Healthmark

LIFE IN AND OUT OF THE OR

SUMMER 2026

DIGITAL SUPPLEMENT

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CORPORATE PROFILE

Healthmark

What Every OR Nurse Should Know: Insulation Failure in Minimally Invasive Surgery

Healthmark, a Getinge Company s surgical volumes and case

to infection prevention: combining infrastructure workflow expertise, consumables, • Sterile processing, surgical design equipment, education and service and workflow consultation solutions grow, expectations for infection support into a more unified system.

• life an cycle support prevention continue to rise.

Minimally invasive surgery has transformed patient care So, why does insulationService failure and remain underrecognized In today’s healthcare environment, • Digital health, data and connectivity Sterile processing departments by reducing recovery time, minimizing complications, and risk?entire What does the data reveal? And, most importantly, predictability across the solutions (SPD) and operating rooms (OR) improving outcomes.

Yet, alongside these is a matters more what canever.

OR nurses do to help close this patient safety workflow than Together, Healthmark + Getinge are under constant pressure to advances create a fully integrated infection improve efficiency, maintain largely invisible risk that continues to impact patient safety gap? Drawing on clinical experience, industry research, and prevention ecosystem, combining compliance, reduce risk and Built on Complementary Strengths long-standing in operating rooms across the country: insulation failure in Healthmark’s focus on instrument care and workflow expertise, consumables, support uninterrupted clinical For decades, Healthmark has built electrosurgical instruments. inspection, this articleequipment, aims to reframe insulation testing as a education and service into performance. trusted relationships with SPD and a connected support model across the perioperative teams by focusing on shared responsibility across the OR–SPD continuum. full perioperative continuum.

At the same time, surgical workflows the realities of day-to-day workflow While insulation testing is critical to patient safety, many are becoming increasingly interconexecution. These teams rely on operating room (OR) nurses have limited visibility into the in-not onlyThe nected.

Instrument readiness, processHealthmark for products, Supporting the ORInvasive

by Strengthening the Hiddenbut Risk of Minimally Surgery ing quality, equipment reliability, staff for practical Entire Workflow spection and testing processes carried out in sterile process- guidance in navigating confidence and compliance execution standards, improving In repeatability, OR performance on faronly more laparoscopic and minimally invasivedepends procedures, a ing (SP)allfor insulated surgical instruments. This inspection directly impact OR performance troubleshooting challenges and than what happens inside the operating small portion—the working tip—of the instrument visible procedure feels distant practice. and patient care. from the day-to-day nursing supporting operational performance. room. Every surgical procedure is relies Yet, instrument processing challenges That role has positioned on the readiness reliability the to the surgeon. The remainder of the and insulated shaftofoften rarely stem from a single product or Healthmark as more operates than a supplier. sterile processing workflow supporting off-screen, in close proximity to adjacent tissue and However, evidence and real-world experience suggest othisolated issue. More often, they emerge Healthmark has become a workflowit behind the scenes. organs. erwise.through Insulation failures often occur outside thefocused surgeon’s disconnected systems, inconsispartner helping SPD and OR When breakdowns occur in sterile data andgo gaps between capital equipteams translate evolving requirements processing, the impact extends across field oftent view, may unrecognized during a procedure, and ment, consumables, workflow practices into repeatable daily When practice. the perioperative environment, affectinsulation is intact, electrical energy is delivered can result in unintended burns, unexplained postoperative and cross-departmental coordination.

Getinge brings complementary ing patient care, OR efficiency and precisely where intended.

When insulation is compromised, complications, and patient harm. have Healthmark and Getinge capabilities at global scale, including: financial performance: come together to address those gaps • Capital equipment and • Delayed or unavailable instrumentathrough a more connected approach

A complexity continue to

Healthmark, A Getinge company / hmark.com / 800.521.6224

tion that can lead to case delays or cancellations • Rework and workflow disruption that increases pressure on OR and SPD teams • Instrument damage or compromised device integrity that may impact usability, longevity and patient safety • Lost OR time, reduced throughput, and revenue impact These challenges rarely originate from one isolated failure. More often, they occur at the intersections between systems, vendors, departments and processes. As healthcare systems continue to face staffing pressures and increasing procedural demand, improving coordination across perioperative teams and processes becomes even more critical.

more sophisticated and operationally demanding.

Healthmark has long supported customers through this complexity by helping bridge the gap between standards and execution. Through practical education, workflow guidance and hands-on support, healthcare teams gain greater confidence in how standards apply to daily operations.

Combined with Getinge’s broader systems expertise and life cycle support capabilities, this creates a more connected framework for operational consistency across both SPD and OR environments.

Education, in this context, becomes more than training – it becomes an essential part of workflow performance.

Closing the Gaps Between Systems

Healthmark + Getinge support healthcare organizations through interconnected solution areas designed to strengthen infection prevention performance across the perioperative continuum.

Healthmark + Getinge help healthcare organizations reduce fragmentation across infection prevention activities by bringing together equipment, consumables, service, education and workflow support across SPD and OR environments.

This connected model helps healthcare organizations: • Improve workflow consistency across departments and shifts • Resolve issues faster through more coordinated support • Strengthen communication between SPD and OR teams • Improve surgical readiness and operational reliability It also creates a more streamlined customer experience. Instead of navigating multiple disconnected providers, healthcare teams gain access to a more unified partner with visibility across the broader workflow.

Turning Standards into Operational Confidence One of the greatest challenges facing healthcare organizations today is not simply how to understand evolving standards – it is knowing how to implement them consistently in real clinical environments.

From water quality and steam requirements to cleaning monitoring and documentation expectations, infection prevention efforts continue to grow

Connected Solutions Across the Entire Workflow

Instrument Processing Support Supporting cleaning, inspection, assembly, and preparation with tools, education, and practical guidance that help improve consistency and instrument readiness.

Cleaning Chemistry & Compatibility Aligning cleaning chemistries, equipment and instrumentation to support consistent cleaning outcomes and reduce uncertainty in daily workflows.

Inspection, Testing & Quality Assurance Providing inspection and monitoring solutions that help healthcare teams identify risks and support compliance objectives.

Capital Equipment, Service & Life Cycle Support Through Getinge’s portfolio, supporting sterile processing and surgical infrastructure with equipment, service and long-term life cycle support that improves reliability.

Education and Clinical Enablement Delivering practical education that helps SPD and OR teams apply evolving

CORPORATE PROFILE

Healthmark

Our Integrated Infection Prevention Portfolio • Decontamination Ultrasonics, Decontamination Sinks, Automation Solutions, Washer-Disinfectors, PPE, Brushes, Cleaning Chemistries, Cleaning Monitoring

• Inspection & Assembly Prep & Pack Tables, Sterile Barriers, Inspection Systems, Instrument Integrity Testing

• Sterilization Sterilizers, Instrument Trays, Sterility Monitoring, Indicators

• Storage & Transport Case Carts, Storage Solutions, Labeling and Signage

• OR Readiness Tracking & Sterile Supply Asset Management

CORPORATE PROFILE

Healthmark

What Healthcare Teams Rely On Us For

What Every OR Nurse Should Know:

• Reliable instrument cleaning and inspection tools

Insulation Failure in Minimally Invasive Surgery standards more consistently in realworld healthcare environments.

What This Means for Healthcare Organizations

• Sterilization assurance and monitoring products • Workflow consumables used daily in SPD and OR environments between systems, departments, and partners who understand how sterile processing performance impacts both SPD and OR outcomes.

• Capital equipment and service support through Getinge • Education and hands-on

By bringing together expertise across We’ve Got You Covered. workflow guidance from equipment, consumables, education, Healthmark + Getinge are focused Healthmark service and sterile processing on building those connections – beMinimally invasive surgery has transformed patient care So, why does insulation failure remain an underrecognized operations, Healthmark + Getinge tween products, processes, people, by reducing recovery time, minimizing complications, and risk? What does the data reveal? And, most importantly, help healthcare organizations move and performance, so healthcare toward a more coordinated infection teams can greater improving outcomes.

Yet, alongside these advances is a operate with what canconOR nurses do to help close this patient safety prevention strategy. sistency, efficiency and confidence largely invisible risk that continues to impact patient safety gap? Drawing on clinical experience, industry research, and This enables teams to: across the entire perioperative in operating rooms across theacross country: insulation failure in Healthmark’s long-standing focus on instrument care and • Improve consistency workflow. perioperative workflows Because infection prevention is this article aims to reframe insulation testing as a electrosurgical instruments. inspection, • Strengthen coordination between not a series of independent tasks. shared responsibility across the OR–SPD continuum.

SPD and OR teams It is a connected system that While insulation is critical to patient safety, many • Resolve testing issues faster through supports surgical readiness, operational reliability, safety operatingconnected room (OR)support nurses and haveexpertise limited visibility into the in- and patient The Hidden Risk of Minimally Invasive Surgery • Support surgical readiness, every day. spection and testing processes carried out in sterile processcompliance, and operational We’ve Got You Covered.

In laparoscopic and minimally invasive procedures, only a ing (SP) for insulated surgical instruments. This inspection continuity helps health- nursing practice. small portion—the working tip—of the instrument is visible procedureMost feelsimportantly, distant fromit the day-to-day care organizations build greater confito the surgeon. The remainder of the insulated shaft often dence that every part of the workflow operates off-screen, in close proximity to adjacent tissue and However, evidence and real-world experience suggest othis working together as intended.

erwise. Insulation failures often occur outside the surgeon’s

Looking Ahead field of view, may go unrecognized during a procedure, and As healthcare systems continue

organs.

can result in unintended unexplained postoperative to evolve, infectionburns, prevention

When insulation is intact, electrical energy is delivered

will require than standalone complications, andmore patient harm.

precisely where intended. When insulation is compromised,

products or isolated expertise. It will require stronger coordination

Healthmark, A Getinge company / hmark.com / 800.521.6224

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Healthmark & Getinge believe by combining our strengths, we are positioned to better serve healthcare facilities moving forward into the future. We’re committed to providing innovative solutions, personalized implementation and best-in-class educational resources more than ever before. Together, we are striving to give you an unparalleled customer experience.

Scan to explore the benefits of our partnership. Discover how we’re redefining the customer experience to empower your facility.

What Every OR Nurse Should Know: Insulation Failure in Minimally Invasive Surgery

Minimally invasive surgery has transformed patient care

So, why does insulation failure remain an underrecognized

by reducing recovery time, minimizing complications, and

risk? What does the data reveal? And, most importantly,

improving outcomes. Yet, alongside these advances is a

what can OR nurses do to help close this patient safety

largely invisible risk that continues to impact patient safety

gap? Drawing on clinical experience, industry research, and

in operating rooms across the country: insulation failure in

Healthmark’s long-standing focus on instrument care and

electrosurgical instruments.

inspection, this article aims to reframe insulation testing as a shared responsibility across the OR–SPD continuum.

While insulation testing is critical to patient safety, many operating room (OR) nurses have limited visibility into the inspection and testing processes carried out in sterile process-

The Hidden Risk of Minimally Invasive Surgery

ing (SP) for insulated surgical instruments. This inspection

In laparoscopic and minimally invasive procedures, only a

procedure feels distant from the day-to-day nursing practice.

small portion—the working tip—of the instrument is visible to the surgeon. The remainder of the insulated shaft often

However, evidence and real-world experience suggest oth-

operates off-screen, in close proximity to adjacent tissue and

erwise. Insulation failures often occur outside the surgeon’s

organs.

field of view, may go unrecognized during a procedure, and can result in unintended burns, unexplained postoperative

When insulation is intact, electrical energy is delivered

complications, and patient harm.

precisely where intended. When insulation is compromised,

Healthmark, A Getinge company / hmark.com / 800.521.6224

even by a pinhole breach, electrical energy can escape and

What the Data Tells Us—and What It Misses

cause unintended burns to surrounding tissue. These injuries may not be immediately apparent during surgery and can

A multi-facility study (Rojo, 2023) revealed concerning

manifest later as fever, pain, or unexplained postoperative

findings:

complications.

• 54% of insulated instruments failed inspection when tested across 49 facilities.†

This is a unique challenge for OR nurses. By the time charting is complete and the procedure is underway, the circulator or

• 42% of nurses surveyed reported experiencing an insulation failure during their career.††

scrub nurse may be the only additional set of eyes capable of noticing abnormal electrical activity along the nonoperative

These numbers are striking but likely underrepresent

portion of an instrument. Without clear awareness of the risk

the true scope of the problem. In many cases, patient

of insulation failure, warning signs can be easily missed.

complications are treated without ever identifying the root cause as an electrosurgical insulation breach.

As a scrub nurse or a circulating nurse, this is a perfect op-

Without direct awareness of insulation integrity, OR

portunity to monitor for electrical strays away from the focal

nurses may never connect postoperative outcomes to

point of the surgery. For example, when the surgeon is re-

instrument failure.

moving the gall bladder (i.e., laparoscopic cholecystectomy) from the liver bed with electrical cautery, the circulator and/

The reporting gap between occurrence and recogni-

or scrub nurse could be watching the instrument’s insulated

tion helps explain why insulation failure remains a per-

shaft to identify any potential electrical injuries.

sistent, underreported risk in surgical environments.

Even with increased awareness and attention, when there is a limited field of view, it is possible to have an electrical injury.

This is where a registered nurse first assistant (RNFA), who is educated on the risks of electrical cautery use might enable some minor adjustments during and after the procedure.

Let’s revisit the example of a laparoscopic cholecystectomy.

The RNFA who is driving the camera for the procedure could provide a wider field of view, when possible, to facilitate observation of dangerous electrical strays. The RNFA could also perform a final safety check with the camera (after the procedure is completed and before closing) by quickly visually inspecting for any signs of burns or injuries on the adjacent organs that may have come into contact with the instrument.

54% of insulated instruments failed inspection when tested across 49 facilities †

Scrub nurses could consider conducting a visual inspection on the insulated instrument shafts for any evidence of testing device, it is a simple inspection procedure that could

42%

prevent damaged instruments from being used on patients.

of nurses surveyed

damage. While this isn’t as effective as using an insulation

This inspection could be done after the sterile field is set up, before the case starts, and before lights are turned off in the operating room. OR nurses and SPD managers have a unique opportunity to unify inspection practices, educate all stakeholders involved in perioperative patient care and to lead the charge for impactful change in safety procedures.

reported experiencing an insulation failure during their career †

The OR Nurse’s Role—Even If Testing Happens in SPD While insulation testing is typically performed in sterile processing, OR nurses play a critical role in patient safety before, during, and after the procedure.

What Effective Insulation Testing Actually Looks Like

OR Nurses: • Advocate for safe practices across departments.

Effective insulation testing is not a once-a-week

• Identify trends in unexplained complications.

task or a box-checking exercise.

• Support compliance with evidence-based standards.

• Serve as patient safety champions in both hospitals and ambulatory surgical centers (ASCs).

Effective insulation testing must be: Performed every time an insulated instrument is processed

In many ASCs, OR nurses may also oversee or directly manage sterile processing operations, making insulation testing

Conducted using equipment capable of

knowledge essential, not optional.

detecting microscopic breaches

Even when insulation testing is performed correctly in SPD,

Adjusted according to manufacturer-

OR awareness adds a critical layer of defense. Recognizing

recommended voltage settings

signs of unintended electrical energy, asking informed questions about inspection protocols, and collaborating with

Applied to all insulated components,

SPD colleagues all contribute to safer surgical outcomes.

including shafts, handles, bipolar forceps, and reusable cords

The OR–SPD Partnership: A Shared Safety Responsibility

Commonly observed gaps include: Inconsistent testing frequency

Patient safety does not stop at departmental boundaries.

When OR nurses and sterile processing teams share under-

Inability to test reusable cords effectively

standing and accountability, insulation failures are far less likely to reach the patient.

Lack of voltage specificity

OR nurses can strengthen this partnership by:

Missing accessories that limit thorough

• Asking how insulation testing is performed and how often.

inspection

• Requesting demonstrations or audits of inspection processes.

Variations in the education and training of

• Encouraging education and annual competency validation.

SP technicians regarding proper insulation

• Supporting SPD teams when production pressure threatens

inspection practices

safety steps.

These gaps increase risk—not only for patients A culture that prioritizes inspection, even under time con-

but also for the OR teams who rely on these

straints, protects everyone involved.

instruments every day.

Healthmark, A Getinge company / hmark.com / 800.521.6224

How Healthmark Supports Safer OR Outcomes

Me e tt

For more than five decades, Healthmark has focused on

he

uc Ed

helping healthcare teams deliver safe, reliable instrumentation

r ato

to the point of care. Healthmark combines education, process expertise, and innovative tools to address real-world risks like insulation failure.

Healthmark’s approach emphasizes: • Education-first implementation • Inspection solutions designed for repeatability and accuracy • Alignment with AAMI ST79 and evolving industry standards • Tools that support both sterile processing and OR confidence The McGan Insulation Testing system is part of this broader commitment, designed not simply to detect failures but to enable safer surgical environments through awareness, consistency, and collaboration.

Kevin Anderson BSN, RN, CSSM Emeritus, CRCST, CHL, CIS, CER Kevin Anderson is Senior Manager, Commercial Education Services for Healthmark, a Getinge company. He is a registered nurse (BSN) that

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completed his MBA in 2021. He also has multiple

Healthmark supports OR nurses and sterile processing teams

CHL, CIS, and CER.

certifications, including CSSM Emeritus, CRCST,

with education, inspection solutions, and expertise focused on instrument integrity and patient safety.

Before joining Healthmark, Kevin worked for 18 years in the acute care setting serving in various

To learn more about insulation testing best practices or

clinical and leadership capacities including clinical

Healthmark’s solutions, visit hmark.com or connect with a

coordinator of general surgery, operating room

Healthmark representative to continue the conversation.

manager and manager of sterile processing and endoscopy services. His sterile processing team

Scan to learn more about how the McGan Insulation Tester supports safer instrument inspections.

was recognized with IAHCSMM’s, (now HSPA), Confidence Builder Award for their outstanding quality improvement in 2018.

References: † Rojo, C. (2023, March/April). Findings of an internal auditing study of insulation testing practices to improve inspection, testing, and patient outcomes. Process.

Protect Staff & Patients. Pinpoint Insulation Flaws.

The McGan Insulation Tester helps you ensure safety, maintain compliance, and prevent costly failures — with accuracy you can trust.

hmark.com 800.521.6224

Identify hidden damage Detect cracks, pinholes, and insulation defects before they reach the OR.

Work with ease Lightweight, handheld design makes testing quick and simple anywhere.

Stay ahead of compliance Helps meet recommended standards for inspection and patient safety.

Scan to explore features and request a demo.

MYTH BUSTING

Cleaning Chemistries for OR & SPD Teams

Myth 1a All Enzymatic Cleaning Chemistries are the Same While enzymatic cleaning chemistries share general properties, their specific enzymes and formulation can vary significantly. The American National Standards Institute (ANSI) Association for the Advancement of Medical Instrumentation (AAMI) AAMI ST79:2017 Comprehensive guide to steam sterilization and sterility as-

Myth 1b Cost is the Only Differentiator Between Cleaning Chemistries

surance in health care facilities1 recommends selecting

Initial purchase price does not reflect total cost of use.

products validated for the types of soil encountered.

Factors such as dose efficiency, temperature require-

Proteins, lipids, and polysaccharides require different

ments, and material compatibility, as well as consider-

enzymatic activity(ies) for effective breakdown. Further-

ations for use among varied cleaning processes (manual,

more, formulation differences impact rinsability and

ultrasonic, and automated cleaning) influence long-term

material compatibility—key concerns for delicate and

cost. Chemistries that perform reliably over a broad tem-

complex instrumentation.

perature range reduce waste and energy use.

For example, XEN Enzymatic+2 includes a blend of en-

Cleaning chemistries designed for effective use across

zymes which target specific soil types targeted at mul-

variable manual cleaning and washer conditions (e.g.,

tiple soil types and has demonstrated effective protein,

XEN chemistries) minimize the need for exacting control

hemoglobin, and biofilm removal well below the AAMI

of wash parameters and potentially lower total repro-

ST79 limit in both internal and independent testing.

cessing costs.

1

Healthmark, A Getinge company / hmark.com / 800.521.6224

Myth 2

Myth 3

Dosing Ratios are Static After Washer Installation

More Detergent Equals Better Cleaning

According to AAMI ST108:2023 Water for the process-

Excess detergent does not result in better cleaning. In

ing of medical devices , key utility water characteristics,

fact, high concentrations of detergent can cause resi-

such as hardness and total dissolved solids (TDS), can

due, stains, and make rinsing more difficult. These issues

fluctuate based on municipal source changes. These

can compromise sterilization. AAMI ST791 emphasiz-

variations impact cleaning chemistry dilution, pH bal-

es the importance of thorough rinsing to remove left-

ance, and efficacy.

over chemicals. Therefore, it is critical to select cleaning

3

chemistries designed to work effectively at low doses Users must consider cleaning chemistries tested for ef-

to reduce waste and improve rinsing while still meeting

fectiveness across a range of water conditions to ensure

cleaning standards.

consistent results (even when utility inputs vary). Continued support after purchase—including education— should be an essential component of the pre-purchase evaluation process.

Myth 5

Myth 4 Once Implemented, Cleaning Chemistry is on Auto-Pilot

Point-of-Use Treatment (POUT) Requires Enzymatic Cleaning Chemistries.

Cleaning protocols, instrument types, and surgical case

AAMI ST791 emphasizes keeping soil moist from the

mix evolve over time. AAMI ST791 recommends periodic

point of use but does not mandate enzymatic action.

review of cleaning agents to ensure continued compat-

Surfactant-based pretreatment products (e.g., XEN Xcel-

ibility and effectiveness. Departments must take advan-

erate+2), can offer broader effective soil coverage and

tage of training and product updates to maintain best

reduce enzymatic residue risks—especially critical for

practices.

ophthalmic instrumentation. With a single product enabling proper point of use treatment (POUT) practices, the procedural staff are equipped with tools to set the sterile processing department (SPD) staff up for success.

Conclusion

Myths around cleaning chemistries can hinder progress in sterile processing.

By aligning with AAMI and AORN4 recommendations and evaluating product performance (through objective metrics), departments can make informed, sustainable choices.

Healthmark, A Getinge company / hmark.com / 800.521.6224

Ready to Rethink Your Reprocessing Chemistry?

Empower your team with the tools & knowledge to move beyond the myths XEN Cleaning Chemistries are engineered for performance, safety, and efficiency, designed to adapt to real-world conditions and support compliance with AAMI ST791 and ST1083 guidelines.

 Backed by testing  Effective across variable conditions  Supported by ongoing education hmark.com 800.521.6224

Request a trial of XEN Visit: hmark.com/xen-trial-request/

References 1. AAMI (2020). ANSI/AAMI ST79:2017 Comprehensive guide to steam sterilization and sterility assurance in health care facilities. Arlington, VA: Association for the Advancement of Medical Instrumentation.

2. Healthmark Industries. (2025). XEN Xcelerate+. Healthmark, A Getinge company. https://www.hmark.com/product/xen-enzymatic/ 3. AAMI (2023). ANSI/AAMI ST108:2023 Water for the processing of medical This article is intended for general informational purposes only and does

devices. Arlington, VA: Association for the Advancement of Medical Instrumen-

not constitute professional advice or guidance. Always refer to your facility’s

tation.

policies and procedures. Consult with appropriate experts or authorities when implementing changes to clinical practice. Always refer to the product

4. AORN. (2024). Guidelines for Perioperative Practice, Guideline for instrument

manufacturers’ instructions for use

cleaning. The Association of periOperative Registered Nurses. Denver, CO.

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Healthmark & Getinge believe by combining our strengths, we are positioned to better serve healthcare facilities moving forward into the future. We’re committed to providing innovative solutions, personalized implementation and best-in-class educational resources more than ever before. Together, we are striving to give you an unparalleled customer experience.

Scan to explore the benefits of our partnership. Discover how we’re redefining the customer experience to empower your facility.