General Orientation Made Easy!

For new hires in healthcare and their Educators, General Orientation is like running a marathon. So many topics to cover, so little time. It is true that general orientation is the window of time that the facility has to officially welcome you as a new hire to the organization and take care of the business of getting you on board. But beyond the Human Resources necessities regarding payroll, benefits and such, there are many topics that must be covered that are designed to introduce you to the vision and priorities of the organization. These include the mandatories dictated by The Joint Commission and other accreditation bodies, the Centers for Medicare and Medicaid Services (CMS), and the Occupational Health and Safety Administration (OSHA).

Immediate-Use Steam “Flash” Sterilization? Not So Fast!

Every day, acute care and ambulatory surgery centers face challenges on how to lower healthcare-associated infections. In the operating room, a large part of this effort involves the proper cleaning and sterilization of surgical devices and equipment. But with limited numbers of instruments, tight turnaround schedules, and decreasing budgets, many facilities are performing immediate-use steam sterilization (aka “flash” sterilization) in an effort to sterilize items quickly to avoid buying additional surgical instruments. The fact is, rather than save money and time, immediate-use steam sterilization has been implicated in increasing a patient’s risk for infection, which may lead to lawsuits and loss of accreditation for a facility.

Originally, this type of sterilization was intended for use only in an emergency, such as when a one-of-a-kind instrument was contaminated or dropped from the sterile field. Unfortunately, it has now become common place and used too frequently due to time and budget constraints. Because items do not recieve the complete traditional sterilization processing, professional groups and accreditation agencies believe that IUSS should not be  a routine practice, but rather used only in select clinical situations, and in a controlled manner.

“The reason that it’s not looked upon as a good solution is because oftentimes in the tight timeframe that we use, there are chances that corners may be cut; that during that rushed process to get the instrument turned around there could be processes and protocols that are missed completely, or at least not fully complied with. Immediate-use steam sterilization is denoted as a process that is used only in emergencies and only if the devices that are to be sterilized are compatible with that process.” – Natalie Lind, CRCST, CHL, FCS, IAHCSMM Education Director.

In this day and age, healthcare facilities are under great pressure to prevent surgical site infections. It seems obvious that items that do not receive full sterilization cycles are likely to be the source of infections. Surgical Technicians and Central Service professionals must become aware of the issues surrounding this form of sterilization, and the standards, regulations and best practices regarding its use. It is vital that immediate-use steam sterilization be utilized in accordance with professional guidelines; facility policies and procedures; as well as in strict compliance with validated written instructions provided by device manufacturers, sterilization equipment manufacturers, and container or textile manufacturers. This is especially critical for short sterilization cycles, as it takes time for steam to penetrate a sterilizer load and achieve an acceptable sterility assurance level.

In an effort to promote best practices regarding the use of IUSS, a multi-agency position paper was released January 2011 by the International Association of Healthcare Central Service Materiel Management (IAHCSMM), the Association for the Advancement of Medical Instrumentation (AAMI), the Association of peri-Operative Registered Nurses (AORN), the Association for Professionals in Infection Prevention and Control (APIC), the ASC Quality Collaboration,  and the Accreditation Association for Ambulatory Health Care (AAAHC) .  In addition, the Centers for Disease Control and Prevention (CDC) has recommendations, and The Joint Commission has standards regarding proper use and protocols for IUSS that must be followed and closely documented.

Envision, Inc. and IAHCSMM are proud to present a NEW 11 minute staff training program entitled “Protocols for Immediate-Use Steam Sterilization,”  part of the Of Critical Importance staff education series for Central Service and Operating Room professionals who process surgical instruments and devices.  For a preview of the program in it’s entirety, visit www.EnvisionInc.net.

Moderate Sedation: Complying With Regulatory and Accreditation Requirements

Moderate sedation or analgesia, also known as “conscious sedation”, involves the use of a medication to provide relief of anxiety and pain. The patient does not lose consciousness, but does not perceive pain to the extent he or she may have otherwise. Each year, millions of procedures using moderate sedation are performed in ambulatory, ancillary, or acute care settings by non-anesthesia credentialed personnel for common procedures such as cardiac catheterization, endoscopy, and colonoscopy. Sedation of some level is often performed in critical care units to help patient’s better tolerate mechanical ventilation; and in the Emergency Department, moderate sedation is often used for endotracheal intubation, fracture reductionand lumbar puncture.

OMC Lowers Surgical Infection Rates. You Can Too!

Its a winning formula:

Patient education + handwashing + surgical site preparation + sterility in operating rooms = low surgical infection rates.

That’s what the Oconee Medical Center in Seneca, SC accomplished after setting a goal of zero infections. According to the state Department of Health and Environmental Control, the Oconee Medical Center reported 4 infections out of 70 hip procedures, 3 infections out of 144 knee replacements, and ZERO infections during 1,445 adult inpatient days and during 499 critical care patient days! When asked how the center achieved these rates, Heather Goss, Marketing Director at the facility cited various efforts:

Strict infection prevention protocols throughout the hospital, particularly related to patient education, hand washing, surgical site preparation, and sterility in ORs
Active surveillance screening for resistant bacteria upon patients arrival
A stand alone Joint Center unit that is segregated from the sick patient population
A partnership with Duke University Medical Center to have access to an infection control network for on-site support and resources

Global Handwashing Day Is October 15

The idea is simple: Washing hands with soap and water removes potential disease-causing organisms from the hands. It is one of the most effective and inexpensive ways to prevent diarrhea and pneumonia in global communities, which together are responsible for the majority of child deaths. Hand hygiene is also the primary method of preventing the transmission of pathogens to and from patients in healthcare settings that result in an estimated 1.4 million bloodstream infections, urinary tract infections, surgical site infections, chest/respiratory infections or gastrointestinal infections every year. Handwashing is clearly important, and yet 60% of the time healthcare professionals fail to clean their hands when indicated!

Drug-Resistant Bacteria Pose a New Threat

Drug-resistant bacteria are making the news again, and this time with the ultimate threat: There are no viable drugs to treat them.

Nearly as long as there have been antibiotics there have been drug-resistant bacterial strains. Selective pressure due to overprescribing as well as improper usage by patients allow bacteria to develop defenses against antibiotics. And after years of warnings by health officials, we are now seeing the presence of superstrains – bacteria that are impervious to all of our available antibiotic medications.

Palliative Care Relieves Symptoms, and Extends Lives

The evidence for the benefits of palliative care is growing. Palliative care is a comprehensive service that improves the quality of life for patients with serious illnesses. It helps patients receive adequate pain and symptom management, avoid inappropriate prolongation of dying, helps patients achieve a sense of control over their illness, as well as helps them make the most of their remaining time. It is a consultative service where caregivers from various disciplines work together as a unit to consider the list of symptoms and needs of the patient, and then create a practical plan for addressing the physical, emotion, social, cultural, and spiritual needs to the furthest extent possible.

Healthcare Worker Influenza Vaccination: Save A Life Today! (It Just Might Be Your Own)

According to flu.gov, in an average year, 5 to 20% of the population will contract seasonal influenza. 200,000 people are hospitalized from flu-related complications, and approximately 36,000 people will die from it.  There is a significant amount of literature that points to the reasons for the spread of influenza: poor hand hygiene, lack of proper respiratory etiquette, and most notably, a lack of immunity to the virus.  While many people will carry a natural immunity from the previous year’s exposure to an influenza strain, strains vary from year to year; and many individuals are a risk of serious illness from influenza should they catch it.

The start of the flu season will be upon us soon, and once again healthcare workers as a group have an opportunity to decrease the spread of influenza in our communities and in our healthcare facilities. How?  With vaccination.  It is one of the most important things that healthcare workers in hospitals and outpatient settings can do to prevent transmission of influenza to patients, and prevent catching the flu themselves.

The most efficient method of preventing these outbreaks and the associated morbidity and mortality is through pre-exposure vaccination. Healthcare personnel (HCP) are at high risk for acquiring influenza infection due to their exposure to ill patients as well as their exposure in the community. Because those persons who are at greatest risk of developing complications of influenza are exposed to healthcare personnel in a variety of in patient and outpatient settings, an important strategy to decrease exposure to these high risk individuals is to immunize healthcare workers. – APIC Position Paper: Influenza Immunization of Healthcare Personnel, 2008.

Many hospitals have set high benchmarks for personnel vaccination rates driven by research, accreditation requirements and mandatory vaccination policies. And yet, despite recommendations by the CDC, APIC, and other healthcare organizations, and despite the evidence that  vaccination can and does make a difference in lowering patient deaths by 40 percent and improving patient safety, healthcare personnel vaccination rates remain low.  What are the reasons for the 46% vaccination rate, and how can this be overcome?

Here are some interesting facts: Personnel who decline vaccination have egg allergy, religious or philosophical convictions, or a history of Guillain-Barre. But this is a small percentage of those who are unvaccinated year after year. It seems that the remainder are likely to be socially isolated from others who choose vaccination, or simply have misconceptions regarding vaccination.  This is why the most successful campaigns in hospitals today incorporate staff education to target individuals who persistently decline vaccination.

Envision, Inc. has created a 12 minute visual presentation to address questions and concerns staff may have about vaccination in an effort to promote their participation in an influenza vaccination program entitled “Dispelling the Myths: Infection, Vaccination and Prevention.”

This program will dispel some of the myths surrounding the flu vaccine by:

• Explaining modes of transmission and the impact on patients
• Describing symptoms of flu, risk factors for complications, and treatment options
• Outlining flu prevention techniques that reduce transmission
• Explaining vaccine options and their possible side effects
• Addressing the need for a declination statement if not vaccinated

Let’s make 2010 the most successful year for healthcare worker vaccination!  The life you save might just be your own.

Sources: Health-Care Worker Vaccination Rates Remain Perilously Low. http://www.sciencedaily.com/releases/2010/03/100317091255.htm

APIC Position Paper: Influenza Immunization of Healthcare Personnel. http://www.apic.org/AM/Template.cfm?Section=Home1&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTFILEID=11049

www.flu.gov

www.cdc.gov/flu/

Joint Commission monograph: http://www.jointcommission.org/PatientSafety/InfectionControl/flu_monograph.htm

Patient Falls: Can they be prevented?

It might surprise you to learn that patient falls are the most common hospital adverse event. In fact, an estimated 30% of hospital falls result in serious injury; and 10% of fatal falls for older adults actually occur in hospitals, the very place where patients should be safe!

Raise the Voice Campaign Increases Awareness of Nurses Transforming Healthcare

If the current debate on health care reform has taught us anything, it is that health care in the U.S. is inaccessible to many, expensive for most, and fragmented for all. Transforming the current health care system based on physician-dependent, hospital-based and acuity-oriented/reactive care to a system based on care that is patient-centered and pro-active is not only possible, it’s an absolute necessity. The financial and human cost of care that is often wasteful and ineffective must be reformed if we are to make healthcare affordable and improve clinical outcomes. Enter the American Academy of Nursing, a group of nursing’s most accomplished leaders in education, management, practice and research.