OR Today Magazine February 2021

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INDUSTRY INSIGHTS STERILIZATION IN DENTISTRY

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PRODUCT FOCUS ENDOSCOPES

FITNESS PT EXERCISES AREN’T JUST FOR PHYSICAL THERAPY

LIFE IN AND OUT OF THE OR

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OR TODAY | February 2021

contents features

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MAINTAINING A CLEAN OPERATING ROOM The worldwide COVID-19 pandemic has reinforced the need for everyone to practice effective personal hygiene, such as washing hands frequently and not touching one’s face. Cleanliness and hygiene are also important in the health care setting – especially in operating rooms and ambulatory surgery centers. In this article, we look at maintaining a clean and sterile OR environment.

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OR Today (Vol. 21, Issue #2) February 2021 is published monthly by MD Publishing, 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290. POSTMASTER: Send address changes to OR Today at 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290.

For subscription information visit www.ortoday.com. The information and opinions expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher. Reproduction in whole or in part without written permission is prohibited. © 2021

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INDUSTRY INSIGHTS

CIRCULATION

8 News & Notes 15 Webinars: 2020 Series Averaged 364 Registrants per Session 16 Surgery Starts Here: Flexible Endoscopes: High-Level Disinfection or Sterilization?

18 IAHCSMM: Why SPDs Should ‘Lean” into Departmental Transformation 20 Avante: 3 Questions to Ask Before Purchasing a Refubished Surgical Table 22 CCI: Perioperative Nursing - The Apprenticeship Model 24 TJC: The Joint Commission Prepares for the Future 26 AAMI: AAMI Explores Sterilization in Dentistry with New Standards Initiative

28 M arket Analysis: Reports Predict Endoscope Market Growth 29 Product Focus: Endoscopes 32 CE Article: Surviving and Thriving With Conflict on the Job 40 Company Showcase: Collaborative Medical Solutions

46 S potlight On: Brian Dawson, MSN, RN, CNOR, CSSM 48 Fitness 50 Health 52 EQ Factor 54 Nutrition 55 Recipe 56 Pinboard 58 Index

ACCOUNTING Diane Costea

WEBINARS Jennifer Godwin

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IN THE OR

OUT OF THE OR

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INDUSTRY INSIGHTS

news & notes

Sympliant Introduces Disruptive Endoscope Reprocessing Compliance Platform for the GI Suite Sympliant LLC has announced the U.S. commercial launch of a proprietary, innovative digital endoscope reprocessing compliance platform to support endoscopy professionals in their efforts to employ industry best practices for infection prevention and patient safety.

Sympliant, appropriately named to mean “Sim”-ple, com”pliance”, transforms any endoscopy department work flow into a digital platform with a simple, customized integration of the existing inventory, assets, documentation and reporting practices. This innovative solution allows any department where endoscopic surgical procedures are performed to immediately deploy “best-in-class” practices for endoscope reprocessing compliance and scope tracking with advanced analytics and reporting functions.

The global health care sterilization services market is expected to reach $4.4 billion in 2027, according to a Globe Newswire report. The market is estimated to grow at a compound annual growth rate (CAGR) of 6.3% from 20202027. Factors driving the growth of the sterilization services markets are increasing prevalence of healthcare-associated infections (HAIs) and an increasing number of surgical procedures worldwide, according to the report.

Healthcare-associated infections (HAIs) are a complex and persistent issue in health care facilities. Each year, approximately 1.7 million HAIs occur, and outbreaks also pose a severe economic burden to the health system, with the total direct, indirect and nonmedical social costs of HAIs to

hospitals ranging from $96 billion to $147 billion, according to a recent Becker’s Hospital Review article.

“We are thrilled to be introducing this critically important and needed innovation to help our endoscopy customers in their tireless efforts to enhance infection prevention best practices and improve patient safety,” Sympliant Founder and Chief Operating Officer Michael Cousin said. “We continue to listen to our endoscopy customers to make sure that our platform best represents the kind of tool that they need to help deliver quality patient care on a daily basis. We understand that it is not enough to simply offer a scope tracking platform, so we took the time to understand at a granular level the entire endoscope reprocessing workflow, and to develop a solution that streamlines, simplifies and improves everywhere it possibly can along that continuum. The best health care facilities are the ones where there is investment in and reliance on technology-enabled solutions wherever possible. There is an opportunity in the care area of endoscopy to deploy suitable technology and make a measurable impact in infection prevention and patient safety.”

Within the United States, users of Sympliant’s digital endoscope reprocessing compliance platform will experience industry-leading customer support from system implementation, on-boarding and training, product upgrades and technical support, Cousin said. • For more information, visit sympliant.com/why-sympliant.

Aspen Surgical Acquires Protek Medical Products Aspen Surgical Products Inc. has announced its acquisition of Protek Medical Products Inc. Based in Coralville, Iowa, Protek is a global manufacturer of single-use ultrasonic probe covers and needle guides used in tissue biopsies, fluid aspiration and vascular access procedures as well as protective covers for medical instruments and equipment. The company has demonstrated a consistent track record of driving recurring revenue growth

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OR TODAY | February 2021

and innovation, fueled by best-in-class R&D capabilities.

Protek has become a supplier of choice for leading OEMs in the ultrasound equipment space.

The acquisition of Protek strengthens Aspen’s broad portfolio of medical and patient and staff safety products sold into hospital and surgery center markets. This includes Protek’s patented Pull-Up probe cover technology which helps support efficiency in the clinical environment. •

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INDUSTRY INSIGHTS

news & notes

Medline Launches 2 Health Care Sustainability Programs Medline has announced two new health care sustainability programs. The programs, a Green Product Portfolio and a Sustainable Packaging Lab, will help hospitals reduce the amount of product waste coming out of their facilities.

According to a recent industry report, the United States is the world’s highest emitter of health care greenhouse gases, accounting for 27% of the global health care footprint.

“More and more, we are hearing directly from hospitals that they understand the negative consequence their environmental footprint can have on their patient population,” said Hannah Anderson, Medline sustainability specialist. “There is a culture change happening to find ways to make their supply chain more sustainable. Being a primary medical supplier partner, we are well positioned to help customers develop meaningful and actionable strategies to improve the health of patients in the communities they serve through sustainability.”

Medline is introducing a new web page to help make

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it easier for health care providers to find and purchase green products. The company currently has over 40 unique product types that meet Medline’s Green Product Portfolio Standards, which are informed by Kaiser Permanente’s Environmentally Preferred Purchasing guidelines, the Federal Trade Commission’s Green Guides, and the Environmental Protection Agency’s guidelines. Hospitals can explore products within three key focus areas: environmental services; health care essentials; and perioperative care.

The Healthcare Plastics Recycling Council estimates that 2,800 to 3,500 tons of plastic packaging product waste is generated daily by U.S. health care facilities. To help reduce material use and waste, Medline is unveiling a Sustainable Packaging Lab, a cross-functional group consisting of employees who specialize in research and development, engineering, packaging and product design. The group will tackle packaging waste from every step of the process and aims to complete and roll out four new projects by the end of 2021. •

February 2021 | OR TODAY

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INDUSTRY INSIGHTS

news & notes

ACS Recognizes ChristianaCare for ‘Meritorious’ Surgical Outcomes ChristianaCare has been honored as one of only 89 institutions out of 722 by the American College of Surgeons (ACS) Clinical Congress for achieving “meritorious” outcomes in surgical patient care.

This is the ninth consecutive year that ChristianaCare has been recognized through the organization’s National Surgical Quality Improvement Program – also known as ACS NSQIP –which is the only nationally validated quality improvement program that measures and enhances the care of surgical patients.

“The extraordinary caregivers that comprise our surgical care team strive to be even more exceptional tomorrow than they are today, and this recognition – for the ninth consecutive year – affirms that continuous improvement,” said Gerard Fulda, M.D., chair of ChristianaCare’s department of surgery. “Our surgical colleagues follow evidencebased practices and find ways, with compassion, to elevate our patients from their injury and health issue to active, healthy lives. We are grateful to receive this recognition as we work to deliver excellence to each and every one of our patients.”

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The award recognizes ChristianaCare’s coordinated delivery of perioperative care within the general, colorectal, neurologic, orthopaedic and oral and maxillofacial and otorhinolaryngology (ear, nose and throat) surgery specialties.

It includes Christiana Hospital and Wilmington Hospital, as well as the Christiana Surgicenter in Newark, representing a combined total of nearly 38,000 surgical procedures a year.

The ACS NSQIP measures actual surgical results 30 days after the operation and makes risk adjustments to compensate for differences among patient populations and acuity levels. Participating hospitals are required to track the outcomes of inpatient and outpatient surgical procedures and then analyze their results, which direct patient safety initiatives within the hospital and impact the quality of surgical care.

ChristianaCare was honored with ACS NSQIP recognition for its performance in eight clinical areas: mortality; cardiac arrest and heart attack; pneumonia; unplanned intubation; ventilator use for longer than 48 hours; renal failure; surgical site infections; and urinary tract infection. •

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INDUSTRY INSIGHTS

news & notes

Technipaq Introduces New Coated Tyvek Capabilities Technipaq Inc., a leading manufacturer of flexible sterilizable packaging solutions, has announced its investment in one of the industry’s most sophisticated air-knife coating machines. As an authorized converter of DuPont Tyvek, the installation of this new production line equips Technipaq with the unique ability to apply proprietary coatings to Tyvek for health care product offerings in-house. This places Technipaq amongst a small group of medical packaging manufacturers who can claim such capabilities.

Designed in collaboration with one of the world’s top manufacturers of coating equipment, this new line also serves to significantly expand and enhance Technipaq’s breadth of Rollstock, Lidstock and Header Bag product offerings, as well as bolster levels of customization.

“Our long-standing mission to consistently deliver increasingly higher quality packaging solutions to our customers is perfectly encapsulated by the addition of such new and innovative coating technology,” said Technipaq President and CEO Brian Rosenburg. “This represents one of the most important, future-forward investments in our 35-plus year history. Simply put, this means more efficient processes and higher-quality products for our customers.”

Built for continuous coating operation, the new line features an advanced Web-based master control that allows for real-time end-to-end monitoring of all production processes. This brings tighter quality control to the process and ensures greater product uniformity. Additional benefits include increased customization and flexibility, greater product diversity and faster delivery.

Technipaq remains committed to deliver packaging products with superior durability and clean peel through DuPont Tyvek products to keep medical equipment and pharmaceuticals sterile throughout their life cycle – protecting the health and well-being of millions without any compromise.

“The collaborative partnerships we share with our customers affords us an intimate understanding of their pain points, as well as insight to emerging needs,” added Rosenburg. “We make it a top priority to follow through on these learnings with real-world practical solutions. For decades it is a formula that has fueled business growth – for our customers, our partners and for Technipaq.” •

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February 2021 | OR TODAY

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INDUSTRY INSIGHTS

news & notes

Exactech Announces First Surgery Using Vantage Ankle PSI Exactech, a developer and producer of implants, instrumentation and smart technologies for joint replacement surgery, has announced the first ankle replacement procedure using the Vantage Ankle PSI, patientspecific surgical planning and 3Dprinted instruments. Manufactured by Rock Hill, South Carolina-based 3D Systems, the instrumentation allows surgeons to pre-plan bone resections with its personalized cutting guides.

Design Team Member Jason Nowak, DPM, FACFAS, of Shasta Orthopaedics performed the first surgery in California.

“I was very proud to be the first to use these instruments,” Nowak said.

“The unique 3D-printed tibia and talar cutting guides, specifically made for my patient, helped me align and

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OR TODAY | February 2021

cut each bone with one instrument, saving time and increasing my surgical efficiency.”

An Exactech Active Intelligence technology, the Vantage Ankle PSI cutting guides are created from patients’ CT scans and delivered in approximately two weeks. The cutting slots on the instrumentation feature a rippled surface to allow water to flow through to keep the bone cool during surgery. In addition, the instrumentation includes soft tissue offsets, which are designed to allow the surgeon to remove less soft tissue.

“The Vantage Ankle PSI showcases our commitment to delivering personalized solutions and smart technologies that optimize the way surgeons perform every case,” said Chris Roche, a vice president with

Exactech. “This successful first surgery is a rewarding milestone and a testament to our exclusive partnership with 3D Systems to enhance the total ankle surgery experience.”

In other news, Exactech announced the launch of Predict+, a data-driven, clinical decision support tool that uses machine learning to predict individual patient outcomes after shoulder replacement surgery to assist surgeon decision making.

The software is designed to better inform surgeons regarding the expected outcomes that can be achieved after shoulder arthroplasty, based on the clinical experience documented within the world’s largest singleshoulder prosthesis outcomes database, consisting of more than 10,000 patients. •

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INDUSTRY INSIGHTS

news & notes

Censis Technologies, Cantel Medical to Develop Software Solution Censis Technologies and Cantel Medical Corp. have announced a long-term partnership to combine Cantel’s infection prevention endoscope reprocessing workflow portfolio with the surgical asset management and instrument tracking solutions from Censis.

The new enhanced, co-branded software solution will combine the CANEXIS Integrated Workflow Solution for Endoscopy from Cantel with Censis’ CensiTrac surgical asset management software to create instrument reprocessing and scope tracking software. “Leveraging Censis’

strengths in software development, cloud-based technology and professional services and support with the leading position in endoscope reprocessing and infection prevention from Cantel, the combined solution will support endoscopy customers with best-in-class quality management tools, providing peace of mind and confidence that their facility is executing best practices to support patient safety and infection prevention,” according to a news release.

“This enhanced integrated workflow solution is a key tool in the fight

to avoid the spread of infection, while helping to protect patients and reducing the economic burden on facilities, while also supporting improved efficiency and understanding of the use of critical medical devices in health care facilities. In today’s environment, efficiency and process consistency are increasingly critical to the day-to-day and long-term success of infection prevention, and this software application is an important resource for helping to ensure a consistent repeatable standard of care and process at each facility,” the release adds. •

AAAHC Publishes Revised Preoperative Evaluation and Testing Toolkit The Accreditation Association for Ambulatory Health Care (AAAHC) has announced the release of a fully updated Ambulatory Surgery and Preoperative Evaluation and Testing Toolkit. Ambulatory surgery centers can utilize this toolkit to guide development of their preoperative evaluation program. The toolkit includes more visual aids and recommendations by patient condition for patients undergoing intermediate and high-risk elective procedures.

Emphasizing the importance of preoperative evaluation as a means to identify patient comorbidities, this toolkit is designed to help organizations minimize adverse perioperative outcomes and maximize patient safety. Additionally, the toolkit outlines parameters for preoperative testing. For low-risk patients or for those receiving minimally invasive or low anesthesia procedures, the benefits of preoperative testing may be outweighed by the risks of performing tests that are not needed, expensive, or likely to cause unnecessary anxieties due to a false positive. Evidence also suggests that current guidelines may be recommending more testing than is necessary for ambulatory surgery patients.

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“Based on current research and AAAHC Standards, the toolkit is designed to help ambulatory providers systemize preoperative evaluation in order to decide which, if any, tests are required based upon the clinical situation and the patient’s medical history,” said Noel Adachi, MBA, president and CEO of AAAHC. “Ambulatory providers must balance routine testing against the need to recognize and protect against risks for patients who are not as healthy or are having more invasive procedures and higher levels of anesthesia.”

The toolkit provides guidance on the necessary steps for preoperative evaluation, which include completing a medical history and physical exam, conducting a risk assessment and determining if a preoperative test is necessary. In addition, the toolkit provides important considerations related to the timing of various preoperative evaluations. • For more information, and to order the Ambulatory Surgery and Preoperative Evaluation and Testing Toolkit, visit AAAHC. org/quality/patient-safety-toolkits/.

February 2021 | OR TODAY

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INDUSTRY INSIGHTS

news & notes

University of Iowa Health Care Contracts with Caresyntax Caresyntax has announced an agreement with the University of Iowa Health Care to help improve the safety and efficiency of surgeries performed at the university medical center.

As part of the project, UI Health Care will use near real-time data to improve patient safety and quality across the surgical continuum. Caresyntax will install hardware to collect surgical and procedural and team-based video and audio data using CX-ADVANCE, a component of the company’s digital surgery platform that enables hospitals to manage and review surgical data for quality improvement and risk reduction. Vendor-neutral and web-based, CX-ADVANCE will guide team-based

and technical refinements to continuously improve patient outcomes beginning in January 2021.

“The COVID-19 pandemic has exacerbated the clinical, regulatory, and financial demands hospitals and health systems must meet,” said Dennis Kogan, caresyntax CEO and co-founder.

“Our work with this renowned institution will help it adapt the outstanding technical skills of its faculty and staff to respond to these needs by improving technical — and non-technical skills — to create a more predictable, consistent and reliable OR.” A major focus of this initiative at UI Health Care is to enhance cooperation among surgical teams. The data collected and analyzed by caresyntax will

enable surgical teams to evaluate the relationship between teamwork scores and surgical complications or adverse events.

“A big challenge hospitals currently face is making use of somewhat scattered OR data to meaningfully drive how we operate,” said John W. Cromwell, M.D., F.A.C.S, director of the division of gastrointestinal surgery, minimally-invasive and bariatric surgery at the University of Iowa Carver College of Medicine. “Innovative tools, like those developed by caresyntax, help us determine where to best allocate resources to improve outcomes in a systematic way that meets the ever-increasing challenges of clinical practice.” •

Fujifilm Earns FDA ‘Breakthrough Device’ Designation for Endosurgical Image Enhancement Technology FUJIFILM Medical Systems U.S.A. Inc. announced that the U.S. Food and Drug Administration (FDA) granted its Breakthrough Device Designation for Fujifilm’s new, in-development, endoscopic light and image processing technology. Although not yet 510(k) cleared, the goal of Fujifilm’s in-development image processing technology is to arm surgeons with the resources needed to care for patients at risk for ischemic states of the gastrointestinal tract.

“Leveraging our 80+ year imag-

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OR TODAY | February 2021

ing legacy, we develop technologies designed to enhance visualization and guide health care providers as they make critical clinical decisions caring for their patients,” says Taisuke Fujita, general manager-endoscopy, FUJIFILM Medical Systems U.S.A. Inc. “We’re proud to receive this designation through the FDA’s Breakthrough Devices Program on the heels of several advancements in 2019, and we look forward to bringing more innovations to the endoscopic and endosurgical markets in the years to come.”

Fujifilm’s new image processing technology is being developed to enhance endosurgical visualization and will be an upgrade to the ELUXEO Surgical System – the company’s inmarket video imaging system which leverages 4-LED multi-light technology to enable advanced visualization modes including White Light Endoscopy, Linked Color Imaging (LCI) and Blue Light Imaging (BLI). These imaging modes are designed to improve visualization, detection, and characterization during procedures.

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INDUSTRY INDUSTRY INSIGHTS INSIGHTS

WEBINAR SERIES

newswebinars & notes

2020 Series Averaged 364 Registrants per Session he December 17, 2020, OR Today webinar “Making a List and Checking it Twice” sponsored by Healthmark Industries was eligible for one (1) continuing (CE) hour by the State of California Board of Registered Nursing as well as (1) contact hour from CBSPD. This was the final webinar of the 2020 OR Today Webinar Series.

The series had 5,800 registrants in 2020 and averaged 364 registrants per webinar!

T

This 60-minute webinar featured a panel of experts from Healthmark, including Clinical Educator Emeritus Stephen Kovach, Clinical Education Coordinators Seth Hendee, John Whelan and Kevin Anderson, and Special Projects Manager Jahan Azizi. These professionals provided an overview of the importance of the use of checklists in health care facilities as significant steps for patient safety. Along with improving patient safety, checklists create a great sense of confidence that the process is completed accurately and thoroughly. Overall, the webinar explained why checklists are necessary and how they are used in sterile processing, endoscopy, the OR and for biomedical engineering staff.

Over 190 registered attendees tuned in for the live presentation, and even more have viewed a recording of the session at ORToday.com.

A post-webinar survey allowed the audience to provide valuable feedback about the presentation.

“It was very interesting to learn about the various ways that checklists are used in the hospital setting and the importance behind them. It really helped to drive home how much paWWW.ORTODAY.COM

tient lives can be impacted when steps are missed. I am looking forward to using what I have learned to reinforce existing/implement new checklists in our sterile processing department,” stated Sterile Processing Quality Assurance & Education Coordinator V. Reed.

“The speakers were engaging and knowledgeable, and the personal stories and flashes of humor they showed made it seem like they were speaking to us live. The topics were well-organized and, as Steve Kovach pointed out at the beginning, were relevant in many health care settings,” added A. Hewitt, clinical education fellow.

“I feel that OR Today webinars share current, relevant topics that help the team become more efficient, effective and stay up-to-date on topics. Really enjoy them,” said T. Ralls, AVP CEE.

Reprocessing Laryngoscopes, Bronchoscopes The recent OR Today webinar “Take a Deep Breath: Reprocessing of Laryngoscopes and Bronchoscopes” sponsored

by Advanced Sterilization Products was eligible for one (1) continuing (CE) hour by the State of California Board of Registered Nursing. It was also eligible for 1 credit for IAHCSMM and CBSPD. This 60-minute webinar featured Senior Manager of Commercial and Clinical Education Regina Hammond and Senior Clinical Education Consultant Janet Moran. The duo provided a review of airway devices, and their proper handling and associated reprocessing guidelines. The webinar also touched on some of the challenges and options for reprocessing these devices.

The analysis covered defining the terms laryngoscope and bronchoscope; identifying when and why airway devices are utilized; reviewed common or-

ganisms associated with airway devices; and examined reprocessing options for airway devices and discussed the barriers to properly reprocessing airway devices.

The webinar was popular with 153 attendees for the live presentation and even more have viewed a recording of the session at ORToday.com.

A post-webinar survey drew positive feedback regarding the webinar. The survey asked several questions about the webinar and the OR Today webinar series.

“Great webinar, very good information on scope processing,” Program Specialist D. Johnson said.

“Learning about scopes and ways they are used and ways to clean them are so very important. We use these items quite a bit so there is a learning curve and whatever we can do for the patient is what we do,” said L. Allen, CRCST. “OR Today provides up-to-date, unbiased, data driven, best practice webinars that are relevant in today’s workforce. I enjoy the information that I get from these webinars as they are useful and help keep me informed of changes in my practice setting,” OR Manager R. McCann said.

The next OR Today webinar is scheduled for Thursday, January 21, 2021.

For more information, visit ORToday. com and click on the “Webinars” tab.

Thank you to our sponsors:

February 2021 | OR TODAY

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INDUSTRY INDUSTRY INSIGHTS INSIGHTS Surgery

news notes Starts & Here

Flexible Endoscopes: High-Level Disinfection or Sterilization?

By Brandon Huffman, BS, CRCST, CIS have been asked quite a few times over my career whether I believe flexible endoscopes should be high-level disinfected or sterilized. This is a great question and I will tell you why. Not because there is a right or wrong answer, but because it opens the door of discovery into practices and processes currently going on with flexible endoscope reprocessing.

I

High-level disinfection is currently validated as an option for flexible endoscope reprocessing. But with the emergence of superbugs and even more recently SARS-CoV-2, it is unclear whether high-level disinfection will remain adequate as the world of organisms continue to evolve. Superbugs such as vancomycin-resistant enterococci (VRE) and carbapenemresistant enterobacteriaceae (CRE) are very concerning and give insight into the capabilities and adaptation of organisms resisting treatment. What works now may not work tomorrow.

Generally, the question of whether to sterilize or high-level disinfect comes from a concern in the efficacy of the process in use. If you ask any sterile processing technician, they will say sterilization is greater than disinfection. So, since we believe sterilization is king why wouldn’t we seek to 16

OR TODAY | February 2021

sterilize? If the answer was that easy, I wouldn’t need to write this column.

Before we assess sterilization, let’s talk about the most important factor in flexible endoscope reprocessing; manual cleaning. A switch from disinfection to sterilization does nothing for patient safety if the cleaning process is flawed to begin with. For disinfectants or sterilants to properly perform their function, it must be able to contact all surfaces of the medical device. This includes inside the working channels.

Improper cleaning increases the risk of leftover tissue and/or organic material which can protect microorganisms during disinfection or sterilization. If the manual cleaning isn’t nailed down with proper education, supplies, cleaning efficacy tests and audits verifying the process is standardized and sustained by all staff members, then the entire effort is undermined. Though we have come a long way since the bombshell news articles of flexible endoscope-related outbreaks from several years back, cleaning remains inconsistent and challenging in real time across most organizations. This doesn’t apply only to flexible endoscope reprocessing; this applies to the cleaning of any medical device. I have had the privilege of entering a large number of sterile processing departments and working with thousands of sterile techs over my career, and cleaning ef-

ficacy is always the number one challenge. The number of medical devices that are returned to the decontamination area due to improper cleaning on the first go around is haunting.

A move to sterilization is dependent on several factors such as number of procedures performed, number of flexible endoscopes available whether owned or loaned, length of time to sterilize flexible endoscopes, and availability of proper sterilant within the facility such as an ethylene oxide (EO), hydrogen peroxide or ozone sterilizers depending on flexible endoscope manufacturer instructions for use. When it comes to sterilizing flexible endoscopes, EO remains one of the main options available and approved by flexible endoscope manufacturers.

Besides the issues of inherent risk to health care workers and the limited capacity of each load, the EO cycle time with aeration presents a significant barrier to efficient workflows and daily procedure volume capabilities.

A single EO cycle can take up to 16 hours. That is of course if your facility owns and operates an EO sterilizer of which most facilities do not. The fact of the matter is that sterilization isn’t impossible, it just brings a long list of logistical challenges that must be addressed.

I hope I haven’t scared you away just yet, we are safe for now if we WWW.ORTODAY.COM

follow current guidelines, manufacturer instructions for use and ensure our cleaning practices are in order. As the FDA continues to look at flexible endoscopes and their complex designs, there has been significant push for disposable options. Many device manufacturers have risen to the challenge with designing and providing flexible endoscopes containing disposable tips, and even flexible endoscopes that are completely disposable. These are incredible advancements in short periods of time working towards patient safety while maintaining high standards for surgical devices.

Whether you choose to high-level disinfect or sterilize your flexible endoscopes, remain vigilant on your pursuit of clean. The adage of “If it’s not clean, it cannot be sterilized” is very true. But I would take it a step further to be all inclusive and say, “If it’s not clean, it cannot be disinfected or sterilized.”

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INDUSTRY INSIGHTS

IAHCSMM

Why SPDs Should ‘Lean’ into Departmental Transformation

By Nicholas Schmitz, PMP, LSSBB, and Julie E. Williamson early every health care professional in every department hopes for positive changes that increase efficiency and throughput while eliminating bottlenecks and process-related headaches. This is certainly the case for those in sterile processing.

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While most team members have likely heard of “process improvement” and, perhaps, even lean concepts aimed at bringing about positive change, many struggle in their implementation – and for numerous reasons.

Lean concepts may seem simple; however, a true lean transformation may take years to accomplish (many years, in fact), and that often makes facilities and their departmental leaders afraid to take the first steps.

Instead, it may become a goal that just keeps being placed on the backburner, relegated behind other projects deemed higher priority. Instead of steering away from lean projects for fear of long-term commitment and sacrifice, SP leaders can finally commit to taking those first steps toward meaningful transformation – all set into motion by a succession of minor changes as opposed to one massive alteration.

Toyota (the most famous lean practitioner) expresses lean as an integrated system that begins with people at the center of a triangle.

Each tenant is represented by a side; 18

OR TODAY | February 2021

the base is the philosophy (what we believe), with technical tools (what we do) and managerial tools (how we manage) each forming a side.

This all comes together to create the organizational or lean culture. Lean involves elimination of waste, all while respecting people. This is often missed with early implementations.

People often latch onto a few technical tools and it becomes a way to beat up others rather than a tool to provide insight on where improvement can be found. To successfully move to a lean organization is to fundamentally believe that nobody is there to do a bad job. Everyone (as individuals and as a collective group) generally wants to succeed.

Any organization/department will collectively go through the change curve as the tools are implemented and, individually, people will go through that progression as individual jobs/tasks change. The most impactful changes will be accomplished with a succession of minor changes rather than one massive alteration. Here are some key points about lean and how to set realistic expectations: � Angst and setbacks will arise. This is potentially the most important aspect of any change, and not just lean. Things will not always be as planned, regardless of the preparation that went into it. Don’t let that derail the efforts. Identify the setback, make changes and keep moving forward.

� Communication is critical. It would never be advised to just walk into the department one day and declare that you’re ‘going lean.’ It’s important to engage all members of the department and ensure everyone has a role to play and will be heard. Lean philosophy focuses on the people as much as the process. � Don’t try to blindly copy what others have done. Surely, we should all learn from the lean leaders, but those lessons should be used to develop your own system of improvement (not merely try to duplicate what another organization has already done). All organizations and departments are different, so you will have your own starting point, culture and goals to accomplish. � Don’t overthink or over plan. Action, experimentation and learning are as vital as thinking and planning, so don’t be too afraid to get out of the muck and start taking actual steps forward. When we take action, we start to see what works and what doesn’t, and why. That helps us focus on the positives and start seeing progress. � Get employee/team buy in. Communicate why lean initiatives are being considered and what the expected benefits will be and engage the team in the discussion from the onset. All change can lead to stress and questions, but open dialog helps bring everyone in, which helps lead to success.

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� Consider leaning on a different label. “Lean” has some negative connotations (lean living) and it can even come with some negative bias because of previous experiences.

This is why it’s wise to borrow from the lean leaders.

ThedaCare Improvement System, the Virginia Mason Production System, or the Bolton Improving Care System are not successful because of a name. Quite possibly they were able to achieve that success because it wasn’t called lean. Get creative: find a term and system that works for your own department, organization and culture. Doing so will also allow flexibility to introduce components of Six Sigma and other methodologies. � Don’t short-change change management. People do adapt and accept change (and often, even thrive in it) but, again, the key is to engage them in the decisions.

Any system or change that is forced upon the team will quickly backfire. Remember, this is a marathon, not a sprint, and there are no shortcuts to success. When we take time to do things right (another core component of lean), rewards will follow and you’ll be rewarded. � Last but not least, avoid equating (higher) cost with “waste.” Sometimes, high(er) costs are a necessary factor in delivery value and quality service to the health care customer and, most importantly, patients. When we keep value and quality at the forefront, everyone wins.

Nicholas Schmitz, PMP, LSSBB is president of Schmitz Consulting LLC and has served as a contributing columnist for the International Association of Healthcare Central Service Materiel Management (IAHCSMM) since 2015. He holds two master’s degrees in organization development and change management, and project management, and is a certified Project Management Professional and Lean Six Sigma Black Belt.

Julie E. Williamson serves as editor and director of communications for IAHCSMM. WWW.ORTODAY.COM

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SPECIAL ADVERTISING SECTION

INDUSTRY INSIGHTS CCI Avante

3 Questions to Ask Before Purchasing a Refurbished Surgical Table

By Matt Cameron, Biomedical Support Specialist refurbished surgical table is a good investment for almost any medical facility but finding a properly refurbished table from a reputable equipment source can require some extra research and purchasing considerations.

In this article, I’ll discuss the benefits of purchasing a refurbished surgical table and how to choose the right equipment refurbishment partner.

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The most obvious advantage of purchasing a refurbished surgical table is the discounted price. Opting for a refurbished table allows your facility to have a like-new surgical table that is comparable in terms of function and longevity with the proper care and maintenance – at a fraction of the price.

Choosing a less expensive refurbished surgery table over a new model can leave some room in your facility’s budget, allowing you to allocate more money to bigger projects. For example, save on a refurbished surgery table and put the savings toward new imaging equipment or a new procedure suite.

Purchasing a refurbished surgical table similar to the model you are 20

OR TODAY | February 2021

MATT CAMERON

Biomedical Support Specialist already using also eliminates the learning curve that inevitably occurs when there is a change in your facility’s workflow. Instead of training your staff on new, cutting-edge technology, you can stay with a platform you already know.

How to Find the Right Equipment Refurbishment Partner While a refurbished surgery table can offer your facility a variety of benefits, it is important to understand that these advantages only apply to properly refurbished equipment from a reputable company. Not all equipment refurbishment sources are comparable in experience and skill.

Avoiding the pitfalls of paying for an improperly refurbished surgical

table requires some additional research when compared to shopping for a brand-new table. Here are some questions to consider before choosing an equipment partner.

Does the company have the necessary industry experience?

Be sure to find out about the company’s history and current market standing. Ask how long the company has been in business, and how long they have been refurbishing surgical tables.

You should also make sure that the company you choose has access to industry-standard, late model surgical tables. Choosing a table that has been tested and approved by the market is crucial and finding a later model will help to ensure that the table is still supported by the manufacturer.

Does the company follow a set protocol for refurbishing surgical tables?

The company you choose should have a standard refurbishment process that is transparent and addresses all aspects of the table. This process should include evaluation, refurbishment, repairing and testing.

Here is an example of a typical refurbishment process for a surgical table: � Evaluation: When a surgical table arrives at the facility, technicians perform a full evaluation of the table to assess its condition.

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Sign up for the � Biomedical Refurbishment: Technicians replace, adjust and verify the effectiveness of the table’s working parts. � Cosmetic Refurbishment: The table is cleaned and polished, with new patient pads and labels applied. � Testing: The table is thoroughly tested to make sure it meets original equipment manufacturer specifications.

Does the company employ dedicated surgical table technicians?

Another sign that a company will be a good refurbished equipment provider is if they dedicate significant time and effort specifically toward surgical table refurbishment.

Ask whether the company employs technicians with skills directly related to surgical tables, and if they maintain a dedicated area to table refurbishment and testing.

Refurbished surgical tables offer a variety of benefits to medical facilities but finding a reliable equipment partner can take some extra legwork. Be sure to use the above questions to help guide your research for a smoother purchasing process.

Matt Cameron is a Biomedical Support Specialist for the Avante Health Solutions Louisville Center of Excellence. To learn more about Avante’s selection of professionally refurbished surgical tables, visit avantehs.com.

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INDUSTRY INSIGHTS CCI

Perioperative Nursing – The Apprenticeship Model

By James X. Stobinski, Ph.D., RN, CNOR, CSSM (E) ast month, I wrote of perioperative nursing as the first recognized nursing specialty. Isabel Robb in 1907 stated that operating room nursing required extensive training for those wishing to specialize. Beginning with the early hospital-based training methods in the late 1800s the employing facility has played a large role in the education and training of perioperative nurses.

The influence of the employer continues today. It can be argued that the employer has more authority than professional organizations and/or certification bodies regarding entry into practice.

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Logically, it follows that for specialization in nursing practice there should be defined educational criteria for those wishing to practice in that specialty. This is part of the social contract between nursing and those we serve. That is, that perioperative nurses possess competency predicated on specialty-specific education and training. Although perioperative nursing has been a recognized nursing specialty for decades, there is not yet a universally agreed upon educational course for entry to the profession.

In the United States perioperative 22

OR TODAY | February 2021

nurses begin autonomous practice after an extended orientation period which features classroom learning, lab experiences for skills and a lengthy precepted learning experience. This orientation may be guided by supporting materials from an external source or the program may be devised entirely by the employer. Notably, current programs have many of the characteristics of apprenticeship programs which historically were used for skilled trades such as electricians and carpenters.

The Department of Labor defines an apprenticeship as, “ … an industrydriven, high-quality career pathway where employers can develop and prepare their future workforce, and individuals can obtain paid work experience, classroom instruction, and a portable, nationally recognized credential.” Such programs require mentors or preceptors and the awarding of a nationally recognized credential upon completion. This aptly describes the current methods used in perioperative nursing except for one key factor – a nationally recognized credential.

Although the nursing profession has a marked disdain for the terminology, the current processes have many of the elements of an apprenticeship program. Patricia Benner (2013) used a framework she termed the “Three Apprenticeships” to describe how a

nurse assimilates into the profession and a specialty of nursing. Benner and co-authors spoke to the need for intellectual training, a skills-based apprenticeship and socialization to the role, all these elements being necessary to attain competency. Crider and McNiesh (2011) describe the use of this framework in psychiatric nursing, but such usage has not been well documented in perioperative nursing.

The time seems ripe for perioperative nursing as a profession to reexamine the theoretical assumptions underpinning current methods used to bring nurses into the profession and to also evaluate the utility of the programs espoused by the Department of Labor. Benner’s work is not inconsistent with the precepts of the Department of Labor programs. Perioperative nursing is experiencing staffing shortages and the demand for surgery is not declining. Now is the time to strengthen the rigor of perioperative nursing orientation programs and to evaluate best practices in apprenticeship programs which are now used in industries such as advanced manufacturing, information technology and the energy sector.

The Competency and Credentialing Institute (CCI) believes that a high quality, rigorous period of education and training provides an essential foundation for the long-term profesWWW.ORTODAY.COM

we’re on instagram! sional growth of a perioperative nurse.

We also believe that the principles of apprenticeship programs should be evaluated and adapted if suitable for our complex specialty. As a profession we must address the key deficit in our current methods – the lack of a nationally recognized credential. Next month, I will outline the CCI plans for that shortfall.

References Crider, M.C. & McNiesh, S.G. (2011). Integrating a

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professional apprenticeship model with psychiatric clinical simulation. Journal of Psychosocial Nursing and Mental Health Services. 49(5):42-9. doi: 10.3928/02793695-20110329-01. Epub 2011 Apr 13.

Robb, I.H. (1907). Educational Standards for Nurses: With Other Addresses on Nursing Subjects. E. C. Koeckert.

Shulman, L. S., Leonard, V., Benner, P., Sutphen,

James X. Stobinski, PhD, RN, CNOR, CSSM(E), is Chief Executive Officer at Competency & Credentialing Institute (CCI).

M., & Day, L. (2013). Educating nurses: A call for radical transformation. San Francisco, Calif: Jossey-Bass.

U.S. Department of Labor (n.d.) Explore apprenticeship. Accessed November 21, 2020 at: https://www.apprenticeship.gov/employers/ explore-apprenticeship.

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INDUSTRY INSIGHTS TJC

The Joint Commission Prepares for the Future

By James Kendig he next deadly disease

“T that will cause a global

pandemic is coming. We’re not ready. An illness like the pandemic 1918 influenza could kill 30 million people within six months,” Bill Gates said during a presentation in 2015. He added that the next disease might not even be a flu, but something we’ve never seen. “The world should prepare as it does for war,” Gates later said in 2017. We now all know that Bill was right!

The Joint Commission is helping our accredited organizations better prepare for the future based on what the COVID-19 pandemic has taught us.

Recently, The Joint Commission enterprise worked with C+R Research to conduct an assessment among several Joint Commission accredited health care organizations to measure the perceived impact of COVID-19 on their organizations. Interestingly, the data validates some of the information our surveyors reported from the field.

For example, the impact of COVID-19 on accredited organizations is not necessarily tied to an elevated number of cases in one area (being designated as a “hot spot”). Joint Commission surveyors noted this same issue as the research reported 20% of hospitals were experiencing a significant surge whereas 80% did not see a surge of patients. However, it is worth noting that the census recording lower 24

OR TODAY | February 2021

numbers in non-impacted areas were because of decreased non-emergency surgeries and outpatient visits.

The Joint Commission learned that the decrease of elective procedures coupled with the lower census numbers in many cases, which hovered at approximately 43%, had a dramatic impact on the financial status of many health care organizations.

Our research also illustrated Joint Commission-accredited organizations needed an increase in support and resources in the areas of communications and planning. Common needs included communications on regulatory/guideline changes resulting from COVID-19, including those related to 1135 Waivers from the Centers for Medicare & Medicaid Services (CMS).

These waivers have helped ease the burden of timely actions related to inspection, testing and maintenance activities – easing the burden on health care organizations severely impacted

by COVID-19.

Updates to Emergency Management Standards Accredited organizations asked for support around emergency management planning, development and implementation. As a result, a Joint Commission committee and subject matter experts are currently updating standards and elements of performance in the emergency management (EM) chapter for all accreditation programs, including adding a much-

needed glossary. These updates tie into the overall issue that most EM plans are designed for a short-term disaster, which has been a shortcoming during the pandemic. In addition, EM plans are not designed to address an influx of patients presenting challenges in the areas of supply, staffing, finances and morale. We believe our revised standards will focus on these longerterm needs.

Updates to Survey Process Another Joint Commission team is evaluating survey process with the goal to make EM sessions more meaningful for health care organizations, help identify unknown risks and share novel approaches to the pandemic and other EC scenarios.

The Joint Commission’s EM Committee has historically learned from organizations post disaster (e.g., Hurricane Harvey, Super Storm Sandy, the Pulse night-club shooting) and the impact that the standards and elements of performance had on an organization’s ability to “weather” the storm.

Many lessons learned from speaking with organizations post-storm have been incorporated into updated standards and elements of performance as well as into survey process tips.

For example, one lesson learned after the Joplin tornado on May 22, 2011 was that according to postevent reports, patients were able to ambulate but could not self-evacuate because of significant amounts of glass WWW.ORTODAY.COM

INDUSTRY INSIGHTS

TJC news & notes

and metal debris that had collected. As a result, some organizations acquired slippers (one size fits all) to be taped to patients’ feet to assist in evacuation.

Kits compete with emergency slippers are now kept in command centers. Additional learning opportunities will be available by addressing staff psychological support during and after the pandemic. We continue to learn more as we investigate.

COVID-19 Experiences and Challenges For The Joint Commission to understand health care organizations’ experiences and challenges of the impact of COVID-19, our accredited organizations shared via the research, longer-term challenges for which they felt prepared. These challenges included overall preparedness, personal protective equipment (PPE)/supplies/ equipment, revised guidelines/protocols and receiving updated information.

Accredited organizations also expressed challenges related to physical space changes and facilitating remote interactions. HHS ASPR Technical Resources, Assistance Center and Information Exchange (TRACIE askasprtracie@hhs. gov) continues to be a vital partner in sharing information.

Considerations should be given to specific variables while evaluating the impact of the pandemic on health care organizations. These variables include length of the impact (short term to permanent); challenge level of issues addressed (from easy to difficult); and, finally, level of preparation (not prepared for the pandemic to fully prepared).

Impact on Ambulatory Settings For ambulatory settings, some have closed and some, using the CMS 1135 Waivers, have taken the opportunity to increase hospital capacity under WWW.ORTODAY.COM

the CMS program, CMS HOSPITALS WITHOUT WALLS. CMS is allowing health care systems and hospitals to provide services in locations beyond their existing walls to help address the urgent need to expand care capacity and to develop sites dedicated to COVID-19 treatment.

Ambulatory surgery centers can contract with local health care systems to provide hospital services or they can enroll and bill as hospitals during an emergency declaration as long as they are not inconsistent with their state’s Emergency Preparedness or Pandemic Plan. The new flexibilities also leverage these types of sites to decant services typically provided by hospitals such as cancer procedures, trauma surgeries and other essential surgeries.

Ambulatory settings that have been idle will need to develop a plan to address recommissioning their facility with special attention to water systems, power, medical equipment and gases, as well as other aspects of the physical environment that support patient care. A thorough review of these systems is necessary to assure health care organizations continue to operate as designed.

“Overall, the standards have helped our agency prepare for this situation. Our infection control plan, our environment of care processes and our performance improvement program have resulted in systems which were adaptable to the pandemic. The only area in which I wish we had been more prepared was videoconferencing. I wish we had the technology and equipment to implement telehealth services in a much broader spectrum,” one individual said when The Joint Commission’s EM Committee members met with organizations post-

disaster. They also noted that Environment of Care (EC) and EM standards and elements of performance afforded them the opportunity to prepare well.

Virtual Surveys Joint Commission leadership has led the way in a dialogue supporting the value of virtual surveys. When Joint Commission-accredited organizations were asked their survey preferences, interestingly an increase in virtual surveys was noted. Research shows that 38% of respondents preferred a virtual survey during the COVID-19 pandemic; only 18% noted an inperson survey was preferred; and 44% noted a mix of virtual and in-person survey was the more preferred method of surveying. The Joint Commission has a history of virtual surveys that goes back to 2017. Additional virtual surveys are being scheduled for triennial, follow up surveys, and, of course, initial surveys approved to be conducted virtually earlier in the year by CMS. Deemed initial surveys require an in-person survey once counties meet our on-site survey criteria.

Moving ahead, we expect to see many health care organizations updating and addressing the pandemic in their future requirements and guidance, including the National Fire Protection Association (NFPA), the Facility Guidelines Institute (FGI), Centers for Disease Control and Prevention (CDC) and others. COVID-19 is part of our history and is inevitability shaping our future.

James Kendig is the field director for the life safety code surveyors/engineers at The Joint Commission. In this role, he oversees half of the surveyors who specialize in surveying the Joint Commission’s life safety, environment of care and emergency management standards.

February 2021 | OR TODAY

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INDUSTRY INSIGHTS AAMI

AAMI Explores Sterilization in Dentistry with New Standards Initiative AMI is exploring a new direction for AAMI guidance and standardization – a joint effort with the American Dental Association (ADA) aimed at developing a steam sterilization standard for dental facilities.

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Amanda Benedict, vice president of standards at AAMI, is working with leadership from the ADA to create a new AAMI Sterilization working group focused on creating a steam sterilization and sterility assurance standard specifically for dental practices.

“There are more than 80,000 dental facilities across the country, and many of them are relatively small,” she explained. “These facilities’ sterile processing operations are on a much different scale than those of sterile processing departments within a hospital, for example, and there is a need to provide these facilities with comprehensive recommendations for steam sterilization and sterility assurance that are applicable to the dental facility sterile processing environment.”

The anticipated sterilization standard will draw from the recommendations in ANSI/AAMI ST79, Comprehensive guide to steam sterilization and sterility assurance in health care facilities, the preeminent American National Standard for steam sterilization in a health care facility.

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OR TODAY | February 2021

The aim, said Benedict, is to “work with a committee of subject-matter experts, including representatives from dentistry, industry and regulatory agencies such as the U.S. Food and Drug Administration (FDA), to distill the content to what is relevant to dental facilities and include additional specific applicable guidance.”

The AAMI Sterilization working group for the joint AAMI/ADA standard will be starting soon.

“The best time for stakeholders to join these efforts and add their perspectives and expertise to shaping the standards is at the beginning of the work,” said Benedict.

There is no deadline for committee applications, and they will be accepted on a rolling basis. Interested

parties, including representatives of clinical practices, academia, regulatory authorities and industry can email standards@aami.org to get involved.

ST79 Amendments Coming Soon The fundamental steam sterilization standard, ANSI/AAMI ST79, is getting four amendments! Visit www.aami. org/ST79 for instructions on how you can get them.

Call for Papers!

Share your knowledge and make a difference in your field by submitting a paper to AAMI’s peer-reviewed journal, BI&T. Please submit a brief description of your article idea by contacting Editor-in-Chief Gavin Stern at gstern@aami.org.

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IN THE OR

market analysis

Reports Predict Endoscope Market Growth Staff report he global endoscopes market size was valued at $10.4 billion in 2019 and is expected to grow at a compound annual growth rate (CAGR) of 8.8% from 2020 to 2027, according to a Grand View Research report.

T

An increasing geriatric population, growing awareness of the benefits of minimally invasive surgeries over open invasive surgeries, rising prevalence of chronic diseases such as heart diseases, cancer and diabetes continue to drive the market. Various technological advancements are also among key trends boosting the demand for endoscopes globally, according to the report.

“Minimally invasive surgeries are driving the use of various endoscopic procedures for diagnosis such as proctoscopy, gastroscopy and cystoscopy. These surgeries require smaller incisions and hence offer advantages such as lesser pain, low or no risk of complications and quicker recovery when compared to open surgery,” according to Grand View Research.

“Minimally invasive surgeries are also cost-effective and result in improved quality of life. The shift in trend from 28

OR TODAY | February 2021

open surgery to minimally invasive procedures is expected to drive the demand for endoscopes.”

The increasing prevalence of cancer is listed as another key factor contributing to the growth of the market.

The growing prevalence of cancer is expected to drive the demand for biopsies in cancer diagnosis. Endoscopy for biopsies and endoscopic ultrasound are the most preferred procedures for cancer diagnosis. According to the World Health Organization (WHO), cancer is the second leading cause of death worldwide, accounting for an estimated 9.6 million deaths in 2018, which is estimated to increase to 22.0 million by 2034.

Emergence of endoscopic bariatric surgeries, namely, endoscopic sleeve gastroplasty is also expected to drive the market growth, Grand View Research states. This procedure uses sutures for restructuring the stomach and helps reduce the stomach size by 70%. Although weight loss due to endoscopic bariatric surgery is not as effective as a surgical bariatric procedure, the former results in better health outcomes. Thus, the rise in demand for bariatric procedures is further expected to drive the demand for endoscopes.

“Owing to the effects of aging and the adoption of unhealthy lifestyles, disease burden is highest in geriatric patients. Furthermore, the geriatric population accounts for the maximum cases of cancer and chronic cardiovascular, respiratory, spinal and neurological diseases,” the report adds.

“The economic impact of the geriatric population is much higher in developed nations as compared to emerging nations. The growing geriatric population is expected to boost the demand for various endoscopic procedures such as stomach, esophagus, cervical, orthopedic, and pulmonary endoscopy, subsequently driving the demand for endoscopes.”

Technavio has been monitoring the flexible endoscopes market and reports that it is poised to grow by $1.75 billion from 2020 to 2024, progressing at a CAGR of over 6% during the forecast period.

Technavio says that the value of the market was $5.10 billion in 2019 and it is projected to reach $6.85 billion by 2024. The global technology research and advisory company states that the rising popularity of minimally invasive procedures is one of the key factors driving the market growth.

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IN THE OR

Ambu

product focus

aScope Ambu has led the way in singleuse endoscopy since it launched the world’s first single-use flexible endoscope in 2009. The fourth-generation Ambu aScope improves patient care, optimizes workflow and reduces health care costs. In a world more attuned to infection prevention than ever before, the endoscopes provide protection against patient crosscontamination. Ambu’s flexible bronchoscopes, rhinolaryngoscopes and cystoscopes pair with the Ambu aView 2 Advance monitor for high-quality imaging on a 12.8-inch touchscreen. Safe, sterile endoscopes – ready when needed. •

Boston Scientific

EXALT Model D Single-Use Duodenoscope The EXALT Model D Single-Use Duodenoscope is the world’s first commercially available singleuse duodenoscope. The duodenoscope has been developed as an alternative to reusable duodenoscopes and to deliver a familiar design in a single-use platform. A single-use scope eliminates the need for reprocessing and repairs and allows physicians to use a new, sterile device for every procedure. The EXALT Model D Single-Use Duodenoscope was granted Breakthrough Device Designation from the FDA. This program was implemented to expedite the development and review process for medical devices that are novel or offer new technology for patients with life-threatening or irreversibly debilitating conditions. •

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February 2021 | OR TODAY

29

IN THE OR

product focus

FUJIFILM Medical Systems USA Inc. ELUXEO Surgical System

The innovative ELUXEO Surgical System

by FUJIFILM Medical Systems USA Inc., is a first-of-its-kind equipment tower comprised of products from the company’s endoscopy and minimally invasive surgery portfolios. The system leverages the company’s endoscopic image processing technology to deliver surgeons unparalleled visualization while performing flexible and rigid endoscopy from a single tower.

The ELUXEO Surgical System is engineered to assist clinicians during a wide range of procedures, and is particularly effective for procedures that require both flexible and rigid endoscopes including pre- and post-operative EGD, colonoscopy, bariatric procedures, thoracic and interventional pulmonology surgeries, among others. There is a strong industry need for this resource to save capital costs, maximize space and improve ease of mobility in the OR. •

Healthmark

EndoPro-Cam Designed for evaluating the condition of rigid endoscopes, the EndoPro-Cam is a portable endoscopic video system providing 1080p high-resolution HD imagining that assists health care workers with inspection of their facilities’ rigid scope to check if their device is damaged.

Manufactured for visual inspection of rigid scopes after cleaning and prior to further processing, the lightweight ergonomic EndoPro-Cam allows for image capture, recording and adapts to any C-Mount coupler. Featuring a 4.3 Inch LCD monitor, the EndoPro-Cam is equipped with a Micro SD card slot, Micro USB port and Mini HDMI port. •

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product focus

KARL STORZ

Rubina NIR/ICG Telescopes The new Rubina endoscopy system from KARL STORZ combines vivid 4K resolution with multimode fluorescence-guided imaging. Specialized dual-chip technology lets the surgeon toggle seamlessly between white light and near infrared with remarkable edge-to-edge clarity. The monochromatic mode can be helpful in perfusion assessment. The overlay mode, which superimposes the fluorescent image over the white-light image, accentuates structures that might be hard to discern with the naked eye. The intensity map shows the relative response of the fluorescent dye, providing clues about subsurface features.

Rubina is the latest addition to the modular IMAGE1 S system. •

OLYMPUS

TJF-Q19V Duodenoscope The TJF-Q190V is the newest Olympus duodenoscope with features that meet FDA recommendations for the use of disposable components to help facilitate and ease reprocessing.

In addition to a removable distal cap, the TJFQ190V comes packaged with the MAJ-2319 flushing adapter, which refines flushing steps by ensuring controlled and repeatable distribution of detergent and disinfectant solution to the distal tip of the endoscope during manual reprocessing. Clinical advances include an expanded vertical field of view that is 20% greater than the previous generation duodenoscope and high force transmission technology for improved maneuverability. •

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Surviving and Conflict

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Thriving With on the Job

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continuing education

By Debra Anscombe Wood, BS, RN

Is W hat Conflict?

Conflict is a disagreement between two or more people who differ in attitudes, beliefs, values, feelings, or needs.

It’s a part of every work environment, including healthcare organizations.

The ingredients of conflict include:1 • Needs: The things that are essential to someone’s or an organization’s well-being; therefore, conflict can arise when needs are not met. Not to be confused with desires (what we would like), needs are vital elements.

• Perceptions: The interpretation of a situation, which people tend to view differently. Misperceptions can cause a breakdown in communication, leading to conflict.

• Power: The use and definition of power can influence conflict. Conflict may arise when one person seeks to influence or exert power over another.

• Values: Values are beliefs that a person deems important. Serious conflict can occur when people have incompatible values.

• Feelings and emotions: People often let emotions dictate how they react in certain circumstances.

Conflict can arise when people let their feelings lead the way, or if another person’s feelings are ignored or devalued. It’s important to separate emotions from the issue.

In the past, conflict in the workplace was regarded as dysfunctional, representing a breakdown in communication that would either go away by itself or be resolved with someone winning and someone losing.2 Today, conflict is no longer considered harmful or inherently bad. Instead, it’s expected in a dynamic organizational environment. Many experts view conflict as a normal aspect of interWWW.ORTODAY.COM

Relias LLC guarantees this educational program free from bias. The planners and authors have declared no relevant conflicts of interest that relate to this educational activity.

See Page 38 to learn how to earn CE credit for this module.

Goal and Objectives The goal of this continuing education program is to enhance nurses’, medical assistants’, laboratory professionals’, and respiratory therapists’ ability to effectively deal with conflict on the job. After studying the information presented here, you will be able to: • Identify various types of conflict.

• Analyze the dynamics of conflict in the workplace.

• Apply conflict resolution strategies to specific situations.

personal relations in organizations and believe that when handled correctly, it can be managed and resolved to achieve beneficial outcomes. In fact, such friction can be a motivator for change and growth, a medium for airing problems, and a dynamic force for preventing stagnation. When managed from a positive perspective, conflict and the resulting resolutions can hold an organization together.2 It would be naive to assume everybody comes to the table wielding an equal balance of power. Differences in the parties’ power can affect the decision to address the conflict.3 Because sources of conflict are so diverse and their consequences so important to patient care, all healthcare professionals need to communicate and to be adept at recognizing different types of conflict and employing appropriate strategies to resolve them.3 February 2021 | OR TODAY

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Levels of Conflict Healthcare professionals can encounter four levels of organizational conflict: intrapersonal, interpersonal, intragroup, and intergroup.4 A healthcare professional can experience intrapersonal conflict when confronted with two or more incompatible demands.

Examples of job-related struggles include ethical dilemmas, role conflict, work overload, and uncertainty about job expectations. Intrapersonal conflict can also be related to organizational structure, supervisory style, and the position that the professional occupies within the organization.2 Interpersonal conflict occurs between two or more people when one person perceives or values a situation differently from the other.2 It is common in healthcare settings. This type of conflict can happen when there is a clash between core work values, such as determining how a job should be done, or setting different priorities or expectations because of age, experience, sex, race, and other personal attributes.

Intragroup conflict is between members of a group who are arguing about responsibilities.4 Intergroup conflict occurs between two or more groups and may result from competition between departments within a single healthcare facility or from rivalry among several organizations.

Most organizational conflict in healthcare organizations emerges at the interpersonal and intergroup levels. Major sources include:4 • Individual differences about values and opinions • Professional differences • Organizational structure; changes due to restructuring • Interpersonal differences in perception • Generational or cultural differences Additionally, in today’s healthcare environment, change — new policies and procedures, employee layoffs, and 34

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rapid growth — or even the threat of change, can contribute to conflict.

Primary Types of Conflict: What Are the Differences?

In the workplace (or other settings), you are likely to find two types of conflict — substantive and personalized.5 Substantive conflict occurs when two people disagree about a certain issue, such as a policy or how to perform a procedure. With substantive conflict, both parties work toward a win-win outcome that usually provides an innovative resolution to the conflict.

This is normally a positive conflict experience; each party walks away feeling that the outcome was worth the struggle involved in resolution.

This type of conflict can be productive, and often leads to richer, more fulfilling working relationships where people feel confident to share honest opinions and work through the details.

Substantive conflict may also stimulate new thoughts and ideas and can create an exciting work environment.

Keep in mind that emotions may be involved, but they are usually related to the specific issue and not to the people involved.

Ambiguous policies or those policies that are not consistently enforced can lead to conflict, which can result in people not understanding what is expected of them or what the results might be. Assumptions can be incorrect and lead to conflict.

Another type of conflict, one many people are all too familiar with, is known as personalized conflict. This type of conflict frequently occurs when people don’t like each other, they have no desire to work through an issue, and they elect to use almost any situation to make the other person look bad in front of others.5 Frequently, this type of conflict involves others in the form of “taking sides,” and a great deal of energy and emotion are spent on dealing with the repercus-

sions this type of conflict generates.

In personalized conflict, emotions run high and mainly involve anger and frustration. Neither party wishes to seek resolution, and the original issue (if there truly was one) is often lost in the heated exchange. New issues are generated to escalate the conflict, and normal problem-solving techniques fail because neither person is willing to address or resolve the issue.

Personalized conflict seldom has a positive ending, and usually worsens over time.5 It’s commonly known, or referred to, as a “personality conflict” between two people.

Moving Toward Resolution …

No matter what type of conflict you are involved in or are trying to mediate, it’s important to focus on the issues at hand; it’s critical to separate the problem from the person. Making an issue personal will only extend the conflict and prevent clear thought toward resolution.5 Whenever possible, sort through information based on the evidence.

This takes the emotional aspect out of the issue, keeping it reality-based.

Seek out creative resolutions, and engage in discussion with all involved parties so people feel they are a part of the process and have a stake in the outcome. Keep in mind that conflict resolution is a negotiation; therefore, it’s an ongoing process. Approach conflict resolution with positive energy, a good attitude, and a goal, to reach the best solution.

Common Approaches to Conflict Resolution Five common approaches to conflict resolution have been identified:6 Confront: This style approaches the conflict head-on and may invoke high emotional levels. It can be construed as not being considerate of the other person’s viewpoint. Emotions typically run high during confrontations. It is WWW.ORTODAY.COM

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often used when each side’s goals are unclear, relationships are weak, little concern exists about formalities, or there is fear of punishment. There may be a moderate concern for tradition and self-concept.6 Compromise: This approach involves negotiation, tradeoffs, and swapping. Each person gets something, but gives up something else in the process, creating a win-lose/win-lose situation for the two sides. Everyone must cooperate when negotiating, must communicate, and there must be a balance of power.7 Compromise might be appropriate when the conflicting goals do not reach a high level of importance, and it is not worth a major argument. Time pressures might also lead to compromise. Additionally, if the two sides are powerful and strongly committed to mutually exclusive goals, a compromise might be the way to let everyone win something and give up something.4 Each party achieves a partial win.

Collaborate: Collaboration occurs when each party meets the problem head on with equal concern for both the issues and maintaining a working relationship. This approach allows everyone to win by identifying areas of agreement and differences, evaluating alternatives, and selecting solutions that have the full support and commitment of both parties. It requires emotional intelligence and high selfconcept. Collaboration is ideal when the issue is significant to the organization’s goals, to patient care, or to work relationships. Creative solutions can satisfy both sides of the disagreement. Through collaboration, the parties may be able to merge different viewpoints into something they all agree on.4 Collaboration is more timeconsuming than other approaches but that can lead to a long-term resolution.

Accommodate: Accommodation occurs when one person or group is willing to yield to the other. This conWWW.ORTODAY.COM

Steps to Mediate and Resolve a Work Conflict7,9,10 Supervisors and managers who need to mediate conflicts at work must remember to stay calm; intervene quickly, fairly, and appropriately to stop negative conflict; and remain positive about the ultimate resolution. A few steps to successful mediation of a conflict are outlined below.

Meet with both parties together and follow a few ground rules, such as: • Keep both parties focused on the issue at hand — don’t bring up past issues • Do not lose your cool • Encourage each person not to personalize the conflict • Use “I” statements, without adding expectations. There should be a clear statement about how the speaker views the conflict • Allow only one person to talk at a time • Encourage each party to participate in active listening • Remain flexible • Encourage both people to agree to seek a positive outcome • Allow each person to concisely identify the issue and exactly what the conflict is about — as each party perceives it • As the supervisor, make sure to have the facts straight, but allow time for each person to share details as he or she perceives them, and to indicate what resolution is sought • As the supervisor, let both parties know that you won’t choose sides, but the expectation is for both parties to resolve the conflict as proactive adults • Let both parties know that you believe they will resolve the conflict in a positive, professional manner • Commit to making changes • Once a solution has been achieved, write it down and review it • Thank everyone for participating • Set a future date for review of the resolution and for further problem solving as needed Creating a work environment where people know they can trust their leader to fairly and quickly manage a conflict requires a calm, reasonable approach. The supervisor should not solve the conflict but rather should mediate it. Following these steps and letting each person know his or her voice will be heard can lead to successful conflict management, and to a more autonomous, productive staff.

ciliation, or giving in, involves listening and accepting without resistance.

Accommodation may be appropriate when one person admits to making a mistake; the outcome is more important to others than to you; other people’s ideas seem better; and by accommodating now, you may be in a better position to deal with issues in the future.7 Avoidance: Avoidance is one of the most commonly used conflict-management strategies when one side is unco-

operative, denies that a problem exists, or withdraws from the situation, so that there’s no active resolution of the conflict. Personal needs are ignored, as is any potential contribution to the working relationship with the other person. Avoidance can also increase stress among healthcare providers. This may happen when a less powerful person involved in a conflict responds with accommodation and avoidance to bypass possible retaliation, even at the risk of sacrificing his or her interests February 2021 | OR TODAY

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or the interests of others. Avoidance is a negative conflict-management style, which leads to a lack of communication and can result in increased work stress levels.8 However, avoidance can have a place in conflict resolution; for instance, when a problem needs reflection or time for people to calm down, when additional information is needed, or if there is a desire to avoid no-win situations.7

How Healthcare Professionals Process Conflict Those who experience on-the-job conflict often go through a series of identifiable stages: 1. Disbelief is often the first emotional reaction, particularly when others are disagreeing with personal values.

2. Disconnectedness often follows the initial sense of shock, making the individual feel confused on how best to cope with the conflict.

3. Obsession with the conflict can develop. The individual may spend much of the day thinking about the problem and how to deal with it.

4. Self-evaluation begins. This is a crucial turning point when the individual either begins to recover a sense of balance or experiences symptoms of burnout — withdrawal, apathy, and depression.

If the conflict has been intense, the individual may have to fight a tendency to internalize negative attitudes about him or herself.

5. Purposeful alienation — emotional space between the individual and colleagues — may cause the individual to take time off or seek to avoid confrontation.

6. Once the conflict is resolved, and if it’s processed positively, the individual may gain insight into personal shortcomings and gain experience for managing future conflict.

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Fitting the Strategy to the Situation The ability to manage conflict is a critical organizational skill that healthcare professionals of all disciplines can use to be more productive.

Whenever conflict develops, whether with a leader, subordinate, or peer, the person needs to choose a strategy that fits the situation. Unfortunately, many healthcare professionals often select an approach that’s more comfortable than effective. Of the five common approaches to conflict resolution, research indicates that we all tend to prefer the more comfortable and often less effective choices of avoidance and compromise. Rather than trying to confront the conflict or deal with it in a way that is most comfortable, healthcare professionals need to use whatever strategy is necessary to effectively and positively achieve beneficial outcomes for all involved.7 Although conflict in organizations is inevitable, it’s generally resolvable.

The important issue is not to engage in futile attempts to avoid conflict, but to seek resolution through actively applying the appropriate strategy — confrontation, compromise, collaboration, accommodation, or avoidance. Each method of conflict resolution can be appropriate according to the situation.

Successful Resolution Whatever strategy is used, successful conflict resolution starts by identifying the problem and the desired behavior or outcome, then confronting the conflict. Timing and location can be crucial. People shouldn’t attempt to resolve a problem when emotions are out of control. In most cases, a private setting is best for conflict discussion.

Active listening is critical to avoiding conflict and to achieving successful conflict resolution.11 This requires focusing on the speaker, making eye contact, avoiding distractions, and concentrating. The listener should not

judge the speaker nor become emotional; just stick to the facts. Active listening requires practice.11 The temptation to listen passively, while mentally constructing what to say next, is a huge misstep toward a positive resolution. Instead, it is important to actively listen to the other person and hear his or her words, striving first to understand and focus entirely on what he or she is saying.12 Consistent verbal and nonverbal messages must be established with a self-confident tone and manner.

Healthcare professionals can establish credibility by being fair and consistent in interpersonal relations.

Healthcare professionals need to avoid responding automatically or reactively to others during a confrontation. People tend to react in a style they have used in the past. They often will deploy those strategies automatically without thinking about it. These learned behaviors can be replaced with new strategies if they are unproductive.11 Self-examination is one way to gain insight into your own customary methods of conflict resolution and to recognize “hot buttons” that are likely to trigger inappropriate responses.

As professionals, healthcare workers usually should seek to resolve conflict through collaboration with other professionals. The procedure for winwin conflict resolution consists of the following steps:13 1. Identify the root problem and “clarify issues surrounding values, purposes, and goals.”

2. “Encourage a free exchange of ideas, feelings, and attitudes to cultivate an atmosphere of trust.”

Focus on the problem, not the personalities.

3. “Search for alternative ways to resolve the problem.”

4. Seek evidence-based resolutions to problems whenever possible.

5. “Ask for help from outside sources as needed. “ WWW.ORTODAY.COM

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6. “Set up a process for evaluating possible solutions.”

7. Keep interacting until all parties agree to a solution.

A collaborative approach requires willing participation from both parties, an atmosphere of acceptance, and open and honest communication.

Encourage full expression of positive and negative feelings. Healthcare professionals can improve their ability to communicate clearly and appropriately and flex their negotiation muscles in instances of workplace conflict by practicing in their personal lives. On a personal level, increasing the awareness of the manageability of conflict will help all professionals in improving and strengthening relationships with friends, family, and coworkers.

Research into patient safety and patient care indicates positive working relationships within healthcare teams produce a significant effect on the safety and efficacy of the care provided to patients. Communication, collaboration, and respect among healthcare team members are vital components that contribute to a professional’s ability to provide safe, quality care to patients.14 Healthcare professionals can anticipate that conflict will characterize their practice in every work setting. Knowing how to choose and apply appropriate strategies allows healthcare professionals to successfully manage and resolve conflict. Appropriate conflict resolution should be seen as positive and can facilitate professional development, increase collaboration among colleagues, support organizational goals, and enhance the overall care provided to patients and families.

Fight Fair: 12 Questions to Ask Yourself The Conflict Resolution Network created these questions to help create genuine collaboration and help resolve conflict.10 You may work on these questions alone or in a group. Writing the answers often helps with the exercise.

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Technology Affects the Art of Communication15 Technology such as e-mail, cell phones, social media, texting, instant messaging, and video calling/conferencing has forever altered the way people communicate. In many ways, technology has greatly enhanced communication; however, there are negatives to using technology that can lead to conflict, miscommunication, and unprofessional behavior. Technology in healthcare is definitely an important factor in providing seamless, excellent patient care.

But providers should not lose the personal touch of speaking directly with patients and coworkers and using all the skills involved in effective interpersonal communication and conflict resolution.

• Communication moves quickly. Texting, e-mails, and other forms of rapid communication can pick up the pace of workflow and be extremely useful • E-mails can be misinterpreted. Be thoughtful when sending a quick message or reply — it’s almost instantly received and can’t be retrieved — so make sure not to hit the send-before-you-think button and deliver a message you might regret, which can lead to conflict, hurt feelings, and misunderstanding. If not sure how it might be received, ask a colleague to read it over • Be respectful and set a positive tone • Be clear about what sort of response to the electronic communication is required, such as feedback or a final decision • Respond to text or e-mail promptly, even if just to say you will answer more fully later • The personal touch is often lost. In schools and workplaces, technology is replacing face-to-face communication skills. This can be a disadvantage for new healthcare professionals who fail to develop the soft skills of social interaction with patients and healthcare team members. An e-mail or text is usually not the best means to attempt conflict resolution

1. “Do I want to resolve the problem?

Be willing to fix the problem.”

2. “Can I see the whole picture not just my own point of view?

Broaden your outlook.”

3. “What are the needs and anxieties of everyone involved? Write them down.”

4. “How can we make this fair?

Negotiate.”

5. “What are the possibilities? Think of as many as you can. Pick the one that gives everyone more of what they want.”

6. “Can we work it out together?

Treat each other as equals.”

7. “What am I feeling?” Am I personalizing this issue and becoming too emotional? Could I get more facts?

Take time to calm down. Tell the participants how I feel about the issue.

8. “What do I want to change? Be clear. Attack the problem, not the person.”

9. “What opportunity can this bring?

Work on the positives, not the negatives.”

10. “What is it like to be in their shoes? Do they know I understand them?”

11. “Do we need a neutral third person? Could this help us to understand each other and create our own solutions?”

12. “How can we both win? Work toward solutions where everyone’s needs are respected.”

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Resources for Learning More about Conflict Resolution Patterson K, Grenny J, McMillan R, Switzler A. Crucial Conversations: Tools for Talking When the Stakes are High. New York, NY: McGraw-Hill; 2002.

TeamSTEPPS. Agency for Healthcare Research and Quality Web site. https://www.ahrq.gov/teamstepps/index.html. Accessed June 28, 2019.

resolution. The Balance Web site. https://www. thebalance.com/workplace-conflict-resolution-1918675. Updated September 26, 2018 Accessed June 28, 2019.

10. Resolve the conflict guide. Conflict Resolution Network Web site. http://www.crnhq.org/ content.aspx?file=66138|37382l. Accessed June 28, 2019.

EDITOR’S NOTE: Valerie Restifo, MA, MS, RN; Marilynn Jackson, PhD, RN; and Margi J. Schultz, PhD, MSN, RN, CNE; past authors of this educational activity, have not had the opportunity to influence this version.

people. Clin Colon Rectal Surg. 2013;26(4):259-

Relias LLC guarantees the content of this educational activity is free from bias.

5. Conflict & cooperation in the workplace — is

resolution. Susan Ingram Mediation and

conflict bad? Work911.com Web site. http://

Coaching Web site. http://www.susan-ingram.

www.work911.com/conflict/carticles/conflict.

com/2013/05/active-listening-a-key-to-conflict-

htm. Accessed June 28, 2019.

resolution. Published May 28, 2013. Accessed

264. doi: 10.1055/s-0033-1356728.

11. Malone L. Dealing with conflict. In: Stanley D, ed. Clinical Leadership in Nursing and Health-

4. Power and conflict. In: Huber D. Leadership

care: Values into Action. 2nd ed. Hoboken, NJ:

and Nursing Care Management. 5th ed. St.

John Wiley & Sons, Ltd.; 2017:215-232.

Louis, MO: Elsevier Saunders; 2015:159-185.

12. Ingram S. Active listening: a key to conflict

Debra Anscombe Wood, BS, RN, a health writer and editor, practices in ambulatory care in Orlando, Fla.

June 28, 2019.

6. Gatlin J, Wysocki A, Kepner K, Farnsworth D, Clark JL. Managing conflict in the workplace.

13. Registered Nurses’ Association of Ontario.

University of Florida Web site. http://edis.ifas.

Developing and Sustaining Nursing Leadership.

ufl.edu/pdffiles/HR/HR02500.pdf. Updated

2nd ed. Toronto, ON: Registered Nurses’ As-

October 2015. Accessed June 28, 2019.

sociation of Ontario;2013.

Information Center (CTIC). Utah State Univer-

7. Folse VN. Conflict: the cutting edge of

14. Ladden MD, Hassmiller SB, eds. Ten years

sity University Libraries Web site. http://digital.

change. In: Yoder-Wise PS, ed. Leading and

after keeping patients safe: have nurses’ work

lib.usu.edu/cdm/ref/collection/Bear/id/37395.

Managing in Nursing. 6th ed. St. Louis, MO:

environments been transformed? Robert Wood

Published 1992. Accessed June 28, 2019.

Elsevier Mosby; 2015:431-449.

Johnson Foundation Web site. https://www.rwjf.

2. Effective conflict resolution and negotiation.

8. Johansen ML, Cadmus E. Conflict manage-

after-keeping-patients-safe.html. Published

In: Marquis BL, Huston CJ. Leadership Roles and

ment style, supportive work environments and

March 3, 2014. Accessed June 28, 2019.

Management Functions in Nursing: Theory and

the experience of work stress in emergency

Application. 8th ed. Philadelphia, PA: Wolters

nurses. J Nurs Manag. 2016;24(2):211-218. doi:

15. Ferrazzi K. How to avoid virtual miscom-

Kluwer; 2015:487-506.

10.1111/jonm.12302.

munication. Harvard Business Review Web site.

3. Overton AR, Lowry AC. Conflict manage-

9. Heathfield SM. Workplace conflict resolution:

miscommun. Published April 12, 2013. Accessed

ment: difficult conversations with difficult

avoid these actions to create effective conflict

June 28, 2019.

References 1. Hoban TJ. Managing conflict: a guide for watershed partnerships. Conservation Technology

org/en/library/research/2014/03/cnf-ten-years-

https://hbr.org/2013/04/how-to-avoid-virtual-

Clinical Vignette Ted Jones, an experienced medical assistant, is often assigned to the same team as Mary Smith, a new graduate medical assistant. The rumor on the unit is that Ted freely discusses Mary’s lack of skill and the unsatisfactory care she provides when she is on the care team. Mary has heard about Ted’s feedback from her peers but has avoided discussing the issue with him. Mary is puzzled and is beginning to doubt herself and the care she provides. Although Mary’s patients praise her for the caring, professional attitude she maintains, and her care team providers offer the same praise, she decides to ask several colleagues why Ted is so negative toward her. She is also considering asking the team leader to assign her to another care team, so she does not have to interact with Ted at all.

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After self-reflection and using the 12 questions regarding conflict resolution, Mary decides to meet with Ted to discuss the issues between them. Mary explains that she wants to understand his point of view so they can resolve any conflict.

Furthermore, she expresses her desire to work collaboratively so the patients receive the best care possible. After discussing several issues and future expectations, a mutual understanding was achieved, and both medical assistants agreed to meet periodically to continue the open dialogue.

1. What type of conflict are Mary and Ted predominantly experiencing? a. Intrapersonal c. Intergroup b. Interpersonal d. Organizational 2. What stages did Mary go through to process the conflict? a. Anger, disbelief, selfc. D isbelief, considering evaluation, obsession avoidance, self-evaluation b. C ompromise, selfd. Avoidance, compromise, evaluation, anger, alienation anger, self-evaluation 3. Mary elected the collaborative approach to conflict resolution based on the knowledge that: a. Appropriate resolution c. P atients receive more can enhance professional cohesive care when development colleagues work as a team b. C onflict resolution can d. All the above increase collaboration among colleagues 4. It is important for healthcare professionals to understand the ingredients of conflict, which include: a. P ower, compromise, c. N eeds, perceptions, power, perceptions, avoidance, and values, and avoidance feelings and emotions d. Active listening, perceptions, b. N eeds, perceptions, power, power, values, and avoidance values, and feelings and emotions

Clinical VignettE ANSWERS 1. Answer: B. Mary and Ted are experiencing interpersonal conflict, as this conflict type occurs most frequently between two people.

This kind of conflict can happen when there is a clash between core work values, such as determining how a job should be done, or when co-workers have different priorities or expectations because of age, experience, gender, race, and other personal attributes. 2. Answer: C. Mary initially experienced disbelief and disconnectedness, not understanding what the issues were and feeling blindsided by the negativity. Mary then asked others what they knew, leading to a desire to avoid the issue, and finally, after self-evaluation, decided to openly discuss the conflict with Ted. 3. Answer: D. All the above answers are correct related to successful conflict resolution. In addition to these benefits, appropriate conflict resolution also supports organizational goals and assists with fulfillment of the mission and vision of the organization. 4. Answer: B. Conflict is a disagreement between 2 or more people who differ in attitudes, beliefs, values, feelings, or needs.

Conflict is a part of every work environment, including healthcare organizations.

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CE112-60

How to Earn Continuing Education Credit 1. Read the Continuing Education article.

2. Go online to ce.nurse.com to take the test for $12.

If you are an Unlimited CE subscriber, you can take this test at no additional charge. You can sign up for an Unlimited CE membership at https://www.nurse.com/ sign-up for $49.95 per year.

Deadline Courses must be completed by 7/29/2022 3. If the course you have chosen to take includes a clinical vignette, you will be asked to review the vignette and answer 3 or 4 questions. You must answer all questions correctly to proceed. If you answer a question incorrectly, we will provide a clue to the correct answer.

4. Once you successfully complete the short test associated with the clinical vignette (if there is one), proceed to the course posttest. To earn contact hours, you must achieve a score of 75%. You may retake the test as many times as necessary to pass the test.

5. All users must complete the evaluation process to complete course. You will be able to view a certificate on screen and print or save it for your records.

Accredited In support of improving patient care, OnCourse Learning (a Relias LLC company) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

OnCourse Learning is also an approved provider by the Florida Board of Nursing, the District of Columbia Board of Nursing, and the South Carolina Board of Nursing (provider #50-1489). OnCourse Learning’s continuing education courses are accepted by the Georgia Board of Nursing. Relias LLC is approved by the California Board of Registered Nursing, provider # CEP13791.

ONLINE

Questions

Nurse.com You can take this test online or select from the list of courses available.

Prices subject to change.

Questions or for a complete listing of our courses Phone: 877-843-8374 Email: nursesupport@relias.com

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company showcase Collaborative Medical Solutions

collaborative medical solutions Upgrade | Buy | Sell | Repair

C

ollaborative Medical Solutions Inc. is founded on nearly 20 years of experience helping domestic and international clients manage their previously owned medical imaging equipment.

It has been successful in helping clients capture the best value for their used equipment and creating an easy path to upgrade technology.

“Over those years we’ve built a reputation for an excellent customer experience that prioritizes relationships and true solutions,” Collaborative Medical Solutions Inc. Principal Trey McIntyre said. “Now we’ve taken the same principles into endoscopy equipment sales, purchasing and repairs.”

The company’s facility in South Carolina has storage for Olympus, Fuji and Pentax processors and scopes inventory. It also has a QA/QC testing area where everything is verified before shipment, as well as refurbishment capability.

“In our experience, having ready-to-

40 OR TODAY | February 2021

ship inventory is critical to our clients,” he added.

McIntyre shared more about Collaborative Medical Solutions in a recent interview.

He explained that the company provides many advantages that set it apart from the competition.

“We don’t stop short at a ‘buy-sell’ model. It’s a consultative approach, and we look at every client’s needs differently, understanding their unique challenges and finding creative solutions to improve and better manage their endoscopy suite,” he said. “We pride ourselves on making the process

easy, providing great value and being well funded to create fast and easy transactions.”

Collaborative Medical Solutions’ core competencies and unique selling points include unique partnerships that help the company excel.

“In the endoscopy space, we’ve partnered with great people that give us decades of experience and who share the same values. Our focus is on the best brands and equipment, including Olympus, Fuji and Pentax.

This previously owned technology has a lot of value as part of an overall plan to manage and upgrade endoscopy scopes and equipment,” McIntyre said.

“We’re able to show how older or unused equipment can contribute to that larger strategy – there can be value where clients don’t expect it, and that’s why our purchasing programs have been so successful.”

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“Our unique approach is comprehensive and brings together quality equipment with creative financial solutions, customizable warranty options and powerful trade-in programs,” he added.

Clients are quick to provide feedback regarding Collaborative Medical Solutions.

“It was a great pleasure working with Trey at Collaborative Medical Solutions,” a client in New York shared. “Not only did he ship the four

doscopy equipment. The process could not have been simpler from the quote to check in hand,” the client said.

Every business also has challenges.

“It would be impossible to talk about challenges this past year without first pointing to all the health care workers that have been at the frontline for so long, with the world relying on them. Everything else looks

pay-per-procedure or other creative structuring, it’s critical to manage and upgrade technology in these uncertain times,” McIntyre said.

He said the goal for the near future is to start more conversations around what’s possible and finding creative ways to work together.

“Every facility and practice has the opportunity to elevate their endoscopy

“ Every facility and practice has the opportunity to elevate their endoscopy technology and that doesn’t mean you have to sacrifice quality or blow out a budget. We believe that, and that is what we are built to do.” – Trey McIntyre

Trey McIntyre Principal scopes and the processor in time, he was able to deliver on his promise of great pricing and good quality scopes.

He has kept his word at providing loaners at a moment’s notice and time and time again has come up with suggestions for the smooth and efficient functioning of an endoscopy suite. I whole-heartedly endorse him for your endoscopy needs and services.”

Another client discussed the process of selling some of its existing equipment to Collaborative Medical Solutions.

“I just wanted to say thank you and that it has been a pleasure working with [Collaborative Medical Solutions] on the resale of our Pentax enWWW.ORTODAY.COM

small. The endoscopy industry has surely changed as elective procedures are rescheduled and there’s been a lingering uncertainty about what the next few months or even weeks will look like,” McIntyre said. “At the same time, there’s so much opportunity to get creative and work together. We’ve been able to offer unique financial solutions and scopes at price points that help clients keep their technology moving forward. Equally as important, we’ve offered very strong buy-back values for their current equipment, whether it’s to help meet your goals or a much-needed cash injection.”

He said the future appears to be one filled with growth and additional opportunities to help clients provide quality health care to patients.

“We see the business growing over the next few years, both internationally and here in the U.S. We’ll be expanding the team and adding sales staff soon to help launch new offerings. Our clients will be able to tailor financing solutions by working with our great partners. Whether it’s

technology and that doesn’t mean you have to sacrifice quality or blow out a budget. We believe that, and that is what we are built to do,” McIntyre said.

“It’s been fun and surprising to see clients’ response to the name Collaborative Medical Solutions. You can name a company anything, and you want to make it memorable; you want it to represent who you are and how you can help. If it’s easy to find on the web, that’s a bonus! But it’s struck a chord with people, and it says something about how we all want to do business. ‘Let’s work together to achieve a common goal.’ It’s simple but says everything,” he explained.

“It may sound silly, but when we collaborate, great things happen. Let’s discuss your needs, and where you see your practice going in the future. We can get there together, and it may be simpler or faster than you think,” he added.

For more information, visit CMSscopes.com.

February 2021 | OR TODAY

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COVER STORY

ler

ad on S

By D

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“No one would want anyone close to them to undergo a procedure at a hospital or ASC that did not abide by all nationally recognized guidelines for maintaining a clean and sterile operating environment.”

– Jan Martin

T

he worldwide COVID-19 pandemic has reinforced the need for everyone to practice effective personal hygiene, such as washing hands frequently and not touching one’s face. Cleanliness and hygiene are also important in the health care setting – especially in operating rooms and ambulatory surgery centers (ASCs).

“Maintaining a clean and sterile OR environment is integral to patient safety,” says Jan Martin MSN, RN, CIC, interim manager, infection prevention at WellStar Atlanta Medical Center.

Preventing Adverse Outcomes Martin points out that all nationally recognized evidence-based standards point to maintaining a clean and sterile operating room (OR) environment as one of the most important steps in preventing adverse outcomes in that specific setting.

“It’s just the right thing to do,” says Martin. “No one would want anyone close to them to undergo a procedure at a hospital or ASC that did not abide by all nationally recognized guidelines for maintaining a clean and sterile operating environment.”

David Taylor, MSN, RN, CNOR, the president of Resolute Advisory Group LLC, says that the consequences of failure to maintain a clean OR environment “can be devastating and have a life-altering impact on patients. Nobody goes into surgery thinking they are going to become infected because the OR leadership fails to maintain their department.”

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According to Karen deKay, MSN, RN, CNOR, CIC, perioperative practice specialist with the Association of periOperative Registered Nurses (AORN), the environment is the third component in the epidemiological triangle.

“The triangle represents the elements required for disease transmission: a susceptible host, an agent or viable pathogen, and an environment that facilitates transmission,” says deKay. “If we can perform measures to reduce pathogens on environmental surfaces and patient care devices, we can assist in interrupting the infectious process or decreasing transmission.” deKay stresses that the OR environment itself cannot be sterilized. “Instead, it is cleaned and disinfected,” she says. “This eliminates the bioburden and microorganisms found on surfaces. Supplies such as drapes and sutures and instruments are sterilized using specially designed machines that remove all microorganisms, including spores. Sterile technique is then utilized to maintain their sterility.”

SSIs Promote Other Problems Poor infection control practices can result in increased incidences of surgical site infections (SSIs) that in turn lead to a host of problems, says Taylor. These include increased length of patient stay, financial burdens for additional care, physical disability and even death.

“The best way to avoid these problems is to implement a robust preoperative assessment testing (PAT) program to ensure each patient is worked up medically before their procedure,” says Taylor. “A patient who is medically stable – or optimized – for February 2021 | OR TODAY

43

“ The triangle represents the elements required for disease transmission: a susceptible host, an agent or viable pathogen, and an environment that facilitates transmission.” – Karen deKay, MSN, RN, CNOR, CIC, perioperative practice specialist with the Association of periOperative Registered Nurses (AORN)

surgery can provide opportunities to improve outcomes and reduce length of stay and SSI rates.”

Another benefit of a robust PAT program is fewer scheduling conflicts, delays and day of surgery cancellations, Taylor adds. deKay points to research that investigated the transmission of pathogens within the anesthesia workspace. “These studies not only demonstrated intraoperative transmission of pathogens, but also found that virulent and antibioticresistant bacterial strains were often the transmissible agents,” she says.

In the hundreds of assessments he has performed on operating rooms across the country, Taylor says he has found OR cleanliness and infection prevention practices to be lacking.

“Perioperative leaders are not maintaining their ORs to the standard they should be,” he says. “And the statistics are evidence of this – SSIs are occurring in hundreds of thousands of patients annually and costing hospitals as much as $10 billion a year.”

Martin has also observed shortcomings when it comes to maintaining a clean operating room environment. She attributes them to a wide range of factors including: � A lack of staff training � Long dwell times of cleaning products � A lack of accountability among leadership for strict adherence to maintaining a clean and sterile OR environment � Quick OR turnarounds that are expected in order to maintain patient flow � The fact that infection prevention often does not maintain a presence in the OR and conduct regular rounds “I frequently observe products drying well before the required dwell time without application of additional product,” says Martin. “I personally believe that hospitals should use products with the shortest dwell time and the highest 44 OR TODAY | February 2021

kill capability. Products with 10-minute dwell times may not be the best for disinfection.”

In her personal observations, deKay says that surfaces are not always cleaned as thoroughly as they should be due to expectations for quick OR turnover.

“Additionally, clear designation of who was cleaning what item did not always occur, so items were missed or cleaned twice. This led to cross-contamination as team members would clean in the cleanest area of a room, move to a dirtier area and then return to a cleaner area.” deKay points to studies that found compliance with OR cleaning protocols was low. In one of them, the mean overall thoroughness of cleaning was just 25% of 946 objects evaluated.

Unfortunately, there are some obstacles that can make it difficult for health care facilities to improve their infection control practices. “These can include personal opinion and bias as well as facilities not providing the training needed to understand the recommended practice standards and how they should be incorporated into daily practice,” says Taylor.

Technology Solutions The good news is that there are some exciting technology solutions that are making it easier for hospitals and ASCs to create and maintain a clean and sterile operating environment. One of these is Needlepoint Bipolar Air Ionization, also known as NPBI. Taylor explains how it works.“The NPBI produces a high concentration of positive and negative ions which allows similarly charged particles to combine, making it easier for them to be filtered in the HVAC system more effectively. As the ions travel within the air stream, they attach to pathogens, particles and gas molecules, breaking them down and rendering them ineffective.”

Ultraviolet light (or UV-C) technology is also being used to help maintain

a clean OR environment. “It works by using UV-C band wavelength to degrade organic material and inactivate microorganisms and pathogens,” says Taylor. “UV-C technology has been used more extensively during the COVID-19 pandemic.”

“Using UV-C for mask disinfection has been especially beneficial during the pandemic,” adds Martin. deKay stresses that these technologies should be considered adjuncts to environmental cleaning and disinfection in the operating room.

“Physically cleaning surfaces is the first step in environmental cleaning, followed by the application of EPA-registered, hospital-grade disinfectant for the designated contact time. UV-C technology could possibly be used after the environmental cleaning process to kill any residual germs left behind on surfaces,” deKay adds.

“But since this technology is in addition to normal cleaning and disinfection, it is important to consider the implications of adding it to your environmental cleaning process.” deKay believes that further research is needed to determine clinical benefit of this technology in the prevention of SSIs and the potential harm of using these devices in the OR, including their effect on sterile supplies and environmental parameters like temperature and humidity.

“If more training and resources were spent on manual cleaning processes and personnel instead, could this help reduce the spread of infections?” deKay wonders.

Meanwhile, Taylor points out some limitations regarding the use of UV-C technology to maintain a clean OR environment. “Because UV exposure is hazardous to humans, it is typically only used in certain configurations,” he says.

“These include in unoccupied room disinfection, upper room disinfection, air handler unit surface disinfection and air handler surface airstream disinfection.”

“However, this technology has been thoroughly vetted and has a proven track record,” says Taylor.

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D i d yo u k n o w en d osco py co uld be thi s co lorfu l?

Endoscopic procedures require the right tools and support from beginning to end; and back around again.

Key Surgical now offers an improved line of products for clinical procedures and endoscopic infection prevention.

From bite blocks to biopsy valves and from snares to sponges – think of us as your (very colorful) scope sidekick.

Visit Keysurgical .com to learn more

t h g i l t Spo Brian Dawson

MSN, RN, CNOR, CSSM System VP, Perioperative Services, CommonSpirit Health

By Matt Skoufalos

W

hen Brian Dawson was just 12 years old, his mother was diagnosed with breast cancer. He spent the next four-and-a-half years of his adolescence witnessing her undergoing surgery, chemotherapy, cancer treatment and, unfortunately, dying. Through it all, what he most remembered was how well the nurses tended to her as she fought for her life, and that experience cemented in his mind the decision to seek a career in medicine.

In between his junior and senior years at American University, Dawson participated in an immersive student nurse program through which he was detailed to the burn unit at Children’s National Medical Center in Washington, D.C. The physicians spent a handful of minutes with the patients and their families, and the rest of the time, nurses managed their pain.

“I’ve said it a number of times throughout my career: physicians cure and nurses care,” Dawson said. “I was the one who tucked them in, who would dress their burns, who held them, who took care of them and, to me, that was what I was there to do.”

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After graduating nursing school, Dawson was commissioned as an Ensign in the U.S. Navy, and was assigned to his first duty station in Oakland, California. While working the med/surg floor, Dawson met Patty Smith, an OR nurse who arrived every day to handle patients’ preoperative needs. Dawson took an interest in her work, and asked her how he could become an OR nurse; Smith became a lifelong mentor and his “Navy mom.”

“I got into OR school and man, I found my world,” he remembered. Nothing felt more inspiring than the adrenaline rush that followed a surgical procedure that went smoothly, or the feeling of a surgeon saying “good job” at the end of the case. A two-sport athlete in high school, Dawson brought a level of competitiveness to the work he did in the OR, priding himself on facilitating cases and his team in order to have the fastest room turnover possible.

“It was a small unit, so it was me and two techs against the challenge,” he said. “I got to care for patients and I loved it. I used to go into surgery like the [1987 Florida State] Seminoles or the [University of Miami] Hurricanes. My team and I were the baddest OR nurses ever; my team and I had swagger.”

From there, his career took off. Dawson went from being WWW.ORTODAY.COM

n O t

a room nurse to having his own line of service to heading up a department at a two-room OR in North Carolina as a young Navy Lieutenant. He got to help design an OR at the naval hospital in Portsmouth, Virginia. As he progressed, so did Smith, his mentor; when she encouraged him to earn his master’s degree in nursing administration, Dawson enrolled in a fast-track program at Old Dominion University. There, he learned the business of health care as much as the science of it.

“That opened my eyes,” Dawson said. “How does that business run? COVID really illustrated how, when we shut down elective surgery, the money generated by health systems evaporated. I realized during graduate school that the OR was the engine, so now I had even more swagger: ORs are the engine that drive our hospitals, and I was given the pleasure of running that engine.”

After graduate school, Dawson went on to teach at the OR technician school at the Bethesda Naval Hospital, now known as Walter Reed National Military Medical Center.

The opportunity brought him closer in spirit to his mother, who was a teacher. Dawson poured his energy and enthusiasm for his trade into the classroom. After an assignment that sent him to Okinawa, Japan, he returned to Bethesda to take over the OR there. Leveraging his education in the business of health care, Dawson made changes that began to generate revenue for the facility, which soon drew the notice of leadership.

First, Admiral Don Arthur, who eventually became the Navy Surgeon General, made Dawson the Homeland Security Officer for the national capital area during Gulf War II. Overseeing the Wounded Warrior Program, Dawson backfilled the hospital with reservists to keep its surgical unit operational. When Admiral Adam Robinson replaced Arthur, Dawson was his room nurse at Portsmouth Naval Hospital.

Robinson put him in charge of the “flag unit,” the executive medicine clinic, where he met high-ranking figures like U.S. Senator John Kerry and Chief Justice William Rehnquist. Dawson eventually became COO of the Naval Hospital at Marine Corps Base Camp Lejeune in Jacksonville, North Carolina, and was then later chosen to lead U.S. Naval Hospital Okinawa, in Japan as its CEO. In his final two years in the Navy, Dawson was Robinson’s executive assistant and chief of staff at Navy Medicine during Robinson’s term as surgeon general. When he retired after 28 years, Dawson had risen to the rank of captain, and tucked away a lifetime of experiences.

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“When I came in, there weren’t a lot of male nurses, or black nurses, and there weren’t a lot of black officers in Navy Medicine,” he said. “I had a lot of unbelievable mentors who saw something in me, and every door they opened, I ran through – and after I got through the door, I kept my foot in the door to help others come in. I’m still building teams, grooming young leaders to replace me.”

After retiring, Dawson “started to move backwards,” retracing his steps with his daughters in an effort to regain time that he’d dedicated to his professional career.

“I was just like my father,” he said. “I realized that I was the type of leader that really went out of my way for my staff, but I wasn’t necessarily doing that at home. I came to Colorado to be with my youngest, who was living here with her mom, my ex-wife. Working on my relationship with my youngest and her older sisters was when I made the transition from a father to a dad.”

“At the end of the day, no one’s going to say, ‘Brian Dawson was the first black, male nurse to command a naval hospital,’ ” he said. “What they’re going to talk about was how was I as a dad to those three girls, as a poppi to my grandchildren; and how was I as a true friend to the people that I know, and as a true partner to my significant other?

That’s what they’re going to remember.”

Brian Dawson is currently the system vice president of Perioperative Services for CommonSpirit Health of Chicago, Illinois.

February 2021 | OR TODAY

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OUT OF THE OR fitness

PT Exercises Aren’t Just for Physical Therapy

By Miguel J. Ortiz any people believe that the only time to do physical therapy (PT) is after an injury and this couldn’t be further from the truth. I think the name “therapy” sometimes infers that something is wrong. We need to take a different perspective when it comes to PT work, especially when considering adding it to our program design.

M

In order to change our view, we need to revisit the intention. Why does PT work? It is probably because of a trauma, injury or muscular imbalance. We can’t prevent all circumstances from occurring just because of exercise. However, what we can do is improve our behaviors and understanding around correctional exercise and general movement patterns in order to move more biomechanically sound. Here are three best practices and reasons for improving your movement patterns by adding in PT or correctional exercises.

First, we need to lengthen before we strengthen. When you begin any program, you should understand what is being demanded of you. For ex48

OR TODAY | February 2021

ample, the first couple of days before you begin a program you should have a plan for mobility and stretching.

This will help you properly move your body and preform exercises. This can easily be tested by doing some correctional exercises. If you are doing a shoulder workout go through some external rotation movements or knock out some YTA raises. If it’s for your hips, do some light band and hip mobility work. If it’s for your ankle, foam roll and do some balance exercises to strengthen your ankle complex. By focusing on the range of motion and making sure you can properly do the exercises correctly, you can easily find where to fix imbalances. You can also give your body an optimal chance at moving more efficiently.

Second, proper movement patterns can require a great deal of focus which means you’ll develop a greater awareness for neuromuscular control and coordination. When you perform exercises at a slower pace it can reinforce movements in the future.

The reason correctional exercises help is because they can expose weak or imbalanced muscles. So, when performing certain exercises – like a

shoulder cable external rotation – you should not be swinging your arm back and forth like you’re about to be doing 100 reps. Slow and controlled always wins the race. Proper neuromuscular development helps ensure that when you do place a higher demand on said joint/muscle complex your body will be more prepared to handle the load properly.

Third, if you have a program that requires a lot of time or you can’t see where to fit in correctional movements, then look no further than your recovery days. Utilize these days to do very light recovery and correctional work. Yoga can go a long way but if your program requires high demands then make sure those demands are met on the back end and supported with quality recovery and light correctional movements to ensure quality movements in the future.

Miguel J. Ortiz is a personal trainer in Atlanta, Georgia. He is a member of the National Personal Trainer Institute and a Certified Nutritional Consultant with more than a decade of professional experience. He can be found on Instagram at @migueljortiz.

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OUT OF THE OR health

Stay Healthy and Promote Longevity By family features ging may be inevitable, but with advancement in research and technology, there are plenty of ways you can slow, or even reverse, the hands of time to stay healthy and promote longevity.

A

Consider these ideas from Longevity Labs+, a company dedicated to cutting-edge aging research and the makers of spermidineLIFE, a first-ofits kind, clinically studied supplement containing natural spermidine, which renews cells and can reverse the signs of aging.

Protect Your Skin Not only does your skin protect vital internal organs, it’s an essential barrier to intruders like bacteria and other infection-causing microbes. The skin is also the body’s greatest tool in managing hydration levels and providing critical cues to your nervous system about things like temperature and pain.

With such a big role in your overall health and well-being, the skin often shows the first signs of aging. Wrinkles and age spots are often indicators of a person’s true age.

50 OR TODAY | February 2021

However, you can reduce the visible impacts of aging on the skin with daily care. Regularly moisturizing helps keep skin supple, and diligent sunscreen application year-around can protect your skin from damaging sun rays. Some compounds and nutrient plans can help nurture youthful skin.

It’s also important to closely monitor your skin for changes, especially changes to moles or other spots that may be signs of skin cancer, which is generally treatable when caught and managed early. In addition, collagen peptides and a spermidine-rich diet can be key in ensuring healthy skin into your later years.

Maintain Clean and Healthy Cells You may not realize it, but as each day passes, your body’s cells age, die and accumulate toxic matter, which disrupts cellular function and causes a myriad of age-related diseases such as dementia and cardiovascular disease as well as decreased immune function. However, a compound naturally produced by the body and found in nature called spermidine can clean cells of toxic matter so they can operate with renewed youth and efficiency.

Spermidine triggers a cellular renewal

process called autophagy, which allows cells to shed layers of waste and regenerate instead of slowing down and dying off. As the body ages, natural levels of spermidine decline, cellular regeneration slows and signs of aging are accelerated.

Spermidine is a key to anti-aging and is believed to help reduce the onset of neurodegenerative and age-related diseases. You can boost spermidine levels by eating certain foods that are high in spermidine, like lentils, soybeans, mushrooms, aged cheese, pears, broccoli, peas and cauliflower.

However, few people eat enough spermidine-rich foods to maintain optimal levels in their later years. Taking a supplement like spermidineLIFE* can support cellular renewal and help cells stay young and healthy. The first and only clinically studied spermidine supplement in the world, it includes spermidine naturally extracted from European non-GMO wheat germ along with carefully selected vitamins, minerals and healthy fats.

Manage Physical Health As you grow older, your metabolism slows, making it easier to hold onto extra weight. Excess pounds are associated WWW.ORTODAY.COM

with numerous health risks, in addition to slowing you down overall. Maintain a more youthful body and mobility by consuming a well-rounded, nutritious, whole-food diet and committing to regular exercise, which can help not only banish extra calories but also keep your muscle tone strong, your balance steady and your posture straight.

Just as important as what you do to protect your health as you age is what you don’t do. That means limiting alcohol, quitting smoking and avoiding the temptation to indulge in high-fat and sugary foods.

Support Mind Matters Worry lines aren’t just wrinkles that come with age; they can be a sign of persistent angst. From stress to lack of sleep to slips in memory, there are plenty of reasons to focus on your mental health as you advance in years.

Getting enough rest can play a big role in your physical health as well as your mental wellness. Too little sleep prevents your body from reenergizing itself fully and can affect your cognition and mood. Worry and stress can also cause you to feel your years.

Information is key, and smart devices such as heart rate and sleep trackers can provide you with the necessary information to find what helps and what hurts healthy circadian rhythms and deep, regenerative sleep.

Growing forgetful as you age is also common to an extent, but memory problems can be exacerbated by stress, lack of sleep and other factors. You can also keep your mind sharp by playing games, doing puzzles, reading and maintaining an active and engaging social life with others. Even during this pandemic, phone and video calls can help engage your mental state through important social activity.

Find more ideas for navigating your later years with grace at spermidinelife.us.

Eat Away Your Age This tasty recipe features three of the top 10 spermidine-rich foods: broccoli, mushrooms and aged cheese. It also keeps well, so you can prepare it for a casual brunch then reheat for an easy breakfast the next day.

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Longevity Breakfast Bake Prep time: 30 minutes | Cook time: 1 hour | Servings: 8 INGREDIENTS: • 1 tablespoon olive oil • 1 pound uncured, organic bacon • 1 pound sliced, organic white mushrooms • 1 pound organic broccoli • 1/2 cup water • 2 cups grated aged cheddar cheese • 14 organic eggs • 1-2 teaspoons garlic salt • fresh ground black pepper, to taste

1. In skillet over medium-high heat, heat oil. While skillet is warming, chop bacon into small pieces. Cook bacon until crispy. Transfer bacon to plate covered with paper towel to absorb excess grease.

2. Drain most grease from skillet,

reserving some to sauté mushrooms.

3. Saute mushrooms until translucent.

Cut broccoli into thick, bite-sized pieces; cover and microwave 4 minutes with water to soften.

4. Heat oven to 350 F. 5. Crack eggs and whisk until egg whites and yolks blend together in one consistent color. Season with garlic salt and pepper, to taste.

6. In bottom of baking pan or castiron skillet, spread broccoli and mushrooms evenly. Add crispy bacon bits and cheddar cheese. Pour eggs into pan and carefully stir until ingredients are evenly mixed.

7. Bake 40-45 minutes, or until top of casserole starts to brown.

* These statements have not been evaluated by the Food and Drug Administration.

These products are not intended to diagnose, treat, cure or prevent any disease.

February 2021 | OR TODAY

51

OUT OF THE OR EQ factor

Working With

‘Dominant’ Styles By daniel bobinski, M.Ed. mong the world’s population are four basic behavioral styles. This isn’t a new discovery. At least as far back as Hippocrates, four different styles of behavior have been observed. Two thousand years ago it was thought those differences were the result of differences in body chemistry.

Thus, Hippocrates used the terms choleric, sanguine, phlegmatic and melancholy to identify the different styles.

It wasn’t until the 1920s that a gentleman named William Marston working at Columbia University came up with a more scientific method for classifying behavioral styles.

A

This is the second installment is a series on identifying and working with different behavioral styles. Our focus today is on people who are more taskfocused and comfortable making highrisk decisions quickly. Marston noticed that the predominant characteristic of people like this is a desire to dominate any problem that comes their way.

If a challenge or obstacle presented itself, these folks tended to jump on the problem right away with a strong will to win. Hence, Marston chose the word “Dominant” to identify people with these tendencies.

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Value to the team Those with strong Dominant tendencies are forward thinking, tenacious and innovative. They are self-starters who place a high value on time.

Ideal environment and motivations It’s not a good idea to assign strong Dominant styles a lot of routine work.

They prefer being innovative and free from control or details. They operate best when they can solve challenging problems and be evaluated on the results, not the methods they used to achieve those results. They usually do well when they have the power and authority to achieve the results expected and are given opportunities to express their viewpoints.

Best communication methods Because people with Dominant styles strive for efficiency, one of the best pieces of advice I can give for those who work with Dominant styles is, “Be brief, be bright, be gone.” In other words, don’t strive to build relationship. Stick to bullet-point facts presented in a logical order and offer recommendations based on facts, not mere opinions. And then be done. Steer clear of too many details unless asked. Rambling, telling stories or attempting to build relationship are also not good choices.

If you disagree with someone who has a Dominant style, be sure you have facts to back up your position. And,

when presenting your case, show how your approach will bring desired results.

Those with Dominant styles sometimes come across as argumentative, but really, they’re just testing the strength of various perspectives. Remember that those with this style desire to be efficient, so while it seems like they’re impatiently challenging your perspective, in their mind they are simply seeking quick answers. For those with a Dominant style, facts are far more important than feelings, so at times they can appear to be cold-hearted. This isn’t necessarily the case. It’s just that they’re striving to win and achieve a quick resolution to a problem.

In the next issue I’ll be reviewing the “Influencing” style.

Daniel Bobinski, M.Ed. is a best-selling author and a popular speaker at conferences and retreats. For more than 30 years he’s been working with teams and individuals (1:1 coaching) to help them achieve excellence. He was also teaching Emotional Intelligence since before it was a thing.

Reach Daniel through his website, MyWorkplaceExcellence.com, or his office 208-375-7606.

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OUT OUTOF OFTHE THEOR OR recipe nutrition

Greens Anyone?

By Kristin Serrano know summer seems so very far away but do not stop reaching for those leafy greens!

Your body needs them yearround. The whole “greens equals salad” thing is a myth anyway.

There are a million options beyond lettuce and spinach.

“Greens” are not even all green!

Make this the season that you venture into the world of not just kale and chard but also mustard greens, mâche (corn salad) and radicchio – just to name a few.

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The category of greens includes an amazing array of flavors, textures, colors and nutrient profiles. Greens are excellent sources of the B-A-C-K Vitamins. Vitamins B, A (pre-cursors*), C and K are commonly high amounts in leafy greens. One cup of cooked kale has over 1,000% the daily value of Vitamin K, nearly 100% the daily value of Vitamin A pre-cursors and 70% of the daily value of Vitamin C. Spinach provides a quarter to over half of your daily needs for three B Vitamins. This high-vitamin content means greens are working to protect your nervous system, build your immune system, improve skin, keep bones strong, protect your heart and so much more.

Vitamins are not the end of the story.

Leaves are crammed full of phytonutrients like lutein (for eye health) and quercetin (an anti-inflammatory and anti-cancer superstar). Research is currently underway studying the effects of quercetin on COVID-19.

The fiber in greens is just as important. I know, you hear about fiber all 54

OR TODAY | February 2021

the time but the lack of it in your diet is a bigger deal than you think. On average, Americans are getting about 15 grams of fiber which is less than half of what we need. “Gut health” is all the rage in wellness circles, but not enough are getting the message that fiber is the lynchpin of a healthy, happy gut. The ripple effects of a high-fiber healthy-gut diet are seemingly endless.

Researchers in 2016 showed that a diet low in fiber and higher in saturated fat led to less productive sleep. In 2020, researchers looking at an Iowa Women’s Health study saw the correlation between high-fiber diets and improved gut-mediated mental health in post-menopausal women. Getting your greens not only nourishes your body, but improves your sleep and your mood! Sign me up.

In winter, it is important to get creative with greens. You many not feel like eating a traditional salad and that is fine. In fact, if you are only getting greens as salads, it is time to shake things up. Here are a few ideas to get more greens and not get bored: • Be Daring. Check out the cookbook “The Book of Greens” by Jenn Louis which has a lifetime of delicious ways to enjoy greens. I am serious. You will be inspired.

• Warm It Up. Greens do not have to be eaten raw! Greens like chard, kale, escarole, mustard and collards can take some heat. You can enjoy a warm salad or use greens in other cooking.

• My Secret Weapon. Keep frozen greens (kale and spinach can usually be found in the freezer case at

your local grocer) in your freezer and add them to everything. I add greens to soups, casseroles, pastas, omelets, frittatas, smoothies and anything else I can think of. Honestly, any time I cook I ask myself “Could I add greens to this?” Usually, the answer is yes.

• Embrace Herbs. Herbs like cilantro, oregano, basil and sage are leafy greens and they make life taste better. So, eat that parsley on your plate! Enjoy sauces like pesto and chimichurri.

• Have an Air Fryer? If you do, you can easily make delicious (really) kale chips. Remove kale from stem and tear into pieces. Toss with olive oil and lemon juice to coat. Salt to taste. Now dry the “chips” on the lowest setting of your air fryer until they are crisp. *Vitamin A pre-cursors: True Vitamin A (Retinol) is only found in animal foods. Vitamin A precursors, like the carotenoids in carrots, have to be converted by our bodies into true Vitamin A. We do this surprisingly inefficiently.

The best sources of Vitamin A are liver, grassfed dairy, egg and seafood. Do not despair – carotenoids are nutrition powerhouses in their own right.

Kirsten Serrano is a nutrition consultant, chef, farmer, food literacy educator, and the bestselling author of “Eat to Your Advantage.” You can find out more about her work at SmallWonderFood.com.

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OUT OF THE OR recipe

Easy Dishes to Boost Immunity

By Family Features taying healthy is important year-round, but especially in the cooler months when temperatures drop, people spend more time inside and germs can spread easily. What you eat and the lifestyle you embrace are critical components of staying healthy.

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Nourishing meals full of fruits, vegetables, protein-rich foods and whole grains help provide the body’s immune system with the nutrients it needs. Maintaining a healthy lifestyle by getting enough sleep, being physically active every day, having enough fluids and reducing stress also help keep the immune system in shape.

As a nutritious food to include on your grocery list, grapes of all colors – red, green and black – contain more than 1,600 natural plant compounds such as antioxidants and other polyphenols that help protect the health of cells throughout the body. They also contain about 82% water, so they provide important fluids for hydration, which is also critical to

Chicken, Spinach and Grape Pita SERVINGS: 4 1. In small skillet over mediumhigh heat, toast pine nuts, stirring constantly until toasted, about 5 minutes. Transfer to bowl and let WWW.ORTODAY.COM

Chicken, Spinach and Grape Pita INGREDIENTS: • 2 tablespoons pine nuts • 2 tablespoons lemon juice • 2 tablespoons minced shallot • 3 tablespoons extra-virgin olive oil • 1 pinch red pepper flakes • 1/4 teaspoon ground sumac • salt • freshly ground black pepper • 1 package (5-6 ounces) fresh baby spinach, washed and dried • 1 1/2 cups shredded, cooked chicken (about 8 ounces) • 1 cup red California grapes, sliced • 1/4 cup crumbled feta cheese • 4 whole-wheat pita breads (6 1/2 inches each), warmed and halved

a healthy immune system.

Grapes can be enjoyed as a healthy snack or an immuneboosting ingredient in recipes like Chicken, Spinach and Grape Pita sandwiches. It provides a mix of immune-supporting nutrients, including zinc in chicken, vitamins A and C in kale, polyphenols in grapes and other important nutrients.

Find this recipe and more at grapesfromcalifornia.com.

cool. In large bowl, whisk lemon juice, shallot, olive oil, red pepper flakes, sumac, salt and pepper.

Add spinach, chicken, grapes, feta and pine nuts; toss to mix. Stuff into pita breads and serve.

February 2021 | OR TODAY

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BLACKCURRANTS ARE FAVORABLE FOR GLUCOSE METABOLISM

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lackcurrants have a beneficial effect on the blood glucose response after a meal. They balance the

glucose response of ingested sugar by attenuating its rise and delaying its fall. The effect is likely associated with berry-derived polyphenolic compounds, anthocyanins, which are rich in blackcurrants.

The beneficial health effect of blackcurrants was supported by a recent study conducted at the University of Eastern Finland. In the clinical meal study (Maqua) the beneficial effect on postprandial glucose response was achieved by 75 g (1.5 dL) of blackcurrants, a remarkably smaller portion size than in earlier studies. Blackcurrants are often consumed with added sugar because of their natural sourness, which may be a cause of concern for health-conscious consumers. However, it seems that sugar consumed with blackcurrants is not as unhealthy as sugar consumed without berries.

The study was conducted in collaboration between the Institute of Public Health and Clinical Nutrition at the University of Eastern Finland and Savonia University of Applied Sciences by utilizing the regional Food Valley ecosystem.

In the Maqua study, 26 healthy participants (22 female, 4 male) consumed three different test products and sugar water as a control product at four separate study visits. The test products were a blackcurrant purée with added sugar, a blackcurrant product containing fermented quinoa, and a blackcurrant product base without blackcurrants. Each of them and the control product contained 31g of available carbohydrates and had a similar composition of sugar components. Blood samples were taken before the meals in fasting state and postprandially in 15, 30, 45, 60, 90, 120 and 180 minutes after consuming the meal, and analyzed for glucose, insulin and free fatty acids.

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Compared to sugar water, both blackcurrant products had attenuated postprandial glycemic response, which was seen in reduced maximum glucose and insulin, delayed fall of glucose, and delayed rise of free fatty acids because of hypoglycemia. The effect was enhanced for the blackcurrant product because of the innovative product base. The results support earlier findings on the beneficial effects of blackcurrant on blood glucose response after a meal, showing the effect with a smaller portion size. Over a longer period of time, smaller variations in the blood glucose and insulin levels, and improved insulin sensitivity, may decrease the risk of type 2 diabetes.

For more information, visit https://tinyurl.com/y4rxexcv.

February 2021 | OR TODAY

57

INDEX

advertisers

ALPHABETICAL Action Products, Inc.…………………………………………21

Healthmark Industries Company, Inc.…………… 4

Ruhof Corporation……………………………………………2, 3

AIV Inc.………………………………………………………………… 11

Key Surgical……………………………………………………… 45

Sympliant……………………………………………………………… 5

ALCO Sales & Service Co.…………………………………17

MD Technologies Inc.……………………………………… 23

TBJ Incorporated……………………………………………… 27

Cygnus Medical………………………………………………… 60

MedWrench……………………………………………………… 49

Encompass Group………………………………………………19

OR Today Webinar Series……………………………… 59

CATEGORICAL CARTS/CABINETS

Cygnus Medical………………………………………………… 60

REPAIR SERVICES

ALCO Sales & Service Co.…………………………………17

Encompass Group………………………………………………19

Cygnus Medical………………………………………………… 60

Cygnus Medical………………………………………………… 60

MD Technologies Inc.……………………………………… 23

REPROCESSING STATIONS

TBJ Incorporated……………………………………………… 27

Ruhof Corporation……………………………………………2, 3

CS/SPD

TBJ Incorporated……………………………………………… 27

MD Technologies Inc.……………………………………… 23

INSTRUMENT STORAGE/TRANSPORT

TBJ Incorporated……………………………………………… 27

Ruhof Corporation……………………………………………2, 3

Cygnus Medical………………………………………………… 60

SAFETY

DISINFECTION

Key Surgical……………………………………………………… 45

Key Surgical……………………………………………………… 45

Cygnus Medical………………………………………………… 60

Ruhof Corporation……………………………………………2, 3

Ruhof Corporation……………………………………………2, 3

INVENTORY CONTROL

Ruhof Corporation……………………………………………2, 3

DISPOSABLES

Key Surgical……………………………………………………… 45

TBJ Incorporated……………………………………………… 27

ALCO Sales & Service Co.…………………………………17

ONLINE RESOURCE

STERILIZATION

ENDOSCOPY

MedWrench……………………………………………………… 49

Cygnus Medical………………………………………………… 60

Cygnus Medical………………………………………………… 60

OR Today Webinar Series……………………………… 59

MD Technologies Inc.……………………………………… 23

MD Technologies Inc.……………………………………… 23

OR TABLES/BOOMS/ACCESSORIES

TBJ Incorporated……………………………………………… 27

Action Products, Inc.…………………………………………21

SURGICAL

Ruhof Corporation……………………………………………2, 3 Sympliant……………………………………………………………… 5

FALL PREVENTION ALCO Sales & Service Co.…………………………………17 Encompass Group………………………………………………19

FLUID MANAGEMENT

OTHER AIV Inc.………………………………………………………………… 11

PATIENT MONITORING AIV Inc.………………………………………………………………… 11

MD Technologies Inc.……………………………………… 23

PATIENT WARMING

GENERAL

Encompass Group………………………………………………19

AIV Inc.………………………………………………………………… 11

POSITIONING PRODUCTS

HOSPITAL BEDS/PARTS

Action Products, Inc.…………………………………………21

ALCO Sales & Service Co.…………………………………17

Cygnus Medical………………………………………………… 60

MD Technologies Inc.……………………………………… 23 Ruhof Corporation……………………………………………2, 3

SINKS

MD Technologies Inc.……………………………………… 23

SURGICAL INSTRUMENT/ACCESSORIES Cygnus Medical………………………………………………… 60 Healthmark Industries Company, Inc.…………… 4 Key Surgical……………………………………………………… 45

TELEMETRY AIV Inc.………………………………………………………………… 11

TEMPERATURE MANAGEMENT Encompass Group………………………………………………19

WASTE MANAGEMENT

INFECTION CONTROL

PRESSURE ULCER MANAGEMENT

MD Technologies Inc.……………………………………… 23

ALCO Sales & Service Co.…………………………………17

Action Products, Inc.…………………………………………21

TBJ Incorporated……………………………………………… 27

58

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