JoPP PG January 2015 (Vol:3 Issue:6)

Journal of Perioperative Practice

PROCUREMENT GUIDE January 2015 Volume 03 Issue 06 01423 881300 www.afpp.org.uk

01423 881300 www.afpp.org.uk

Journal of Perioperative Practice PROCUREMENT GUIDE January 2015 Volume 03 Issue 06 www.afpp.org.uk

02

Contents 03

Journal of Perioperative Practice PROCUREMENT GUIDE January 2015 Volume 03 Issue 06 www.afpp.org.uk

Welcome to your January 2015 Guide 05 Prewarming 07 Maintaining perioperative normothermia

09 Product news:

Eco EZ Cleanse and Valvesafe launch

10 Product news: Central Medical Supplies

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 2015 Medical Devices/Instruments May 2015 Infection Prevention/Control July 2015 Consumables/Innovation September 2015 Airway Management/Anaesthesia November 2015 Safety/Sharps

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

Journal of Perioperative Practice PROCUREMENT GUIDE January 2015 Volume 03 Issue 06 www.afpp.org.uk

Product News 04

Patient Warming 05

Journal of Perioperative Practice PROCUREMENT GUIDE January 2015 Volume 03 Issue 06 www.afpp.org.uk

Prewarming Almost any patient undergoing anaesthesia is susceptible to inadvertent perioperative hypothermia. Inadvertent perioperative hypothermia has been called a frequent, preventable complication of surgery (Kurtz 2008). Many publications have documented the adverse effects on patient outcomes, which include an increase in wound infections (Barie 2002), increased length of stay (Kurtz et al 1996) and higher mortality rates (Tryba et al 1996). Some estimates say that more than 50% of all surgical patients are hypothermic on arrival to the recovery room (Young 2006).

Research has shown that patients can lose up to 1.6°C during the first 60 minutes of anaesthesia (Sessler 1997), due to anaesthesia induced vasodilatation. Under normal conditions the temperature gradient between the body’s core and periphery is approximately 2 to 4°C and is very tightly controlled. Anaesthesia induced vasodilatation allows the warmer blood in the core, to flow freely around the cooler periphery. As the blood circulates throughout the periphery, it cools before returning back to the heart, where it causes a drop in core body temperature.

This process of reducing core body temperature is known as, redistribution temperature drop (RTD) and is responsible for 81% of the heat loss during the first hour of anaesthesia (Sessler 2000). After the first hour of anaesthesia, the body continues to lose heat, but at a slower rate, with RTD contributing to only 43% of this further reduction (Sessler 2000). Therefore during the first hour of anaesthesia the main cause of hypothermia, is core-to-periphery redistribution.

One of the most important factors controlling the extent redistribution hypothermia affects the patient’s temperature, is their initial body heat content

Actively prewarming patients before surgery has been shown to reduce the effect of redistribution temperature drop, maintain normothermia (Just et al 1993) and improve patient outcomes by reducing postoperative shivering (Just et al 1993) and aid in the reduction of postoperative wound infection (Melling et al 2001).

(Sessler 2000). Core body temperature remains relatively constant, even in warm environments. However as the peripheral tissues warm, the body heat content increases reducing the core-to-periphery gradient. As heat requires a gradient to flow, the extent to which redistribution hypothermia affects body temperature decreases as body heat content increases.

Actively warming patients before induction of anaesthesia (prewarming) is an effective way to increase body heat content and help prevent perioperative hypothermia in many surgical procedures. Cotton blankets, especially warmed ones may be comforting, but these passive insulators do not provide any active warming. In fact heat from cotton blankets dissipates into the environment (Sessler & Schroeder 1993).

Actively prewarming patients before surgery has been shown to reduce the effect of redistribution temperature drop, maintain normothermia (Just et al 1993) and improve patient outcomes by reducing postoperative shivering (Just et al 1993) and aid in the reduction of postoperative wound infection (Melling et al 2001). Prewarming

has also been shown to reduce length of stay in the recovery room and reduce the cost of anaesthesia (Bock et al 1998).

The 3MTM Bair PawsTM system offers a new way of reducing anaesthesia induced redistribution temperature drop and improving patient outcomes, through a reduction in the adverse effects of hypothermia.

The Bair Paws system uses Bair Hugger® therapy to provide both preoperative warming, that will contribute to increasing body heat content, as well as perioperative clinical warming for many surgical procedures.

There are two parts to the Bair Paws system: the warming gown and the warming unit. The Bair Paws gown is worn like a traditional gown. However unlike a traditional gown, it has its own special features. Inside the front of the Bair Paws gown is a Bair Hugger blanket, that has two independent air channels for delivering Bair Hugger therapy preoperatively, perioperatively and postoperatively. When using the Bair Paws warming unit, the temperature of the air flowing through the gown can be controlled by the patient, by the use of a handheld controller.

This ensures the patient remains comfortable during the preoperative warming period.

For a number of surgical procedures, the Bair Paws gown can be used to deliver perioperative clinical warming, by connecting the Bair Paws gown to a Bair Hugger warming unit.

With only a minimum of 10 to 20 minutes of prewarming required (Horn et al 2012). The Bair Paws system offers an easy method of ensuring you can provide your patients with a high standard of care and assist in reducing the adverse effects of inadvertent perioperative hypothermia. >>

Patient Warming 06

Journal of Perioperative Practice PROCUREMENT GUIDE January 2015 Volume 03 Issue 06 www.afpp.org.uk

References Barie PS 2002 Surgical site infections: epidemiology and prevention Surgical Infections 3 9-21, Supplement Bock M, Müller J, Bach A, Böhrer H, Martin E, Motsch J 1998 Effects of preinduction and intraoperative warming during major laparotomy British Journal of Anaesthesia 80 (2) 159-163 Horn EP, Bein B, Böhm R, Steinfath M, Sahili N, Höcker J 2012 The effect of short time periods of pre-operative warming in the prevention of peri-operative hypothermia Anaesthesia 67 (6) 612-617

Just B, Trévien V, Delva E, Lienhart A 1993 Prevention of intraoperative hypothermia by preoperative skin-surface warming Anesthesiology 79 (2) 214-218 Kurz A 2008 Thermal care in the perioperative period Best Practice & Research Clinical Anaesthesiolog 22 (1) 39-62 Kurz A, Sessler DI, 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 (19) 1209-15

Melling AC, Ali B, Scott EM, LeaperDJ 2001 Effects of preoperative warming on the incidence of wound infection after clean surgery: a randomised controlled trial The Lancet 358 (9285) 876-880 Sessler DI 1997 Current concepts: mild perioperative hypothermia New England Journal of Medicine 336 1730-1737 Sessler DI 2000 Perioperative heat balance Anesthesiology 92 (2) 578-596 Sessler DI, Schroeder M 1993 Heat loss in humans covered with cotton hospital blankets Anesthesia & Analgesia 77 (1) 73-77

Tryba M, Leben J, Heuer L 1996 Does active warming of severely injured trauma patients influence perioperative morbidity?

Anesthesiology 85 A283 Young VL, Watson ME 2006 Prevention of perioperative hypothermia in plastic surgery Aesthetic Surgery Journal 26 (5) 551-571

Patient Warming 07

Journal of Perioperative Practice PROCUREMENT GUIDE January 2015 Volume 03 Issue 06 www.afpp.org.uk

Maintaining perioperative normothermia Hypothermia is defined as a core body temperature of lower than 36°C, and is a common problem for patients undergoing surgery. Hypothermia is further defined as follows:

It is important that this risk is managed adequately within the perioperative environment. There is evidence that preventing intraoperative hypothermia can prevent serious postoperative complications.

It is known that all patients are potentially at risk of inadvertent perioperative hypothermia, but it is acknowledged that the following factors can increase the risk: • Age, particularly the elderly of 70 or over and neonates • Systemic diseases such as diabetes, peripheral vascular disease • Nutritional status as it is known that a poor nutritional state can increase the risk of hypothermia • Prolonged preoperative fasting • Administering cool intravenous fluids • Type and duration of surgical intervention • Exposure of large areas of the body during the procedure • Loss of body heat through the evaporation of skin preparation solutions • Vasodilation and resultant heat loss from the use of volatile agents • Loss of shivering from the use of muscle relaxants • Patient gowns from material that is poor at heat retention • Cool ambient temperatures, particularly during transfer from ward to theatre • Minimal covering during transfer • Exposure of a large area of skin at the surgical site • Exposure due to gown design • Female gender • The level of anaesthesia block in patients receiving spinal anaesthesia.

Hypothermia may occur during any stage of the patient’s perioperative care pathway.

NICE guidelines and other literature have identified measures to be taken in the preoperative, intraoperative and postoperative phases of perioperative interventions and procedures. Maintaining the core temperature of the patient at or above 36°C is beneficial for the patient.

• Mild hypothermia is a core body temperature between 32° and 35 C°.

• Moderate hypothermia is a core body temperature between 30° and 32°C. • Severe hypothermia is a core body temperature below 30° Perioperative hypothermia can have a wide range of detrimental effects to the patient undergoing a surgical intervention: • Increased rates of surgical wound infection • Delayed wound healing • Altered drug metabolism • Increased rate of stroke or heart attack due to the formation of blood clots • Increased perioperative blood loss and increased transfusion requirements • Postoperative shivering and oxygen consumption • Prolonged post-anaesthetic recovery and hospital stay • Morbidity • Increased risk of pressure ulcer formation • Increased risk of adverse myocardial outcomes.

Hypothermia can be deliberate or inadvertent. Deliberate hypothermia may be induced for medical or surgical reasons such as in cardiac or neurosurgery when it is beneficial to reduce metabolic activity. (The reduced metabolic rate prevents organ damage despite reduced perfusion.)

Hypothermia affects the circulatory, immune and coagulation systems of the body. This may contribute to increased blood loss by around 30%, as well as up to a 70% higher probability of need for transfusion during surgery or trauma.

Hypothermia affects the circulatory, immune and coagulation systems of the body. This may contribute to increased blood loss by around 30%, as well as up to a 70% higher probability of need for transfusion during surgery or trauma.

The young and the elderly are at risk of hypothermia. In children the increased surface area to body weight ratio allows cooling to occur more efficiently. In the elderly the fixed or reduced cardiac output as a result of disease or drugs reduces the efficiency of vasodilatation, sweating and exercise.

Reference This is an extract from AfPP’s Standards and Recommendations for Safe Perioperative Practice 2011 (Section 2)

Journal of Perioperative Practice PROCUREMENT GUIDE January 2015 Volume 03 Issue 06 www.afpp.org.uk

Patient Warming 08

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.

How long does it last?

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

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

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

Product News 09

Journal of Perioperative Practice PROCUREMENT GUIDE January 2015 Volume 03 Issue 06 www.afpp.org.uk

Eco EZ Cleanse and Valvesafe launch Peskett Solutions Ltd would like to introduce two recently acquired endoscopy products called Eco Ez Cleanse and Valvesafe. They are technologically advanced and significantly more cost effective than similar products on the market.

The Eco EZ Cleanse has been proven to potentially save Endoscopy units on average a cost savings of over £500 per month for a unit running 3-4 rooms using a premixed detergent. Both products have been developed in response to recent changes in UK and European guidelines regarding endoscope reprocessing

Eco EZ Cleanse™ - A endoscope ultra pre-cleaner designed for the initial flush and wipe of an endoscope immediately postprocedure. It brings together all the necessary components to undertake the pre-clean stage in one easy-to use single-use kit. This product has been designed with the very latest BSG and JAG guidelines in mind.

By including a sachet of concentrated endoscopic nonenzymatic detergent we are not packaging water, this means Eco EZ Cleanse is significantly more cost-effective than other bedside cleansers, shipping costs are greatly reduced and the box only takes up a quarter of the space of competitive products thus freeing up storage space.

The Eco EZ Cleanse™ tray can be used as the receptacle for the sterile water when performing the pre-use inspection and testing of the endoscope. The tray is filled to the desired level of either 250ml or 500ml with the sterile water. At the end of the procedure the sterile water can be saved and if required topped up and used for the pre-cleaning process by adding the sachet of Liquiclean S detergent. Saving time and money.

Valve safe™ is an eloquent single-use solution for keeping endoscope valves with the parent endoscope during the entire cleaning, disinfection and storage process. Valve safe™ is designed to take up to 4 valves.

As you may be aware, BSG and JAG Guidelines for Decontamination of Equipment for Gastrointestinal Endoscopy states: “Valves (including rinsing valves) should stay with a named endoscope as a set to prevent cross-infection and enable full traceability.”

A Medical Device alert was recently issued by MHRA regarding Endoscope Accessory Holders.

The alert states “an inappropriate device was used to hold accessories together through an AER. When used in a reprocess or such holders can deteriorate and contaminants may be introduced to the decontamination chemicals, reprocessor and the endoscope.

The fine mesh of the holder may also trap contaminants such as soil and may invalidate the decontamination process.”

Valve safe™ has been purposely designed for this application and therefore directly addresses the action that customers need to take. In addition, the issue of the fine mesh described in the alert is something we deliberately tackled in our design of the single-use Valve safe “Hi-flow” design with large ‘windows’ throughout.

For more information or free samples for trial, please do not hesitate to contact our office on 01323 511038 or email support@ peskettsolutions.com

Product News 10

Journal of Perioperative Practice PROCUREMENT GUIDE January 2015 Volume 03 Issue 06 www.afpp.org.uk

Effective, affordable solutions Central Medical Supplies Ltd continues its commitment to provide effective, affordable solutions to the operating theatre environment, including: • Swabsafe©, a swab disposal system fully compliant with AfPP guidelines.

• A comprehensive range of Temperature Management products for all surgical scenarios.

• Action© Pressure Relief products providing optimum pressure relief and shear reduction to patients.

For further information please log on to www.centralmedical.co.uk or contact CMS on 01538 399541 or e-mail: sales@centralmedical.co.uk.

Journal of Perioperative Practice PROCUREMENT GUIDE January 2015 Volume 03 Issue 06 www.afpp.org.uk

News 11

The Association for Perioperative Practice is a registered charity (number 1118444) and a company limited by guarantee, registered in England (number 6035633). AfPP Ltd is its wholly owned subsidiary company, registered in England (number 3102102).

The registered office for both companies is Daisy Ayris House, 42 Freemans Way, Harrogate, HG3 1DH.

Journal of Perioperative Practice PROCUREMENT GUIDE January 2015 Volume 03 Issue 06 www.afpp.org.uk

News 12