The

Aligning practice with policy to improve patient care

Volume 5, Issue 3
FREE CE!

Health Care
Survey
Winners
Military Nursing
in IRAQ

Take the
SCIP
Measure
#
9 Pink Glove
Survey
Page 72
Booklet Inside!
VHA Catheter From OR to
Case Study Courtroom
 The

OR Connection
Aligning practice with policy to improve patient care

Editor
Sue MacInnes, RD, LD
PATIENT SAFETY
Clinical Editor
8 Three Important National Initiatives for Improving Patient Care
Alecia Cooper, BS, MBA, RN, CNOR
Senior Writer 19 A Refresher Course on Safe Injection Practices
Carla Esser Lake 38 Back To Basics: Are you In Line with SCIP Measure Number Nine
Creative Director
52 Changing Clinical Behaviors to Lower Costs and Reduce CAUTI
Mike Gotti
Clinical Team
OR ISSUES Page 26
Jayne Barkman, BSN, RN, CNOR
Margaret Falconio-West, BSN, RN, APN/CNS, 16 ASC News Round-up
CWOCN, DAPWCA
23 AORN Updates Standards on Surgical Attire
Rhonda J. Frick, RN, CNOR
Anita Gill, RN 32 Go Green in the OR
Kimberly Haines, RN, Certified OR Nurse 56 From OR to Courtroom
Carla Nitz, BSN, RN
Connie Sackett, RN, Nurse Consultant
SPECIAL FEATURES
Claudia Sanders, RN, CFA
Megan Shramm, RN, CNOR, RNFA 6 The Survey Results Are In Page 32
Angel Trichak, RN, BSN, CNOR 10 Healthcare Reform: What It Means For Hospitals
Perioperative Advisory Board
26 All In A Day’s Work – Military Nursing In Iraq
Larry Creech, RN, MBA, CDT
Carilion Clinic, Virginia 50 Social Practice and Clinicians’ Meaning of Catheter Insertions
Sharon Danielewicz, MSN, RN, RNFA 64 Fail-safe Strategies to Deal With Difficult People
Never miss an issue of The OR Connection! St. Luke’s The Woodlands, Texas
Tracy Diffenderfer, MSN, RN
71 CDC Forms New Advisory Committee on Breast Cancer in
Subscriptions are free and signing up is a snap! Vanderbilt University Medical Center, Tennessee Young Women
Barb Fahey RN, CNOR 72 Take the Pink Glove Survey! Page 38
Cleveland Clinic, Ohio
Subscribing to The OR Connection guarantees that you’ll To subscribe, simply go to www.medline.com/orconnection. Susan Garrett, RN
continue to receive this info-packed magazine and won’t miss You will need to provide: Hughston Hospital Inc., Georgia CARING FOR YOURSELF
out on our industry updates and articles addressing on-the- Your name Zaida I. Jacoby, MA, M.Ed, RN 76 Breast Health
job issues and tips on caring for yourself! Facility and position NYU Medical Center, New York
78 Taste the Fountain of Youth
Mailing address Jackie Kraft, RN, CNOR
E-mail address Huntsville Hospital, Alabama 80 Healthy Eating: Chilled Tuscan Tomato Soup
Tom McLaren
Florida Hospital, Florida
FORMS & TOOLS Page 56
We also welcome any suggestions you might have on how we can continue to improve Donna A. Pritchard, BSN, MA, RN, CNOR, NE-BC
The OR Connection! Love the content? Want to see something new? Just let us know! Kingsbrook Jewish Medical Center, New York 83 Surgical Site Infections FAQs
Debbie Reeves, MS, RN, CNOR 85 SCIP Measures
Hutcheson Medical Center, Georgia
87 Clean Hands Save Lives
Diane M. Strout, BSN, RN, CNOR
Chesapeake Regional Medical Center, Virginia 88 Sample Recycling Coordinator Job Description
Content Key
We've coded the articles and information in this magazine to indicate which patient
care initiatives they pertain to. Throughout the publication, when you see these icons
you'll know immediately that the subject matter on that page relates to one or more of
Page 68
the following national initiatives:
• IHI's Improvement Map About Medline
• Joint Commission 2009 National Patient Safety Goals Medline, headquartered in Mundelein, IL, manufactures and distributes more than Meeting the highest level of national and international quality standards, Medline is FDA
• Surgical Care Improvement Project (SCIP) 100,000 products to hospitals, extended care facilities, surgery centers, home care QSR compliant and ISO 13485 registered. Medline serves on major industry quality
dealers and agencies and other markets. Medline has more than 800 dedicated committees to develop guidelines and standards for medical product use including
sales representatives nationwide to support its broad product line and cost manage- the FDA Midwest Steering Committee, AAMI Sterilization and Packaging Committee
We've tried to include content that clarifies the initiatives or gives you ideas and tools ment services. and various ASTM committees. For more information on Medline, visit our Web site,
for implementing their recommendations. For a summary of each of the initiatives, www.medline.com.

see pages 8 and 9. ©2010 Medline Industries, Inc. The OR Connection is published by Medline Industries, Inc. One Medline Place, Mundelein, IL 60060. 1-800-MEDLINE.

Aligning practice with policy to improve patient care 3

 The

OR Connection
Aligning practice with policy to improve patient care

Editor
Sue MacInnes, RD, LD
PATIENT SAFETY
Clinical Editor
8 Three Important National Initiatives for Improving Patient Care
Alecia Cooper, BS, MBA, RN, CNOR
Senior Writer 19 A Refresher Course on Safe Injection Practices
Carla Esser Lake 38 Back To Basics: Are you In Line with SCIP Measure Number Nine
Creative Director
52 Changing Clinical Behaviors to Lower Costs and Reduce CAUTI
Mike Gotti
Clinical Team
OR ISSUES Page 26
Jayne Barkman, BSN, RN, CNOR
Margaret Falconio-West, BSN, RN, APN/CNS, 16 ASC News Round-up
CWOCN, DAPWCA
23 AORN Updates Standards on Surgical Attire
Rhonda J. Frick, RN, CNOR
Anita Gill, RN 32 Go Green in the OR
Kimberly Haines, RN, Certified OR Nurse 56 From OR to Courtroom
Carla Nitz, BSN, RN
Connie Sackett, RN, Nurse Consultant
SPECIAL FEATURES
Claudia Sanders, RN, CFA
Megan Shramm, RN, CNOR, RNFA 6 The Survey Results Are In Page 32
Angel Trichak, RN, BSN, CNOR 10 Healthcare Reform: What It Means For Hospitals
Perioperative Advisory Board
26 All In A Day’s Work – Military Nursing In Iraq
Larry Creech, RN, MBA, CDT
Carilion Clinic, Virginia 50 Social Practice and Clinicians’ Meaning of Catheter Insertions
Sharon Danielewicz, MSN, RN, RNFA 64 Fail-safe Strategies to Deal With Difficult People
Never miss an issue of The OR Connection! St. Luke’s The Woodlands, Texas
Tracy Diffenderfer, MSN, RN
71 CDC Forms New Advisory Committee on Breast Cancer in
Subscriptions are free and signing up is a snap! Vanderbilt University Medical Center, Tennessee Young Women
Barb Fahey RN, CNOR 72 Take the Pink Glove Survey! Page 38
Cleveland Clinic, Ohio
Subscribing to The OR Connection guarantees that you’ll To subscribe, simply go to www.medline.com/orconnection. Susan Garrett, RN
continue to receive this info-packed magazine and won’t miss You will need to provide: Hughston Hospital Inc., Georgia CARING FOR YOURSELF
out on our industry updates and articles addressing on-the- Your name Zaida I. Jacoby, MA, M.Ed, RN 76 Breast Health
job issues and tips on caring for yourself! Facility and position NYU Medical Center, New York
78 Taste the Fountain of Youth
Mailing address Jackie Kraft, RN, CNOR
E-mail address Huntsville Hospital, Alabama 80 Healthy Eating: Chilled Tuscan Tomato Soup
Tom McLaren
Florida Hospital, Florida
FORMS & TOOLS Page 56
We also welcome any suggestions you might have on how we can continue to improve Donna A. Pritchard, BSN, MA, RN, CNOR, NE-BC
The OR Connection! Love the content? Want to see something new? Just let us know! Kingsbrook Jewish Medical Center, New York 83 Surgical Site Infections FAQs
Debbie Reeves, MS, RN, CNOR 85 SCIP Measures
Hutcheson Medical Center, Georgia
87 Clean Hands Save Lives
Diane M. Strout, BSN, RN, CNOR
Chesapeake Regional Medical Center, Virginia 88 Sample Recycling Coordinator Job Description
Content Key
We've coded the articles and information in this magazine to indicate which patient
care initiatives they pertain to. Throughout the publication, when you see these icons
you'll know immediately that the subject matter on that page relates to one or more of
Page 68
the following national initiatives:
• IHI's Improvement Map About Medline
• Joint Commission 2009 National Patient Safety Goals Medline, headquartered in Mundelein, IL, manufactures and distributes more than Meeting the highest level of national and international quality standards, Medline is FDA
• Surgical Care Improvement Project (SCIP) 100,000 products to hospitals, extended care facilities, surgery centers, home care QSR compliant and ISO 13485 registered. Medline serves on major industry quality
dealers and agencies and other markets. Medline has more than 800 dedicated committees to develop guidelines and standards for medical product use including
sales representatives nationwide to support its broad product line and cost manage- the FDA Midwest Steering Committee, AAMI Sterilization and Packaging Committee
We've tried to include content that clarifies the initiatives or gives you ideas and tools ment services. and various ASTM committees. For more information on Medline, visit our Web site,
for implementing their recommendations. For a summary of each of the initiatives, www.medline.com.

see pages 8 and 9. ©2010 Medline Industries, Inc. The OR Connection is published by Medline Industries, Inc. One Medline Place, Mundelein, IL 60060. 1-800-MEDLINE.

Aligning practice with policy to improve patient care 3

 THE OR CONNECTION Letter from the Editor

The
Aligning practice with policy to improve patient care

Dear Reader,
Introducing
Volume 5, Issue 3
FREE CE!

Health Care
Survey
Winners

25th
October is nearly upon us. What used to be the One daughter wrote, my mom has not smiled nor has

Deb!
Military Nursing
in IRAQ

month known for Halloween and “trick or treat” has she gotten off the couch since she was diagnosed. Take the
SCIP
Measure
#
9 Pink Glove
Survey
now become the month to recognize breast cancer. When she saw the video, she smiled for the first time Page 76

Anniversary
Special Insert:
VHA Catheter From OR to
What used to be the month of black and orange is in months. Another woman said she was getting treat- Case Study Courtroom

now the month of pink. As a matter of fact, Breast ments for stage 4 breast cancer, and the video was so
Cancer Awareness Month has been celebrated and uplifting. At AORN Congress last year, we showed the of Breast Cancer Awareness Month
supported worldwide since 1985. video to 1,200 perioperative nurses, and introduced Starring in “The Pink Glove Dance”
some of the individuals from St. Vincent’s who partic- Some historical facts
I have never been a part of a cause that generates ipated in the filming. Several of the attendees
such passion. It seems like everyone knows someone asked if we would do a pink glove dance at their hos-
who has been touched by breast cancer. I have spo-
ken to many, many breast cancer survivors. There is a
pitals. And that was just the beginning ... soon there
were others who called and wanted to participate.
“
I want to extend
a heartfelt thank
2010 In her Generation Pink™
special quality emanating from their being, from the marks the 25th anniversary of Breast Cancer Gloves, pink bouffant cap
depths of their souls, reaching out to help others get So, September 17, 2010, Medline will launch the Pink you to the health-
Awareness Month, whose purpose is to remind and scrubs, Deb danced
through the disease. They want to tell their stories. Glove Dance Sequel. Starting at St. Vincent’s in Portland, care workers who
women about the value of early detection and in the Pink Glove Video
They join support groups. They attend support events. you will see healthcare workers from 10 hospitals and show compassion
mammograms. Sequel, which will be
And they all say breast cancer has redefined their 3 nursing homes from North America dance, and as a and care to those
lives. I know this now because I have been a part of diagnosed and released September
special note of appreciation, you will see breast cancer
the Pink Glove Dance video. I have read survivors’
letters of support, listened to their lows and shared in
their highs... in their laughter and joy as they dance in
survivors from coast to coast dance in appreciation of
their healthcare workers—caregivers and survivors
coming together celebrating. More than 3,600 people
”
their families.
1993 17, 2010.

To order your own

celebration of life.
The whole idea of doing a pink glove dance was to
get people talking about breast cancer. Think about
it, a patient sees the pink gloves and may say that’s a
pretty color. And the radiology tech might say, yes,
pink for breast cancer. And a hospital visitor might say,
my sister was recently diagnosed but caught it early.
And the nurse might say, I’m a survivor. And so it
goes. But the bottom line is people are talking.
The first video, launched in November 2009, now has
over 11 million hits on YouTube. It has been all over
the globe. When it hit the Netherlands and the com-
ments were in Dutch, my daughter, Emily Somers,
and I were so excited. You see, Emily is the chore-
ographer, and this year she has been super busy trav-
eling for the making of the Pink Glove Dance Sequel.
Shortly after the video release last year, St. Vincent’s
Hospital in Portland, Oregon, where the original Pink
Glove Dance was filmed, and Medline began receiving
countless phone calls and e-mails about people’s
experiences with breast cancer.
have participated. We are thrilled, honored and filled
with the hope that this sequel will spur more people
to talk about breast cancer, support each other
through tough times, and give everyone hope.
On behalf of all the breast cancer survivors and their
families, I want to extend a heartfelt thank you to the
healthcare workers who continue to show compas-
sion and care to those diagnosed and their families.
You are spectacular!
Enjoy this edition of The OR Connection! And, take a
moment to reflect on all the good you do. Watch the
video, share it with friends and spread the cheer.
My deepest thanks to all of you,
Sue MacInnes, RD, LD
Editor
Evelyn Lauder, senior corporate vice president Deb doll, visit
of the Estee Lauder Companies founded the www.medline.com/dolls
Breast Cancer Research foundation and began
distributing pink ribbons to symbolize breast
cancer awareness.
1985
Breast Cancer Awareness Month was created
in October 1985 as a collaborative effort among
the American Academy of Physicians, Cancer-
Care Inc. and various other sponsors.
Pink
was chosen as the breast cancer ribbon color
because it symbolizes health and femininity.

www.pinkglovedance.com

4 The OR Connection
 THE OR CONNECTION Letter from the Editor

The
Aligning practice with policy to improve patient care

Dear Reader,
Introducing
Volume 5, Issue 3
FREE CE!

Health Care
Survey
Winners

25th
October is nearly upon us. What used to be the One daughter wrote, my mom has not smiled nor has

Deb!
Military Nursing
in IRAQ

month known for Halloween and “trick or treat” has she gotten off the couch since she was diagnosed. Take the
SCIP
Measure
#
9 Pink Glove
Survey
now become the month to recognize breast cancer. When she saw the video, she smiled for the first time Page 76

Anniversary
Special Insert:
VHA Catheter From OR to
What used to be the month of black and orange is in months. Another woman said she was getting treat- Case Study Courtroom

now the month of pink. As a matter of fact, Breast ments for stage 4 breast cancer, and the video was so
Cancer Awareness Month has been celebrated and uplifting. At AORN Congress last year, we showed the of Breast Cancer Awareness Month
supported worldwide since 1985. video to 1,200 perioperative nurses, and introduced Starring in “The Pink Glove Dance”
some of the individuals from St. Vincent’s who partic- Some historical facts
I have never been a part of a cause that generates ipated in the filming. Several of the attendees
such passion. It seems like everyone knows someone asked if we would do a pink glove dance at their hos-
who has been touched by breast cancer. I have spo-
ken to many, many breast cancer survivors. There is a
pitals. And that was just the beginning ... soon there
were others who called and wanted to participate.
“
I want to extend
a heartfelt thank
2010 In her Generation Pink™
special quality emanating from their being, from the marks the 25th anniversary of Breast Cancer Gloves, pink bouffant cap
depths of their souls, reaching out to help others get So, September 17, 2010, Medline will launch the Pink you to the health-
Awareness Month, whose purpose is to remind and scrubs, Deb danced
through the disease. They want to tell their stories. Glove Dance Sequel. Starting at St. Vincent’s in Portland, care workers who
women about the value of early detection and in the Pink Glove Video
They join support groups. They attend support events. you will see healthcare workers from 10 hospitals and show compassion
mammograms. Sequel, which will be
And they all say breast cancer has redefined their 3 nursing homes from North America dance, and as a and care to those
lives. I know this now because I have been a part of diagnosed and released September
special note of appreciation, you will see breast cancer
the Pink Glove Dance video. I have read survivors’
letters of support, listened to their lows and shared in
their highs... in their laughter and joy as they dance in
survivors from coast to coast dance in appreciation of
their healthcare workers—caregivers and survivors
coming together celebrating. More than 3,600 people
”
their families.
1993 17, 2010.

To order your own

celebration of life.
The whole idea of doing a pink glove dance was to
get people talking about breast cancer. Think about
it, a patient sees the pink gloves and may say that’s a
pretty color. And the radiology tech might say, yes,
pink for breast cancer. And a hospital visitor might say,
my sister was recently diagnosed but caught it early.
And the nurse might say, I’m a survivor. And so it
goes. But the bottom line is people are talking.
The first video, launched in November 2009, now has
over 11 million hits on YouTube. It has been all over
the globe. When it hit the Netherlands and the com-
ments were in Dutch, my daughter, Emily Somers,
and I were so excited. You see, Emily is the chore-
ographer, and this year she has been super busy trav-
eling for the making of the Pink Glove Dance Sequel.
Shortly after the video release last year, St. Vincent’s
Hospital in Portland, Oregon, where the original Pink
Glove Dance was filmed, and Medline began receiving
countless phone calls and e-mails about people’s
experiences with breast cancer.
have participated. We are thrilled, honored and filled
with the hope that this sequel will spur more people
to talk about breast cancer, support each other
through tough times, and give everyone hope.
On behalf of all the breast cancer survivors and their
families, I want to extend a heartfelt thank you to the
healthcare workers who continue to show compas-
sion and care to those diagnosed and their families.
You are spectacular!
Enjoy this edition of The OR Connection! And, take a
moment to reflect on all the good you do. Watch the
video, share it with friends and spread the cheer.
My deepest thanks to all of you,
Sue MacInnes, RD, LD
Editor
Evelyn Lauder, senior corporate vice president Deb doll, visit
of the Estee Lauder Companies founded the www.medline.com/dolls
Breast Cancer Research foundation and began
distributing pink ribbons to symbolize breast
cancer awareness.
1985
Breast Cancer Awareness Month was created
in October 1985 as a collaborative effort among
the American Academy of Physicians, Cancer-
Care Inc. and various other sponsors.
Pink
was chosen as the breast cancer ribbon color
because it symbolizes health and femininity.

www.pinkglovedance.com

4 The OR Connection
 Special Feature

Congratulations to our SURVEY WINNERS!

The SURVEY RESULTS Are In!
Thank you to everyone who took the time to complete the Medline Healthcare Survey
Question:
Describe an innovative program, initiative and/or solution implemented at
in the last issue of The OR Connection.
your facility that made a significant impact on quality and patient care.
We are pleased to report that everyone who completed the survey will be receiving our new
“Deb” doll. In her Medline Generation Pink Gloves, pink bouffant cap and scrubs, Deb energetically
raises awareness for breast cancer and the “Together We Can Save Lives Through Early Detection”
Our grand prize winner
Grand Prize Winner
campaign. To learn more, visit www.medline.com/dolls.
will receive an engraved The children’s hospital is rolling out a new skin care Now, skin care representatives on each floor will
plaque and the entire bundle consisting of a comprehensive assessment present the bundle to unit staff. Families of those
Medline Doll Collection, tool, pressure ulcer standards of behavior and patients at risk for skin breakdown will receive a
which includes eight educational handouts for staff and patients’ fami- handout that provides an illustration of the skin’s
Where you work What you do Your top three priorities dolls in all, including the lies. In addition, a diaper-rash algorithm has been pressure points, an explanation of proper posi-
new Deb Doll. Our four established to assist staff on deciding which tioning during an inpatient stay and while at home
other winners will receive course of action is needed for their patients. The and additional information to educate caregivers.
9% the entire Medline doll Save Our Skin (SOS) committee created the skin
Other collection. care bundle to support clinical staff in preserving Crystal Wallace, RN, CNOR
14% 37% 12%
Staff 17% the integrity of patients’ skin. The bundle was Manatee Memorial Hospital
Surgery Infection
OR Staff found to be a success following a trial in the Sarasota, FL
Center Nurse – OR Control
Manager
28% pediatric intensive care unit in late 2009.
Patient
77% Safety
Hospital 12%
6% Quality
Clinical 29% Winners
Care
Educator-OR 11% All other
positions
Last winter we implemented a Reduce the utilization of Foley Proper positioning/padding for For robotic abdominal hysterec-
Tech/Assistant “Preventing CAUTI” protocol catheter usage. SCIP initiated all patients. Seq stockings, heel tomies, we implemented a
hospital wide. In surgery, this the removal of Foley on Day 2. protectors, proper extremity positioning system that
involved only placing catheters As ICP, I made rounds on a padding to elbow, hands. Use pads/protects the patient,
on needed cases, not inflating daily basis and increased the of bean bag as needed, proper prevents the patient from
the balloon prior to insertion, awareness for necessity of a padding for prone and lateral slipping and helps prevent the
Your facility’s pressure ulcer incidence Do you have a facility protocol for Kinds of technology devices you use
pre-connecting the urine collec- catheter. I attend nursing rounds position. Secure safety straps. occurrence of slip/shear/tear
Unknown/no data 56% prevention of perioperative pressure iPhone® 39% tion bag to catheter prior to and would inquire as to reason Continually check pressure injuries to the patient.
Minimal or zero 26% ulcers? Blackberry® 33% placement and removing the for Foley. After a year I did a areas during procedures.
5-10% 9% Yes 80% Palm® 11% catheter at end of case if not point prevalence study to find Proper use of padding of the Karen Davidson, RN
15-25% 6% No 20% Droid™ 6% needed postop. In surgery, we that less than 40% of patients head. Team works together Hancock Regional Hospital
did not have a closed system had a Foley. We are tracking to prevent pressure sores. Greenfield, IN
Cell phone 86%
catheter available to us. The utilization and note that as our
Clinical position of most concern iPod®/mp3 46% Juanakee Pearson-Ceol,
hospital did carry a closed census increases, utilization of
for successful implementation of DVD player 94% system catheter/drainage bag Foleys are decreasing after six MS, RN
necessary changes at your facility CD player 32% system, but not with a urine months. Rounding with quick The Ohio State University
Physicians 44% Electronic reading device, meter. As a staff nurse, I asked education spots coordinated Medical Center
i.e., Kindle®, Sony®, iPad® 20% “why can’t we change to a with the SCIP initiative is Galena, OH
Nurses 32%
closed system with a urine decreasing Foley utilization
Computer 97%
meter?” Finally, with committee and concurrently UTI.
approval and product selection,
the closed catheter system is Donna Gebhart, RN
being added to our totes. Not Decatur Memorial Hospital
Turn the page to see the bonus question winners! all specialties are able to make Decatur, IL
this change, but for the ones
that can, it will be a change
that will support our goal of
Blackberry and Palm are registered trademarks of Research In Motion Limited, iPhone, iPod and iPad are registered trademarks of Apple Inc.
“Preventing CAUTI.”
Kindle is a registered trademark of Amazon Technologies, Inc., Sony is a registered trademark of Sony Corporation

Diana Engle, LPN, HRH

The OR Connection Aligning practice with policy to improve patient care 7

Lewisville, IN
6
 Special Feature

Congratulations to our SURVEY WINNERS!

The SURVEY RESULTS Are In!
Thank you to everyone who took the time to complete the Medline Healthcare Survey
Question:
Describe an innovative program, initiative and/or solution implemented at
in the last issue of The OR Connection.
your facility that made a significant impact on quality and patient care.
We are pleased to report that everyone who completed the survey will be receiving our new
“Deb” doll. In her Medline Generation Pink Gloves, pink bouffant cap and scrubs, Deb energetically
raises awareness for breast cancer and the “Together We Can Save Lives Through Early Detection”
Our grand prize winner
Grand Prize Winner
campaign. To learn more, visit www.medline.com/dolls.
will receive an engraved The children’s hospital is rolling out a new skin care Now, skin care representatives on each floor will
plaque and the entire bundle consisting of a comprehensive assessment present the bundle to unit staff. Families of those
Medline Doll Collection, tool, pressure ulcer standards of behavior and patients at risk for skin breakdown will receive a
which includes eight educational handouts for staff and patients’ fami- handout that provides an illustration of the skin’s
Where you work What you do Your top three priorities dolls in all, including the lies. In addition, a diaper-rash algorithm has been pressure points, an explanation of proper posi-
new Deb Doll. Our four established to assist staff on deciding which tioning during an inpatient stay and while at home
other winners will receive course of action is needed for their patients. The and additional information to educate caregivers.
9% the entire Medline doll Save Our Skin (SOS) committee created the skin
Other collection. care bundle to support clinical staff in preserving Crystal Wallace, RN, CNOR
14% 37% 12%
Staff 17% the integrity of patients’ skin. The bundle was Manatee Memorial Hospital
Surgery Infection
OR Staff found to be a success following a trial in the Sarasota, FL
Center Nurse – OR Control
Manager
28% pediatric intensive care unit in late 2009.
Patient
77% Safety
Hospital 12%
6% Quality
Clinical 29% Winners
Care
Educator-OR 11% All other
positions
Last winter we implemented a Reduce the utilization of Foley Proper positioning/padding for For robotic abdominal hysterec-
Tech/Assistant “Preventing CAUTI” protocol catheter usage. SCIP initiated all patients. Seq stockings, heel tomies, we implemented a
hospital wide. In surgery, this the removal of Foley on Day 2. protectors, proper extremity positioning system that
involved only placing catheters As ICP, I made rounds on a padding to elbow, hands. Use pads/protects the patient,
on needed cases, not inflating daily basis and increased the of bean bag as needed, proper prevents the patient from
the balloon prior to insertion, awareness for necessity of a padding for prone and lateral slipping and helps prevent the
Your facility’s pressure ulcer incidence Do you have a facility protocol for Kinds of technology devices you use
pre-connecting the urine collec- catheter. I attend nursing rounds position. Secure safety straps. occurrence of slip/shear/tear
Unknown/no data 56% prevention of perioperative pressure iPhone® 39% tion bag to catheter prior to and would inquire as to reason Continually check pressure injuries to the patient.
Minimal or zero 26% ulcers? Blackberry® 33% placement and removing the for Foley. After a year I did a areas during procedures.
5-10% 9% Yes 80% Palm® 11% catheter at end of case if not point prevalence study to find Proper use of padding of the Karen Davidson, RN
15-25% 6% No 20% Droid™ 6% needed postop. In surgery, we that less than 40% of patients head. Team works together Hancock Regional Hospital
did not have a closed system had a Foley. We are tracking to prevent pressure sores. Greenfield, IN
Cell phone 86%
catheter available to us. The utilization and note that as our
Clinical position of most concern iPod®/mp3 46% Juanakee Pearson-Ceol,
hospital did carry a closed census increases, utilization of
for successful implementation of DVD player 94% system catheter/drainage bag Foleys are decreasing after six MS, RN
necessary changes at your facility CD player 32% system, but not with a urine months. Rounding with quick The Ohio State University
Physicians 44% Electronic reading device, meter. As a staff nurse, I asked education spots coordinated Medical Center
i.e., Kindle®, Sony®, iPad® 20% “why can’t we change to a with the SCIP initiative is Galena, OH
Nurses 32%
closed system with a urine decreasing Foley utilization
Computer 97%
meter?” Finally, with committee and concurrently UTI.
approval and product selection,
the closed catheter system is Donna Gebhart, RN
being added to our totes. Not Decatur Memorial Hospital
Turn the page to see the bonus question winners! all specialties are able to make Decatur, IL
this change, but for the ones
that can, it will be a change
that will support our goal of
Blackberry and Palm are registered trademarks of Research In Motion Limited, iPhone, iPod and iPad are registered trademarks of Apple Inc.
“Preventing CAUTI.”
Kindle is a registered trademark of Amazon Technologies, Inc., Sony is a registered trademark of Sony Corporation

Diana Engle, LPN, HRH

The OR Connection Aligning practice with policy to improve patient care 7

Lewisville, IN
6
 Patient Safety
Three Important National Initiatives
for Improving Patient Care IHI Improvement Map: 73 Processes to Transform Hospital Care
The IHI Improvement Map is an online tool that distills the best knowledge available on the key process
Achieving better outcomes starts with an understanding of current improvements that lead to exceptional patient care.
patient-care initiatives. Here’s what you need to know about national
projects and policies that are driving changes in care.
1. Anticoagulation Management 1. Central Line Bundle
3 New Key Processes as of June 2010 Top 5 Key Processes Shared by Improvement Map Users

1 2. Essential Care for Frail Older Patients 2. CA-UTI

3. Glycemic Control in Non-Critically Ill Patients 3. Anti-Biotic Stewardship
IHI Improvement Map
Origin: Launched by the Institute for Healthcare Improvement (IHI) in January 2009 4. Falls Prevention
Purpose: To help hospitals improve patient care by focusing on an essential set of processes needed to 5. Heart Failure Core Processes
achieve the highest levels of performance in areas that matter most to patients.
To learn more about the IHI Improvement Map and the 73 processes to transform hospital care, go to www.ihi.org/imap/tool
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 70 processes grouped into three domains: leadership and management, Joint Commission 2010 National Patient Safety Goals
patient care and processes to support care.
• Improve the accuracy of patient identification. • The organization identifies safety risks inherent in
• Improve the effectiveness of communication its patient population.
among caregivers. • Universal Protocol for Preventing Wrong Site,
2 Joint Commission 2010 National Patient Safety Goals • Improve the safety of using medications. Wrong Procedure, and Wrong Person Surgery.™
• Reduce the risk of healthcare-associated
Origin: Developed by Joint Commission staff and the Patient Safety Advisory Group
infections.
(formerly the Sentinel Event Advisory Group)
• Accurately and completely reconcile medications No new NPSGs have been developed for 2010.
Purpose: To promote specific improvements in patient safety, particularly in problematic areas
across the continuum of care. Effective January 1, 2010, organizations are expected
• Reduce the risk of patient harm resulting from falls. to have fully implemented the requirements related to
Joint Commission-accredited organizations are evaluated for compliance with these goals. The Joint Commission offers
• Prevent healthcare-associated pressure ulcers healthcare-associated infections established in 2009.
guidance to help organizations meet goal requirements.
(decubitus ulcers).
Over the next year, the current National Patient Safety Goals (NPSGs) will undergo an extensive review process. As a result,
no new NPSGs will be developed for 2010; however, revisions to the NPSGs will be effective in 2010. To learn more about National Patient Safety Goals, go to www.jointcommission.org.

Surgical Care Improvement Project (SCIP): Target Areas

3 1. Surgical infections
By the numbers:
* Antibiotics, blood sugar control, hair removal, perioperative
Surgical Care Improvement Project (SCIP)
• 3,740 hospitals are submitting
Origin: Initiated in 2003 as a national partnership. Steering committee includes the following temperature management data on SCIP measure #9, representing
organizations: CDC, CMS, ACS, AHRQ, AHA, ASA, AORN, VA, IHI and the • Remove urinary catheter on Post Operative Day (POD) 1 or 2 75 percent of all U.S. hospitals
Joint Commission
2. Perioperative cardiac events • Currently, SCIP has more than 36
Purpose: To improve patient safety by reducing postoperative complications
• Use of perioperative beta-blockers association and business partners
Goal: To reduce nationally by 25 percent the incidence of surgical complications by 2010
3. Venous thromboembolism
• Use of appropriate prophylaxis
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. Visit www.qualitynet.org

8 The OR Connection Aligning practice with policy to improve patient care 9

 Patient Safety
Three Important National Initiatives
for Improving Patient Care IHI Improvement Map: 73 Processes to Transform Hospital Care
The IHI Improvement Map is an online tool that distills the best knowledge available on the key process
Achieving better outcomes starts with an understanding of current improvements that lead to exceptional patient care.
patient-care initiatives. Here’s what you need to know about national
projects and policies that are driving changes in care.
1. Anticoagulation Management 1. Central Line Bundle
3 New Key Processes as of June 2010 Top 5 Key Processes Shared by Improvement Map Users

1 2. Essential Care for Frail Older Patients 2. CA-UTI

3. Glycemic Control in Non-Critically Ill Patients 3. Anti-Biotic Stewardship
IHI Improvement Map
Origin: Launched by the Institute for Healthcare Improvement (IHI) in January 2009 4. Falls Prevention
Purpose: To help hospitals improve patient care by focusing on an essential set of processes needed to 5. Heart Failure Core Processes
achieve the highest levels of performance in areas that matter most to patients.
To learn more about the IHI Improvement Map and the 73 processes to transform hospital care, go to www.ihi.org/imap/tool
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 70 processes grouped into three domains: leadership and management, Joint Commission 2010 National Patient Safety Goals
patient care and processes to support care.
• Improve the accuracy of patient identification. • The organization identifies safety risks inherent in
• Improve the effectiveness of communication its patient population.
among caregivers. • Universal Protocol for Preventing Wrong Site,
2 Joint Commission 2010 National Patient Safety Goals • Improve the safety of using medications. Wrong Procedure, and Wrong Person Surgery.™
• Reduce the risk of healthcare-associated
Origin: Developed by Joint Commission staff and the Patient Safety Advisory Group
infections.
(formerly the Sentinel Event Advisory Group)
• Accurately and completely reconcile medications No new NPSGs have been developed for 2010.
Purpose: To promote specific improvements in patient safety, particularly in problematic areas
across the continuum of care. Effective January 1, 2010, organizations are expected
• Reduce the risk of patient harm resulting from falls. to have fully implemented the requirements related to
Joint Commission-accredited organizations are evaluated for compliance with these goals. The Joint Commission offers
• Prevent healthcare-associated pressure ulcers healthcare-associated infections established in 2009.
guidance to help organizations meet goal requirements.
(decubitus ulcers).
Over the next year, the current National Patient Safety Goals (NPSGs) will undergo an extensive review process. As a result,
no new NPSGs will be developed for 2010; however, revisions to the NPSGs will be effective in 2010. To learn more about National Patient Safety Goals, go to www.jointcommission.org.

Surgical Care Improvement Project (SCIP): Target Areas

3 1. Surgical infections
By the numbers:
* Antibiotics, blood sugar control, hair removal, perioperative
Surgical Care Improvement Project (SCIP)
• 3,740 hospitals are submitting
Origin: Initiated in 2003 as a national partnership. Steering committee includes the following temperature management data on SCIP measure #9, representing
organizations: CDC, CMS, ACS, AHRQ, AHA, ASA, AORN, VA, IHI and the • Remove urinary catheter on Post Operative Day (POD) 1 or 2 75 percent of all U.S. hospitals
Joint Commission
2. Perioperative cardiac events • Currently, SCIP has more than 36
Purpose: To improve patient safety by reducing postoperative complications
• Use of perioperative beta-blockers association and business partners
Goal: To reduce nationally by 25 percent the incidence of surgical complications by 2010
3. Venous thromboembolism
• Use of appropriate prophylaxis
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. Visit www.qualitynet.org

8 The OR Connection Aligning practice with policy to improve patient care 9


HEALTHCARE REFORM
WHAT IT MEANS FOR HOSPITALS
On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act of 2010, also known
as PPACA. The accompanying Health Care and Education Reconciliation Act of 2010 was signed one week later on
March 30, 2010. The following is a summary of how this legislation will affect hospitals, as outlined in a white paper by
the law firm Pillsbury, Winthrop, Shaw, Pittman LLP.
Funding and reimbursement changes
1. Insurance coverage requirement
• Virtually every U.S. citizen and legal immigrant must
obtain health insurance; those who do not comply
will face a tax penalty.
• The American Health Benefit Exchange will be
established no later than 2014 to make affordable
health insurance available to individuals and
companies with 100 or fewer employees.
• Benefit for hospitals – decreased expenditures for
unreimbursed care.
2. Bundled payments for episodes of care
• Five-year voluntary Medicare pilot program to begin
January 1, 2013 to integrate care across hospitals,
physicians and post acute providers for certain
Medicare conditions.
• Five-year demonstration project will study bundled
payments under Medicaid for hospitals and
physician services.
10 The OR Connection
The Outcomes of
Healthcare Reform
Successes achieved by hospital associations
• Inclusion of insurance coverage mandates
• Expanded eligibility through enrollment in
exchanges
• Defeat of the single-payor and public
option proposals
Unaddressed concerns for hospitals
• Significant numbers still left uncovered
(e.g., exclusion of illegal immigrants)
• Lack of meaningful tort reform
• Expanded reporting requirements that
likely will result in further reimbursement
consequences
• Many provisions are vague and
lacking definitions
3. Pay for performance
• Value-based purchasing program (VBP) for Medicare
to pay hospitals based on performance compared
to quality measures; Medicare Physician Quality
Reporting Initiative extended beyond 2010
• A percentage of payments to hospitals will be tied to
a hospital’s performance on quality measures for the
following conditions beginning in 2013:
– Acute myocardial infarction
– Heart failure
– Pneumonia
– Surgeries
– Healthcare-associated infections
• If a hospital meets or exceeds performance stan-
dards for the performance period, the base operating
DRG payment amount is increased
• If a hospital does not meet performance standards
for the performance period, the base operating DRG
payment amount is decreased
4. Market basket updates and reductions
• Market basket updates for hospitals to be modified
beginning 2012; could result in reduced hospital
payment rates with failure to report data contributing
to even further reduction in payments.
5. Expansion of Medicaid
• Medicaid will cover individuals up to 133% of the
federal poverty level. The purpose is to reduce
state-by-state variations in eligibility for Medicaid.
6. Primary care funding
• Increased focus on primary care by increasing
Medicaid reimbursement to 100% of Medicare
rates in 2013 and 2014.
7. DSH payments
• Beginning in 2014 payments to disproportionate
share hospitals (DSH) will be dramatically reduced.
The initial reduction will be 75%.
8. Independent payment advisory board
• A new 15-member board will submit legislative
proposals containing recommendations for reducing
the per capita rate of growth in Medicare spending in
the event spending exceeds a target growth rate.
Aligning practice with policy to improve patient care 11
Special Feature
Clinical operations changes
1. Accountable care organizations
• Providers organized as accountable care organiza-
tions (ACOs) are allowed to share in cost savings re-
alized by Medicare as long as they voluntarily meet
quality thresholds.
2. Hospital-acquired conditions
• There will be a 1% reduction in Medicare payments
to certain hospitals for hospital-acquired conditions
effective fiscal year 2015.
• The payment reduction is meant to incentivize
hospitals to improve infection control programs
and pay particular attention to the potential for
other pay-for-performance indicators.
3. Preventable readmissions
• Medicare payments by October 2012 to hospitals
will be reducted to account for preventable hospital
readmissions.
• “Readmission” has yet to be defined by the Secretary
of Health and Human Services. Currently the text
suggests that an admission to the same hospital
within 30 days after discharge could be considered
a readmission.
Transparency
1. Limits on aggregate physician whole ownership
interests in hospitals
• Physician-owned hospitals are limited in two respects:
their aggregate physician ownership percentage may
not increase from current levels and these hospitals
may not add beds, surgical suites or procedure rooms.
2. Disclosure of financial relationships
• Financial relationships between health entities must
be disclosed to participate in Medicare, Medicaid or
the Children’s Health Insurance Program. These en-
tities include physicians, hospitals, pharmacists,
other providers, manufacturers and distributors of
covered drugs, devices, biologicals and medical
supplies.

HEALTHCARE REFORM
WHAT IT MEANS FOR HOSPITALS
On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act of 2010, also known
as PPACA. The accompanying Health Care and Education Reconciliation Act of 2010 was signed one week later on
March 30, 2010. The following is a summary of how this legislation will affect hospitals, as outlined in a white paper by
the law firm Pillsbury, Winthrop, Shaw, Pittman LLP.
Funding and reimbursement changes
1. Insurance coverage requirement
• Virtually every U.S. citizen and legal immigrant must
obtain health insurance; those who do not comply
will face a tax penalty.
• The American Health Benefit Exchange will be
established no later than 2014 to make affordable
health insurance available to individuals and
companies with 100 or fewer employees.
• Benefit for hospitals – decreased expenditures for
unreimbursed care.
2. Bundled payments for episodes of care
• Five-year voluntary Medicare pilot program to begin
January 1, 2013 to integrate care across hospitals,
physicians and post acute providers for certain
Medicare conditions.
• Five-year demonstration project will study bundled
payments under Medicaid for hospitals and
physician services.
10 The OR Connection
The Outcomes of
Healthcare Reform
Successes achieved by hospital associations
• Inclusion of insurance coverage mandates
• Expanded eligibility through enrollment in
exchanges
• Defeat of the single-payor and public
option proposals
Unaddressed concerns for hospitals
• Significant numbers still left uncovered
(e.g., exclusion of illegal immigrants)
• Lack of meaningful tort reform
• Expanded reporting requirements that
likely will result in further reimbursement
consequences
• Many provisions are vague and
lacking definitions
3. Pay for performance
• Value-based purchasing program (VBP) for Medicare
to pay hospitals based on performance compared
to quality measures; Medicare Physician Quality
Reporting Initiative extended beyond 2010
• A percentage of payments to hospitals will be tied to
a hospital’s performance on quality measures for the
following conditions beginning in 2013:
– Acute myocardial infarction
– Heart failure
– Pneumonia
– Surgeries
– Healthcare-associated infections
• If a hospital meets or exceeds performance stan-
dards for the performance period, the base operating
DRG payment amount is increased
• If a hospital does not meet performance standards
for the performance period, the base operating DRG
payment amount is decreased
4. Market basket updates and reductions
• Market basket updates for hospitals to be modified
beginning 2012; could result in reduced hospital
payment rates with failure to report data contributing
to even further reduction in payments.
5. Expansion of Medicaid
• Medicaid will cover individuals up to 133% of the
federal poverty level. The purpose is to reduce
state-by-state variations in eligibility for Medicaid.
6. Primary care funding
• Increased focus on primary care by increasing
Medicaid reimbursement to 100% of Medicare
rates in 2013 and 2014.
7. DSH payments
• Beginning in 2014 payments to disproportionate
share hospitals (DSH) will be dramatically reduced.
The initial reduction will be 75%.
8. Independent payment advisory board
• A new 15-member board will submit legislative
proposals containing recommendations for reducing
the per capita rate of growth in Medicare spending in
the event spending exceeds a target growth rate.
Aligning practice with policy to improve patient care 11
Special Feature
Clinical operations changes
1. Accountable care organizations
• Providers organized as accountable care organiza-
tions (ACOs) are allowed to share in cost savings re-
alized by Medicare as long as they voluntarily meet
quality thresholds.
2. Hospital-acquired conditions
• There will be a 1% reduction in Medicare payments
to certain hospitals for hospital-acquired conditions
effective fiscal year 2015.
• The payment reduction is meant to incentivize
hospitals to improve infection control programs
and pay particular attention to the potential for
other pay-for-performance indicators.
3. Preventable readmissions
• Medicare payments by October 2012 to hospitals
will be reducted to account for preventable hospital
readmissions.
• “Readmission” has yet to be defined by the Secretary
of Health and Human Services. Currently the text
suggests that an admission to the same hospital
within 30 days after discharge could be considered
a readmission.
Transparency
1. Limits on aggregate physician whole ownership
interests in hospitals
• Physician-owned hospitals are limited in two respects:
their aggregate physician ownership percentage may
not increase from current levels and these hospitals
may not add beds, surgical suites or procedure rooms.
2. Disclosure of financial relationships
• Financial relationships between health entities must
be disclosed to participate in Medicare, Medicaid or
the Children’s Health Insurance Program. These en-
tities include physicians, hospitals, pharmacists,
other providers, manufacturers and distributors of
covered drugs, devices, biologicals and medical
supplies.
 3. Community needs assessments for
non-profit hospitals
• Non-profit hospitals must conduct a community Medline University
needs assessment every three years.
Introduces ...
4. Publication of charges
• Each hospital operating within the United States
must establish, update, and make public a list of
iPhone® App
the hospital’s standard charges for items and serv-
ices provided by the hospital, including for DRGs.
At home, at work or on the go…
earn free CE credits
Source: Main DC & Starry MM. The effect of health care reform on hospitals: It’s even easier to maintain licensure and certification
a summary overview. Pillsbury, Winthrop, Shaw, Pittman, LLP. June 30, 2010. and validate competencies! All Medline University
Available at http://www.pillsburylaw.com/index.cfm?pageid=34&itemid=39703.
courses are now available as free iPhone® and iPod
Accessed July 19, 2010.
touch® apps that can be downloaded from The
Apple® Store.

Viewpoint: Michael Raymond, MD

As always, you can also access courses online
on your computer and download podcasts to your
In the end, the true measure of health care reform’s success
will be whether it can drive down medical costs over the long MP3 player. New courses and competencies are
run. Features of the plan that are designed to ensure care more interactive with graphics, sound and animation
that is more efficient and effective yet less expensive, are to make learning fun.
bundling of medical payments and the use of value-based
purchasing. These changes could greatly increase produc- Nurses Are Getting WIRED...
tivity while also improving quality of care.
In a recent poll of 762 clinicians:
“Healthcare reform will align financial incentives between • 89 percent said they would download
hospitals and their medical staffs in ways they never have in available content from Medline
the past,” according to Michael Raymond, MD, a member • 88 percent have downloaded content
of the National Advisory Council for Healthcare Research and from the iTunes store
Quality (AHRQ) and associate chief medical quality officer, • 64 percent were 40 or older
North Shore University Health System, Skokie, IL. “Bundled
• 30 percent currently use their
payments for episodes of care will necessitate alignment of
iPhone as a reference at work
providers and hospitals, with the intent to ‘bend the cost
curve’ downward, and finding creative ways to apportion the ...You Can TOO!
reimbursement.”
Visit www.medlineuniversity.com today
Beginning in 2011, hospitals will be financially incentivized to
and start earning CE credits* – FREE.
improve quality, as the current “pay for reporting” core meas-
ures stipulation will change to “pay for performance.” In other
words, hospitals with higher core measure scores or signifi- * Courses approved for continuing education by the
Florida Board of Nursing and the California Board
cant improvement from baseline performance have the of Registered Nursing
potential to earn greater reimbursement.

12 The OR Connection
 3. Community needs assessments for
non-profit hospitals
• Non-profit hospitals must conduct a community Medline University
needs assessment every three years.
Introduces ...
4. Publication of charges
• Each hospital operating within the United States
must establish, update, and make public a list of
iPhone® App
the hospital’s standard charges for items and serv-
ices provided by the hospital, including for DRGs.
At home, at work or on the go…
earn free CE credits
Source: Main DC & Starry MM. The effect of health care reform on hospitals: It’s even easier to maintain licensure and certification
a summary overview. Pillsbury, Winthrop, Shaw, Pittman, LLP. June 30, 2010. and validate competencies! All Medline University
Available at http://www.pillsburylaw.com/index.cfm?pageid=34&itemid=39703.
courses are now available as free iPhone® and iPod
Accessed July 19, 2010.
touch® apps that can be downloaded from The
Apple® Store.

Viewpoint: Michael Raymond, MD

As always, you can also access courses online
on your computer and download podcasts to your
In the end, the true measure of health care reform’s success
will be whether it can drive down medical costs over the long MP3 player. New courses and competencies are
run. Features of the plan that are designed to ensure care more interactive with graphics, sound and animation
that is more efficient and effective yet less expensive, are to make learning fun.
bundling of medical payments and the use of value-based
purchasing. These changes could greatly increase produc- Nurses Are Getting WIRED...
tivity while also improving quality of care.
In a recent poll of 762 clinicians:
“Healthcare reform will align financial incentives between • 89 percent said they would download
hospitals and their medical staffs in ways they never have in available content from Medline
the past,” according to Michael Raymond, MD, a member • 88 percent have downloaded content
of the National Advisory Council for Healthcare Research and from the iTunes store
Quality (AHRQ) and associate chief medical quality officer, • 64 percent were 40 or older
North Shore University Health System, Skokie, IL. “Bundled
• 30 percent currently use their
payments for episodes of care will necessitate alignment of
iPhone as a reference at work
providers and hospitals, with the intent to ‘bend the cost
curve’ downward, and finding creative ways to apportion the ...You Can TOO!
reimbursement.”
Visit www.medlineuniversity.com today
Beginning in 2011, hospitals will be financially incentivized to
and start earning CE credits* – FREE.
improve quality, as the current “pay for reporting” core meas-
ures stipulation will change to “pay for performance.” In other
words, hospitals with higher core measure scores or signifi- * Courses approved for continuing education by the
Florida Board of Nursing and the California Board
cant improvement from baseline performance have the of Registered Nursing
potential to earn greater reimbursement.

12 The OR Connection
 FREE
Informational
Webinars

®
STERILLIUM RUB: FASTER RUBTO GLOVE

No More Sticky Hands Exceeds FDA Requirements1

Sterillium Rub Waterless Surgical Scrub Sterillium Rub is the only waterless, brushless
evaporates quickly for faster OR preparation.
Emollients leave hands feeling soft and silky
surgical scrub with 80% (w/w) ethyl alcohol —
the highest alcohol concentration of any surgical
Now Available
— never sticky or tacky — minimizing friction
and skin trauma when donning gloves. It’s
rub available in the US. Its long-lasting, persistent
effect exceeds FDA requirements for surgical hand
On Demand 24/7!
also CHG, latex and non-latex compatible. antisepsis. Sterillium Rub provides a rapid and
comprehensive kill of transient and resident skin
Click on the links below to participate in a webinar any time.
flora, with a 6 log reduction within two minutes.2
Perioperative Pressure Ulcer Prevention
www.medline.com/PUPP-webinar
For a FREE Sterillium® Rub
Hand Hygiene Compliance Improvement Strategies
Waterless Surgical Scrub
trial, contact Lynsey Wolfe
www.medline.com/handhygiene
at 847-643-4329
Innovation in the Prevention of CAUTI
(lwolfe@medline.com).
www.medline.com/erase/webinar.asp
Live webinars conducted by Medline’s nurse specialists are
1. Topical Antimicrobial Drug Products for Over-the-Counter Human Use;
Tentative Final Monograph for Health Care Antiseptic Drug Products,
also available by personal appointment. Contact your Medline
59 FR 31042 (1994) (to be codified at 21 CFR 333) representative for information regarding scheduling.
2. Data on file

©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc. Sterillium is a registered trademark of Bode Chemie GmbH
 FREE
Informational
Webinars

®
STERILLIUM RUB: FASTER RUBTO GLOVE

No More Sticky Hands Exceeds FDA Requirements1

Sterillium Rub Waterless Surgical Scrub Sterillium Rub is the only waterless, brushless
evaporates quickly for faster OR preparation.
Emollients leave hands feeling soft and silky
surgical scrub with 80% (w/w) ethyl alcohol —
the highest alcohol concentration of any surgical
Now Available
— never sticky or tacky — minimizing friction
and skin trauma when donning gloves. It’s
rub available in the US. Its long-lasting, persistent
effect exceeds FDA requirements for surgical hand
On Demand 24/7!
also CHG, latex and non-latex compatible. antisepsis. Sterillium Rub provides a rapid and
comprehensive kill of transient and resident skin
Click on the links below to participate in a webinar any time.
flora, with a 6 log reduction within two minutes.2
Perioperative Pressure Ulcer Prevention
www.medline.com/PUPP-webinar
For a FREE Sterillium® Rub
Hand Hygiene Compliance Improvement Strategies
Waterless Surgical Scrub
trial, contact Lynsey Wolfe
www.medline.com/handhygiene
at 847-643-4329
Innovation in the Prevention of CAUTI
(lwolfe@medline.com).
www.medline.com/erase/webinar.asp
Live webinars conducted by Medline’s nurse specialists are
1. Topical Antimicrobial Drug Products for Over-the-Counter Human Use;
Tentative Final Monograph for Health Care Antiseptic Drug Products,
also available by personal appointment. Contact your Medline
59 FR 31042 (1994) (to be codified at 21 CFR 333) representative for information regarding scheduling.
2. Data on file

©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc. Sterillium is a registered trademark of Bode Chemie GmbH

Ambulatory Surgery Centers
www.medline.com
ASC News Roundup
ASC Quality Collaboration
Introduces Infection
Prevention Toolkit Series1
The Ambulatory Surgery Center Quality
Collaboration (ASCQC) is a collection of
leaders from organizations and compa-
nies with a focus on healthcare quality
and safety. ASCQC has introduced a
new campaign to support the industry’s
focus on high quality care.
The campaign, “Advancing ASC Quality,”
is developing and distributing ASC Tools
for Infection Prevention (TIPs), a
c o l l e c t i o n o f a sses sm en t tools ,
implementation aids, training materials,
monitoring tools, workplace reminders
and guidelines from leading authorities.
The first toolkit in the series focuses on
hand hygiene.
Additional toolkits are being planned for
point-of-care devices, injection prac-
tices, reprocessing, sterilization and
high-level disinfection. To access ASC
TIPs, visit www.ascquality.org/advancing
_asc_quality.cfm.
Study Finds Lapses in Infection
Control Practices at ASCs
More than two-thirds of a sample of
ambulatory surgery centers (ASCs) in
three states had infection control lapses
identified during routine inspections,
according to a study funded by the Cen-
16 Healthy Skin
THE OR CONNECTION
ters for Disease Control and Prevention
(CDC) and the Centers for Medicare &
Medicaid Services (CMS).2
A total of 68 ASCs were assessed in
Maryland, North Carolina and Okla-
homa. CMS surveyors, who are trained
in use of the audit tool, assessed com-
pliance in five areas of infection control:
hand hygiene, injection safety and
medication handling, equipment repro-
cessing, environmental cleaning and
handling of blood glucose monitoring
equipment.3
Overall, 46 of the 68 ASCs (67.6%)
had at least one lapse in infection con-
trol and 12 (17.6%) had lapses in
Volume 5, Issue 3
three or more of the five infection control
categories.
Common problem areas included:3
• Lapses in the handling of
blood glucose monitoring
equipment (46.3%)
• Failure to adhere to
recommended practices
regarding reprocessing of
equipment (28.4%)
• Using single-dose medication
vials for more than one patient
(28.1%)
The study was published June 8, 2010
in the Journal of the American Medical
Association (JAMA).
OR Issues
ASC News Roundup
CMS Issues Reminder Memo:
ASCs Must Maintain Separate
Waiting Areas
In a May 21, 2010 memo to state sur-
Medline’s Ambulatory Surgery Center
CMS Survey Readiness Program
Attend a free webinar to learn more
vey agency directors, the Centers for
Medicare & Medicaid Services (CMS) If you are struggling with interpreting the new Centers for Medicare & Medicaid
reiterated the requirement for ambula-
tory surgery centers to have a sepa-
rate waiting area set aside for patients
Services (CMS) survey guidelines, Medline’s CMS Survey Readiness Program
can help. The program is a series of six modules, which we will be introducing
over the next several months. The program is designed to assist you in prepar-
and families, outside of areas used to
ing for regulatory surveys by giving you a wealth of useful tips, tools, products
prepare patients for their procedures,
perform procedures or recover from and programs to make your job a little easier.
procedures. The waiting areas also
must be separated from other building The first module covers Infection Control. Subsequent modules will include:
occupants by walls having no less • Environmental Compliance for Ambulatory Surgery
than a one-hour fire resistance rating. • Crafting a Quality Assessment and Improvement Program
Waivers will be considered for existing • Complying with New Rules and Regulations for Governing Boards
ASCs that share a waiting room, how- • Understanding Patient Rights and Admission/Discharge Needs
ever; interim separation barriers and • Understanding Safety in Ambulatory Surgery Centers
signage are required.4
PRACTICAL GUIDE TO UNDERSTANDING
Infection Control
Infection Control Product Catalog
in Ambulatory Surgery Centers
References
1. Ambulatory Surgery Center Collaboration re-
leases ASC tools for infection prevention. Sur- CMS SU
FOR AM
RV EY READ
giStrategies website. Posted June 4, 2010. PRODUCT AREAS TO CONSIDER FOR YOUR
INFECTION CONTROL PROGRAM
BULATO
Infection
Con
trol Module
INE
RY SURGER SS PROGRA
Y CENTER
S
M
Available at: http://www.vpico.com/
„ Isolation Personal
Protective Equipment
Equipment
„ Glo
Gloves
ves
articlemanager/printerfriendly.aspx?arti-
„ Hand Hygiene
„S
Sharps
harps Injury
Injury Protection
„ EEnvironmental
nvironmental Cleaning
„S
Sterilization
terilization and
High-Level Disinfection
Disinfection Module
Product Program Catalog CD
Resources
cle=307090. Accessed June 17, 2010.
„S
Surgical
urgical Drapes,
Drapes, Gowns
Gowns
and Standard Packs
Standard Pac ks
2. New study finds lapses in infection control prac-
tices at ambulatory surgical centers. Agency for
Healthcare Research and Quality (AHRQ) Med-
ical Errors & Patient Safety Update. June 11,
2010.
3. Schaefer MK, Jhung M, Dahl M, Schillie S,
Simpson C, Llata E, et al. Infection control as- Upcoming Infection Control Module Webinars (Central Time)
sessment of ambulatory surgical centers. Jour-
nal of the American Medical Association.
To register, go to www.medlineuniver-
2010;303(22):2273-2279.
4. Centers for Medicare & Medicaid Services sity.com/DesktopShell.aspx?tabId=
Memo to State Survey Agency Directors and 220 and click on the desired date on
State Fire Authorities. May 21, 2010. Ambula-
the calendar. All of these live webinars
tory Surgical Center (ASC) Waiting Area Separa- Aug. 26 Sept. 30
tion Requirements. Available at:
2 – 3 pm 3 – 4 pm are presented by board-certified infec-
http://www.cms.gov/SurveyCertificationGen-
tion preventionist Lorri Downs, RN,
Info/downloads/SCLetter10_20.pdf. Accessed
June 20, 2010. Sept. 13 Oct. 13 BSN, MS, CIC.
1 – 2 pm 11 am – 12 pm
*Also available on demand at
www.medlineuniversity.com
Aligning practice with policy to improve patient care 17

Ambulatory Surgery Centers
www.medline.com
ASC News Roundup
ASC Quality Collaboration
Introduces Infection
Prevention Toolkit Series1
The Ambulatory Surgery Center Quality
Collaboration (ASCQC) is a collection of
leaders from organizations and compa-
nies with a focus on healthcare quality
and safety. ASCQC has introduced a
new campaign to support the industry’s
focus on high quality care.
The campaign, “Advancing ASC Quality,”
is developing and distributing ASC Tools
for Infection Prevention (TIPs), a
c o l l e c t i o n o f a sses sm en t tools ,
implementation aids, training materials,
monitoring tools, workplace reminders
and guidelines from leading authorities.
The first toolkit in the series focuses on
hand hygiene.
Additional toolkits are being planned for
point-of-care devices, injection prac-
tices, reprocessing, sterilization and
high-level disinfection. To access ASC
TIPs, visit www.ascquality.org/advancing
_asc_quality.cfm.
Study Finds Lapses in Infection
Control Practices at ASCs
More than two-thirds of a sample of
ambulatory surgery centers (ASCs) in
three states had infection control lapses
identified during routine inspections,
according to a study funded by the Cen-
16 Healthy Skin
THE OR CONNECTION
ters for Disease Control and Prevention
(CDC) and the Centers for Medicare &
Medicaid Services (CMS).2
A total of 68 ASCs were assessed in
Maryland, North Carolina and Okla-
homa. CMS surveyors, who are trained
in use of the audit tool, assessed com-
pliance in five areas of infection control:
hand hygiene, injection safety and
medication handling, equipment repro-
cessing, environmental cleaning and
handling of blood glucose monitoring
equipment.3
Overall, 46 of the 68 ASCs (67.6%)
had at least one lapse in infection con-
trol and 12 (17.6%) had lapses in
Volume 5, Issue 3
three or more of the five infection control
categories.
Common problem areas included:3
• Lapses in the handling of
blood glucose monitoring
equipment (46.3%)
• Failure to adhere to
recommended practices
regarding reprocessing of
equipment (28.4%)
• Using single-dose medication
vials for more than one patient
(28.1%)
The study was published June 8, 2010
in the Journal of the American Medical
Association (JAMA).
OR Issues
ASC News Roundup
CMS Issues Reminder Memo:
ASCs Must Maintain Separate
Waiting Areas
In a May 21, 2010 memo to state sur-
Medline’s Ambulatory Surgery Center
CMS Survey Readiness Program
Attend a free webinar to learn more
vey agency directors, the Centers for
Medicare & Medicaid Services (CMS) If you are struggling with interpreting the new Centers for Medicare & Medicaid
reiterated the requirement for ambula-
tory surgery centers to have a sepa-
rate waiting area set aside for patients
Services (CMS) survey guidelines, Medline’s CMS Survey Readiness Program
can help. The program is a series of six modules, which we will be introducing
over the next several months. The program is designed to assist you in prepar-
and families, outside of areas used to
ing for regulatory surveys by giving you a wealth of useful tips, tools, products
prepare patients for their procedures,
perform procedures or recover from and programs to make your job a little easier.
procedures. The waiting areas also
must be separated from other building The first module covers Infection Control. Subsequent modules will include:
occupants by walls having no less • Environmental Compliance for Ambulatory Surgery
than a one-hour fire resistance rating. • Crafting a Quality Assessment and Improvement Program
Waivers will be considered for existing • Complying with New Rules and Regulations for Governing Boards
ASCs that share a waiting room, how- • Understanding Patient Rights and Admission/Discharge Needs
ever; interim separation barriers and • Understanding Safety in Ambulatory Surgery Centers
signage are required.4
PRACTICAL GUIDE TO UNDERSTANDING
Infection Control
Infection Control Product Catalog
in Ambulatory Surgery Centers
References
1. Ambulatory Surgery Center Collaboration re-
leases ASC tools for infection prevention. Sur- CMS SU
FOR AM
RV EY READ
giStrategies website. Posted June 4, 2010. PRODUCT AREAS TO CONSIDER FOR YOUR
INFECTION CONTROL PROGRAM
BULATO
Infection
Con
trol Module
INE
RY SURGER SS PROGRA
Y CENTER
S
M
Available at: http://www.vpico.com/
„ Isolation Personal
Protective Equipment
Equipment
„ Glo
Gloves
ves
articlemanager/printerfriendly.aspx?arti-
„ Hand Hygiene
„S
Sharps
harps Injury
Injury Protection
„ EEnvironmental
nvironmental Cleaning
„S
Sterilization
terilization and
High-Level Disinfection
Disinfection Module
Product Program Catalog CD
Resources
cle=307090. Accessed June 17, 2010.
„S
Surgical
urgical Drapes,
Drapes, Gowns
Gowns
and Standard Packs
Standard Pac ks
2. New study finds lapses in infection control prac-
tices at ambulatory surgical centers. Agency for
Healthcare Research and Quality (AHRQ) Med-
ical Errors & Patient Safety Update. June 11,
2010.
3. Schaefer MK, Jhung M, Dahl M, Schillie S,
Simpson C, Llata E, et al. Infection control as- Upcoming Infection Control Module Webinars (Central Time)
sessment of ambulatory surgical centers. Jour-
nal of the American Medical Association.
To register, go to www.medlineuniver-
2010;303(22):2273-2279.
4. Centers for Medicare & Medicaid Services sity.com/DesktopShell.aspx?tabId=
Memo to State Survey Agency Directors and 220 and click on the desired date on
State Fire Authorities. May 21, 2010. Ambula-
the calendar. All of these live webinars
tory Surgical Center (ASC) Waiting Area Separa- Aug. 26 Sept. 30
tion Requirements. Available at:
2 – 3 pm 3 – 4 pm are presented by board-certified infec-
http://www.cms.gov/SurveyCertificationGen-
tion preventionist Lorri Downs, RN,
Info/downloads/SCLetter10_20.pdf. Accessed
June 20, 2010. Sept. 13 Oct. 13 BSN, MS, CIC.
1 – 2 pm 11 am – 12 pm
*Also available on demand at
www.medlineuniversity.com
Aligning practice with policy to improve patient care 17
 Patient Safety

A Refresher Course on

Safe Injection
Practices
Can I use that
Frequently Asked Questions
Since 1999, more than 125,000 patients in the United States have been notified of potential exposure to
hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV due to lapses in basic infection control practices.

when you’re done?

Many of these lapses involved healthcare providers reusing syringes, resulting in contamination of
medication vials or containers, which were used on subsequent patients.

The following is a quick review of proper Q: Where should I draw up medications?

injection practices to keep your patients safe.
Q: How should I draw up medications?
A: Parenteral medications should be accessed in an aseptic
manner. This includes using a new sterile syringe and needle
to draw up medications while preventing contact between the
injection materials and the non-sterile environment. Proper hand
hygiene should be performed before handling medications, and
You wouldn’t share this with anyone.
if a medication vial has already been opened, the rubber
septum should be disinfected with alcohol prior to piercing it.
A: Medications should be drawn up in a designated “clean”
medication area that is not adjacent to areas where potentially
contaminated items are placed. Examples of contaminated
items that should not be placed in or near the medication
preparation area include: used equipment such as syringes,
needles, IV tubing, blood collection tubes, needle holders (e.g.,
Vacutainer® holder), or other soiled equipment or materials that
have been used in a procedure. In general, any item that could
have come in contact with blood or body fluids should not be
in the medication preparation area.

Your provider shouldn’t share your syringe.
About the One & Only Campaign
The goal of the One & Only Campaign is
to improve safe injection practices across
healthcare settings. The practices within
an organization are highly influenced
by its culture or are an expression of its
culture. Thus, through education, outreach,
and grassroots initiatives, the One & Only
Campaign will seek to influence the culture
of patient safety. The One & Only Campaign is
an education and awareness campaign aimed
at both healthcare providers and the public
to increase proper adherence to safe injection
practices to prevent disease transmission
from the misuse of needles, syringes, and
medication vials in outpatient settings.
While the campaign will be initially rolled
out in targeted locations, the vision is to
develop a concept that can be replicated
nationwide. For more information, please
visit: www.ONEandONLYcampaign.org.
Safe Injection Practices Coalition partners
include the following organizations:
Accreditation Association for Ambulatory
Health Care (AAAHC), American Association of
Nurse Anesthetists (AANA), Ambulatory Surgery
Foundation, Association for Professionals in
Infection Control and Epidemiology,
Q: What does single-use mean? Q: Is it acceptable to use the same syringe to give IM or
A: A single-use parenteral medication should be administered to subcutaneous (SC) injections to more than one patient if
one patient only. Single-use IV solutions should be administered I change the needle between patients?
Inc (APIC), BD (Becton, Dickinson and
to one patient only, during one treatment. Syringes and needles A: NO. Once they are used, the syringe and needle are both
Company), Centers for Disease Control
and Prevention (CDC), CDC Foundation, should be used for a single patient only for a single procedure. contaminated and must be discarded. Use a new sterile
HONOReform Foundation, Nebraska
syringe and needle for each patient.
Medical Association (NMA), Nevada State
Medical Association (NSMA), and Premier
Safety Institute.

www.ONEandONLYcampaign.org
Aligning practice with policy to improve patient care 19
 Patient Safety

A Refresher Course on

Safe Injection
Practices
Can I use that
Frequently Asked Questions
Since 1999, more than 125,000 patients in the United States have been notified of potential exposure to
hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV due to lapses in basic infection control practices.

when you’re done?

Many of these lapses involved healthcare providers reusing syringes, resulting in contamination of
medication vials or containers, which were used on subsequent patients.

The following is a quick review of proper Q: Where should I draw up medications?

injection practices to keep your patients safe.
Q: How should I draw up medications?
A: Parenteral medications should be accessed in an aseptic
manner. This includes using a new sterile syringe and needle
to draw up medications while preventing contact between the
injection materials and the non-sterile environment. Proper hand
hygiene should be performed before handling medications, and
You wouldn’t share this with anyone.
if a medication vial has already been opened, the rubber
septum should be disinfected with alcohol prior to piercing it.
A: Medications should be drawn up in a designated “clean”
medication area that is not adjacent to areas where potentially
contaminated items are placed. Examples of contaminated
items that should not be placed in or near the medication
preparation area include: used equipment such as syringes,
needles, IV tubing, blood collection tubes, needle holders (e.g.,
Vacutainer® holder), or other soiled equipment or materials that
have been used in a procedure. In general, any item that could
have come in contact with blood or body fluids should not be
in the medication preparation area.

Your provider shouldn’t share your syringe.
About the One & Only Campaign
The goal of the One & Only Campaign is
to improve safe injection practices across
healthcare settings. The practices within
an organization are highly influenced
by its culture or are an expression of its
culture. Thus, through education, outreach,
and grassroots initiatives, the One & Only
Campaign will seek to influence the culture
of patient safety. The One & Only Campaign is
an education and awareness campaign aimed
at both healthcare providers and the public
to increase proper adherence to safe injection
practices to prevent disease transmission
from the misuse of needles, syringes, and
medication vials in outpatient settings.
While the campaign will be initially rolled
out in targeted locations, the vision is to
develop a concept that can be replicated
nationwide. For more information, please
visit: www.ONEandONLYcampaign.org.
Safe Injection Practices Coalition partners
include the following organizations:
Accreditation Association for Ambulatory
Health Care (AAAHC), American Association of
Nurse Anesthetists (AANA), Ambulatory Surgery
Foundation, Association for Professionals in
Infection Control and Epidemiology,
Q: What does single-use mean? Q: Is it acceptable to use the same syringe to give IM or
A: A single-use parenteral medication should be administered to subcutaneous (SC) injections to more than one patient if
one patient only. Single-use IV solutions should be administered I change the needle between patients?
Inc (APIC), BD (Becton, Dickinson and
to one patient only, during one treatment. Syringes and needles A: NO. Once they are used, the syringe and needle are both
Company), Centers for Disease Control
and Prevention (CDC), CDC Foundation, should be used for a single patient only for a single procedure. contaminated and must be discarded. Use a new sterile
HONOReform Foundation, Nebraska
syringe and needle for each patient.
Medical Association (NMA), Nevada State
Medical Association (NSMA), and Premier
Safety Institute.

www.ONEandONLYcampaign.org
Aligning practice with policy to improve patient care 19
 Q: Is it acceptable to use single-use medication vials
or pre-filled syringes for more than one patient?
A: NO. Medication vials that are labeled for single-use and
pre-filled medication syringes should never be used for more
than one patient.
Q: When should a multi-dose medication vial be discarded?
A: Medication vials should be discarded upon expiration or any
time there are concerns regarding the sterility of the medication.
Q: Is it acceptable to leave a needle or other device
inserted in the septum of a medication vial for multiple
medication draws?
A: NO. A needle or other device should never be left inserted
into a medication vial septum for multiple uses. This provides
a direct route for microorganisms to enter the vial and contam-
inate the fluid.
Q: What is the best way to use multi-dose medication vials?
A: The safest thing to do is restrict each medication vial to a sin-
gle patient, even if it’s a multi-dose vial. Proper aseptic tech-
nique should always be followed. If multi-dose medication vials
must be used for more than one patient, the vial should only
be accessed with a new sterile syringe and needle. It is also
preferred that these medications not be prepared in the imme-
diate patient care area.
Q: Is it acceptable to combine leftover medication from
single-use vials?
A: NO. Do not administer medications from single-use vials
or ampules to multiple patients or combine leftover contents
for later use.
Q: Is it acceptable to use the same syringe to give an IM or
IV injection to more than one patient if I change the needle
between patients and I don't draw back before injecting?
A: NO. A small amount of blood can flow into the needle
and syringe even when only positive pressure is applied out-
ward. The syringe and needle are both contaminated and must
be discarded.
Source: Centers for Disease Control and Prevention
The One & Only Campaign Promoting safe injection practices
The One & Only Campaign is a public health campaign, led by the Centers for Disease
Control and Prevention (CDC) and the Safe Injection Practices Coalition (SIPC), to raise
awareness among patients and healthcare providers about safe injection practices.
The campaign aims to eradicate outbreaks resulting from unsafe injection practices.
To learn more about the campaign, visit www.oneandonlycampaign.org.
20 The OR Connection
Q: If I used a syringe only to infuse medications into an
IV tubing port that is several feet away from the patient's
IV catheter site, is it ok to use the same syringe for
another patient?
A: NO. Everything from the medication bag to the patient’s
catheter is a single interconnected unit. All of the components
are directly or indirectly exposed to the patient'’s blood and
cannot be used for another patient. A syringe that intersects
through ports in the IV tubing or bags also becomes contami-
nated and cannot be used for another patient. Separation from
the patient’s IV by distance, gravity, and/or positive infusion
Infections Increased
pressure does not ensure that small amounts of blood are not
present in these items.
Q: Are these recommendations new?
A: NO. These recommendations are part of established guid-
ance. It is a well established practice to never use the same
syringe or needle for more than one patient nor to enter a med-
ication vial with a syringe or needle used for one patient if the
same vial might be used for another patient.
Q: Why can't I just visually inspect syringes to determine
whether they are contaminated or can be used again?
A: Pathogens including HCV, HBV, and human immunodefi-
ciency virus (HIV) can be present in sufficient quantities to pro-
duce infection in the absence of visible blood. Similarly, bacteria
Human Services (HHS) 2009 quality report to
and other microbes can be present without clouding or other
Congress came out this past April 2010, it
visible evidence of contamination. Just because you don't see
blood or other material in a used syringe or IV tubing does not
mean the item is free from potentially infectious agents. All used
injection supplies and materials are potentially contaminated
and should be discarded.
Q: How can healthcare providers ensure that injections
are performed correctly?
A: To help ensure that staff understand and adhere to safe
injection practices, we recommend the following:
• Designate someone to provide ongoing oversight for
infection control issues
• Develop written infection control policies
• Provide training
• Conduct quality assurance assessments
CAUTI,
Bloodstream The report showed the following:1
• Urinary infections from the use of a catheter
following surgery increased by 3.6 percent
• Rates of bloodstream infections following surgery
increased by 8 percent
in 2009 per HHS The good news is that the Health Research & Educational
Trust (HRET), through a contract with the Agency for
Healthcare Research and Quality (AHRQ), and in partner-
Quality Report ship with the Johns Hopkins University Quality and Safety
Research Group, the Keystone Center for Patient Safety
and Quality of the Michigan Health & Hospital Association
(MHA Keystone) and investigators from the University of
New collaborative formed Michigan are implementing a patient safety program to
dramatically reduce CAUTI nationwide.2
to reduce HAIs
The project is called “On the CUSP: Stop HAI.”
Key project goals are to: 2
When the U.S. Department of Health and
• Reduce mean catheter-associated urinary tract
infection (CAUTI) rates in participating ICUs and
other clinical units by 25 percent over two years
showed little progress on eliminating
• Disseminate CUSP (Comprehensive Unit-based Safety
hospital-acquired infections and called
Program) education modules to improve patient safety.
for urgent attention to address
• Partner with the Centers for Disease Control and
shortcomings.1
Prevention (CDC) to support the measurement and
timely feedback of CAUTI and other healthcare-
acquired infection (HAI) data, and for state hospital
associations to partner with state-based organizations
to address the elimination of HAIs.
For more information, visit
www.onthecusptostophai.org
References
1 U.S. Department of Health and Human Services. Agency for Healthcare
Research and Quality. National Healthcare Quality Report, 2009. Key Themes
and Highlights from the National Healthcare Quality Report. Available at:
www.ahrq.gov/qual/nhqr09/Key.htm. Accessed June 2, 2010.
2 Stop UTI. On the Cusp: Stop HAI website. Available at
www.onthecusptostophai.org. Accessed June 2, 2010.
Aligning practice with policy to improve patient care 21
 Q: Is it acceptable to use single-use medication vials
or pre-filled syringes for more than one patient?
A: NO. Medication vials that are labeled for single-use and
pre-filled medication syringes should never be used for more
than one patient.
Q: When should a multi-dose medication vial be discarded?
A: Medication vials should be discarded upon expiration or any
time there are concerns regarding the sterility of the medication.
Q: Is it acceptable to leave a needle or other device
inserted in the septum of a medication vial for multiple
medication draws?
A: NO. A needle or other device should never be left inserted
into a medication vial septum for multiple uses. This provides
a direct route for microorganisms to enter the vial and contam-
inate the fluid.
Q: What is the best way to use multi-dose medication vials?
A: The safest thing to do is restrict each medication vial to a sin-
gle patient, even if it’s a multi-dose vial. Proper aseptic tech-
nique should always be followed. If multi-dose medication vials
must be used for more than one patient, the vial should only
be accessed with a new sterile syringe and needle. It is also
preferred that these medications not be prepared in the imme-
diate patient care area.
Q: Is it acceptable to combine leftover medication from
single-use vials?
A: NO. Do not administer medications from single-use vials
or ampules to multiple patients or combine leftover contents
for later use.
Q: Is it acceptable to use the same syringe to give an IM or
IV injection to more than one patient if I change the needle
between patients and I don't draw back before injecting?
A: NO. A small amount of blood can flow into the needle
and syringe even when only positive pressure is applied out-
ward. The syringe and needle are both contaminated and must
be discarded.
Source: Centers for Disease Control and Prevention
The One & Only Campaign Promoting safe injection practices
The One & Only Campaign is a public health campaign, led by the Centers for Disease
Control and Prevention (CDC) and the Safe Injection Practices Coalition (SIPC), to raise
awareness among patients and healthcare providers about safe injection practices.
The campaign aims to eradicate outbreaks resulting from unsafe injection practices.
To learn more about the campaign, visit www.oneandonlycampaign.org.
20 The OR Connection
Q: If I used a syringe only to infuse medications into an
IV tubing port that is several feet away from the patient's
IV catheter site, is it ok to use the same syringe for
another patient?
A: NO. Everything from the medication bag to the patient’s
catheter is a single interconnected unit. All of the components
are directly or indirectly exposed to the patient'’s blood and
cannot be used for another patient. A syringe that intersects
through ports in the IV tubing or bags also becomes contami-
nated and cannot be used for another patient. Separation from
the patient’s IV by distance, gravity, and/or positive infusion
Infections Increased
pressure does not ensure that small amounts of blood are not
present in these items.
Q: Are these recommendations new?
A: NO. These recommendations are part of established guid-
ance. It is a well established practice to never use the same
syringe or needle for more than one patient nor to enter a med-
ication vial with a syringe or needle used for one patient if the
same vial might be used for another patient.
Q: Why can't I just visually inspect syringes to determine
whether they are contaminated or can be used again?
A: Pathogens including HCV, HBV, and human immunodefi-
ciency virus (HIV) can be present in sufficient quantities to pro-
duce infection in the absence of visible blood. Similarly, bacteria
Human Services (HHS) 2009 quality report to
and other microbes can be present without clouding or other
Congress came out this past April 2010, it
visible evidence of contamination. Just because you don't see
blood or other material in a used syringe or IV tubing does not
mean the item is free from potentially infectious agents. All used
injection supplies and materials are potentially contaminated
and should be discarded.
Q: How can healthcare providers ensure that injections
are performed correctly?
A: To help ensure that staff understand and adhere to safe
injection practices, we recommend the following:
• Designate someone to provide ongoing oversight for
infection control issues
• Develop written infection control policies
• Provide training
• Conduct quality assurance assessments
CAUTI,
Bloodstream The report showed the following:1
• Urinary infections from the use of a catheter
following surgery increased by 3.6 percent
• Rates of bloodstream infections following surgery
increased by 8 percent
in 2009 per HHS The good news is that the Health Research & Educational
Trust (HRET), through a contract with the Agency for
Healthcare Research and Quality (AHRQ), and in partner-
Quality Report ship with the Johns Hopkins University Quality and Safety
Research Group, the Keystone Center for Patient Safety
and Quality of the Michigan Health & Hospital Association
(MHA Keystone) and investigators from the University of
New collaborative formed Michigan are implementing a patient safety program to
dramatically reduce CAUTI nationwide.2
to reduce HAIs
The project is called “On the CUSP: Stop HAI.”
Key project goals are to: 2
When the U.S. Department of Health and
• Reduce mean catheter-associated urinary tract
infection (CAUTI) rates in participating ICUs and
other clinical units by 25 percent over two years
showed little progress on eliminating
• Disseminate CUSP (Comprehensive Unit-based Safety
hospital-acquired infections and called
Program) education modules to improve patient safety.
for urgent attention to address
• Partner with the Centers for Disease Control and
shortcomings.1
Prevention (CDC) to support the measurement and
timely feedback of CAUTI and other healthcare-
acquired infection (HAI) data, and for state hospital
associations to partner with state-based organizations
to address the elimination of HAIs.
For more information, visit
www.onthecusptostophai.org
References
1 U.S. Department of Health and Human Services. Agency for Healthcare
Research and Quality. National Healthcare Quality Report, 2009. Key Themes
and Highlights from the National Healthcare Quality Report. Available at:
www.ahrq.gov/qual/nhqr09/Key.htm. Accessed June 2, 2010.
2 Stop UTI. On the Cusp: Stop HAI website. Available at
www.onthecusptostophai.org. Accessed June 2, 2010.
Aligning practice with policy to improve patient care 21
 OR Issues

PerforMAX
SURGICAL SCRUBS
Superior performance
in the OR and in the wash
PerforMAX high-performance surgical scrubs
are a Medline exclusive. The proprietary blend of
specially selected synthetic fibers moves heat
updates standards
and moisture away from the skin while remaining
light and dry. on surgical attire
PerforMAX scrubs also hold color better, won’t
fade or shrink, and last longer. Fewer replacements
mean more uses. What’s more, the fibers simulate Facility laundering now recommended AORN standards previously preferred professional laun-
the absorbency of cotton, yet they release moisture The Association of periOperative Registered Nurses dering of surgical attire, yet still allowed for home launder-
quickly for improved drying times and stain resistance. (AORN) has revised its Recommended Practices for ing as long as certain products and temperatures were
Surgical Attire to reflect the most current evidence-based used. The standards now strongly discourage home laun-
practices regarding patient and staff safety. dering because it cannot be monitored to ensure the same

“ We turn or process these scrubs on a

daily basis and they finish out the same today
as they did after the first laundering. The staff
and doctors who wear them are happy with
the feel and fit too.”
- Tony Ellerbrock
Cintas Laundry Services
Lima, OH
Try the PerforMAX difference! Simply go to
www.medline.com/offers/performax for a free
sample scrub top or pants in your choice of
color and size.
“The key regarding surgical attire is to keep in mind
patient and personal safety. Because surgical attire is
something perioperative nurses ‘do’ every day, it’s impor-
tant for perioperative leaders to regularly remind their
teams about the safety hazards that can occur if nurses
don’t follow appropriate guidelines for surgical attire,” said
Joan Blanchard, RN, BSN, MSS, CNOR,CIC, an AORN
perioperative nursing specialist responsible for overseeing
AORN’s recommended practices for surgical attire. She
was quoted in the June 2010 issue of the AORN
Connections newsletter.
The primary change is AORN’s new recommendation that
healthcare organizations should provide freshly laundered
or disposable surgical attire for all personnel entering the
perioperative suite.
level of quality and standardized practices that can be
achieved in certified laundry facilities. These facilities have
the technology and tools to reduce infectious diseases
and harmful pathogens in soiled surgical laundry.
The standards now strongly discourage home
laundering because it cannot be monitored to
ensure the same level of quality
Blanchard specifically noted a 2007 study by Gerba and
Boone that showed a correlation between the presence
of infectious diseases on objects, clothing, hands and
other surfaces and the transmission of infectious disease
among patients.
Source: Stanton C. Thinking about safe surgical attire.
AORN Connections. 2010;8(6):1,8-9.

Aligning practice with policy to improve patient care 23

©2010 Medline Industries, Inc.
Medline is a registered trademark of Medline Industries, Inc.
 OR Issues

PerforMAX
SURGICAL SCRUBS
Superior performance
in the OR and in the wash
PerforMAX high-performance surgical scrubs
are a Medline exclusive. The proprietary blend of
specially selected synthetic fibers moves heat
updates standards
and moisture away from the skin while remaining
light and dry. on surgical attire
PerforMAX scrubs also hold color better, won’t
fade or shrink, and last longer. Fewer replacements
mean more uses. What’s more, the fibers simulate Facility laundering now recommended AORN standards previously preferred professional laun-
the absorbency of cotton, yet they release moisture The Association of periOperative Registered Nurses dering of surgical attire, yet still allowed for home launder-
quickly for improved drying times and stain resistance. (AORN) has revised its Recommended Practices for ing as long as certain products and temperatures were
Surgical Attire to reflect the most current evidence-based used. The standards now strongly discourage home laun-
practices regarding patient and staff safety. dering because it cannot be monitored to ensure the same

“ We turn or process these scrubs on a

daily basis and they finish out the same today
as they did after the first laundering. The staff
and doctors who wear them are happy with
the feel and fit too.”
- Tony Ellerbrock
Cintas Laundry Services
Lima, OH
Try the PerforMAX difference! Simply go to
www.medline.com/offers/performax for a free
sample scrub top or pants in your choice of
color and size.
“The key regarding surgical attire is to keep in mind
patient and personal safety. Because surgical attire is
something perioperative nurses ‘do’ every day, it’s impor-
tant for perioperative leaders to regularly remind their
teams about the safety hazards that can occur if nurses
don’t follow appropriate guidelines for surgical attire,” said
Joan Blanchard, RN, BSN, MSS, CNOR,CIC, an AORN
perioperative nursing specialist responsible for overseeing
AORN’s recommended practices for surgical attire. She
was quoted in the June 2010 issue of the AORN
Connections newsletter.
The primary change is AORN’s new recommendation that
healthcare organizations should provide freshly laundered
or disposable surgical attire for all personnel entering the
perioperative suite.
level of quality and standardized practices that can be
achieved in certified laundry facilities. These facilities have
the technology and tools to reduce infectious diseases
and harmful pathogens in soiled surgical laundry.
The standards now strongly discourage home
laundering because it cannot be monitored to
ensure the same level of quality
Blanchard specifically noted a 2007 study by Gerba and
Boone that showed a correlation between the presence
of infectious diseases on objects, clothing, hands and
other surfaces and the transmission of infectious disease
among patients.
Source: Stanton C. Thinking about safe surgical attire.
AORN Connections. 2010;8(6):1,8-9.

Aligning practice with policy to improve patient care 23

©2010 Medline Industries, Inc.
Medline is a registered trademark of Medline Industries, Inc.
 Support Staff

Housekeeping

Benefits Of A Great
Patient Transfer
Work Environment
Nursing (RNs) By Greg Smith

Advanced Care Partners Businesses can improve retention and make their organization
the good place to work by following the five-step PRIDE model:

Respiratory Therapy
P – Provide a positive working environment
R – Recognize, reinforce, and reward individual efforts
Physical Therapy I – Involve and engage everyone
D – Develop the potential of your workforce

Volunteers
E – Evaluate and hold managers accountable

http://workz.com/content/view_content.html?
Nursing Assistants section_id=531&content_id=6965

LOOK GREAT AND IMPROVE PATIENT SAFETY AND SATISFACTION

WITH COLOR-BY-DISCIPLINE Medline Named One of Becker’s

100 Best Places to Your Medline Doll Can Look
SuiteStyles® by Medline is a color-by-discipline With SuiteStyles you will also receive: as Great as You Do!
uniform program that helps patients quickly identify an
employee by the color they are wearing. The apparel
• Scrubs sizing events to try on garments
before ordering
Work in Healthcare
SuiteStyles Nurse Scrubs
line features breathtaking colors and fabulous styles. • Bag-by-name delivery - orders are individually and Accessories Set
bagged, boxed by department and delivered to Becker’s recognizes company for
What people are saying about SuiteStyles… each department “Excellence in Promoting Teamwork, Brought to you by Medline’s SuiteStyles color-by-
• Custom online store for employee reorders that

“ …I have personally been able to compare the Professional Development” discipline uniform program, you and your doll will
complements your unique uniform program
before and after! I had surgery in December when get noticed by the color you wear!
everyone was wearing whatever they wanted. Then, Medline Industries, Inc. has been named one of the “100 Best
in July, I had an emergency operation and was Places to Work in Healthcare” for 2010 by Becker's ASC Review The doll scrubs and accessories set includes:
thrilled to know who (nurse, tech, other) was walking and Becker's Hospital Review, well respected industry publications. contrast trim top, drawstring pants, cardigan
into my room before he/she got close enough for me jacket, stethoscope and Oxypas clogs. The
to see their tag. Wow, what a difference!” According to Becker’s, the list was developed “through nomina- set will be available for sale in June 2010 at
tions, recommendations and research, and the organizations were www.medline.com/dolls.
- Mary McMahon, Director Perinatal Services, selected for their demonstrated excellence in creating a work envi-
Memorial Health System ronment promoting teamwork, professional development and qual- Enter the following code at checkout for a
ity patient care.” discount off your Medline Doll Nurse Scrubs
and Accessories Set: DOLL10 - 00022

Visit www.SuiteStyles.com to learn more about Discount expires December 31, 2010.
color-by-discipline and browse a sample store.

©2010 Medline Industries, Inc.

©2010 Medline Industries, Inc. Medline and SuiteStyles are registered trademarks of Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
 Support Staff

Housekeeping

Benefits Of A Great
Patient Transfer
Work Environment
Nursing (RNs) By Greg Smith

Advanced Care Partners Businesses can improve retention and make their organization
the good place to work by following the five-step PRIDE model:

Respiratory Therapy
P – Provide a positive working environment
R – Recognize, reinforce, and reward individual efforts
Physical Therapy I – Involve and engage everyone
D – Develop the potential of your workforce

Volunteers
E – Evaluate and hold managers accountable

http://workz.com/content/view_content.html?
Nursing Assistants section_id=531&content_id=6965

LOOK GREAT AND IMPROVE PATIENT SAFETY AND SATISFACTION

WITH COLOR-BY-DISCIPLINE Medline Named One of Becker’s

100 Best Places to Your Medline Doll Can Look
SuiteStyles® by Medline is a color-by-discipline With SuiteStyles you will also receive: as Great as You Do!
uniform program that helps patients quickly identify an
employee by the color they are wearing. The apparel
• Scrubs sizing events to try on garments
before ordering
Work in Healthcare
SuiteStyles Nurse Scrubs
line features breathtaking colors and fabulous styles. • Bag-by-name delivery - orders are individually and Accessories Set
bagged, boxed by department and delivered to Becker’s recognizes company for
What people are saying about SuiteStyles… each department “Excellence in Promoting Teamwork, Brought to you by Medline’s SuiteStyles color-by-
• Custom online store for employee reorders that

“ …I have personally been able to compare the Professional Development” discipline uniform program, you and your doll will
complements your unique uniform program
before and after! I had surgery in December when get noticed by the color you wear!
everyone was wearing whatever they wanted. Then, Medline Industries, Inc. has been named one of the “100 Best
in July, I had an emergency operation and was Places to Work in Healthcare” for 2010 by Becker's ASC Review The doll scrubs and accessories set includes:
thrilled to know who (nurse, tech, other) was walking and Becker's Hospital Review, well respected industry publications. contrast trim top, drawstring pants, cardigan
into my room before he/she got close enough for me jacket, stethoscope and Oxypas clogs. The
to see their tag. Wow, what a difference!” According to Becker’s, the list was developed “through nomina- set will be available for sale in June 2010 at
tions, recommendations and research, and the organizations were www.medline.com/dolls.
- Mary McMahon, Director Perinatal Services, selected for their demonstrated excellence in creating a work envi-
Memorial Health System ronment promoting teamwork, professional development and qual- Enter the following code at checkout for a
ity patient care.” discount off your Medline Doll Nurse Scrubs
and Accessories Set: DOLL10 - 00022

Visit www.SuiteStyles.com to learn more about Discount expires December 31, 2010.
color-by-discipline and browse a sample store.

©2010 Medline Industries, Inc.

©2010 Medline Industries, Inc. Medline and SuiteStyles are registered trademarks of Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
 Special Feature

Ambulatory Surgery Center

Quality Collaboration
Expands Mission
All in a Day’s Work
Military Nursing in

Iraq
About 32 miles north of Bagh-
dad, Iraq, an oasis of sorts rises
up from the hot desert sands. It’s
the Joint Base Balad, and once
you’re inside this safe haven,
you would have no idea you were so close
to a war zone. Well, except for maybe the
occasional mortar blast.

26 The OR Connection Aligning practice with policy to improve patient care 27

 Special Feature

Ambulatory Surgery Center

Quality Collaboration
Expands Mission
All in a Day’s Work
Military Nursing in

Iraq
About 32 miles north of Bagh-
dad, Iraq, an oasis of sorts rises
up from the hot desert sands. It’s
the Joint Base Balad, and once
you’re inside this safe haven,
you would have no idea you were so close
to a war zone. Well, except for maybe the
occasional mortar blast.

26 The OR Connection Aligning practice with policy to improve patient care 27

 Left: Outside Major Melanie McDonald (standing,
the cement at right) with two co-workers at the
barricade that Balad Air Force Theater Hospital.
protects
Joint Base
Balad.

Right:
Transporting
a patient to
Germany.

U.S. Air Force Major Melanie McDonald, a registered nurse,
was deployed to Balad from May to August 2005, where she
had the opportunity to share her nursing skills at the Balad
Air Force Theater Hospital (AFTH), housed almost entirely
under tents.
But don’t let the tent structure fool you, it was a fully func-
tioning acute care hospital equivalent to a civilian Level I
trauma center, with all the main areas of any stateside brick
and mortar hospital: an emergency department, five med-
ical/surgical wards, three ICUs, and five operating suites. The
ORs were the only areas housed inside a more substan-
tial structure – metal trailers referred to as conexes.
The tent hospital was barricaded all around with sandbags 5
feet high, as well as 10 foot high concrete barriers, as pro-
tection from mortars, which Melanie said came by two to
three times a day.
“Luckily, there were limited injuries related to these attacks,”
Caring for patients
The AFTH provided care to U.S. forces, civilians and con-
tractors, as well as coalition forces, Iraqi military, civilians and
detainees. The majority of treatment involved washing out
wounds and caring for burns and eye injuries. Similarly, most
of the surgeries were to repair eye injuries, burns and gun-
shot and mortar wounds. There were also many amputations
of wounded limbs that could not be saved. The average
hospital census was 30 to 50 patients on any given day. More
than 500 emergency room patients were admitted and 600
surgical procedures were performed each month.
Patients who required air evacuation for further care at Land-
stuhl Regional Medical Center in Germany usually remained
less than 24 hours, and those with potential for immediate re-
turn to duty were kept up to two days in order to clear them
for duty. The hospital boasted a 97 percent survival rate dur-
ing the time Melanie was there; current reports have in-
creased to 98 percent.
Much the same as any acute care hospital, patients first
arrived to the emergency department (usually by helicopter),
where they were triaged, and then, depending on the severity
of their condition, transferred for immediate surgery or care
in the ICU or med/surg wards.
“We had a very active OR, which performed between five
and 20 surgeries per night,” she said. “Ours was the only
facility with neurosurgeons on staff. We also had ophthal-
mologists, orthopedic surgeons, urologists and cardiotho-
racic surgeons.”
A day in the life of a military tent hospital
nursing supervisor
So what kind of challenges do you think a nursing supervisor
would face working on a military base near a war zone? Well,
for Melanie the challenges were much the same as any nursing
supervisor would face at a civilian hospital back in the United
States. Surprised?
Melanie said she wasn’t. “I guess it shows that people are
people no matter where they are, and the same kinds of
issues come up.”
To provide some background, the Balad Air Force Theater
Hospital has most of the modern amenities of any hospital:
advanced equipment and supplies, adequate staffing and
even air conditioning. Likewise, the military base itself is like
a small city, with five dining facilities and plentiful food, cof-
fee shops complete with lattes, three recreation centers with
televisions, Internet, pool tables and snacks, Olympic-size
indoor and outdoor swimming pools, fitness facilities and a
movie theatre with all current release movies. In short, every
basic need and then some are met.
So, what was Melanie’s biggest challenge?
Conflicts among staff. Sound familiar?
“A big issue almost every night was figuring out who would

Melanie said. “The hospital was never actually hit while she
was there. But every time there was a mortar attack, most
staff would calmly put on their body armor and helmets as
they continued caring for patients, while other staff members
escorted ambulatory patients into the cement bunkers just
outside the tent facility.
“We told the bed-ridden patients to remain lying down (keep-
“
Melanie spent the first half of her deployment as a bedside
nurse, and then when she accepted an extension of her tour
in Iraq, she was promoted to nursing supervisor of the hos-
pital on nights.
Similar to a nursing supervisor at a civilian hospital, Melanie
managed the flow of patients and staff throughout the facility.
She needed to know when the helicopters were coming in,
The military base itself is like a small city, with
five dining facilities and plentiful food, coffee
shops complete with lattes, three recreation
centers with televisions, Internet, pool tables
and snacks, Olympic-size indoor and outdoor
swimming pools, fitness facilities and a movie
run out for chow,” Melanie said.
Clinical staff felt they were too busy, and they pointed to
administrative staff to go out because they “were just sitting
there at their computers.”
“I had to make the determination each night, based on who
I really needed at the hospital. As it turned out, I usually

ing them below the level of outside sandbag protection), and
we just continued on as usual. You get used to it,” she said.
”
theatre with all current release movies. couldn’t be without my administrative staff, so I sent clinical
including the number of injured. Based on that information,
she needed to make sure there was adequate staffing and people out for food. That usually didn’t go over too well, but
that patient beds and ORs were available and ready.

28 The OR Connection Aligning practice with policy to improve patient care 29

 Left: Outside Major Melanie McDonald (standing,
the cement at right) with two co-workers at the
barricade that Balad Air Force Theater Hospital.
protects
Joint Base
Balad.

Right:
Transporting
a patient to
Germany.

U.S. Air Force Major Melanie McDonald, a registered nurse,
was deployed to Balad from May to August 2005, where she
had the opportunity to share her nursing skills at the Balad
Air Force Theater Hospital (AFTH), housed almost entirely
under tents.
But don’t let the tent structure fool you, it was a fully func-
tioning acute care hospital equivalent to a civilian Level I
trauma center, with all the main areas of any stateside brick
and mortar hospital: an emergency department, five med-
ical/surgical wards, three ICUs, and five operating suites. The
ORs were the only areas housed inside a more substan-
tial structure – metal trailers referred to as conexes.
The tent hospital was barricaded all around with sandbags 5
feet high, as well as 10 foot high concrete barriers, as pro-
tection from mortars, which Melanie said came by two to
three times a day.
“Luckily, there were limited injuries related to these attacks,”
Caring for patients
The AFTH provided care to U.S. forces, civilians and con-
tractors, as well as coalition forces, Iraqi military, civilians and
detainees. The majority of treatment involved washing out
wounds and caring for burns and eye injuries. Similarly, most
of the surgeries were to repair eye injuries, burns and gun-
shot and mortar wounds. There were also many amputations
of wounded limbs that could not be saved. The average
hospital census was 30 to 50 patients on any given day. More
than 500 emergency room patients were admitted and 600
surgical procedures were performed each month.
Patients who required air evacuation for further care at Land-
stuhl Regional Medical Center in Germany usually remained
less than 24 hours, and those with potential for immediate re-
turn to duty were kept up to two days in order to clear them
for duty. The hospital boasted a 97 percent survival rate dur-
ing the time Melanie was there; current reports have in-
creased to 98 percent.
Much the same as any acute care hospital, patients first
arrived to the emergency department (usually by helicopter),
where they were triaged, and then, depending on the severity
of their condition, transferred for immediate surgery or care
in the ICU or med/surg wards.
“We had a very active OR, which performed between five
and 20 surgeries per night,” she said. “Ours was the only
facility with neurosurgeons on staff. We also had ophthal-
mologists, orthopedic surgeons, urologists and cardiotho-
racic surgeons.”
A day in the life of a military tent hospital
nursing supervisor
So what kind of challenges do you think a nursing supervisor
would face working on a military base near a war zone? Well,
for Melanie the challenges were much the same as any nursing
supervisor would face at a civilian hospital back in the United
States. Surprised?
Melanie said she wasn’t. “I guess it shows that people are
people no matter where they are, and the same kinds of
issues come up.”
To provide some background, the Balad Air Force Theater
Hospital has most of the modern amenities of any hospital:
advanced equipment and supplies, adequate staffing and
even air conditioning. Likewise, the military base itself is like
a small city, with five dining facilities and plentiful food, cof-
fee shops complete with lattes, three recreation centers with
televisions, Internet, pool tables and snacks, Olympic-size
indoor and outdoor swimming pools, fitness facilities and a
movie theatre with all current release movies. In short, every
basic need and then some are met.
So, what was Melanie’s biggest challenge?
Conflicts among staff. Sound familiar?
“A big issue almost every night was figuring out who would

Melanie said. “The hospital was never actually hit while she
was there. But every time there was a mortar attack, most
staff would calmly put on their body armor and helmets as
they continued caring for patients, while other staff members
escorted ambulatory patients into the cement bunkers just
outside the tent facility.
“We told the bed-ridden patients to remain lying down (keep-
“
Melanie spent the first half of her deployment as a bedside
nurse, and then when she accepted an extension of her tour
in Iraq, she was promoted to nursing supervisor of the hos-
pital on nights.
Similar to a nursing supervisor at a civilian hospital, Melanie
managed the flow of patients and staff throughout the facility.
She needed to know when the helicopters were coming in,
The military base itself is like a small city, with
five dining facilities and plentiful food, coffee
shops complete with lattes, three recreation
centers with televisions, Internet, pool tables
and snacks, Olympic-size indoor and outdoor
swimming pools, fitness facilities and a movie
run out for chow,” Melanie said.
Clinical staff felt they were too busy, and they pointed to
administrative staff to go out because they “were just sitting
there at their computers.”
“I had to make the determination each night, based on who
I really needed at the hospital. As it turned out, I usually

ing them below the level of outside sandbag protection), and
we just continued on as usual. You get used to it,” she said.
”
theatre with all current release movies. couldn’t be without my administrative staff, so I sent clinical
including the number of injured. Based on that information,
she needed to make sure there was adequate staffing and people out for food. That usually didn’t go over too well, but
that patient beds and ORs were available and ready.

28 The OR Connection Aligning practice with policy to improve patient care 29

 Setting up for a bedside radiology
exam at the Balad Air Force Theater
Hospital. (Note the tent walls.)

SAFER CATHETERIZATION
FOR KIDS
those were the decisions I needed to make as supervisor,” a control room at Davis-Monthan Air Force base in Tucson,
Pediatric
Melanie said. Arizona, as part of a new mission being undertaken by the Catheter
183rd Air Operations Group. Tray
Reflecting on the time she spent in Balad, Melanie said,
“I will never be the same after this experience – being a part “I’m really excited to take on this new mission. My team is
of an amazing team of caregivers in a joint (and multi-cul- tasked to be ready for this mission by 2011,” she said.
tural) military environment at the world’s busiest and most
successful trauma center – the first forward operating
theater hospital of it’s kind since Vietnam.” Children’s
Introducing Medline’s new Activities

She said she also felt an undeniable sense of divine inter- Pediatric Catheter Tray. The
vention over all that went on in the tent hospital. “Watching latest addition to the innovative
the love, compassion and patriotism flow out of the men and ERASE CAUTI product line.
women I worked with, pouring their hearts into their work in
Sometimes, you just need a buddy. Buddy
ra
mB v
all situations from the care of an Iraqi child to a U.S. or Iraqi
the Brave lion cub is here to help your youngest
service member...witnessing the courage of our injured

e
catheter patients. Along with some serious patient

I’
military men and women in the worst of circumstances … Key Stats
Balad Air Force Theater Hospital (and parent) education resources, you’ll find some
believing in their mission, injured, on their way to Germany,
• 98 percent survival rate upbeat fun and even a bravery award sticker in
excited to reunite with family, but, of course, wishing only that

dy
• 30-50 average daily census/admissions every tray.

Li
they could return to duty … and lastly, the indescribable sense ke
of peace felt after returning home and feeling safe again.” •
•
5-20 surgeries per night/600 per month
1 emergency department
But it’s more than just fun. There’s published evidence Bud
that distraction helps children tolerate unpleasant
Plans for the future • 3 fully functioning medical/surgical wards Bravery Sticker
procedures better than adult reassurance does.
Fast forward to 2010, Melanie just completed a tour as a with room to expand to 5
Chief Nurse Executive at the 183rd Medical Group, Illinois • 2 fully functioning intensive care units with You trust Medline for clinical innovations, such as our To learn more about Medline’s ERASE CAUTI
Air National Guard base in Springfield, Ill. She is currently room to expand to 3 industry-leading catheter tray design. Now, we can be program and alternatives to catheterization,
training to be an Aeromedical Evacuation Control Team Chief, • 5 operating suites with 8 OR tables your patient’s buddy, too. visit http://erasecauti.com.
tasked with directing patient movement missions over Cen-
tral and South America. These missions will be tasked out of

30 The OR Connection ©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
 Setting up for a bedside radiology
exam at the Balad Air Force Theater
Hospital. (Note the tent walls.)

SAFER CATHETERIZATION
FOR KIDS
those were the decisions I needed to make as supervisor,” a control room at Davis-Monthan Air Force base in Tucson,
Pediatric
Melanie said. Arizona, as part of a new mission being undertaken by the Catheter
183rd Air Operations Group. Tray
Reflecting on the time she spent in Balad, Melanie said,
“I will never be the same after this experience – being a part “I’m really excited to take on this new mission. My team is
of an amazing team of caregivers in a joint (and multi-cul- tasked to be ready for this mission by 2011,” she said.
tural) military environment at the world’s busiest and most
successful trauma center – the first forward operating
theater hospital of it’s kind since Vietnam.” Children’s
Introducing Medline’s new Activities

She said she also felt an undeniable sense of divine inter- Pediatric Catheter Tray. The
vention over all that went on in the tent hospital. “Watching latest addition to the innovative
the love, compassion and patriotism flow out of the men and ERASE CAUTI product line.
women I worked with, pouring their hearts into their work in
Sometimes, you just need a buddy. Buddy
ra
mB v
all situations from the care of an Iraqi child to a U.S. or Iraqi
the Brave lion cub is here to help your youngest
service member...witnessing the courage of our injured

e
catheter patients. Along with some serious patient

I’
military men and women in the worst of circumstances … Key Stats
Balad Air Force Theater Hospital (and parent) education resources, you’ll find some
believing in their mission, injured, on their way to Germany,
• 98 percent survival rate upbeat fun and even a bravery award sticker in
excited to reunite with family, but, of course, wishing only that

dy
• 30-50 average daily census/admissions every tray.

Li
they could return to duty … and lastly, the indescribable sense ke
of peace felt after returning home and feeling safe again.” •
•
5-20 surgeries per night/600 per month
1 emergency department
But it’s more than just fun. There’s published evidence Bud
that distraction helps children tolerate unpleasant
Plans for the future • 3 fully functioning medical/surgical wards Bravery Sticker
procedures better than adult reassurance does.
Fast forward to 2010, Melanie just completed a tour as a with room to expand to 5
Chief Nurse Executive at the 183rd Medical Group, Illinois • 2 fully functioning intensive care units with You trust Medline for clinical innovations, such as our To learn more about Medline’s ERASE CAUTI
Air National Guard base in Springfield, Ill. She is currently room to expand to 3 industry-leading catheter tray design. Now, we can be program and alternatives to catheterization,
training to be an Aeromedical Evacuation Control Team Chief, • 5 operating suites with 8 OR tables your patient’s buddy, too. visit http://erasecauti.com.
tasked with directing patient movement missions over Cen-
tral and South America. These missions will be tasked out of

30 The OR Connection ©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
 OR Issues

Ways to make surgery more list of ite ms to

Check n the OR
GO GREEN IN THE environmentally friendly recycle i terials a
tic packing m aste)1

OR
❑ P la s al w
tal surgic
(30% of to rd
o r r u g ate d cardboa
❑C oxes
With statistics showing that U.S. healthcare facilities dispose
r a ft p a p er bags, b
❑K
of more than four billion pounds of waste per year,1 any effort oard
and chipb jars
to reduce waste is a step in the right direction. Based on ottles and
anecdotal reports, operating rooms (ORs) are the biggest ❑ Glass b
s
waste generator, producing 20 to 30 percent of total hospital ❑ Plastic a r to n s and tray
s
a m c
waste, even though they represent a proportionally small area ❑ Styrofo
rile wrap
❑ Blue ste
1
of the hospital.2 ste)
ta l su rgical wa
(19% of to
To give an even more practical perspective, one routine oper-
ation in a hospital often generates more waste than a family of
four might produce in one week. One reason ORs generate so carefully analyze the contents of surgical and anesthesia kits
much waste is the need for absolute sterility of surgical sup- to ensure all supplies are being used. For example, the five
plies and equipment, which creates the need for extra pack- hospitals in one health system in the Pacific Northwest
aging and an impetus for the use of disposable equipment.2 worked with their surgical pack supplier to eliminate rarely
used items, saving the system roughly $30,000 per year and
Although there are many ways to reduce, reuse and recycle in eliminating 11,000 pounds of waste.3
the operating room, let’s focus on the following four basic
strategies: reviewing and revising surgical pack contents, Recycling
recycling product packaging and other waste, donating The OR also presents substantial opportunities for recycling,
unneeded medical equipment and supplies and using LED especially in the form of product packaging. In fact, a guid-
surgical lights instead of halogen. ance statement from the Association of periOperative Regis-
tered Nurses (AORN) recommends recycling paper,
Reviewing and revising surgical pack contents plastic, glass, cardboard, sterilization (“blue”) wrap and
Most surgical supplies come packed inside an individual sur- other noninfectious waste.4
gical kit for each surgery. These kits may contain a standard
set of supplies, or may be custom-packed by the vendor with Surgeons and nurses at one Oregon hospital recycle about
specifically requested items. Standard kits have the potential 300 pounds of uncontaminated paper and plastic products
to increase waste if not all items in the kit are routinely used, from their 21 operating rooms each day. The recycled mate-
or if extra kits are regularly opened to obtain only a single com- rials include the packaging components that surround steril-
ponent that is not available by itself.2 Once the pack has been ized instruments, suture material and gauze pads.5 During
opened, it is no longer considered sterile, and the rest of the 2007, the hospital recycled nearly 1,100 tons of solid waste
components cannot be used for another patient. Similarly, and saved more than $85,000 in waste management fees.6
poorly planned contents inside custom kits can also produce
waste issues. Donating equipment and supplies
In the past it’s been all too easy, not to mention expensive, for
To avoid routinely ordering custom packs with disposable hospitals across the country to discard equipment and sup-
items that are used infrequently or not at all, many facilities plies into dumpsters ultimately headed for landfills. With a

32 The OR Connection Aligning practice with policy to improve patient care 33

 OR Issues

Ways to make surgery more list of ite ms to

Check n the OR
GO GREEN IN THE environmentally friendly recycle i terials a
tic packing m aste)1

OR
❑ P la s al w
tal surgic
(30% of to rd
o r r u g ate d cardboa
❑C oxes
With statistics showing that U.S. healthcare facilities dispose
r a ft p a p er bags, b
❑K
of more than four billion pounds of waste per year,1 any effort oard
and chipb jars
to reduce waste is a step in the right direction. Based on ottles and
anecdotal reports, operating rooms (ORs) are the biggest ❑ Glass b
s
waste generator, producing 20 to 30 percent of total hospital ❑ Plastic a r to n s and tray
s
a m c
waste, even though they represent a proportionally small area ❑ Styrofo
rile wrap
❑ Blue ste
1
of the hospital.2 ste)
ta l su rgical wa
(19% of to
To give an even more practical perspective, one routine oper-
ation in a hospital often generates more waste than a family of
four might produce in one week. One reason ORs generate so carefully analyze the contents of surgical and anesthesia kits
much waste is the need for absolute sterility of surgical sup- to ensure all supplies are being used. For example, the five
plies and equipment, which creates the need for extra pack- hospitals in one health system in the Pacific Northwest
aging and an impetus for the use of disposable equipment.2 worked with their surgical pack supplier to eliminate rarely
used items, saving the system roughly $30,000 per year and
Although there are many ways to reduce, reuse and recycle in eliminating 11,000 pounds of waste.3
the operating room, let’s focus on the following four basic
strategies: reviewing and revising surgical pack contents, Recycling
recycling product packaging and other waste, donating The OR also presents substantial opportunities for recycling,
unneeded medical equipment and supplies and using LED especially in the form of product packaging. In fact, a guid-
surgical lights instead of halogen. ance statement from the Association of periOperative Regis-
tered Nurses (AORN) recommends recycling paper,
Reviewing and revising surgical pack contents plastic, glass, cardboard, sterilization (“blue”) wrap and
Most surgical supplies come packed inside an individual sur- other noninfectious waste.4
gical kit for each surgery. These kits may contain a standard
set of supplies, or may be custom-packed by the vendor with Surgeons and nurses at one Oregon hospital recycle about
specifically requested items. Standard kits have the potential 300 pounds of uncontaminated paper and plastic products
to increase waste if not all items in the kit are routinely used, from their 21 operating rooms each day. The recycled mate-
or if extra kits are regularly opened to obtain only a single com- rials include the packaging components that surround steril-
ponent that is not available by itself.2 Once the pack has been ized instruments, suture material and gauze pads.5 During
opened, it is no longer considered sterile, and the rest of the 2007, the hospital recycled nearly 1,100 tons of solid waste
components cannot be used for another patient. Similarly, and saved more than $85,000 in waste management fees.6
poorly planned contents inside custom kits can also produce
waste issues. Donating equipment and supplies
In the past it’s been all too easy, not to mention expensive, for
To avoid routinely ordering custom packs with disposable hospitals across the country to discard equipment and sup-
items that are used infrequently or not at all, many facilities plies into dumpsters ultimately headed for landfills. With a

32 The OR Connection Aligning practice with policy to improve patient care 33

 little effort and planning; however, these unwanted items can
be donated for use in developing countries. The advantage
for hospitals is significant savings in waste disposal costs.1 In
additional to durable medical equipment, such as beds and
wheelchairs, donated items can also include surgical supplies
that have been deemed no longer usable because they
were designated for a particular patient but not used dur-
ing that patient’s procedure.2
The logistics are handled by not-for-profit organizations, such
as the AFYA Foundation (www.afyafoundation.org), based in
Yonkers, NY, which partners with a network of hospitals,
health organizations and corporations to collect medical and
non-medical supplies and equipment. AFYA warehouses and
sorts its donations, and then loads them into containers
bound for health clinics in Africa and the Caribbean.7
St. John’s Riverside Hospital in New York City regularly con-
tributes to AFYA. In 2007 alone, the hospital donated more
than 25 tons of furniture, wheelchairs, stretchers, respiratory
therapy and other medical equipment to AFYA and various
charitable organizations. Other donations have included IV
bags, sutures, gauze and surgical tools. All medical equip-
ment that leaves St. John’s Riverside is tested and screened
by the hospital’s biomedical engineers to ensure it functions
safely and reliably. 7
Two other organizations that collect hospital equipment and
supplies for distribution to developing countries are Project
C.U.R.E. (www.projectcure.org)1 and REMEDY Project
(www.remedyinc.org), which was founded by Dr. William
Rosenblatt at Yale-New Haven Hospital in Connecticut.8
LED surgical lights
Halogen lights have been the traditional bulbs of choice in
most operating rooms; however, they use a lot of energy, burn
hot enough to raise the temperature of the OR and require
frequent replacement. A green alternative is the light-emitting
diode (LED) bulb, which consumes 33 percent less energy
than halogen, emits 34 percent less heat (higher temperatures
require more energy to cool ORs) and lasts 30 times longer
than halogen bulbs.9
34 The OR Connection
The Kaiser Permanente healthcare system recently switched
to all LED lights for their operating rooms, realizing a six per-
cent cost savings per year.9 Similarly, Oregon Health &
Science University (OHSU) saves 340,000 kilowatt hours of
energy per year by using energy efficient LED operating room
lights and low-mercury lamps, for an annual cost savings of
$40,000.5
Starting a green team at your facility10
Implementing a sustainable greening program requires partic-
ipation from administration and staff alike. According to Hos-
pitals for a Healthy Environment (HHE), the key to success lies
in creating a framework to bring decision makers and imple-
menters together to make change happen. HHE proposes cre-
ating three layers of leadership to implement a green initiative:
An environmental leadership council composed of senior leaders
with authority to make high-level institutional commitments for
greening activities and authorize related funding. Medline natural OR towels
A green team composed of department heads who oversee the
day-to-day implementation of the program. A LITTLE CHANGE
Recycling coordinators from different departments who
actually implement the green initiative. (See Forms & Tools
A LOT OF DIFFERENCE
at the back of this issue for a sample job description for this
voluntary position.) The greensmart™ collection of OR products helps
reduce your impact on the environment. It includes:
We’ve only just begun • Dye-free towels with a third less manufacturing and processing.
The ideas outlined here represent only a small sampling of More lint-free and absorbent than traditional towels.
ways to implement more environmentally sound practices in
• 100% biodegradable trays made of compressed paper with an
the OR. Other initiatives might include the reduction of perflu-
eco-friendly, water-resistant coating.
oroctanoic acids (PFOAs), as well as reclaiming and recycling
anesthetic gases. (An estimated 80 to 95 percent of these • The revolutionary EcoDrapeTM with all the features and protection
gases are vented into the atmosphere, contributing to air you expect. It breaks down in landfills in about six months.
pollution.)
To learn more about Medline’s green products, visit
Approach your supervisor or administration about starting a www.medline.com/greensmart or www.medline.com/
greening program in your surgical department – and maybe green-initiatives/pdf/medline_eco_product_guide.pdf.
even hospital wide.
Continued on page 36
©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc. greensmart and EcoDrape are trademarks of Medline Industries, Inc.
 little effort and planning; however, these unwanted items can
be donated for use in developing countries. The advantage
for hospitals is significant savings in waste disposal costs.1 In
additional to durable medical equipment, such as beds and
wheelchairs, donated items can also include surgical supplies
that have been deemed no longer usable because they
were designated for a particular patient but not used dur-
ing that patient’s procedure.2
The logistics are handled by not-for-profit organizations, such
as the AFYA Foundation (www.afyafoundation.org), based in
Yonkers, NY, which partners with a network of hospitals,
health organizations and corporations to collect medical and
non-medical supplies and equipment. AFYA warehouses and
sorts its donations, and then loads them into containers
bound for health clinics in Africa and the Caribbean.7
St. John’s Riverside Hospital in New York City regularly con-
tributes to AFYA. In 2007 alone, the hospital donated more
than 25 tons of furniture, wheelchairs, stretchers, respiratory
therapy and other medical equipment to AFYA and various
charitable organizations. Other donations have included IV
bags, sutures, gauze and surgical tools. All medical equip-
ment that leaves St. John’s Riverside is tested and screened
by the hospital’s biomedical engineers to ensure it functions
safely and reliably. 7
Two other organizations that collect hospital equipment and
supplies for distribution to developing countries are Project
C.U.R.E. (www.projectcure.org)1 and REMEDY Project
(www.remedyinc.org), which was founded by Dr. William
Rosenblatt at Yale-New Haven Hospital in Connecticut.8
LED surgical lights
Halogen lights have been the traditional bulbs of choice in
most operating rooms; however, they use a lot of energy, burn
hot enough to raise the temperature of the OR and require
frequent replacement. A green alternative is the light-emitting
diode (LED) bulb, which consumes 33 percent less energy
than halogen, emits 34 percent less heat (higher temperatures
require more energy to cool ORs) and lasts 30 times longer
than halogen bulbs.9
34 The OR Connection
The Kaiser Permanente healthcare system recently switched
to all LED lights for their operating rooms, realizing a six per-
cent cost savings per year.9 Similarly, Oregon Health &
Science University (OHSU) saves 340,000 kilowatt hours of
energy per year by using energy efficient LED operating room
lights and low-mercury lamps, for an annual cost savings of
$40,000.5
Starting a green team at your facility10
Implementing a sustainable greening program requires partic-
ipation from administration and staff alike. According to Hos-
pitals for a Healthy Environment (HHE), the key to success lies
in creating a framework to bring decision makers and imple-
menters together to make change happen. HHE proposes cre-
ating three layers of leadership to implement a green initiative:
An environmental leadership council composed of senior leaders
with authority to make high-level institutional commitments for
greening activities and authorize related funding. Medline natural OR towels
A green team composed of department heads who oversee the
day-to-day implementation of the program. A LITTLE CHANGE
Recycling coordinators from different departments who
actually implement the green initiative. (See Forms & Tools
A LOT OF DIFFERENCE
at the back of this issue for a sample job description for this
voluntary position.) The greensmart™ collection of OR products helps
reduce your impact on the environment. It includes:
We’ve only just begun • Dye-free towels with a third less manufacturing and processing.
The ideas outlined here represent only a small sampling of More lint-free and absorbent than traditional towels.
ways to implement more environmentally sound practices in
• 100% biodegradable trays made of compressed paper with an
the OR. Other initiatives might include the reduction of perflu-
eco-friendly, water-resistant coating.
oroctanoic acids (PFOAs), as well as reclaiming and recycling
anesthetic gases. (An estimated 80 to 95 percent of these • The revolutionary EcoDrapeTM with all the features and protection
gases are vented into the atmosphere, contributing to air you expect. It breaks down in landfills in about six months.
pollution.)
To learn more about Medline’s green products, visit
Approach your supervisor or administration about starting a www.medline.com/greensmart or www.medline.com/
greening program in your surgical department – and maybe green-initiatives/pdf/medline_eco_product_guide.pdf.
even hospital wide.
Continued on page 36
©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc. greensmart and EcoDrape are trademarks of Medline Industries, Inc.
 Benefits of Going Green3
· Reducing waste disposal costs
· Creating income for hospitals
· Reducing the volume of waste that
goes to the landfill
· Making communities healthier; landfills are
the second highest source of greenhouse
gas emissions
Consumes 33% less
energy than halogen
A GREEN alternative
Emits 34% less heat
(LED) bulb Lasts 30 times longer
than halogen bulbs.9
“Greening the OR Initiative”
In an effort to join together healthcare facilities and product
suppliers to devise a strategy to green the nation’s operating
rooms, the not-for-profit group Practice Greenhealth
launched its “Greening the OR Initiative” in May 2010.11 The
goal of the initiative is to analyze interventions in the OR that
reduce environmental impact, reduce cost, increase efficiency
and improve worker or patient safety.12
To learn more, visit www.greeningtheor.org.
36 The OR Connection
References
1 Bondy JN, Kagoma YK, Stall NM. Waste management in
the operating room: exploring and improving the environ-
mental, human health and economic impacts. Presented
at: Practice Greenhealth CleanMed 2010 Conference: May
11 2010; Baltimore, MD. Available at: http://www.clean-
med.org/2010/downloads/presentations/default.htm. Ac-
cessed June 8, 2010.
2 Esaki RK & Macario A. Wastage of supplies and drugs in
the operating room. Medscape Anesthesiology. Posted Oc-
tober 21, 2009. Available at:
http://www.medscape.com/viewarticle/710513. Accessed
May 26, 2010.
3 Gaskill M. Going green — RNs tackle hospital waste.
NurseWeek website. Available at: http://www.h2e-
online.org/docs/nurseweek42406.pdf. Accessed
June 11, 2010.
4 DeJohn P. Reducing OR refuse. Materials Management in
Healthcare magazine website. Available at:
http://www.matmanmag.com/matmanmag_app/jsp/arti-
cledisplay.jsp?dcrpath=MATMANMAG/Article/data/03MAR
2010/1003MMH_FEA_purchasing&domain=MATMAN-
MAG. Accessed June 25, 2010.
5 McGowan A. The OR goes green. Surgical Products mag-
azine website. Available at: http://www.surgicalproducts-
mag.com/scripts/ShowPR~PUBCODE~0S0~ACCT~0000
100~ISSUE~0912~RELTYPE~FCUT~PRODCODE~0000~
PRODLETT~FL.asp. Accessed June 11, 2010.
6 Surgeons make the operating room environmentally sensi-
The OR Goes Green
tive. Medical News Today website. Available at:
http://www.medicalnewstoday.com/articles/125353.php.
Accessed June 29, 2010.
7 St. John’s Riverside finds home for unused medical sup-
plies, equipment. Premier web site. Available at:
http://www.premierinc.com/quality-safety/tools-
services/safety/green-link/green-corner/StJohns_EquipRe-
covery.pdf. Accessed June 10, 2010. – the only TRULY eco-friendly surgical drape
8 Suh G. Recycling at Yale-New Haven saves money and
lives. The Yale Herald. October 6, 1995. Available at: Medline’s new patent-pending EcoDrape is the only Composition Comparison
http://www.yaleherald.com/archive/xxi/2.2.96/news/recy-
eco-friendly surgical drape available today. Made of EcoDrape SMS
cling.htm. Accessed June 10, 2010.
9 Kaiser Permanente. LED surgical lights – improve or
more than 96% wood pulp, EcoDrape will biodegrade Fibers More than 96% No wood
light quality with reduced energy consumption. December wood pulp pulp
2009. in only two to five months in a landfill – polypropylene
Petrochemical 0% 100% PP
10 Brannen L. Institutionalizing environmental programs: creat-
ing “green teams” in your facility. Available at
drapes take hundreds of years to break down. EcoDrape ingredients (plastics)
http://www.h2e-online.org/docs/h2egreenteams32106.pdf. has all the same great features as other Medline Additives Bio-based Fluorine
Accessed June 29, 2010.
drapes, including hook-and-loop line holders, large
11 Hospital group says ORs need a heavy dose of green. May
11, 2010. Available at: reinforcement zones, and premium tape and incise
http://www.greenbiz.com/news/2010/05/11/hospital-
group-says-ors-need-heavy-dose-green. Accessed May film flush to the fenestration. For a quick online video demonstration,
26, 2010. visit www.medline.com/ecodrape
12 Greening the Operating Room (OR) Initiative Project
Try the new EcoDrape and take your OR to the next
Overview. Practice Greenhealth website. Available at:
http://www.practicegreenhealth.org/educate/greening/ level of green!
greening-the-or. Accessed June 8, 2010.
©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
EcoDrape and greensmart are trademarks of Medline Industries, Inc.
 Benefits of Going Green3
· Reducing waste disposal costs
· Creating income for hospitals
· Reducing the volume of waste that
goes to the landfill
· Making communities healthier; landfills are
the second highest source of greenhouse
gas emissions
Consumes 33% less
energy than halogen
A GREEN alternative
Emits 34% less heat
(LED) bulb Lasts 30 times longer
than halogen bulbs.9
“Greening the OR Initiative”
In an effort to join together healthcare facilities and product
suppliers to devise a strategy to green the nation’s operating
rooms, the not-for-profit group Practice Greenhealth
launched its “Greening the OR Initiative” in May 2010.11 The
goal of the initiative is to analyze interventions in the OR that
reduce environmental impact, reduce cost, increase efficiency
and improve worker or patient safety.12
To learn more, visit www.greeningtheor.org.
36 The OR Connection
References
1 Bondy JN, Kagoma YK, Stall NM. Waste management in
the operating room: exploring and improving the environ-
mental, human health and economic impacts. Presented
at: Practice Greenhealth CleanMed 2010 Conference: May
11 2010; Baltimore, MD. Available at: http://www.clean-
med.org/2010/downloads/presentations/default.htm. Ac-
cessed June 8, 2010.
2 Esaki RK & Macario A. Wastage of supplies and drugs in
the operating room. Medscape Anesthesiology. Posted Oc-
tober 21, 2009. Available at:
http://www.medscape.com/viewarticle/710513. Accessed
May 26, 2010.
3 Gaskill M. Going green — RNs tackle hospital waste.
NurseWeek website. Available at: http://www.h2e-
online.org/docs/nurseweek42406.pdf. Accessed
June 11, 2010.
4 DeJohn P. Reducing OR refuse. Materials Management in
Healthcare magazine website. Available at:
http://www.matmanmag.com/matmanmag_app/jsp/arti-
cledisplay.jsp?dcrpath=MATMANMAG/Article/data/03MAR
2010/1003MMH_FEA_purchasing&domain=MATMAN-
MAG. Accessed June 25, 2010.
5 McGowan A. The OR goes green. Surgical Products mag-
azine website. Available at: http://www.surgicalproducts-
mag.com/scripts/ShowPR~PUBCODE~0S0~ACCT~0000
100~ISSUE~0912~RELTYPE~FCUT~PRODCODE~0000~
PRODLETT~FL.asp. Accessed June 11, 2010.
6 Surgeons make the operating room environmentally sensi-
The OR Goes Green
tive. Medical News Today website. Available at:
http://www.medicalnewstoday.com/articles/125353.php.
Accessed June 29, 2010.
7 St. John’s Riverside finds home for unused medical sup-
plies, equipment. Premier web site. Available at:
http://www.premierinc.com/quality-safety/tools-
services/safety/green-link/green-corner/StJohns_EquipRe-
covery.pdf. Accessed June 10, 2010. – the only TRULY eco-friendly surgical drape
8 Suh G. Recycling at Yale-New Haven saves money and
lives. The Yale Herald. October 6, 1995. Available at: Medline’s new patent-pending EcoDrape is the only Composition Comparison
http://www.yaleherald.com/archive/xxi/2.2.96/news/recy-
eco-friendly surgical drape available today. Made of EcoDrape SMS
cling.htm. Accessed June 10, 2010.
9 Kaiser Permanente. LED surgical lights – improve or
more than 96% wood pulp, EcoDrape will biodegrade Fibers More than 96% No wood
light quality with reduced energy consumption. December wood pulp pulp
2009. in only two to five months in a landfill – polypropylene
Petrochemical 0% 100% PP
10 Brannen L. Institutionalizing environmental programs: creat-
ing “green teams” in your facility. Available at
drapes take hundreds of years to break down. EcoDrape ingredients (plastics)
http://www.h2e-online.org/docs/h2egreenteams32106.pdf. has all the same great features as other Medline Additives Bio-based Fluorine
Accessed June 29, 2010.
drapes, including hook-and-loop line holders, large
11 Hospital group says ORs need a heavy dose of green. May
11, 2010. Available at: reinforcement zones, and premium tape and incise
http://www.greenbiz.com/news/2010/05/11/hospital-
group-says-ors-need-heavy-dose-green. Accessed May film flush to the fenestration. For a quick online video demonstration,
26, 2010. visit www.medline.com/ecodrape
12 Greening the Operating Room (OR) Initiative Project
Try the new EcoDrape and take your OR to the next
Overview. Practice Greenhealth website. Available at:
http://www.practicegreenhealth.org/educate/greening/ level of green!
greening-the-or. Accessed June 8, 2010.
©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
EcoDrape and greensmart are trademarks of Medline Industries, Inc.
 Back to Basics Thirteenth in a Series
Are You In Line with
SCIP Measure Number Nine?
By Alecia Cooper, RN, BS, MBA, CNOR
SCIP-Inf-9 Urinary Catheter Removed on Postoperative
Day 1 (POD 1) or Postoperative Day 2 (POD 2) With Day
of Surgery Being Day Zero.
There are two major issues that are now causing a significant
impact on what has been a routine practice for many surgical
procedures, that of inserting an indwelling Foley catheter prior
to a surgical procedure. According to one study, as many as 86
percent of patients undergoing surgery have urinary catheters
and 50% of these catheters remain in place for more than 2
days.1 This evidence led the Surgical Care Improvement Project
(SCIP) to add a new measure for hospitals (SCIP-Inf-9) effective
October 1, 2009.2
In 2008, catheter-associated urinary tract infections (CAUTI)
made the Centers for Medicare & Medicaid Services (CMS) list
of ten Hospital Acquired Conditions (HACs) as part of the
Inpatient Prospective Payment System (IPPS) payment provi-
sion.3 Many hospitals reacted by putting together improvement
teams to reduce the incidence of CAUTI, as CMS would no
38 The OR Connection Aligning practice with policy to improve patient care 39
Patient Safety
longer reimburse for this condition if it was not documented as
present at the time of hospital admission. Upon closer analysis,
hospitals began to uncover that a number of their CAUTIs were
occurring in post-surgical patients. In addition, it was discov-
ered that insertion of a Foley catheter is not clinically necessary
in all surgical patients.
SCIP-Inf-9 is now leading clinicians to think about how to iden-
tify which surgical procedures have a valid clinical indication for
insertion of a Foley catheter and to eliminate the insertions
in procedures with no valid clinical indication. In addition,
there is a need to develop processes and procedures to make
sure Foleys are removed in a timely manner. So once again,
health care is faced with a major change in a practice that for
many years has been considered routine for surgical patients.
The Foley catheter might not be needed in the first place, and
if left in too long, can lead to a preventable hospital-acquired in-
fection. But we all know how hard it can be to change a prac-
tice that has been ingrained in us for years.
 Back to Basics Thirteenth in a Series
Are You In Line with
SCIP Measure Number Nine?
By Alecia Cooper, RN, BS, MBA, CNOR
SCIP-Inf-9 Urinary Catheter Removed on Postoperative
Day 1 (POD 1) or Postoperative Day 2 (POD 2) With Day
of Surgery Being Day Zero.
There are two major issues that are now causing a significant
impact on what has been a routine practice for many surgical
procedures, that of inserting an indwelling Foley catheter prior
to a surgical procedure. According to one study, as many as 86
percent of patients undergoing surgery have urinary catheters
and 50% of these catheters remain in place for more than 2
days.1 This evidence led the Surgical Care Improvement Project
(SCIP) to add a new measure for hospitals (SCIP-Inf-9) effective
October 1, 2009.2
In 2008, catheter-associated urinary tract infections (CAUTI)
made the Centers for Medicare & Medicaid Services (CMS) list
of ten Hospital Acquired Conditions (HACs) as part of the
Inpatient Prospective Payment System (IPPS) payment provi-
sion.3 Many hospitals reacted by putting together improvement
teams to reduce the incidence of CAUTI, as CMS would no
38 The OR Connection Aligning practice with policy to improve patient care 39
Patient Safety
longer reimburse for this condition if it was not documented as
present at the time of hospital admission. Upon closer analysis,
hospitals began to uncover that a number of their CAUTIs were
occurring in post-surgical patients. In addition, it was discov-
ered that insertion of a Foley catheter is not clinically necessary
in all surgical patients.
SCIP-Inf-9 is now leading clinicians to think about how to iden-
tify which surgical procedures have a valid clinical indication for
insertion of a Foley catheter and to eliminate the insertions
in procedures with no valid clinical indication. In addition,
there is a need to develop processes and procedures to make
sure Foleys are removed in a timely manner. So once again,
health care is faced with a major change in a practice that for
many years has been considered routine for surgical patients.
The Foley catheter might not be needed in the first place, and
if left in too long, can lead to a preventable hospital-acquired in-
fection. But we all know how hard it can be to change a prac-
tice that has been ingrained in us for years.
 CAUTI Causes and Pathogenesis
For our back to basics review of CAUTI, let’s first look at the
common causes. These infections are costly and potentially
lethal. All of the following factors can lead to the development
of CAUTI:
• CAUTIs account for approximately 40 percent
of all nosocomial infections.4
• Urinary catheters are inserted in more than
five million patients per year.
• One in four hospitalized patients will have a urinary
catheter placed during their hospital stay.5
• Up to 50 percent of these catheters are
unnecessarily placed.6
• Physician’s orders are frequently lacking for
catheter placement.
• Oftentimes nursing makes the determination
on which patients should have a urinary catheter,
and many times the reason is simply for nursing
convenience.7
• As many as 56 percent of hospitals do not keep
track of which patients have catheters in place and
74 percent do not keep track of how long the
catheter has been in place.5
• Urinary catheters are often left in place longer than
necessary because they are forgotten about or the
physician did not know they were in place.
Combine these common causes and factors with the oppor-
tunity for contamination and breaches in aseptic technique that
can occur when catheters are being inserted; and there’s no
wonder why CAUTI is the number one nosocomial infection.
There are three major issues:
1. too many catheters are being placed
2. catheters are staying in too long
3. contamination occurs when catheters are inserted.
So these become the major focus in a comprehensive CAUTI
prevention program that includes perioperative services.
Now take a look at the pathogenesis and microbiology of
CAUTI to better understand how the infection develops. Or-
ganisms can gain access to the urinary tract by several routes;
at the time of catheter insertion or later by organisms ascend-
ing from the perineum by capillary action in the thin mucous
40 The OR Connection
film contiguous to the external catheter surface. Microor- Table 1
ganisms can also gain access to the catheter lumen from fail- Evidence-Based CAUTI Prevention Strategies
ure of closed drainage or contamination of urine in the
collection bag. The most frequent pathogens associated with
1. The MOST effective way to prevent
CAUTI according to hospital reports between 2006 and 2007
CAUTI is to AVOID catheterization
were Escherichia coli (21.4%) and Candida spp (21.0%),
followed by Enterococcus spp (14.9%), Pseudomonas aerug-
inosa (10.0%), Klebsiella pneumoniae (7.7%) and Enterobac- 2. Assess alternatives to catheterization
ter spp (4.1%). A smaller proportion was caused by other
gram-negative bacteria and Staphylococcus spp.8
3. Documentation should include:
CAUTI Prevention indications; date and time of inser-
In October 2009 the Centers for Disease Control and Preven- tion; individual inserting the catheter
tion (CDC) published a document prepared by their Health- and date and time of removal
care Infection Control Practices Advisory Committee (HICPAC)
and titled “Guideline For Prevention of Catheter-Associated
4. Use aseptic technique
Urinary Tract Infections 2009.” The 67-page document is
available at www.cdc.gov/hicpac/pdf/CAUTI/CAUTIguide-
line2009final.pdf. This publication is the first update to the CDC 5. Hand washing is the first and most
1981 guideline and includes new research and technological important preventative measure
advancements for preventing CAUTI.8 It is estimated that 17 to
69 percent of CAUTIs may be preventable with recommended
infection control measures, meaning that up to 380,000 in- 6. Staff members need education on
fections and 9,000 deaths related to CAUTI could be pre- appropriate indications and possible
vented each year. alternatives to catheterization
The HICPAC CAUTI prevention guideline
7. Patients need education to avoid
identifies six categories of recommendations
readmissions
that are organized as follows:8
1. Recommendations for who should receive indwelling
Valid Clinical Indicators for Surgical Procedures
urinary catheters (or, for certain populations, alterna-
CDC guidelines identify six examples of appropriate indications
tives to indwelling catheters)
for indwelling urethral catheter use. Table 2 (next page) is taken
2. Recommendations for catheter insertion
directly from the CDC document, which also includes three
3. Recommendations for catheter maintenance
examples of inappropriate uses of indwelling catheters.8
4. Quality improvement programs to achieve appropriate
placement, care and removal of catheters
The CDC identifies the following guidelines for urinary catheter
5. Administrative infrastructure required
use in selected surgical procedures:
6. Surveillance strategies
• Patients undergoing urologic surgery or other surgery
on contiguous structures of the genitourinary tract
Table 1 (next page) lists the most important evidence-based
• Anticipated prolonged duration of surgery (catheters
prevention strategies to prevent CAUTI in all patient popula-
inserted for this reason should be removed in PACU)
tions according to the CDC’s findings.
• Patients anticipated to receive large-volume infusions or
diuretics during surgery
• Need for intraoperative monitoring of urinary output
Aligning practice with policy to improve patient care 41
 CAUTI Causes and Pathogenesis
For our back to basics review of CAUTI, let’s first look at the
common causes. These infections are costly and potentially
lethal. All of the following factors can lead to the development
of CAUTI:
• CAUTIs account for approximately 40 percent
of all nosocomial infections.4
• Urinary catheters are inserted in more than
five million patients per year.
• One in four hospitalized patients will have a urinary
catheter placed during their hospital stay.5
• Up to 50 percent of these catheters are
unnecessarily placed.6
• Physician’s orders are frequently lacking for
catheter placement.
• Oftentimes nursing makes the determination
on which patients should have a urinary catheter,
and many times the reason is simply for nursing
convenience.7
• As many as 56 percent of hospitals do not keep
track of which patients have catheters in place and
74 percent do not keep track of how long the
catheter has been in place.5
• Urinary catheters are often left in place longer than
necessary because they are forgotten about or the
physician did not know they were in place.
Combine these common causes and factors with the oppor-
tunity for contamination and breaches in aseptic technique that
can occur when catheters are being inserted; and there’s no
wonder why CAUTI is the number one nosocomial infection.
There are three major issues:
1. too many catheters are being placed
2. catheters are staying in too long
3. contamination occurs when catheters are inserted.
So these become the major focus in a comprehensive CAUTI
prevention program that includes perioperative services.
Now take a look at the pathogenesis and microbiology of
CAUTI to better understand how the infection develops. Or-
ganisms can gain access to the urinary tract by several routes;
at the time of catheter insertion or later by organisms ascend-
ing from the perineum by capillary action in the thin mucous
40 The OR Connection
film contiguous to the external catheter surface. Microor- Table 1
ganisms can also gain access to the catheter lumen from fail- Evidence-Based CAUTI Prevention Strategies
ure of closed drainage or contamination of urine in the
collection bag. The most frequent pathogens associated with
1. The MOST effective way to prevent
CAUTI according to hospital reports between 2006 and 2007
CAUTI is to AVOID catheterization
were Escherichia coli (21.4%) and Candida spp (21.0%),
followed by Enterococcus spp (14.9%), Pseudomonas aerug-
inosa (10.0%), Klebsiella pneumoniae (7.7%) and Enterobac- 2. Assess alternatives to catheterization
ter spp (4.1%). A smaller proportion was caused by other
gram-negative bacteria and Staphylococcus spp.8
3. Documentation should include:
CAUTI Prevention indications; date and time of inser-
In October 2009 the Centers for Disease Control and Preven- tion; individual inserting the catheter
tion (CDC) published a document prepared by their Health- and date and time of removal
care Infection Control Practices Advisory Committee (HICPAC)
and titled “Guideline For Prevention of Catheter-Associated
4. Use aseptic technique
Urinary Tract Infections 2009.” The 67-page document is
available at www.cdc.gov/hicpac/pdf/CAUTI/CAUTIguide-
line2009final.pdf. This publication is the first update to the CDC 5. Hand washing is the first and most
1981 guideline and includes new research and technological important preventative measure
advancements for preventing CAUTI.8 It is estimated that 17 to
69 percent of CAUTIs may be preventable with recommended
infection control measures, meaning that up to 380,000 in- 6. Staff members need education on
fections and 9,000 deaths related to CAUTI could be pre- appropriate indications and possible
vented each year. alternatives to catheterization
The HICPAC CAUTI prevention guideline
7. Patients need education to avoid
identifies six categories of recommendations
readmissions
that are organized as follows:8
1. Recommendations for who should receive indwelling
Valid Clinical Indicators for Surgical Procedures
urinary catheters (or, for certain populations, alterna-
CDC guidelines identify six examples of appropriate indications
tives to indwelling catheters)
for indwelling urethral catheter use. Table 2 (next page) is taken
2. Recommendations for catheter insertion
directly from the CDC document, which also includes three
3. Recommendations for catheter maintenance
examples of inappropriate uses of indwelling catheters.8
4. Quality improvement programs to achieve appropriate
placement, care and removal of catheters
The CDC identifies the following guidelines for urinary catheter
5. Administrative infrastructure required
use in selected surgical procedures:
6. Surveillance strategies
• Patients undergoing urologic surgery or other surgery
on contiguous structures of the genitourinary tract
Table 1 (next page) lists the most important evidence-based
• Anticipated prolonged duration of surgery (catheters
prevention strategies to prevent CAUTI in all patient popula-
inserted for this reason should be removed in PACU)
tions according to the CDC’s findings.
• Patients anticipated to receive large-volume infusions or
diuretics during surgery
• Need for intraoperative monitoring of urinary output
Aligning practice with policy to improve patient care 41

Table 2
A. Examples of Appropriate Indications for Indwelling Urethral Catheter Use
Patient has acute urinary retention or bladder outlet obstruction
Need for accurate measurements of urinary output in critically ill patients
Perioperative use for selected surgical procedures:
• Patients undergoing urologic surgery or other surgery on contiguous structures
of the genitourinary tract
• Anticipated prolonged duration of surgery (catheters inserted for this reason
should be removed in PACU)
• Patients anticipated to receive large-volume infusions or diuretics during surgery
• Need for intraoperative monitoring of urinary output
To assist in healing of open sacral or perineal wounds in incontinent patients
Patient requires prolonged immobilization (e.g., potentially unstable thoracic or
lumbar spine, multiple traumatic injuries such as pelvic fractures)
To improve comfort for end of life care if needed
B. Examples of Inappropriate Uses of Indwelling Catheters
As a substitute for nursing care of the patient or resident with incontinence
As a means of obtaining urine for culture or other diagnostic tests when the patient can
voluntarily void
For prolonged postoperative duration without appropriate indications (e.g., structural
repair of urethra or contiguous structures, prolonged effect of epidural anesthesia, etc.)
42 The OR Connection
One of the best ways to assure that each surgical patient meets
at least one of the recommended criteria is to assess each
patient prior to the surgical procedure and determine if there is
a valid clinical indication. This assessment should take place and
be documented in the patient’s medical record. If you are using
surgical preference cards at your facility, instead of providing
instructions to insert a catheter prior to the procedure, a better
notation on the preference card would be to list the four surgical
categories listed above and ensure that each patient is assessed.
Contamination During Insertion
In several clinical observations of nurses inserting Foley catheters
in various clinical departments including perioperative services,
there were examples of contamination occurring during the pro-
cedure.9 Contamination during insertion of indwelling catheters
is not generally anticipated in the OR, as OR professionals are
often well-trained on aseptic technique. But, as with any proce-
dure performed in a sterile environment, errors can and do occur.
Dr. Lucian Leape from Harvard states, “Medical errors most
often result from a complex interplay of multiple factors. Only
rarely are they due to the carelessness or misconduct of a
single individual.” This statement addresses the complexity
of a medical error and the challenges of determining what
happened, who’s involved and why.10 The kind of error we
are discussing here can be attributed to the inability to main-
tain a sterile field. There are many factors that can interfere
with maintaining sterility.
Aligning practice with policy to improve patient care 43
Some Examples of Common Breaches
in Aseptic Technique:
• Lack of space – there may not be enough room to
properly place all of the contents and Foley tray(s) inside
the sterile field.
• Multiple simultaneous procedures – the patient
may be critical or crashing at the same time a catheter
is being inserted, or other clinicians are performing
additional procedures such as prepping the patient,
and the sterile field is not maintained.
• Too many people in the room – in any large group
working on various aspects of setting up for and
preparing the patient for surgery, it is possible for a
breach in aseptic technique and/or contamination of
the sterile field to go unseen or unnoticed.
• Lack of a secure area to place the Foley
catheter prior to insertion – after the catheter
has been lubricated while you are prepping the
patient, the catheter moves off the sterile field
onto an unsterile surface area.
• Frequent distractions – when the person inserting
the catheter is constantly distracted, it is hard to
ensure the sterile field is maintained.
• Not draping the perineum – nursing may omit the
draping of the perineum when inserting catheters to
perform the procedure more quickly or because they
do not require the same stringent principles in aseptic
technique that are used for other procedures performed
during surgery.
• Prepping with cotton balls and forceps – many
times the plastic forceps included in catheter kits will
either not work properly or they will break, and nursing
will either start or continue the prepping procedure with
their gloved hand holding the PVP saturated cotton ball,
thus contaminating the gloved hand that will be inserting
the catheter.
Getting Catheters Out Sooner
Now that we have addressed establishing valid clinical indi-
cations for catheterization and aseptic technique, let’s look at
the most important CAUTI prevention strategy in surgical
patients who require catheterization. This strategy is the bot-
tom line in SCIP-Inf-9. As stated in the evidenced-based
strategies previously mentioned, if the patient must have an
indwelling catheter for the surgical procedure, then it should
be removed as soon as possible after the procedure is com-

Table 2
A. Examples of Appropriate Indications for Indwelling Urethral Catheter Use
Patient has acute urinary retention or bladder outlet obstruction
Need for accurate measurements of urinary output in critically ill patients
Perioperative use for selected surgical procedures:
• Patients undergoing urologic surgery or other surgery on contiguous structures
of the genitourinary tract
• Anticipated prolonged duration of surgery (catheters inserted for this reason
should be removed in PACU)
• Patients anticipated to receive large-volume infusions or diuretics during surgery
• Need for intraoperative monitoring of urinary output
To assist in healing of open sacral or perineal wounds in incontinent patients
Patient requires prolonged immobilization (e.g., potentially unstable thoracic or
lumbar spine, multiple traumatic injuries such as pelvic fractures)
To improve comfort for end of life care if needed
B. Examples of Inappropriate Uses of Indwelling Catheters
As a substitute for nursing care of the patient or resident with incontinence
As a means of obtaining urine for culture or other diagnostic tests when the patient can
voluntarily void
For prolonged postoperative duration without appropriate indications (e.g., structural
repair of urethra or contiguous structures, prolonged effect of epidural anesthesia, etc.)
42 The OR Connection
One of the best ways to assure that each surgical patient meets
at least one of the recommended criteria is to assess each
patient prior to the surgical procedure and determine if there is
a valid clinical indication. This assessment should take place and
be documented in the patient’s medical record. If you are using
surgical preference cards at your facility, instead of providing
instructions to insert a catheter prior to the procedure, a better
notation on the preference card would be to list the four surgical
categories listed above and ensure that each patient is assessed.
Contamination During Insertion
In several clinical observations of nurses inserting Foley catheters
in various clinical departments including perioperative services,
there were examples of contamination occurring during the pro-
cedure.9 Contamination during insertion of indwelling catheters
is not generally anticipated in the OR, as OR professionals are
often well-trained on aseptic technique. But, as with any proce-
dure performed in a sterile environment, errors can and do occur.
Dr. Lucian Leape from Harvard states, “Medical errors most
often result from a complex interplay of multiple factors. Only
rarely are they due to the carelessness or misconduct of a
single individual.” This statement addresses the complexity
of a medical error and the challenges of determining what
happened, who’s involved and why.10 The kind of error we
are discussing here can be attributed to the inability to main-
tain a sterile field. There are many factors that can interfere
with maintaining sterility.
Aligning practice with policy to improve patient care 43
Some Examples of Common Breaches
in Aseptic Technique:
• Lack of space – there may not be enough room to
properly place all of the contents and Foley tray(s) inside
the sterile field.
• Multiple simultaneous procedures – the patient
may be critical or crashing at the same time a catheter
is being inserted, or other clinicians are performing
additional procedures such as prepping the patient,
and the sterile field is not maintained.
• Too many people in the room – in any large group
working on various aspects of setting up for and
preparing the patient for surgery, it is possible for a
breach in aseptic technique and/or contamination of
the sterile field to go unseen or unnoticed.
• Lack of a secure area to place the Foley
catheter prior to insertion – after the catheter
has been lubricated while you are prepping the
patient, the catheter moves off the sterile field
onto an unsterile surface area.
• Frequent distractions – when the person inserting
the catheter is constantly distracted, it is hard to
ensure the sterile field is maintained.
• Not draping the perineum – nursing may omit the
draping of the perineum when inserting catheters to
perform the procedure more quickly or because they
do not require the same stringent principles in aseptic
technique that are used for other procedures performed
during surgery.
• Prepping with cotton balls and forceps – many
times the plastic forceps included in catheter kits will
either not work properly or they will break, and nursing
will either start or continue the prepping procedure with
their gloved hand holding the PVP saturated cotton ball,
thus contaminating the gloved hand that will be inserting
the catheter.
Getting Catheters Out Sooner
Now that we have addressed establishing valid clinical indi-
cations for catheterization and aseptic technique, let’s look at
the most important CAUTI prevention strategy in surgical
patients who require catheterization. This strategy is the bot-
tom line in SCIP-Inf-9. As stated in the evidenced-based
strategies previously mentioned, if the patient must have an
indwelling catheter for the surgical procedure, then it should
be removed as soon as possible after the procedure is com-
 pleted. The SCIP measure states “Removed on Postopera-
tive Day 1 (POD 1) or Postoperative Day 2 (POD 2) With Day
of Surgery Being Day Zero.”2 If your facility is participating in
SCIP, you have most likely implemented a method to deter-
mine exactly when the catheter was inserted and when the
procedure was completed to assure that catheterization is
discontinued before POD 2 ends. Sound easy? Not exactly.
This information often is not readily available or even docu-
mented in the medical record.
How important is it to discontinue catheters sooner? Accord-
ing to the CDC, there was moderate-quality evidence sug-
gesting a benefit of shorter versus longer postoperative
durations of catheterization.8 Moderate evidence is catego-
rized along with the CDC’s highest recommendation, Category
1A. This was based on a decreased risk of bacteriuria/unspec-
ified UTI, decreased time to ambulation, no differences in uri-
nary retention or symptomatic urinary tract infection (SUTI) and
increased risk of re-catheterization. Significant decreases in
bacteriuria/unspecified UTI were found at comparisons of one
day versus three or five days of postoperative catheterization.
According to SCIP, it is well-established that the risk of
catheter-associated urinary tract infection increases with
increasing duration.2 Among surgical patients, two studies of
postoperative patients discharged to subacute care with uri-
nary catheters were more likely to be readmitted to the hospi-
tal with a CAUTI compared to those who had catheters
removed prior to hospital discharge. As previously mentioned,
in a study of selected major surgical patients, as many as 85
percent of patients undergoing surgery have urinary catheters
and 50 percent of these catheters remain in place for more
than two days.1 These patients were twice as likely to develop
CAUTI prior to hospital discharge.
Ways to Ensure Catheters are Discontinued within
24 to 48 Hours after Completion of Surgery
• Document the insertion date and time not only in the
medical record, but in a prominent place on the closed
urinary tubing system for nursing to find easily.
• Ask surgeons to write an order to discontinue the
catheter on POD 1 or POD 2 unless there is an order
to keep the catheter in place.
• Develop a nursing protocol approved by the medical
staff for nursing to be able to remove Foley catheters
based upon clinical assessment of the surgical patient.
• Program visual reminders and cues for nursing into
your electronic medical record to remind nursing to
assess the patient every 24 hours for the continued
need for a catheter.
Innovations to the Rescue
CAUTI was the number one hospital-acquired infection in
1981 and is still number one today. By and large, there
have been very few changes in Foley catheter systems in
those 30 years. Yes, closed-system kits, anti-reflux
devices and non-latex materials have been introduced,
but none of these has significantly reduced the prevalence
of CAUTI. Even the silver-coated, antimicrobial catheters
that were introduced during this period have not elimi-
MEDLINE’S FOLEY INSERTAG™
One little sticker that makes
all the difference Foley
InserTag
Medline’s Foley InserTag means never wondering when
your patient’s catheter was placed. Despite CDC guide-
lines recommending prompt removal of urinary catheters,
about 56 percent of hospitals do not keep track of which
patients have catheters and 74 percent do not keep track
of how long the catheter has been in place.1
Medline’s Foley InserTag is a sticker to be placed on each
catheter bag. It has space to write when the catheter
was placed in order to minimize duration and encourage
prompt, timely removal. The InserTag is included in each
Medline ERASE CAUTI tray. To learn more about Medline’s Foley InserTag and
the ERASE CAUTI program, attend an informational
Medline’s Foley InserTag. The one little sticker that can webinar at www. medline.com/erase/webinar.asp.
make all the difference.
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

44 The OR Connection
©2010 Medline Industries, Inc. Medline is a registered trademark and InserTag is a trademark of Medline Industries, Inc.
Continued on page 46
 pleted. The SCIP measure states “Removed on Postopera-
tive Day 1 (POD 1) or Postoperative Day 2 (POD 2) With Day
of Surgery Being Day Zero.”2 If your facility is participating in
SCIP, you have most likely implemented a method to deter-
mine exactly when the catheter was inserted and when the
procedure was completed to assure that catheterization is
discontinued before POD 2 ends. Sound easy? Not exactly.
This information often is not readily available or even docu-
mented in the medical record.
How important is it to discontinue catheters sooner? Accord-
ing to the CDC, there was moderate-quality evidence sug-
gesting a benefit of shorter versus longer postoperative
durations of catheterization.8 Moderate evidence is catego-
rized along with the CDC’s highest recommendation, Category
1A. This was based on a decreased risk of bacteriuria/unspec-
ified UTI, decreased time to ambulation, no differences in uri-
nary retention or symptomatic urinary tract infection (SUTI) and
increased risk of re-catheterization. Significant decreases in
bacteriuria/unspecified UTI were found at comparisons of one
day versus three or five days of postoperative catheterization.
According to SCIP, it is well-established that the risk of
catheter-associated urinary tract infection increases with
increasing duration.2 Among surgical patients, two studies of
postoperative patients discharged to subacute care with uri-
nary catheters were more likely to be readmitted to the hospi-
tal with a CAUTI compared to those who had catheters
removed prior to hospital discharge. As previously mentioned,
in a study of selected major surgical patients, as many as 85
percent of patients undergoing surgery have urinary catheters
and 50 percent of these catheters remain in place for more
than two days.1 These patients were twice as likely to develop
CAUTI prior to hospital discharge.
Ways to Ensure Catheters are Discontinued within
24 to 48 Hours after Completion of Surgery
• Document the insertion date and time not only in the
medical record, but in a prominent place on the closed
urinary tubing system for nursing to find easily.
• Ask surgeons to write an order to discontinue the
catheter on POD 1 or POD 2 unless there is an order
to keep the catheter in place.
• Develop a nursing protocol approved by the medical
staff for nursing to be able to remove Foley catheters
based upon clinical assessment of the surgical patient.
• Program visual reminders and cues for nursing into
your electronic medical record to remind nursing to
assess the patient every 24 hours for the continued
need for a catheter.
Innovations to the Rescue
CAUTI was the number one hospital-acquired infection in
1981 and is still number one today. By and large, there
have been very few changes in Foley catheter systems in
those 30 years. Yes, closed-system kits, anti-reflux
devices and non-latex materials have been introduced,
but none of these has significantly reduced the prevalence
of CAUTI. Even the silver-coated, antimicrobial catheters
that were introduced during this period have not elimi-
MEDLINE’S FOLEY INSERTAG™
One little sticker that makes
all the difference Foley
InserTag
Medline’s Foley InserTag means never wondering when
your patient’s catheter was placed. Despite CDC guide-
lines recommending prompt removal of urinary catheters,
about 56 percent of hospitals do not keep track of which
patients have catheters and 74 percent do not keep track
of how long the catheter has been in place.1
Medline’s Foley InserTag is a sticker to be placed on each
catheter bag. It has space to write when the catheter
was placed in order to minimize duration and encourage
prompt, timely removal. The InserTag is included in each
Medline ERASE CAUTI tray. To learn more about Medline’s Foley InserTag and
the ERASE CAUTI program, attend an informational
Medline’s Foley InserTag. The one little sticker that can webinar at www. medline.com/erase/webinar.asp.
make all the difference.
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

44 The OR Connection
©2010 Medline Industries, Inc. Medline is a registered trademark and InserTag is a trademark of Medline Industries, Inc.
Continued on page 46

nated CAUTI. This may be, in part, because the CDC has
cautioned that antimicrobial catheters should not be used
as a common practice to reduce the incidence of CAUTI.8
The great news today is that there are a handful of clinical
teams and manufacturers working together as innovators by
observing practice, introducing redesigned products with visual
reminders and cues and influencing appropriate processes for
inserting and removing Foley catheters. By using observational
studies and context-based design, manufacturers are now able
to build human factors and social behaviors into an innovative
and revolutionary product redesign. According to one case
study, through redesign, clinicians can be influenced to provide
high quality care by creating a greater focus on providing
patient comfort, maintaining sterile technique and decreasing
the time of the entire insertion process.9
These observational studies and context-based learning that
provide insight into why errors occur, along with the role human
factors and social behaviors play in improving patient care, are
being led by VHA, a group purchasing organization based in
Irving, Texas. VHA Inc. is a national network of not-for-profit
healthcare organizations working together to drive maximum
savings in the supply chain arena, set new levels of clinical per-
formance and identify and implement best practices to improve
operational efficiency and clinical outcomes. Formed in 1977,
VHA serves more than 1,400 hospitals and more than 23,000
non-acute care providers nationwide. Dr. Trent Haywood, sen-
ior vice president of clinical performance and chief medical
officer for VHA, is the leader for these projects.
Are You In Line with SCIP-INF-9?
If your answer is yes, then your organization is well on its way
to reducing the incidence of preventable CAUTIs. If not, inves-
tigate how you can better comply with this new measure and
how you can reduce the number of catheters inserted by
ensuring that there is a valid clinical indication, that alternatives
to routine catheterizations have been considered and the role
that you can play in getting necessary catheters out of your
patients sooner once the surgery is completed. Timely removal
is one of the most important aspects to an overall CAUTI pre-
vention strategy. It becomes one of the most prominent, evi-
denced-based prevention strategies after a catheter has been
inserted. Take the time to do what Dr. Haywood and the VHA
team have done to observe clinical practice to learn how to
identify human factors and reengineer practice. And finally, look
46 The OR Connection
CE Test Questions Back to Basics
CAUTI was the number
one hospital-acquired Are You in Line with SCIP Measure Number Nine?
infection in 1981 and is
True/False 8. As many as ____ percent of catheters inserted in sur-
still number one today. 1. Assessing alternatives to catheterization is an gical patients remain in place for more than two days.
evidence-based CAUTI prevention strategy. T F a. 18
to experts such as the CDC and SCIP and other organizations
b. 50
that provide us with evidence-based strategies and recom-
2. The need for intraoperative monitoring of urinary c. 36
mendations to improve patient outcomes.
output is a valid reason for urinary catheterization d. 72
during surgery. T F
References
1. Wald HL, Ma A, Bratzler DW, Kramer AM. Indwelling urinary catheter use in the 9. Which of the following is NOT an appropriate indica-
postoperative period: analysis of the national surgical infection prevent project
3. Urinary catheters are inserted in more than 10 million tion for indwelling catheter use?
data. Arch Surg. 2008; 143:551-557.
2. Surgical Care Improvement Project (SCIP). SCIP-Inf-9. Available at: patients per year. T F a. Patient has acute urinary retention or bladder
http://www.hsag.com/App_Resources/Documents/SCIP_LS3_Inf9_MIF.pdf. outlet obstruction
Accessed July 20, 2010.
3. Centers for Medicare & Medicaid Services. Proposed Changes to the Hospital
4. The most effective way to prevent catheter- b. Nursing convenience
IPPS and FY2009 rates. Available at: associated urinary infection (CAUTI) is to avoid c. To assist in healing of open sacral or perineal
http://edocket.access.gpo.gov/2008/pdf/08-1135.pdf/ Accessed July 20, 2010.
catheterization. T F wounds in incontinent patients
4. Prevention and Intervention of CAUTI. First Do No Harm. Available at
http://www.firstdonoharm.com/prevention/UTI. Accessed July 16, 2010. d. Need for accurate measurements of urine in
5. Saint S, Kaufman SR, Thompson M, Rogers MA, Chenoweth CE. A reminder 5. According to SCIP-INF-9, if a patient must critically ill patients
reduces urinary catheterization in hospitalized patients. Jt Comm J Qual Patient
Saf. 2005;31(8):455-462.
have an indwelling catheter for a surgical procedure,
6. Stokowski, LA. Preventing catheter-associated urinary tract infections. Med- is should be removed as soon as possible after the 10. Documentation regarding urinary catheterization
scape Nursing Perspectives. February 3, 2009. Available at http://www.med-
procedure is completed. T F should include which of the following?
scape.com/viewarticle/587464_4. Accessed July 19, 2010.
7. Ribby KJ. Decreasing urinary tract infections through staff development, out- a. Date and time of insertion
comes, and nursing process. J Nurs Care Qual. 2006;21:272-276. Multiple Choice b. Date and time of removal
8. Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA, et al. Guideline for
prevention of catheter-associated urinary tract infections 2009. Available at:
6. As many as _____ percent of hospitals do not keep c. Patient’s general mood when catheter is placed
www.cdc.gov/hicpac/pdf/CAUTI/CAUTIguideline2009final.pdf . Accessed July track of which patients have catheters in place. d. Both a and b
20, 2010.
a. 56
9. Haywood TT, Kosel K, Martin JN, Clark TN. Social practice and clinicians’
meaning of urinary catheter insertions: a case study of context-based design. b. 75
April 2010. Publication pending. c. 34
10. U.S. Food and Drug Administration website. Improving patient safety by report-
ing problems with medical devices – operating room version – speaker notes.
d. 17
Available at: http://www.fda.gov/MedicalDevices/Safety/MedSunMedicalProd-
uctSafetyNetwork/ucm171924.htm. Accessed July 20, 2010.
7. Which of the following pathogens is NOT frequently
associated with CAUTI?
a. Klebsiella pneumoniae
b. Candida
c. Escherichia coli
d. Clostridium dificile
Submit your answers at
www.medlineuniversity.com
Courses approved for continuing education by the Florida Board
and receive 1 FREE CE credit of Nursing and the California Board of Reigistered Nursing.
Aligning practice with policy to improve patient care 47

nated CAUTI. This may be, in part, because the CDC has
cautioned that antimicrobial catheters should not be used
as a common practice to reduce the incidence of CAUTI.8
The great news today is that there are a handful of clinical
teams and manufacturers working together as innovators by
observing practice, introducing redesigned products with visual
reminders and cues and influencing appropriate processes for
inserting and removing Foley catheters. By using observational
studies and context-based design, manufacturers are now able
to build human factors and social behaviors into an innovative
and revolutionary product redesign. According to one case
study, through redesign, clinicians can be influenced to provide
high quality care by creating a greater focus on providing
patient comfort, maintaining sterile technique and decreasing
the time of the entire insertion process.9
These observational studies and context-based learning that
provide insight into why errors occur, along with the role human
factors and social behaviors play in improving patient care, are
being led by VHA, a group purchasing organization based in
Irving, Texas. VHA Inc. is a national network of not-for-profit
healthcare organizations working together to drive maximum
savings in the supply chain arena, set new levels of clinical per-
formance and identify and implement best practices to improve
operational efficiency and clinical outcomes. Formed in 1977,
VHA serves more than 1,400 hospitals and more than 23,000
non-acute care providers nationwide. Dr. Trent Haywood, sen-
ior vice president of clinical performance and chief medical
officer for VHA, is the leader for these projects.
Are You In Line with SCIP-INF-9?
If your answer is yes, then your organization is well on its way
to reducing the incidence of preventable CAUTIs. If not, inves-
tigate how you can better comply with this new measure and
how you can reduce the number of catheters inserted by
ensuring that there is a valid clinical indication, that alternatives
to routine catheterizations have been considered and the role
that you can play in getting necessary catheters out of your
patients sooner once the surgery is completed. Timely removal
is one of the most important aspects to an overall CAUTI pre-
vention strategy. It becomes one of the most prominent, evi-
denced-based prevention strategies after a catheter has been
inserted. Take the time to do what Dr. Haywood and the VHA
team have done to observe clinical practice to learn how to
identify human factors and reengineer practice. And finally, look
46 The OR Connection
CE Test Questions Back to Basics
CAUTI was the number
one hospital-acquired Are You in Line with SCIP Measure Number Nine?
infection in 1981 and is
True/False 8. As many as ____ percent of catheters inserted in sur-
still number one today. 1. Assessing alternatives to catheterization is an gical patients remain in place for more than two days.
evidence-based CAUTI prevention strategy. T F a. 18
to experts such as the CDC and SCIP and other organizations
b. 50
that provide us with evidence-based strategies and recom-
2. The need for intraoperative monitoring of urinary c. 36
mendations to improve patient outcomes.
output is a valid reason for urinary catheterization d. 72
during surgery. T F
References
1. Wald HL, Ma A, Bratzler DW, Kramer AM. Indwelling urinary catheter use in the 9. Which of the following is NOT an appropriate indica-
postoperative period: analysis of the national surgical infection prevent project
3. Urinary catheters are inserted in more than 10 million tion for indwelling catheter use?
data. Arch Surg. 2008; 143:551-557.
2. Surgical Care Improvement Project (SCIP). SCIP-Inf-9. Available at: patients per year. T F a. Patient has acute urinary retention or bladder
http://www.hsag.com/App_Resources/Documents/SCIP_LS3_Inf9_MIF.pdf. outlet obstruction
Accessed July 20, 2010.
3. Centers for Medicare & Medicaid Services. Proposed Changes to the Hospital
4. The most effective way to prevent catheter- b. Nursing convenience
IPPS and FY2009 rates. Available at: associated urinary infection (CAUTI) is to avoid c. To assist in healing of open sacral or perineal
http://edocket.access.gpo.gov/2008/pdf/08-1135.pdf/ Accessed July 20, 2010.
catheterization. T F wounds in incontinent patients
4. Prevention and Intervention of CAUTI. First Do No Harm. Available at
http://www.firstdonoharm.com/prevention/UTI. Accessed July 16, 2010. d. Need for accurate measurements of urine in
5. Saint S, Kaufman SR, Thompson M, Rogers MA, Chenoweth CE. A reminder 5. According to SCIP-INF-9, if a patient must critically ill patients
reduces urinary catheterization in hospitalized patients. Jt Comm J Qual Patient
Saf. 2005;31(8):455-462.
have an indwelling catheter for a surgical procedure,
6. Stokowski, LA. Preventing catheter-associated urinary tract infections. Med- is should be removed as soon as possible after the 10. Documentation regarding urinary catheterization
scape Nursing Perspectives. February 3, 2009. Available at http://www.med-
procedure is completed. T F should include which of the following?
scape.com/viewarticle/587464_4. Accessed July 19, 2010.
7. Ribby KJ. Decreasing urinary tract infections through staff development, out- a. Date and time of insertion
comes, and nursing process. J Nurs Care Qual. 2006;21:272-276. Multiple Choice b. Date and time of removal
8. Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA, et al. Guideline for
prevention of catheter-associated urinary tract infections 2009. Available at:
6. As many as _____ percent of hospitals do not keep c. Patient’s general mood when catheter is placed
www.cdc.gov/hicpac/pdf/CAUTI/CAUTIguideline2009final.pdf . Accessed July track of which patients have catheters in place. d. Both a and b
20, 2010.
a. 56
9. Haywood TT, Kosel K, Martin JN, Clark TN. Social practice and clinicians’
meaning of urinary catheter insertions: a case study of context-based design. b. 75
April 2010. Publication pending. c. 34
10. U.S. Food and Drug Administration website. Improving patient safety by report-
ing problems with medical devices – operating room version – speaker notes.
d. 17
Available at: http://www.fda.gov/MedicalDevices/Safety/MedSunMedicalProd-
uctSafetyNetwork/ucm171924.htm. Accessed July 20, 2010.
7. Which of the following pathogens is NOT frequently
associated with CAUTI?
a. Klebsiella pneumoniae
b. Candida
c. Escherichia coli
d. Clostridium dificile
Submit your answers at
www.medlineuniversity.com
Courses approved for continuing education by the Florida Board
and receive 1 FREE CE credit of Nursing and the California Board of Reigistered Nursing.
Aligning practice with policy to improve patient care 47
 What did we do after
designing a revolutionary
new catheter tray system?

1 Real photography on the outside –

so you know exactly what’s inside
A photo on the package helps identify the
contents of the kit, serves as an educational
tool for the clinician and can be used to
discuss the procedure with the patient.
Also, the label opens up to a booklet with
step-by-step instructions and helpful tips
for the clinician.

We found THREE more ways

to make it even better. 2 A checklist that fits better
in the medical record
The reformatted checklist is smaller, making
We’re obsessed with engineering new and better Combined with the previous innovative tray redesign it easier to fit in the patient chart or medical
technology for healthcare workers. So after we and comprehensive ERASE education, these three record. It is also available as an attachment
revolutionized the outdated Foley catheter tray with new features help to improve patient safety and quality, for electronic documentation.
a unique, one-layer system design, we immediately while reducing avoidable costs associated with waste
turned our attention to addressing how we could and urinary tract infections.
make it even easier to use. We studied how the
tray was being used in the field. The result was To learn about the ERASE CAUTI system, as well as
3 Education you’ll want to present
to your patient
There’s nothing like the new Patient
three more great improvements. other strategies for minimizing the risk of CAUTI, sign Education Care Card. Designed to look
up for a free Innovation in the Prevention of CAUTI and feel like a “Get Well Soon” card, it
webinar at www.medline.com/erase/webinar. tells patients about catheterization so
they know you are providing them the
best care possible.
©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
 What did we do after
designing a revolutionary
new catheter tray system?

1 Real photography on the outside –

so you know exactly what’s inside
A photo on the package helps identify the
contents of the kit, serves as an educational
tool for the clinician and can be used to
discuss the procedure with the patient.
Also, the label opens up to a booklet with
step-by-step instructions and helpful tips
for the clinician.

We found THREE more ways

to make it even better. 2 A checklist that fits better
in the medical record
The reformatted checklist is smaller, making
We’re obsessed with engineering new and better Combined with the previous innovative tray redesign it easier to fit in the patient chart or medical
technology for healthcare workers. So after we and comprehensive ERASE education, these three record. It is also available as an attachment
revolutionized the outdated Foley catheter tray with new features help to improve patient safety and quality, for electronic documentation.
a unique, one-layer system design, we immediately while reducing avoidable costs associated with waste
turned our attention to addressing how we could and urinary tract infections.
make it even easier to use. We studied how the
tray was being used in the field. The result was To learn about the ERASE CAUTI system, as well as
3 Education you’ll want to present
to your patient
There’s nothing like the new Patient
three more great improvements. other strategies for minimizing the risk of CAUTI, sign Education Care Card. Designed to look
up for a free Innovation in the Prevention of CAUTI and feel like a “Get Well Soon” card, it
webinar at www.medline.com/erase/webinar. tells patients about catheterization so
they know you are providing them the
best care possible.
©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
 Special Feature
Your Complimentary Copy of
VHA Study on Social Practice and Clinicians’
Meaning of Urinary Catheter Insertions
50 The OR Connection
BioCon™- 500
Bladder Scanner
Safely Measures
Bladder Volume
Minimize unnecessary catheterization
Research has shown that 80 percent of urinary tract
infections acquired at healthcare facilities are associated
with an indwelling urethral catheter.1 This type of infection
is known as CAUTI, or catheter-associated urinary tract
infection. What’s more, Medicare no longer reimburses
for treatment of CAUTI if it happens while a patient is
hospitalized, giving hospitals a major incentive to prevent
it. But how?
Avoiding unnecessary catheter use is a primary strategy
for preventing CAUTI, and clinical guidelines recommend
the consideration of alternatives to catheterization.2
Bladder scanners can be used in place of a urinary
catheter to assess bladder volumes, and many
catheterizations can be avoided.3
To learn more about CAUTI
prevention and the BioCon-500, visit
www.erasecauti.com/alternatives.asp
or contact your Medline
sales representative.
1. Lo E, Nicolle L, Classen D, Arias A, Podgorny K, Anderson DJ, et al. SHEA/IDSA
practice recommendation: strategies to prevent catheter-associated urinary tract
infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008;29:S41-S50.
2. Stokowski, LA. Preventing catheter-associated urinary tract infections. Medscape
Nursing Perspectives. February 3, 2009.
3. Stevens E. Bladder ultrasound: avoiding unnecessary catheterizations. Med/Surg
Nursing. 2005; 14(4):249-253.
©2010 Medline Industries, Inc.
Medline is a registered trademark of Medline Industries, Inc.
BioCon-500 is a trademark of Mcube Technology Co., Ltd.
 Special Feature
Your Complimentary Copy of
VHA Study on Social Practice and Clinicians’
Meaning of Urinary Catheter Insertions
50 The OR Connection
BioCon™- 500
Bladder Scanner
Safely Measures
Bladder Volume
Minimize unnecessary catheterization
Research has shown that 80 percent of urinary tract
infections acquired at healthcare facilities are associated
with an indwelling urethral catheter.1 This type of infection
is known as CAUTI, or catheter-associated urinary tract
infection. What’s more, Medicare no longer reimburses
for treatment of CAUTI if it happens while a patient is
hospitalized, giving hospitals a major incentive to prevent
it. But how?
Avoiding unnecessary catheter use is a primary strategy
for preventing CAUTI, and clinical guidelines recommend
the consideration of alternatives to catheterization.2
Bladder scanners can be used in place of a urinary
catheter to assess bladder volumes, and many
catheterizations can be avoided.3
To learn more about CAUTI
prevention and the BioCon-500, visit
www.erasecauti.com/alternatives.asp
or contact your Medline
sales representative.
1. Lo E, Nicolle L, Classen D, Arias A, Podgorny K, Anderson DJ, et al. SHEA/IDSA
practice recommendation: strategies to prevent catheter-associated urinary tract
infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008;29:S41-S50.
2. Stokowski, LA. Preventing catheter-associated urinary tract infections. Medscape
Nursing Perspectives. February 3, 2009.
3. Stevens E. Bladder ultrasound: avoiding unnecessary catheterizations. Med/Surg
Nursing. 2005; 14(4):249-253.
©2010 Medline Industries, Inc.
Medline is a registered trademark of Medline Industries, Inc.
BioCon-500 is a trademark of Mcube Technology Co., Ltd.
 Patient Safety
Arkansas Methodist Medical Center
Changing Clinical Behaviors to Lower Costs and Reduce
Catheter-Associated Urinary Tract Infections (CAUTI)

Arkansas Methodist Medical Center: How a Foley Catheter AMMC often exceeds state and national decision on whether catheterization was addition, the tray was labeled in a
averages for quality care and continues appropriate for their patients would also specific sequence that helped guide
Management System Combined With Education Helped Reduce to raise the bar with high marks on na- be important in assuring that the educa- the nurse during catheterization to adhere
tional patient safety goals, quality core tion transferred into everyday clinical to current recommendations, including
Catheter Utilization by 21 percent. measures and patient satisfaction practice. aseptic technique.
scores. An important component of this
initiative is infection prevention followed Moreover, there was a significant risk of The program emphasizes evidence-
Lisa Bridges, RN, Infection Preventionist, Arkansas Methodist Medical Center by cost reduction. Implementing this im- increased CAUTI cases due to the lack based techniques backed by teaching
provement project would satisfy many of communication amongst our staff materials that help bridge the gap
important aspects of our overall strate- and physicians on the exact day a between inconsistent practices. The
Hospital: gic plan. We knew it would not be easy, patient had been catheterized. One of acronym ERASE is easy to remember,
Arkansas Methodist Medical Center, but it was an important initiative. the leading factors for developing CAUTI reminding our clinicians to:
Paragould, AR is leaving a catheter in place for more E—Evaluate indications;
Following are the major goals of our than two days post-operatively. In the R—Read directions and tips;
Size: CAUTI reduction plan: first quarter of 2010, only 20 percent of A—Aseptic technique;
129-bed acute care hospital - Reduce CAUTI rate the catheters we placed in the operat- S—Secure catheter;
- Reduce catheter utilization ing room were being removed after two E—Educate the patient.
- Improve staff education on proper days. We needed to get this to 100
insertion techniques percent. We decided not only to implement the
- Enhance staff and patient new product, but also to require all of
interaction Another very important issue was the our clinicians who insert catheters to go
- Implement SCIP measures to new CMS focus on a list of hospital- through the education program and to
mission on Accreditation of Rehabilita- we serve, thus establishing AMMC as a remove catheters post-operatively acquired conditions in 2008, which measure the results to determine if this
tion Facilities (CARF). According to the patient’s first choice for healthcare. in a timely manner included CAUTI as a preventable health- program and product would help us to
Quality Improvement Goal:
most recent survey data, 24,802 pa- care-acquired condition. achieve our goals for reduced catheter-
Reduce the number of catheter-associ-
tients visit the hospital's emergency Our Challenge In January 2010, when we set our hos- izations and a reduction in CAUTI.
ated urinary tract infections (CAUTI) by
room annually; a total of 4,196 patients Arkansas is currently a voluntary report- pital-wide goal of reducing the risk of It was overwhelmingly clear that AMMC
identifying a systematic behavioral
are admitted. Physicians perform 795 ing state for hospital-acquired infections CAUTI, we did not have an updated and had to reevaluate the current CAUTI There were other benefits of the new
approach formulated from the CAUTI
inpatient and 1,827 outpatient surgeries. (HAIs), but we are seeing the trend comprehensive education program for program and create a new, prevention- tray that made this an easier change in
guidelines released in 2009 by the Cen-
The medical center includes: among most states to mandate public our staff of nearly 300 clinicians. Our oriented system. practice and procedure for our nurses.
ters Disease Control and Prevention
• A 129-bed inpatient facility reporting and believe it to only be a mat- goal was to implement a more effective These included:
(CDC). The quality goals for this project
• More than 200 nurses ter of time before we will be required to way to educate our patients about the The Solution
were to identify patients with valid clini-
• Women’s services report these infections. procedure, including the risks and com- In January we were introduced to Med- 1. Clear photography of tray
cal indications for closed system Foley
• Heart catheterization lab plications associated with closed sys- line’s new ERASE CAUTI Foley catheter contents on the outside of
catheter insertion prior to utilization,
• Infection isolation room Historically we have experienced rela- tem Foley catheters. management program. Timing could not the package.
developing alternatives to catheteriza-
• Critical care unit tively low CAUTI rates; however, AMMC have been better, as this program incor- The product instructions and clear
tion when no valid clinical indication is
• Imaging services is striving to get that number to zero by We expected that a number of catheter porated the CDC’s guidelines into not color images are located on the
identified, maintaining aseptic tech-
implementing practices that reduce the insertions could be attributed to a gen- only a comprehensive educational outside to encourage clinicians to
nique, and removing catheters when
The hospital is a local, not-for-profit, risk of CAUTI. In addition, we wanted to eral lack of focus on the appropriate program and competency tool that review the information before they
they are no longer needed.
community-focused organization that also reduce the chance of infection and indications for catheter insertion based supported our initiatives, but also pro- start. Clinicians can review the
promotes the health and wellness of improve patient satisfaction by improv- upon historical practice and conven- vided the clinician at the bedside instructions before entering the
Facility Demographics: Arkansas
Northeast Arkansas and Southeast Mis- ing our rates of removing catheters ience of the clinician. Our clinicians with visual reminders and cues through patient room as well as reminders
Methodist Medical Center (AMMC) is a
souri families. Through dedication, we post-operatively within 24-48 hours of needed education on the CDC guide- checklists, instructions, and organization and tips for prevention of CAUTI.
general medical and surgical hospital,
provide quality healthcare and promote insertion per the new SCIP (Surgical lines for CAUTI prevention and the alter- of the procedure. The product design
with 129 beds. AMMC is accredited by
wellness to the people and communities Care Improvement Project) measures. natives to catheterization. We decided was different from our traditional Foley
The Joint Commission, plus the Com-
that a checklist to help them make a kits in that the tray was only one layer. In

52 The OR Connection Aligning practice with policy to improve patient care 53

 Patient Safety
Arkansas Methodist Medical Center
Changing Clinical Behaviors to Lower Costs and Reduce
Catheter-Associated Urinary Tract Infections (CAUTI)

Arkansas Methodist Medical Center: How a Foley Catheter AMMC often exceeds state and national decision on whether catheterization was addition, the tray was labeled in a
averages for quality care and continues appropriate for their patients would also specific sequence that helped guide
Management System Combined With Education Helped Reduce to raise the bar with high marks on na- be important in assuring that the educa- the nurse during catheterization to adhere
tional patient safety goals, quality core tion transferred into everyday clinical to current recommendations, including
Catheter Utilization by 21 percent. measures and patient satisfaction practice. aseptic technique.
scores. An important component of this
initiative is infection prevention followed Moreover, there was a significant risk of The program emphasizes evidence-
Lisa Bridges, RN, Infection Preventionist, Arkansas Methodist Medical Center by cost reduction. Implementing this im- increased CAUTI cases due to the lack based techniques backed by teaching
provement project would satisfy many of communication amongst our staff materials that help bridge the gap
important aspects of our overall strate- and physicians on the exact day a between inconsistent practices. The
Hospital: gic plan. We knew it would not be easy, patient had been catheterized. One of acronym ERASE is easy to remember,
Arkansas Methodist Medical Center, but it was an important initiative. the leading factors for developing CAUTI reminding our clinicians to:
Paragould, AR is leaving a catheter in place for more E—Evaluate indications;
Following are the major goals of our than two days post-operatively. In the R—Read directions and tips;
Size: CAUTI reduction plan: first quarter of 2010, only 20 percent of A—Aseptic technique;
129-bed acute care hospital - Reduce CAUTI rate the catheters we placed in the operat- S—Secure catheter;
- Reduce catheter utilization ing room were being removed after two E—Educate the patient.
- Improve staff education on proper days. We needed to get this to 100
insertion techniques percent. We decided not only to implement the
- Enhance staff and patient new product, but also to require all of
interaction Another very important issue was the our clinicians who insert catheters to go
- Implement SCIP measures to new CMS focus on a list of hospital- through the education program and to
mission on Accreditation of Rehabilita- we serve, thus establishing AMMC as a remove catheters post-operatively acquired conditions in 2008, which measure the results to determine if this
tion Facilities (CARF). According to the patient’s first choice for healthcare. in a timely manner included CAUTI as a preventable health- program and product would help us to
Quality Improvement Goal:
most recent survey data, 24,802 pa- care-acquired condition. achieve our goals for reduced catheter-
Reduce the number of catheter-associ-
tients visit the hospital's emergency Our Challenge In January 2010, when we set our hos- izations and a reduction in CAUTI.
ated urinary tract infections (CAUTI) by
room annually; a total of 4,196 patients Arkansas is currently a voluntary report- pital-wide goal of reducing the risk of It was overwhelmingly clear that AMMC
identifying a systematic behavioral
are admitted. Physicians perform 795 ing state for hospital-acquired infections CAUTI, we did not have an updated and had to reevaluate the current CAUTI There were other benefits of the new
approach formulated from the CAUTI
inpatient and 1,827 outpatient surgeries. (HAIs), but we are seeing the trend comprehensive education program for program and create a new, prevention- tray that made this an easier change in
guidelines released in 2009 by the Cen-
The medical center includes: among most states to mandate public our staff of nearly 300 clinicians. Our oriented system. practice and procedure for our nurses.
ters Disease Control and Prevention
• A 129-bed inpatient facility reporting and believe it to only be a mat- goal was to implement a more effective These included:
(CDC). The quality goals for this project
• More than 200 nurses ter of time before we will be required to way to educate our patients about the The Solution
were to identify patients with valid clini-
• Women’s services report these infections. procedure, including the risks and com- In January we were introduced to Med- 1. Clear photography of tray
cal indications for closed system Foley
• Heart catheterization lab plications associated with closed sys- line’s new ERASE CAUTI Foley catheter contents on the outside of
catheter insertion prior to utilization,
• Infection isolation room Historically we have experienced rela- tem Foley catheters. management program. Timing could not the package.
developing alternatives to catheteriza-
• Critical care unit tively low CAUTI rates; however, AMMC have been better, as this program incor- The product instructions and clear
tion when no valid clinical indication is
• Imaging services is striving to get that number to zero by We expected that a number of catheter porated the CDC’s guidelines into not color images are located on the
identified, maintaining aseptic tech-
implementing practices that reduce the insertions could be attributed to a gen- only a comprehensive educational outside to encourage clinicians to
nique, and removing catheters when
The hospital is a local, not-for-profit, risk of CAUTI. In addition, we wanted to eral lack of focus on the appropriate program and competency tool that review the information before they
they are no longer needed.
community-focused organization that also reduce the chance of infection and indications for catheter insertion based supported our initiatives, but also pro- start. Clinicians can review the
promotes the health and wellness of improve patient satisfaction by improv- upon historical practice and conven- vided the clinician at the bedside instructions before entering the
Facility Demographics: Arkansas
Northeast Arkansas and Southeast Mis- ing our rates of removing catheters ience of the clinician. Our clinicians with visual reminders and cues through patient room as well as reminders
Methodist Medical Center (AMMC) is a
souri families. Through dedication, we post-operatively within 24-48 hours of needed education on the CDC guide- checklists, instructions, and organization and tips for prevention of CAUTI.
general medical and surgical hospital,
provide quality healthcare and promote insertion per the new SCIP (Surgical lines for CAUTI prevention and the alter- of the procedure. The product design
with 129 beds. AMMC is accredited by
wellness to the people and communities Care Improvement Project) measures. natives to catheterization. We decided was different from our traditional Foley
The Joint Commission, plus the Com-
that a checklist to help them make a kits in that the tray was only one layer. In

52 The OR Connection Aligning practice with policy to improve patient care 53

 Arkansas Methodist Medical Center
2. Outer label checklist.
Listed on the checklist label on the
outside packaging are the CDC’s six
valid clinical indications for inserting
an indwelling catheter. Additionally,
there are clinician-specific questions
included on the checklist to ensure
we are following all of the CDC’s
recommended CAUTI prevention
guidelines. The checklist is printed on
a peel-off sticker, making it easy to
complete and place in the patient
chart. Ultimately, we hoped this would
help us reduce the number of poten-
tially unnecessary catheter placements.
3. Patient Education Care Cards™.
The first thing you see when you
open up the Medline tray is a
Patient Care Card. It looks just like an
actual get well card, however, it
contains patient education informa-
tion. Before, we had to print our edu-
cation from the computer, and it was
not something the patient or the clini-
cian normally took time to review. We
think this new card will more effec-
tively communicate how the patient
and family can be involved in their
care to reduce the incidence of CAUTI
even after they are discharged, thus
reducing the opportunity for read-
missions.
Execution
After being educated on the program
and agreeing to continue the approval
process in the hospital, we followed
three crucial steps toward implementation.
Step 1 – Cost Analysis
We first met with materials management
to perform a cost-benefit analysis. We
did not want to get far down the road in
our evaluation, and then have a stum-
bling block because of cost. The cost of
54 The OR Connection
the new tray was comparable to the tray
that we had been buying, so we deter-
mined that acquisition cost was not an
issue. If we were successful in reducing
the number of catheters inserted, then
we further believed we would see an
overall cost savings. In addition, al-
though we were not certain of the exact
costs we were incurring when a patient
developed a CAUTI, we predicted that
additional savings would be gained
through CAUTI reduction.
Step 2 – Department Manager
Education
We introduced Medline’s ERASE CAUTI
program to the hospital’s chief nursing
officer, the quality control team and the
nurse managers following one of our in-
fection control committee meetings.
Because we had an idea of the pricing
and the education materials that would
accompany the program, we immedi-
ately were able to schedule a two-day
in-service with the nurse managers to
fully introduce the ERASE CAUTI pro-
gram. Following the in-service training,
it was agreed that AMMC would convert
to Medline’s ERASE CAUTI program.
Step 3 – The Implementation
After buy-in from our CNO and depart-
ment managers, we converted to the
ERASE CAUTI program throughout the
entire facility at the end of February
2010. The system is now being used in
the emergency department, labor &
delivery, operating room, the medical
surgery floor and the critical care unit.
Medline provided clinical and product
staff to implement the education com-
ponent to all clinicians covering three
nursing shifts. Nursing staff were shown
how to use the tray correctly and
retrained on the principles of Foley
catheter insertion. Every nurse was also
required to watch an educational film
that accompanies the program and
teaches the indications and alternatives
to catheterization; aseptic technique
and proper insertion of a Foley catheter;
care and maintenance, signs and symp-
toms of CAUTI and timely removal; and
competency validation. This video is
currently on the hospital’s internal web-
site (intranet) to make viewing accessible
to our nursing staff any time of the day.
Having it on our intranet will also help
train our incoming nursing students in a
timely manner. Ensuring proper educa-
tion is a crucial step in the success of
the program.
The Results
By April 2010 – about six weeks into the
conversion – we were able to compare
the usage rate, the CAUTI cases, timely
removal and cost savings to a similar
time period the previous year. The re-
sults were impressive.
Reduction in Catheterization
We saw a 21 percent reduction in Foley
usage from March 2009 to March 2010
based on adjusted patient days (91 vs. 72)
and a 22 percent reduction in April com-
pared to the previous year (101 vs. 79).
Reduction in CAUTIs
While we did not have high CAUTI rates
prior to implementation, we did get to
our goal of zero in April 2010, compared
to the three we had in April 2009. We
expect to maintain lower rates as we go
forward.
Cost Savings
With the inclusion of the securement
device in the new tray (in the old tray, the
securement device was purchased sep-
arately), the price of the actual ERASE
Arkansas Methodist Medical Center
CAUTI tray was comparable to our old
tray. But when you factor in the reduced Foley Catheter Tray Utilization (based on adjusted patient days)
utilization (151 catheterizations in March
and April combined in 2010 vs. 192 in 2009 2010 % decrease
2009), we projected an annual reduction March 91 72 21%
in acquisition costs for Foley kits of 21 April 101 79 22%
percent – or more than $2,500 annually. Total 192 151 21%
Combining this savings with the elimina-
tion of three CAUTIs (which could be as
high as $44,043 per case according to CAUTI Rates (per 1,000 urinary catheter days) trending down
CMS), the cost reduction we anticipate 2009 2010 % decrease
is substantial. March 2 2 0
April 3 0 100%
Timely Removal in Post-Operative Care
Our two-day post-operative removal
rate increased to 50 percent (from 20 Timely Removal in Post-Operative Care
percent) for the first quarter of 2010. (% of catheters removed within 2 days post-operatively)
With the Foley InserTag and checklist
2009 2010 % Improvement
sticker on the chart, nurses and physi-
1st Quarter 20% 50% 150%
cians knew exactly when the catheters
had been placed and were able to re-
move them in the necessary 24 – 48
hours post-op.
and symptoms of CAUTI and how they iors were reinforced through visual
We found that the ERASE CAUTI pro- can help reduce the chances of devel- reminders and cues that were incorpo-
gram clearly supports the CDC guide- oping a CAUTI, which we are confident rated into the new product and sup-
lines and is helping us change the can only increase patient satisfaction. ported by an evidence-based education
behavior of our clinicians to incorporate program provided to our clinicians.
proven, consistent insertion techniques. Summary of Clinical Outcomes:
Additionally, we have turned to alterna- Changing clinical behaviors resulted in About the author
tive, cost-effective solutions for patients an average 21 percent reduction in Lisa Bridges, BS, RN,
who do not need to be catheterized, catheter utilization, decreased the num- began working for
including bedside urinals, bed type ber of CAUTIs to zero to date and in- Arkansas Methodist
commodes and bed pans. creased timely removal of catheters in Medical Center (AMMC)
post-operative care from 20 percent to seven years ago as a
Finally, the patient education component 50 percent. We believe these outcomes registered nurse in the
in the ERASE CAUTI program (the Pa- were a result of changing clinician be- critical care unit, and
tient Education Care Card) has signifi- havior by reducing variability in the in- she has been head of AMMC’s infection pre-
cantly improved our ability to provide the sertion process and ultimately vention program for the past two years. She
patient and family with a tool to help reduced opportunity for CAUTI through has a bachelor’s degree in health services
them better understand the proper care implementation of the CDC guidelines. administration.
and maintenance of the catheter, signs Together these processes and behav-
Aligning practice with policy to improve patient care 55
 Arkansas Methodist Medical Center
2. Outer label checklist.
Listed on the checklist label on the
outside packaging are the CDC’s six
valid clinical indications for inserting
an indwelling catheter. Additionally,
there are clinician-specific questions
included on the checklist to ensure
we are following all of the CDC’s
recommended CAUTI prevention
guidelines. The checklist is printed on
a peel-off sticker, making it easy to
complete and place in the patient
chart. Ultimately, we hoped this would
help us reduce the number of poten-
tially unnecessary catheter placements.
3. Patient Education Care Cards™.
The first thing you see when you
open up the Medline tray is a
Patient Care Card. It looks just like an
actual get well card, however, it
contains patient education informa-
tion. Before, we had to print our edu-
cation from the computer, and it was
not something the patient or the clini-
cian normally took time to review. We
think this new card will more effec-
tively communicate how the patient
and family can be involved in their
care to reduce the incidence of CAUTI
even after they are discharged, thus
reducing the opportunity for read-
missions.
Execution
After being educated on the program
and agreeing to continue the approval
process in the hospital, we followed
three crucial steps toward implementation.
Step 1 – Cost Analysis
We first met with materials management
to perform a cost-benefit analysis. We
did not want to get far down the road in
our evaluation, and then have a stum-
bling block because of cost. The cost of
54 The OR Connection
the new tray was comparable to the tray
that we had been buying, so we deter-
mined that acquisition cost was not an
issue. If we were successful in reducing
the number of catheters inserted, then
we further believed we would see an
overall cost savings. In addition, al-
though we were not certain of the exact
costs we were incurring when a patient
developed a CAUTI, we predicted that
additional savings would be gained
through CAUTI reduction.
Step 2 – Department Manager
Education
We introduced Medline’s ERASE CAUTI
program to the hospital’s chief nursing
officer, the quality control team and the
nurse managers following one of our in-
fection control committee meetings.
Because we had an idea of the pricing
and the education materials that would
accompany the program, we immedi-
ately were able to schedule a two-day
in-service with the nurse managers to
fully introduce the ERASE CAUTI pro-
gram. Following the in-service training,
it was agreed that AMMC would convert
to Medline’s ERASE CAUTI program.
Step 3 – The Implementation
After buy-in from our CNO and depart-
ment managers, we converted to the
ERASE CAUTI program throughout the
entire facility at the end of February
2010. The system is now being used in
the emergency department, labor &
delivery, operating room, the medical
surgery floor and the critical care unit.
Medline provided clinical and product
staff to implement the education com-
ponent to all clinicians covering three
nursing shifts. Nursing staff were shown
how to use the tray correctly and
retrained on the principles of Foley
catheter insertion. Every nurse was also
required to watch an educational film
that accompanies the program and
teaches the indications and alternatives
to catheterization; aseptic technique
and proper insertion of a Foley catheter;
care and maintenance, signs and symp-
toms of CAUTI and timely removal; and
competency validation. This video is
currently on the hospital’s internal web-
site (intranet) to make viewing accessible
to our nursing staff any time of the day.
Having it on our intranet will also help
train our incoming nursing students in a
timely manner. Ensuring proper educa-
tion is a crucial step in the success of
the program.
The Results
By April 2010 – about six weeks into the
conversion – we were able to compare
the usage rate, the CAUTI cases, timely
removal and cost savings to a similar
time period the previous year. The re-
sults were impressive.
Reduction in Catheterization
We saw a 21 percent reduction in Foley
usage from March 2009 to March 2010
based on adjusted patient days (91 vs. 72)
and a 22 percent reduction in April com-
pared to the previous year (101 vs. 79).
Reduction in CAUTIs
While we did not have high CAUTI rates
prior to implementation, we did get to
our goal of zero in April 2010, compared
to the three we had in April 2009. We
expect to maintain lower rates as we go
forward.
Cost Savings
With the inclusion of the securement
device in the new tray (in the old tray, the
securement device was purchased sep-
arately), the price of the actual ERASE
Arkansas Methodist Medical Center
CAUTI tray was comparable to our old
tray. But when you factor in the reduced Foley Catheter Tray Utilization (based on adjusted patient days)
utilization (151 catheterizations in March
and April combined in 2010 vs. 192 in 2009 2010 % decrease
2009), we projected an annual reduction March 91 72 21%
in acquisition costs for Foley kits of 21 April 101 79 22%
percent – or more than $2,500 annually. Total 192 151 21%
Combining this savings with the elimina-
tion of three CAUTIs (which could be as
high as $44,043 per case according to CAUTI Rates (per 1,000 urinary catheter days) trending down
CMS), the cost reduction we anticipate 2009 2010 % decrease
is substantial. March 2 2 0
April 3 0 100%
Timely Removal in Post-Operative Care
Our two-day post-operative removal
rate increased to 50 percent (from 20 Timely Removal in Post-Operative Care
percent) for the first quarter of 2010. (% of catheters removed within 2 days post-operatively)
With the Foley InserTag and checklist
2009 2010 % Improvement
sticker on the chart, nurses and physi-
1st Quarter 20% 50% 150%
cians knew exactly when the catheters
had been placed and were able to re-
move them in the necessary 24 – 48
hours post-op.
and symptoms of CAUTI and how they iors were reinforced through visual
We found that the ERASE CAUTI pro- can help reduce the chances of devel- reminders and cues that were incorpo-
gram clearly supports the CDC guide- oping a CAUTI, which we are confident rated into the new product and sup-
lines and is helping us change the can only increase patient satisfaction. ported by an evidence-based education
behavior of our clinicians to incorporate program provided to our clinicians.
proven, consistent insertion techniques. Summary of Clinical Outcomes:
Additionally, we have turned to alterna- Changing clinical behaviors resulted in About the author
tive, cost-effective solutions for patients an average 21 percent reduction in Lisa Bridges, BS, RN,
who do not need to be catheterized, catheter utilization, decreased the num- began working for
including bedside urinals, bed type ber of CAUTIs to zero to date and in- Arkansas Methodist
commodes and bed pans. creased timely removal of catheters in Medical Center (AMMC)
post-operative care from 20 percent to seven years ago as a
Finally, the patient education component 50 percent. We believe these outcomes registered nurse in the
in the ERASE CAUTI program (the Pa- were a result of changing clinician be- critical care unit, and
tient Education Care Card) has signifi- havior by reducing variability in the in- she has been head of AMMC’s infection pre-
cantly improved our ability to provide the sertion process and ultimately vention program for the past two years. She
patient and family with a tool to help reduced opportunity for CAUTI through has a bachelor’s degree in health services
them better understand the proper care implementation of the CDC guidelines. administration.
and maintenance of the catheter, signs Together these processes and behav-
Aligning practice with policy to improve patient care 55
 OR Issues

By Kevin W. Yankowsky, JD

Let’s start by considering the following surgery patient scenario:

An 80-year-old man suffers a fall in a hotel bathroom, fracturing his cervical spine at C3-C4.
He is rushed to your facility where an emergent neurosurgical procedure successfully stabi-
lizes his fracture. Despite the successful surgery, the patient remains paralyzed from the waist
down and ventilator-dependent post-operatively. The surgery itself lasted approximately 6.5
hours. No supplemental pressure reducing surface was used on the operating room table.

The patient spends five days postoperatively in the ICU. On post-operative day one a small
red area on the patient’s sacrum is noticed by a nurse while performing a bath. It is labeled a
Stage I pressure ulcer by that nurse in the patient’s chart. The wound is not noted in any
nursing documentation on post-operative day two. On post-operative day three a different
nurse notices that the same general area on the patient’s sacrum has become blistered, with
damage to skin integrity. She labels the wound as a Stage II pressure ulcer. She verbally
relays this finding to the attending physician who consults a wound and ostomy nurse. The
wound and ostomy nurse sees the patient that day but does not write a progress note in the
chart. The patient’s family is not informed when the Stage I pressure ulcer is first identified.
The patient’s family is informed when the Stage II wound is identified, but does not actually
see the wound itself.

The facility has a generally applicable wound care policy, which requires all patients to be
assessed for their risk of skin breakdown, and further requires all patients to be turned every

T O
two hours. The policy also requires the use of a wound care charting addendum form once a

R
Stage I is identified. ICU nurses typically do not perform a skin assessment on postoperative

O
patients, and none is done in this case. Additionally, because of their routinely more exten-

M
sive charting, the additional documentation tool called for by the policy is never routinely used

O
FR TROOM
by the ICU nurses at this facility, including any of the ICU nurses caring for this patient.

On post-operative day five the same area on the patient’s sacrum is noted to be black with

R
purulent drainage and eschar. It is labeled a Stage III pressure ulcer by the nurse doing the

U
assessment. The wound and ostomy nurse is consulted again. This time wound care orders

CO OW
are received and implemented and a progress note is made in the patient’s chart. The patient’s

’T K N family sees the pressure ulcer for the first time this day.

D O N
U
The patient is weaned off the ventilator on post-operative day five and leaves the ICU that

T Y O Y O U same day. The sacral wound is ultimately debrided and heals appropriately. The patient walks

WH A H U RT e ase
out of the hospital on post-operative day 11.

CAN in c r
ingly ow ionigat
Twenty-two months following the patient’s discharge, a suit is filed against the hospital for neg-

n kn e lit ligent operative and post-operative care. The suit seeks both compensatory and punitive

u may u practic damages. Because the suit involves an elderly patient, it is alleged that the cap on punitive

w y o f mal damages generally applicable in this jurisdiction will not apply to this case. In their court
Ho r i sko filings, the family makes a specific claim for $2 million in total damages.
you r

56 The OR Connection Aligning practice with policy to improve patient care 57

 OR Issues

By Kevin W. Yankowsky, JD

Let’s start by considering the following surgery patient scenario:

An 80-year-old man suffers a fall in a hotel bathroom, fracturing his cervical spine at C3-C4.
He is rushed to your facility where an emergent neurosurgical procedure successfully stabi-
lizes his fracture. Despite the successful surgery, the patient remains paralyzed from the waist
down and ventilator-dependent post-operatively. The surgery itself lasted approximately 6.5
hours. No supplemental pressure reducing surface was used on the operating room table.

The patient spends five days postoperatively in the ICU. On post-operative day one a small
red area on the patient’s sacrum is noticed by a nurse while performing a bath. It is labeled a
Stage I pressure ulcer by that nurse in the patient’s chart. The wound is not noted in any
nursing documentation on post-operative day two. On post-operative day three a different
nurse notices that the same general area on the patient’s sacrum has become blistered, with
damage to skin integrity. She labels the wound as a Stage II pressure ulcer. She verbally
relays this finding to the attending physician who consults a wound and ostomy nurse. The
wound and ostomy nurse sees the patient that day but does not write a progress note in the
chart. The patient’s family is not informed when the Stage I pressure ulcer is first identified.
The patient’s family is informed when the Stage II wound is identified, but does not actually
see the wound itself.

The facility has a generally applicable wound care policy, which requires all patients to be
assessed for their risk of skin breakdown, and further requires all patients to be turned every

T O
two hours. The policy also requires the use of a wound care charting addendum form once a

R
Stage I is identified. ICU nurses typically do not perform a skin assessment on postoperative

O
patients, and none is done in this case. Additionally, because of their routinely more exten-

M
sive charting, the additional documentation tool called for by the policy is never routinely used

O
FR TROOM
by the ICU nurses at this facility, including any of the ICU nurses caring for this patient.

On post-operative day five the same area on the patient’s sacrum is noted to be black with

R
purulent drainage and eschar. It is labeled a Stage III pressure ulcer by the nurse doing the

U
assessment. The wound and ostomy nurse is consulted again. This time wound care orders

CO OW
are received and implemented and a progress note is made in the patient’s chart. The patient’s

’T K N family sees the pressure ulcer for the first time this day.

D O N
U
The patient is weaned off the ventilator on post-operative day five and leaves the ICU that

T Y O Y O U same day. The sacral wound is ultimately debrided and heals appropriately. The patient walks

WH A H U RT e ase
out of the hospital on post-operative day 11.

CAN in c r
ingly ow ionigat
Twenty-two months following the patient’s discharge, a suit is filed against the hospital for neg-

n kn e lit ligent operative and post-operative care. The suit seeks both compensatory and punitive

u may u practic damages. Because the suit involves an elderly patient, it is alleged that the cap on punitive

w y o f mal damages generally applicable in this jurisdiction will not apply to this case. In their court
Ho r i sko filings, the family makes a specific claim for $2 million in total damages.
you r

56 The OR Connection Aligning practice with policy to improve patient care 57

 The Problems
The vast majority of that information comes from
Sound familiar or far-fetched? Either
one of two sources:
way, rest assured this can and does
1. The story told by the patient, which is often
happen at facilities all across the
emotional and somewhat unreliable
country, all the time. Completely
2. The story told by the clinicians’ written words
leaving aside the medicine and clin-
in the patient’s medical record.
ical care issues involved, it can be said with confidence that
the chances are high this case will likely settle – and for a
If the patient’s medical record suggests improper care, it is likely
significant amount of money. There are several reasons,
that the case initially will be judged to be one with potential merit
entirely separate and apart from the quality of the medical
by the plaintiff’s lawyer, and the case will likely be filed. Even if
care provided, that make this case a very likely one to end up
subsequent discovery demonstrates that little, if any, substan-
in litigation from virtually day one, and will make this lawsuit
dard care was actually provided, your facility (and more impor-
a difficult one to defend. It is therefore likely to settle, and
tantly your clinical associates) has already incurred the time,
could easily settle for up to $250,000, and quite possibly in
expense and stress inevitably associated with the adversarial
excess of $500,000.
legal process. Thus, once a lawsuit is filed, everyone named in
the suit has already lost, to one degree or another.
Problem 1: The complication was an unexpected one.
Complications can occur in any critically ill patient’s case,
In this case, the failure to appropriately document the pres-
often despite the provision of the highest quality care. An
sure ulcer as required by hospital policy will likely lead to the
important fact that few health care providers realize is that
appearance that proper care was not provided. Addition-
purely from a legal and liability standpoint it is often not the
ally, the failure to document anything about the wound on
severity of complication that triggers litigation; it is the
postoperative day two could be interpreted as proof that
degree of surprise associated with the complication itself. It
the wound either was not recognized (nothing was docu-
is important to keep in mind that it is often not outstanding
mented, therefore nothing was known) or treated (nothing
medical results that avoid litigation, but rather satisfactory
was documented, therefore nothing was done), or both, and simple meaning in most cases. Juries are rarely recep- patient, due to his ventilator dependant status, was probably
medical results. And the satisfactory result is often the
during that critical 24-hour period. Likewise, the simple failure tive to the argument that a common word in a policy really not even capable of being turned every two hours during his
expected one, even when the expected result is less than
of the wound and ostomy nurse to document in the doesn’t mean what they believe it to mean. This is especially immediate post-operative recovery. Furthermore, his spinal
medically optimal. Put another way, expected deaths with
patient’s chart during his or her first consultation could eas- true when that argument comes from the author of the policy injury may have made frequent turning during his imme-
dignity can often occur without subsequent litigation,
ily lead a plaintiff’s attorney to initially conclude that the con- who is attempting to avoid the implications of a literal inter- diate postoperative days ill-advised or even dangerous.
whereas miraculous recoveries accompanied by
sultation did not occur in a timely fashion. pretation of his or her own written work. Nevertheless, the policy leaves no room for discretion in turn-
unavoidable yet surprising complications can often result
ing under such unusual circumstances. On its face, the failure
in lawsuits being filed. In this example, the simple facts that
Problem 3: Poorly written policies contribute to the In this example, the hospital’s wound care policy mandates to turn this patient violates hospital policy as well. That
this pressure ulcer was unexpected and was not
appearance of poor care. As a general rule, policies that a skin assessment be performed on all patients. Postopera- violation too can be used to establish liability on the part of
revealed to the family until days after it originally developed
contain mandates and absolute words can also create the tive patients are not exempt from this requirement by the the facility.
in and of themselves make it more likely that this patient’s
appearance of substandard care. Examples of such words plain words of the policy. Thus, even though there may be no
case will end up in the legal system.
are “must,” “always” and “immediately.” It is important to real reason to perform a skin assessment on every patient The Solutions
keep in mind that regardless of how clinicians intend these who leaves the OR and is admitted to the ICU, the failure to How do you minimize the chances
Problem 2: Documentation creates the appearance
words to be interpreted, lay juries almost always give the do so appears to violate policy, and could be considered the of litigation faced when faced with
of poor care. It is often not the existence of poor care but
words their plain and ordinary meaning. “Always” and its provision of substandard care for that reason alone. this fact scenario? Certainly, the
rather the appearance of poor care, which initially prompts
polar opposite “never” both mean without discretion to most most important thing is to do
a plaintiff’s attorney to take a case rather than reject it.
laypeople. “Always” means in every single case, regardless Likewise, hospital policy mandates that a certain form be everything possible to provide the
Keep in mind that a plaintiff’s lawyer has very little concrete
of the special circumstances a unique patient may present. used to document the progress of the wound care. The fail- best, highest quality care you can, and minimize the inci-
information upon which to base his or her critical initial
“Immediately” means just that. It does not mean minutes ure to utilize that form in the ICU (even for a good and prac- dences of all postoperative complications in your surgical
decision whether to retain a patient as a client.
and certainly not hours later. “Never” means in not a single tical reason) could form another initial basis of liability. Finally, patients. But once again, without changing any of the medical
case, regardless of special circumstances as well. And since the hospital’s policy requiring that all patients must be turned facts in the example set forth above, there are a number of
these are the clinicians’ words, they will be held to their plain every two hours could also be problematic. This particular

58 The OR Connection Aligning practice with policy to improve patient care 59

 The Problems
The vast majority of that information comes from
Sound familiar or far-fetched? Either
one of two sources:
way, rest assured this can and does
1. The story told by the patient, which is often
happen at facilities all across the
emotional and somewhat unreliable
country, all the time. Completely
2. The story told by the clinicians’ written words
leaving aside the medicine and clin-
in the patient’s medical record.
ical care issues involved, it can be said with confidence that
the chances are high this case will likely settle – and for a
If the patient’s medical record suggests improper care, it is likely
significant amount of money. There are several reasons,
that the case initially will be judged to be one with potential merit
entirely separate and apart from the quality of the medical
by the plaintiff’s lawyer, and the case will likely be filed. Even if
care provided, that make this case a very likely one to end up
subsequent discovery demonstrates that little, if any, substan-
in litigation from virtually day one, and will make this lawsuit
dard care was actually provided, your facility (and more impor-
a difficult one to defend. It is therefore likely to settle, and
tantly your clinical associates) has already incurred the time,
could easily settle for up to $250,000, and quite possibly in
expense and stress inevitably associated with the adversarial
excess of $500,000.
legal process. Thus, once a lawsuit is filed, everyone named in
the suit has already lost, to one degree or another.
Problem 1: The complication was an unexpected one.
Complications can occur in any critically ill patient’s case,
In this case, the failure to appropriately document the pres-
often despite the provision of the highest quality care. An
sure ulcer as required by hospital policy will likely lead to the
important fact that few health care providers realize is that
appearance that proper care was not provided. Addition-
purely from a legal and liability standpoint it is often not the
ally, the failure to document anything about the wound on
severity of complication that triggers litigation; it is the
postoperative day two could be interpreted as proof that
degree of surprise associated with the complication itself. It
the wound either was not recognized (nothing was docu-
is important to keep in mind that it is often not outstanding
mented, therefore nothing was known) or treated (nothing
medical results that avoid litigation, but rather satisfactory
was documented, therefore nothing was done), or both, and simple meaning in most cases. Juries are rarely recep- patient, due to his ventilator dependant status, was probably
medical results. And the satisfactory result is often the
during that critical 24-hour period. Likewise, the simple failure tive to the argument that a common word in a policy really not even capable of being turned every two hours during his
expected one, even when the expected result is less than
of the wound and ostomy nurse to document in the doesn’t mean what they believe it to mean. This is especially immediate post-operative recovery. Furthermore, his spinal
medically optimal. Put another way, expected deaths with
patient’s chart during his or her first consultation could eas- true when that argument comes from the author of the policy injury may have made frequent turning during his imme-
dignity can often occur without subsequent litigation,
ily lead a plaintiff’s attorney to initially conclude that the con- who is attempting to avoid the implications of a literal inter- diate postoperative days ill-advised or even dangerous.
whereas miraculous recoveries accompanied by
sultation did not occur in a timely fashion. pretation of his or her own written work. Nevertheless, the policy leaves no room for discretion in turn-
unavoidable yet surprising complications can often result
ing under such unusual circumstances. On its face, the failure
in lawsuits being filed. In this example, the simple facts that
Problem 3: Poorly written policies contribute to the In this example, the hospital’s wound care policy mandates to turn this patient violates hospital policy as well. That
this pressure ulcer was unexpected and was not
appearance of poor care. As a general rule, policies that a skin assessment be performed on all patients. Postopera- violation too can be used to establish liability on the part of
revealed to the family until days after it originally developed
contain mandates and absolute words can also create the tive patients are not exempt from this requirement by the the facility.
in and of themselves make it more likely that this patient’s
appearance of substandard care. Examples of such words plain words of the policy. Thus, even though there may be no
case will end up in the legal system.
are “must,” “always” and “immediately.” It is important to real reason to perform a skin assessment on every patient The Solutions
keep in mind that regardless of how clinicians intend these who leaves the OR and is admitted to the ICU, the failure to How do you minimize the chances
Problem 2: Documentation creates the appearance
words to be interpreted, lay juries almost always give the do so appears to violate policy, and could be considered the of litigation faced when faced with
of poor care. It is often not the existence of poor care but
words their plain and ordinary meaning. “Always” and its provision of substandard care for that reason alone. this fact scenario? Certainly, the
rather the appearance of poor care, which initially prompts
polar opposite “never” both mean without discretion to most most important thing is to do
a plaintiff’s attorney to take a case rather than reject it.
laypeople. “Always” means in every single case, regardless Likewise, hospital policy mandates that a certain form be everything possible to provide the
Keep in mind that a plaintiff’s lawyer has very little concrete
of the special circumstances a unique patient may present. used to document the progress of the wound care. The fail- best, highest quality care you can, and minimize the inci-
information upon which to base his or her critical initial
“Immediately” means just that. It does not mean minutes ure to utilize that form in the ICU (even for a good and prac- dences of all postoperative complications in your surgical
decision whether to retain a patient as a client.
and certainly not hours later. “Never” means in not a single tical reason) could form another initial basis of liability. Finally, patients. But once again, without changing any of the medical
case, regardless of special circumstances as well. And since the hospital’s policy requiring that all patients must be turned facts in the example set forth above, there are a number of
these are the clinicians’ words, they will be held to their plain every two hours could also be problematic. This particular

58 The OR Connection Aligning practice with policy to improve patient care 59

 additional things a facility can do to reduce its chances of
being the target for litigation in these types of circumstances.
None of these are inconsistent with efforts to continually
improve clinical care. To the contrary, they should all com-
plement such efforts if executed and implemented properly.
Solution 1: Create documentation systems that succeed.
In many acute care hospitals, the documentation requirements
imposed on hospital staff are both unnecessarily onerous and
almost impossible to meet on a consistent, day to day basis.
Unnecessarily rigid requirements regarding: 1. exactly what doc-
umentation forms are used, 2. when certain documents must
be updated (i.e., no later than every 24 hours, as opposed to
either every 24 hours or as clinically indicated), 3. who (i.e.,
charge nurses or RNs) is allowed to document certain facts and
4. unnecessarily ambiguous and/or unnecessarily complex
checklists all create documentation expectations that nurses
simply cannot always meet even when providing the most
outstanding nursing care.
To the maximum extent possible when consistent with qual-
ity patient care, simplify your documentation requirements.
Allow important information to be appropriately documented
in a number of different ways and a number of different
places in a medical chart. Allow your staff reasonable flexi-
bility in the face of time deadlines and clinical patient
demands. Eliminate long cumbersome checklists and check
boxes to the extent this can be done consistently with the
provision of good patient care. By doing so, you will elimi-
nate the ability of plaintiff’s lawyers to argue that certain
important tasks were not done simply because a particular
It is imperative that you review
all of your clinical policies and
procedures not only with an
eye toward their effect on
patient care, but also for their
impact on potential litigation.
60 The OR Connection
check box was not marked or a particular form was not
used on a particular day or shift during a patient’s hospital- In such situations, a process can in and of itself
be sufficient to defuse patients’ anger and
ization.
confusion and avoid litigation entirely:
1. Recognizing the legitimacy of the patient’s or
Solution 2: Conduct a medical-legal evaluation of your
family members questions
hospital policies. It is imperative that you review all of your
2. Acknowledging that the nurse or staff member
clinical policies and procedures not only with an eye toward
cannot appropriately answer that question
their effect on patient care, but also for their impact on
3. Identifying the person who can answer
potential litigation. Any policies inappropriately titled “rules”
that question
or “regulations” should be recast as “guidelines” or, at a min-
4. Acting immediately to contact that person
imum, “policies.” Mandatory and absolute words such as
and obtain the answer.
“must,” “always,” “never” and “immediately” should be
removed unless they are truly necessary for the provision of
quality patient care. Flexibility and sound nursing discretion
Conclusions
should be built into the policy language, recognizing that
Truly minimizing legal and litigation risks 1 Contact Hour
LEGAL IMPLICATIONS
nurses treat patients, not books of written policies.
starts long before a patient arrives in
OF PRESSURE ULCERS
your hospital, and goes far beyond
Solution 3: Invest in improving communication skills.
efforts to provide the best clinical care
Patients primarily turn to attorneys in a search for answers.
you can. Recognize and respond to why
It is also a sad truth that that hospital personnel most likely
your patients and their families seek out attorneys following
to be faced with difficult questions from family members are
medical procedures. Recognize how your documents and
those least trained in how to deal with that situation. Take
your charting can create erroneous and harmful perceptions Join us for this webcast presentation as two
the time to educate your staff members on the importance
regarding the quality of care your institution provides. industry experts bring you critical infor-
of frank, direct and helpful patient communication. Teach
Prospectively consider not only the medical, but also the mation on how the utilization of the nursing
frontline staff members to notify patients and their families
medical-legal implications of decisions on documentation, process and proper documentation are vital
of complications when they are discovered and respond
policies and patient communication, and you will spend more components in maintaining the standard of
directly and with empathy. Additionally, teach staff mem-
time with patients and less time with lawyers. And who in care and avoiding litigation.
bers not to go beyond their own real expertise in attempt-
health care doesn’t (very appropriately) want that?
ing to answer questions or explain the cause of medical
complications they may not accurately and completely
Presented by attorney Kevin W. Yankowsky,
understand, and therefore not appropriately address.
JD, a partner in the health law litigation
About the author
group of Fulbright & Jaworski, LLP, Hous-
Kevin W. Yankowsky, JD, is a partner in
ton, Texas, and physician Caroline Fife, MD,
the health law litigation group of Fulbright
& Jaworski, LLP in Houston, Texas. A true
the Chief Medical Officer of Intellicure, Inc.
trial lawyer, Kevin’s trial practice encom- and an associate professor at the University
passes virtually all types of civil litigation Texas Medical School at Houston.
facing the healthcare industry. In addition
to his extensive courtroom experience,
he advises on Joint Commission inves- To view this webcast, visit
tigations, hospital committee and medical
peer review matters.
www.medlineuniversity.com
Courses approved for continuing education by the Florida Board
of Nursing and the California Board of Reigistered Nursing.
 additional things a facility can do to reduce its chances of
being the target for litigation in these types of circumstances.
None of these are inconsistent with efforts to continually
improve clinical care. To the contrary, they should all com-
plement such efforts if executed and implemented properly.
Solution 1: Create documentation systems that succeed.
In many acute care hospitals, the documentation requirements
imposed on hospital staff are both unnecessarily onerous and
almost impossible to meet on a consistent, day to day basis.
Unnecessarily rigid requirements regarding: 1. exactly what doc-
umentation forms are used, 2. when certain documents must
be updated (i.e., no later than every 24 hours, as opposed to
either every 24 hours or as clinically indicated), 3. who (i.e.,
charge nurses or RNs) is allowed to document certain facts and
4. unnecessarily ambiguous and/or unnecessarily complex
checklists all create documentation expectations that nurses
simply cannot always meet even when providing the most
outstanding nursing care.
To the maximum extent possible when consistent with qual-
ity patient care, simplify your documentation requirements.
Allow important information to be appropriately documented
in a number of different ways and a number of different
places in a medical chart. Allow your staff reasonable flexi-
bility in the face of time deadlines and clinical patient
demands. Eliminate long cumbersome checklists and check
boxes to the extent this can be done consistently with the
provision of good patient care. By doing so, you will elimi-
nate the ability of plaintiff’s lawyers to argue that certain
important tasks were not done simply because a particular
It is imperative that you review
all of your clinical policies and
procedures not only with an
eye toward their effect on
patient care, but also for their
impact on potential litigation.
60 The OR Connection
check box was not marked or a particular form was not
used on a particular day or shift during a patient’s hospital- In such situations, a process can in and of itself
be sufficient to defuse patients’ anger and
ization.
confusion and avoid litigation entirely:
1. Recognizing the legitimacy of the patient’s or
Solution 2: Conduct a medical-legal evaluation of your
family members questions
hospital policies. It is imperative that you review all of your
2. Acknowledging that the nurse or staff member
clinical policies and procedures not only with an eye toward
cannot appropriately answer that question
their effect on patient care, but also for their impact on
3. Identifying the person who can answer
potential litigation. Any policies inappropriately titled “rules”
that question
or “regulations” should be recast as “guidelines” or, at a min-
4. Acting immediately to contact that person
imum, “policies.” Mandatory and absolute words such as
and obtain the answer.
“must,” “always,” “never” and “immediately” should be
removed unless they are truly necessary for the provision of
quality patient care. Flexibility and sound nursing discretion
Conclusions
should be built into the policy language, recognizing that
Truly minimizing legal and litigation risks 1 Contact Hour
LEGAL IMPLICATIONS
nurses treat patients, not books of written policies.
starts long before a patient arrives in
OF PRESSURE ULCERS
your hospital, and goes far beyond
Solution 3: Invest in improving communication skills.
efforts to provide the best clinical care
Patients primarily turn to attorneys in a search for answers.
you can. Recognize and respond to why
It is also a sad truth that that hospital personnel most likely
your patients and their families seek out attorneys following
to be faced with difficult questions from family members are
medical procedures. Recognize how your documents and
those least trained in how to deal with that situation. Take
your charting can create erroneous and harmful perceptions Join us for this webcast presentation as two
the time to educate your staff members on the importance
regarding the quality of care your institution provides. industry experts bring you critical infor-
of frank, direct and helpful patient communication. Teach
Prospectively consider not only the medical, but also the mation on how the utilization of the nursing
frontline staff members to notify patients and their families
medical-legal implications of decisions on documentation, process and proper documentation are vital
of complications when they are discovered and respond
policies and patient communication, and you will spend more components in maintaining the standard of
directly and with empathy. Additionally, teach staff mem-
time with patients and less time with lawyers. And who in care and avoiding litigation.
bers not to go beyond their own real expertise in attempt-
health care doesn’t (very appropriately) want that?
ing to answer questions or explain the cause of medical
complications they may not accurately and completely
Presented by attorney Kevin W. Yankowsky,
understand, and therefore not appropriately address.
JD, a partner in the health law litigation
About the author
group of Fulbright & Jaworski, LLP, Hous-
Kevin W. Yankowsky, JD, is a partner in
ton, Texas, and physician Caroline Fife, MD,
the health law litigation group of Fulbright
& Jaworski, LLP in Houston, Texas. A true
the Chief Medical Officer of Intellicure, Inc.
trial lawyer, Kevin’s trial practice encom- and an associate professor at the University
passes virtually all types of civil litigation Texas Medical School at Houston.
facing the healthcare industry. In addition
to his extensive courtroom experience,
he advises on Joint Commission inves- To view this webcast, visit
tigations, hospital committee and medical
peer review matters.
www.medlineuniversity.com
Courses approved for continuing education by the Florida Board
of Nursing and the California Board of Reigistered Nursing.

Relieve Pressure on Vulnerable Heels
HEELMEDIX™ Heel Protector
Pressure relief and skin protection all in one
The heels are the most common site for facility-acquired pressure ulcers in long-term
care, and the second most common site overall.1 According to clinical experts, the most
effective aspect of pressure ulcer prevention for heels is pressure relief, also known as
offloading.1,2 Offloading is achieved with the use of pillows or heel protection devices that
relieve pressure by elevating the heel.
Open back provides
maximum ventilation The HEELMEDIX Heel Protector is designed to help eliminate pressure, friction and
shear on the skin by elevating the heel. Made of soft, suede-like material on the inside
and easy-to-clean nylon on the outside. Adjustable straps are soft against vulnerable
skin. Includes a mesh laundry bag with patient ID label to simplify washing and sorting.
Mention this ad to receive a 10 percent discount on your first order.
Contact your Medline sales representative or call 1-800-MEDLINE.
1
Fowler E, Scott-Williams S, McGuire JB. Practice recommendations for preventing
heel pressure ulcers. Ostomy Wound Management. 2008;54(10):42:48.
2 Recommended practices for positioning the patient in the perioperative practice setting. In:
Langemo D, Thompson P, Hunter S, Hanson D, Anderson J. Heel pressure ulcers:
stand guard. Advances in Skin & Wound Care. 2008;21(6):282-292.
©2010 Medline Industries, Inc. Medline is a registered trademark and HEELMEDIX is a trademark of Medline Industries, Inc.
KEEP YOUR SURGICAL
PATIENTS DESERT DRY.
Medline’s Sahara® Super Absorbent OR table sheets QuickSuite®
OR Clean Up Kit
are designed with your patients’ skin integrity in mind.
The Braden Scale tells us that moisture is one of the
major risk factors for developing a pressure ulcer.1 We also
know that as many as 66 percent of all hospital-acquired
pressure ulcers come out of the operating room.2
That’s why we developed the Sahara Super Absorbent
OR table sheet. The Sahara’s super-absorbent polymer
technology rapidly wicks moisture from the skin and
locks it away to help keep your patients dry.
Sahara OR table sheets are available on their own or
as a component in our QuickSuite® OR Clean Up Kits,
which were designed to help you dramatically improve To sign up for a FREE webinar on perioperative
your OR turnover time and help reduce cross contamina- pressure ulcer prevention, go to
www.medline.com/pupp-webinar.
tion risk through a combination of disposable products.
References
1
Braden Scale for Predicting Pressure Sore Risk. Available at:
www.bradenscale.com/braden.PDF. Accessed November 6, 2008.
2
Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2008.
©2010 Medline Industries, Inc. Medline, QuickSuite and Sahara are registered trademarks of Medline Industries, Inc.

Relieve Pressure on Vulnerable Heels
HEELMEDIX™ Heel Protector
Pressure relief and skin protection all in one
The heels are the most common site for facility-acquired pressure ulcers in long-term
care, and the second most common site overall.1 According to clinical experts, the most
effective aspect of pressure ulcer prevention for heels is pressure relief, also known as
offloading.1,2 Offloading is achieved with the use of pillows or heel protection devices that
relieve pressure by elevating the heel.
Open back provides
maximum ventilation The HEELMEDIX Heel Protector is designed to help eliminate pressure, friction and
shear on the skin by elevating the heel. Made of soft, suede-like material on the inside
and easy-to-clean nylon on the outside. Adjustable straps are soft against vulnerable
skin. Includes a mesh laundry bag with patient ID label to simplify washing and sorting.
Mention this ad to receive a 10 percent discount on your first order.
Contact your Medline sales representative or call 1-800-MEDLINE.
1
Fowler E, Scott-Williams S, McGuire JB. Practice recommendations for preventing
heel pressure ulcers. Ostomy Wound Management. 2008;54(10):42:48.
2 Recommended practices for positioning the patient in the perioperative practice setting. In:
Langemo D, Thompson P, Hunter S, Hanson D, Anderson J. Heel pressure ulcers:
stand guard. Advances in Skin & Wound Care. 2008;21(6):282-292.
©2010 Medline Industries, Inc. Medline is a registered trademark and HEELMEDIX is a trademark of Medline Industries, Inc.
KEEP YOUR SURGICAL
PATIENTS DESERT DRY.
Medline’s Sahara® Super Absorbent OR table sheets QuickSuite®
OR Clean Up Kit
are designed with your patients’ skin integrity in mind.
The Braden Scale tells us that moisture is one of the
major risk factors for developing a pressure ulcer.1 We also
know that as many as 66 percent of all hospital-acquired
pressure ulcers come out of the operating room.2
That’s why we developed the Sahara Super Absorbent
OR table sheet. The Sahara’s super-absorbent polymer
technology rapidly wicks moisture from the skin and
locks it away to help keep your patients dry.
Sahara OR table sheets are available on their own or
as a component in our QuickSuite® OR Clean Up Kits,
which were designed to help you dramatically improve To sign up for a FREE webinar on perioperative
your OR turnover time and help reduce cross contamina- pressure ulcer prevention, go to
www.medline.com/pupp-webinar.
tion risk through a combination of disposable products.
References
1
Braden Scale for Predicting Pressure Sore Risk. Available at:
www.bradenscale.com/braden.PDF. Accessed November 6, 2008.
2
Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2008.
©2010 Medline Industries, Inc. Medline, QuickSuite and Sahara are registered trademarks of Medline Industries, Inc.

Fail-Safe Strategies to Deal with
DIFFICULT PEOPLE
By Dr. Wolf J. Rinke, RD, CSP
Let’s face it. Certain people just like to make your life difficult. Maybe it’s a
patient who seems to get his jollies from making you miserable. Or a team member
who refuses to perform at an acceptable level. Or what about your colleagues who
drive you nuts? Any of these can be a huge challenge and cause you a great deal
of difficulty and stress. But don’t despair. There are specific steps you can take to
deal more effectively with these kinds of people.
64 The OR Connection
Special Feature
The Most Powerful Stress Control System of All Time
But first let me share with you what I consider the most powerful
stress control system of all time. It’s very simple—only three steps,
but if you can master it, your ability to deal with all types of stress
and conflict, not just difficult people, will be significantly enhanced.
Here they are:
1. Change the Changeable.
Don’t like something? Change it! Don’t fret, complain or whine …
just do it! (I know you’ve heard that before.) Remember, you don’t
have to do anything you don’t want to do. Alright, you caught me.
There is one thing you have to do—die. No choice—not yet. Every-
thing else is a choice. And no matter how badly other people
behave, you always are able to control your response to their
behavior. Notice I said you can control your response, but you cannot
control them or their behavior, so quit wasting time trying to do
the impossible.
2. Remove Yourself from the Unacceptable
Find something or someone unacceptable? Get out of the way.
Sitting with someone who is bitching and griping? Get up and sit
somewhere else. Working for a toxic boss? Start shopping for a
new one. About to be sucked into another conversation with an
employee who is always complaining about his team members?
Tell him you are busy and that you prefer that he talk to the other
party directly instead of coming to you. Can’t remove yourself? Min-
imize the time you are exposed to unacceptable people. Whatever
you do, just do it without fretting and whining … I know you’re
catching on!
Continued on page 67
Aligning practice with policy to improve patient care 65

Fail-Safe Strategies to Deal with
DIFFICULT PEOPLE
By Dr. Wolf J. Rinke, RD, CSP
Let’s face it. Certain people just like to make your life difficult. Maybe it’s a
patient who seems to get his jollies from making you miserable. Or a team member
who refuses to perform at an acceptable level. Or what about your colleagues who
drive you nuts? Any of these can be a huge challenge and cause you a great deal
of difficulty and stress. But don’t despair. There are specific steps you can take to
deal more effectively with these kinds of people.
64 The OR Connection
Special Feature
The Most Powerful Stress Control System of All Time
But first let me share with you what I consider the most powerful
stress control system of all time. It’s very simple—only three steps,
but if you can master it, your ability to deal with all types of stress
and conflict, not just difficult people, will be significantly enhanced.
Here they are:
1. Change the Changeable.
Don’t like something? Change it! Don’t fret, complain or whine …
just do it! (I know you’ve heard that before.) Remember, you don’t
have to do anything you don’t want to do. Alright, you caught me.
There is one thing you have to do—die. No choice—not yet. Every-
thing else is a choice. And no matter how badly other people
behave, you always are able to control your response to their
behavior. Notice I said you can control your response, but you cannot
control them or their behavior, so quit wasting time trying to do
the impossible.
2. Remove Yourself from the Unacceptable
Find something or someone unacceptable? Get out of the way.
Sitting with someone who is bitching and griping? Get up and sit
somewhere else. Working for a toxic boss? Start shopping for a
new one. About to be sucked into another conversation with an
employee who is always complaining about his team members?
Tell him you are busy and that you prefer that he talk to the other
party directly instead of coming to you. Can’t remove yourself? Min-
imize the time you are exposed to unacceptable people. Whatever
you do, just do it without fretting and whining … I know you’re
catching on!
Continued on page 67
Aligning practice with policy to improve patient care 65
 3. Accept the Unchangeable
There are lots of things beyond your control, such as your
parents. No matter how much you would like them to be
different, they won’t be. So love them the way they are, not
the way they ought to be. (By the way, that is a great pre-
scription for getting along with all people!) Bad weather?

Get a grip. Deal with it. Learn to associate any type of bad
weather with prior positive events in your life. For example,
when it is rainy, misty or foggy, I’ve taught myself to think
back to my days in Germany. When it is freezing cold, I think
10
Ten Fail-Safe Strategies to Deal with Difficult People
After you have mastered these three biggies, let’s take a

THE NEW SHAPE OF SURGER

SURGERY
Y of cuddling in front of a toasty warm, roaring fireplace with
Superwoman – my wife and lover of 42 years.
look at what other strategies you can use to make your life
less aggravating:

Getting older? Accept it. You are beautiful just the way you 1. Change your response to the other person.
are! A wise person once remarked, “God doesn’t make As I mentioned earlier, you are the only one you can change.
The DDASH
ASHTM absorbent rretractor
etractor bends
junk.” In fact, evaluating both my physical and emotional (And most of us have lots of difficulty achieving that!) In deal-
into
into just the shape you
you need
health, I have never felt better in my life as I do right now. ing with difficult people, don’t try to change the other per-
Fewer sponges, gentler rretraction.
etraction. The DASH retractor
retractor (I’m 66—thanks for asking.) One reason is that I have never son; you will only get into a power struggle, cause
is 12 times more absorbent than a standard
more standard lap sponge, been as content and at peace as I am right now. So don’t defensiveness, invite criticism or otherwise make things
with a smooth stainless steel core that you can’t
core can’t miss. sweat your chronological age—something you can’t worse. It also makes you a more difficult person to deal with.
It’s the cor
It’s e that gives the DASH device strength
core strength and change. Instead, take care of your body … that’s something On the other hand you can always control your response to
malleability
malleability.. Shape it into almost any for
formm to gently rretract
etract you can have a positive impact on right now. the other person. So don’t let negative people live in your
tissues from the surgical field—without the pinch-point
from
Before
Befor e DASH
DASH™™ After DASH
DASH™™ head rent free.
trauma traditional rretractors
etractors can cause. Challenging access Maximum exposur e
exposure Difficult people? Accept that some people like to be miserable.
Just don’t try to take it away from them. (I hope you are 2. Manage your perceptions.
Strong and solid to rretract
Strong etract with confidence. Formable
Formable to smiling. Otherwise you are taking this much too seriously.) Remember that most relationship difficulties are due to a
adapt to many patients and procedures. Absorbent to
procedures. Accept them just the way they are, and minimize the time dynamic between two people rather than one person being
rreduce
educe sponge count. The DASH rretractor
etractor may rreshape
eshape you spend with them. If they report to you make sure that “bad.” In other words it takes two to tango. This is one thing
To find out how
To how to
to get
get your
your free DASH
free DASH Retractor
Retractor
your surgical technique. you do not place them in patient sensitive positions, and do that has been driven home to me time and time again as a
sample, log on tto
sample, o www.medline.com/of
.com/offfers/dash.
www.medline.com/offers/dash.
your best to get them out of your team or organization as result of my coaching and consulting experiences. I listen
Once you see the DASH in action you’ll never want to
soon as possible. to one person and they tell me in excruciating detail how
go back to old, bulky metal rretractors.
etractors.

Aligning practice with policy to improve patient care 67

©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
DASH is a trademark of EZ Surgical, Ltd.
©2009
©2009 Medline
Medline Industries,
Industries, Inc.
Inc. M
Medline
edline is
is a registered
registered trademark
trademark o
off M
Medline
edline Industries,
Industries, IInc.
nc.
 3. Accept the Unchangeable
There are lots of things beyond your control, such as your
parents. No matter how much you would like them to be
different, they won’t be. So love them the way they are, not
the way they ought to be. (By the way, that is a great pre-
scription for getting along with all people!) Bad weather?

Get a grip. Deal with it. Learn to associate any type of bad
weather with prior positive events in your life. For example,
when it is rainy, misty or foggy, I’ve taught myself to think
back to my days in Germany. When it is freezing cold, I think
10
Ten Fail-Safe Strategies to Deal with Difficult People
After you have mastered these three biggies, let’s take a

THE NEW SHAPE OF SURGER

SURGERY
Y of cuddling in front of a toasty warm, roaring fireplace with
Superwoman – my wife and lover of 42 years.
look at what other strategies you can use to make your life
less aggravating:

Getting older? Accept it. You are beautiful just the way you 1. Change your response to the other person.
are! A wise person once remarked, “God doesn’t make As I mentioned earlier, you are the only one you can change.
The DDASH
ASHTM absorbent rretractor
etractor bends
junk.” In fact, evaluating both my physical and emotional (And most of us have lots of difficulty achieving that!) In deal-
into
into just the shape you
you need
health, I have never felt better in my life as I do right now. ing with difficult people, don’t try to change the other per-
Fewer sponges, gentler rretraction.
etraction. The DASH retractor
retractor (I’m 66—thanks for asking.) One reason is that I have never son; you will only get into a power struggle, cause
is 12 times more absorbent than a standard
more standard lap sponge, been as content and at peace as I am right now. So don’t defensiveness, invite criticism or otherwise make things
with a smooth stainless steel core that you can’t
core can’t miss. sweat your chronological age—something you can’t worse. It also makes you a more difficult person to deal with.
It’s the cor
It’s e that gives the DASH device strength
core strength and change. Instead, take care of your body … that’s something On the other hand you can always control your response to
malleability
malleability.. Shape it into almost any for
formm to gently rretract
etract you can have a positive impact on right now. the other person. So don’t let negative people live in your
tissues from the surgical field—without the pinch-point
from
Before
Befor e DASH
DASH™™ After DASH
DASH™™ head rent free.
trauma traditional rretractors
etractors can cause. Challenging access Maximum exposur e
exposure Difficult people? Accept that some people like to be miserable.
Just don’t try to take it away from them. (I hope you are 2. Manage your perceptions.
Strong and solid to rretract
Strong etract with confidence. Formable
Formable to smiling. Otherwise you are taking this much too seriously.) Remember that most relationship difficulties are due to a
adapt to many patients and procedures. Absorbent to
procedures. Accept them just the way they are, and minimize the time dynamic between two people rather than one person being
rreduce
educe sponge count. The DASH rretractor
etractor may rreshape
eshape you spend with them. If they report to you make sure that “bad.” In other words it takes two to tango. This is one thing
To find out how
To how to
to get
get your
your free DASH
free DASH Retractor
Retractor
your surgical technique. you do not place them in patient sensitive positions, and do that has been driven home to me time and time again as a
sample, log on tto
sample, o www.medline.com/of
.com/offfers/dash.
www.medline.com/offers/dash.
your best to get them out of your team or organization as result of my coaching and consulting experiences. I listen
Once you see the DASH in action you’ll never want to
soon as possible. to one person and they tell me in excruciating detail how
go back to old, bulky metal rretractors.
etractors.

Aligning practice with policy to improve patient care 67

©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
DASH is a trademark of EZ Surgical, Ltd.
©2009
©2009 Medline
Medline Industries,
Industries, Inc.
Inc. M
Medline
edline is
is a registered
registered trademark
trademark o
off M
Medline
edline Industries,
Industries, IInc.
nc.
 badly someone else has behaved. In fact, because of their
vivid descriptions I’m often tempted to take their word for it.
Until … wait for it … I talk to the other person, and then I find
out that their reality is diametrically opposite of the other
party, and by the way, equally as convincing. In other words
there is no reality, there are only perceptions, and we all cre-
ate our own.
The fastest way to begin to no longer perceive people as
“difficult” is to look for what they are doing right. And then
let them know about that. In other words, look for the pos-
itive aspects in others, especially when dealing with the
important people in your life, and focus on those things. The
neat part of this is that over the long run we all tend to find
what we are looking for. (Read that again!) And before you
know it, the other person will feel more appreciated, and
you will begin to develop a more positive relationship.
3. Minimize the time you spend with difficult people.
I know I’ve mentioned this before so this must be a biggie,
especially for people in leadership positions. Time and time
again I find that managers, supervisors and team leaders
tend to spend a disproportionate amount of time with trou-
ble makers. What they don’t get is that their time is a re-
ward. This means that they will get more trouble.
Remember: Whatever you reward is what you will get more
of. Instead, if you want peak performance, then you should
spend the greatest share of your time with the “water walk-
ers”—the people who make you look good.
What about the other difficult people in your life? Know
when it’s time to distance yourself, and do so. If no matter
what you do, the other person still antagonizes you, mini-
mizing your exposure may be the key. If they’re continually
abusive, it’s best to cut ties and let them know why. Explain
what needs to happen if there ever is to be a relationship,
and then let them go. If the difficult person is your boss it
may be time for you to find another job. We spend far too
great a portion of our life at work to be miserable. Life is
simply too short to work for a toxic boss or organization.
4. Avoid discussing divisive issues.
Issues such as religion and politics, or other topics that push
certain people’s “buttons” are best avoided. If the other per-
son tries to engage you in a discussion that has the poten-
tial to become an argument, change the subject or remove
yourself.
68 The OR Connection
5. Don’t beat yourself up. Avoid blaming yourself or the
other person for negative interactions. It may just be a case
of two personalities being like “oil and water.” Remember
that you don’t have like everyone; just being polite goes a
long way toward getting along and appropriately dealing
with difficult people.
6. Respond with a sense of humor. Much can be solved
by just lightening up. Somehow a sense of humor often low-
ers the intensity of a difficult situation and allows both of you
to laugh instead of continuing to escalate the situation.
7. See it through the other persons’ eyes. As cliché as
this may sound, we tend to forget that we become blind-
sided when we are angry or stressed. Instead put yourself
in the other person’s position and consider how you may
have hurt their feelings. This understanding will give you a
new perspective, may help you to become more rational,
and help you develop compassion for the other person.
8. Hang out with positive people. Negative people drain
your battery. Positive people charge your battery. So mini-
mize the time you are together with “stinking thinking” peo-
ple and cultivate other more positive relationships in your
life to offset the negativity of dealing with difficult people.
(If you would like to know more about this, read my Beat
The Blues: How to Manage Stress and Balance Your Life
CPE program. It’s available at www.easyCPEcredits.com.)
9. Don’t fight fire with fire. When you interact with some-
one who is going into attack mode or becoming excessively
defensive, recognize that it is useless to argue with him.
Realize the other person may be behaving in this way
because he is feeling very insecure. Don’t continue to push
or attempt to convince him because he will only get more
difficult. Let it go, and come back at another time.
10. Make the other person right. I’ve left the best for last.
The most effective way you can deal with difficult people is
to make them right by expressing the most powerful conflict
resolution phrase of all time: “You are right about that.” (Try
it in any situation that appears to be spinning out of control.
What you will find will amaze you. It literally makes any type
of conflict evaporate. It’s so powerful that Superwoman and
I no longer even use the five words, we just hold up our
hand with all five fingers extended.) Or express agreement
in any other way you wish. For example you might say, “I
see why you feel that way;” or “I can understand why you
are upset,” or “That’s an interesting perspective.” (The
words are not important as long as you express agreement.)
If you find yourself arguing for the sake of being right, ask
“Does it matter if I am right?” If yes, then ask “Why do I need
to be right? What will I gain?” In virtually all situations you will
find that the only reason you feel a need to be right is to sat-
isfy your ego.
If that still does not let the “hot air out of the balloon” find
something, no matter how small, to agree on. And if noth-
ing else works you can at least agree to disagree, and get
on with your life.
© 2010 Wolf J. Rinke
Dr. Wolf J. Rinke, RD, CSP is a keynote
speaker, seminar leader, management con-
sultant, executive coach and editor of the
free electronic newsletters Make It a Winning
Life and The Winning Manager, available at
www.WolfRinke.com; and a new electronic
newsletter Read and Grow Rich, targeted
specifically to nutrition professionals, avail-
able at www.easyCPEcredits.com. In addi-
tion, he has authored numerous CDs, DVDs and books including
Make It a Winning Life: Success Strategies for Life, Love and Busi-
ness; Winning Management: 6 Fail-Safe Strategies for Building
High-Performance Organizations and Don’t Oil the Squeaky Wheel
and 19 Other Contrarian Ways to Improve Your Leadership Effec-
tiveness; all available at www.WolfRinke.com. His company also
produces a wide variety of quality pre-approved continuing pro-
fessional education (CPE) self-study courses, available at
www.easyCPEcredits.com, including his latest Delegation and
Coaching: High Impact Strategies for Doing More with Less,
approved for 15 CPEUs, from which this article was extracted.
Reach him at WolfRinke@aol.com.
 badly someone else has behaved. In fact, because of their
vivid descriptions I’m often tempted to take their word for it.
Until … wait for it … I talk to the other person, and then I find
out that their reality is diametrically opposite of the other
party, and by the way, equally as convincing. In other words
there is no reality, there are only perceptions, and we all cre-
ate our own.
The fastest way to begin to no longer perceive people as
“difficult” is to look for what they are doing right. And then
let them know about that. In other words, look for the pos-
itive aspects in others, especially when dealing with the
important people in your life, and focus on those things. The
neat part of this is that over the long run we all tend to find
what we are looking for. (Read that again!) And before you
know it, the other person will feel more appreciated, and
you will begin to develop a more positive relationship.
3. Minimize the time you spend with difficult people.
I know I’ve mentioned this before so this must be a biggie,
especially for people in leadership positions. Time and time
again I find that managers, supervisors and team leaders
tend to spend a disproportionate amount of time with trou-
ble makers. What they don’t get is that their time is a re-
ward. This means that they will get more trouble.
Remember: Whatever you reward is what you will get more
of. Instead, if you want peak performance, then you should
spend the greatest share of your time with the “water walk-
ers”—the people who make you look good.
What about the other difficult people in your life? Know
when it’s time to distance yourself, and do so. If no matter
what you do, the other person still antagonizes you, mini-
mizing your exposure may be the key. If they’re continually
abusive, it’s best to cut ties and let them know why. Explain
what needs to happen if there ever is to be a relationship,
and then let them go. If the difficult person is your boss it
may be time for you to find another job. We spend far too
great a portion of our life at work to be miserable. Life is
simply too short to work for a toxic boss or organization.
4. Avoid discussing divisive issues.
Issues such as religion and politics, or other topics that push
certain people’s “buttons” are best avoided. If the other per-
son tries to engage you in a discussion that has the poten-
tial to become an argument, change the subject or remove
yourself.
68 The OR Connection
5. Don’t beat yourself up. Avoid blaming yourself or the
other person for negative interactions. It may just be a case
of two personalities being like “oil and water.” Remember
that you don’t have like everyone; just being polite goes a
long way toward getting along and appropriately dealing
with difficult people.
6. Respond with a sense of humor. Much can be solved
by just lightening up. Somehow a sense of humor often low-
ers the intensity of a difficult situation and allows both of you
to laugh instead of continuing to escalate the situation.
7. See it through the other persons’ eyes. As cliché as
this may sound, we tend to forget that we become blind-
sided when we are angry or stressed. Instead put yourself
in the other person’s position and consider how you may
have hurt their feelings. This understanding will give you a
new perspective, may help you to become more rational,
and help you develop compassion for the other person.
8. Hang out with positive people. Negative people drain
your battery. Positive people charge your battery. So mini-
mize the time you are together with “stinking thinking” peo-
ple and cultivate other more positive relationships in your
life to offset the negativity of dealing with difficult people.
(If you would like to know more about this, read my Beat
The Blues: How to Manage Stress and Balance Your Life
CPE program. It’s available at www.easyCPEcredits.com.)
9. Don’t fight fire with fire. When you interact with some-
one who is going into attack mode or becoming excessively
defensive, recognize that it is useless to argue with him.
Realize the other person may be behaving in this way
because he is feeling very insecure. Don’t continue to push
or attempt to convince him because he will only get more
difficult. Let it go, and come back at another time.
10. Make the other person right. I’ve left the best for last.
The most effective way you can deal with difficult people is
to make them right by expressing the most powerful conflict
resolution phrase of all time: “You are right about that.” (Try
it in any situation that appears to be spinning out of control.
What you will find will amaze you. It literally makes any type
of conflict evaporate. It’s so powerful that Superwoman and
I no longer even use the five words, we just hold up our
hand with all five fingers extended.) Or express agreement
in any other way you wish. For example you might say, “I
see why you feel that way;” or “I can understand why you
are upset,” or “That’s an interesting perspective.” (The
words are not important as long as you express agreement.)
If you find yourself arguing for the sake of being right, ask
“Does it matter if I am right?” If yes, then ask “Why do I need
to be right? What will I gain?” In virtually all situations you will
find that the only reason you feel a need to be right is to sat-
isfy your ego.
If that still does not let the “hot air out of the balloon” find
something, no matter how small, to agree on. And if noth-
ing else works you can at least agree to disagree, and get
on with your life.
© 2010 Wolf J. Rinke
Dr. Wolf J. Rinke, RD, CSP is a keynote
speaker, seminar leader, management con-
sultant, executive coach and editor of the
free electronic newsletters Make It a Winning
Life and The Winning Manager, available at
www.WolfRinke.com; and a new electronic
newsletter Read and Grow Rich, targeted
specifically to nutrition professionals, avail-
able at www.easyCPEcredits.com. In addi-
tion, he has authored numerous CDs, DVDs and books including
Make It a Winning Life: Success Strategies for Life, Love and Busi-
ness; Winning Management: 6 Fail-Safe Strategies for Building
High-Performance Organizations and Don’t Oil the Squeaky Wheel
and 19 Other Contrarian Ways to Improve Your Leadership Effec-
tiveness; all available at www.WolfRinke.com. His company also
produces a wide variety of quality pre-approved continuing pro-
fessional education (CPE) self-study courses, available at
www.easyCPEcredits.com, including his latest Delegation and
Coaching: High Impact Strategies for Doing More with Less,
approved for 15 CPEUs, from which this article was extracted.
Reach him at WolfRinke@aol.com.
 Special Feature

he Centers for Disease Control and

T Prevention (CDC) has just announced the
establishment of the Advisory Committee on
Breast Cancer in Young Women.

The committee has been established to assist

in creating a national evidence-based public
education and media campaign to provide
age-appropriate messages and materials to:
CDC Forms New
Advisory Committee 1. Increase awareness of good breast
health habits
on Breast Cancer in 2. Identify risk factors based on familial,

The benefits of counting Young Women racial, ethnic and cultural backgrounds
3. Encourage young women and healthcare
and detection in one professionals to increase early detection
of breast cancers
advanced system. 4. Increase the availability of health
information and other resources for
young women diagnosed with
breast cancer

For more information, contact Ena Wanliss,

MS, Lead Public Health Advisor, Centers for
Disease Control and Prevention, National Cen-
ter for Chronic Disease Prevention and Health
Promotion, Division of Cancer Prevention and
Control, 4770 Buford Highway, Mailstop K-57,
Chamblee, GA 30316. (770) 488-4225.

The SmartSponge® System takes the worry

Source: Federal Register June 24, 2010. Available at
out of finding and counting surgical sponges http://edocket.access.gpo.gov/2010/2010-15293.htm.
Accessed July 9, 2010.

For stressed nurses facing time pressures and distractions,

there’s nothing more relieving than getting an accurate
surgical sponge count. So it’s worth noting that the
SmartSponge® System counts, locates and recounts each
sponge up to 80,000 times during a single surgery. And
because it is the only FDA-approved system that uses
radio-frequency identification, it uniquely identifies each
sponge, so you can use the SmartWand-DTXTM to find
missing sponges below, beside or inside a patient.
A quick demonstration will give you the practical proof
of how the ClearCount SmartSponge System can make
your time in the O.R. a little less stressful. Call your
Medline representative or 1-800-MEDLINE today and
find out how you can get 10% off your first order.

Visit Booth 3601 at AORN Congress

©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.

Aligning practice with policy to improve patient care 71

SmartSponge is a registered trademark and SmartWand-DTX is a trademark of ClearCount
Medical
©2010 Sloutions.
Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
SmartSponge® is a registered trademark of ClearCount Medical Solutions.
 Special Feature

he Centers for Disease Control and

T Prevention (CDC) has just announced the
establishment of the Advisory Committee on
Breast Cancer in Young Women.

The committee has been established to assist

in creating a national evidence-based public
education and media campaign to provide
age-appropriate messages and materials to:
CDC Forms New
Advisory Committee 1. Increase awareness of good breast
health habits
on Breast Cancer in 2. Identify risk factors based on familial,

The benefits of counting Young Women racial, ethnic and cultural backgrounds
3. Encourage young women and healthcare
and detection in one professionals to increase early detection
of breast cancers
advanced system. 4. Increase the availability of health
information and other resources for
young women diagnosed with
breast cancer

For more information, contact Ena Wanliss,

MS, Lead Public Health Advisor, Centers for
Disease Control and Prevention, National Cen-
ter for Chronic Disease Prevention and Health
Promotion, Division of Cancer Prevention and
Control, 4770 Buford Highway, Mailstop K-57,
Chamblee, GA 30316. (770) 488-4225.

The SmartSponge® System takes the worry

Source: Federal Register June 24, 2010. Available at
out of finding and counting surgical sponges http://edocket.access.gpo.gov/2010/2010-15293.htm.
Accessed July 9, 2010.

For stressed nurses facing time pressures and distractions,

there’s nothing more relieving than getting an accurate
surgical sponge count. So it’s worth noting that the
SmartSponge® System counts, locates and recounts each
sponge up to 80,000 times during a single surgery. And
because it is the only FDA-approved system that uses
radio-frequency identification, it uniquely identifies each
sponge, so you can use the SmartWand-DTXTM to find
missing sponges below, beside or inside a patient.
A quick demonstration will give you the practical proof
of how the ClearCount SmartSponge System can make
your time in the O.R. a little less stressful. Call your
Medline representative or 1-800-MEDLINE today and
find out how you can get 10% off your first order.

Visit Booth 3601 at AORN Congress

©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.

Aligning practice with policy to improve patient care 71

SmartSponge is a registered trademark and SmartWand-DTX is a trademark of ClearCount
Medical
©2010 Sloutions.
Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
SmartSponge® is a registered trademark of ClearCount Medical Solutions.
 Take the
Pink Glove Survey!

Precious. And Pink.

Soft and shimmery.

Layered with organic aloe.
Fashioned from nitrile.

1
The Pink Pearl.

To take the survey, go to Medline’s newest Generation Pink glove.

Supporting the National Breast Cancer Foundation.

www.medline.com/orconnection/survey
or complete the business reply card. AD
©2010 Medline Industries, Inc. The cross-fingered pink glove hand image is a trademark
of Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc. 1

2 Answer these questions: AD 1

A. What does the Pink Glove Dance mean to you?
I only wear Pink Pearls.

B. Do you think pink gloves get people talking about

breast cancer?
Yes, They’re Genuine.
Precious. And Pink.
3
Only Medline’s Pink Pearl gloves combine

Take a look at the Pink Pearl ads on the next three

aloe, nitrile and breast cancer awareness.

Only Medline’s Pink Pearl gloves combine AD

aloe, nitrile and breast cancer awareness. 2
pages and pick your favorite. ©2010 Medline Industries, Inc. The Pink Pearl glove is a trademark of Medline
Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.

AD 2
Soft and shimmery.
Layered with organic aloe.
Fashioned from nitrile.

©2010 Medline Industries, Inc.

The Pink Pearl glove is a trademark
of Medline Industries, Inc. Medline is
a registered trademark of Medline
The Pink Pearl.™
Industries, Inc.

AD
3

Medline’s newest Generation Pink glove.

AD 3
Supporting the National Breast Cancer Foundation.

Participate today!
The first 1,000 readers to respond
will receive the new Deb doll!

www.PinkGloveDance.com ©2010 Medline Industries, Inc. Medline is a registered trademark and Pink Pearl
is a trademark of Medline Industries, Inc.
AD
1
72 The OR Connection
 Take the
Pink Glove Survey!

Precious. And Pink.

Soft and shimmery.

Layered with organic aloe.
Fashioned from nitrile.

1
The Pink Pearl.

To take the survey, go to Medline’s newest Generation Pink glove.

Supporting the National Breast Cancer Foundation.

www.medline.com/orconnection/survey
or complete the business reply card. AD
©2010 Medline Industries, Inc. The cross-fingered pink glove hand image is a trademark
of Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc. 1

2 Answer these questions: AD 1

A. What does the Pink Glove Dance mean to you?
I only wear Pink Pearls.

B. Do you think pink gloves get people talking about

breast cancer?
Yes, They’re Genuine.
Precious. And Pink.
3
Only Medline’s Pink Pearl gloves combine

Take a look at the Pink Pearl ads on the next three

aloe, nitrile and breast cancer awareness.

Only Medline’s Pink Pearl gloves combine AD

aloe, nitrile and breast cancer awareness. 2
pages and pick your favorite. ©2010 Medline Industries, Inc. The Pink Pearl glove is a trademark of Medline
Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.

AD 2
Soft and shimmery.
Layered with organic aloe.
Fashioned from nitrile.

©2010 Medline Industries, Inc.

The Pink Pearl glove is a trademark
of Medline Industries, Inc. Medline is
a registered trademark of Medline
The Pink Pearl.™
Industries, Inc.

AD
3

Medline’s newest Generation Pink glove.

AD 3
Supporting the National Breast Cancer Foundation.

Participate today!
The first 1,000 readers to respond
will receive the new Deb doll!

www.PinkGloveDance.com ©2010 Medline Industries, Inc. Medline is a registered trademark and Pink Pearl
is a trademark of Medline Industries, Inc.
AD
1
72 The OR Connection
 Yes, They’re Genuine.
Only Medline’s Pink Pearl™ gloves combine
aloe, nitrile and breast cancer awareness.

I only wear Pink Pearls.

©2010 Medline Industries, Inc.

Medline is a registered trademark
and Pink Pearl is a trademark of
Medline Industries, Inc.
Only Medline’s Pink Pearl™ gloves combine AD
aloe, nitrile and breast cancer awareness. 2 AD
©2010 Medline Industries, Inc. Medline is a registered trademark and Pink
Pearl is a trademark of Medline Industries, Inc. 3
 Yes, They’re Genuine.
Only Medline’s Pink Pearl™ gloves combine
aloe, nitrile and breast cancer awareness.

I only wear Pink Pearls.

©2010 Medline Industries, Inc.

Medline is a registered trademark
and Pink Pearl is a trademark of
Medline Industries, Inc.
Only Medline’s Pink Pearl™ gloves combine AD
aloe, nitrile and breast cancer awareness. 2 AD
©2010 Medline Industries, Inc. Medline is a registered trademark and Pink
Pearl is a trademark of Medline Industries, Inc. 3
 Caring for Yourself
Breast Self-Examination
1. In the Shower
Fingers flat – move gently over
every part of each breast.
Use your right hand to examine left
breast, left hand to examine right
breast. Check for any lump, hard
knot or thickening. Carefully observe
any changes in your breast.
2. Before a Mirror
Inspect your breasts with your arms
raised high overhead. Next, place
your arms at your sides. Look for
any changes in contour of each
breast; a swelling, a dimpling of
skin, or changes in the nipple.
Then rest palms on hips and press
firmly to flex your chest muscles.
Left and right breasts will not match
exactly. Few women’s breasts
do match.
3. Lying Down
Place pillow under right shoulder,
right arm behind your head. With
fingers of left hand flat, press right
breast gently in small circular
motions, moving vertically or in
a circular pattern covering the
entire breast.
Use light, medium and firm pressure.
Squeeze nipple, check for discharge
and lumps. Repeat these steps on
your left breast.
Recommended Reading
Dr. Susan Love’s Breast Book
Susan M. Love, MD
Da Capo Press, 2005
Everything you wanted to know about
breasts and breast cancer. Each treatment
option is reviewed with realistic outcome
statistics. Also check out Dr. Love’s
website www.dslrf.org/breastcancer.
76 The OR Connection
Mammograms
Save Lives
The U.S. Preventive Services Task Force (USPSTF), a
group of health experts that reviews published research
to make healthcare recommendations, points out
that women who have screening mammograms die of
breast cancer less frequently than women who do not
get mammograms.
Although the USPSTF recently changed their breast
screening guildelines, recommending mammograms to
be performed every two years beginning at age 50.
The American Cancer Society (ACS), Mayo Clinic, and
others, however, have not changed their recommendations.
®
• The ACS and Mayo Clinic continue to recommend
yearly mammogram screening beginning at age 40
MEDLINE SURGICAL PACKS
for women at average risk of breast cancer. THE HIGHEST QUALITY STANDARDS
• ACS says breast self-exams are optional; however,
Mayo Clinic recommends breast self-exams to allow
Medline Surgical Packs – The Highest Quality Standards Our customer satisfaction has never been higher.*
women to identify breast abnormalities and become
• Over 350 quality assurance specialists
familiar with their breasts so they can tell their doctor Medline’s Decrease in Customer Complaints
• Production-line inspections with picture-driven
about any changes.
build instructions
1.5
• Specialized scales along the production line weigh
If you are confused about any of these recommendations,
COMPLAINTS PER $100K OF
each pack to detect missing components
MEDLINE PACK SALES
it is best to talk to your doctor to learn what’s right for you
• Assembly in dedicated clean rooms 1.0
based on your individual risk factors.
• Our Kaizen program implements employee suggestions
for process improvement and standardization
Source: Pruthi S. Mammogram guidelines: what’s changed? Mayo 0.5
Clinic website. Available at: http://www.mayocliic.com/health.mam- • Validated EO sterilization process
mogram-guidelines/AN02052. Accessed July 30, 2010.
If there is a problem, our formal procedure includes:
0.0
• Investigation – determining why it happened 1996 2002 2009
• Correction – ensuring it doesn’t happen again YEAR
*Internal trending data on file.
• Communication – informing all possibly affected customers
• Satisfaction – providing customers with an appropriate
and timely resolution For a FREE virtual tour of our manufacturing
The Breast Cancer Survival Manual: facilities, contact your Medline representative today
A Step-by-Step Guide for the Woman or call 1-800-MEDLINE.
“
with Newly Diagnosed Breast Cancer
John Link, MD Over the 15 years that I’ve been using Medline as
Stop by Booth 3601 at AORN Congress.
Henry Holt and Company, 2000 the manufacturer of my surgical procedure trays,
A complete guide on how to survive a quality complaints have effectively gone down to zero.”
diagnosis of breast cancer: how to pick
a team of specialists, diagnostic tests, Larry Creech, Senior Vice President, Carilion Clinic, Roanoke, VA
adjuvant therapy choices, management
of side effects and diet.
© 2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
 Caring for Yourself
Breast Self-Examination
1. In the Shower
Fingers flat – move gently over
every part of each breast.
Use your right hand to examine left
breast, left hand to examine right
breast. Check for any lump, hard
knot or thickening. Carefully observe
any changes in your breast.
2. Before a Mirror
Inspect your breasts with your arms
raised high overhead. Next, place
your arms at your sides. Look for
any changes in contour of each
breast; a swelling, a dimpling of
skin, or changes in the nipple.
Then rest palms on hips and press
firmly to flex your chest muscles.
Left and right breasts will not match
exactly. Few women’s breasts
do match.
3. Lying Down
Place pillow under right shoulder,
right arm behind your head. With
fingers of left hand flat, press right
breast gently in small circular
motions, moving vertically or in
a circular pattern covering the
entire breast.
Use light, medium and firm pressure.
Squeeze nipple, check for discharge
and lumps. Repeat these steps on
your left breast.
Recommended Reading
Dr. Susan Love’s Breast Book
Susan M. Love, MD
Da Capo Press, 2005
Everything you wanted to know about
breasts and breast cancer. Each treatment
option is reviewed with realistic outcome
statistics. Also check out Dr. Love’s
website www.dslrf.org/breastcancer.
76 The OR Connection
Mammograms
Save Lives
The U.S. Preventive Services Task Force (USPSTF), a
group of health experts that reviews published research
to make healthcare recommendations, points out
that women who have screening mammograms die of
breast cancer less frequently than women who do not
get mammograms.
Although the USPSTF recently changed their breast
screening guildelines, recommending mammograms to
be performed every two years beginning at age 50.
The American Cancer Society (ACS), Mayo Clinic, and
others, however, have not changed their recommendations.
®
• The ACS and Mayo Clinic continue to recommend
yearly mammogram screening beginning at age 40
MEDLINE SURGICAL PACKS
for women at average risk of breast cancer. THE HIGHEST QUALITY STANDARDS
• ACS says breast self-exams are optional; however,
Mayo Clinic recommends breast self-exams to allow
Medline Surgical Packs – The Highest Quality Standards Our customer satisfaction has never been higher.*
women to identify breast abnormalities and become
• Over 350 quality assurance specialists
familiar with their breasts so they can tell their doctor Medline’s Decrease in Customer Complaints
• Production-line inspections with picture-driven
about any changes.
build instructions
1.5
• Specialized scales along the production line weigh
If you are confused about any of these recommendations,
COMPLAINTS PER $100K OF
each pack to detect missing components
MEDLINE PACK SALES
it is best to talk to your doctor to learn what’s right for you
• Assembly in dedicated clean rooms 1.0
based on your individual risk factors.
• Our Kaizen program implements employee suggestions
for process improvement and standardization
Source: Pruthi S. Mammogram guidelines: what’s changed? Mayo 0.5
Clinic website. Available at: http://www.mayocliic.com/health.mam- • Validated EO sterilization process
mogram-guidelines/AN02052. Accessed July 30, 2010.
If there is a problem, our formal procedure includes:
0.0
• Investigation – determining why it happened 1996 2002 2009
• Correction – ensuring it doesn’t happen again YEAR
*Internal trending data on file.
• Communication – informing all possibly affected customers
• Satisfaction – providing customers with an appropriate
and timely resolution For a FREE virtual tour of our manufacturing
The Breast Cancer Survival Manual: facilities, contact your Medline representative today
A Step-by-Step Guide for the Woman or call 1-800-MEDLINE.
“
with Newly Diagnosed Breast Cancer
John Link, MD Over the 15 years that I’ve been using Medline as
Stop by Booth 3601 at AORN Congress.
Henry Holt and Company, 2000 the manufacturer of my surgical procedure trays,
A complete guide on how to survive a quality complaints have effectively gone down to zero.”
diagnosis of breast cancer: how to pick
a team of specialists, diagnostic tests, Larry Creech, Senior Vice President, Carilion Clinic, Roanoke, VA
adjuvant therapy choices, management
of side effects and diet.
© 2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
 Caring for Yourself

Want to fight the effects of aging?

Add these powerful foods to your diet!

1. Fatty fish. Mackerel, bluefish, 6. Green tea. This traditional Asian

salmon and tuna are rich sources of drink has been shown to have anti-can-
omega-3 fatty acids, which improve cer properties. It also contains theanine,
circulation, reduce inflammation and an amino acid known for its relaxation
reduce the risk of heart disease. benefits.

2. Whole grains. Pass up the 7. Mangosteen. Never heard of it?

white bread, and fill your plate with Never mind. Just give it a try. This small,
whole grains, an excellent source purplish fruit from Southeast Asia contains
of B-complex vitamins, including anti-inflammatory compounds known as
riboflavin and niacin, which are xanthones, which have been shown to
essential for optimal energy improve gastrointestinal function, control
metabolism. pain and reduce markers of inflammation
in the blood, such as C-reactive protein.
3. Low-fat dairy products. The mangosteen is best in juice form.
Drink your skim milk, and eat
plenty of yogurt to receive the 8. Exotic spices. Jazz up your recipes

Taste the anti-aging benefits of calcium

and vitamin D. Not only are they
good for your bones, calcium
also helps boost your metabolic
with turmeric, curcumin and ginger, which
have profound anti-cancer properties.
Used in Indian and Thai cuisine, each
of these spices has been linked with

Fountain rate, and vitamin D exhibits

anti-cancer activity.
prevention and accelerated healing of
cancers of the mouth, throat and
gastrointestinal tract.

ofYouth
4. Green leafy vegetables.
Never underestimate the power of 9. Citrus fruits. Whether it’s oranges,
spinach and salad greens. Green lemons, limes, grapefruit or tangerines,
leafy vegetables are terrific sources citrus fruits are a rich source of vitamin C.
of fiber, calcium and beta-carotene, Plus, the white underside of the peels is
an important antioxidant that pro- a source of specialized flavanoids known
tects the skin from the effects as poly-methoxylated-flavones (PMFs),
of ultraviolet radiation. which have been shown to reduce stress
hormones and cholesterol levels.
5. Berries. Try them all –
strawberries, blueberries, 10. Red wine. Sip a glass of your
raspberries. They are rich favorite Merlot, and reap the benefits of
in flavonoids, which have resveratrol, a flavanoid found in the skins
been shown to help reduce of red grapes. Animal studies have shown
the risk of heart disease, that diets high in resveratrol are associated
cancer and diabetes. with a unique set of anti-aging benefits.
Studies of resveratrol’s effects on humans
Source: Talbott S. Anti-aging power foods slideshow. HealthyAging. Available at are underway.
http://healthy-aging.advanceweb.com. Accessed May 16, 2010.

78 The OR Connection Aligning practice with policy to improve patient care 79

 Caring for Yourself

Want to fight the effects of aging?

Add these powerful foods to your diet!

1. Fatty fish. Mackerel, bluefish, 6. Green tea. This traditional Asian

salmon and tuna are rich sources of drink has been shown to have anti-can-
omega-3 fatty acids, which improve cer properties. It also contains theanine,
circulation, reduce inflammation and an amino acid known for its relaxation
reduce the risk of heart disease. benefits.

2. Whole grains. Pass up the 7. Mangosteen. Never heard of it?

white bread, and fill your plate with Never mind. Just give it a try. This small,
whole grains, an excellent source purplish fruit from Southeast Asia contains
of B-complex vitamins, including anti-inflammatory compounds known as
riboflavin and niacin, which are xanthones, which have been shown to
essential for optimal energy improve gastrointestinal function, control
metabolism. pain and reduce markers of inflammation
in the blood, such as C-reactive protein.
3. Low-fat dairy products. The mangosteen is best in juice form.
Drink your skim milk, and eat
plenty of yogurt to receive the 8. Exotic spices. Jazz up your recipes

Taste the anti-aging benefits of calcium

and vitamin D. Not only are they
good for your bones, calcium
also helps boost your metabolic
with turmeric, curcumin and ginger, which
have profound anti-cancer properties.
Used in Indian and Thai cuisine, each
of these spices has been linked with

Fountain rate, and vitamin D exhibits

anti-cancer activity.
prevention and accelerated healing of
cancers of the mouth, throat and
gastrointestinal tract.

ofYouth
4. Green leafy vegetables.
Never underestimate the power of 9. Citrus fruits. Whether it’s oranges,
spinach and salad greens. Green lemons, limes, grapefruit or tangerines,
leafy vegetables are terrific sources citrus fruits are a rich source of vitamin C.
of fiber, calcium and beta-carotene, Plus, the white underside of the peels is
an important antioxidant that pro- a source of specialized flavanoids known
tects the skin from the effects as poly-methoxylated-flavones (PMFs),
of ultraviolet radiation. which have been shown to reduce stress
hormones and cholesterol levels.
5. Berries. Try them all –
strawberries, blueberries, 10. Red wine. Sip a glass of your
raspberries. They are rich favorite Merlot, and reap the benefits of
in flavonoids, which have resveratrol, a flavanoid found in the skins
been shown to help reduce of red grapes. Animal studies have shown
the risk of heart disease, that diets high in resveratrol are associated
cancer and diabetes. with a unique set of anti-aging benefits.
Studies of resveratrol’s effects on humans
Source: Talbott S. Anti-aging power foods slideshow. HealthyAging. Available at are underway.
http://healthy-aging.advanceweb.com. Accessed May 16, 2010.

78 The OR Connection Aligning practice with policy to improve patient care 79

 Healthy Eating
Chilled Tuscan Tomato Soup (6 servings)
• 1 teaspoon olive oil • 3 pounds ripe tomatoes, cut into
• 1 clove garlic, minced quarters
• 2 cups (1-inch cubes) country style • ¼ cup loosely packed fresh basil
bread (only hearty dense bread will do) leaves, chopped
Directions:
In a small skillet, heat oil on medium heat until hot. Add garlic and
cook for one minute – stirring constantly. Remove from heat.
In a food processor with knife blade attached, pulse bread until
coarsely chopped. Add tomatoes and garlic. Pulse until mixture
is almost a puree. Pour soup into a bowl and stir in chopped
basil, sugar and salt. Cover and refrigerate until well chilled – at
least two hours. (Best overnight.)
Operations analyst Mary Lanciloti, who
works at Medline’s Vernon Hills, Ill. office,
won a bronze medal for this recipe in the
International Cookoff during Employee
Appreciation Week.
80 The OR Connection
Forms & Tools
Nutrition
Information
Servings: 6
Calories: 271
Fat: 3.38 g
Sodium: 579 mg
Fiber: 4.9 g
The following pages contain practical tools for implementing
patient-focused care practices at your facility.
• 1 teaspoon sugar
• ¼ teaspoon salt
Surgical Site Infections FAQs . . . . . . . . . . . . . . . . . . . . . . . . . . . .83
Surgical Safety
SCIP Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85
She subscribes to lots of different magazines, and always scans
them for new recipes to try. This one caught her eye because
Clean Hands Save Lives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87
it’s quick, easy and nutritious. She also noted that it’s perfect for Hand Hygiene
anyone who is trying to drop a few pounds because it’s low in
calories and very filling.
Recycling Coordinator Job Description . . . . . . . . . . . . . . . . . . . . .88
“I’m a big gardener, so this recipe gives me a chance to use Going Green
fresh tomatoes and basil from my own garden,” Mary said. “Of
course, you can always find good summer tomatoes at the local
farm stand or supermarket, too.”
Mary shared that she likes to cook and loves to bake. She took
it up based on her grandmother’s advice that if you like to cook
and bake and sew, you’ll land yourself a good husband.
“I guess it wasn’t the greatest advice,” Mary said. “Because I’ve
always been single! Oh, well.”
Aligning practice with policy to improve patient care 81
 Healthy Eating
Chilled Tuscan Tomato Soup (6 servings)
• 1 teaspoon olive oil • 3 pounds ripe tomatoes, cut into
• 1 clove garlic, minced quarters
• 2 cups (1-inch cubes) country style • ¼ cup loosely packed fresh basil
bread (only hearty dense bread will do) leaves, chopped
Directions:
In a small skillet, heat oil on medium heat until hot. Add garlic and
cook for one minute – stirring constantly. Remove from heat.
In a food processor with knife blade attached, pulse bread until
coarsely chopped. Add tomatoes and garlic. Pulse until mixture
is almost a puree. Pour soup into a bowl and stir in chopped
basil, sugar and salt. Cover and refrigerate until well chilled – at
least two hours. (Best overnight.)
Operations analyst Mary Lanciloti, who
works at Medline’s Vernon Hills, Ill. office,
won a bronze medal for this recipe in the
International Cookoff during Employee
Appreciation Week.
80 The OR Connection
Forms & Tools
Nutrition
Information
Servings: 6
Calories: 271
Fat: 3.38 g
Sodium: 579 mg
Fiber: 4.9 g
The following pages contain practical tools for implementing
patient-focused care practices at your facility.
• 1 teaspoon sugar
• ¼ teaspoon salt
Surgical Site Infections FAQs . . . . . . . . . . . . . . . . . . . . . . . . . . . .83
Surgical Safety
SCIP Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85
She subscribes to lots of different magazines, and always scans
them for new recipes to try. This one caught her eye because
Clean Hands Save Lives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87
it’s quick, easy and nutritious. She also noted that it’s perfect for Hand Hygiene
anyone who is trying to drop a few pounds because it’s low in
calories and very filling.
Recycling Coordinator Job Description . . . . . . . . . . . . . . . . . . . . .88
“I’m a big gardener, so this recipe gives me a chance to use Going Green
fresh tomatoes and basil from my own garden,” Mary said. “Of
course, you can always find good summer tomatoes at the local
farm stand or supermarket, too.”
Mary shared that she likes to cook and loves to bake. She took
it up based on her grandmother’s advice that if you like to cook
and bake and sew, you’ll land yourself a good husband.
“I guess it wasn’t the greatest advice,” Mary said. “Because I’ve
always been single! Oh, well.”
Aligning practice with policy to improve patient care 81
 Patient Handout - About SSIs Forms & Tools

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ͻůĞĂŶƚŚĞŝƌŚĂŶĚƐĂŶĚĂƌŵƐƵƉƚŽƚŚĞŝƌĞůďŽǁƐǁŝƚŚĂŶĂŶƟƐĞƉƟĐ ͻ&ĂŵŝůLJĂŶĚĨƌŝĞŶĚƐǁŚŽǀŝƐŝƚLJŽƵƐŚŽƵůĚŶŽƚƚŽƵĐŚƚŚĞƐƵƌŐŝĐĂůǁŽƵŶĚ
ͻ&ĂŵŝůLJĂŶĚĨƌŝĞŶĚƐǁŚŽǀŝƐŝƚLJŽƵƐŚŽƵůĚŶŽƚƚŽƵĐŚƚŚĞƐƵƌŐŝĐĂůǁŽƵŶĚ
ĂŐĞŶƚũƵƐƚďĞĨŽƌĞƚŚĞƐƵƌŐĞƌLJ͘
ĂŐĞŶƚũƵƐƚďĞĨŽƌĞƚŚĞƐƵƌŐĞƌLJ͘ ŽƌĚƌĞƐƐŝŶŐƐ͘
ŽƌĚƌĞƐƐŝŶŐƐ͘
ͻůĞĂŶƚŚĞŝƌŚĂŶĚƐǁŝƚŚƐŽĂƉĂŶĚǁĂƚĞƌŽƌĂŶĂůĐŽŚŽůͲďĂƐĞĚŚĂŶĚ
ͻůĞĂŶƚŚĞŝƌŚĂŶĚƐǁŝƚŚƐŽĂƉĂŶĚǁĂƚĞƌŽƌĂŶĂůĐŽŚŽůͲďĂƐĞĚŚĂŶĚ ͻ&ĂŵŝůLJĂŶĚĨƌŝĞŶĚƐƐŚŽƵůĚĐůĞĂŶƚŚĞŝƌŚĂŶĚƐǁŝƚŚƐŽĂƉĂŶĚǁĂƚĞƌŽƌĂŶ
ͻ&ĂŵŝůLJĂŶĚĨƌŝĞŶĚƐƐŚŽƵůĚĐůĞĂŶƚŚĞŝƌŚĂŶĚƐǁŝƚŚƐŽĂƉĂŶĚǁĂƚĞƌŽƌĂŶ
ƌƵďďĞĨŽƌĞĂŶĚĂŌĞƌĐĂƌŝŶŐĨŽƌĞĂĐŚƉĂƟĞŶƚ͘
ƌƵďďĞĨŽƌĞĂŶĚĂŌĞƌĐĂƌŝŶŐĨŽƌĞĂĐŚƉĂƟĞŶƚ͘ ĂůĐŽŚŽůͲďĂƐĞĚŚĂŶĚƌƵďďĞĨŽƌĞĂŶĚĂŌĞƌǀŝƐŝƟŶŐLJŽƵ͘/ĨLJŽƵĚŽŶŽƚƐĞĞ
ĂůĐŽŚŽůͲďĂƐĞĚŚĂŶĚƌƵďďĞĨŽƌĞĂŶĚĂŌĞƌǀŝƐŝƟŶŐLJŽƵ͘/ĨLJŽƵĚŽŶŽƚƐĞĞ
ƚŚĞŵĐůĞĂŶƚŚĞŝƌŚĂŶĚƐ͕ĂƐŬƚŚĞŵƚŽĐůĞĂŶƚŚĞŝƌŚĂŶĚƐ͘
ƚŚĞŵĐůĞĂŶƚŚĞŝƌŚĂŶĚƐ͕ĂƐŬƚŚĞŵƚŽĐůĞĂŶƚŚĞŝƌŚĂŶĚƐ͘
ARGLAES® IN THE OR ͻDĂLJƌĞŵŽǀĞƐŽŵĞŽĨLJŽƵƌŚĂŝƌŝŵŵĞĚŝĂƚĞůLJďĞĨŽƌĞLJŽƵƌƐƵƌŐĞƌLJ
ͻDĂLJƌĞŵŽǀĞƐŽŵĞŽĨLJŽƵƌŚĂŝƌŝŵŵĞĚŝĂƚĞůLJďĞĨŽƌĞLJŽƵƌƐƵƌŐĞƌLJ
ƵƐŝŶŐĞůĞĐƚƌŝĐĐůŝƉƉĞƌƐŝĨƚŚĞŚĂŝƌŝƐŝŶƚŚĞƐĂŵĞĂƌĞĂǁŚĞƌĞƚŚĞƉƌŽͲ
ƵƐŝŶŐĞůĞĐƚƌŝĐĐůŝƉƉĞƌƐŝĨƚŚĞŚĂŝƌŝƐŝŶƚŚĞƐĂŵĞĂƌĞĂǁŚĞƌĞƚŚĞƉƌŽͲ
ĐĞĚƵƌĞǁŝůůŽĐĐƵƌ͘dŚĞLJƐŚŽƵůĚŶŽƚƐŚĂǀĞLJŽƵǁŝƚŚĂƌĂnjŽƌ͘
ĐĞĚƵƌĞǁŝůůŽĐĐƵƌ͘dŚĞLJƐŚŽƵůĚŶŽƚƐŚĂǀĞLJŽƵǁŝƚŚĂƌĂnjŽƌ͘ tŚĂƚĚŽ/ŶĞĞĚƚŽĚŽǁŚĞŶ/ŐŽŚŽŵĞĨƌŽŵƚŚĞŚŽƐƉŝƚĂů͍
tŚĂƚĚŽ/ŶĞĞĚƚŽĚŽǁŚĞŶ/ŐŽŚŽŵĞĨƌŽŵƚŚĞŚŽƐƉŝƚĂů͍
ANTIMICROBIAL SILVER TECHNOLOGY ͻtĞĂƌƐƉĞĐŝĂůŚĂŝƌĐŽǀĞƌƐ͕ŵĂƐŬƐ͕ŐŽǁŶƐ͕ĂŶĚŐůŽǀĞƐĚƵƌŝŶŐƐƵƌŐĞƌLJ
ͻtĞĂƌƐƉĞĐŝĂůŚĂŝƌĐŽǀĞƌƐ͕ŵĂƐŬƐ͕ŐŽǁŶƐ͕ĂŶĚŐůŽǀĞƐĚƵƌŝŶŐƐƵƌŐĞƌLJ ͻĞĨŽƌĞLJŽƵŐŽŚŽŵĞ͕LJŽƵƌĚŽĐƚŽƌŽƌŶƵƌƐĞƐŚŽƵůĚĞdžƉůĂŝŶĞǀĞƌLJƚŚŝŶŐ
ͻĞĨŽƌĞLJŽƵŐŽŚŽŵĞ͕LJŽƵƌĚŽĐƚŽƌŽƌŶƵƌƐĞƐŚŽƵůĚĞdžƉůĂŝŶĞǀĞƌLJƚŚŝŶŐ
ƚŽŬĞĞƉƚŚĞƐƵƌŐĞƌLJĂƌĞĂĐůĞĂŶ͘
ƚŽŬĞĞƉƚŚĞƐƵƌŐĞƌLJĂƌĞĂĐůĞĂŶ͘ LJŽƵŶĞĞĚƚŽŬŶŽǁĂďŽƵƚƚĂŬŝŶŐĐĂƌĞŽĨLJŽƵƌǁŽƵŶĚ͘DĂŬĞƐƵƌĞLJŽƵ
LJŽƵŶĞĞĚƚŽŬŶŽǁĂďŽƵƚƚĂŬŝŶŐĐĂƌĞŽĨLJŽƵƌǁŽƵŶĚ͘DĂŬĞƐƵƌĞLJŽƵ
ͻ'ŝǀĞLJŽƵĂŶƟďŝŽƟĐƐďĞĨŽƌĞLJŽƵƌƐƵƌŐĞƌLJƐƚĂƌƚƐ͘/ŶŵŽƐƚĐĂƐĞƐ͕LJŽƵ
ͻ'ŝǀĞLJŽƵĂŶƟďŝŽƟĐƐďĞĨŽƌĞLJŽƵƌƐƵƌŐĞƌLJƐƚĂƌƚƐ͘/ŶŵŽƐƚĐĂƐĞƐ͕LJŽƵ ƵŶĚĞƌƐƚĂŶĚŚŽǁƚŽĐĂƌĞĨŽƌLJŽƵƌǁŽƵŶĚďĞĨŽƌĞLJŽƵůĞĂǀĞƚŚĞŚŽƐƉŝƚĂů͘
ƵŶĚĞƌƐƚĂŶĚŚŽǁƚŽĐĂƌĞĨŽƌLJŽƵƌǁŽƵŶĚďĞĨŽƌĞLJŽƵůĞĂǀĞƚŚĞŚŽƐƉŝƚĂů͘
Use silver to fight bacteria and surgical site infections ƐŚŽƵůĚŐĞƚĂŶƟďŝŽƟĐƐǁŝƚŚŝŶϲϬŵŝŶƵƚĞƐďĞĨŽƌĞƚŚĞƐƵƌŐĞƌLJƐƚĂƌƚƐ
ƐŚŽƵůĚŐĞƚĂŶƟďŝŽƟĐƐǁŝƚŚŝŶϲϬŵŝŶƵƚĞƐďĞĨŽƌĞƚŚĞƐƵƌŐĞƌLJƐƚĂƌƚƐ ͻůǁĂLJƐĐůĞĂŶLJŽƵƌŚĂŶĚƐďĞĨŽƌĞĂŶĚĂŌĞƌĐĂƌŝŶŐĨŽƌLJŽƵƌǁŽƵŶĚ͘
ͻůǁĂLJƐĐůĞĂŶLJŽƵƌŚĂŶĚƐďĞĨŽƌĞĂŶĚĂŌĞƌĐĂƌŝŶŐĨŽƌLJŽƵƌǁŽƵŶĚ͘
ĂŶĚƚŚĞĂŶƟďŝŽƟĐƐƐŚŽƵůĚďĞƐƚŽƉƉĞĚǁŝƚŚŝŶϮϰŚŽƵƌƐĂŌĞƌƐƵƌŐĞƌLJ͘
ĂŶĚƚŚĞĂŶƟďŝŽƟĐƐƐŚŽƵůĚďĞƐƚŽƉƉĞĚǁŝƚŚŝŶϮϰŚŽƵƌƐĂŌĞƌƐƵƌŐĞƌLJ͘ ͻĞĨŽƌĞLJŽƵŐŽŚŽŵĞ͕ŵĂŬĞƐƵƌĞLJŽƵŬŶŽǁǁŚŽƚŽĐŽŶƚĂĐƚŝĨLJŽƵŚĂǀĞ
ͻĞĨŽƌĞLJŽƵŐŽŚŽŵĞ͕ŵĂŬĞƐƵƌĞLJŽƵŬŶŽǁǁŚŽƚŽĐŽŶƚĂĐƚŝĨLJŽƵŚĂǀĞ
Arglaes provides: The Arglaes family of products has something ͻůĞĂŶƚŚĞƐŬŝŶĂƚƚŚĞƐŝƚĞŽĨLJŽƵƌƐƵƌŐĞƌLJǁŝƚŚĂƐƉĞĐŝĂůƐŽĂƉƚŚĂƚ
ͻůĞĂŶƚŚĞƐŬŝŶĂƚƚŚĞƐŝƚĞŽĨLJŽƵƌƐƵƌŐĞƌLJǁŝƚŚĂƐƉĞĐŝĂůƐŽĂƉƚŚĂƚ ƋƵĞƐƟŽŶƐŽƌƉƌŽďůĞŵƐĂŌĞƌLJŽƵŐĞƚŚŽŵĞ͘
ƋƵĞƐƟŽŶƐŽƌƉƌŽďůĞŵƐĂŌĞƌLJŽƵŐĞƚŚŽŵĞ͘
ŬŝůůƐŐĞƌŵƐ͘
ŬŝůůƐŐĞƌŵƐ͘ ͻ/ĨLJŽƵŚĂǀĞĂŶLJƐLJŵƉƚŽŵƐŽĨĂŶŝŶĨĞĐƟŽŶ͕ƐƵĐŚĂƐƌĞĚŶĞƐƐĂŶĚƉĂŝŶĂƚ
ͻ/ĨLJŽƵŚĂǀĞĂŶLJƐLJŵƉƚŽŵƐŽĨĂŶŝŶĨĞĐƟŽŶ͕ƐƵĐŚĂƐƌĞĚŶĞƐƐĂŶĚƉĂŝŶĂƚ
for every wound:
• Antimicrobial protection for up to 7 days ƚŚĞƐƵƌŐĞƌLJƐŝƚĞ͕ĚƌĂŝŶĂŐĞ͕ŽƌĨĞǀĞƌ͕ĐĂůůLJŽƵƌĚŽĐƚŽƌŝŵŵĞĚŝĂƚĞůLJ͘
ƚŚĞƐƵƌŐĞƌLJƐŝƚĞ͕ĚƌĂŝŶĂŐĞ͕ŽƌĨĞǀĞƌ͕ĐĂůůLJŽƵƌĚŽĐƚŽƌŝŵŵĞĚŝĂƚĞůLJ͘
• Moist wound healing • Arglaes Film is ideal for managing bacterial penetration tŚĂƚĐĂŶ/ĚŽƚŽŚĞůƉƉƌĞǀĞŶƚ^^/Ɛ͍
tŚĂƚĐĂŶ/ĚŽƚŽŚĞůƉƉƌĞǀĞŶƚ^^/Ɛ͍
• Fewer dressing changes on post-op incision and line sites. Before your surgery:
Before surgery: /ĨLJŽƵŚĂǀĞĂĚĚŝƟŽŶĂůƋƵĞƐƟŽŶƐ͕ƉůĞĂƐĞĂƐŬLJŽƵƌĚŽĐƚŽƌŽƌŶƵƌƐĞ͘
/ĨLJŽƵŚĂǀĞĂĚĚŝƟŽŶĂůƋƵĞƐƟŽŶƐ͕ƉůĞĂƐĞĂƐŬLJŽƵƌĚŽĐƚŽƌŽƌŶƵƌƐĞ͘
• Non-attaining assay • Arglaes Island features a calcium alginate pad for fluid ͻdĞůůLJŽƵƌĚŽĐƚŽƌĂďŽƵƚŽƚŚĞƌŵĞĚŝĐĂůƉƌŽďůĞŵƐLJŽƵŵĂLJŚĂǀĞ͘
ͻdĞůůLJŽƵƌĚŽĐƚŽƌĂďŽƵƚŽƚŚĞƌŵĞĚŝĐĂůƉƌŽďůĞŵƐLJŽƵŵĂLJŚĂǀĞ͘
• Transparency for wound monitoring management in addition to controlled-release silver. ,ĞĂůƚŚƉƌŽďůĞŵƐƐƵĐŚĂƐĂůůĞƌŐŝĞƐ͕ĚŝĂďĞƚĞƐ͕ĂŶĚŽďĞƐŝƚLJĐŽƵůĚĂĨĨͲͲ
,ĞĂůƚŚƉƌŽďůĞŵƐƐƵĐŚĂƐĂůůĞƌŐŝĞƐ͕ĚŝĂďĞƚĞƐ͕ĂŶĚŽďĞƐŝƚLJĐŽƵůĚĂĨͲ
ĨĞĐƚLJŽƵƌƐƵƌŐĞƌLJĂŶĚLJŽƵƌƚƌĞĂƚŵĞŶƚ͘
ĨĞĐƚLJŽƵƌƐƵƌŐĞƌLJĂŶĚLJŽƵƌƚƌĞĂƚŵĞŶƚ͘

ŽͲƐƉŽŶƐŽƌĞĚďLJ͗
ŽͲƐƉŽŶƐŽƌĞĚďLJ͗
To schedule a FREE demonstration of Arglaes
in your OR, contact your Medline representative,
call 1-800-MEDLINE or visit www.medline.com.

©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
Arglaes is a registered trademark of Giltech Limited Corporation.
 Patient Handout - About SSIs Forms & Tools

&YƐ
;ĨƌĞƋƵĞŶƚůLJĂƐŬĞĚƋƵĞƐƟŽŶƐͿ “Surgical Site
“
ĂďŽƵƚ

/ŶĨĞĐƟŽŶƐ͟

tŚĂƚŝƐĂ^ƵƌŐŝĐĂů^ŝƚĞ/ŶĨ
tŚĂƚŝƐĂ^ƵƌŐŝĐĂů^ŝƚĞ/ŶĨĞĐƟŽŶ;^^/Ϳ͍
Ğ/ŶĨĞĐƟŽŶ;^^/Ϳ͍
ĞĐƟŽŶ;^^/Ϳ͍
ƐƵƌŐŝĐĂůƐŝƚĞŝŶĨĞĐƟŽŶŝƐĂŶŝŶĨĞĐƟŽŶƚŚĂƚŽĐĐƵƌƐĂŌĞƌƐƵƌŐĞƌLJŝŶƚŚĞ
ƐƵƌŐŝĐĂůƐŝƚĞŝŶĨĞĐƟŽŶŝƐĂŶŝŶĨĞĐƟŽŶƚŚĂƚŽĐĐƵƌƐĂŌĞƌƐƵƌŐĞƌLJŝŶƚŚĞ ĂůŬƚŽLJŽƵƌ
ͻYƵŝƚƐŵŽŬŝŶŐ͘WĂƟĞŶƚƐǁŚŽƐŵŽŬĞŐĞƚŵŽƌĞŝŶĨĞĐƟŽŶƐ͘dĂůŬƚŽLJŽƵƌ
ͻYƵŝƚƐŵŽŬŝŶŐ͘WĂƟĞŶƚƐǁŚŽƐŵŽŬĞŐĞƚŵŽƌĞŝŶĨĞĐƟŽŶƐ͘d
ĞĐƟŽŶƐ͘dĂůŬƚ
ƉĂƌƚŽĨƚŚĞďŽĚLJǁŚĞƌĞƚŚĞƐƵƌŐĞƌLJƚŽŽŬƉůĂĐĞ͘DŽƐƚƉĂƟĞŶƚƐǁŚŽŚĂǀĞ
ƉĂƌƚŽĨƚŚĞďŽĚLJǁŚĞƌĞƚŚĞƐƵƌŐĞƌLJƚŽŽŬƉůĂĐĞ͘DŽƐƚƉĂƟĞŶƚƐǁŚŽŚĂǀĞ ĚŽĐƚŽƌĂďŽƵƚŚŽǁLJŽƵĐĂŶƋƵŝƚďĞĨŽƌĞLJŽƵƌƐƵƌŐĞƌLJ͘
ĚŽĐƚŽƌĂďŽƵƚŚŽǁLJŽƵĐĂŶƋƵŝƚďĞĨŽƌĞLJŽƵƌƐƵƌŐĞƌLJ͘
ƐƵƌŐĞƌLJĚŽŶŽƚĚĞǀĞůŽƉĂŶŝŶĨĞĐƟŽŶ͘,ŽǁĞǀĞƌ͕ŝŶĨĞĐƟŽŶƐĚĞǀĞůŽƉŝŶ
ƐƵƌŐĞƌLJĚŽŶŽƚĚĞǀĞůŽƉĂŶŝŶĨĞĐƟŽŶ͘,ŽǁĞǀĞƌ͕ŝŶĨĞĐƟŽŶƐĚĞǀĞůŽƉŝŶ ͻŽŶŽƚƐŚĂǀĞŶĞĂƌǁŚĞƌĞLJŽƵǁŝůůŚĂǀĞƐƵƌŐĞƌLJ͘^ŚĂǀŝŶŐǁŝƚŚĂƌĂnjŽƌ
ͻŽŶŽƚƐŚĂǀĞŶĞĂƌǁŚĞƌĞLJŽƵǁŝůůŚĂǀĞƐƵƌŐĞƌLJ͘^ŚĂǀŝŶŐǁŝƚŚĂƌĂnjŽƌ
ĂďŽƵƚϭƚŽϯŽƵƚŽĨĞǀĞƌLJϭϬϬƉĂƟĞŶƚƐǁŚŽŚĂǀĞƐƵƌŐĞƌLJ͘
ĂďŽƵƚϭƚŽϯŽƵƚŽĨĞǀĞƌLJϭϬϬƉĂƟĞŶƚƐǁŚŽŚĂǀĞƐƵƌŐĞƌLJ͘ ĐĂŶŝƌƌŝƚĂƚĞLJŽƵƌƐŬŝŶĂŶĚŵĂŬĞŝƚĞĂƐŝĞƌƚŽĚĞǀĞůŽƉĂŶŝŶĨĞĐƟŽŶ͘
ĐĂŶŝƌƌŝƚĂƚĞLJŽƵƌƐŬŝŶĂŶĚŵĂŬĞŝƚĞĂƐŝĞƌƚŽĚĞǀĞůŽƉĂŶŝŶĨĞĐƟŽŶ͘
^ŽŵĞŽĨƚŚĞĐŽŵŵŽŶƐLJŵƉƚŽŵƐŽĨĂƐƵƌŐŝĐĂůƐŝƚĞŝŶĨĞĐƟŽŶĂƌĞ͗
^ŽŵĞŽĨƚŚĞĐŽŵŵŽŶƐLJŵƉƚŽŵƐŽĨĂƐƵƌŐŝĐĂůƐŝƚĞŝŶĨĞĐƟŽŶĂƌĞ͗
ƚƚŚĞƟŵĞŽĨLJŽƵƌƐƵƌŐĞƌLJ͗
ƚƚŚĞƟŵĞŽĨLJŽƵƌƐƵƌŐĞƌ
ƚƚŚĞƟŵĞŽĨLJŽƵƌƐƵƌŐĞƌLJ͗ LJ͗
ͻZĞĚŶĞƐƐĂŶĚƉĂŝŶĂƌŽƵŶĚƚŚĞĂƌĞĂǁŚĞƌĞLJŽƵŚĂĚƐƵƌŐĞƌLJ
ͻZĞĚŶĞƐƐĂŶĚƉĂŝŶĂƌŽƵŶĚƚŚĞĂƌĞĂǁŚĞƌĞLJŽƵŚĂĚƐƵƌŐĞƌLJ
ͻ^ƉĞĂŬƵƉŝĨƐŽŵĞŽŶĞƚƌŝĞƐƚŽƐŚĂǀĞLJŽƵǁŝƚŚĂƌĂnjŽƌďĞĨŽƌĞƐƵƌŐĞƌLJ͘
ͻ^ƉĞĂŬƵƉŝĨƐŽŵĞŽŶĞƚƌŝĞƐƚŽƐŚĂǀĞLJŽƵǁŝƚŚĂƌĂnjŽƌďĞĨŽƌĞƐƵƌŐĞƌLJ͘
ͻƌĂŝŶĂŐĞŽĨĐůŽƵĚLJŇƵŝĚĨƌŽŵLJŽƵƌƐƵƌŐŝĐĂůǁŽƵŶĚ
ͻƌĂŝŶĂŐĞŽĨĐůŽƵĚLJŇƵŝĚĨƌŽŵLJŽƵƌƐƵƌŐŝĐĂůǁŽƵŶĚ ƐŬǁŚLJLJŽƵŶĞĞĚƚŽďĞƐŚĂǀĞĚĂŶĚƚĂůŬǁŝƚŚLJŽƵƌƐƵƌŐĞŽŶŝĨLJŽƵŚĂǀĞ
ƐŬǁŚLJLJŽƵŶĞĞĚƚŽďĞƐŚĂǀĞĚĂŶĚƚĂůŬǁŝƚŚLJŽƵƌƐƵƌŐĞŽŶŝĨLJŽƵŚĂǀĞ
ͻ&ĞǀĞƌ
ͻ&ĞǀĞƌ ĂŶLJĐŽŶĐĞƌŶƐ͘
ĂŶLJĐŽŶĐĞƌŶƐ͘
ͻƐŬŝĨLJŽƵǁŝůůŐĞƚĂŶƟďŝŽƟĐƐďĞĨŽƌĞƐƵƌŐĞƌLJ͘
ͻƐŬŝĨLJŽƵǁŝůůŐĞƚĂŶƟďŝŽƟĐƐďĞĨŽƌĞƐƵƌŐĞƌLJ͘
ĂŶ^^/ƐďĞƚƌĞĂƚĞĚ͍
ĂŶ^^/ƐďĞƚƌĞĂƚĞĚ͍
ŌĞƌLJŽƵƌƐƵƌŐĞƌLJ͗
ŌĞƌLJŽƵƌƐƵƌŐĞƌ
ĞƌLJŽƵƌƐƵƌŐĞƌLJ͗
LJ͗
zĞƐ͘DŽƐƚƐƵƌŐŝĐĂůƐŝƚĞŝŶĨĞĐƟŽŶƐĐĂŶďĞƚƌĞĂƚĞĚǁŝƚŚĂŶƟďŝŽƟĐƐ͘dŚĞ
zĞƐ͘DŽƐƚƐƵƌŐŝĐĂůƐŝƚĞŝŶĨĞĐƟŽŶƐĐĂŶďĞƚƌĞĂƚĞĚǁŝƚŚĂŶƟďŝŽƟĐƐ͘dŚĞ
ĂŶƟďŝŽƟĐŐŝǀĞŶƚŽLJŽƵĚĞƉĞŶĚƐŽŶƚŚĞďĂĐƚĞƌŝĂ;ŐĞƌŵƐͿĐĂƵƐŝŶŐƚŚĞ
ĂŶƟďŝŽƟĐŐŝǀĞŶƚŽLJŽƵĚĞƉĞŶĚƐŽŶƚŚĞďĂĐƚĞƌŝĂ;ŐĞƌŵƐͿĐĂƵƐŝŶŐƚŚĞ ͻDĂŬĞƐƵƌĞƚŚĂƚLJŽƵƌŚĞĂůƚŚĐĂƌĞƉƌŽǀŝĚĞƌƐĐůĞĂŶƚŚĞŝƌŚĂŶĚƐďĞĨŽƌĞ
ͻDĂŬĞƐƵƌĞƚŚĂƚLJŽƵƌŚĞĂůƚŚĐĂƌĞƉƌŽǀŝĚĞƌƐĐůĞĂŶƚŚĞŝƌŚĂŶĚƐďĞĨŽƌĞ
ŝŶĨĞĐƟŽŶ͘^ŽŵĞƟŵĞƐƉĂƟĞŶƚƐǁŝƚŚ^^/ƐĂůƐŽŶĞĞĚĂŶŽƚŚĞƌƐƵƌŐĞƌLJƚŽ
ŝŶĨĞĐƟŽŶ͘^ŽŵĞƟŵĞƐƉĂƟĞŶƚƐǁŝƚŚ^^/ƐĂůƐŽŶĞĞĚĂŶŽƚŚĞƌƐƵƌŐĞƌLJƚŽ ĞdžĂŵŝŶŝŶŐLJŽƵ͕ĞŝƚŚĞƌǁŝƚŚƐŽĂƉĂŶĚǁĂƚĞƌŽƌĂŶĂůĐŽŚŽůͲďĂƐĞĚŚĂŶĚ
ĞdžĂŵŝŶŝŶŐLJŽƵ͕ĞŝƚŚĞƌǁŝƚŚƐŽĂƉĂŶĚǁĂƚĞƌŽƌĂŶĂůĐŽŚŽůͲďĂƐĞĚŚĂŶĚ
ƚƌĞĂƚƚŚĞŝŶĨĞĐƟŽŶ͘
ƚƌĞĂƚƚŚĞŝŶĨĞĐƟŽŶ͘ ƌƵď͘
ƌƵď͘
/ĨLJŽƵĚŽŶŽƚƐĞĞLJŽƵƌƉƌŽǀŝĚĞƌƐĐůĞĂŶƚŚĞŝƌŚĂŶĚƐ͕
/ĨLJŽƵĚŽŶŽƚƐĞĞLJŽƵƌƉƌŽǀŝĚĞƌƐĐůĞĂŶƚŚĞŝƌŚĂŶĚƐ͕
tŚĂƚĂƌĞƐŽŵĞŽĨƚŚĞƚŚŝŶŐƐƚŚĂƚŚŽƐƉŝƚĂůƐĂƌĞĚŽŝŶŐƚŽƉƌĞǀĞŶƚ^^/Ɛ͍
tŚĂƚĂƌĞƐŽŵĞŽĨƚŚĞƚŚŝŶŐƐƚŚĂƚŚŽƐƉŝƚĂůƐĂƌĞĚŽŝŶŐƚŽƉƌĞǀĞŶƚ^^/Ɛ͍ ƉůĞĂƐĞĂƐŬƚŚĞŵƚŽĚŽƐŽ͘
ƉůĞĂƐĞĂƐŬƚŚĞŵƚŽĚŽƐŽ͘
dŽƉƌĞǀĞŶƚ^^/Ɛ͕ĚŽĐƚŽƌƐ͕ŶƵƌƐĞƐ͕ĂŶĚŽƚŚĞƌŚĞĂůƚŚĐĂƌĞƉƌŽǀŝĚĞƌƐ͗
dŽƉƌĞǀĞŶƚ^^/Ɛ͕ĚŽĐƚŽƌƐ͕ŶƵƌƐĞƐ͕ĂŶĚŽƚŚĞƌŚĞĂůƚŚĐĂƌĞƉƌŽǀŝĚĞƌƐ͗
ͻůĞĂŶƚŚĞŝƌŚĂŶĚƐĂŶĚĂƌŵƐƵƉƚŽƚŚĞŝƌĞůďŽǁƐǁŝƚŚĂŶĂŶƟƐĞƉƟĐ
ͻůĞĂŶƚŚĞŝƌŚĂŶĚƐĂŶĚĂƌŵƐƵƉƚŽƚŚĞŝƌĞůďŽǁƐǁŝƚŚĂŶĂŶƟƐĞƉƟĐ ͻ&ĂŵŝůLJĂŶĚĨƌŝĞŶĚƐǁŚŽǀŝƐŝƚLJŽƵƐŚŽƵůĚŶŽƚƚŽƵĐŚƚŚĞƐƵƌŐŝĐĂůǁŽƵŶĚ
ͻ&ĂŵŝůLJĂŶĚĨƌŝĞŶĚƐǁŚŽǀŝƐŝƚLJŽƵƐŚŽƵůĚŶŽƚƚŽƵĐŚƚŚĞƐƵƌŐŝĐĂůǁŽƵŶĚ
ĂŐĞŶƚũƵƐƚďĞĨŽƌĞƚŚĞƐƵƌŐĞƌLJ͘
ĂŐĞŶƚũƵƐƚďĞĨŽƌĞƚŚĞƐƵƌŐĞƌLJ͘ ŽƌĚƌĞƐƐŝŶŐƐ͘
ŽƌĚƌĞƐƐŝŶŐƐ͘
ͻůĞĂŶƚŚĞŝƌŚĂŶĚƐǁŝƚŚƐŽĂƉĂŶĚǁĂƚĞƌŽƌĂŶĂůĐŽŚŽůͲďĂƐĞĚŚĂŶĚ
ͻůĞĂŶƚŚĞŝƌŚĂŶĚƐǁŝƚŚƐŽĂƉĂŶĚǁĂƚĞƌŽƌĂŶĂůĐŽŚŽůͲďĂƐĞĚŚĂŶĚ ͻ&ĂŵŝůLJĂŶĚĨƌŝĞŶĚƐƐŚŽƵůĚĐůĞĂŶƚŚĞŝƌŚĂŶĚƐǁŝƚŚƐŽĂƉĂŶĚǁĂƚĞƌŽƌĂŶ
ͻ&ĂŵŝůLJĂŶĚĨƌŝĞŶĚƐƐŚŽƵůĚĐůĞĂŶƚŚĞŝƌŚĂŶĚƐǁŝƚŚƐŽĂƉĂŶĚǁĂƚĞƌŽƌĂŶ
ƌƵďďĞĨŽƌĞĂŶĚĂŌĞƌĐĂƌŝŶŐĨŽƌĞĂĐŚƉĂƟĞŶƚ͘
ƌƵďďĞĨŽƌĞĂŶĚĂŌĞƌĐĂƌŝŶŐĨŽƌĞĂĐŚƉĂƟĞŶƚ͘ ĂůĐŽŚŽůͲďĂƐĞĚŚĂŶĚƌƵďďĞĨŽƌĞĂŶĚĂŌĞƌǀŝƐŝƟŶŐLJŽƵ͘/ĨLJŽƵĚŽŶŽƚƐĞĞ
ĂůĐŽŚŽůͲďĂƐĞĚŚĂŶĚƌƵďďĞĨŽƌĞĂŶĚĂŌĞƌǀŝƐŝƟŶŐLJŽƵ͘/ĨLJŽƵĚŽŶŽƚƐĞĞ
ƚŚĞŵĐůĞĂŶƚŚĞŝƌŚĂŶĚƐ͕ĂƐŬƚŚĞŵƚŽĐůĞĂŶƚŚĞŝƌŚĂŶĚƐ͘
ƚŚĞŵĐůĞĂŶƚŚĞŝƌŚĂŶĚƐ͕ĂƐŬƚŚĞŵƚŽĐůĞĂŶƚŚĞŝƌŚĂŶĚƐ͘
ARGLAES® IN THE OR ͻDĂLJƌĞŵŽǀĞƐŽŵĞŽĨLJŽƵƌŚĂŝƌŝŵŵĞĚŝĂƚĞůLJďĞĨŽƌĞLJŽƵƌƐƵƌŐĞƌLJ
ͻDĂLJƌĞŵŽǀĞƐŽŵĞŽĨLJŽƵƌŚĂŝƌŝŵŵĞĚŝĂƚĞůLJďĞĨŽƌĞLJŽƵƌƐƵƌŐĞƌLJ
ƵƐŝŶŐĞůĞĐƚƌŝĐĐůŝƉƉĞƌƐŝĨƚŚĞŚĂŝƌŝƐŝŶƚŚĞƐĂŵĞĂƌĞĂǁŚĞƌĞƚŚĞƉƌŽͲ
ƵƐŝŶŐĞůĞĐƚƌŝĐĐůŝƉƉĞƌƐŝĨƚŚĞŚĂŝƌŝƐŝŶƚŚĞƐĂŵĞĂƌĞĂǁŚĞƌĞƚŚĞƉƌŽͲ
ĐĞĚƵƌĞǁŝůůŽĐĐƵƌ͘dŚĞLJƐŚŽƵůĚŶŽƚƐŚĂǀĞLJŽƵǁŝƚŚĂƌĂnjŽƌ͘
ĐĞĚƵƌĞǁŝůůŽĐĐƵƌ͘dŚĞLJƐŚŽƵůĚŶŽƚƐŚĂǀĞLJŽƵǁŝƚŚĂƌĂnjŽƌ͘ tŚĂƚĚŽ/ŶĞĞĚƚŽĚŽǁŚĞŶ/ŐŽŚŽŵĞĨƌŽŵƚŚĞŚŽƐƉŝƚĂů͍
tŚĂƚĚŽ/ŶĞĞĚƚŽĚŽǁŚĞŶ/ŐŽŚŽŵĞĨƌŽŵƚŚĞŚŽƐƉŝƚĂů͍
ANTIMICROBIAL SILVER TECHNOLOGY ͻtĞĂƌƐƉĞĐŝĂůŚĂŝƌĐŽǀĞƌƐ͕ŵĂƐŬƐ͕ŐŽǁŶƐ͕ĂŶĚŐůŽǀĞƐĚƵƌŝŶŐƐƵƌŐĞƌLJ
ͻtĞĂƌƐƉĞĐŝĂůŚĂŝƌĐŽǀĞƌƐ͕ŵĂƐŬƐ͕ŐŽǁŶƐ͕ĂŶĚŐůŽǀĞƐĚƵƌŝŶŐƐƵƌŐĞƌLJ ͻĞĨŽƌĞLJŽƵŐŽŚŽŵĞ͕LJŽƵƌĚŽĐƚŽƌŽƌŶƵƌƐĞƐŚŽƵůĚĞdžƉůĂŝŶĞǀĞƌLJƚŚŝŶŐ
ͻĞĨŽƌĞLJŽƵŐŽŚŽŵĞ͕LJŽƵƌĚŽĐƚŽƌŽƌŶƵƌƐĞƐŚŽƵůĚĞdžƉůĂŝŶĞǀĞƌLJƚŚŝŶŐ
ƚŽŬĞĞƉƚŚĞƐƵƌŐĞƌLJĂƌĞĂĐůĞĂŶ͘
ƚŽŬĞĞƉƚŚĞƐƵƌŐĞƌLJĂƌĞĂĐůĞĂŶ͘ LJŽƵŶĞĞĚƚŽŬŶŽǁĂďŽƵƚƚĂŬŝŶŐĐĂƌĞŽĨLJŽƵƌǁŽƵŶĚ͘DĂŬĞƐƵƌĞLJŽƵ
LJŽƵŶĞĞĚƚŽŬŶŽǁĂďŽƵƚƚĂŬŝŶŐĐĂƌĞŽĨLJŽƵƌǁŽƵŶĚ͘DĂŬĞƐƵƌĞLJŽƵ
ͻ'ŝǀĞLJŽƵĂŶƟďŝŽƟĐƐďĞĨŽƌĞLJŽƵƌƐƵƌŐĞƌLJƐƚĂƌƚƐ͘/ŶŵŽƐƚĐĂƐĞƐ͕LJŽƵ
ͻ'ŝǀĞLJŽƵĂŶƟďŝŽƟĐƐďĞĨŽƌĞLJŽƵƌƐƵƌŐĞƌLJƐƚĂƌƚƐ͘/ŶŵŽƐƚĐĂƐĞƐ͕LJŽƵ ƵŶĚĞƌƐƚĂŶĚŚŽǁƚŽĐĂƌĞĨŽƌLJŽƵƌǁŽƵŶĚďĞĨŽƌĞLJŽƵůĞĂǀĞƚŚĞŚŽƐƉŝƚĂů͘
ƵŶĚĞƌƐƚĂŶĚŚŽǁƚŽĐĂƌĞĨŽƌLJŽƵƌǁŽƵŶĚďĞĨŽƌĞLJŽƵůĞĂǀĞƚŚĞŚŽƐƉŝƚĂů͘
Use silver to fight bacteria and surgical site infections ƐŚŽƵůĚŐĞƚĂŶƟďŝŽƟĐƐǁŝƚŚŝŶϲϬŵŝŶƵƚĞƐďĞĨŽƌĞƚŚĞƐƵƌŐĞƌLJƐƚĂƌƚƐ
ƐŚŽƵůĚŐĞƚĂŶƟďŝŽƟĐƐǁŝƚŚŝŶϲϬŵŝŶƵƚĞƐďĞĨŽƌĞƚŚĞƐƵƌŐĞƌLJƐƚĂƌƚƐ ͻůǁĂLJƐĐůĞĂŶLJŽƵƌŚĂŶĚƐďĞĨŽƌĞĂŶĚĂŌĞƌĐĂƌŝŶŐĨŽƌLJŽƵƌǁŽƵŶĚ͘
ͻůǁĂLJƐĐůĞĂŶLJŽƵƌŚĂŶĚƐďĞĨŽƌĞĂŶĚĂŌĞƌĐĂƌŝŶŐĨŽƌLJŽƵƌǁŽƵŶĚ͘
ĂŶĚƚŚĞĂŶƟďŝŽƟĐƐƐŚŽƵůĚďĞƐƚŽƉƉĞĚǁŝƚŚŝŶϮϰŚŽƵƌƐĂŌĞƌƐƵƌŐĞƌLJ͘
ĂŶĚƚŚĞĂŶƟďŝŽƟĐƐƐŚŽƵůĚďĞƐƚŽƉƉĞĚǁŝƚŚŝŶϮϰŚŽƵƌƐĂŌĞƌƐƵƌŐĞƌLJ͘ ͻĞĨŽƌĞLJŽƵŐŽŚŽŵĞ͕ŵĂŬĞƐƵƌĞLJŽƵŬŶŽǁǁŚŽƚŽĐŽŶƚĂĐƚŝĨLJŽƵŚĂǀĞ
ͻĞĨŽƌĞLJŽƵŐŽŚŽŵĞ͕ŵĂŬĞƐƵƌĞLJŽƵŬŶŽǁǁŚŽƚŽĐŽŶƚĂĐƚŝĨLJŽƵŚĂǀĞ
Arglaes provides: The Arglaes family of products has something ͻůĞĂŶƚŚĞƐŬŝŶĂƚƚŚĞƐŝƚĞŽĨLJŽƵƌƐƵƌŐĞƌLJǁŝƚŚĂƐƉĞĐŝĂůƐŽĂƉƚŚĂƚ
ͻůĞĂŶƚŚĞƐŬŝŶĂƚƚŚĞƐŝƚĞŽĨLJŽƵƌƐƵƌŐĞƌLJǁŝƚŚĂƐƉĞĐŝĂůƐŽĂƉƚŚĂƚ ƋƵĞƐƟŽŶƐŽƌƉƌŽďůĞŵƐĂŌĞƌLJŽƵŐĞƚŚŽŵĞ͘
ƋƵĞƐƟŽŶƐŽƌƉƌŽďůĞŵƐĂŌĞƌLJŽƵŐĞƚŚŽŵĞ͘
ŬŝůůƐŐĞƌŵƐ͘
ŬŝůůƐŐĞƌŵƐ͘ ͻ/ĨLJŽƵŚĂǀĞĂŶLJƐLJŵƉƚŽŵƐŽĨĂŶŝŶĨĞĐƟŽŶ͕ƐƵĐŚĂƐƌĞĚŶĞƐƐĂŶĚƉĂŝŶĂƚ
ͻ/ĨLJŽƵŚĂǀĞĂŶLJƐLJŵƉƚŽŵƐŽĨĂŶŝŶĨĞĐƟŽŶ͕ƐƵĐŚĂƐƌĞĚŶĞƐƐĂŶĚƉĂŝŶĂƚ
for every wound:
• Antimicrobial protection for up to 7 days ƚŚĞƐƵƌŐĞƌLJƐŝƚĞ͕ĚƌĂŝŶĂŐĞ͕ŽƌĨĞǀĞƌ͕ĐĂůůLJŽƵƌĚŽĐƚŽƌŝŵŵĞĚŝĂƚĞůLJ͘
ƚŚĞƐƵƌŐĞƌLJƐŝƚĞ͕ĚƌĂŝŶĂŐĞ͕ŽƌĨĞǀĞƌ͕ĐĂůůLJŽƵƌĚŽĐƚŽƌŝŵŵĞĚŝĂƚĞůLJ͘
• Moist wound healing • Arglaes Film is ideal for managing bacterial penetration tŚĂƚĐĂŶ/ĚŽƚŽŚĞůƉƉƌĞǀĞŶƚ^^/Ɛ͍
tŚĂƚĐĂŶ/ĚŽƚŽŚĞůƉƉƌĞǀĞŶƚ^^/Ɛ͍
• Fewer dressing changes on post-op incision and line sites. Before your surgery:
Before surgery: /ĨLJŽƵŚĂǀĞĂĚĚŝƟŽŶĂůƋƵĞƐƟŽŶƐ͕ƉůĞĂƐĞĂƐŬLJŽƵƌĚŽĐƚŽƌŽƌŶƵƌƐĞ͘
/ĨLJŽƵŚĂǀĞĂĚĚŝƟŽŶĂůƋƵĞƐƟŽŶƐ͕ƉůĞĂƐĞĂƐŬLJŽƵƌĚŽĐƚŽƌŽƌŶƵƌƐĞ͘
• Non-attaining assay • Arglaes Island features a calcium alginate pad for fluid ͻdĞůůLJŽƵƌĚŽĐƚŽƌĂďŽƵƚŽƚŚĞƌŵĞĚŝĐĂůƉƌŽďůĞŵƐLJŽƵŵĂLJŚĂǀĞ͘
ͻdĞůůLJŽƵƌĚŽĐƚŽƌĂďŽƵƚŽƚŚĞƌŵĞĚŝĐĂůƉƌŽďůĞŵƐLJŽƵŵĂLJŚĂǀĞ͘
• Transparency for wound monitoring management in addition to controlled-release silver. ,ĞĂůƚŚƉƌŽďůĞŵƐƐƵĐŚĂƐĂůůĞƌŐŝĞƐ͕ĚŝĂďĞƚĞƐ͕ĂŶĚŽďĞƐŝƚLJĐŽƵůĚĂĨĨͲͲ
,ĞĂůƚŚƉƌŽďůĞŵƐƐƵĐŚĂƐĂůůĞƌŐŝĞƐ͕ĚŝĂďĞƚĞƐ͕ĂŶĚŽďĞƐŝƚLJĐŽƵůĚĂĨͲ
ĨĞĐƚLJŽƵƌƐƵƌŐĞƌLJĂŶĚLJŽƵƌƚƌĞĂƚŵĞŶƚ͘
ĨĞĐƚLJŽƵƌƐƵƌŐĞƌLJĂŶĚLJŽƵƌƚƌĞĂƚŵĞŶƚ͘

ŽͲƐƉŽŶƐŽƌĞĚďLJ͗
ŽͲƐƉŽŶƐŽƌĞĚďLJ͗
To schedule a FREE demonstration of Arglaes
in your OR, contact your Medline representative,
call 1-800-MEDLINE or visit www.medline.com.

©2010 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.
Arglaes is a registered trademark of Giltech Limited Corporation.

Patient Safety Quality Measures for the
Surgical Care Improvement Project
Measure
Prophylactic antibiotics are
SCIP-Inf-1 administered one hour prior to
incision.
Prophylactic antibiotics are
consistent with current
SCIP-Inf-2
guidelines (specific to each type
of surgical procedure).
Prophylactic antibiotics are to be
discontinued within 24 hours
after anesthesia end time.
SCIP-Inf-3
The discontinuation time
extends to 48 hours for cardiac
surgery patients.
FREE MEDICLIP TRIAL! ®
Cardiac surgery patients with
controlled 6 a.m. blood glucose
SCIP-Inf-4
(”0 mg/dL) for the first two
postoperative days.
Why choose MediClip?
Clippers can help you avoid nicking or cutting the patient’s skin during preoperative hair removal,
Surgery patients with
helping to reduce the patient’s risk for surgical site infections. MediClip is designed to be held at a
appropriate surgical site hair
30-degree angle to prevent the cutting blades from ever coming in contact with the patient’s skin.
SCIP-Inf-6 removal. No hair removal, hair
Other reasons to try MediClip removal with clippers, or
• User instructions are right on the handle for ease of use depilatory is appropriate.
Surgical patients with urinary
• Ergonomic handle design provides a comfortable grip
catheter removed on
• Hands-free blade disposal protects the user
Postoperative Day 1 or
• Clean-up is easy with the sealed, waterproof handle
Postoperative Day 2 with day of
SCIP-Inf-9
• Smooth surface has no screws, crevices or engraving to trap dirt and debris
surgery being day zero. (This
measure does not apply to
certain urological, gynecological
Sign up now to conduct your own extensive test of MediClip! Get up to 10 clippers and
or perineal procedures.)
five cases of blades FREE!* Visit www.medline.com/special/MediClip-Trial.asp today.
* This offer is good through 12/31/2010. It applies to new customers only and is good for up to 10 MediClip Clippers
and up to five cases of MediClip blades.
©2010 Medline Industries, Inc. Medline and MediClip are registered trademarks of Medline Industries, Inc.
Patient Safety/SCIP Forms & Tools
Rationale Strategy
Studies find that the lowest incidence of post- Include administration and documentation of
operative infection is associated with
x
the antibiotic in the surgical time out.
antibiotic administration during the one hour
For one-hour antibiotics, the antibiotic is hung
prior to surgery. The risk of infection
x
in pre-op, a surgical team member administers
increases progressively with greater time
and documents the antibiotic infusion.
intervals between administration of the
antibiotic and the skin incision.
Use an agent that is safe, cost-effective, and The use of pre-printed orders that include the
has a spectrum of action that covers most of
x
recommended antibiotic will assist surgeons
the probable intraoperative contaminants for with choosing appropriate antibiotics.
the operation. First- or second-generation
Vancomycin is appropriate if there is a risk of
cephalosporins satisfy these criteria for most
x
MRSA.
operations, although anaerobic coverage is
needed for colon surgery.
Administration of antibiotics for more than a Begin antibiotics in the PACU.
few hours after the incision is closed offers no
x
Administer cephalosporins every 6 hours
additional benefit to the surgical patient.
x
rather than every 8 hours.
Prolonged administration increases the risk of
Antibiotics are not provided for more than 24
Clostridium difficile infection and the
x
development of antimicrobial resistant hours after surgery without appropriate
documentation.
pathogens.
Hyperglycemia in the immediate Blood glucose levels are monitored from pre-
postoperative phase increases the risk of
x
op through 48 hours post operative.
infection in both diabetic and non-diabetic
The use of an insulin protocol for treating
patients; the higher the level of
x
hyperglycemia with an insulin drip is strongly
hyperglycemia, the higher the potential for
recommended.
infection in both patient populations.
There is no strong evidence to contraindicate Take ALL razors out of the peri-operative area.
preoperative hair removal; however, there is
x
Instruct patients not to shave the surgical site.
strong evidence against hair removal with a
x
razor. Shaving is considered inappropriate.
It is well-established that the risk of catheter- Create a system of alerts or reminders to
x
associated urinary tract infection (UTI) identify all patients with urinary catheters and
increases with increasing duration of
assess the need for continued catheterization.
indwelling urinary catheterization. Develop guidelines and protocols for nurse-
x
directed removal of unnecessary urinary
catheters and management of postoperative
urinary retention.
Consider the use of external catheters for
x
cooperative males
Aligning
–1–
practice with policy to improve patient care 85

Patient Safety Quality Measures for the
Surgical Care Improvement Project
Measure
Prophylactic antibiotics are
SCIP-Inf-1 administered one hour prior to
incision.
Prophylactic antibiotics are
consistent with current
SCIP-Inf-2
guidelines (specific to each type
of surgical procedure).
Prophylactic antibiotics are to be
discontinued within 24 hours
after anesthesia end time.
SCIP-Inf-3
The discontinuation time
extends to 48 hours for cardiac
surgery patients.
FREE MEDICLIP TRIAL! ®
Cardiac surgery patients with
controlled 6 a.m. blood glucose
SCIP-Inf-4
(”0 mg/dL) for the first two
postoperative days.
Why choose MediClip?
Clippers can help you avoid nicking or cutting the patient’s skin during preoperative hair removal,
Surgery patients with
helping to reduce the patient’s risk for surgical site infections. MediClip is designed to be held at a
appropriate surgical site hair
30-degree angle to prevent the cutting blades from ever coming in contact with the patient’s skin.
SCIP-Inf-6 removal. No hair removal, hair
Other reasons to try MediClip removal with clippers, or
• User instructions are right on the handle for ease of use depilatory is appropriate.
Surgical patients with urinary
• Ergonomic handle design provides a comfortable grip
catheter removed on
• Hands-free blade disposal protects the user
Postoperative Day 1 or
• Clean-up is easy with the sealed, waterproof handle
Postoperative Day 2 with day of
SCIP-Inf-9
• Smooth surface has no screws, crevices or engraving to trap dirt and debris
surgery being day zero. (This
measure does not apply to
certain urological, gynecological
Sign up now to conduct your own extensive test of MediClip! Get up to 10 clippers and
or perineal procedures.)
five cases of blades FREE!* Visit www.medline.com/special/MediClip-Trial.asp today.
* This offer is good through 12/31/2010. It applies to new customers only and is good for up to 10 MediClip Clippers
and up to five cases of MediClip blades.
©2010 Medline Industries, Inc. Medline and MediClip are registered trademarks of Medline Industries, Inc.
Patient Safety/SCIP Forms & Tools
Rationale Strategy
Studies find that the lowest incidence of post- Include administration and documentation of
operative infection is associated with
x
the antibiotic in the surgical time out.
antibiotic administration during the one hour
For one-hour antibiotics, the antibiotic is hung
prior to surgery. The risk of infection
x
in pre-op, a surgical team member administers
increases progressively with greater time
and documents the antibiotic infusion.
intervals between administration of the
antibiotic and the skin incision.
Use an agent that is safe, cost-effective, and The use of pre-printed orders that include the
has a spectrum of action that covers most of
x
recommended antibiotic will assist surgeons
the probable intraoperative contaminants for with choosing appropriate antibiotics.
the operation. First- or second-generation
Vancomycin is appropriate if there is a risk of
cephalosporins satisfy these criteria for most
x
MRSA.
operations, although anaerobic coverage is
needed for colon surgery.
Administration of antibiotics for more than a Begin antibiotics in the PACU.
few hours after the incision is closed offers no
x
Administer cephalosporins every 6 hours
additional benefit to the surgical patient.
x
rather than every 8 hours.
Prolonged administration increases the risk of
Antibiotics are not provided for more than 24
Clostridium difficile infection and the
x
development of antimicrobial resistant hours after surgery without appropriate
documentation.
pathogens.
Hyperglycemia in the immediate Blood glucose levels are monitored from pre-
postoperative phase increases the risk of
x
op through 48 hours post operative.
infection in both diabetic and non-diabetic
The use of an insulin protocol for treating
patients; the higher the level of
x
hyperglycemia with an insulin drip is strongly
hyperglycemia, the higher the potential for
recommended.
infection in both patient populations.
There is no strong evidence to contraindicate Take ALL razors out of the peri-operative area.
preoperative hair removal; however, there is
x
Instruct patients not to shave the surgical site.
strong evidence against hair removal with a
x
razor. Shaving is considered inappropriate.
It is well-established that the risk of catheter- Create a system of alerts or reminders to
x
associated urinary tract infection (UTI) identify all patients with urinary catheters and
increases with increasing duration of
assess the need for continued catheterization.
indwelling urinary catheterization. Develop guidelines and protocols for nurse-
x
directed removal of unnecessary urinary
catheters and management of postoperative
urinary retention.
Consider the use of external catheters for
x
cooperative males
Aligning
–1–
practice with policy to improve patient care 85
 Forms & Tools Patient Safety/SCIP
Measure
Surgical patients should be
actively warmed during surgery
or have at least one recorded
body temperature equal to or
SCIP-Inf- greater than 96.8° F within 30
10
minutes prior to the end of
anesthesia to 15 minutes after
anesthesia end time. (Patients
with intentional hypothermia are
excluded from this measure.)
Surgery patients on beta-
blockers prior to admission
SCIP-
should continue beta-blocker
CARD-2
therapy during the perioperative
period.
Surgery patients with
recommended venous
SCIP-VTE- thromboembolism (VTE)
1 prophylaxis ordered anytime
from hospital arrival to 48 hours
after Anesthesia End Time.
Surgery patients who received
appropriate venous
thromboembolism (VTE)
SCIP-VTE-
prophylaxis within 24 hours prior
2 variability related to the initiation of
to Anesthesia Start Time to 24
hours after Anesthesia End
Time.
This material was prepared by Health Services Advisory Group, Inc., the Medicare Quality Improvement Organization for Arizona, under contract with
the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do
not necessarily reflect CMS policy. Publication No. AZ-9SOW-6.2.3-110609-01
86 The OR Connection
Rationale
Research has correlated impaired wound
healing, adverse cardiac events, altered drug
metabolism, and coagulopathies with
unplanned perioperative hypothermia. A study
by Kurtz, et al. (1996), found that incidence of
culture-positive surgical site infections among
those with mild perioperative hypothermia
was three times higher than the normothermic
perioperative patients.
The American College of Cardiology and the
American Heart Association recommend
continuation of beta-blocker therapy in the
perioperative period as a class I indication,
and accumulating evidence suggests that
titration to maintain tight heart rate control
should be the goal.
Despite the evidence that VTE is one of the
most common postoperative complications
and prophylaxis is the most effective strategy
to reduce morbidity and mortality, it is often
underused.
The frequency of venous thromboembolism
(VTE), which includes deep vein thrombosis
and pulmonary embolism, is related to the
type and duration of surgery, patient risk
factors, duration and extent of postoperative
immobilization, and use or nonuse of
prophylaxis.
Timing of prophylaxis is based on the type of
procedure, prophylaxis selection, and clinical
judgment regarding the impact of patient risk
factors. The optimal start of pharmacologic
prophylaxis in surgical patients varies and
must be balanced with the efficacy-versus-
bleeding potential. Due to the inherent
prophylaxis for surgical procedures, 24 hours
prior to surgery to 24 hours post surgery was
recommended by consensus of the SCIP
Technical Expert Panel in order to establish a
timeframe that would encompass most
procedures.
–2–
Aligning practice with policy to improve patient care 86
Clean Hands Poster Forms & Tools
Strategy
Use aggressive warming measures during
x
surgery.
Ensure accurate documentation of post-
Enterococcus
x
operative temperature.
RSV
Candida
VELIVES
Pseudomonas
Protect patients, protect yourself
x Instruct patients to take their beta blockers the
day of surgery.
Educate in-house clinicians about the
Staphylococcus
x
importance of patients receiving their beta
blockers the day of surgery, even while the
patients are otherwise NPO.
x Meet with physician office staff to ensure
consistent instructions to the patients.
www.cdc.gov/ handhygiene
x Use pre-printed orders that include nationally
recommended guidelines for VTE prophylaxis.
A “hard stop” would be not to allow patients to
CLEAN HANDSSA
x
leave the recovery area until VTE orders are
completed by the surgeon.
Ensure that surgeon “preference” cards mirror
x
national guidelines.
x Pharmacists should assist surgeons with
understanding the risk of bleeding with
pharmacological interventions.
Klebsiella
(Please note that rates for SCIP-VTE- 2 may
x
be lower than those for SCIP-VTE-1 as a result
of more stringent criteria. SCIP-VTE-2 requires
before and after EVER Y contact.
documentation that prophylaxis was ordered
and actually started, whereas SCIP-VTE-1
requires only documentation of an order. )
Organizations with decreased VTE 2 rates
x
should assess their processes to determine
Influenza
why physician orders are not being
implemented.
Alcohol-rub or wash
DEP ARTMENT OF HEAL TH AND HUMAN SER VI CES
CENTERS FOR DI SEASE CONTROL AND PREVENTI ON
Aligning practice with policy to improve patient care 87
 Forms & Tools Patient Safety/SCIP
Measure
Surgical patients should be
actively warmed during surgery
or have at least one recorded
body temperature equal to or
SCIP-Inf- greater than 96.8° F within 30
10
minutes prior to the end of
anesthesia to 15 minutes after
anesthesia end time. (Patients
with intentional hypothermia are
excluded from this measure.)
Surgery patients on beta-
blockers prior to admission
SCIP-
should continue beta-blocker
CARD-2
therapy during the perioperative
period.
Surgery patients with
recommended venous
SCIP-VTE- thromboembolism (VTE)
1 prophylaxis ordered anytime
from hospital arrival to 48 hours
after Anesthesia End Time.
Surgery patients who received
appropriate venous
thromboembolism (VTE)
SCIP-VTE-
prophylaxis within 24 hours prior
2 variability related to the initiation of
to Anesthesia Start Time to 24
hours after Anesthesia End
Time.
This material was prepared by Health Services Advisory Group, Inc., the Medicare Quality Improvement Organization for Arizona, under contract with
the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do
not necessarily reflect CMS policy. Publication No. AZ-9SOW-6.2.3-110609-01
86 The OR Connection
Rationale
Research has correlated impaired wound
healing, adverse cardiac events, altered drug
metabolism, and coagulopathies with
unplanned perioperative hypothermia. A study
by Kurtz, et al. (1996), found that incidence of
culture-positive surgical site infections among
those with mild perioperative hypothermia
was three times higher than the normothermic
perioperative patients.
The American College of Cardiology and the
American Heart Association recommend
continuation of beta-blocker therapy in the
perioperative period as a class I indication,
and accumulating evidence suggests that
titration to maintain tight heart rate control
should be the goal.
Despite the evidence that VTE is one of the
most common postoperative complications
and prophylaxis is the most effective strategy
to reduce morbidity and mortality, it is often
underused.
The frequency of venous thromboembolism
(VTE), which includes deep vein thrombosis
and pulmonary embolism, is related to the
type and duration of surgery, patient risk
factors, duration and extent of postoperative
immobilization, and use or nonuse of
prophylaxis.
Timing of prophylaxis is based on the type of
procedure, prophylaxis selection, and clinical
judgment regarding the impact of patient risk
factors. The optimal start of pharmacologic
prophylaxis in surgical patients varies and
must be balanced with the efficacy-versus-
bleeding potential. Due to the inherent
prophylaxis for surgical procedures, 24 hours
prior to surgery to 24 hours post surgery was
recommended by consensus of the SCIP
Technical Expert Panel in order to establish a
timeframe that would encompass most
procedures.
–2–
Aligning practice with policy to improve patient care 86
Clean Hands Poster Forms & Tools
Strategy
Use aggressive warming measures during
x
surgery.
Ensure accurate documentation of post-
Enterococcus
x
operative temperature.
RSV
Candida
VELIVES
Pseudomonas
Protect patients, protect yourself
x Instruct patients to take their beta blockers the
day of surgery.
Educate in-house clinicians about the
Staphylococcus
x
importance of patients receiving their beta
blockers the day of surgery, even while the
patients are otherwise NPO.
x Meet with physician office staff to ensure
consistent instructions to the patients.
www.cdc.gov/ handhygiene
x Use pre-printed orders that include nationally
recommended guidelines for VTE prophylaxis.
A “hard stop” would be not to allow patients to
CLEAN HANDSSA
x
leave the recovery area until VTE orders are
completed by the surgeon.
Ensure that surgeon “preference” cards mirror
x
national guidelines.
x Pharmacists should assist surgeons with
understanding the risk of bleeding with
pharmacological interventions.
Klebsiella
(Please note that rates for SCIP-VTE- 2 may
x
be lower than those for SCIP-VTE-1 as a result
of more stringent criteria. SCIP-VTE-2 requires
before and after EVER Y contact.
documentation that prophylaxis was ordered
and actually started, whereas SCIP-VTE-1
requires only documentation of an order. )
Organizations with decreased VTE 2 rates
x
should assess their processes to determine
Influenza
why physician orders are not being
implemented.
Alcohol-rub or wash
DEP ARTMENT OF HEAL TH AND HUMAN SER VI CES
CENTERS FOR DI SEASE CONTROL AND PREVENTI ON
Aligning practice with policy to improve patient care 87
 Forms & Tools Sample Recycling Coordinator

Setting
a new
standard
in patient
safety.

Medline’s Gold Standard Safety Program—

a complete tool kit for surgical safety.
Designed to break down barriers to surgical safety
compliance by offering easy-to-use tools to help you
reach your safety goals, Medline’s Gold Standard
Safety Program offers three levels of safety options:

1. The Gold Standard Safety Bundle: Includes

six products to serve as visual safety reminders
to reduce needle sticks and wrong site surgery.

2. Innovative safety products: Surgical Time Out

Procedure (S.T.O.P.™) Flag and Dual Tip Marker
remind OR staff to take time to verify key information
Visit www.medline.com/goldstandard for a quick
before the first incision to reduce wrong site surgery.
video overview on how Medline’s Gold Standard
3. Med-Pack™: Electronic pack audit and a review Safety Program can help improve safety in your OR.
of safety components.

88 The OR Connection
©2010 Medline Industries, Inc. Medline, S.T.O.P. and Med-Pack are registered trademarks of Medline Industries, Inc.
 Forms & Tools Sample Recycling Coordinator

Setting
a new
standard
in patient
safety.

Medline’s Gold Standard Safety Program—

a complete tool kit for surgical safety.
Designed to break down barriers to surgical safety
compliance by offering easy-to-use tools to help you
reach your safety goals, Medline’s Gold Standard
Safety Program offers three levels of safety options:

1. The Gold Standard Safety Bundle: Includes

six products to serve as visual safety reminders
to reduce needle sticks and wrong site surgery.

2. Innovative safety products: Surgical Time Out

Procedure (S.T.O.P.™) Flag and Dual Tip Marker
remind OR staff to take time to verify key information
Visit www.medline.com/goldstandard for a quick
before the first incision to reduce wrong site surgery.
video overview on how Medline’s Gold Standard
3. Med-Pack™: Electronic pack audit and a review Safety Program can help improve safety in your OR.
of safety components.

88 The OR Connection
©2010 Medline Industries, Inc. Medline, S.T.O.P. and Med-Pack are registered trademarks of Medline Industries, Inc.
 Announcing New Online Skin &
Risk Assessment Competency
The Latest Addition to Medline’s
Sarah is in a coma with a naso-gastric
Pressure Ulcer Prevention Program feeding tube. She has a visible wound
on her right arm.
Medline’s Pressure Ulcer Prevention Program –
an educational initiative aimed at reducing the
incidence of pressure ulcers – has added an
interactive online competency to allow nurses to
demonstrate what they’ve learned in a virtual clinical
setting. This approach provides consistency, as
each learner performs the same assessments.

The learner proceeds through the compe- When the learner clicks on Sarah’s
tency using the computer mouse to com- arm, a close-up photograph of her
plete each step – from dispensing hand wound and a related multiple choice
sanitizer at the wall unit to pulling back the question appear on the screen.
bed linens and patient gown, performing
assessments on three separate patients.
An illustrated hand replaces the usual
mouse arrow on the screen.

At the end of each skin assessment, the

learner completes the Braden Scale to
determine the patient’s level of risk for
pressure ulcers.

James is a 44-year-old male who

is recovering from a heart attack. The only way to access the Skin and Risk
Assessment Competency is by joining the
Pressure Ulcer Prevention Program. Visit
www.medline.com/PUPP-webinar to sign up
for an informational webinar to learn more.
(See back cover for webinar dates.)

90 The OR Connection Aligning practice with policy to improve patient care 91

 Announcing New Online Skin &
Risk Assessment Competency
The Latest Addition to Medline’s
Sarah is in a coma with a naso-gastric
Pressure Ulcer Prevention Program feeding tube. She has a visible wound
on her right arm.
Medline’s Pressure Ulcer Prevention Program –
an educational initiative aimed at reducing the
incidence of pressure ulcers – has added an
interactive online competency to allow nurses to
demonstrate what they’ve learned in a virtual clinical
setting. This approach provides consistency, as
each learner performs the same assessments.

The learner proceeds through the compe- When the learner clicks on Sarah’s
tency using the computer mouse to com- arm, a close-up photograph of her
plete each step – from dispensing hand wound and a related multiple choice
sanitizer at the wall unit to pulling back the question appear on the screen.
bed linens and patient gown, performing
assessments on three separate patients.
An illustrated hand replaces the usual
mouse arrow on the screen.

At the end of each skin assessment, the

learner completes the Braden Scale to
determine the patient’s level of risk for
pressure ulcers.

James is a 44-year-old male who

is recovering from a heart attack. The only way to access the Skin and Risk
Assessment Competency is by joining the
Pressure Ulcer Prevention Program. Visit
www.medline.com/PUPP-webinar to sign up
for an informational webinar to learn more.
(See back cover for webinar dates.)

90 The OR Connection Aligning practice with policy to improve patient care 91

The dance sensation spreads

–––––––––––––––––––––––––
across North America!

· New York City · Chicago, IL ·

· San Francisco, CA · Indianapolis, IN ·
· Minneapolis, MN · Richmond, VA ·
· Tallahassee, FL · Newark, NY ·
· La Jolla, CA · New Orleans, LA ·
· Denver, CO · Nova Scotia, Canada ·

–––––––––––––––––––––––––
· Plano, TX ·

Partial proceeds from the sale of

Medline’s pink gloves are donated
to the National Breast Cancer
Foundation.

MKT210218/LIT082R/30M/HLG
©2010 Medline Industries, Inc.
Medline is a registered trademark
of Medline Industries, Inc.