JPP PG May 2017 (Vol:06 Issue:02)

Journal of Perioperative Practice

PROCUREMENT GUIDE May 2017 Volume 06 Issue 02 01423 881300 www.afpp.org.uk

01423 881300 www.afpp.org.uk

SURGICAL

DO YOU KNOW THE EXACT TEMPERATURE OF YOUR IRRIGATION FLUID? Even mild hypothermia (36ºC) can increase post-anaesthesia recovery time, blood loss and morbid cardiac outcomes, and lengthen hospital stays.2

Are you putting your patients at risk?

The new IntraTemp™ Fluid Warming System from Ecolab prevents this risk by taking the guesswork out of irrigation fluid temperatures.

1. National Institute of Clinical Excellence (NICE) clinical guideline 65, Inadvertent perioperative hypothermia, April 2008 2. Association of Perioperative Registered Nurses (AORN) Recommended practices for the prevention of unplanned perioperative hypothermia. AORN J. 2007 May; 85(5): 972-988

ECOLAB HEALTHCARE Lotherton Way, Garforth, Leeds LS25 2JY, UK 0113 232 2480

© Ecolab 2014 6828/10.14

IntraTemp™

36ºC NICE AND AORN SUPPORT THE USE OF WARM IRRIGATION FLUID (NEAR 37ºC) TO DECREASE HEAT LOSS 1,2

FLUID TEMPERATURE DROPS BY 1ºC PER MINUTE AFTER REMOVAL FROM WARMING CABINET

NOT KNOWING THE EXACT FLUID TEMPERATURE AT TIME OF USE JEOPARDISES PATIENT SAFETY

FOR FURTHER DETAILS ABOUT THE INTRATEMP SYSTEM CALL ALISON ON 0113 232 2480

www.ecolab.co.uk

03

Journal of Perioperative Practice PROCUREMENT GUIDE May 2017 Volume 06 Issue 02 www.afpp.org.uk

Contents

Welcome to your May 2017 Guide 04 Infection prevention for procurement within a surgical setting

08 A novel device for preoperative skin preparation

11-14 Product News: 11 Elite disposable drapes 12 VIO3 from Erbe - “plug and operate”

13 desderman® pure hand rub from schülke

14 Vacsax Ltd Suction

Liner Products with Antimicrobial Protection

14 Bailey Instruments Ltd

launch their new Elastic Stay Retraction Kit for ENT and Micro Suction Range

15 News: WHO recommends 29 ways to stop surgical infections and avoid superbugs

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 2017 Consumables/Patient Trolleys

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

Medical Device Companies.

November 2017 Sharps Safety/Patient Safety/ Swabs Safety/Patient Handling Equipment

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:

January 2018 Patient Warming/ Patient Monitoring

September 2017 Airway Management/Difficult Airways/Anaesthesia

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

04

Journal of Perioperative Practice PROCUREMENT GUIDE May 2017 Volume 06 Issue 02 www.afpp.org.uk

Infection Prevention

Infection prevention for procurement within a surgical setting Infection prevention and control is an important issue for patients, staff and public alike. In 2011 The Chief Medical Officer (CMO) described a future where we will not be able to treat a simple surgical site infection (SSI) and many new treatments will be vulnerable to failure due to ineffective antibiotic prophylaxis (DH 2013a).

In 2013 the anti-microbial five year strategy was published underlining the importance of infection prevention practice in clinical care (DH 2013b).

SSI is a healthcare associated infection that can affect 5% of all patients undergoing a surgical procedure (Smyth et al 2008). The costs to patient and hospital alike are significant. A simple SSI can cost £3,000, may double the length of inpatient care and hugely affect quality of life (Kirkland et al 1999, Plowman et al 1999, Whitehouse et al 2002, Coello et al 2005).

The opportunities to prevent SSI are multi-faceted (NICE 2008a, NICE 2008b, Loveday et al 2014, WHO 2016).

Certain products facilitate practice that we know will influence the risk of SSI and so the relationship between procurement, infection prevention staff and theatre department must see this as a central objective in their decision making process.

How procurement fits in to this picture Understanding roles across the procurement process is vital for success in mitigating the risk of SSI and

A simple SSI can cost £3,000, may double the length of inpatient care and hugely affect quality of life (Kirkland et al 1999, Plowman et al 1999, Whitehouse et al 2002, Coello et al 2005).

contributing to prolonging the durability of the current available antibiotics.

The relationship between surgery, infection prevention and procurement must be able to support decisions that are mindful of the risk of SSI. Cost saving, is essential but must not in any way support pushing costs further down the patient journey in the development of infection.

The process of surgery is in itself a high risk activity and

Surgical procedure

as well as the obvious potential for contamination, the effects of anaesthetic also create physiological responses that reduce an individual’s response to combat infection. Equally other invasive procedures that support surgery carry a risk of contributing to a risk of infection, for example intravenous therapy.

The following table highlights products of importance in supporting practice that can achieve an irreducible level of SSI risk for the patient.

Anaesthetic support

All implants Sterile instruments (from an accredited provider of sterile services)

Products that Maintain normothermia throughout the entire surgical journey

Personal protective equipment used throughout the procedure: sterile gloves, surgical face masks, sterile scrub suits, respirator

Any intravascular device

Skin disinfection products that are used immediately prior to incision and for surgical hand scrub

Mechanical ventilation device

Sterile drapes Closure material Drainage systems

>>

p=0.02

Incidence of SSIs (% of patients)

Incidence of SSIs (% of patients)

8

p=0.02 7.3

8 6

7.3

6 4

4 2

4.0

4.0

2 0

0

Alcoholic povidone iodine (n=575) ChloraPrep (n=572)

2% CHG / 70% IPA didn’t 2% CHG / 70% IPA didn’t deliver a 45% reduction deliver 45% reduction TM did in SSIs: aChloraPrep TM

did in SSIs: ChloraPrep Preparing patients for caesarean delivery

with ChloraPrep cut for SSIscaesarean by almostdelivery half, Preparing patients 1 compared with alcoholic iodine with ChloraPrep cut SSIspovidone by almost half, compared with alcoholic povidone iodine1

Alcoholic povidone iodine (n=575) ChloraPrep (n=572) Prescribing Information ChloraPrep® & ChloraPrep with Tint 2% chlorhexidine gluconate w/v / 70% isopropyl alcohol v/v cutaneous solution. Refer to the Summary of Product Characteristics before prescribing.

Presentation: ChloraPrep – each applicator contains 0.67ml, 1.5ml, 3ml, 10.5ml or 26ml of 20 mg/ ml chlorhexidine & 0.70 ml/ml isopropyl alcohol; ChloraPrep with Tint – each applicator contains Prescribing Information ® 3ml, 10.5ml or 26ml with of 20Tint mg/ml 0.70 ml/ml alcohol. alcohol Indication: & ChloraPrep 2% chlorhexidine chlorhexidine &gluconate w/visopropyl / 70% isopropyl v/v ChloraPrep Disinfection of skin priortoto invasive medical of procedures. & administration: Applicator cutaneous solution.

Refer the Summary Product Dosage Characteristics before prescribing. volume dependent on –invasive procedurecontains being undertaken.

May 3ml, be used for all age groups and Presentation: ChloraPrep each applicator 0.67ml, 1.5ml, 10.5ml or 26ml of 20 mg/ patient populations.

Use with care inalcohol; newborn babies and those prematurely. ml chlorhexidine & 0.70 ml/ml isopropyl ChloraPrep with Tint born – each applicatorApplicator contains squeezedorto26ml break of ampoule and release antiseptic&solution onto sponge.

Solution applied by gently 3ml, 10.5ml 20 mg/ml chlorhexidine 0.70 ml/ml isopropyl alcohol.

Indication: pressingofsponge against and moving and forth for 30 seconds.

The area coveredApplicator should be Disinfection skin prior to skin invasive medicalback procedures.

Dosage & administration: allowed to air dry. Contra-indications: Patients with known hypersensitivity to ChloraPrep or volume dependent on invasive procedure being undertaken. May be used for all age groups and ChloraPrep with Tint or any of its components, especially those with a history of possible patient populations. Use with care in newborn babies and those born prematurely. Applicator Chlorhexidine-related allergic reactions. Warnings and precautions: Solution is flammable. Do not squeezed to break ampoule release onto sponge.allow Solution applied by gently use with ignition sourcesand until dry. Doantiseptic not use insolution excessive quantities, to pool in patient skin pressing sponge against skin andinmoving forth for 30Remove seconds.any Thesoaked area covered should be folds or drip on materials contactback withand patient skin. materials before allowed to air dry.

Contra-indications: Patients with known hypersensitivity to ChloraPrep proceeding with the intervention. Ensure no excess product is present prior to application or of ChloraPrep with Tint or of its history of orpossible occlusive dressing.

Forany external usecomponents, only on intact especially skin, do notthose use onwith openaskin wounds broken Chlorhexidine-related allergic reactions.

Warnings and precautions: Solution is flammable.

Do not or damaged skin. Over-vigorous use on fragile or sensitive skin or repeated use may lead to local skin use with ignition sources until dry. not use in excessive quantities, allow membranes, to pool in patient reactions.

Avoid prolonged skinDo contact.

Avoid contact with eyes, mucous middleskin ear folds and or drip ontissue. materials in contact skin. Remove anygeneralised soaked materials before neural Chlorhexidine may with inducepatient hypersensitivity, including allergic reactions proceeding with the shock. intervention.

Ensure no excess present prior application of and anaphylactic May cause chemical burns inproduct neonates,iswith a higher risktoin preterm infants occlusive external useofonly intact skin,&dolactation: not use on open skin or broken and dressing. within theForfirst 2 weeks life.onPregnancy Although no wounds studies have been Very conducted, effects are anticipated as systemic exposure or damaged skin.no Over-vigorous use on fragile or sensitive skinisornegligible. repeated Undesirable use may leadeffects: to local skin allergicprolonged or irritation skincontact. reactions to chlorhexidine, alcoholmembranes, or sunset yellow (E110, rare; Avoid reactions. skin Avoid contact withisopropyl eyes, mucous middle ear present in ChloraPrep with Tint including erythema,including rash, pruritus and blisters or application and neural tissue.

Chlorhexidine mayonly), induce hypersensitivity, generalised allergic reactions site vesicles,shock. other local have burns included skin burning sensation, and inflammation. and anaphylactic May symptoms cause chemical in neonates, with a higherpain risk in preterm infants

and within the first 2 weeks of life. Pregnancy & lactation: Although no studies have been

Frequency not known; hypersensitivity including anaphylactic shock, dermatitis, eczema, urticaria, chemical burns in neonates. Discontinue use at the first sign of local skin reaction. 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: Marketing Authorisation Numbers: ChloraPrep, PL31760/0004 ChloraPrep Frequency GSL. not known; hypersensitivity including anaphylactic shock, dermatitis,&eczema, urticaria, with Tint, PL31760-0001.

Marketing Authorisation CareFusion UK 244 Ltd, ThePer Crescent, chemical burns in neonates.

Discontinue use at theHolder: first sign of local skin reaction. applicator Jays Basingstoke, Hampshire, RG22 4BS.–Date Preparation: 2016.– 78p; 3ml – 85p; costsClose, (ex VAT) ChloraPrep: 0.67ml (SEPP) 30p;of1.5ml (FREPP) February – 55p; 1.5ml 10.5ml – £2.92; 26ml – £6.50. ChloraPrep with Tint: 3ml – 89p; 10.5ml – £3.07; 26ml – £6.83. Legal ReportingGSL. suspected adverse reactions is important monitor thePL31760/0004 benefit/risk balance category: Marketing Authorisation Numbers:toChloraPrep, & ChloraPrep of the product.

ReportingAuthorisation forms and information can be found www.mhra. with Tint,medicinal PL31760-0001.

Marketing Holder: CareFusion UK at 244 Ltd, The Crescent, gov.uk/yellowcard. Adverse events should also be reported to CareFusion Freephone Jays Close, Basingstoke, Hampshire, RG22 4BS. Date of Preparation: February 2016. number: 0800 0437 546 or email: CareFusionGB@professionalinformation.co.uk

adverse reactions is important toand monitor the benefit/risk balance © Reporting 2016 BD. BDsuspected and BD Logo are property of Becton, Dickinson Company.

ChloraPrep logo is of the medicinal Reporting forms and information can be found at www.mhra. registered trademarkproduct. of CareFusion Corporation. gov.uk/yellowcard. Adverse events should also be reported to CareFusion Freephone

number: 0800 546 email: CareFusionGB@professionalinformation.co.uk al.or N Engl J Med 2016; 374(7): 647-55.

Reference: 1. Tuuli0437 MG et

© 2016 BD. BD andgluconate BD Logo are property of Becton, Dickinson and Company. ChloraPrep logo is CHG: chlorhexidine registered trademark IPA: isopropyl alcohol of CareFusion Corporation.

SSI: surgical site infection Reference: 1. Tuuli MG et al. N Engl J Med 2016; 374(7): 647-55.

CHG: chlorhexidine gluconate

0000CF02997 1 IPA: isopropylIssue alcohol Date of preparation: November 2016 SSI: surgical site infection

06

Journal of Perioperative Practice PROCUREMENT GUIDE May 2017 Volume 06 Issue 02 www.afpp.org.uk

>>

Conclusion In summary as a rule of thumb the closer the activity to the patient the greater the risk of infection, consequently as the risk of infection reduces, the opportunities to reduce expenditure may be greater.

However, crucial to delivering and supporting effective and efficient care is the cohesion between procurement, infection prevention and clinical end users. As we experience amazing advances in surgery complacency may be the biggest risk. Acknowledging and understanding the risk of infection, its potential in surgery to decrease the success antibiotics have allowed us to achieve, must be at the forefront of product choice in an area of such high risk.

Infection Prevention

The relationship between surgery, infection prevention and procurement must be able to support decisions that are mindful of the risk of SSI. Cost saving, is essential but must not in any way support pushing costs further down the patient journey in the development of infection.

References Coello R, Charlett A, Wilson J et al 2005 Adverse impact of surgical site infections in English hospitals Journal of Hospital Infection 60 (2) 93–103 Department of Health 2013a Chief Medical Officer Annual Report 2011, Volume Two, Infections and the rise of antimicrobial resistance Online: https://www.gov.uk/ government/publications/ chief-medical-officerannual-report-volume-2 [Accessed March 2017] Department of Health 2013b UK 5 Year Antimicrobial Resistance Strategy, 2013 to 2018 Online: www.gov. uk/dh https://www.gov.uk/ government/publications/ uk-5-year-antimicrobialresistance-strategy-2013to-2018 [Accessed March 2017] Kirkland KB, Briggs JP, Trivette SL et al 1999 The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs Infection Control and Hospital Epidemiology 20 (11) 725–730 Loveday HP, Wilson JA, Pratt RJ et al 2014 epic3: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England Journal of Hospital Infection 86 (Supp 1) S1–S70 National Institute for Health and Care Excellence 2008a (updated 2017) Surgical site infections: prevention and treatment CG74 Online: https://www.nice. org.uk/guidance/CG74 [Accessed March 2017]

National Institute for Health and Care Excellence 2008b (updated 2016) Hypothermia: prevention and management in adults having surgery CG65 Online: https://www. nice.org.uk/guidance/ cg65?unlid=1416801292016 1492931 [Accessed March 2017] Plowman R, Graves N, Griffin M et al 1999 The socioeconomic burden of hospital acquired infection London, Public Health Laboratory Service Smyth ET, McIlvenny G, Enstone JE et al 2008 Four Country Healthcare Associated Infection Prevalence Survey 2006: Overview of the results Journal of Hospital Infection 69 (3) 230–248 Whitehouse JD, Friedman ND, Kirkland KB et al 2002 The impact of surgicalsite infections following orthopaedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay, and extra cost Infection Control and Hospital Epidemiology 23 (4)183–189 World Health Organization 2016 Global Guidelines for the Prevention of Surgical Site Infection Online: http://www.who.int/gpsc/ ssi-prevention-guidelines/en/ [Accessed March 2017] Kat Topley Clinical Efficiency Manager Infection Prevention Division, UK and Ireland 3M United Kingdom PLC

WORKING WITH YOU Cupboard Trolleys available with UN 3291 approval for transportation of clinical waste.

188 page procurement catalogue available.

Packed full of specialist storage solutions including: HTM 71 Storage Trolleys | Trays | Racking | Cupboard Trolleys Tel. 01908 641118 | Email. medicalsystems@zarges.co.uk | Web. zarges-medical.co.uk

08

Journal of Perioperative Practice PROCUREMENT GUIDE May 2017 Volume 06 Issue 02 www.afpp.org.uk

Infection Prevention

A novel device for preoperative skin preparation*

* This is an abridged and edited version of: Webb J, Hilliam R, Bainbridge LC. A Novel Device for Preoperative Skin Preparation - Journal of Perioperative Practice, (in press subject to review).

Surgical site infections (SSIs) can increase management costs and extend length of stay. We undertook a single blinded non-inferiority trial to evaluate the efficacy and utility of a novel system for preoperative limb antisepsis.

Surgical site infection (SSI) can result in longer hospital stay, antibiotic usage, repeat surgery, and with orthopaedic implants amputation or death.

Interventions to prevent SSI include laminar flow theatres, scrub suits, hoods, masks, water-proof disposable drapes (Jacobson et al 2005), extraction systems (Wong & Leung 2004) and skin disinfection (Mackenzie 1988).

Skin disinfectant solutions in use in the UK are iodophore, povidone-iodine and chlorhexidine gluconate (Lilly & Lowbury 1971). Hardin and Nichols (1997) suggest skin disinfections should: • be bactericidal and viricidal • be non-toxic and hypoallergenic • be non-absorbable • have residual activity While there is no validated evidence which suggests that preoperative skin antisepsis reduces postoperative wound infection rates (Dumville et al 2015), it is accepted that the source of most SSI in clean elective cases is the patients’ skin microbial flora (Altemeir et al 1968). In addition, no antiseptic kills more than 80% of the initial bacterial load (Selwyn & Ellis 1972) as surface application fails to reach bacteria within hair follicles and other skin appendages,

although repeated applications are thought to have a cumulative action (Hardin & Nichols 1997).

During preoperative disinfection, the limb is ‘painted’ using a sponge or gauze square in a sponge-holding forceps whilst a non-scrubbed staff member lifts it, which may cause back and shoulder injury. If a tourniquet is used, a guard is required to prevent seepage of alcohol containing antiseptic (Ellanti & Hurson 2015, Dickinson & Bailey 1988).

We therefore designed a sealed system which includes a tourniquet guard and a standard portal to instil antiseptic.

Applied prior to induction of anaesthesia, it allows the patient to be involved thereby reducing lifting requirements.

No antiseptic kills more than 80% of the initial bacterial load (Selwyn & Ellis 1972) as surface application fails to reach bacteria within hair follicles and other skin appendages.

It is applied sock-like to the distal edge of the tourniquet and 50ml of antiseptic instilled; the limb remains in contact with the antiseptic until its sleeve is removed in theatre. Drapes can be applied as the sleeve is retracted to a position level with the tourniquet. To determine whether exposing the limb could be performed safely and without further contamination of the skin either from inadvertent contact or the traction of the device across the skin we undertook a non-inferiority trial of the system.

Method A randomised, single blind study was undertaken. Based on studies of the effectiveness of different surgical antiseptic solutions, RH determined that a sample size of 60 participants would have a power of 90% to show noninferiority. Sixty healthy, adult volunteer members of staff were recruited; staff who had scrubbed within the previous 8 hours were excluded. Volunteers were allocated to either the Limb Sleeve group (study) or control group using random number tables and numbered sequential opaque envelopes.

Alcoholic Betadine® was used as antiseptic. The study was undertaken in an operating theatre with laminar flow

routinely used for orthopaedic surgery. All participants including the research team wore surgical theatre clothing.

In the study group, the upper limb was prepared up to the mid upper arm using the Limb Sleeve; a standard volume of 30ml of antiseptic was instilled and the arm placed horizontally on a table. The researcher massaged the antiseptic around the arm and between the fingers - volunteers opened and closed their fingers to further spread the antiseptic.

A consultant surgeon prepared the limb of control group participants by painting on the antiseptic using a gauze swab held in sponge-forceps.

Although it is normal to move immediately to draping after skin preparation, both groups waited for 10 minutes after application to allow optimum skin antisepsis. The hand of the prepped limb was then tested for residual bacteria using the glove juice technique (ASTM 2011). A latex glove containing 50ml of sampling fluid (Sheikh 1981) was placed on the participant’s hand and massaged for 1 minute; after removal the fluid in the glove was transferred to a sterile bottle and sent to the microbiology laboratory. The sampling fluid neutralises the

>>

10

Journal of Perioperative Practice PROCUREMENT GUIDE May 2017 Volume 06 Issue 02 www.afpp.org.uk

>>

Infection Prevention

bactericidal and bacteriostatic effect of the antiseptic agent, allowing any remaining bacteria to be identified.

Bacillus cereus. No pathogens were grown in the study group.

Aliquots of each glove juice sample were serially diluted (by 102 and 103), plated onto trypticase soy agar plates and incubated aerobically for 48 hours, after which the colony forming units (CFUs) were counted. The microbiologist was blind to which skin preparation method had been used. The results were analysed by RH using the chi-squared test and Fisher’s exact test.

All antiseptic agents recommend a significant period of contact before surgery starts to maximise efficacy. The reduction of CFUs in the study group may be due to the prolonged duration of contact with wet alcohol, as all other elements in the two study groups were identical. It is also possible that the plastic sleeve encourages a more even coverage of antiseptic solution through capillary action between the skin and sleeve.

Results Thirty volunteers were allocated to each group. A glove-juice sample was sent to the microbiology laboratory for each volunteer; one bottle from the control group broke prior to analysis. Fifty percent of the samples from the study group and 1.6% (n=1) of the samples from the control group grew no bacteria (Figure 1). The difference was highly significant, (p<0.0001, single tailed), indicating that the samples from the study group produced significantly fewer bacterial colonies compared with the controls.

The cultures were typed and pathogenic bacteria in a healthy person were noted. Four samples (6.6%) from the study group grew Staphylococcus aureus, 1 sample (1.6%) grew Figure 1: Colony Forming Units

Discussion

complaining of back pain in theatres, but the anecdotal evidence suggests a significant risk of injury. Removing all need for the theatre staff, apart from the surgeon, to lift the limb reduces significantly the risk of back injury which is an obligation on all employers.

Conclusion The system was designed to reduce theatre time, reduce lifting as far as possible, prolong antiseptic contact as long as possible and reduce wastage. The study results seem to support these aims.

This study was adequately powered for the outcome and showed a statistically significant difference. A limitation may be that it was undertaken on the upper limb when the main use of the sleeve is probably for lower limb surgery. However whilst the bacterial load on an unwashed foot may be different to a hand, the relative effectiveness of the Limb Sleeve would be maintained. We have not identified a minimum adequate amount of antiseptic agent for a lower limb; however we recommend 50-60ml based on our experience. We believe this provides an opportunity to control more rigorously the volume and cost of antiseptic used.

Acknowledgements

We have not been able to find details of numbers of staff

Dickinson JC, Bailey BN 1988 Chemical burns beneath tourniquets British Medical Journal 297 (6662) 1513

We thank the members of staff who volunteered their time.

References Altemeier WA, Culbertson WR, Hummel RP 1968 Surgical considerations of endogenous infections- sources, types, and methods of control Surgical Clinics of North America 48 (1) 227â&#x20AC;&#x201C;240 ASTM International 2011 E111502 Standard test method for evaluation of surgical hand scrub formulations [online]: ftp://185.72.26.245/Astm/2/01/ Section%2011/ASTM1105/PDF/ E1115.pdf [Accessed April 2017]

Ellanti P, Hurson C 2015 Tourniquet-associated povidone-iodine-induced chemical burns BMJ Case Reports Published online: [2015 Mar 5] doi:10.1136/bcr-2014208967 [Accessed April 2017] Dumville JC, McFarlane E, Edwards P et al 2015 Preoperative skin antiseptics for preventing surgical wound infections after clean surgery Cochrane Database of Systematic Reviews Issue 4. Art. No: CD003949

Hardin W, Nichols R 1997 Handwashing and patient skin preparation. In: Malangoni MA (ed) Critical Issues in Operating Room Management Philadelphia, Lippincott-Raven Jacobson C, Osmon DR, Hanssen A et al 2005 Prevention of wound contamination using DuraPrep Solution plus Ioban 2 drapes Clinical Orthopaedics and Related Research 439 32-37 Lilly HA, Lowbury EJL 1971 Disinfection of the skin: An assessment of some new preparations British Medical Journal 3 (5776) 674-676 Mackenzie I 1988 Preoperative skin preparation and surgical outcome Journal of Hospital Infection 11 (suppl B) 27-32 Selwyn S, Ellis H 1972 Skin bacteria and skin disinfection reconsidered British Medical Journal 1 (5793) 136-140 Sheikh W 1981 Development and validation of a neutralizer system for in-vitro evaluation of some antiseptics Antimicrobial Agents and Chemotherapy 19 (3) 429-434 Wong KC, Leung KS 2004 Transmission and prevention of occupational infections in orthopaedic surgeons Journal of Bone and Joint Surgery 86A (5) 1065-76 J Webb Consultant plastic Surgeon, University Hospital Birmingham, UK R Hilliam Director of Teaching for Mathematics and Statistics, The Open University, Department of Mathematics and Statistics, Walton Hall, Milton Keynes, UK LC Bainbridge Pulvertaft Hand Unit, Derby Teaching Hospitals NHS Foundation Trust Derby, UK

11

Journal of Perioperative Practice PROCUREMENT GUIDE May 2017 Volume 06 Issue 02 www.afpp.org.uk

Product News

Elite disposable drapes - The best quality at the right price Elite is a brand new disposable drape range from Guardian Surgical.

Designed to assist in the prevention of infection and control costs, it breaks down the barrier between high quality and price to offer the best possible protection against bacterial migration in all high performance surgical procedures, with bursting and tensile strength exceeding the current market standard.

Elite is available in bilaminate and trilaminate material, with an absorbent patch designed to be used in combination with the Elite trilaminate to give ultimate performance, even in the most

demanding of procedures. In all critical areas of the drapes, the fabric offers high density, low linting properties, with durable resistance against fluid and microbial penetration.

All products in the extensive range comply with the High Performance Critical Area requirements of BS ISO EN 13795, as well as BS ISO EN10993-5 and BS ISO EN 10993-10.

For more information please call 0808 168 5785 or visit www.guardiansurgical.com

To receive a copy of the new Swabsafe video please contact CMS:

Tel: 01538 399 541 Email: info@centralmedical.co.uk Website: www.centralmedical.co.uk

The new Swabsafe training video is now avaliable, contact info@centralmedical.co.uk for your free digital copy

Reduces the risk of swab counting errors Reduces the handling of dirty swabs Improves patient & staff safety Complies with AfPP Guideleines & Health and Safety Assists in accurate weighing of swabs Easy to use

Swabsafe isnâ&#x20AC;&#x2122;t a change of practice - just a progression

12

Journal of Perioperative Practice PROCUREMENT GUIDE May 2017 Volume 06 Issue 02 www.afpp.org.uk

Product News Find out what’s behind the new Elite drapes from Guardian.

We’ll soon be revealing our new Elite drape range which offers high levels of infection prevention at controlled costs, breaking down the barrier between high quality and price.

For more information call 0808 168 5785 or email info@guardiansurgical.com

Why Compromise?

VIO3 from Erbe - “plug and operate” Erbe have shaped electrosurgery, developing it into today’s leading-edge operating theatre technology, making Erbe an essential and reliable partner for many users worldwide.

VIO® 3 plug and operate

VIO3 is yet another of our milestones in electro-surgical technology, following the ICC series and alongside VIO200/300.

With its logical and intuitive interface the VIO3 is designed to ensure optimally userfriendly operation. The size of the touchscreen display alone speaks for itself; from the operating field the team always have a clear view of all control elements.

Electrosurgery with maximum convenience Handling of the VIO 3 with stepGUIDE, the new modes,

Then there are the other advantages:

VIO3 provides via “stepGUIDE”, guidance by suggesting experienced starting settings used in various clinical applications.

This results in less setting adjustment or modification.

For further information please visit: vio.erbe-med.com

“Plug and Operate”. It couldn’t be easier.

Tel: 0113 253 0333 Email: sales@erbe-uk.com

VIO3 has the right mode for your surgical application, supporting monopolar and bipolar techniques and our proprietary hybrid technology.

Erbe Medical UK, The Antler Complex, 1A Bruntcliffe Way, Morley, Leeds LS27 0JG.

13

Journal of Perioperative Practice PROCUREMENT GUIDE May 2017 Volume 06 Issue 02 www.afpp.org.uk

Product News

desderman® pure – for gentle but effective hand disinfection desderman® pure is an advanced rapid acting alcohol based hand rub for hygienic hand disinfection in 30 seconds.

A study of hand rubs concluded that desderman was significantly more effective than non-medical hand rubs in terms of reducing bacteria on the hands. Available in both liquid and gel variants.

A IN VA CA TH ILA TA E BL LO NH E GU S E

It is effective against bacteria, Norovirus, e coli, MRSA and a wide range of enveloped viruses including HIV, HBV and HCV. desderman pure contains emollients and is both colour and perfume free, so even frequent use is gentle on the skin.

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

Contact us for a full range of single use instruments and devices for ENT

susol@baileyinstruments.co.uk

NEW PRODUCT LAUNCH

SINGLE USE ELASTIC STAY RETRACTORS FOR ENT SPECIFICALLY DESIGNED AND PACKAGED FOR HEAD AND NECK PROCEDURES

Unit 19, Guinness Road Trading Estate, Guinness Rd, Trafford Park, M17 1SB Tel: 0161 872 8707 | Email: susol@baileyinstruments.co.uk www.susol.co.uk

MICRO SUCTION TUBES / CANNULAE NEW ADDITION TO THE SUSOL® ENT RANGE

14

Journal of Perioperative Practice PROCUREMENT GUIDE May 2017 Volume 06 Issue 02 www.afpp.org.uk

Product News

Single use solutions VacSax, UK leaders in the design and manufacture of disposable suction system for use in all departments within the hospital, has taken the unprecedented step to manufacture all Suction Liner Products with Antimicrobial Protection.

Founded in 1996, the company currently exports to more than 25 countries around the world. The VacSax BactiClear® Antimicrobial system is seen by over 60% of hospital beds across the UK and has been proven to reduce harmful bacteria such as MRSA and E-Coli by up to 99 per cent as independently tested to the ISO 22196:2011 standard.

VacSax BactiClear® Antimicrobial Suction Liner system is the only system where all external surfaces are totally antimicrobial, designed to minimise the risk of cross-infection.

VacSax Bacticlear® Antimicrobial liners are available in 1 litre, 2 litre and 3 litre versions and are PVC-free, producing only carbon dioxide and water upon 100% combustion.

The unique patented designed liner is folded for ease of storage and begins to inflate as soon as the vacuum is attached. VacSax Bacticlear® Antimicrobial canisters fit any bracket within the hospital and are suitable for all clinical areas. www.vacsax.com

Bailey Instruments Ltd have launched their new Elastic Stay Retraction Kit for ENT and Micro Suction Range The presentation of the Elastic Stay Kit is designed to support new techniques being adopted to use such systems for the more challenging locations for operative sites in ENT. The technique is increasingly being used for procedures such as skin incision/closure, tracheostomy, lymph node biopsy, excision of thyroglossal duct cyst, parodictectomy and lateral neck access. The stays are designed to be used with anchor plates or rings or now more commonly adapted for use with artery forceps.

This is an exciting new development for this wellestablished UK instrument manufacturer under its innovatory susol® brand. They are working on a product pipeline of elastic stay retraction systems actively involving surgeons, particularly in

ENT, max fax and plastic surgery, in design and clinical evaluation to arrive at more effective solutions.

The 4 stay pack is available via the NHS Catalogue in England and directly from the Company and designed for use with retractor rings, anchor plates and artery forceps.

The products have easily held and manipulated ergonomic handles and micro clean steel tubes with atraumatic tips. Each one is packed with a stillette.

They are also available in the NHS Catalogue, Bunzl Healthcare or direct from our Manchester Distribution centre.

Managing Director, Simon Charlesworth said ‘the Company is responding to surgeons who are frustrated with current device designs and materials looking to improve or facilitate techniques and patient safety’.

Nurses and clinicians working in busy ENT units, outpatients or in operating theatres who are using micro suction daily have a new option to source a susol® Micro Suction device. Available in Magill, Zoellner and Frazier patterns.

Contact susol@baileyinstruments.co.uk to arrange supply and evaluation.

Contact sales@baileyinstruments.co.uk to place an order or call 0161 872 8707.

Manufacturers of Bespoke Endoscopy & Sterile Services Products Height Adjustable Sinks

Established in 1962, Goldsworth Medical are the leading UK specialist manufacturers for both Sterile Services and Endoscopy Departments within hospitals.

Our product range includes: Height Adjustable Sinks - HTM64 Compliant Height Adjustable & Static Packing Tables Autoclave and Washer Loading Trolleys Transfer Trollys (Incl. UN3291) Transfer Hatches Loading Equipment Easyload Loading Systems We also service equipment from all over the UK. Our experienced engineers can cover service, maintenance and breakdown to suit your bespoke or desired applications.

ENT Scope Storage Cabinet

Transfer Hatches

Electrical Lift Trolleys

CERTIFIED TO BS EN 16442:2015

Servicing

For more information call 01273 516661 Goldsworth Medical (Felcon Ltd) Unit 11, Euro Business Park, New Road, Newhaven, East Sussex BN9 0DQ. Tel: 01273 516 661 Fax: 01273 512695 Social Media: FelconLtd Email: sales@goldsworth.co.uk Web: www.goldsworth.co.uk

15

Journal of Perioperative Practice PROCUREMENT GUIDE May 2017 Volume 06 Issue 02 www.afpp.org.uk

News

WHO recommends 29 ways to stop surgical infections and avoid superbugs People preparing for surgery should always have a bath or shower but not be shaved, and antibiotics should only be used to prevent infections before and during surgery, not afterwards, according to guidelines from WHO that aim to save lives, cut costs and arrest the spread of superbugs.

The “Global Guidelines for the Prevention of Surgical Site Infection” includes a list of 29 concrete recommendations distilled by 20 of the world’s leading experts from 26 reviews of the latest evidence.

The recommendations were also published in “The Lancet Infectious Diseases” and are designed to address the increasing burden of health care associated infections on both patients and health care systems globally. http://www.who.int/gpsc/ssiprevention-guidelines/en “No one should get sick while seeking or receiving care,” said Dr Marie-Paule Kieny, WHO’s Assistant Director-General for Health Systems and Innovation.

“Preventing surgical infections has never been more important but it is complex and requires a range of preventive measures.

These guidelines are an invaluable tool for protecting patients.”

Surgical site infections are caused by bacteria that get in through incisions made during surgery. They threaten the lives of millions of patients each year and contribute to the spread of antibiotic resistance. In low- and middle-income countries, 11% of patients who undergo surgery are infected in the process. In Africa,

up to 20% of women who have a caesarean section contract a wound infection, compromising their own health and their ability to care for their babies.

However, surgical site infections are not just a problem for poor countries. In the United States, they contribute to patients spending more than 400 000 extra days in hospital at a cost of an additional US$ 900 million per year.

Preventing infections before, during and after surgery The guidelines include 13 recommendations for the period before surgery, and 16 for preventing infections during and after surgery. They range from simple precautions such as ensuring that patients bathe or shower before surgery and the best way for surgical teams to clean their hands, to guidance on when to use antibiotics to prevent infections, what disinfectants to use before incision, and which sutures to use.

“Sooner or later many of us will need surgery, but none of us wants to pick up an infection on the operating table,” said Dr Ed Kelley, Director of WHO’s Department of Service Delivery and Safety. “By applying these new guidelines surgical teams

can reduce harm, improve quality of life, and do their bit to stop the spread of antibiotic resistance.

We also recommend that patients preparing for surgery ask their surgeon whether they are following WHO’s advice.”

No international evidencebased guidelines had previously been available and there are inconsistencies in the interpretation of evidence and recommendations in existing national guidelines. The WHO guidelines are valid for any country and suitable to local adaptations, and take account of the strength of available scientific evidence, the cost and resource implications, and patient values and preferences. They complement WHO’s popular “Surgical Safety Checklist”, which gives a broad range of safety measures, by giving more detailed recommendations on preventing infections.

Halting the spread of antibiotic resistance Importantly, the guidelines recommend that antibiotics be used to prevent infections before and during surgery only, a crucial measure in stopping the spread of antibiotic resistance. Antibiotics should not be used after surgery, as is often done.

Antibiotics are medicines used to prevent and treat bacterial infections. Antibiotic resistance occurs when bacteria change in response to the use of these medicines. Resistance develops naturally over time, but misuse of antibiotics in humans and animals is rapidly accelerating the process.

Antibiotic resistance is putting the achievements of modern medicine at risk. Without effective antibiotics for the prevention and treatment of infections, organ transplants, cancer chemotherapy and surgeries such as caesarean sections and hip replacements become much more dangerous.

This leads to longer hospital stays, higher medical costs, and increased mortality.

Many studies show that implementing a range of preventive measures significantly reduces harm from surgical site infections. A pilot study in four African countries showed that implementing a selection of the new recommendations could result in a 39% reduction in surgical site infections. Building upon these successful examples, WHO is developing a guide and toolkit that will help national and local authorities to put the recommendations into action.

The widest range of single use suctions.

t. 02920 767 800 e. info@susl.co.uk