JPP PG January 2016 (Vol:04 Issue:06)

Journal of Perioperative Practice

PROCUREMENT GUIDE January 2016 Volume 04 Issue 06 01423 881300 www.afpp.org.uk

01423 881300 www.afpp.org.uk

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Journal of Perioperative Practice PROCUREMENT GUIDE January 2016 Volume 04 Issue 06 www.afpp.org.uk

Contents

Welcome to your January 2016 Guide 07 Patient Warming 09 Product News:

Ruhof AquaBrush, Wardray Premise x-ray protection

12 Product News: Angloplas

13

Product News: PROACT Metal Max速 Disposable Laryngoscope Blades

14-15 News:

Cleo速 90 Infusion Set, Infections drop 69 per cent with Curos and compliance, Hospital reduces norovirus outbreaks by 91%

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.

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

Medical Device Companies.

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:

March 2016 Medical Instruments/Devices/ Equipment May 2016 Infection Control/Prevention, Decontamination July 2016 Consumables September 2016 Anaesthesia/Airway Management/Difficult Airways

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

Patient Warming 07

Journal of Perioperative Practice PROCUREMENT GUIDE January 2016 Volume 04 Issue 06 www.afpp.org.uk

Patient Warming Interest and knowledge of avoiding inadvertent perioperative hypothermia has grown in recent years following the publication of the NICE guidelines – Hypothermia: prevention management in adults having surgery.

Effective perioperative temperature management requires an understanding of patient heat balance and heat distribution. After induction of anaesthesia body heat is redistributed to the peripheries which increases the potential for heat loss and leads to an immediate drop in core temperature – redistribution temperature drop. It is not unusual for a patient’s core temperature to drop to less than 35ºC within the first 30 to 40 minutes of anaesthesia. If the perioperative team does not manage this risk throughout the perioperative patient pathway, as many as 70 percent of patients undergoing routine surgery may be hypothermic on admission to the recovery room. Understanding these changes and their implications are essential for successful outcomes and effective economic management.

The key principle focuses on balancing heat gains with heat losses. The more professionals know about the principles of perioperative heat exchange, the more patients stay warm!

Key reasons why perioperative hypothermia should be avoided are that it can cause increased blood loss and a higher chance of wound infections which can often mean longer hospital stays or re-admissions. Hypothermia can be prevented through (a combination) of different therapies: forced air warming,

Key reasons why perioperative hypothermia should be avoided are that it can cause increased blood loss and a higher chance of wound infections which can often mean longer hospital stays or re-admissions.

blood and fluid warming and heat reflective technology. Furthermore a normothermic patient means a comfortable patient.

The perioperative period commences on the ward when the patient is being prepared for surgery and continues through and after the surgery is completed so requires a team approach from personnel in all areas the patient moves through.

Hypothermia may be found at any stage of the perioperative pathway; to optimise patient temperature, heat balance must be maintained. Effective temperature management and heat balance throughout the entire perioperative phase requires careful planning which should start well before the patient enters the operating theatre.

Recent research has concentrated on the concept of ‘pre-warming’ patients as if the patient is warm at the point of anaesthesia induction the effects of redistribution temperature drop will be lessened. Recommendations state that patient temperature should be recorded in the hour before they leave the ward to go for their surgery. At this point if temperatures are below 36°C some active warming, for example, a convective warming blanket should be utilised to enable the patient to be taken to the operating theatres at a normothermic temperature.

Prior to anaesthetic being given the patients temperature should be at least 36°C and should be recorded every fifteen to thirty minutes during surgery. A standard operating procedure is advisable to determine what to do in each phase of the pathway. Informed patients will appreciate your efforts more if they are aware of the importance of effective temperature management.

Appropriate communication with patients can help prevent hypothermia. This should include regularly assessing thermal comfort by asking how warm they feel both before and after surgery! It is critical to reduce avoidable heat loss by insulating unprotected areas with passive warming methods and/or actively warming the patient as is appropriate to what stage of the pathway the patient is in.

During surgery unavoidable heat loss is determined by the length of the operation, the size of any open cavity and the amount of exposure. Therefore it is advisable to take multiple measures to maintain heat balance during major surgery using warming blankets and fluid warming appropriately. The larger the exposed areas the more important active warming becomes.

There are a variety of blanket designs available that are developed for differing surgical

Patient Warming 08

Journal of Perioperative Practice PROCUREMENT GUIDE January 2016 Volume 04 Issue 06 www.afpp.org.uk

positions patients are placed in.

Taking time to consider blanket choice can have a great impact on temperature outcomes and it is good for the healthcare providers to be aware of the differences in blankets and the changes in heat input that each can provide.

Once the patient reaches the recovery area it may be required to continue to actively warm to ensure normothermia is maintained, again recommendations require a patients temperature to be at least 36°C prior to being released from the theatre recovery area. Once back on the ward temperature should continue to be monitored and active warming used when required. Implementation of best practice to prevent inadvertent

perioperative hypothermia could lead to reductions in surgical site infections, reductions in the length of hospital stays and in the end a significant reduction in costs per patient. To assess how effective your temperature management is you should measure and document each patient’s temperature regularly.

References Jurkovich GJ, Greiser WB, Luterman A, Curreri PW 1987 Hypothermia in trauma victims: An ominous predictor of survival The Journal of Trauma 27 (9):1019-24

Remember normothermia is the goal! You should also audit and assess your departmental data which will allow your whole team to improve care delivery, its organisation of temperature management and ultimately patient outcomes.

Kurz A, Sessler D, Lenhardt R 1996 Perioperative normothermia to reduce the incidence of surgicalwound infection and shorten hospitalization.

Study of Wound Infection and Temperature Group New England Journal of Medicine 334 1209-15

Central Medical Supplies Ltd, CMS House, Fynney Fields, Brooklands Way, Leek, Staffordshire, ST13 7QG Tel: 01538 399541

Luna GK, Maier RV, Pavlin EG, Anardi D, Copass MK, Oreskovich MR 1987 Incidence and effect of hypothermia in seriously

injured patients The Journal of Trauma 27 (9)1014-8 Mahoney C and Odom J 1999 Maintaining intraoperative normothermia: A metaanalysis of outcomes with costs A.N.N.A Journal 67 (2) 155-164 National Institute for Health and Care Excellence 2008 Hypothermia: prevention and management in adults having surgery (NICE guidelines CG65) [online] Available from: https://www.nice.org.uk/ guidance/cg65 [Accessed November 2015] Prof. Dr. med., D.E.A.A. Wolfgang Weyland, Kaiserswerther Diakonie, Dusseldorf, Germany

Product News 09

Journal of Perioperative Practice PROCUREMENT GUIDE January 2016 Volume 04 Issue 06 www.afpp.org.uk

Introducing the AquaBrush The only totally submersible rechargeable cleaning brush for surgical instruments The Ruhof AquaBrush is a rechargeable, completely submersible surgical instrument cleaning brush, which eliminates manual scrubbing for easier, more efficient instrument reprocessing. The AquaBrush comes with both large and small brush heads to accommodate various instrument sizes.

were Audere Medical Services Ltd, Amity International Ltd, and the project leader was Peskett Solutions Ltd (Ruhof UK).

Why You Should Consider Alternative EWD Chemistries

We have saved our project Hospital £56,000 per annum on their EWD detergent, disinfectant.

The alternative EWD chemistries project was started nearly two years ago. The Project partners

We are pleased to announce that the project was a resounding success and we are now in a position to offer our services to all hospitals using EWD’s.

The customer has been monitoring the chemical effects

X-ray protection Wardray Premise Ltd has made x-ray protective clothing in the UK for 40 plus years. Their aprons epitomize everything customers expect from Wardray in terms of product quality and longevity.

Wardray’s protective clothing range includes traditional aprons and top & kilts. Garments are offered in a range of lead equivalents, come in a wide range of sizes and lengths to ensure a comfortable fit.

To discuss your requirements or to arrange a sample for trial please contact Michelle Killick, phone 0208 3989911 ext 231 Email: mkillick@wardraypremise.com

Wardray aprons are suited for use in theatres as the double shoulder clips allow easy / quick garment removal. Their design ensures that the weight of the apron is carried and supported at the waist.

Full details of Wardray’s products and services are available at www.wardray-premise.com.

to the EWD’s and Endoscopes. The endoscope manufacturer has reported a 13% reduction in scope damage from the cleaning and disinfectant chemistries.

The customer has reported an impressive up time, increase by 41%. This has been contributed to the alternative chemistries and improved servicing and parts.

For more information contact Matthew Peskett Tel: 01323 511038 or Email: support@peskettsolutions.com

Product News 12

Journal of Perioperative Practice PROCUREMENT GUIDE January 2016 Volume 04 Issue 06 www.afpp.org.uk

Angloplas Leading UK Antimicrobial Products Manufacturer Angloplas are Helping to Kit out ... ...six new scrub rooms within the new Theatre Suite at East Cramlington NHS Hospital in Northumberland. Angloplas were approached by Theatre Team Leader Sr Polly Lee to equip their state of the art theatres with many space saving products including dispensers for surgical gloves; gowns; masks and theatre caps. These are all made from the world’s first proven antimicrobial PVC with BioCote® silver ion technology.

This helps reduce the risk of cross infection by stopping the growth of bacteria and mould and works continuously for the lifetime of the product, reducing levels of bacteria such as MRSA, E Coli, Legionella, Salmonella and mould by up to 99.99%.

Polly says; “East Cramlington NHS Hospital sets the standard for other NHS organisations across the country and our new scrub rooms replicate this.

We chose to order Angloplas’

products for several different reasons including their hygienic properties and the fact they help keep our working environment in order. Their products keep our work surfaces clear and provide quick and convenient access for our staff to reach essential equipment.”

Angloplas works with over 200 NHS and private hospitals, care homes, GP and dental surgeries, laboratories, pharmaceutical companies and is happy to manufacture bespoke products usually at no extra charge.

Tel: 01621 868 400. www.angloplas.co.uk.

Product News

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Journal of Perioperative Practice PROCUREMENT GUIDE January 2016 Volume 04 Issue 06 www.afpp.org.uk

PROACT PROACT Metal Max® Disposable Laryngoscope Blades.

PROACT have been providing innovative Laryngoscope solutions for over 20 years.

With many unique features our full metal disposable Laryngoscopes offer strength and no compromise in performance or safety when compared to reusable blades.

We offer the disposable Metal Max® Combi™ all in one Test-In-Bag, handle and blade set with pre-loaded

batteries. As well as a full range of Green System Fibre Optic and Conventional Metal Max® meLED blades.

All ranges come in a variety of sizes from paediatric to adult, and have different size handles to suit.

For further information please call 01536 461981

Journal of Perioperative Practice PROCUREMENT GUIDE January 2016 Volume 04 Issue 06 www.afpp.org.uk

News

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AfPP’s Theatre access course Who’s it for?

This course has been tailored specifically for medical device representatives but may also be suitable for students wanting to get a ‘taste’ of theatres.

Where is it held?

Either at AfPP HQ in Harrogate or onsite at your offices (a minimum of 10 delegates are required for onsite courses).

What do you get out of it?

- An understanding of theatre etiquette, correct protocol and the roles and responsibilities of those within theatres.

What does it cost?

- £250+VAT for medical device representatives - £150+VAT for students

- A certificate and theatre access course ID pass card.

The course can also be ‘tailor made’ to your specifications.

How long does it last?

The course is valid for two years, after which you will be required to complete a refresher module.

To book your place or for further information, please call Kelly Squires on 01423 882969 or visit www.afpp.org.uk/events/theatreaccess

Cleo® 90 infusion set available on Drug Tariff Smiths Medical’s Cleo® 90 infusion set is now available on Drug Tariff.

The Cleo® 90 is used for subcutaneous infusions. A subcutaneous infusion is an infusion of fluid under the skin.

In a subcutaneous infusion, a needle is inserted under the skin, rather than into a vein, and connected to an infusion pump. This allows fluid to slowly enter the injection site.

The Cleo® 90 infusion set is pre-assembled and designed to help make subcutaneous insertions simple, fast and secure. The ‘all in one’ device features a unique patented housing containing both a cannula inserter and a needle retractor, providing maximum convenience and control.

The enclosed needle retracts automatically into the housing

after insertion, reducing the risk of accidental needlestick injuries.

The Cleo® 90 infusion set also features an integral adhesive dressing. This small, transparent, hypoallergenic dressing breathes yet at the same time keeps water out. It also requires less tape to stay in place, while being easy to remove via a patented release tab.

The Cleo® 90 infusion set is designed to enable one-handed insertion and disconnection, making it quick and easy to use by healthcare professionals, patients or carers. It comes with a choice of two cannula lengths - 6mm and 9mm - and three tubing lengths - 60cm, 80cm and 110cm. www.smiths-medical.com

News

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Journal of Perioperative Practice PROCUREMENT GUIDE January 2016 Volume 04 Issue 06 www.afpp.org.uk

Infections drop 69 per cent with Curos and compliance

A six month study into staff compliance when using Vygon’s Curos Port Protectors – a passive disinfection device - has shown a 69 per cent drop in patients’ Catheter Related Bloodstream Infections.

The study involved more than 1,000 patients on four wards across two hospitals and was carried out by Corinne Cameron-Watson a Senior Infection Control Nurse at the Barking, Havering and Redbridge University Hospitals NHS Trust.

The trial period saw catheter related bloodstream infection rates drop from 26 cases previously to just eight, when staff compliance was 80 per cent or more.

Corinne said: “The study results indicated that a high compliance rate by staff has a positive correlation on the effectiveness of Curos, a passive disinfection device. This has also been shown in three peer review studies in America (1).”

Patients on the Oncology, Acute Care of the Elderly, Critical Care

and Surgical wards at Queen’s Hospital, Romford, and the King George Hospital in Goodmayes, Ilford, were involved in the study and there was intensive staff training prior to and during the study. Regular audits were also made, as well as ongoing training, maintenance and support during the trial.

Disinfection wipes used for needle-free devices were removed from all trial areas and Curos was incorporated in the trial wards ANTT protocols. For six months Curos was used on all needle free devices including Central Venous Catheters, Peripheral Intravenous Catheters and Arterial Lines.

Currently in the UK, all IV needlefree access devices are required to be disinfected before every access.

EPIC3 (2) guidelines recommend

‘Scrubbing the Hub’ for a minimum of 15 seconds. Product manufacturers and suppliers advise that the disinfectant should then be left to dry for a recommended 30 seconds.

maintenance and supply of stock levels. Based on this study I have now submitted a business case at Barking, Havering and Redbridge that Curos is used as standard in our hospitals.”

Corinne said: “Current practice relies on the caregiver using a consistent, active disinfection technique and also ensuring the correct time is given to both the scrubbing of the needle-free device and the drying or ‘kill time’.

This is a multiple step approach and is open to variation in the way each carer disinfects the needlefree device. The study gave clear evidence that when used correctly the passive infection technique provided by Curos led to lower rates of infection than the method of active disinfection.

The important issues when using Curos are thorough and ongoing education and training, and

If you would like to know more about the study contact Corinne on Corinne.ccw@googlemail.com References 1. The Society for Healthcare Epidemiology of America (SHEA).

Marshall et al. Infection Control and Hospital Epidemiology 2014;35:753-771 2. EPIC3: National EvidenceBased Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England H.P. Lovedaya J.A. Wilsona, R.J. Pratta, M. Golsorkhia, A. Tinglea, A. Baka,J. Brownea, J. Prietob, M. Wilcox.

Hospital reduces norovirus outbreaks by 91% Norovirus outbreaks have dropped by 91% as shown in a study published in BMJ Quality & Safety. The Queen Alexandra Hospital in Cosham, Portsmouth, implemented a multidimensional quality improvement initiative based on superbug-killing robotic technology. In comparison outbreak numbers only fell by 28% in England.

Every winter, norovirus outbreaks can create chaos in hospitals as they can lead to bed or ward closures, staff sickness as well as general disruption. ‘We believe norovirus outbreaks cost the NHS £41.5m a year. If every

hospital achieved the same result as Portsmouth the savings could be £38m a year’, says Dr Peter Greengross, Medical Director of the Learning Clinic.

This multidimensional quality improvement initiative led by the use of hydrogen peroxide vapour (HPV) biodecontamination technology also includes education, enhanced patient surveillance, early automated detection and notification of infected patients as well as proactive care and control measures. Dr Caroline Mitchell, Associate Director for Infection and Patient Safety,

at the Portsmouth Hospitals Trust, said: ‘By application of simple measures, we have significantly reduced the number of cases of norovirus and other gastrointestinal viruses which can cause serious and unpleasant symptoms in patients and massively disrupt the operational capacity of the hospital. The combination of new technology and better training and organisation of our staff has contributed hugely to our successful results in this field.’

As reported in a BBC One South Today feature broadcasted on 17th November 2015, ‘a strategy

combining high standards of cleanliness with cutting-edge technology’ has led to no outbreaks since 2010. The rare single cases have been contained with no transmission to other patients or members of staff. The cleaning robots (Bioquell Q-10 suite) used at the Queen Alexandra Hospital rely on hydrogen peroxide vapour (HPV) to decontaminate rooms.

This technology has been proven to kill 99.9999% of pathogens. A smaller and faster version (Bioquell BQ-50) of this HPV generator is now available from Bioquell.

For more information, please visit www.bioquell.com