Tag Archives: self-study CE courses

Jan 24, 2017

Better medical adhesives, better outcomes

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Even under normal conditions it’s tough to stick something to skin. Skin is flexible. It stretches and sweats. Skin’s natural oils cause water to bead up. A medical adhesive must accommodate all these conditions and more.

And stickiness is only half the equation. A medical adhesive must also remove easily, without causing pain, and without leaving residue or damaging often delicate skin.

Surgical Drape Health Care Academy Learning Course

Learn the “do and don’t” of draping and taping

The science of sticky

A pressure-sensitive adhesive that sticks firmly yet is easy to remove requires the right physical properties. It must tolerate movement and moisture, and be scientifically formulated to transmit vapor away from the skin.

Creating such an adhesive requires cutting-edge science and technology. It takes a multi-disciplinary approach that combines the efforts of numerous professionals including engineers, chemists and biologists. But the results are worth the effort: better patient experience and a higher standard of care.

Wound care that helps heal, doesn’t hurt

A good wound dressing helps create an environment where a wound can heal. And it does the job without increasing the risk of Medical Adhesive-Related Skin Injuries (MARSI).

The adhesive in the dressing plays an important role. It should move vapor away from the skin to prevent moisture build-up that could cause the adhesive to fail and the dressing to lift. When a dressing is removed from skin the adhesive should facilitate a removal that is gentle, doesn’t cause pain and doesn’t leave a residue.

Medical adhesives are also a critical component of the numerous medical tapes used throughout the health care continuum. Health care providers need a variety of tapes to address a variety of clinical needs. Some medical tapes feature high adhesion for damp skin. Others, like some silicone tapes, can be easily repositioned or cleanly removed without causing pain.

A surgical drape that stays put

One of the most significant risks to a patient during surgery is the bacteria that lives on their own skin. Surgical preps do not sterilize the skin. There is always some bacteria left on the patient’s skin even after the most effective prep.

An incise drape, applied before surgery begins, provides a sterile surface all the way to the edge of the surgical wound. The drape immobilizes bacteria on the skin to help reduce the risk of bacterial wound contamination. But in order to reduce the risk of surgical site contamination, the drape must stay put.

Many procedures, like heart surgery, require the surgeon to retract the skin after incision which puts a lot of stress on the drape. You must have a good adhesive to keep the drape in place. And drape lift during surgery has been associated with an increased risk of surgical site infection (SSI).1 An adhesive with a high degree of stickiness can help prevent drape lift.

Deploying science to improve patient experience and cost of care

For patients, a wound dressing or surgical drape that works as intended helps achieve the desired outcomes and avoid complications that can cause the patient and their family pain, suffering and expense. And it gives health care professionals the peace of mind they’re doing all they can to provide the best possible standard of care.

Science plays a role in choosing a clinical approach. But it’s how science is used to comfort and protect patients that makes it powerful.

Featured 3MSM Health Care Academy learning course, Medical Grade Adhesives: The Do and Don’t of Draping and Taping.

1Alexander JW, Aerni S, and Plettner JP. 1985. Development of a safe and effective one-minute preoperative skin preparation. Arch Surg. 120:1357-1361.

May 19, 2016

The Prevention of Perioperative Hypothermia Toolkit

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The Prevention of Perioperative Hypothermia

Guest blogger: Victoria M. Steelman, PhD, RN, CNOR, FAAN Associate Professor, College of Nursing, The University of Iowa Disclosure: Victoria M. Steelman, PhD, RN, CNOR, FAAN has served as a consultant for 3M and VitaHEAT. This article is sponsored by 3M.

The Prevention of Perioperative Hypothermia Toolkit

I am sometimes asked, “Is perioperative hypothermia really a big deal?” The answer is “yes, it is.” Most patients undergoing surgery will become hypothermia unless we use effective interventions to prevent it.

Why is preventing perioperative hypothermia important?

It is important to prevent perioperative hypothermia because it is associated with negative patient outcomes. Perioperative hypothermia increases:

  • surgical site infection risk,1
  • morbid cardiac events,2
  • blood loss,3,4
  • length of stay in the recovery room,5 and
  • impairment of drug metabolism.5

All of this increases the cost of healthcare.

Why does hypothermia occur?

One common misconception is that perioperative hypothermia is caused by the operating room being cool, and if the room temperature is increased, hypothermia will not occur. This is a myth. Although the room temperature plays a role, anesthesia plays the primary role. General and regional anesthesia impair the normal thermoregulatory responses.6 Upon induction of anesthesia, heat is redistributed from the core to the peripheral tissues, which are much (2-4oC) cooler. This causes the core temperature to drop significantly during the first hour of anesthesia.7 Anesthesia also impairs the body’s ability to respond to cold. Normally, the body would respond to a drop in temperature of 0.4oC. An anesthetized patient does not respond until there is a 4oC drop in core temperature.So, the patient does not produce enough heat to overcome the initial hypothermia.

Will using cotton blankets prevent hypothermia?

Passive warming with blankets retains heat. But, because the anesthetized patient is unable to produce enough heat, retention of heat alone is inadequate. Applying heated cotton blankets is only slightly more effective, and the benefit only lasts 10 minutes.9 In a randomized clinical trial, applying heated cotton blankets failed to prevent hypothermia.10

Will heating insufflation gases for laparoscopy prevent hypothermia?

Another commonly used, ineffective way of preventing hypothermia is heating the carbon dioxide used for insufflation during laparoscopy. A meta-analysis of 16 randomized clinical trials found that heating CO2 gas had no effect on core temperature, and there was no evidence to support the use of heated CO2 gas, with our without humidification, for laparoscopic surgery.11

How can we prevent hypothermia?

Applying heat to actively warm the patient is required to prevent perioperative hypothermia. The most common method of active warming is forced air warming (FAW), which distributes warm air over the skin surface, heating peripheral tissues, and minimizing core-to-periphery temperature gradient. Intraoperative FAW is more effective in maintaining body temperature than cotton blankets,10,12  reflective blankets,12 or thermo-lite® insulation.12,13

What patients should receive active warming?

Patients undergoing surgery that will be at least 30 minutes long, with general or regional anesthesia (spinal, epidural) should be actively warmed.

When should we use active warming?

To be most effective, active warming should be initiated preoperatively for at least 30 minutes and also used intraoperatively. Actively warming the patient preoperatively minimizes heat lost during redistribution of heat from the core to periphery upon induction of anesthesia, and minimizes the incidence of hypothermia.14-16

Why are hospitals not using these evidence-based practices?

Unfortunately, active warming is not always used when needed and is often not used correctly. First, practitioners are not knowledgeable enough about perioperative hypothermia, and do not always consider it a priority. Secondly, they do not understand the importance of prewarming the patient, and often start active warming after induction of anesthesia. Third, there was a quality performance measure that has been retired that required active warming or normothermia. Practitioners were in compliance with the measure even if they used active warming incorrectly, starting it after induction of anesthesia, and the patient became hypothermic.17 Actual evaluation of patient outcomes and reducing the incidence of hypothermia were not emphasized, resulting in a “checklist mentality”. And, lastly, complacency is an incredibly strong force, and a concentrated effort is required to make a change in practice.

How can we get practitioners to use this evidence to prevent perioperative hypothermia?

We need to use a combination of strategies to engage busy professionals and integrate a change into their work processes. For that reason, a team at the University of Iowa developed the Prevention of Perioperative Hypothermia Toolkit©. Use of this toolkit has been tested for the past two years, and refined with lessons learned. The toolkit includes is a list of steps for planning the implementation of changes. The second component is a template for a risk assessment, a Healthcare Failure Mode and Effect Analysis (HFMEA), to identify potential issues that can arise during implementation. The next component is an educational program that can be modified with taped statements of support from key perioperative leaders in the setting. A list of data elements to use for modifying the electronic documentation system is included to allow for the generation of reports. And, there are spreadsheets that can be used as templates for audit and feedback.

The Prevention of Perioperative Hypothermia Toolkit© is available free of charge.

For more information, watch the 3M webinar Strategies for Infusing Evidence-based Practices for Prevention of Perioperative Hypothermia.

The Prevention of Perioperative Hypothermia (PPH) Toolkit was funded by the Agency for Healthcare Research and Quality, grant 3 IR18HS021422-01A1.

Dr. Steelman has been a perioperative nurse for over 25 years. As a perioperative advanced practice nurse at the University of Iowa Hospitals and Clinics, she focused on implementing evidence-based practice changes for 20 years. She is currently Associate Professor in the College of Nursing at the University of Iowa where she teaches graduate students evidence-based practice. Her program of research focuses on perioperative safety and quality. She has extensively published and presented about issues related safe patient care in the operating room, including five research studies focusing on prevention of retained surgical sponges. She is well recognized for her contributions and received AORN’s Outstanding Achievement awards for Research and Evidence-based Practice. In 2008, she received the AORN’s highest award, the Award for Excellence in recognition of her contributions to perioperative nursing. In 2007, she was inducted into the American Academy of Nursing in recognition of the national and global impact of her work. 

REFERENCES

1. 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;334:1209-1215.

2. Frank SM, Fleisher LA, Breslow MJ, et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA. 1997;277:1127-1134.

3. Schmied H, Kurz A, Sessler DI, Kozek S, Reiter A. Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty. Lancet. 1996;347:289-292.

4. Winkler M, Akca O, Birkenberg B, et al. Aggressive warming reduces blood loss during hip arthroplasty. Anesth Analg. 2000;91:978-984.

5. Lenhardt R, Marker E, Goll V, et al. Mild intraoperative hypothermia prolongs postanesthetic recovery. Anesthesiology. 1997;87:1318-1323.

6. Sessler DI. Temperature monitoring and perioperative thermoregulation. Anesthesiology. 2008;109:318-338.

7. Sessler DI. Perioperative heat balance. Anesthesiology. 2000;92:578-596.

8. Torossian A. Thermal management during anaesthesia and thermoregulation standards for the prevention of inadvertent perioperative hypothermia. Best Pract Res Clin Anaesthesiol. 2008;22:659-668.

9. Sessler DI, Schroeder M. Heat loss in humans covered with cotton hospital blankets. Anesth Analg. 1993;77:73-77.

10. Fossum S, Hays J, Henson MM. A comparison study on the effects of prewarming patients in the outpatient surgery setting. J Perianesth Nurs. 2001;16:187-194.

11. Birch DW, Manouchehri N, Shi X, Hadi G, Karmali S. Heated CO(2) with or without humidification for minimally invasive abdominal surgery. Cochrane Database Syst Rev. 2011;(1):CD007821.

12. Ng SF, Oo CS, Loh KH, Lim PY, Chan YH, Ong BC. A comparative study of three warming interventions to determine the most effective in maintaining perioperative normothermia. Anesth Analg. 2003;96:171-176.

13. Borms SF, Engelen SL, Himpe DG, Suy MR, Theunissen WJ. Bair hugger forced-air warming maintains normothermia more effectively than thermo-lite insulation. J Clin Anesth. 1994;6:303-307.

14. Andrzejowski J, Hoyle J, Eapen G, Turnbull D. Effect of prewarming on post-induction core temperature and the incidence of inadvertent perioperative hypothermia in patients undergoing general anaesthesia. Br J Anaesth. 2008;101:627-631.

15. Horn EP, Schroeder F, Gottschalk A, et al. Active warming during cesarean delivery. Anesth Analg. 2002;94:409-414.

16. Vanni SM, Braz JR, Modolo NS, Amorim RB, Rodrigues GR,Jr. Preoperative combined with intraoperative skin-surface warming avoids hypothermia caused by general anesthesia and surgery. J Clin Anesth. 2003;15:119-125.

17. Steelman, V. M., Perkhounkova, Y. S., & Lemke, J. H. The gap between compliance with the quality performance measure “Perioperative Temperature Management” and normothermia. J Healthc Qual. 2014 January 13. PMID: 24417607. doi: 10.1111/jhq.12063.

May 5, 2016

Remember the importance of hand hygiene

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Hospital hand hygiene

Imagine your Mom gets sick and is admitted to the hospital. A healthcare provider arrives and starts checking her vitals. You notice they’re not wearing gloves and didn’t wash their hands. But you were afraid to ask. A month goes by and Mom takes a turn for the worse.  She’s back in the hospital, this time, she has a new infection. Out of the blue. Where did this come from? Was it from the healthcare provider who didn’t wash their hands? Could something as simple as using soap and water or hand sanitizer have prevented this? I wish I would’ve said something.

As everyone knows, hand hygiene is critical on a daily basis. Once a year on May 5, the World Health Organization (WHO) initiates a global campaign, Save Lives: Clean Your Hands day to engage healthcare facilities on the importance of hand hygiene. The WHO campaign supports the importance of hand hygiene in healthcare and the improvement of hand hygiene globally. Professor Didier Pittet, from WHO, stresses that washing hands saves lives. Watch his Adapt to Adopt video to see some creative ways on how facilities are focusing on hand hygiene improvements.

Are you following WHO’s recommendations for My 5 Moments for Hand Hygiene?

  1. Before touching a patient.
  2. Before clean and aseptic procedures (eg. inserting devices such as catheters).
  3. After contact with body fluids.
  4. After touching a patient.
  5. After touching patient surroundings.

In support of WHO’s campaign, we want to help you drive proper hand hygiene compliance throughout your healthcare facility. Take time to review the on-demand educational opportunities below. The fight against infection is in your hands.

Getting Hand Hygiene to the Next Level Through Value Based Improvement in a Culture of Safety

Hand Antiseptics Formulation and Regulation…What’s Involved in Developing the Products You Use

Surgical Hand Antisepsis

Importance of a Clean Environment in Keeping Hands Clean

Leading the Way: Healthcare Facility Hygiene

Hand Hygiene in the Perioperative Setting-Reviewing the Recommended Practice

Mar 9, 2016

Applying the Science of Human Factors Engineering to Medical Device Reprocessing

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Endoscope Reprocessing with elevator down

You may not have heard about human factors engineering. But without question, the underlying concepts lie at the heart of what you do every day in a busy Sterile Processing department.As you strive to manage and improve processes and procedures to keep your department running efficiently, human factors provides a new perspective, and, quite possibly, new inspiration. Put simply, human factors is the science behind how we as humans relate to our processes, work methods, and environments. Where do we operate at our most productive levels? Where do we make errors? Why, and how, do we improve? A slightly less general view involves engineers solving the problems that arise when humans integrate with devices and systems, using the scientific method – testing and gathering data, rather than depending on common sense or simple “gut feel.” The specifics are exciting. Beginning with medical device manufacturers, human factors can help to design and verify the processes used for medical device reprocessing. It can include how processes and procedures are communicated for maximum understanding and compliance. It can even include the design of the instruments themselves. In your department, applying human factors engineering can help you define processes that can be performed in your specific, real-world environment. It can also help you establish education, training, and competency verification tools to ensure staff have the necessary information and skills. 3M would like to invite you to learn more about human factors. Our educational webinar, How can Human Factors Engineering Concepts be Applied to Medical Device Reprocessing? explores how human factors affects the design of medical devices and processes. You’ll learn about:

  • How human factors engineering affects instrument and instrument set design
  • Proper design and content of Instructions for Use (IFUs)
  • Design of reprocessing procedures
  • Applying protocols
  • And much more.

Facilitated by 3M’s Christophe de Campeau and Dorothy Larson and featuring Susan Klacik, CSS Manager at St. Elizabeth’s Healthcare, Youngstown, OH and educational consultant to 3M Health Care, this presentation also features case studies that illustrate how human factors can make a difference in any department. View this webinar and other webinars about Sterile Processing at 3M Healthcare Academy.

Feb 12, 2016

If You Struggle With Sterile Processing, Then Read This

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Sterile processing department

Sterile processing is an important function that is vital to every health care facility. Sterile processing technicians need up-to-date, helpful information about standards, guidelines, and recommended practices. To make it easy for technicians to learn best practices, 3MSM  Health Care Academy created a full catalog of free self-study and live continuing education (CE) courses presented by technical experts. Here is a list of some of the most popular 1 hour sterile processing CE courses over the past 12 months.

Sterilization & Disinfection in an ASC Setting

Learning Objectives:

  • Identify the latest requirements and guidelines from accrediting organizations specifically relating to reprocessing of medical devices.
  • Describe key published standards and recommended practices for safe and effective reprocessing of reusable patient care items.
  • List available resources that can help an ASC comply with best practice related to reprocessing of reusable medical devices.

ST79 Essentials for ASCs

Learning Objectives:

  • Discuss AAMI ST79 and the need for the recommended practice.
  • Discuss the different types of steam sterilization processes and cycle parameters.
  • Describe the different types of sterilization monitoring devices, including PCDs.
  • Describe routine load release for implants and non-implants.

What a Gas: A Review of Today’s Low Temperature Sterilization Options

Learning Objectives:

  • List the low temperature sterilization technologies that are available in the industry today.
  • Describe how each of the low temperature sterilization technologies work.
  • Recognize the benefits and limitations of each low temperature sterilization technology.
  • Identify the factors to be considered for choosing a low temperature sterilization technology.

IUSS – Follow the Standards or Get Cited!

Learning Objectives:

  • Review the most current AORN and AAMI standards and recommended practices relating to IUSS.
  • Explain CMS’s Update of Survey and Certification Memorandum Regarding IUSS.
  • Identify The Joint Commissions’ standards related to IUSS.

Steam Sterilization Qualification and Troubleshooting: Process Failures and Wet Packs

Learning Objectives:

  • Discuss steam sterilization qualification testing.
  • Describe available tools to help guide an investigational process on sterilization process failures and wet pack/load assessment.
  • Identify common reasons for steam sterilization process failures and wet packs/loads.

Are you following me? A Surgical Instrument Tray Tracer

Learning Objectives:

  • Understand how tracer methodology applies to sterile processing.
  • Discuss how IFU’s, competencies and processes may be observed by surveyors.
  • Understand the importance of following manufacturers’ IFU.

Duodenoscopes: Are Current Reprocessing Guidelines Adequate?

Learning Objectives:

  • Explain why duodenoscope reprocessing is currently under scrutiny.
  • Summarize the clinical literature describing outbreaks following exposure to duodenoscopes.
  • Discuss the reprocessing challenges that are unique to duodenoscopes.
  • Outline available and proposed options for improving duodenoscope reprocessing.

The Nuts and Bolts of Washers and Disinfectors

Learning Objectives:

  • Describe the steps in a washer/disinfector cycle and the purpose of each step
  • Discuss thermal disinfection and the A0 concept
  • Review means to optimize the effectiveness of your washer/disinfector
  • Identify potential root causes of washer / disinfector monitoring failures

The Science of Speed – The Evolution of Biological Indicators

Learning Objectives:

  • Describe the design and function of biological indicators
  • Discuss how biological indicator incubation time is determined
  • Understand how rapid readout biological indicators work

Sterile Processing in the ASC Environment – Are you ready for a survey?

Learning Objectives:

  • Identify sterile processing standards and guidelines relevant to the ambulatory surgery setting.
  • Describe best practices for instrument processing in the ambulatory surgery setting.
  • Develop a check off list to determine readiness for an accreditation survey.

Need more sterile processing CE learning? View the full course catalog.