Nov 3, 2017

4 Quick Questions on Cleaning Verification Monitoring with ATP

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Clean Trace

Q: We just started using ATP in endoscope reprocessing. Is it normal to see a number of failures when using ATP?

A: It is not unusual to see failing results when beginning a cleaning monitoring program with any type of cleaning indicator. A failing ATP result is signaling where to focus additional efforts to achieve effective cleaning practices. Initially every endoscope should be tested multiple times to achieve a baseline assessment of the effectiveness of the current cleaning process, followed by taking steps to improve the process and decrease failure rates.

Q: Some of our endoscopes always pass the ATP test, but others don’t. What’s happening?

A: It is somewhat typical to discover that a particular endoscope type has higher average ATP values. Upper GI flexible endoscopes (e.g., gastroscopes and duodenoscopes) have been shown in clinical studies to be more contaminated than lower GI flexible endoscopes1,2 (e.g., colonoscopes). Upper GI endoscopes are also more difficult to clean.

Another common finding is that specific scopes (i.e., a particular serial no.) routinely result in higher ATP values after cleaning. When multiple rounds of manual cleaning are required to obtain a passing ATP result, this can be a sign that this particular scope may be damaged and need servicing. ATP is an effective means to help identify endoscopes nearing “end of life” or needing repair.

Q: How are the Pass/Fail numbers determined?

A: The pass/fail thresholds for ATP testing are not arbitrary. They are based on validation with results provided in published clinical studies3,4.

Q: We do a manual clean then process in the AER. We were told to do our ATP check before AER processing. Wouldn’t that provide a false record of how clean our scopes are since they haven’t been through AER yet?

A: Clean and disinfected/sterilized are not the same thing. ATP is a cleaning verification method, used to verify that the cleaning process was effective for removal of clinical soil and that the appropriate level of cleanliness was achieved prior to sterilization or disinfection. ATP testing is not an appropriate tool for measuring disinfection or sterilization, and therefore should not be used to measure the success of the high-level disinfection (HLD) process. Ensuring that an endoscope is clean enough prior to HLD is critical – after all, HLD can’t be effective if the endoscope isn’t clean going in.

Have more questions? 3M is happy to answer any further questions about ATP cleaning verification monitoring – you can contact your local representative, call the 3M Health Care Helpline 1-800-228-3957 or visit go.3M.com/cleantrace.

References:

  1. Ofstead CL, et al. Assessing residual contamination and damage inside flexible endoscopes over time. 2016. Am J of Infect Control. 44: 1675-7.
  2. Ofstead CL, et al. Longitudinal assessment of reprocessing effectiveness for colonoscopes and gastroscopes. 2017. Am J of Infect Control. 45: e26-e33.
  3. Alfa MJ, Fatima I, Olson N. Validation of adenosine triphosphate to audit manual cleaning of flexible endoscope channels. 2013. Am J Infect Control. 41: 245-8.
  4. Alfa MH, Fatima I, Olson N. The adenosine triphosphate test is a rapid and reliable audit tool to assess manual cleaning adequacy of flexible endoscope channels. 2013. Am J Infect Control. 41: 249-53.
Oct 25, 2017

Are you ready for the ASC-13 normothermia measure?

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In an effort to create a health care system that results in better care, smarter spending, and healthier people, the Centers for Medicare & Medicaid Services (CMS) implemented the Ambulatory Surgical Center Quality Reporting (ASCQR) Program in 2012. The ASCQR Program is a pay-for-reporting, quality data program requiring ambulatory surgery centers report on specific quality metrics in return for a full annual update to their annual payment rate.1

Earlier this year, CMS announced new measures will be added to the ASCQR payment determinations in 2020. ASC-13: Normothermia Outcome is one of the new measures and will require data to be submitted directly to CMS via the www.QualityNet.org website. Data collection begins on Jan. 1, 2018. Reporting will be required in 2019 impacting payment determination for 2020.1

ASC-13 timeline

ASC-13: Normothermia Outcome

ASC-13: Normothermia Outcome assesses the percentage of patients having surgical procedures under general or neuraxial anesthesia of 60 minutes or more in duration who are normothermic within 15 minutes of arrival in the post-anesthesia care unit (PACU).1 Data reporting is required for all patients that meet the measure criteria, as defined below.

ASC-13 definition

A reasonable goal for this measure is a normothermia rate in the 95%-100% range.2

Develop Your Warming Strategy

With data collection starting in a matter of months, how do you prepare for the ASC-13 measure? Consider the following as you develop a patient warming strategy.

Conduct a temperature review. Determine how many of your patients currently are normothermic upon arrival at PACU. How you choose to measure and monitor patient temperature is an important consideration. Obtaining an accurate and reliable core body temperature reading becomes vital when determining the success of your warming protocol. 3M can help you take this key first step with a temperature review.

Determine a process for accurately documenting patient temperatures. A simple temperature tracking form can encourage data recording habits consistent with the measure. CMS offers a form template on its website.

Actively prewarm patients. One of the greatest contributors to surgical hypothermia is the physiological effects of anesthesia itself, which disrupts the body’s ability to regulate temperature.3 Prewarming, or increasing the total heat content of the periphery before surgery, can help offset the significant drop in temperature brought on by anesthesia induction, essentially stopping hypothermia before it might otherwise begin.4 Multiple clinical guidelines now recommend the use of prewarming to maintain normothermia.5-9

Expand the use of intraoperative warming. Selecting a warming system that can cover your entire range of needs while effectively serving your most difficult-to-warm patients can help your facility successfully meet the ASC-13 normothermia outcomes measure. The 3M™ Bair Hugger™ normothermia system’s expansive portfolio of products is cost-effective and designed to optimize clinical performance and ease of use.

Look to effective, proven normothermia solutions. Unintended perioperative hypothermia is a frequent, yet preventable, complication of surgery. It can increase the rate of wound infection (SSI)10-12, extend recovery time13, extend length of stay10 and increase mortality rates.14 The Bair Hugger system is the most clinically researched and proven portfolio of warming solutions on the market today, offering a wide range of patient warming products to help maintain normothermia throughout the surgical journey.

As the leaders in forced-air warming, 3M can help you meet your ASC-13 warming goals. We will work with you to understand your warming needs, identify your clinical challenges and evaluate your practice requirements so we can recommend proven, cost-effective solutions.

Visit go.3m.com/ASC to learn how we can help your ASC prepare for the new normothermia quality measure and your overall quality improvement program for SSI prevention.

References:

  1. CY 2017 OPPS/ASC. 81 FR 79562. CMS-1656-FC.
  2. ASC Quality Measures Implementation Guide. Version 3.1. ASC Quality Collaboration, ascquality.org.
  3. Sessler, DI. Current Concepts: Mild Perioperative Hypothermia. N Engl J Med, 336(24): 1730-1737; 1997.
  4. Sessler DI, Schroeder M, Merrifi eld B, Matsukawa T, Cheng C. Optimal Duration and Temperature of Prewarming. Anesthesiology. Mar 1995:82(3)674-681.
  5. Nelson G, Altman AD, et al. Guidelines for pre- and intra-operative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations – Part I. Gynecologic Oncology. 2016;140:313-322.
  6. American Society of PeriAnesthesia Nurses. Clinical guideline for the prevention of unplanned perioperative hypothermia. J Perianesth Nurs. 2001;16:305-314.
  7. Guideline for prevention of unplanned patient hypothermia. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2017:567-590.
  8. Anderson DJ, Podgorny K, et al. Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update. Infection Control and Hospital Epidemiology. 2014;35(6).
  9. Ban KA, Minei JP, Laronga C, Harbrecht BG, Jensen EH, Fry DE, Itani KMF, Dellinger EP, Ko CY, Duane TM. American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update. J Am Coll Surg 2017;224:59-74.
  10. Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med. 1996;334(19):1209–1215.
  11. Scott EM, Buckland R. A systematic review of intraoperative warming to prevent postoperative complications. AORN J. 2006;83(5):1090–1104, 1107-1113.
  12. Melling AC, Ali B, Scott EM, Leaper DJ. Effects of preoperative warming on the incidence of wound infection after clean surgery: a randomized controlled trial. Lancet. 2001;358:876-880.
  13. Lenhardt R, Marker E, Goll V, et al. Mild intraoperative hypothermia prolongs postanesthetic recovery. Anesthesiology. 1997;87(6):1318–1323.
  14. Bush HL Jr, Hydo LJ, et al. Hypothermia during elective abdominal aortic aneurysm repair: the high price of avoidable morbidity. J Vasc Surg. 1995;21: 392–400; discussion 400–392.
Sep 13, 2017

FDA: Keep using patient warming devices, including forced-air technology

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Bair Hugger Multi-Position Blanket Supine Shoulder

The 3M Bair Hugger forced-air warming system

The U.S. Food and Drug Administration recently issued a letter reminding healthcare providers that it continues to recommend patients be warmed during surgery when clinically warranted.

The FDA specifically mentioned that its recommendation includes the continued use of forced-air warming devices. The 3M™ Bair Hugger™ warming system is the world’s leading forced-air warming product.

The FDA said it recently became aware that some providers and patients are foregoing the use of forced-air warming because of concerns about a possible increased risk of surgical site infections. Those concerns have been driven by a 3M competitor and a group of plaintiffs’ attorneys, who are promoting a theory that forced-air warming devices such as the Bair Hugger system lead to an increased risk of surgical site infections.

The FDA, which regulates medical devices, said it has thoroughly reviewed available data and “has been unable to identify a consistently reported association between the use of forced air thermal regulating systems and surgical site infection.”

You can read the letter here.

You can read an update from the Minneapolis Star Tribune here.

Download the 3M™ Bair Hugger™ Research Compendium here.

Aug 3, 2017

Health care hygiene compliance: Not just for hands anymore?

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It’s time to add ‘and stethoscope hygiene’ to ‘practice hand hygiene’ signs

Stethoscope blog

Changing habits is hard. We can see the data, understand the science and even participate in a training session, yet we go back to doing it like we always did.

That is precisely what researchers observed and documented in a recently published quality improvement project on stethoscope hygiene. In the July issue of the American Journal of Infection Control from the Association for Professionals in Infection Control and Epidemiology (APIC), researchers found that healthcare providers rarely perform stethoscope hygiene between patient encounters, despite its importance for infection prevention. The authors call for the inclusion of stethoscope hygiene in all hand hygiene initiatives.

Infection prevention is a complex undertaking, and stethoscope hygiene is an important component. Here are a few simple tips from 3M™ Littmann® stethoscopes along with some hand hygiene essentials.

Stethoscope blog chart

Barriers to change may exist at several levels. Maybe there is a level of disbelief that stethoscopes get as contaminated as hands, despite what research shows. Maybe wiping stethoscopes is perceived as inconvenient or there’s concern that sanitizers and wipes will damage the stethoscope (Tip: All Littmann stethoscopes feature next-generation tubing with improved resistance to alcohol). Whatever the obstacles, let’s challenge ourselves to identify and overcome them. It’s essential to patient safety.

At 3M, we are committed to a future without preventable infections. As with hand hygiene, cleaning stethoscopes between patients should be expected in all health care settings and supported by leadership and clinicians alike. The future of infection prevention and superior patient care will be built upon a culture of compliance. Be a stethoscope hygiene champion in your facility!

 

Jun 23, 2017

8 Reasons the 3M™ Bair Hugger™ System is the Gold Standard in Patient Warming

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The 3M Bair Hugger System is the gold standard for patient warming. See the research in our updated Compendium.

The 3M Bair Hugger System is the gold standard for patient warming. See the research in our updated Compendium.

The 3M™ Bair Hugger™ forced-air warming system keeps patients warm throughout the perioperative process, which is integral to optimal clinical care and patient comfort. Below are eight great reasons you can trust the Bair Hugger system for your patient warming needs.

  1. Over 80% of US hospitals rely on the 3M Bair Hugger system to maintain normothermia.
  2. The 3M Bair Hugger system has safely and effectively warmed patients during surgery for nearly 30 years.
  3. More than 200 million patients have been warmed by Bair Hugger warming blankets or warming gowns.
  4. The number of patients warmed using the Bair Hugger system increases by nearly 50,000 each and every day.
  5. 8 of the top 10 orthopedic hospitals in the U.S. trust the 3M Bair Hugger system for their patient warming needs.¹
  6. The clinical effectiveness of forced-air warming has been documented in over 170 clinical studies and more than 60 randomized controlled clinical trials. Download the Bair Hugger research compendium to learn more.
  7. The 3M Bair Hugger system’s portfolio of 25 blanket designs (including seven underbody models) and three gown styles provides a warming option for nearly any surgical procedure.
  8. The 3M Bair Hugger Model 775 temperature management unit’s performance, precision and ease-of-use stands out from the competition.

Learn more about the 3M Bair Hugger system, or download the Bair Hugger Research Compendium.

1. U.S. News & World Report (online edition); 2015-16 Top Hospitals edition, Best Hospitals for Adult Orthopedics. http://health.usnews.com/best-hospitals/rankings/orthopedics. Published July 21, 2015.