries provide a hearty dose of vitamin C, and

their vibrant color is a sign that they are rich in cancer-

fighting phytochemicals. In addition, strawberries are a

source of ellagic acid, which has shown promising anti-

cancer properties in laboratory studies.

��

��!��"��#��$��%��&��'��%��(��

Delicious food. Healthy food. They’re one in the same—especially when

the recipes are developed by the American Institute for Cancer Research

(AICR) cookbook team. AICR is proud to announce the publication of its

treasure-trove of 200 recipes, which ravish the palate while helping you

manage your weight and reduce the risk of disease. Available at amazon.

com and Barnes & Noble.

Source: American Institute for Cancer Research

http://www.aicr.org/how-you-can-help/get-involved/pink-on-purpose/pop_pink_recipes.html


Myth #3Having a family history of breast

cancer means you will get it.

FactWhile women who have a family history of breast cancer

are in a higher risk group, most women who have breast

cancer have no family history. If you have a mother,

daughter, sister, or grandmother who had breast cancer,

you should have a mammogram five years before the age

of their diagnosis, or starting at age 35.

Myth #2A mammogram can cause

breast cancer to spread.

FactQuite the contrary. Each year it is estimated that

approximately 1,700 men will be diagnosed with breast

cancer and 450 will die. While this percentage is still

small, men should also give themselves regular breast

self-exams and note any changes to their physicians.

Myth #1Men do not get breast cancer.

FactQuite the contrary. Each year it is estimated that

approximately 1,700 men will be diagnosed with breast

cancer and 450 will die. While this percentage is still

small, men should also give themselves regular breast

self-exams and note any changes to their physicians.

BREAST CANCERMythsDon’t let yourself

be a victim of

misinformation

and myths

generated by fear.

Myth #4Finding a lump in your breast

means you have breast cancer.

FactIf you discover a persistent lump in your breast or any

changes in breast tissue, it is very important that you

see a physician immediately. However, 8 out of 10

breast lumps are benign, or not cancerous. Sometimes

women stay away from medical care because they

fear what they might find. Take charge of your health

by performing routine breast self-exams, establishing

ongoing communication with your doctor, and

scheduling regular mammograms.

Myth #5Breast cancer is contagious.

FactYou cannot catch breast cancer or transfer it to some-

one else’s body. Breast cancer is the result of uncon-

trolled cell growth in your own body. However, you can

protect yourself by being aware of the risk factors and

following an early detection plan.

Myth #7Knowing you have changes in the

BRCA1 or BRCA2 gene can help

you prevent breast cancer.

FactWhile alterations in these genes in men and

women can predispose an individual to an

increased risk of breast cancer, only five to 10

percent of patients actually have this mutation.

This is not an absolute correlation. Like your

age or having a family history of breast cancer,

it’s a factor you just can’t control. But you can

let your physician know, perform regular breast

self-exams, and focus on the fact your chances

of not having this disease are greater than

90 percent.

Myth #6Antiperspirants and deodorants cause

breast cancer.

FactResearchers at the National Cancer Institute (NCI) are

not aware of any conclusive evidence linking the use

of underarm antiperspirants or deodorants and the

subsequent development of breast cancer. For more

information, visit http://www.cancer.gov/cancertopics/

factsheet/Risk/AP-Deo.

Source: National Breast Cancer Foundation. Arm yourself

with knowledge. http://www.nationalbreastcancer.org/

About-Breast-Cancer/Myths.aspx.

Remember...

Get your mammogram.

Visit medline.com

Pink merchandise from Medline

helps support the National Breast

Cancer Foundation.


A high rate of HH failure was observed among anesthesia provid-

ers. The operating room environment is an epicenter of infectious

disease organisms where a large number of patients have active

infectious disease and many who are immunocompromised.

Patients and providers have the opportunity to come into contact

with one another with multiple, ongoing opportunities for both

vertical and horizontal transmission of organisms in such an

environment.

The insular nature of anesthesia care is such that a provider works

without much observation from others because of their generally

being at the patient’s head with surgical drapes obscuring view of

them. This is unlike the surgeon, technicians, and nurses, who are

within view of each other and who subscribe to an intense level of

institutional and peer pressure, as well as tradition in achieving a

powerful culture of asepsis. Furthermore, providing surgical anes-

thesia care can be very challenging because of the high intensity

of psychomotor task density that must be accomplished, often

in a very compressed period of time. The current study revealed

a high rate of HH opportunities that averaged 34 to 41 times per

hour over the phase of care and, in some cases, approached 54

opportunities per hour. Audits performed in the intensive care unit

have found that HH is indicated at an average rate of about 20

times per hour.12 Performing adequate HH in such a setting can

prove daunting if not impossible given the intensity and nature of

the provider-to-patient interactions.

Although health care providers are often primarily concerned

about the transmission of microbes from one patient to anoth-

er, or from patient to provider, it is important to recognize that

patients must be protected both from their own flora as well as

flora from their providers. To illustrate this, consider that Staphy-

lococcus aureus is the most common cause of a surgical site

infection.13 Now consider that one-fifth of health care providers

are persistent carriers of S. aureus in our nares, and fully 30% of

us are intermittent carriers.14 Biofilms are ubiquitous throughout

the hospital; are within and on our bodies; and, because of the

constant shedding of organisms from biofilms, we are constantly

inoculating everything we come into contact with, inclusive of our

patients.15,16 HH is vital to breaking the vector chain.

The intent of the current study was not to seek relationship

between anesthesia provider HH behavior and subsequent

patient outcome as has been done in 2 previous studies, although

both employed methodology where any noted “causal link” could

be readily challenged.9,10 Rather, the goals were (1) quantify the

HH behaviors of a range of anesthesia providers during the real-

time care of patients and (2) determine the rate of indicated HH

for these providers over the continuum of perioperative care. With

respect to the first goal, a very low rate of HH success was

observed with an aggregate failure rate of 82%. With respect to

the second goal, there was a very high rate of HH opportunities

that averaged 34 to 41 times per hour.

The resultant taxonomy of failures (Table 1) may provide organi-

zations with the ability to strategically target educational, facility,

and technologic interventions that are designed to improve HH

in the setting of the anesthesia work station and operating room.

The culture of the anesthesia workstation needs a wake-up call,

having been largely, until recently, outside the intense scrutiny

experienced by other domains in the hospital setting. A recent

editorial17 in a prominent international anesthesia journal ends with

the asking of relevant questions, including the following:

complexities in keeping them germ free?

pathogens wear special masks?

permitted to render care?

equipment including computer keyboards?

iPods, and others) to enter the workstation?

It may be that, given the intense culture of asepsis by the OR

team (surgeon, scrub, circulators, and others) yet the persistence

of a disturbing rate of surgical site infections of at least 5%

despite nearly mandated use of preincisional antibiotics,18 then

perhaps our focused attention should be directed at patient and

anesthesia provider factors. Even the ubiquitous use of stop-

82% Results showed an 82% hand hygiene failure rate among

a range of anesthesia providers

Continued from page 54


cocks in facilitating the IV administration of perioperative drugs

is hampered by difficulties in maintaining good aseptic technique

because of their cumbersome design (Fig 1). Stopcock contami-

nation is extraordinarily common with any associated poor HH

providing direct IV entry of pathogenic material into the

patient.9,10,17 Overall, the HH and aseptic practices of anesthe-

sia providers, revealed in this study, were poor. Whereas criticism

might be directed that this study holds anesthesia providers to

an impossibly high standard, it might also be viewed as a further

opportunity to generate a much needed dialogue on the issue

and to promote novel educational and interventional strategies to

improve practice. Given the demands of anesthesia care and the

high rate of HH opportunities, aggressive strategies for achieving

improved rates of HH should be pursued.

In his day, Dr Ignaz Semmelweis was scorned and literally driven

from practice for his zealotry in urging health care providers to

engage in HH. Semmelweis would likely be greatly disturbed at

the current state of affairs of HH in the US health care institutions.

The current study’s findings further fuel this view. Signage,

immediate availability of gloves, access to HH foam/gel dis-

pensers, aggressive education of providers at grand rounds,

journal clubs, and staff meetings have been instituted in an effort

to improve HH among anesthesia providers. A follow-up study

is planned in this calendar year, using a similar methodology to

determine the efficacy of our multidimensional interventional pro-

gram in improving HH among anesthesia providers.

Address correspondence to Chuck Biddle, CRNA, PhD, Box 980226, Virginia

Commonwealth University Medical Center, Richmond, VA 23298-0226. E-mail address:

[email protected] (C. Biddle).

References

1. Trampuz A, Widmer AF. Hand hygiene: a frequently missed lifesaving oppor¬tunity during

patient care. Mayo Clin Proc 2004;79:109-16.

2. Stone PW, Larson E, Kawar LN. A systematic audit of economic evidence lining

nosocomial infections and infection control interventions: 1900-2000. Am J Infect Control

2002;30:145-52.

3. Lee C. Studies: hospitals could do more to avoid infections. The Washington Post.

November 21, 2006. Section 1; p. A-3.

4. Jarvis W. The United States approach to strategies in the battle against

healthcare-associated infections, 2006: transitioning from benchmarking to zero

tolerance and clinician accountability. J Hosp Infect 2006;65:3-9.

5. Cantrell D, Shamriz O, Cohen MJ, Stern Z, Block C, Brezis M, et al. Hand hygiene

compliance by physicians: Marked heterogeneity due to local culture? Am J Infect Control

2009;27:301-5.

6. Wachter RM, Pronovost PJ. Balancing “no blame” with accountability in patient safety.

N Engl J Med 2009;361:1401-6.

7. Muller MP, Detsky AS. Public reporting of hospital hand hygiene compliance: helpful or

harmful? JAMA 2010;304:1116-7.

8. Klevens RM, Edwards JR, Richards CL Jr, Horan T, Gaynes R, Pollock D, et al.

Estimating health care associated infections and deaths in US hospitals, 2002. Public

Health Rep 2007;122:160-6.

9. Loftus RW, Koff MD, Burchman CC, Schwartzman J, Thorum V, Read M, et al.

Transmission of pathogenic bacterial organisms in the anesthesia work area.

Anesthesiology 2008;109:399-407.

10. Koff MD, Loftus RW, Burchman CC, Schwartzman J, Thorum V, Henry E, et al.

Reductin in intraoperative bacterial contamination of peripheral intravenous tubing

through the use of a novel device. Anesthesiology 2009;110:978-85.

11. Biddle C. Semmelweiss revisited: hand hygiene and nosocomial disease transmission

in the anesthesia workstation. AANA J 2009;77:229-37.

12. Boyce JM, Pitter D. Guideline for hand hygiene in healthcare settings: recommendations

of the Healthcare Infection Control Practices Advisory Committee and the HIPAC/SHEA/

APIC/IDSA Hand Hygiene Task Force. Am J Infect Control 2002;30:S1-46.

13. Kaye KS, Anderson DJ, Sloane R, Chen L, Choi Y, Link K, et al. The effect of surgical

site infection on older operative patients. J Am Geriatr Soc 2009;57: 46-54.

14. van Belkum A, Melles DC, Nouwen J, van Leewen W, van Wamel W, Vos M, et al.

Co-evolutinary aspects of human colonization and infection by Staphylococcus aureus.

Infect Genet Evol 2009;9:32-47.

15. Sheretz RJ, Bassetti S, Bassetti-Wyss B. “Cloud” health care workers. Emerg Infect

Dis 2001;7:241-4.

16. Edmiston CE, Seabrook GR, Cambria RA, Brown K, Lewis B, Sommers J, et al.

Molecular epidemiology of microbial contamination in the operating room: is there a risk

for infection. Surgery 2005;138:573-82.

17. Roy RC, Brull SJ, Eichhorn JH. Surgical site infections and the anesthesia

professionals’ microbiome: We’ve all been slimed! Now what are we going to do about it.

Anesth Analg 2011;112:4-7.

18. Neumayer L, Hosokawa P, Itani K, El-Tamer M, Henderson WG, Khuri SF. Multivariable

predictors of postoperative surgical site infection after general and vascular surgery:

results from the patient safety in surgery study. J Am Coll Surg 2007;204:1178-87.

American Journal of Infection Control. Published online 13 February 2012.

Copyright ©2012 by the Association for Professionals in Infection Control and Epidemiology,

Inc. Published by Elsevier Inc. All rights reserved. Reprinted with permission.

5% Given the intense culture of asepsis by the OR team (surgeon, scrub, circulators,

and others) yet the persistence of a disturbing rate of surgical site infections of at

least 5% ... then perhaps our focused attention should be directed at patient and

anesthesia provider factors.


Promote Correct-Site Surgery

Our Surgical Time Out Procedure (S.T.O.P.™)

safety products alert the surgical team to

perform a time-out verification and help reduce

the risk of wrong-site surgery.

Support Sharps Safety Practices

Transfer trays, scalpel holders and needle

counters with blade guards promote sharps

safety and help make you OSHA compliant.1

Improve Fluid Disposal Safety

The Safety-Splash™ fluid management system

converts biohazardous fluids into a solid,

minimizing the risk of exposure.


Safety-Splash and S.T.O.P are trademarks of Medline Industries, Inc.

References: 1. Occupational Safety and Health Standards, Toxic and Hazardous Substances,

Bloodborne pathogens. Regulations (Standards - 29 CFR). Available at: http://

www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_

id=10051#1910.1030(d)(2)(i). Accessed October 13, 2010.

Medline’s Gold Standard safety products stand out against the

sea of blue in the OR to alert the surgical team to focus on safety.

MEDLINE GOLD STANDARD SAFETY COMPONENTS

SAFETY

DESERVES

ATTENTION

Download a QR Code Reader app

Launch the QR app

Scan this QR Code or visit http://

www.medline.com/programs/gold-standard-

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GOLD STANDARD SAFETY PRODUCTS


Healthy Eating

Ingredients

1 pkg broccoli cole slaw

1 6-oz pkg slivered almonds

1 7.25-oz jar sunflower seeds

4 green onions, thinly sliced

1 pkg chicken-flavored ramen noodles, crushed

Crush the uncooked ramen noodles and toss all the ingredients

together. Add dressing and toss immediately before serving for

a great crunchy texture. The next day it’s still very good, but the

ramen will have lost its crunch.

Broccoli is a nutrition star. Its resumé of vitamins and miner-

als includes beta carotene, vitamin C, calcium, fiber, and phyto-

chemicals, specifically indoles and aromatic isothiocynates. Some

suggest broccoli other cruciferous vegetables may be responsible

for boosting certain enzymes that help to detoxify the body, even

helping to prevent cancer, diabetes, heart disease, osteoporosis

and high blood pressure.

Ready-to-use broccoli slaw is available in most grocery stores’

packaged salad aisle. It’s long shreds of broccoli stems (and

sometimes some other veggies, too) that you can substitute for

the shredded cabbage in traditional cole slaw, or as the main

ingredient in this delicious salad.

Lillian Stafford’s Oriental Broccoli

Nutrition

Information

Servings: 6

Calories: 391

Fat: 35.8

Sodium: 156mg

Fiber: 3.2g

The Medline employee cookbook

is $10. To purchase your own

copy, please e-mail Judy at

[email protected].

2

Dressing

½ C canola oil (light virgin olive oil works, too)

3 T vinegar

1 T soy sauce

3 T sugar

1 chicken flavor packet (from the ramen noodles)

Whisk or shake to thoroughly mix the ingredients together. Set

aside until ready to serve the salad.

Diane Seminary is a 15-year Medline veteran who works closely

with the manufacturing team in Medcrest. Born here, her family

is originally from Quebec, which she still visits every summer. The

salad’s namesake is the daughter of Bill Stafford from Medline

warehouse B02, who introduced it to Diane’s family. “This salad

is light and carries well for any picnic adventure.” Enjoy.

Forms & Tools


Sharps Safety

Now You See It, Now You Don’t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101

Sharps Safety Begins with You . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107

Malignant Hyperthermia

Emergency Therapy for Malignant Hyperthermia . . . . . . . . . . . . . . . . . 102

Malignant Hyperthermia Drill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103

Hand Hygiene

Your 5 Moments for Hand Hygiene . . . . . . . . . . . . . . . . . . . . . . . . . . . 104

Preventing SSIs

Caring for Your Surgical Incision at Home . . . . . . . . . . . . . . . . . . . . . . 105

are more absorbent than traditional blue towels.

towels could save up to one half ton of dye, bleach and other chemicals

from polluting the environment every year.

eco-friendly, water-resistant coating.

TM has all the features and protection you expect.

It breaks down in landfills in two to five months.

A LITTLE CHANGE

A LOT OF DIFFERENCE

The greensmart™ collection of OR products helps

reduce your impact on the environment.

©2011 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc. greensmart and EcoDrape are trademarks of Medline Industries, Inc.

Medline natural OR towels

Scan this QR Code or visithttp://www.medline.com/greensmart/

LEARN MORE ABOUT MEDLINE’S

GREENSMART OR PRODUCTS

greensmart™ is not a third-party certification. The use of the greensmart™ trade-

mark is determined by Medline Industries, Inc. through an internal review process


NOW YOU DON’T.

NOW YOU SEE IT.

DISCLAIMER: Mention or depiction of any company or product does not constitute endorsement by CDC.

BE PREPARED. Anticipate injury risks and prepare the patient and work area with prevention in mind. Use a sharps device withsafety features whenever it is available.

BE AWARE. Learn how to use the safety features on sharps devices.

DISPOSE WITH CARE. Engage safety features immediately after use anddispose in sharps safety containers.

PROTECT YOURSELF AND OTHERS- USE SHARPS WITH SAFETY FEATURES

Support for printing this poster came from an unrestricted educational grant provided by Safety Institute, Premier, Inc.




EMERGENCY THERAPY FOR

MALIGNANT HYPERTHERMIA

MH Hotline

1-800-644-9737

Outside the US:

1-315-464-7079

DIAGNOSIS vs. ASSOCIATED PROBLEMS

ACUTE PHASE TREATMENT

POST ACUTE PHASE

Signs of MH: Increasing ETCO2

Sudden/Unexpected Cardiac

Arrest in Young Patients:

Trismus or Masseter Spasm with Succinylcholine

Hyperkalemia

pediatric,

adult,

Follow ETCO27

6

Bicarbonate for metabolic acidosis

Cool

Dysrhythmias

except calcium

channel blockers, which may cause

hyperkalemia or cardiac arrest in the

presence of dantrolene.

3

4

5

GET HELP. GET DANTROLENE – Notify Surgeon

2

Dantrolene 2.5 mg/kg rapidly IV through large-bore IV, if possible

1

2

CAUTION: This protocol may not apply to all patients; alter for specific needs.

A D

E

B

C

Non-Emergency Information

MHAUS

Phone

Fax

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Website

ORPO 5/08/5K Produced by the Malignant Hyperthermia Association of the United States (MHAUS). MHAUS is a non-profit organization under IRS-Code 501(c)3. It operates solely on contributed funds. All contributions are tax deductible. For more information, go to www.mhaus.org.

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Forms & Tools Malignant Hyperthermia


Drill Element Met Not Met Notes

Staff member was able to call MH drill appropriately ( called

operator from location and indicated Malignant Hyperthermia

alert and location

Hospital Operator appropriately called MH event overhead

All members of MH team presented to Drill �

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Hyperthermia Drill Forms & Tools

Emergency Department

Observers


Forms & Tools Hand Hygiene

Your 5 Moments for Hand Hygiene

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WHEN? Clean your hands before touching a patient when approaching him/her.

WHY? To protect the patient against harmful germs carried on your hands.

WHEN? Clean your hands immediately before performing a clean/aseptic procedure.

WHY? To protect the patient against harmful germs, including the patient's own, from entering his/her body.

WHEN? Clean your hands immediately after an exposure risk to body fluids (and after glove removal).

WHY? To protect yourself and the health-care environment from harmful patient germs.

WHEN? Clean your hands after touching a patient and her/his immediate surroundings, when leaving the patient’s side.


WHEN? Clean your hands after touching any object or furniture in the patient’s immediate surroundings, when leaving – even if the patient has not been touched.


BEFORE TOUCHINGA PATIENT

BEFORE CLEAN/ASEPTIC PROCEDURE

AFTER BODY FLUIDEXPOSURE RISK

AFTER TOUCHINGA PATIENT

AFTERTOUCHING PATIENTSURROUNDINGS

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BEFORETOUCHINGA PATIENT 4 AFTER

TOUCHINGA PATIENT

5 AFTERTOUCHING PATIENTSURROUNDINGS

BEFORE

CLEAN/ASEPTIC

PROCEDURE

RISK

FLUID EXPOSUREAFTER BODY

All reasonable precautions have been taken by the World Health Organization to verify the information contained in this document. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.

WHO acknowledges the Hôpitaux Universitaires de Genève (HUG), in particular the members of the Infection Control Programme, for their active participation in developing this material.

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CoverThis fun group of perioperative nurses from the University Medical Center of Princeton at Plainsboro, in Plainsboro, NJ, took first place in Medline’s Pink Glove Dance Photo Contest at the 2012 AORN Conference in March. From left to right, Lori Mozenter, BSN, CNOR, RNFA, Staff Nurse; Mary Zegarski, RN, CNOR, Staff Nurse and Vice President of AORN Chapter 3109; Fe Moreo BSN,CNOR, Staff Nurse and Patricia Lum, RN, BSHA, CNOR, CMLSO, Perioperative Educator/Interim OR Manager.



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Patient Handout Forms & Tools

Caring for Your Surgical Incision at Home

The following are general guidelines. Consult your surgical team for more specific instructions.

Bathing and Showering

Most incisions should be kept dry for several days after surgery, except for incisions closed with surgical glue.

It is usually safe to allow glued incisions to get wet while showering or bathing. It is important, however, to dry

the area around the incision carefully after washing.

Physical Activity and Exercise

Avoid any activity that pulls on the edges of the incision or puts pressure on it. Walking and other light activities

are encouraged to restore normal energy levels and digestive functions. Do not, however, participate in sports,

engage in sexual activity or lift heavy objects until after your postoperative checkup.

Aspirin

Avoid aspirin or over-the-counter medications containing aspirin for a week to 10 days after surgery. Aspirin

interferes with blood clotting and makes it easier for bruises to form near the incision.

Sun Exposure

As an incision heals, the new skin that forms over the cut is very sensitive to sunlight and

will burn more easily than normal skin and lead to worse scarring. Keep the incision area

covered from direct sun exposure for three to nine months in order to prevent burning and

severe scarring.

General Hygiene

Infection is the most common complication of surgical procedures. It is important, therefore, to minimize

the risk of an infection when caring for your incision at home.

Observe the following precautions:

with you

contagious illness

Adapted from www.surgeryencyclopedia.com/Fi-La/Incision-Care.html


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OR Connection Volume 7 Issue 2