JPP PG November 2015 (Vol:04 Issue:05)

Journal of Perioperative Practice

PROCUREMENT GUIDE November 2015 01423 881300

Volume 04 Issue 05 www.afpp.org.uk

The first fully network-based integrated OR

Smart

core nova adapts to your preferences!

Simple

core nova is so easy to use!

Secure

With core nova all your data are safe!

For further information contact: Bryan Fernandez Tel: 020 8944 7447 bryan.fernandez@richard-wolf.com

Discover the new generation www.richard-wolf.com

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 November 2015 Volume 04 Issue 05 www.afpp.org.uk

Contents

Welcome to your November 2015 Guide 05 Sharps Safety:

10

08 Product News:

News: Sharp Instruments in Healthcare

“Ouch! That hurt”: Sharps safety conscience

Schülke Detergent

09 Product News:

Ruhof AquaBrush Wardray Premise M3

Product News: PROACT Professional Laryngoscopes

11 News:

An evaluation of the efficacy of safer sharps devices: systematic review

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.

January 2016 Recovery/Patient Warming

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

Medical Device Companies.

May 2016 Infection Control/Prevention, Decontamination

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

July 2016 Consumables

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

Bair Hugger UK Ad_08/15 125x180.indd 1

17/08/2015 16:04

Journal of Perioperative Practice PROCUREMENT GUIDE November 2015 Volume 04 Issue 05 www.afpp.org.uk

Sharps Safety 05

“Ouch! That hurt”: Sharps safety conscience Any surgical intervention is not risk adverse (Adams et al 2010), as much as we carefully plan and deliver perioperative care (Al-Benna 2010, The Press Association 2012) there would appear to be an increase in reportable incidents? The complexity of the care environment, the team in which you practice and the patient under your care deserves respect, responsible engagement and reflective practice. However, on occasion, I would suggest we sometimes do not take enough care of one of our major assets: Our Hands.

Whatever your perioperative role, like any tools, the use of your hands in care delivery are recognised as a danger to yourself and patients if breaches in safety parameters occur. How many of you in the last week have observed hand care practice that does not meet local and national protocols and guidelines?

Take this one step further, in the last month have you observed, participated or acknowledged a sharps injury which has not been reported as a critical incident by those involved?

This is where a person comes into contact with someone else’s body fluid by direct inoculation by a sharp instrument, such as a blade or a needle, or by splashes of the body fluid in question to the recipients skin, mucous membranes or eyes (Raghavendran 2006).

Some subtle reminders for us all: • Needlestick injury is the second commonest cause of occupation injury within the National Health Service (Adams et al 2010).

• The second commonest site in which such injuries are sustained is in an operating theatre (Health Protection Agency Centre for Infections 2008).

• Exposure prone procedures are where a healthcare worker may be exposed to the blood or open tissues of the patient (through contact with sharp instruments, needle tips or sharp tissues (Raghavendran et al 2006).

• O’Malley et al (2007) reminds us that “The danger of blood-borne virus contraction by the injured person and the associated anxiety experienced by themselves and their contacts, has a significant cost to the organisation, both financial and in terms of lost man-hours”.

I suggest that needlestick / sharp injuries are never intention events, but the result of a breach in the safe utilisation of a piece of equipment, an unintended event occurring as part of a sequence of human functional errors. These errors involve the interface not only between the practitioner’s hands and piece of equipment but may also be influenced by external potential and actual distractions which undermine ability to undertake safety-critical tasks safely i.e. place a suture needle into the jaws of a pair of needle holders?

Public Health England (2014) evidence suggests that the majority of injuries occur: • During the undertaking of the procedure / activity • Lower risks after procedure but before disposal of sharp item • And during or after disposal.

This is highlighted in AfPP’s (2013) Sharps: Guide to Best Practice for Safe Handling of Surgical Sharps. >>

Sharps Safety 06

Journal of Perioperative Practice PROCUREMENT GUIDE November 2015 Volume 04 Issue 05 www.afpp.org.uk

Time out Given the time and resources to be able to reflect upon those activities that put you at risk of needlestick / sharps injuries in your workplace, Smith (2013) observes these could be reduced if we did not multitask and minimise distractions during safety sensitive activities.

As noted above, you will probably have had yourself or know a colleague who has been unfortunate enough to receive such a worrying injury? But how many of you have received feedback regarding exposure in respect of what has gone wrong and what remedial action is required to protect you in the future.

Trust management of needlestick injuries and incidents involving exposure to blood and body

Y O U R

S T E R I L E

fluids guidance and protocol documents are readily available to support reporting post exposure casualties; however Adams (2010) encourages simpler quicker protocols that improve pre-exposure safety compliance.

Personal reflection As an orthopaedic surgical care practitioner undertaking surgical interventions i.e. full closure of knee replacement incisions, has my risk of injury increased over 20 years of surgical practice as

exposed here for you to review (right hand dominant): Logbook of surgical cases n = 9,352 /0.09%.

An emerging part of an assistant’s role is to observe the operating surgeon’s hands

Injury Source

Year

Anatomy

Activity

Self-Inflicted

Suture needle

1998

Left index

Suturing

Yes

Osteotome

1999

Left middle

Bone graft preparation

Yes

Suture needle

2001

Left index

Suturing

Yes

Scalpel blade

2004

Back Right hand

Soft tissue hand retraction

No

Suture needle

2004

Left index

Suturing

Yes

Suture needle

2010

Left thumb

Suturing

Yes

Suture needle

2010

Left index

Suturing

Yes

Scalpel blade

2013

Right hand

Retraction - instr

No

Guide wire ACL

2014

Left hand

Power tool use

Yes

S I N G L E - U S E

S O L U T I O N

W I T H O U T

Inflicted by

Operating Consultant

Trainee Surgeon

C O M P R O M I S E

10 Years

of Innovation in Single-Use Surgery

CELEBRATING 10 YEARS

t +44 (0) 1792 797 910 e info@dtrmedical.com w www.dtrmedical.com

Visit us at Hall 16 F42

Sharps Safety 07

Journal of Perioperative Practice PROCUREMENT GUIDE November 2015 Volume 04 Issue 05 www.afpp.org.uk

for revealed breaches of glove integrity; in the knowledge that reported adherence to protocols amongst senior surgeons is poor.

And even when challenged, “Is that a cut on your hand Mr …...” denial tends to be their normal modus operandi, sad I know, but please tell me I am wrong.

So please accept this as a little time out nudge! Thaler and Sunstein’s (2008) Nudge theory is a flexible and modern concept for: • understanding of how people think, make decisions, and behave, • helping people improve their thinking and decisions, • managing change of all sorts, • Identifying and modifying existing unhelpful influences on people.

Key points • The reporting rate for needlestick / sharps injuries incurred during operations is very poor • Those at most risk of incurring such injuries have the poorest reporting rates • Each member of the operating team should monitor and challenge observed injuries to protect patients and colleagues alike from blood-borne viruses • Accountability is not an option but a professional privilege and responsibility!

Don’t become a victim through neglect Adrian Jones RN - SCP Orthopaedic Surgical Care Practitioner / AfPP Vice President

Needlestick injury is the second commonest cause of occupation injury within the National Health Service (Adams et al 2010).

References Adams S, Stojkovic S, Leveson S 2010 Needlestick injuries during surgical procedures: a multidisciplinary online study Occupational Medicine 60 139-144 Al-Benna S 2010 Needlestick and sharps injuries among theatre care professionals Journal of Perioperative Practice 20 (12) 440-445 Health Protection Agency Centre for Infections, National Public Health Service for Wales, CDSC, Northern Ireland and Health Protection Scotland 2008 Eye of the Needle: Surveillance of Significant Occupational Exposures to Bloodborne Viruses in Healthcare Workers HPA - Wales, Northern Ireland and Scotland O’Malley E, Scott R 2nd, Gayle J et al 2007 Costs of management of occupational exposures to blood and body fluids Infection Control Hospital Epidemiology 28 (70) 66-70 Public Health England 2014 Eye of the Needle: United Kingdom Surveillance of Significant Occupational Exposures to

Bloodborne Viruses in Healthcare Workers [online] Available from: https://www.gov.uk/government/ publications/bloodborne-viruseseye-of-the-needle [Accessed October 2015] Raghavendran S, Bagry H, Leith S, Budd JM 2006 Needlestick injuries: A comparison of practice and attitudes in two UK District General Hospitals Anaesthesia 61 867-872 Smith C 2013 8 Steps to Prevent Surgical Errors [online] Available from: www.aorn/News.aspx?id=25577 [Accessed October 2015] The Association for Perioperative Practice 2013 Sharps: Guide to Best Practice for safe handling of Surgical Sharps Harrogate, AfPP The Press Association 2012 Needle injuries at work doubled in past decade [online] Available from: www. nursingtimes.net/nursing-practice/ specialisms/infection-control/needleinjuries-at-work-doubled-in-pastdecade/5052691.article [Accessed October 2015] Thaler R, Sunstein C 2008 Nudge: Improving decisions about health, wealth and happiness New Haven & London, Yale University Press

Product News 08

Journal of Perioperative Practice PROCUREMENT GUIDE November 2015 Volume 04 Issue 05 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 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.

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. www.schulke.co.uk

Whether gigasan 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.

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

JPP_138x188_sharps_BMS_JULY/AUGUST 27/05/2015 09:24 Page 1

safety

in mind first time, everytime In response to the EU Sharps Directive 2010/32/EU Swann-Morton have launched the KLEEN Blade Management system consisting of their standard blade enclosed within a protective cartridge thus supporting safe handling when fitting and removing the blade from your existing surgical handles. Complimented by Retractable Safety Scalpels, single use Blade Removers and “Cygnetic” they can now offer a complete range of compliant safety solutions.

Swann-Morton can offer in house sharps safety training in line with the new Directive so contact us on sharpssafety@ swann-morton.com for more information.

For more information on the complete range of surgical blades, handles, scalpels, disposable, fine and retractable scalpels please go to our website.

All medical devices are CE marked in accordance with the Medical Device Directive (93/42/EEC)

Owlerton Green, Sheffield S6 2BJ Telephone: 0114 2344231, Sales: 0114 2344223, Fax: 0114 2314966 uksales@swann-morton.com, exportsales@swann-morton.com www.swann-morton.com ‘Swann-Morton’ and the ‘Ring Pattern Logo’ are the registered trade marks of Swann-Morton Limited and related companies.

www.swann-morton.com

Product News 09

Journal of Perioperative Practice PROCUREMENT GUIDE November 2015 Volume 04 Issue 05 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

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

Patient monitoring The M3 has been developed for patient monitoring during MRI examinations. The unit is suitable for use with scanners up to and including 3T systems.

It was developed in conjunction with clinical users and fulfils all the requirements of a modern patient monitor.

The unit can be configured to meet customers’ needs and all components (eg capnography and automatic gas analysis) can be upgraded or added to at any time, helping customers manage and plan their financial commitments.

The M3 provides: • wireless ECG and pulse oximetry • 15” colour touch screen, capable of displaying up to 6 waveforms at one time • up to two channels each of IBP and temperature • automatic gas analysis • mains or battery operated From July 2014 the Restriction of Hazardous Substances

(RoHS 2) encompasses the area of medical devices.

Wardray Premise is pleased that the M3 is fully compliant with this latest legislation.

Full details of Wardray’s products and services are available at www.wardraypremise.com call: 020 8398 9911 or e-mail: sales@ wardray-premise.com

Product News

10

Journal of Perioperative Practice PROCUREMENT GUIDE November 2015 Volume 04 Issue 05 www.afpp.org.uk

PROACT

PROACT Professional Laryngoscopes ISO7376:2009 Reusable Range: • PROACT Reusable Fibre Optic Autoclavable Smoothline Blades and Handles Disposable Range with the full strength of metal through Handle, Hook and Blade: • Metal Max® Green System Fibre Optic Blades with full range of handles • Metal Max® Conventional meLED Blades with full range of handles • Metal Max® Combi+, complete Handle and Blade with pre-loaded batteries and test-in-bag facility – “Ready in seconds”

Sharp Instruments in Healthcare Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 Guidance for employers and employees.

This information sheet is for healthcare employers and employees. It will help you understand your legal obligations under the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 (the ‘Sharps Regulations’).

apply, and provides practical advice on:

It explains under what circumstances the Regulations

Available from: www.hse.gov.uk/ pubns/hsis7.pdf

• the safe use and disposal of sharps • training requirements • procedures for responding to a sharps injury

PROACT are official distributors for Heine Laryngoscopes offering the Classic+ Fibre Optic Reusable Autoclavable range with Heine handles.

All products available either directly or through NHS Supply Chain.

Please call on 01536 461981 for further information.

News

11

Journal of Perioperative Practice PROCUREMENT GUIDE November 2015 Volume 04 Issue 05 www.afpp.org.uk

An evaluation of the efficacy of safer sharps devices: systematic review Sharps-related injuries carry the risk of serious blood borne infection. A systematic review was undertaken to consider the evidence related to safer sharps devices and their impact on needlestick injury reduction within the healthcare sector.

The review sought to determine whether: • the use of safer sharps devices could reduce the incidence of sharps injury; • dedicated educational / training initiatives could reduce the incidence of sharps injuries; • safer sharps devices were accepted by the hospital personnel asked to use them;

ta524_IND_AnaesthesiaPract_Cover_v4_Layout 1 04/04/2013 17:11 Page 1

NICE Guidance

supports the case to adopt Inditherm patient warming systems in the NHS*

• safer sharps devices had any proven impact on patient care outcomes.

The quality and quantity of evidence was limited, mainly due to study designs used by publishing authors.

Despite this, there was sufficient published evidence to consider the use of safer sharps devices to reduce the incidence of sharps injuries amongst UK healthcare workers.

Studies showed that when educational programmes were implemented alongside a safer sharps device, lower rates of sharps injuries were sustained for longer. However, the benefit attributable to education alone could not be isolated from the impact of the introduction of the safer sharps device.

Few studies have investigated user acceptability of safer sharps devices and patient outcomes, and more studies are required to assess these areas with greater certainty.

• Clinical evidence supports Inditherm’s effectiveness at preventing hypothermia • Annual cost savings of £9800 per Operating Theatre • Additional savings from reductions in post-operative infections, energy usage and clinical waste

Over 4,000,000 patients warmed Estimate based on Inditherm data April 2013

www.inditherm.com/medical Tel: Email:

*Full guidance can be found at www.nice.org.uk/guidance/MTG7

+44 (0) 1709 761000 medical@indithermplc.com

This report and the work it describes were funded by the Health and Safety Executive (HSE). Its contents, including any opinions and/ or conclusions expressed, are those of the authors alone and do not necessarily reflect HSE policy.

Available from: www.hse.gov. uk/research/rrpdf/rr914.pdf

So much more than just a Washer

5053 AMSCO速

WASHER / DISINFECTOR

ASK YOUR WASHER/ DISINFECTOR TO: 3 SCAN YOUR TRAYS 3 CHOOSE THE RIGHT CYCLE 3 REDUCE YOUR STRESS & WORKLOAD Find out more on

www.steris-healthcare.com Cleaning Chemistries

Cleaning Indicators

STERIS UK Ltd 30 Waterside Road, Hamilton Industrial Park, Leicester LE5 1TL Tel: 01162 740600 Fax: 01162 764078

Service

www.steris-healthcare.com