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April 2010 See the full issue

Keynote: What would Florence do?

When did the health care crisis get to be a crisis? Was it last year with the capital crunch and reimbursement cutbacks? Was it the evolution of managed care and corporate medicine? Does it go back to when Medicare was established? What would Florence Nightingale say about the health care…

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By: OR Manager
April 1, 2010
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Total joints: Toward zero infections

The Hospital for Special Surgery (HSS) in New York City has one of the highest volumes of total joint replacements in the world. It also has one of the lowest surgical site infection (SSI) rates. The hospital, which performs about 8,000 joint replacements a year, was recently commended by the…

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By: OR Manager
April 1, 2010
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What is the OR’s role in SSI surveillance?

Under the Joint Commission’s National Patient Safety Goal 07.05.01 on preventing surgical site infections (SSIs), organizations are required to measure their SSI rates. They also need to provide process and outcome measures, such as SSI rates, to key stakeholders; for example, surgeons and senior administrators. Perioperative nurses play an important…

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By: OR Manager
April 1, 2010
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Will skin-prep practice change following new study results?

Strong evidence from a new 6-hospital study could lead many ORs to change their traditional practice for surgical skin preparation. In the first prospective, randomized study to compare the effect of 2 skin prep agents on the incidence of surgical site infections (SSIs) after clean-contaminated surgery, a chlorhexidine (CHG)-alcohol product…

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By: OR Manager
April 1, 2010
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Preventing pressure ulcers: New lessons from Minnesota

New data from Minnesota hospitals offers more insight into preventing pressure ulcers during long surgical procedures. Data collected through the state’s adverse event reporting system in 2009 found 13% of the 122 Stage 3, Stage 4, and unstageable pressure ulcers reported were related to long surgical procedures. Attention to this…

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By: OR Manager
April 1, 2010
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What's the value of preop bathing?

Preoperative baths or showers to prevent surgical infections have played to mixed reviews. Enthusiasm was dampened after a systematic Cochrane review in 2006, updated in 2009, examined 7 trials and found no clear evidence of a benefit for bathing or showering with chlorhexidine gluconate (CHG) over a placebo. Preop bathing…

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By: OR Manager
April 1, 2010
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A Lean process for OR technology

With tighter budgets and long lists of technology requests, organizations need a fair and systematic way to set priorities. At Virginia Mason Medical Center (VMMC) in Seattle, where Lean manufacturing principles are part of the culture, it was natural to apply Lean to the review of new surgical supplies and…

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By: Pat Patterson
April 1, 2010
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A plan for fixing sterile reprocessing

Every morning when the central service (CS) staff arrived for work, they were greeted by a jumble of unprocessed sets left from the previous day. There were service problems with the OR, and morale was low. "When the first shift came in, there was a never-ending pile of sets. They…

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By: OR Manager
April 1, 2010
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Walking the tightrope of costs, preference

Purchasing managers are used to walking a tightrope between tough bargaining with suppliers and respect for the product preferences of physicians. Eventually, purchasing professionals, as well as physicians, realize these goals need not be inconsistent. The best value often is in the best product. At many ambulatory surgery centers (ASC),…

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By: Paula DeJohn
April 1, 2010
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Pilot finds ASC infection control lapses

Pilot survey: ASC infection control lapses Infection control category Facilities with lapses* Examples of lapses Hand hygiene, use of gloves 12/62 (19%) 4 facilities had providers who failed to perform hand hygiene after contact with blood, body fluids, or nonintact skin. Injection and medication safety 19/67 (28%) 18 facilities used…

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By: OR Manager
April 1, 2010
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Better outcomes for hospitals highly specialized in orthopedics

Postoperative mortality rates were twice as high (1.4% vs 0.73%) for patients having hip and knee replacements in hospitals that were the least specialized in orthopedic surgery compared to those that were the most specialized in a study published in the British Medical Journal. Patients at the most specialized hospitals…

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By: OR Manager
April 1, 2010
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Sepsis, pneumonia after surgery take heavy toll in lives and costs

Two common hospital-acquired conditions, sepsis and pneumonia, killed 48,000 patients and cost $8.1 billion in 2006 alone, according to a large national study. In a separate analysis of outcomes associated with surgery, the researchers found that nearly 20% of patients who developed sepsis after surgery died as a result. Patients…

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By: OR Manager
April 1, 2010
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New training kit for malignant hyperthermia

The Malignant Hyperthermia Association of the United States has introduced a new training kit to help OR staff better prepare for MH emergencies. The kit includes a 22-minute video of a mock drill and cards that detail how to prepare for a drill and specific responsibilities of participants. The kit…

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By: OR Manager
April 1, 2010
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Small ASC Medicare update recommended

A government advisory panel has recommendeda0.6% inflation update for Medicare payments to ambulatory surgery centers for 2011. The recommendation came from the Medicare Payment Advisory Commission (MedPAC). Though MedPAC does not have an official role in setting the inflation update, its recommendations are influential with Congress and the Centers for…

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By: OR Manager
April 1, 2010
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Pilot finds ASC infection control lapses

Pilot survey: ASC infection control lapses Infection control category Facilities with lapses* Examples of lapses Hand hygiene, use of gloves 12/62 (19%) 4 facilities had providers who failed to perform hand hygiene after contact with blood, body fluids, or nonintact skin. Injection and medication safety 19/67 (28%) 18 facilities used…

Read More

By: OR Manager
April 1, 2010
Share

Walking the tightrope of costs, preference

Purchasing managers are used to walking a tightrope between tough bargaining with suppliers and respect for the product preferences of physicians. Eventually, purchasing professionals, as well as physicians, realize these goals need not be inconsistent. The best value often is in the best product. At many ambulatory surgery centers (ASC),…

Read More

By: Paula DeJohn
April 1, 2010
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Forum

To the Editor: I have read the article titled, "Blunting sharps injuries in the OR continues to be a work in progress" (January 2010) and would like to add information about research that I have carried out on the ability of the hands-free technique to reduce the risk of transmission…

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By: OR Manager
April 1, 2010
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A plan for fixing sterile reprocessing

Every morning when the central service (CS) staff arrived for work, they were greeted by a jumble of unprocessed sets left from the previous day. There were service problems with the OR, and morale was low. “When the first shift came in, there was a never-ending pile of sets. They…

Read More

By: OR Manager
April 1, 2010
Share

A Lean process for OR technology

With tighter budgets and long lists of technology requests, organizations need a fair and systematic way to set priorities. At Virginia Mason Medical Center (VMMC) in Seattle, where Lean manufacturing principles are part of the culture, it was natural to apply Lean to the review of new surgical supplies and…

Read More

By: Pat Patterson
April 1, 2010
Share

What is the OR's role in SSI surveillance?

Under the Joint Commission's National Patient Safety Goal 07.05.01 on preventing surgical site infections (SSIs), organizations are required to measure their SSI rates. They also need to provide process and outcome measures, such as SSI rates, to key stakeholders; for example, surgeons and senior administrators. Perioperative nurses play an important…

Read More

By: OR Manager
April 1, 2010
Share

Total joints: Toward zero infections

The Hospital for Special Surgery (HSS) in New York City has one of the highest volumes of total joint replacements in the world. It also has one of the lowest surgical site infection (SSI) rates. The hospital, which performs about 8,000 joint replacements a year, was recently commended by the…

Read More

By: OR Manager
April 1, 2010
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Nominate OR Manager of the Year

Each year at the Managing Today's OR Suite conference, a perioperative manager or director is named OR Manager of the Year. This year's conference will be September 29 to October 1 in Orlando, Florida. The OR Manager of the Year will receive an expense-paid trip to the meeting, including airfare,…

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By: OR Manager
April 1, 2010
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What's the value of preop bathing?

Preoperative baths or showers to prevent surgical infections have played to mixed reviews. Enthusiasm was dampened after a systematic Cochrane review in 2006, updated in 2009, examined 7 trials and found no clear evidence of a benefit for bathing or showering with chlorhexidine gluconate (CHG) over a placebo. Preop bathing…

Read More

By: OR Manager
April 1, 2010
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Tips for leading a practice change

A new study provides strong evidence that surgical skin prep with chlorhexidine gluconate (CHG)-alcohol is superior to povidone-iodine scrub in preventing surgical site infections (related article). What if most of the surgeons in your OR use povidone-iodine? How can you introduce the new evidence to the surgeons and convince them…

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By: OR Manager
April 1, 2010
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Keynote: What would Florence do?

When did the health care crisis get to be a crisis? Was it last year with the capital crunch and reimbursement cutbacks? Was it the evolution of managed care and corporate medicine? Does it go back to when Medicare was established? What would Florence Nightingale say about the health care…

Read More

By: OR Manager
April 1, 2010
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Editorial

It took a Texas jury less than an hour on February 11 to return a not guilty verdict for Anne Mitchell, RN. An administrator at 15-bed Winkler County Memorial Hospital in the small town of Kermit, Texas, Mitchell was charged by the local sheriff with a felony after she reported…

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By: Pat Patterson
April 1, 2010
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Preventing pressure ulcers: New lessons from Minnesota

New data from Minnesota hospitals offers more insight into preventing pressure ulcers during long surgical procedures. Data collected through the state's adverse event reporting system in 2009 found 13% of the 122 Stage 3, Stage 4, and unstageable pressure ulcers reported were related to long surgical procedures. Attention to this…

Read More

By: OR Manager
April 1, 2010
Share

Will skin-prep practice change following new study results?

Strong evidence from a new 6-hospital study could lead many ORs to change their traditional practice for surgical skin preparation. In the first prospective, randomized study to compare the effect of 2 skin prep agents on the incidence of surgical site infections (SSIs) after clean-contami-nated surgery, a chlorhexidine (CHG)-alcohol product…

Read More

By: OR Manager
April 1, 2010
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Total ankle replacement for degenerative ankle disease

Editor's Note APRIL 2010 OR leaders are striving to make evidence-based decisions about new technology. OR Manager, Inc, and ECRI Institute have joined in a collaboration to bring quarterly supplements with summaries of the Institute's technology assessment reports to OR Manager readers. ECRI Institute is an independent nonprofit organization that…

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By: OR Manager
April 1, 2010
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