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13MS8766

SOLUTIONS GUIDE2013 FALL EDITION

ACHIEVING OPERATIONALEXCELLENCE:Common Cures for the Supply Closet Chaos

BECKER’S 6 TIPS TO BREEZE

THROUGH YOURNEXT SURGERY

CENTERACCREDITATION

STERILIZATIONAUDIT:

Is Your Surgical Facility Ready?

13MS8766 SurgiTeam Solutions_Standard Default 8/30/13 11:59 AM

As our industry continues on the path of transition,operational excellence is becoming increasingly vitalto any out-patient surgical practice, from bothreimbursement and an efficiency stand-point. In thisissue of the SurgiTeam Solutions Guide, we aim to provide guidance on some of the most important facility management topics:

• Surgical instruments sterilization and how to prepare for asterilization audit - what are the important points to considerin preparation for an audit, the typical questions asked as wellas the tools that outline the industry standards andrequirements for proper sterilization.

• Surgery center accreditation - we outline the 6 most importantareas, as identified by Becker’s Online, to focus on inpreparation for a surgery center accreditation.

• Supply closet management - while costs of medical suppliesare important, managing your supply closet efficiently can bevery impactful in saving time and money. We provide helpfultips on eliminating the “supply closet chaos” and achievingoperational excellence.

• Guidelines on endoscope reprocessing – with the increase ininfections, it is vitally important to make sure that your flexibleendoscopes are properly maintained and go through athorough cleaning and high-level disinfection process betweenuses. We outline the current industry guidelines andrecommendations, as well as important pitfalls to look out for.

Peg Olin-Lederman

Vice President, MedSurgHenry Schein Medical

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13MS8766SURGITEAM SOLUTIONS GUIDE

OUR SurgiTeammessage...

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To Order: 1.800.P.SCHEIN (1.800.772.4346) 8am–9pm, et

To Fax: 1.800.329.9109 24 Hrswww.henryschein.com/surgiteam

SurgiTeam Solutions—A single source for everyday surgical products, including:

• A wide range of branded and generic pharmaceuticals

• Broad selection of manufacturers to meet your every need

• Distribution network that is second to none, featuring:

– Reliable and customizable delivery of critical surgical products

– Dedicated account representatives to develop solutionsdesigned specifically for your center

– Inventory-management solutions to drive efficiency and profitability

– Comprehensive online ordering tools

– Over 6,000 high-quality, cost-saving Henry Schein Brand Products

Acheiving OperationalExcellence: Common Curesfor the Supply Closet Chaos

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Sterilization Audit:Is Your SurgicalFacility Ready?

Becker’s 6 Tips to Breeze Through Your Next Surgery Center Accreditation

Crash CartPharmaceuticals

Guidelines on EndoscopeReprocessing

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Proper sterilization of instruments and materials is a critical

aspect of infection prevention and control. In recent years,

accreditation organizations have spent additional time during

surveys evaluating the cleaning, disinfection and sterilization

processes of surgical facilities. For example, in 2009,

Centers for Medicare and Medicaid Services (CMS) revised

their Survey and Certification documents to include more

stringent audits emphasizing compliance with nationally

recognized standards; formal training in areas of infection

control and sterilization; compliant cleaning, sterilization

and monitoring procedures; and established criteria for flash

(now referred to as “immediate-use steam sterilization”). In

2010, Accreditation Association for Ambulatory Healthcare

(AAAHC) added an infection control chapter to their

standards handbook highlighting “adhering to standards,

guidelines, and manufacturer’s instructions for cleaning,

disinfection and sterilization of instruments, equipment,

supplies and implants”. And in 2011, The Joint Commission

provided in-depth training in sterilization and high level

disinfection to their surveyors in collaboration with the

American Association for the Advancement of Medical

Instrumentation (AAMI). AAMI Standards are adopted by

ANSI (American National Standards Institute) as our

American National Standards.

In addition to the CDC guidelines, every surgical facility

should have a copy of AAMI ST79 (Comprehensive Guide

to Steam Sterilization and Sterility Assurance in Health Care

Facilities) and their Policies & Procedures should reference

this national standard. Surgical staff should be in-serviced

on the updated policies and establish a routine schedule of

continuing education (CE) to reinforce best practices.

Supervisors should routinely observe staff for compliance

with best practices. Reprocessing departments should assess

the cleanliness of work stations, equipment and storage areas

while continually reminding staff as to the importance of

frequent and proper hand washing. From a reprocessing

point of view, it is important to emphasize that cleaning and

decontamination are the first and most critical steps in

reprocessing soiled items. Infection Control should establish

a zero tolerance policy regarding non-sterile instruments

used in surgery, which starts with not allowing blood to dry

on instruments after surgery and includes limiting

immediate-use steam sterilization (IUSS) for emergency-use

only. Special Note: IUSS (formerly called “flashing”)

should never be used to sterilize implants.

Compliant reprocessing requires a systems approach and

involves more than just the parameters set on the

sterilization equipment used to process items. You will be

expected to show proper facility design; thorough cleaning

of floors, work surfaces and storage areas; special attention

to air flow (negative pressure in decontamination, positive

pressure in clean areas), and such things as keeping pass-

through windows and doors closed between work areas. You

may be asked if you know what the tissue test is checking

airflow or to produce temperature and humidity records for

the previous 3 months. You will most likely be asked to

show you have an eye wash station and asked if it is

plumbed correctly. How often is it checked (standards say

weekly, allowing it to run for 3-5 minutes) and are the

eyepieces kept clean? Expect to be asked about cleaning,

STERILIZATION AUDIT:IS YOUR SURGICAL FACILITY READY?by Chuck Hughes


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i.e. how often are the sterile processing areas terminally

cleaned? Do you have a policy? Show it to me.

AAMI ST79 recommends wearing clean facility-laundered

attire, appropriate PPE, and frequent hand washing. Expect

to be asked about preparation and transport of soiled items.

Are soiled instruments being wiped of gross soil prior to

transport? Are transport carts, bags, and/or bins labeled

biohazard? In the decontamination area, expect to be asked

about manual cleaning (3 section sink is recommended for

soaking, washing, and rinsing) and a lot of questions around

Instructions for Use (IFU). Are instruments cleaned

according to each manufacturer’s IFU? Are IFUs kept on

file? Can you show me the IFU for the instrument you are

cleaning now? If your surgery center has purchased,

borrowed or even trialed an instrument without first getting

the IFU, then you are not alone. Unfortunately, that is no

excuse and you should secure them right away, not just to

pass your next survey, but for patient safety, as having and

following the manufacturer’s validated IFU is the only way

of knowing your facility is properly reprocessing reusable

devices.

To secure any missing IFUs, call the manufacturers directly

and ask for Quality Assurance or Regulatory Affairs. These

departments routinely work with IFUs and should be able to

fax, e-mail or mail you what you need. Once you have all of

the needed IFUs, it is important to let each of your

manufacturer’s Sales Representatives know that you need a

written IFU prior to trialing, borrowing or purchasing their

reusable devices. AAMI ST79 states “the written IFU of the

device manufacturer should always be followed. The

reusable device manufacturer is responsible for ensuring that

the device can be effectively cleaned and sterilized.

Sterilization qualification of a device requires micro-

biological, engineering, toxicological, and sometimes

clinical evaluations of the device, which are well beyond the

abilities of most health care facilities. The device labeling

should identify specific methods of cleaning and sterilization

that have been validated by the manufacturer. The

manufacturer’s written IFU should be kept on file and

periodically reviewed for any updates. If there is no specific

written IFU in the labeling, then the manufacturer should be

contacted directly to provide a documented method.”

Surveyors will want to confirm that you are testing both

your mechanical washers and sterilizers. You may be asked:

What are the daily and/or weekly routine maintenance

required for each machine? Who is responsible for the

routine maintenance? Are you monitoring each sterilizer

with a biological indicator at least weekly, preferably daily,

as well as every load that contains an implant? Do you run a

daily Bowie-Dick test on your steam prevacuum sterilizers?

Are you running your Bowie-Dick and Biological Indicator

test packs in accordance to their IFU? Are you monitoring

every pouch, wrapped tray and container with a Class 4, 5,

or 6 internal chemical indicator? Do you ever flash

implants? What have you done to reduce or eliminate

immediate-use steam sterilization? Do you have a loaner tray

policy and is it effective? Sterile storage is also an area that

will be reviewed. Expect to be asked “Where are unsterile

items stored?” Once the instruments come out of the

sterilizer, what is the dry time and where do they go? What

do you do when you have a wet pack or wet load? Do you

have a policy and procedure in place for this?

Lastly, expect to be questioned about personnel competency

training and to be asked “Is your staff certified?” Note:

Recommend framing and hanging Certificates for those who

are certified and/or any educational Seminars attended. Be

prepared when asked who trains new staff. Do you have an

orientation program? Do you have a competency

checklist? Have any of the reprocessing personnel observed

surgery? Do you ever allow scrub techs or nurses to assist

in sterile processing? Has this been recorded in their

training records? Is your staff involved in policy

development? How do you stay on top of best practices?


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Buyer’s price may constitute a ‘discount or other reduction in price’ under 42 U.S.C. § 1320a-7b(b) and 42 C.F.R. 1001.952(h). Buyer is solely responsible for (i) accurately reporting all discounts and price reductions claimed or charged to any Federal or State health care program, and (ii) determining whether to report or pass on savings or discounts to payors.

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About the AuthorChuck Hughes is the Vice President of Infection Prevention Consulting Services and lead Educator for SPSmedical Supply Corp.based in Rochester, NY. Certified as a Health Education teacher, he has worked for over 25 years in the manufacturing industry inareas of Regulatory Affairs, Research & Development, Marketing, Microbiology and Sterilization Training. Chuck is a corporatemember of numerous health care organizations, including AAMI and CSA where he contributes to writing sterilization standards. Hecan be contacted at [email protected]

In conclusion, while the delivery of non-sterile instruments

is not considered the leading cause of health care acquired

infections (HAIs), it has been documented by the CDC to be

one of the causes. Therefore, surgical facilities must do

everything possible to deliver sterile instruments by strict

compliance with best practices, such as the CDC guidelines

and AAMI ST79. Doing so ensures you will be ready for a

sterilization audit!

Do you have a copy of AAMI ST79? Note: AAMI ST79

and other national standards are available for purchase in

both text and CD-ROM format. For more information, call

AAMI at (703) 525-4890 or e-mail [email protected].

References

AAAHC - OR Manager Magazine, Volume 26,

Number 2, 2010

ANSI/AAMI ST 79 Comprehensive guide to steamsterilization and sterility assurance in healthcare facilities,Amendment 2. Arlington, VA: AAMI, 2012.

CMS - Infection Control Surveyor Worksheet,

Exhibit 351, 2009.

The Joint Commission (TJC). Steam Sterilization Update on The Joint Commission’s Position. June 15, 2009.

The Joint Commission Online. July 20, 2010.

STERILIZATION AUDIT:IS YOUR SURGICAL FACILITY READY?, cont’d


Illustrations and content provide general description only and may be subject to change. Integra, the Integra logo and Miltex are registered trademarks of Integra LifeSciences Corporation or its subsidiaries in the United States and/or other countries. All other trademarks are property of their respective owners. Copyright © 2013 Integra LifeSciences Corporation Schein SurgiTeam Ad 6/2013

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• Standardize Consider consolidating the number of brands and volume according toyour space requirements to help avoid product backlogs and preserveprecious stockroom space. This will also allow those who place orders toquickly identify approved items and maximize workflow.

• Optimize ordering frequencyConsolidating orders reduces overall costs. Adjust your order frequency tobalance how often you order, receive, and pay for your supplies. This alsoreduces the number of times that boxes are opened and supplies are putaway in a given week.

• LabelingLabel items properly to make navigating supply closets easy for those usingand stocking items—and to ensure that items stay organized.

You’re short on time and searching the supply closet for one small item.Frustrated, you scan drawers, shelves and boxes, thinking there must be a better way. Although it’s important to avoid running out of medicalsupplies, excess inventory can consume precious storage space. Spendingsome time on that closet now can save you time and money later.

“Good inventory control is not just about eliminating the waste associatedwith proper disposal of an expired item,” says Carolyn Pickles, MBA,FACMPE, MGMA-ACMPE member, author of Assessment Workbook forMedical Practices (mgma.com/store-action). “It’s about avoiding the costassociated with inefficiency when a key supply—one that is needed thatminute—is not in stock.”

Here are some steps that, when implemented separately or together, save staff time and office money...

by Trinh Braddock & Jeff Girardi

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• Enable technologyTablets, particularly iPads, are becoming more popular in the office andcan help optimize efficiencies with ordering and inventory management.Practice should consider wireless barcode scanning, which incorporatestablets into electronic supply management.


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Providers of all sizes strive for better inventory control, but you can easily be sidetracked byinefficient supply processes. Implementing seamless stocking and ordering procedures reducessupply-closet chaos, which can improve operations and save money.

Pickles, a practice management consultant who addresses these issues in her book, agrees. “An organized supply closet with labels, stock rotation of items with expiration dates, andperiodic/regular inventory review when there is not an electronic inventory control system can go a long way toward increasing efficiency and controlling costs,” she adds.

• Electronic inventory management systemsAutomation of supply-chain management processes can offer suggested ordersbased on utilization history. It can reduce ordering time, maintain inventorybalances (minimum and maximum levels), streamline ordering processes andtrack inventory and expiring products to reduce obsolescence and avoidexcess inventory.


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Item Code Description Strength Size Manufacturer

(348-1109) Activated Charcoal Powder 1 oz. Bottle Humco(323-0003) Adenocard® (Adenosine) 3 mg./mL 2 mL Syringe Astellas(323-0004) Adenocard® (Adenosine) 3 mg./mL 4 mL Syringe Astellas(248-0408) Adenosine 3 mg./mL 2 mL SDV Akorn(112-7804) Adenosine (Adenocard®) 3 mg./mL 4 mL Syringe Sagent(930-9143) Albuterol (Ventolin®) HFA Inhaler 0.09 mg./Spray 18 Gm. Canister GSK(248-2037) Aminophylline 25 mg./mL 10 mL SDV Hospira(248-5924) Amiodarone HCl (Cordarone®) 50 mg./mL 3 mL SD Ampule Hospira(248-0455) Amiodarone HCl/Nexterone® Pre-Mixed IV 150 mg./100 mL 100 mL IV Bag (12/Case) Baxter(248-0458) Amiodarone HCl/Nexterone® Pre-Mixed IV 360 mg./200 mL 200 mL IV Bag (10/Case) Baxter(840-8449) Ammonia Inhalant (Aspirol®) 0.3 mL Ampule Alexander(120-9048) Amyl Nitrate Inhalant (Aspirol®) 0.3 mL Ampule Banyan(295-0031) Aspirin 325 mg. (5 gr) Packet/2 Tablets Medique(248-7959) Atropine Sulfate 0.05 mg./mL (Infant) 5 mL Ansyr Syringe Hospira(248-7960) Atropine Sulfate 0.1 mg./mL 5 mL Abboject LifeShield Syringe Hospira(248-4141) Atropine Sulfate 0.1 mg./mL 10 mL Abboject LifeShield Syringe Hospira(258-0069) Atropine Sulfate 0.4 mg./mL 1 mL SDV American Regent(248-0537) Atropine Sulfate 1 mg./mL 1 mL SDV American Regent(295-0045) Bumetanide (Bumex®) 0.25 mg./mL 4 mL MDV Bedford(295-0033) Bumetanide (Bumex®) 0.25 mg./mL 10 mL MDV Bedford(295-0034) Butorphanol (Stadol®) – CIV 2 mg./mL 1 mL SDV Bedford(248-0241) Calcium Chloride 10% (100 mg./mL) 10 mL Abboject LifeShield Syringe Hospira(248-2310) Calcium Chloride 10% (100 mg./mL) 10 mL SDV American Regent(248-9765) Calcium Gluconate 10% (100 mg./mL) 10 mL SDV APP (104-5383) Chloroprocaine HCl (Nesacaine®) 2% (400 mg./20 mL) 20 mL SDV Bedford(248-7968) Clonidine HCl (Catapres®) 0.1 mg. 1 Tablet Major (115-7589) Dantrolene Sodium (Dantrium®) IV 20 mg./mL 70 mL SDV (6/Box) JHP Pharma(118-3633) Dantrolene Sodium (Revonto®) IV 20 mg./mL 60 mL SDV (6/Box) US World Med(258-0122) Dexamethasone (Decadron®) 4 mg./mL 5 mL MDV APP (102-4486) Dexamethasone (Decadron®) 4 mg./mL 30 mL MDV APP (248-6407) Dextrose 25% (Infant) 10 mL Ansyr Syringe Hospira(248-0724) Dextrose 50% 50 mL Ansyr Syringe Hospira(248-6614) Dextrose 50% 50 mL SDV Hospira(153-9754) Dextrose 5 in Water (D5W) Minibag 5% 100 mL IV Bag Baxter(153-6161) Dextrose 5 in Water (D5W) 5% 250 mL IV Bag Baxter(258-0265) Dextrose 5 in Water (D5W) 5% 500 mL IV Bag Hospira(104-6850) Dextrose 5 in Water (D5W) 5% 1000 mL IV Bag Hospira(295-0035) Dextrose 5 in Water (D5W) 5% 250 mL Bottle Banyan(153-8920) Dextrose 5% & Sodium Chloride 5%/0.9% 500 mL Bag Baxter(248-0273) Diazepam (Valium®) – CIV 5 mg./mL 2 mL Carpuject Luer-Lock Syringe Hospira(248-0274) Diazepam (Valium®) – CIV 5 mg./mL 10 mL MDV Hospira(248-1659) Digoxin (Lanoxin®) 0.25 mg./mL 2 mL SD Ampule Baxter(119-6366) Diltiazem (Cardizem®) 5 mg./mL 10 mL SDV 10/Box West Ward(248-9358) Diphenhydramine (Benadryl®) 50 mg./mL 1 mL Carpuject Luer-Lock Syringe Hospira(258-5924) Diphenhydramine (Benadryl®) 50 mg./mL 1 mL SDV Baxter(248-7964) Dobutamine (Dobutrex®) 250 mg./20 mL 20 mL SDV Bedford(258-4556) Dopamine (Intropine®) 40 mg./mL 5 mL SDV American Regent(114-7375) Dopamine (Intropine®) 80 mg./mL 5 mL SDV American Regent(115-5645) Dopamine in 5% Dextrose 400 mg./250 mL (1.6 mg./mL) 250 mL IV Bag Baxter(248-8166) Epinephrine (Adrenalin® Chloride) 1:10,000 (0.1 mg./mL) 10 mL Abboject Syringe (18G x 3.5") Hospira(248-8175) Epinephrine (Adrenalin® Chloride) 1:10,000 (0.1 mg./mL) 10 mL Abboject LifeShld Syringe Hospira(258-9483) Epinephrine (Adrenalin® Chloride) 1:1,000 (1 mg./mL) 5 Pack/1mL Ampules Hospira(345-3230) EpiPen® Auto-injector (Epinephrine) 0.15 mg. (Pediatric) Pre-filled Syringes (2/Pk) Dey(345-1926) EpiPen® Auto-injector (Epinephrine) 0.3 mg. (Adult) Pre-filled Syringes (2/Pk) Dey(248-0492) Esmolol HCl (Brevibloc®) 10 mg./mL 10 mL SDV Bedford(248-0538) Flumazenil (Romazicon®) 0.1 mg./mL 5 mL MDV Sandoz(248-0540) Flumazenil (Romazicon®) 0.1 mg./mL 10 mL MDV Sandoz(181-3332) Furosemide (Lasix®) 10 mg./mL 2 mL SDV Hospira(248-9356) Furosemide (Lasix®) 10 mg./mL 10 mL Ansyr Syringe Hospira(104-2145) GlucaGen® Diagnostic Kit (Glucagon) 1 mg. (1 Unit) Kit=vial,GlucaGen+vial, Strl Water Bedford(375-8394) Heparin Sodium Porcine 1,000 U/mL 1 mL MDV 25/Pk APP (248-0407) Hydralazine HCl (Apresoline®) 20 mg./mL 1 mL SDV APP (427-8052) Insta-Glucose® Gel 31 Gm. Tube ICN(248-3658) Isuprel® (Isoproterenol HCl) 1:5,000 (0.2 mg./mL) 1 mL SD Ampule Hospira(258-9639) Ketorolac Tromethamine (Toradol®) 30 mg./mL 1 mL SDV IM/IV Hospira(840-8589) Labetalol HCl (Trandate®) 5 mg./mL 20 mL MDV Hospira(258-8050) Lactated Ringers Solution 500 mL Bag Hospira

CRASH CART PHARMACEUTICALS


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Item Code Description Strength Size Manufacturer

(104-8833) Lactated Ringers Solution 1000 mL Bag Hospira(104-6857) Lactated Ringers Solution in Dextrose 5/Water 5% 1000 mL Bag Hospira(248-7963) Levophed® (Norepinephrine Bitartrate) 4 mg./4 mL 4 mL SD Ampule Hospira(248-0238) Lidocaine HCl (Xylocaine®) 1% (10 mg./mL) 5 mL Abboject LifeShield Syringe Hospira(258-7008) Lidocaine HCl (Xylocaine®) 1% (10 mg./mL) 20 mL MDV Hospira(248-3812) Lidocaine HCl (Xylocaine®) 2% (20 mg./mL) 5 mL Abboject LifeShield Syringe Hospira(248-8012) Lidocaine HCl (Xylocaine®) – Cardiac 2% (20 mg./mL) 5 mL Ansyr Syringe Hospira(248-0235) Lidocaine HCl (Xylocaine®) 2% (20 mg./mL) 5 mL SDV Hospira(258-0603) Lidocaine HCl (Xylocaine®) 2% (20 mg./mL) 20 mL MDV Hospira(153-6016) Lidocaine HCl & Dextrose 5% 0.4%/5% 500 mL IV Bag Baxter(258-0672) Lidocaine HCl w/Epi (Xylocaine® w/Epi) 1%/1:100,000 20 mL MDV Hospira(248-0237) Lidocaine HCl w/Epi (Xylocaine® w/Epi) 2%/1:100,000 20 mL MDV Hospira(258-2820) Magnesium Sulfate 50% (1 gm./2 mL) 2 mL SDV American Regent(258-0220) Magnesium Sulfate 50% (10 gm./20 mL) 20 mL SDV Hospira(258-0112) Methylene Blue 1% (10 mg./mL) 10 mL SDV American Regent(114-8940) Metoclopromide HCl (Reglan®) 5 mg./mL 2 mL Flip Top Vial Hospira(248-8794) Metoprolol (Lopressor®) 1 mg./mL 5 mL SD Ampule Hospira(116-4259) Midazolam HCl (Versed®) – CIV 2 mg./2mL 10 x 2 mL iSecure Syringe Hospira(248-0299) Midazolam HCl (Versed®) – CIV 5 mg./mL 1 mL SDV Hospira(248-0514) Midazolam HCl (Versed®) – CIV 5 mg./mL 2 mL SDV Hospira(408-0210) Midazolam HCl (Versed®) – CIV 2 mg./mL 118 mL Bottle Ranbaxy(248-0314) Nalbuphine (Nubain®) 10 mg./mL 1 mL SD Ampule Hospira(248-9357) Naloxone HCl (Narcan®) 0.4 mg./mL 1 mL Carpuject Luer-Lock Syringe Hospira(248-9568) Naloxone HCl (Narcan®) 0.4 mg./mL 1 mL SDV Hospira(258-7295) Naloxone HCl (Narcan®) 0.4 mg./mL 10 mL SDV Hospira(248-0500) Naloxone HCl (Narcan®) 1 mg./mL 2 mL Syringe (21 G x 1.5") Internat'l Med Sys(258-9609) Neostigmine Methylsulfate (Prostigmin®) 1:1000 (1 mg./mL) 10 mL MDV Baxter(248-5055) Nitroglycerin 5 mg./mL 10 mL SDV American Regent(116-5208) Nitroglycerin Spray (Nitrolingual®) 0.4 mg./Spray 4.9 Gm. (60 Dose) Bottle Wilshire Pharm(116-5209) Nitroglycerin Spray (Nitrolingual®) 0.4 mg./Spray 12 Gm. (200 Dose) Bottle Wilshire Pharm(248-0473) NitroMist® Aerosol Spray (Nitroglycerin) 0.4 mg./Spray 4.1 Gm. (90 Dose) Bottle Akrimax Pharm(248-2398) Nitropress® (Sodium Nitroprusside) 50 mg./2 mL 2 mL SDV (I.V. Only) Hospira(248-0473) NitroMist® Aerosol Spray (Nitroglycerin) 400 mcg./Spray 4.1 Gm. (90 Dose) Bottle Akrimax Pharm(258-0313) Nitrostat® (Nitroglycerin) 0.4 mg. (1/150 gr) 25/Bottle Sublingual Tablets Pfizer/Upjohn(321-3802) Nitrostat® (Nitroglycerin) 0.4 mg. (1/150 gr) 100/Bottle Sublingual Tablets Pfizer/Upjohn(248-0548) Phenylephrine HCl (Neo-Synephrine®) 1% (10 mg./mL) 1 mL SDV American Regent(248-2309) Phenytoin Sodium (Dilantin®) 50 mg./mL 2 mL SDV Baxter(248-0845) Phenytoin Sodium (Dilantin®) 50 mg./mL 5 mL SDV Baxter(248-0240) Potassium Chloride 20 mEq 10 mL SDV APP (258-7296) Procainamide HCl (Pronestyl®) 100 mg./mL 10 mL MDV Hospira(113-2836) Procainamide HCl (Pronestyl®) 500 mg./mL 2 mL MDV Hospira(258-4249) Promethazine HCl (Phenergan®) 25 mg./mL 1 mL SD Ampule Baxter(248-4638) Promethazine HCl (Phenergan®) 50 mg./mL 1 mL SD Ampule Baxter(248-0340) Propranolol HCl (Inderal®) 1 mg./mL 1 mL SDV West-Ward(118-3633) Revonto® IV (Dantrolene Sodium) 20 mg./mL 60 mL SDV (6/Box) US World Med(248-7957) Sodium Bicarbonate (Infant) 4.2% (5 mEq) 10 mL Abboject LifeShield Syringe Hospira(248-8473) Sodium Bicarbonate (Infant) 8.4% (10 mEq) 10 mL Abboject LifeShield Syringe Hospira(248-1288) Sodium Bicarbonate 8.4% (50 mEq) 50 mL Abboject LifeShield Syringe Hospira(248-8109) Sodium Bicarbonate 8.4% (50 mEq) 50 mL SDV Hospira(116-2590) Sodium Chloride (Bacteriostatic) 0.9% 10 mL MDV LifeShield Plastic Hospira(258-0040) Sodium Chloride (Bacteriostatic) 0.9% 30 mL MDV Plastic Hospira(295-0041) Sodium Chloride for Inj (Normal Saline) 0.9% 250 mL IV Bag Hospira(258-1455) Sodium Chloride for Inj (Normal Saline) 0.9% 500 mL IV Bag Hospira(104-6816) Sodium Chloride for Inj (Normal Saline) 0.9% 1000 mL IV Bag Hospira(295-0042) Sodium Chloride Irrigation (Normal Saline) 0.9% 1000 mL Plastic Pour Bottle Hospira(908-0011) Solu-Cortef® (Hydrocortisone Sod Succ) 100 mg. 2 mL Act-O-Vial SDV Pfizer/Upjohn(908-0013) Solu-Cortef® (Hydrocortisone Sod Succ) 250 mg. 2 mL Act-O-Vial SDV Pfizer/Upjohn(248-0255) Solu-Medrol® (Methylprednisolone Sod Succ) 40 mg./1 mL 1 mL Act-O-Vial SDV Pfizer/Upjohn(248-0254) Solu-Medrol® (Methylprednisolone Sod Succ) 125 mg./2 mL 2 mL Act-O-Vial SDV Pfizer/Upjohn(248-0423) Terbutaline Sulfate (Brethine®) 1 mg./mL 1 mL SDV APP (248-0294) Tigan® (Trimethobenzamine HCl) 100 mg./mL 2 mL SDV JHP Pharma(258-2742) Vasopressin (Pitressin®) 20U/mL 1 mL MDV American Regent(248-7969) Vasopressin (Pitressin®) 20U/mL 10 mL MDV American Regent(248-0352) Verapamil (Calan®, Isoptin®) 2.5 mg./mL 2 mL SDV Hospira(248-9359) Verapamil (Calan®, Isoptin®) 2.5 mg./mL 4 mL Ansyr syr Hospira(258-0622) (Sterile) Water for Injection Preservative-Free 10 mL Flip Top Vial Plastic Hospira(181-9911) (Sterile) Water for Injection Preservative-Free 50 mL Flip Top Vial Plastic Hospira

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1. Clear documentation for infection control.Infection control meetings address quality infection

control topics such as sterilization techniques, hand

washing, postoperative infections, protocols for

needle sticks and cleaning processes. Require all

clinical staff members attend and document the

meeting minutes, said David C. Watts, MD, the Vice

President of Education for the American Association

for Accreditation of Ambulatory Surgery Facilities.

"The meeting minutes have to chronicle exactly

what was said and gone over. If there are any

problems, you should document what the plan of

action is and how you plan to correct it," he said.

2. A staff focused on accreditation. For

ambulatory service centers going through the

survey for the first time, the obvious focus is to gain

accreditation. However, for centers that are already

accredited, Gina Dolsen, RN, BSN, MA, Vice

President of operations for Blue Chip Surgical

Center Partners and an Accreditation Association

for Ambulatory Health Care surveyor, said to make

the survey work in the ASC's favor.

She recommended driving the surveyors to where

the center needs help and to use the AAAHC to the

center's advantage. "A survey can be to your

benefit; it doesn't have to mean your demise," Ms.

Dolsen said.

Additionally, ASCs should focus on topics that have

been in the news leading up to the survey date. "If it

has been in the news, it will be on the survey," she

said.

3. Wrong site surgery prevention policies. The

ASC is required to conduct a standardized "time

out" process before every surgical procedure to

ensure that the right patient, right procedure, right

equipment, right medications, right surgical marking

and the right physician are present. The surgical

site is to be marked by the surgeon with a

standardized surgical marking. A "time out"

checklist is required to be used to ensure that all of

the time out steps are consistently followed, said

Donna Tiberi, RN, a standards interpretation staff

member with the Healthcare Facilities Accreditation

Program.

"Sometimes the time out process is being

performed, but staff fails to document it, or

elements of the time out are missing," she said.

"When a surveyor is on site, they will review charts

to verify that time-out was documented." The

verification process should begin from the time a

patient is scheduled for a procedure through to the

time of surgery. "You always want to ensure that

you have the right patient," she said. "You need to

follow consistent policies, and procedures."

6 Tips to Breeze Through Your NextSurgery Center Accreditationby Heather Linder | March 28, 2013 Becker’s ASC Review Online


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4. Smooth care transitions between providers.Although a smooth transition of care between the

ASC and other providers is not commonly surveyed

by accrediting organizations, this may be something

that accrediting bodies move toward surveying in the

future.

"Going forward, we will be starting to look at

communication between providers and the transition

of care," said Susan Lautner, RN, BSN, MSHL, an

accreditation specialist for quality and patient safety

at the Healthcare Facilities Accreditation Program.

"[HFAP] is currently emphasizing this for hospitals

but we eventually want to carry that same thread of

continuity of care to all facilities."

5. Proper quality assurance programs. One of the

most common mistakes Dr. Watts has seen as an

inspector is the lack of an adequate quality

assurance program in surgical facilities. "You want to

look at how you're logging in and tracking narcotics,

handling disciplinary problems, the advanced

directives looked at by patients, the bill of rights

looked at by patients — this has to happen on a daily

basis for every case," he said. "You want to make

sure that documents like pathology reports and

X-rays are being signed off on by the physician doing

the case. All of this has to be checked."

6. Updated past policies. If at all possible, with

permission from the appropriate personnel, surgery

centers should use policies and procedures from

previous workplaces as a template. By using policies

and procedures from her previous hospital employer,

Freida Toler, administrator at Amarillo (Texas)

Endoscopy Center, saved time and energy needed to

build policies from scratch and helped her facility

more quickly achieve accreditation by the AAAHC.

"With permission from the hospital where I was the

manager of the endoscopy lab, I brought over the

policies and procedures that were used there and

revamped them to fit the needs of our endoscopy

center," she said. "It required some changing

because hospitals run in a completely different

manner than ASCs."

Source: http://www.beckersasc.com/asc-accreditation-and-patient-safety/7-tips-to-breeze-through-your-next-surgery-center-accreditation.html


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EXPAREL®

(bupivacaine liposome injectable suspension) for Postsurgical Pain Control

What is Exparel?EXPAREL®—Postsurgical Pain Control That Starts When Surgery Ends and Continues Days Into Recovery*

EXPAREL® is a local analgesic that utilizes bupivacainein combination with the proven product deliveryplatform, DepoFoam®. A single intraoperative injectiongiven at the close of surgery delivers postsurgical paincontrol with reduced opioid requirements† for up to 72hours.*¹

EXPAREL® is the first and only multivesicularliposome-based local anesthetic that can be utilized inthe peri- or postsurgical setting in the same fashion ascurrent local anesthetics. Local infiltration ofEXPAREL® results in significant systemic plasma levelsof bupivacaine that can persist for 96 hours.¹• Systemic plasma levels of bupivacaine following

administration of EXPAREL®are not correlated withlocal efficacy

• Other formulations of bupivacaine should not beadministered within 96 hours followingadministration of EXPAREL®

EXPAREL® is indicated for administration into thesurgical site to produce postsurgical analgesia.¹

*Pivotal studies have demonstrated the safety and efficacy ofEXPAREL in patients undergoing bunionectomy or hemorrhoidectomyprocedures; additional studies are underway to further demonstratethe safety and efficacy in other procedures.

†The clinical benefit of the attendant decrease in opioid consumptionwas not demonstrated.

¹EXPAREL [prescribing information]. Parsippany, NJ: Pacira Pharmaceuticals, Inc.; 2011.

²Gorfine SR, Onel E, et al. Bupivacaine extended-release liposomeinjection for prolonged postsurgical analgesia in patients undergoinghemorrhoidectomy: a multicenter, randomized, double-blind,placebo-controlled trial. Diseases of the Colon & Rectum. 2011;54 (12):1552-1559.

For Important Safety Information and to learn more about Exparel, go to:www.exparel.com/index.shtml

For medical inquiries related to EXPAREL, contactMedical Information at [email protected] 1-855-RX-EXPAREL (1-855-793-9727).

The EXPAREL® DifferenceSame Infiltration Technique Provides Several Days ofPostsurgical Analgesia.* Surgeons who infiltrate localanesthetics can use the same technique to administerEXPAREL® at the close of surgery.

As a non-opioid, single-dose analgesic1, EXPAREL® can:• Provide up to 72 hours* of analgesia with • Reduced opioid requirements†

• Without the need for catheters or pumps

In a pivotal hemorrhoidectomy trial of EXPAREL®

compared to placebo, where all patients withinadequate pain control received opioids for rescuepain relief, a single intraoperative injection ofEXPAREL® demonstrated:• A 30% reduction in cumulative pain scores and more

pain-free patients at all time points up to andincluding 24 hours (P<0.0001)²

• A 45% decrease in the use of opioid rescuemedication at 72 hours and more than a 12-foldincrease in the median time to first opioid use(P=0.0006 and P<0.0001, respectively)²; the clinicalbenefit of the attendant decrease in opioidconsumption was not determined

EXPAREL® is contraindicated in obstetricalparacervical block anesthesia. EXPAREL® has not beenstudied for use in patients younger than 18 years of age.

Exparel®

(289-0000) (Bupivacaine Liposome Injectable Suspension), 1.3% 10/Box

Henry Schein Medical is an authorized distributor

for Exparel™

www.henryschein.com/aesthetics


18


Endoscopy is a frequently used procedurefor diagnostic and therapeutic purposes.More than 20 million gastrointestinal(GI) endoscopic procedures areperformed each year in the UnitedStates.1 The documented pathogentransmission resulting from theseprocedures are rare, approximately 1 in1.8 million procedures.2 However, it issuch a recurrent problem that this topiccontinues to land on the top 10technology hazards list by ECRIInstitute.3 Flexible endoscopereprocessing has been shown to have anarrow margin of safety. Any slightdeviation from the recommendedreprocessing protocol can lead to thesurvival of microorganisms and increasedrisk of infection.4 Almost all thereported cases of infection associatedwith a contaminated GI endoscope havebeen linked to a specific breach orviolation of at least one of severalrequisite reprocessing steps. Severalfactors contribute to these. First, flexibleendoscopes are complex, delicate devicesthat are not readily reprocessed, and theirreprocessing tends to be more manually-intensive, more steps, and more errorprone. Second, flexible endoscopes areexpensive; many clinics have a leaninventory. When demand for theendoscopes is high, endoscopereprocessing personnel are sometimesunder the pressure of reprocessing more

quickly. This can lead to shortcuttingprocedures. To ensure patient safety,flexible endoscopes must undergo athorough cleaning and high-leveldisinfection process between uses.

Current guidelines andrecommendations

Flexible endoscopes should first becompletely cleaned and then subjected toat least high-level disinfection. Thesestandards have been recommended byfederal agencies such as the FDA5 andCDC;6 professional organizations such as the American Society forGastrointestinal Endoscopy (ASGE)7,the Society of Gastroenterology Nurse

and Associates (SGNA),8 theAssociation of periOperative RegisteredNurse (AORN)9, and the Association forProfessionals in Infection Control andEpidemiology (APIC). When theseguidelines and recommendations havebeen followed, there are no publishedstudies of confirmed transmission ofinfection. Below are therecommendations from ASGE,multisociety guideline on reprocessingflexible gastrointestinal endoscopes:2011.7

Personnel:All health care personnel in theendoscopy suite should be trained in andadhere to standard infection preventionand control recommendations (e.g.,

This is a two-part seriesarticle on endoscopereprocessing. Part 2 of the article will befeatured in our nextSurgiTeam SolutionsGuide edition.

ENDOSCOPEREPROCESSING:PART 1


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standard precautions), including those toprotect both patients and health careworkers. Personnel assigned to reprocessendoscopes should receive device-specificreprocessing instructions (i.e., endoscopeand/or AER manufacturer, as needed) toensure proper cleaning and high-leveldisinfection or sterilization. Competencytesting of all personnel who reprocessendoscopes should be performed anddocumented on a regular basis (e.g.,beginning of employment, annually, and when new equipment is purchased).Temporary personnel should not beallowed to reprocess endoscopes untilcompetency has been established. Allpersonnel using chemicals should beeducated about the biological andchemical hazards present whileperforming procedures that usedisinfectants.

Pre-cleaning and transport:Pre-cleaning should be performed at thepoint of use, before bioburden has an

opportunity to dry and before completedecontamination. Point-of-use pre-cleaning should remove visible debris bywiping the exterior of the endoscopewith a wet cloth or sponge withappropriate detergent solutioncompatible with the endoscope andaspirating a large volume of detergentsolution through the air/water and biopsychannels. This step is necessary beforeboth automated and manual disinfection.Follow manufacture’s written instructionsfor use of the (enzymatic) detergent fordilution and soaking time. After point-of-use pre-cleaning, transport the soiledendoscope to the reprocessing area forsubsequent steps in high-leveldecontamination before remaining soildries. During transportation, soiledendoscopes should be contained in amanner that prevents exposure of staff,patients or the environment to thepotentially infectious organisms. Anopen container can suffice for transportto immediately adjacent reprocessing

rooms, but fully enclosed and labeledcontainers or bags should be used fortransportation to distant reprocessingareas.

Leak testing and manualcleaning:To detect damaged endoscopes, test eachflexible endoscope for leaks (pressure/leak testing) after each use and beforeformal reprocessing, according tomanufacturer guidelines. Remove fromclinical use any instrument that fails the leak testing, and send the instrumentfor repair.

Before manual or automated high-leveldisinfection, meticulously clean theentire endoscope, including valves,channels, connectors and all detachableparts. Disconnect and disassembleendoscope components (e.g., air/waterand suction valves) as completely aspossible and completely immerse all


20


components in an appropriate detergentthat is compatible with the endoscope,according to the manufacturer’sinstructions. Flush and brush allaccessible channels to remove all organic(e.g., blood, tissue) and other residues.Repeatedly actuate the valves duringcleaning to facilitate access to allsurfaces. Clean the external surfaces andcomponents of the endoscope by using asoft cloth, sponge, or brushes. Keep thescope submerged during this process toprevent aerosolization. Use cleaningbrushes appropriate for the size of theendoscope channel, parts, connectorsand orifices (e.g., bristles should contactall surfaces) for cleaning. Cleaning items(e.g., brushes, cloth) should be disposableor, if they are not disposable, they shouldbe thoroughly cleaned and either high-level disinfected or sterilized betweenuses. Discard (enzymatic) detergentsafter each use because these products arenot microbicidal and therefore, will notretard microbial growth.

Reusable endoscopic accessories (e.g.,biopsy forceps, other cuttinginstruments) that break the mucosalbarrier should be mechanically cleanedas described previously and thensterilized between each patient use(high-level disinfection is notappropriate). Ultrasonic cleaning ofreusable endoscopic accessories andendoscope components may be used toremove soil and organic material fromhard-to-clean areas.

References:1. Everhart, J.E. The burden of digestive

disease in the United States. NIHpublication no. 09-6443. Washington(DC): U.S. Department of Healthand Human Services; 2008

2. Kimmey, M.B., Burnett, D.A., Carr-Locke, DL, et al. Transmission ofinfection by gastrointestinalendoscopy. Gastrointest Endosc.1993; 36:885-8.

3. https://www.ecri.org/Documents/Secure/Health_Devices_Top_10_Hazards_2013.pdf

4. Alfa, M.J., Olson, N., & Degagne, P.Automated washing with thereliance endoscope processing systemand its equivalence to optimalmanual cleaning. Am. J. Infect.Control. 2006; 34(9), 561-570.

5. U.S. Food and Drug Administration.Draft guidance for the content ofpremarket notifications forendoscopes used in gastroenterologyand urology. Rockville (MD):National Press Office; 1995.

6. Rutala, W.A., Weber, D.J., theHealthcare Infection ControlPractices Advisory Committee(HICPAC). Guideline fordisinfection and sterilization inhealthcare facilities, 2008. Available at:http://www.cdc.gov/hicpac/Disinfection_Sterilization/3_0disinfectEquipment.html

7. Multisociety guideline onreprocessing flexible gastrointestinalendoscopes: 2011. Available at:

http://www.asge.org/uploadedFiles/Publications_and_Products/Practice_Guidelines/Multisociety%20guideline%20on%20reprocessing%20flexible%20gastrointestinal.pdf

8. Standards of Infection Control inReprocessing of FlexibleGastrointestinal Endoscopes, 2012.Available at: http://www.sgna.org/Portals/0/sgna_stand_of_infection_control_0712_FINAL.pdf

9. Recommended practices for high-level disinfection. In: Perioperativestandards and recommendedpractices. Denver (CO): AORN Inc;2010. p. 389-404.

10. Infection Control in AmbulatoryCare by Candace Friedman, KathleenH. Petersen. APIC; p. 71. ISBN 0-7637-3190-0

11. Rutala, W.A., Weber, D.Reprocessing endoscopes: UnitedStates perspective. J. Hosp. Infect.Apr. 2004; 56 Suppl 2: S27-39

12. Cowen, A.E,. The clinical risks ofinfection associated with endoscopy.Can. J. Gastroenterol. May 2001;15(5): 321-331

Metrex is the only company thatspecializes in healthcare consumableproducts across 6 infection preventionhot points: High Level Disinfectants,Instrument Reprocessing, SurfaceDisinfectants, Liquid Medical Waste,Hand Hygiene, and Eye and FaceShields.


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Serving you Quality, Selection and Performance.It’s our promise to you.

Henry Schein is a name you can trust. The Henry Schein Brand product line has met our high standardsof quality and effectiveness — earning the Henry Schein Seal of Excellence — your guarantee of

satisfaction. We invite you to try our line and experience the value, selection and quality that we standbehind with an 80-year history of servicing health care professionals around the world.

Henry Schein Brand Products for your surgical procedures provide a value priced option for your surgical practice. We feature a widevariety of choices focused on everyday essentials including:

• Infection control supplies for instrument reprocessing and overall protection • Surgical products including sutures, instruments and procedure kits/packs/trays • Surgical and exam gloves featuring the popular Criterion® line • Exam room disposables ranging from table paper to drapes, capes and gowns • Wound care items such as gauze, dressings and bandages


13MS8766SURGITEAM SOLUTIONS GUIDE22

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SUTURESABSORBABLE

ITEM CODE NEEDLE LENGTH SIZE MATERIAL100-6120 C-9 18" 3-0 Plain Gut 101-3192 C-3 18" 5-0 Plain Gut 101-2976 C-6 27" 3-0 Plain Gut 101-0668 C-6 27" 4-0 Plain Gut 100-7771 C-6 18" 4-0 Plain Gut 900-7471 PC-1 18" 5-0 Plain Gut900-7485 DSCM-13 18" 6-0 Plain Gut 101-1582 C-6 27" 3-0 Chromic Gut 101-2787 C-6 27" 4-0 Chromic Gut 101-8824 C-3 18" 5-0 Chromic Gut 900-4417 C-3 18" 5-0 PGA - Undyed Braided900-4418 C-3 18" 4-0 PGA - Undyed Braided900-4421 PC-31 18" 3-0 PGA - Undyed Braided900-4419 PC-31 18" 4-0 PGA - Undyed Braided900-4420 C-6 18" 4-0 PGA - Undyed Braided900-7462 C-6 27" 3-0 PGA - Undyed Braided 900-7463 C-6 27" 4-0 PGA - Undyed Braided900-7468 C-3 18" 6-0 PGA - Undyed Braided900-7477 PC-30 18" 4-0 PGA - Undyed Braided900-7465 C-3 18" 4-0 PGA-PCL-Mono 900-7467 C-3 18" 5-0 PGA-PCL-Mono 900-7474 PC-31 18" 3-0 PGA-PCL-Mono 900-7488 DSM-19 18" 4-0 PGA-PCL-Mono

SUTURESNON-ABSORBABLE

ITEM CODE NEEDLE LENGTH SIZE MATERIAL101-6053 C-22 18" 6-0 Black Nylon 101-7137 C-6 18" 5-0 Black Nylon101-1209 C-6 18" 4-0 Black Nylon 101-3728 C-7 18" 3-0 Black Nylon 900-7459 C-17 10" 5-0 Black Nylon 900-7460 C-17 10" 6-0 Black Nylon 900-7461 C-17 10" 4-0 Black Nylon900-7464 C-6 10" 4-0 Black Nylon900-7466 C-3 18" 4-0 Black Nylon 900-7470 C-3 18" 5-0 Black Nylon 900-7472 PC-31 18" 5-0 Black Nylon 900-7473 C-3 18" 6-0 Black Nylon 900-7476 C-8 18" 2-0 Black Nylon 900-7482 C-1 18" 6-0 Black Nylon 900-7487 PC-31 18" 4-0 Black Nylon 101-4378 C-22 18" 6-0 Blue Polypropylene 101-6409 C-6 18" 5-0 Blue Polypropylene 101-7477 C-6 18" 4-0 Blue Polypropylene 101-7700 C-7 18" 3-0 Blue Polypropylene 900-7478 PC-31 18" 4-0 Blue Polypropylene 900-7479 C-3 18" 6-0 Blue Polypropylene 900-7481 DS-18 18" 3-0 Blue Polypropylene 900-7483 C-1 18" 6-0 Blue Polypropylene 900-7484 C-3 18" 5-0 Blue Polypropylene 900-7486 C-3 18" 4-0 Blue Polypropylene 100-7762 C-43 18" 3-0 Black Braided Silk 100-6320 C-9 18" 3-0 Black Braided Silk100-7772 C-6 18" 3-0 Black Braided Silk 100-6830 C-6 18" 4-0 Black Braided Silk 101-3207 C-6 18" 5-0 Black Braided Silk 101-2590 C-3 18" 4-0 Black Braided Silk 101-4148 C-3 18" 5-0 Black Braided Silk 101-2049 C-7 18" 3-0 Black Braided Silk 101-2636 C-22 18" 6-0 Black Braided Silk100-7773 D-14 18" 5-0 Green Braided Polyester

All Sutures.....12/Box

Contact your Henry Schein Medical Consultant to explore our wide selection of Henry Schein brand sutures.


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inInfection Control News for the Health of Your Practice

Visit www.henryschein.com/medical for the latest version of ourInfection Control Quarterly

12MS6542

To Order: 1-800-P-SCHEIN (1-800-772-4346) 8am–9pm (et)To Fax: 1-800-329-9109 24 Hours

www.henryschein.com/medical

SURGITEAMSOLUTIONSGUIDE

SUMMER 2012 EDITION

MOHS SURGERYTIPS & STRATEGIES

SOLUTIONS GUIDE

12MS7337

SOLUTIONS GUIDEWINTER 2012 EDITION

GI/ENDOSCOPY TIPS & STRATEGIES


To Fax: 1.800.329.9109 24 HrsFor more information visit: www.henryschein.com/SurgiTeam

SOLUTIONS GUIDEProducts, resources and services for all facilities performing outpatient procedures


Call1-800-P-SCHEIN

(1-800-772-4346)8am–9pm (et)

Fax:1-800-329-9109

24 Hours

www.henryschein.com/surgiteamDue to manufacturer price increases, prices are subject to change withoutnotification. Offer valid on our full array of products. Upon any request byMedicare, Medicaid, Tricare or other payer, you must report the value of anybenefit received from a discount program (e.g., points redemptions, gifts or otherspecial awards). ©2013 Henry Schein, Inc. No copying without permission.Not responsible for typographical errors. No adjustments from prior sales. Offernot to be combined with other promotions and/or special contract pricing. Voidwhere prohibited. Local regulatory requirements may apply to use or installationof certain products. It is your responsibility to understand and comply with anysuch requirements prior to purchase, use or installation of products. †Forinformational purposes only. Source: ReimbursementCodes.com and/orwww.cms.gov. Customer is responsible for verification of billing/coding inaccordance with applicable specific circumstances.

13MS8766

TOPICAL SKIN ADHESIVESterile, 0.5-mL Single-Patient-Use Plastic AmpulesFDA-approved liquid adhesive consists of n-butyl-2 cyanoacrylate.Available in both regular (translucent) and blue formulations. Bothpolymerize in seconds upon being exposed to water or water-containing substances such as human tissue.• Forms a strong bond that seals wounds quickly• Inhibits growth of bacteria• Provides a precise, controlled application • Won't clog or dry out when opened

Skin Adhesive, 0.5 mLBlue

(112-6111) ...................................................ea CallClear(112-6106) ...................................................ea Call

Call your Henry Schein Sales Consultant to learn more about this new product and receive a Special Offer on your first order!

NEW PRODUCT!
