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Journal of Perioperative Practice

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skin reaction, application should be stopped. Per applicator costs (ex VAT) ChloraPrep: 0.67ml (SEPP) 30p; 1.5ml (FREPP) - 55p; 1.5ml – 78p; 3ml – 85p; 10.5ml - £2.92; 26ml - £6.50 ChloraPrep with Tint: 3ml – 89p; 10.5ml £3.07; 26ml - £6.83 Legal category: GSL Marketing Authorisation Holder: CareFusion UK 244 Ltd, The Crescent, Jays Close, Basingstoke, Hampshire, RG22 4BS Date of preparation: May 2014 Adverse events should be reported. Reporting forms and information can be found at www. yellowcard.mhra.gov.uk. Adverse events should also be reported to CareFusion Freephone number: 0800 0437 546 or email: CareFusionGB@professionalinformation.co.uk References 1. Darouiche R et al. N Engl J Med 2010; 362: 18–26.

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Date of preparation: December 2015. 0000CF01915 Issue 3

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Journal of Perioperative Practice PROCUREMENT GUIDE May 2016 Volume 05 Issue 02 www.afpp.org.uk

Contents

Welcome to your May 2016 Guide 06 Continuing the fight in

reducing the risk of surgical site infections in the perioperative environment

12 Surgical site surveillance needs you

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Product News: Halyard sterilisation wrap, Richard Wolf ENDOCAM Flex, Teleflex

Journal of Perioperative Practice Procurement Guide information In print within the AfPP Journal of Perioperative Practice covering national AfPP members, but also with a dedicated print and e-distribution to supplies and purchasing managers.

July 2016 Consumables

Key Sectors: NHS Supply Chain, Independent Hospitals, Higher Education.

Medical Device Companies.

November 2016 Safety/Sharps Safety/ Patient Safety

Published 6 times a year we will focus on procurement issues in every edition as well as specialist subjects which for the following year include:

September 2016 Anaesthesia/Airway Management/Difficult Airways

January 2017 Patient Warming/ Patient Monitoring

Contact Information: Advertising, Sponsorship & Partner Packages.

Frances Murphy Account Manager Open Box M&C T: 0121 200 7820 E: frances.murphy@ob-mc.co.uk Editorial Chris Wiles Head of Publishing/Editorial AfPP T: 01423 882950 E: chris.wiles@afpp.org.uk

PR & press material.

All press releases welcome and we will feature as many as we can in each issue, all press releases need to be submitted to: Frances Murphy Account Manager Open Box M&C T: 0121 200 7820 E: frances.murphy@ob-mc.co.uk

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Infection Prevention

Continuing the fight in reducing the risk of surgical site infections in the perioperative environment Assessing risk has become part of the process of supporting patients and maintaining safety in the healthcare setting. The risk of healthcare associated infections (HCAIs) has long been well documented and surgical site infection (SSI) is recognised as one of the most prevalent (Tanner & Khan 2008, Wilson 2013a).

SSIs arise when sufficient microorganisms enter the surgical site to overwhelm the host’s natural defence mechanisms (PHE 2014). In the UK, the Health and Social Care Act 2008 Code of Practice for the prevention and control of HCAIs (DH 2015) emphasises the responsibility of care providers to make suitable and sufficient assessment of the risk to patients with respect to HCAIs. The National Patient Safety Agency (2004) also highlighted the importance of risk assessment when it published “Seven Steps to Patient Safety”.

These steps included the need to integrate risk-management activity and implement solutions to prevent harm. Throughout many healthcare facilities, including the perioperative area, many initiatives have been taken to reduce the harm arising as a result of HCAIs and in particular SSIs. In Scotland significant improvements in reducing HCAIs between 2003 and 2010 have been reported (Wilson 2013b).

Public Health England (2015) also reported a significant decrease in SSI incidence occurring following surgery for repair of neck of femur, between 2008 and 2014, and a decreasing trend for SSIs following gastric surgery. However the risks of SSIs are still a cause for concern (Srejic 2015). Health Protection Scotland (2013) and The Northern Ireland (NI) Public Health Agency (2014) report that while significant advances in infection control practices within

Health Protection Scotland (2013) and The Northern Ireland (NI) Public Health Agency (2014) report that while significant advances in infection control practices within operating rooms have been made, SSIs remain a substantial cause of morbidity and mortality.

operating rooms have been made, SSIs remain a substantial cause of morbidity and mortality.

Richmond (2009) cautions against complacency with regard to infection control practice within operating departments.

As part of the effort to reduce risks, staff must be able to identify and separate potential sources of infection (Pyrek 2002).

Understanding the chain of infection and how to implement strategies to disrupt this chain is imperative if the incidences of SSIs are to be reduced. This involves analysing how infectious agents can be transmitted, the susceptibility of patients to infection and the implementing of infection prevention and control precautions while continuing to provide for the individual’s healthcare needs.

There are six links to the chain including the causative agent, the reservoir of infection, portal of exit, mode of transmission, portal of entry and the susceptible host (Damani, 2010). At any time if a link in this chain is broken then the infection risk will be minimised.

Tanner and Khan (2008) and Wilson (2013a) outline a number of sources of SSI risks within the perioperative area to include the patient, the environment and the staff. Particular factors determining the infection risk in an operating suite are the duration and complexity of the surgical procedure itself, the number of

people in contact throughout, the patient’s state of health, such as pre-existing immune deficient conditions, and the nature of the microorganism and its route of transmission.

Not all the organisms cause HCAIs but most often responsible for SSIs are the patient’s endogenous flora and the bacteria most often associated with SSIs are Staphylococcus, Enterococcus and Escherichia coli (Owens & Stoessel 2008, Tanner & Khan 2008). According to Chen et al (2013) staphylococcus aureus is the most common organism responsible for SSIs. Staphylococcus aureus is a gram positive bacteria and can be frequently found as a commensal organism on the surface of human skin. Public Health England (2015) reports that staphylococcus aureus accounted for 13% of inpatient SSIs in 2014/15 following a decreasing trend from 2006. Methicillin-resistant S. aureus (MRSA) accounted for 25% of SSIs and had decreased markedly since 2006.

However Enterobacteriaceae SSIs increased from 2008 and accounted for 25% in 2014.

There are two identified routes of transmission of such microorganisms; through direct contact, or through indirect contact. Direct contact as the name implies consists of bodily contact with the bacteria and a physical transfer from the

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Journal of Perioperative Practice PROCUREMENT GUIDE May 2016 Volume 05 Issue 02 www.afpp.org.uk

>> infected source to the host.

Indirect contact occurs when an agent is carried from a reservoir (the source of infection) to a susceptible host without direct contact with the source.

In the operating environment there are many surfaces that can be contaminated with microorganisms such as dressing trolleys, door handles, keyboards, and soap dispensers (Pellowe 2007). Microorganisms can also be dispersed from contact with unsterile instruments, inadequately decontaminated endoscopes and surgical accessories.

Humphreys (2009) outlines three broad classifications of interventions in the control of SSIs to include interventions before surgery, during surgery and following surgery. In 2014 NICE reviewed the 2008

Infection Prevention infection control guidelines based on the latest available evidence and published recommendations for clinical practice for minimising risks to patients. The key elements of these revised guidelines are summarised under the headings of preoperative, intraoperative and postoperative phases.

Although the 2008 NICE guidelines recommended topical skin decontamination of staphylococcus aureus to routinely prevent surgical site infection the 2014 revised guidelines recommend that in the preoperative phase, patients who are undergoing planned surgery should be advised to shower or bathe with soap on the day before or day of surgery.

The removal of hair from the area of the operative site has

been a tradition but NICE (2014) does not recommend the routine removal of hair.

This is in line with earlier recommendations by Owens and Stoessel (2008) who suggest that hair removal should be avoided unless it might interfere with the surgical procedure. Tanner et al (2011) compared hair removal (shaving, clipping, or depilatory cream) with no hair removal and found no statistically significant difference in SSI rates. In cases where hair removal is necessary the current NICE recommendation is that this should be done with single use headed electric clippers and should be performed on the day of surgery. As in previous guidance, and guidance elsewhere, the use of razors is advised against

due to the risk of small incisions (Tanner & Khan 2008).

Although Kallen et al (2005) have claimed a reduction in SSI rates following nasal mupirocin application, the NICE 2014 guidance recommends against the routine use of such antimicrobial nasal decontamination preparations.

Anderson (2014) also highlights that it is now recognised that mechanical bowel preparation do not reduce the risk of SSI, this is reflected in the NICE guidelines which advises against the routine use of mechanical bowel preparation.

The use of prophylaxis antibiotics is also advised against in routine clean nonprosthetic uncomplicated surgery, but further detailed guidance in the use of antibiotics is given for various types of surgery.

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Journal of Perioperative Practice PROCUREMENT GUIDE May 2016 Volume 05 Issue 02 www.afpp.org.uk

The current NICE guidelines (2014) reiterate the importance of hand decontamination, recommending hand washing with antiseptic surgical solutions prior to the first operation and use of either alcoholic hand rub or antiseptic surgical solutions before subsequent operations.

The recommendations also suggest that skin at the surgical site should be prepared using an

The removal of hair from the area of the operative site has been a tradition but NICE (2014) does not recommend the routine removal of hair.

antiseptic solution. Solutions such as chlorhexidine gluconate in a 2% solution are effective against a wide variety of skinborne pathogens (Edmiston et al 2013).

Gloves protect against contact with infectious materials. NICE recommend the consideration of two pair of sterile gloves when there is a high risk of glove perforation. Cicconi et al (2010) argue that this practice reduces the risk of occupational exposures for healthcare workers and the risk of SSIs for patients. Al Maqbali (2014) reviewed a number of trials which compared single gloves with double gloves for numbers of perforations. There was some evidence that the use of double gloving reduces the risk of the innermost glove being perforated. However as

Al Maqbali (2014) highlight the longer duration of surgery, the bacteria count on the hands of surgical teams increases, as does the number of perforations.

Once contaminated, gloves can become a means for spreading micro-organisms.

The way gloves are used can influence the risk of infection transmission. Incorrect use of clinical gloves and failure to change them between procedures increases the risk of cross-transmission (Loveday et al 2014). Humphreys (2009) highlighted how compliance with preventative measures and guidance is often poor.

A Regulation and Quality Improvement Authority (RQIA) 2014 report of theatre practice in Northern Ireland Healthcare Trusts, found poor practice in the use of gloves with some

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Hand hygiene is the cornerstone of infection control and in both the preoperative and the intraoperative phase. Widespread guidance is available for the moments when hand hygiene should be performed and these include before performing invasive procedures and between procedures on the same patient where soiling of hands is likely to cause cross-contamination of body sites.

Infection Prevention

>>

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Journal of Perioperative Practice PROCUREMENT GUIDE May 2016 Volume 05 Issue 02 www.afpp.org.uk

>> staff failing to wash hands before or after donning gloves, and excessive use of gloves when there was no identifiable clinical need (RQIA 2014).

If gloves become torn or heavily soiled and additional patient care tasks must be performed, then change the gloves before starting the next task. Gloves should always be changed after use on each patient and be discarded in the appropriate receptacle.

Hand decontamination should also occur immediately after removing gloves.

The use of physical barriers, including incise drapes and sterile gowns, to reduce SSI is a long-standing practice in the operating environment.

The use of surgical incise drapes to protect the wound

Infection Prevention from organisms is one strategy used to prevent SSIs. They are considered to provide a sterile barrier to bacteria migrating to the wound and creating an SSI (Evans 2012). However there have been conflicting conclusions regarding their value with regard to reduction of SSIs. Webster and Alghamdi (2013) caution that there are conflicting results from nonrandomised studies about the efficacy of this approach, and that no systematic review has been conducted to date to guide clinical practice.

The antimicrobial efficacy of an iodine-impregnated incise drape against MRSA was evaluated in Casey et al ( 2015) who found that the iodine impregnated drape demonstrated high antimicrobial activity. The current NICE

guidelines recommend against the use of non-iodophor impregnated incise drapes for routine surgery. However the effectiveness of the use of such drapes may be affected by drape lift or drape pull-back from the wound edge allowing skin organisms to contaminate the wound (Evans 2012).

SSIs have been seen as a key performance indicator in the delivery of high quality care and will continue to be so. Adherence to the NICE guidance and to the latest evidence will help to minimise the risks. Ongoing surveillance and review of practice will play an important role in this fight but individual practitioners must also reflect on their own practice and identify risks of infections in the perioperative environment.

References Al Maqbali M 2014 Using double gloves in surgical procedures: a literature review British Journal of Nursing 23 (21) 1117 -1122 Anderson DJ 2014 Prevention of surgical site infection: beyond SCIP AORN Journal 99 (2) 315-319 Casey AL, Karpanen TJ, Nightingale P, Conway BR, Elliott TSJ 2015 Antimicrobial activity and skin permeation of iodine present in an iodine-impregnated surgical incise drape The Journal of Antimicrobial Chemotherapy 70 (8) 2255-60 Chen A, Wessel C, Rao N 2013 Staphylococcus Aureus

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Screening and Decolonization in Orthopaedic Surgery and Reduction of Surgical Site Infections Clinical Orthopaedics and Related Research 471 (7) 2383-2399 Cicconi L, Claypool M, Stevens W 2010 Prevention of Transmissible Infections in the Perioperative Setting AORN Journal 92 (5) 519-527 Damani N 2012 Manual of Infection Prevention and Control Oxford University Press: Oxford Department of Health 2015 The Health and Social Care Act 2008: code of practice on the prevention and control of infections and related guidance [online] https://www.gov.uk/ government/uploads/system/ uploads/attachment_data/ file/449049/Code_of_ practice_280715_acc.pdf [Accessed April 2016] Edmiston CE, Bruden B, Rucinski M, Henen C, Graham MB, Lewis 2013 Reducing the risk of surgical site infections: does chlorhexidine gluconate provide a risk reduction benefit?

American Journal of Infection Control 41 (5 Suppl) 49-55 Evans RP 2012 Incise drape adhesion and the adherence to principles of surgical site infection prevention Journal of Bone and Joint Surgery 94 (13) [online] http://jbjs. org/content/94/13/e99.long [Accessed April 2016] Gillespie BM, Kang E, Roberts S, Lin F, Morley N, Finigan T, Homer A, Chaboyer W 2015 Reducing the risk of surgical site infection using a multidisciplinary approach: an integrative review Journal of Multidisciplinary Healthcare 8 473–487 Health Protection Scotland 2013 Surgical Site infection surveillance protocol 6th edition NHS National Services Scotland [online] http://www.documents.hps.scot. nhs.uk/hai/sshaip/guidelines/ ssi/ssi-protocol-6th-edn/

Infection Prevention SSI-Protocol-6th-Edition.pdf [Accessed April 2016] Humphreys H 2009 Preventing surgical site infection. Where now? Journal of Hospital Infection 73 (4) 316-322 Kallen AJ, Wilson CT, Larson RJ 2005 Perioperative intranasal mupirocin for the prevention of surgical-site infections: systematic review of the literature and meta-analysis Infection Control Hospital Epidemiology 26 (12) 916–922 Loveday HP, Lynam S, Singleton J, Wilson J 2014 Clinical glove use: healthcare workers’ actions and perceptions Journal of Hospital Infection 86 (2)110-116 National Patient Safety Agency 2004 Seven steps to patient safety [online] http://www.nrls.npsa.nhs.uk/ EasySiteWeb/getresource. axd?AssetID=59971& [Accessed April 2016] National Institute for Health and Care Excellence 2014 Surgical site infections: prevention and treatment [CG74} (revised) [online] https://www.nice.org.uk/ guidance/cg74 [Accessed April 2016] Owens CD, Stoessel K 2008 Surgical site infections: epidemiology, microbiology and prevention Journal of Hospital Infection 70 (Suppl 2) 3-10 Pellowe C 2007 Standard Principles: Hospital Environmental Hygiene and Hand Hygiene Nursing Times 103 (26) [online] http://www.nursingtimes. net/nursing-practice/clinicalzones/infection-control/ standard-principles-hospitalenvironmental-hygiene-andhand-hygiene/291499.article [Accessed April 2016] Public Health Agency (Northern Ireland) 2014 Surgical site infection surveillance protocol [online] http://www.publichealth. hscni.net/sites/default/files/

directorates/files/Generic_ SSI%20MANUAL_v2014_1.pdf [Accessed April 2016] Public Health England 2014 Surgical site infection (SSI: guidance, data and analysis) [online] https://www.gov. uk/government/collections/ surgical-site-infection-ssiguidance-data-and-analysis [Accessed April 2016] Public Health England 2015 Surgical site infections surveillance: NHS hospitals in England, 2014/15 London, Public Health England [online] https://www.gov.uk/ government/publications/ surgical-site-infections-ssisurveillance-nhs-hospitals-inengland [Accessed April 2016] Pyrek K 2002 Breaking the Chain of Infection Infection Control Today [online] http://www. infectioncontroltoday.com/ articles/2002/07/breakingthe-chain-of-infection.aspx [Accessed April 2016] Regulation and Quality Improvement Authority 2014 Review of theatre practice in Health and Social Care Trusts in Northern Ireland [online] http://www.rqia.org.uk/ cms_resources/RQIA_Theatre_ Overview_Report_Final_Web_ Version_ISBN.pdf [Accessed April 2016] Richmond S 2009 Minimising the risk of infection in the operating department: a review for practice Journal of Perioperative Practice 19 (4) 142-146 Srejic E 2015 Standard Precautions the Cornerstone of Effective Care Infection Control Today [online] http:// www.infectioncontroltoday. com/articles/2015/04/ standard-precautions-thecornerstone-of-effective-care. aspx [Accessed April 2016] Tanner J, Khan D 2008 Surgical site infection,

preoperative body washing and hair removal Journal of Perioperative Practice 18 (6) 232-242 Tanner J, Norrie P, Melen K 2011 Preoperative hair removal to reduce surgical site infection Cochrane Database of Systematic Reviews Nov 9 (11) CD004122. doi: 10.1002/14651858.CD004122. pub4.

Todar K 2014 Online Textbook of Bacteriology: Staphylococcus aureus and Staphylococcal Disease [online] http:// textbookofbacteriology.net/ staph.html [Accessed April 2016] Webster J, Alghaamdi A 2014 Use of plastic adhesive drapes during surgery for preventing surgical site infection Cochrane Database of Systematic Reviews, 2013, Issue 1 Wilson, J 2013a Surgical site infection: the principles and practice of surveillance: part 2: analyzing and interpreting data Journal of Infection Prevention 14 (6)198-202 Wilson J 2013b Surgical site infection surveillance: a Scottish perspective (20032010) Journal of infection prevention 14 (1) 20-25

Laurence Leonard Lecturer, School of Nursing and Midwifery, Queens University Belfast

Surgical Care 12

Journal of Perioperative Practice PROCUREMENT GUIDE May 2016 Volume 05 Issue 02 www.afpp.org.uk

Surgical site surveillance needs you One of the benefits of employing a surgical care practitioner as a permanent member of a consultant led extended surgical team is being able to ask them to undertake long term departmental projects.

When not in theatres acting as a non-medical surgical assistant, I become the department’s surgical site surveillance nurse (SSSN). This role commenced in 2001, by managing an SSS orthopaedic pilot site (Hogg et al 2005) which helped to re-establish mandatory orthopaedic surgical site surveillance: • Just how many of our orthopaedic patient operations end up with a deep wound infection, lose their joint replacement, limb or even life?

Surgical site surveillance is now managed nationally through Public Health England’s: Surgical site infection surveillance service (PHE 2014), which provides surgical site infection guidance, data and analysis.

PHE helps hospitals record incidents of surgical site infection, to help improve surgical practice and prevent further infections (PHE 2015).

The categories are: • hip replacements • knee replacements • repair of neck of femur • reduction of long bone fracture

• A surgical site is the incision or cut in the skin made by a surgeon to carry out a surgical procedure and the tissue handled or manipulated during the procedure.

• A surgical site infection occurs when microorganisms get into the part of the body that has been operated on and multiply in the tissues.

• PHE helps hospitals record incidents of surgical site infection (SSI), to help improve surgical practice and prevent further infections.

Voluntary surveillance The surveillance service records infections in other categories of procedures including:

Mandatory surveillance Surveillance of infections in these procedures started in April 2004, specifying that each trust should conduct surveillance for at least one orthopaedic category for one period in the financial year.

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Yet this activity is essential as just the start of a chain of data collection on perioperative care (NICE 2008, 2013) and surgical interventions undertaken (NJR 2016) by multidisciplary teams (PHE 2015), which can affect your patient’s life in a positive or negative manner.

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Journal of Perioperative Practice PROCUREMENT GUIDE May 2016 Volume 05 Issue 02 www.afpp.org.uk

Surgical Care 13

Here we share some of our concerns regarding the resources available nationally to support orthopaedic SSS activity (Figure 1).

Challenge 1. Do you know what your surgical speciality surgical site infection rate was for last year?

2. Have you ever attended your department’s monthly morbidity and mortality governance meeting to find out?

3. When was the last time you spoke to a patient, you had cared for in theatres, on the ward, to ask how they were?

Prof Judith Tanner, a leading SSI research commentator on this subject said recently; “Ultimately, it is about the profile of surgical site infections. The scale of the problem is being massively underestimated. We are not going to move forward if SSI rates continue to be underreported and if patients and staff are unaware.”

(Frampton 2016)

Thought for today!

“Even in a safety first culture which seeks to meet balance care of the patient, service and education outcomes, it appears that all staff need to develop high person standards which move form an observed position of ‘They just do not care!’ to one of performance parameters that exist across professional groups. This the writer believes can only truly exist when full engagement of all members exist, sating with the captain of the ship – The consultant in charge of the patient, who what ever the rest of us think including some trust executive officers, bears the ultimate responsibility of patient care.”

(Anonymous)

Figure 1: Orthopaedic surgical site infection surveillance: national audit of current practice by E Tissingh, A Sudlow, A Jones and Mr JF Nolan

Surgical Care 14

Journal of Perioperative Practice PROCUREMENT GUIDE May 2016 Volume 05 Issue 02 www.afpp.org.uk

>> References and further reading Hogg S, Baird N, Richards J, Hughes S, Nolan J, Jones A, Holmes A 2005 Developing surgical site infection surveillance within clinical governance Clinical Governance: An International Journal 10 (1) 24-36 Frampton L 2016 Raising the profile of surgical site infection The Clinical Services Journal February issue 55-58 National Institute for Health and Care Excellence 2008 Surgical site infections: prevention and treatment [online] https://www. nice.org.uk/guidance/cg74 [Accessed April 2016]

National Institute for health and Care Excellence 2013 Surgical site infection: Evidence Update June 2013 [online] https://www.nice.org. uk/guidance/cg74/evidence/ evidence-update-241969645 [Accessed April 2016] National Joint Register 2016 Surgeon Hospital Profile [online] http://www. njrsurgeonhospitalprofile.org.uk [Accessed April 2016] Public Health England 2014 Surgical site infection (SSI): guidance, data and analysis Surgical Site Infection Surveillance Service (SSISS) [online] https:// www.gov.uk/government/ collections/surgical-site-infectionssi-guidance-data-and-analysis [Accessed April 2016]

Public Health England 2015 Surveillance of Surgical Site Infections in NHS Hospitals in England 2014/15 [online] www.gov.uk/government/ uploads/system/uploads/ attachment_data/file/484874/ Surveillance_of_Surgical_Site_ Infections_in_NHS_Hospitals_ in_England_report_2014-15.pdf [Accessed April 2016] Tanner j, Padley W, Kiernan M, Leaper D, Norrie P, Baggott R 2013 A benchmark too far: findings from a national survey of surgical site infection surveillance The Journal of Hospital Infection 83 (2) 87-91 Toms et al 2015 Do you have an infection problem? Bone Joint Journal 97-B:1170–4.

Adrian Jones RN, SCP Orthopaedic Surgical Care Practitioner, Norfolk & Norwich University Hospitals NHS Foundation Trust Vice President, The Association for Perioperative Practice, Harrogate

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Journal of Perioperative Practice PROCUREMENT GUIDE May 2016 Volume 05 Issue 02 www.afpp.org.uk

Halyard sterilisation wrap New scientific study using a dynamic bioaerosol test method demonstrates 0% of instrument trays wrapped in Halyard* sterilisation wrap had detectable contamination1.

According to a new scientific study published in the December publication of the American Journal of Infection Control (AJIC), 100 percent of tested sterilized instrument trays wrapped in HALYARD* sterilisation wrap were free from ingress of aerosolized bacteria under the test conditions used.

The study was conducted by ARA, an independent microbiology laboratory in Florida and was funded by Halyard Health.

Halyard Health, formerly part of Kimberly-Clark, is a medical

technology company focused on preventing infection, eliminating pain and speeding recovery. Halyard Health’s clinically-superior products and remarkable service help to advance health and healthcare worldwide. For more information, visit www.halyardhealth.co.uk Reference 1. Shaffer H, Harnish D, McDonald M, Vernon R, Heimbuch B. Sterility maintenance study: Dynamic evaluation of sterilized rigid containers and wrapped instrument trays to prevent bacterial ingress. Am J Infect Control 2015 Dec 43 (12)1336-41

Richard Wolf ENDOCAM Flex Richard Wolf UK Ltd is proud to announce the arrival of the ENDOCAM Flex range; a portfolio that offers compact, cost-effective solutions across all specialities. For more information, please scan the advertisement or take a look at www.endocamflex.com With ENDOCAM Flex, there is a focus on affordability and versatility with no compromise in quality.

With ENDOCAM Flex, endoscopy is accessible to for wider clinical application.

With ENDOCAM Flex, endoscopy may be performed in A&E, ITU, CCU, HDU, OPD, clinics and consulting rooms.

How can a 2.9mm device deliver 5mm performance?

Percutaneous insertion!

With just a 2.9 mm shaft, Percuvance Percutaneous Surgical System from Teleflex has been engineered to reduce trauma for your patients, maintaining the performance of a 5 mm laparoscopic device.

Percuvance introduces a breakthrough form of minimally invasive surgery: percutaneous laparoscopy.

Using this approach, laparoscopic devices can enter through a small skin incision without trocars.

Your patients benefit from reduced trauma. You get the

versatility and strength of a traditional laparoscopic device.

With the Percuvance System, minimally invasive surgery has now been reimagined– making it even less invasive.

Mob: +44 (0)7739 628969 Tel: +44 (0)1494 532761 Email: ian.mellors@teleflex.com Web: www.teleflex.com Teleflex, Grosvenor House, Horseshoe Crescent, Old Town Beaconsfield, Buckinghamshire HP9 1LJ

Product News 18

Journal of Perioperative Practice PROCUREMENT GUIDE May 2016 Volume 05 Issue 02 www.afpp.org.uk

PROACT

PROACT Medical Present the Creative PC-900B.

The Creative PC-900B is a compact handheld Capnograph and Pulse Oximeter offering extremely easy to use technology, with bright clear displays and full user adjustable alarms.

• Creatives Variable Flow (50-250ml/min) Sidestream Technology allows it to be used for intubated and non-intubated patients and low flow sample lines • Monitors EtCO2/FiCO2, RR, SpO2 and PR • The adjustable pump flow rate allows it to be optimised for both Adult and Infant patients.

• The device can store and display up to 24 hours of graphic and tabular trend even after it has been powered off and downloads to free PC reporting software Please contact us for further information.

PROACT MEDICAL Tel: 01536 461981 Email: sales@proactmedical.co.uk

UK manufacturer and repairer of surgical instruments

Contact us now for details on improving the cleaning efficacy of your instruments.

Refurbishment reduces protein adhesion by improving surface finish.

before

TiN & DLC coatings improve anti-fouling properties.

Basket fixation solutions provide better presentation to the washers.

Containers ensure sealed sterility up to moment of use.

Tel: 01702 602050 Email: info@surgicalholdings.co.uk www.surgicalholdings.co.uk

after

Product News 19

Journal of Perioperative Practice PROCUREMENT GUIDE May 2016 Volume 05 Issue 02 www.afpp.org.uk

Detergent choice from schülke gigasan® ND from schülke is the latest addition to the extensive range of disinfectants and detergents from schülke, which is designed to offer choice, convenience and cost savings. gigasan ND is a non-enzymatic neutral detergent for the manual cleaning of medical and surgical instruments, including endoscopes and endoscopy equipment. Because of the ultra- concentrated formulation a 5 litre container of gigasan ND can be diluted into 12,500 litres of in-use solution. This makes gigasan ND a highly cost effective neutral detergent and also saves on storage space.

If an enzymatic detergent is preferred, gigazyme® contains enzymes and surfactants for optimum cleaning performance. gigazyme is available in both 2 litre and 5 litre pack sizes.

Whether gigasan ND or gigazyme is used, gigazyme® ready-to-use spray foam can be used for the immediate pre-cleaning and disinfection of surgical instruments, including flexible endoscopes. gigazyme spray foam includes three different enzymes for cleaning and disinfection and is designed to keep soiled instruments moist for a prolonged period of time.

Tel: 0114 254 3500 Email: mail.uk@schuelke.com Web: www.schulke.co.uk schülke UK Ltd, Cygnet House, 1 Jenkin Road, Meadowhall, Sheffield S9 1AT

For alveolar bone graft use a single-use Bone Trephine Award-winning UK manufacturer of innovative and high quality single-use surgical instruments DTR Medical, offer their new sterile single-use Bone Trephine as an innovative solution for bone grafts including paediatric cleft surgery.

The sterile single-use Bone Trephine has equivalent quality of a reusable instrument but with the advantage of providing first time sharpness to enable a good harvest to be taken and without the risk of cross contamination.

Designed for use with a T-Handle and Jacob’s chuck, the Bone Trephine has an 8mm internal diameter with a 9mm barrel depth and an overall length of 49mm, and is supplied in a procedure pack with a scalpel to aid bone removal.

A user of the single-use Bone Trephine, Consultant Surgeon, Alistair RM Cobb, UK Cleft Service agrees that the Bone Trephine is less invasive than its reusable counterparts “…

Patients are up and walking the same day after surgery”.

For more information contact: DTR Medical Tel: +44 (0)1792 797 910 Email: info@dtrmedical.com Web: www.dtrmedical.com

Avoiding Waste with Customised Packs Our customised packs of sterile single-use medical instruments and consumables are designed around your specific needs, avoiding unnecessary waste and cost.

We offer a wide selection of medical instruments – contact us to discuss your needs and we will send you, free of charge, a sample non-sterile customised pack.

We carry a huge stock of instruments and provide EtO sterilisation, Class 7 cleanroom packing and global distribution from our UK facility, guaranteeing a rapid turnaround on orders*.

Contact Yvonne Valentine, Operations Director, for more details.

call: +44 (0) 1284 750762 email: sales@disposablemedicalinstruments.co.uk visit: www.disposablemedicalinstruments.co.uk DMI Ltd, 15A Hillside Business Park, Kempson Way, Bury St Edmunds, Suffolk IP32 7EA *Minimum order: 100 packs