exergen ta thermometers · interview green cash ﬂow manufacturer ﬁnancing for immediate cash...

CLINICAL INTELLIGENCE FOR SUPPLY CHAIN LEADERSHIP®

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TemporalScanner™

TemporalScanner™

For more information, pleasecall 617-923-9900 x6234,email: [email protected],or visit: www.exergen.com

Exergen Corporation | 400 Pleasant Street | Watertown, MA 02472

Why You Should Standardize with Exergen TA ThermometersExergen’s Value Proposition:• Improve Patient Outcomes - Exergen has MORE THAN 50 PUBLISHED STUDIES SUPPORTING ACCURACY FROM

PREEMIES TO GERIATRICS IN ALL AREAS OF CARE. Unlike other thermometers, the Exergen Temporal Scanner does not come into contact with mucous membranes, thus greatly reducing the risk of cross contamination. Additionally, full instrument sheaths, protecting the entire thermometer, can be utilized for all levels of cross-contamination protection.

• Improve Patient Safety - Exergen has no probe covers that can break, as often occurs with oral thermometers. With a lifetime warranty, your thermometers can be replaced whenever necessary at no charge. Exergen also has less environmental issues than other thermometer methods, increasing reliability of readings.

• Reduce Costs - Exergen doesn’t require expensive probe covers, and with a LIFETIME WARRANTY, COST SAVINGS OF UP TO 90% OVER OTHER THERMOMETRY METHODS can be achieved. Other thermometers can cost more than $100 per year each for probe covers and repairs. Exergen TA thermometers cost $0 per year.

• Increase Efficiencies - Exergen’s non-invasive temperature collection can be utilized on virtually any patient situation, therefore ONE THERMOMETER CAN BE UTILIZED THROUGHOUT THE FACILITY. Also, Exergen upgraded the thermometer casing to reduce or eliminate stress micro cracks that can allow harsh chemical cleaners to penetrate the material and cause fractures

• Attractive Payback - Elimination of probe covers and repair costs, and easily affordable acquisition costs results in LESS THAN ONE YEAR PAYBACK for standardizing with Exergen TA thermometers.

Add up these values and you’ll want to standardize with:

January 2016 • Vol. 40 No.1$7.00

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mentmethod is amonthlycredit cardchargeby themanufacturer.Nocomplexityof leases, compliancyorcontracts.Thehospitalowns the instrumentsandpays onan installment basis financedby themanu-facturer. For TA thermometers, this charge is lessthan$15/monthper thermometer for24months formost GPO pricing. A typical cost for disposablesalone for other types of thermometers is about$21/month, thus immediately improving cashflowby$6/monthper thermometer.A further cashflowimprovement is fromeliminationofprobe replace-ment and repair charges, which typically are about$100/yr per thermometer. This brings the total im-mediatecashflowgain toapproximately$14/monthper thermometer. After the thermometers are paidfor, the total cashflowimprovement is then100per-cent of the previous cost, or $29/month per ther-mometer. For a hospital with 500 thermometers,over five years this adds up to nearly amillion dol-lars of free cashflow.

Whatmakes thisgreen?FP. Elimination of waste – particularly non-biodegradable plastics used in thermometer probecovers. Onemedium-sized hospital estimated thatit eliminated 2.2 tons of waste per year due to ther-mometerprobecoverswhenconverting toTAther-mometry. Other thermometers are easily brokendue to their design requirement for a probe inser-tion into a body cavity. Because TA thermometersare entirely non-invasive instruments, they can bedesigned tobenearly indestructible.This allows themanufacturer tooffer a lifetimewarranty, eliminat-ing the cost andassociatedwaste for replacing ther-mometer probes aswell as disposables.

Whywouldamanufacturerprovide this typeoffinancing?FP.If themanufacturer has the financial strength tooffer this service to its hospital customers, then it isan excellent use of resources to help improve thefi-nancialhealthof its customers,whichultimately re-sults in increased sales for the manufacturer. Inaddition, themanufacturer, togetherwith itshospi-tal customers, makes a significant improvement incare for our patients and care for our planet.�

ly, even if there is no readily available cash or fi-nancing.Thebest readysourceof thisfinancingmaybe the manufacturer, who even in the toughest oftimes always has the lowest financing costs of any-one in the supply chain. This is because its cost ofproducing any product is always the lowest in thesupply chain.

An example of this is temporal artery (TA)thermometry, anewtechnology thatboth improvespatient care and substantially reduces costs. Patientcare improvement results from the increased speedandaccuracyofmeasurement,with the inherentpa-tient appeal of a gentle forehead scan. This replacesothermethods, which are slower and less accurate,and require an unwelcome probe insertion into abodycavity.The scanof the forehead, like theuseofa stethoscope, lightly touches skinwith nomucousmembranes and requires no disposable – simplecleaningbetweenpatients is adequate. Sincedispos-ables account for about 90 percent of thermometrycosts, this saving is very substantial.

Howdoes themanufacturerfinancingwork?FP.The hospital conducts its evaluations, purchaseandacquisition in thenormalmanner, but thepay-

62 www.executivehm.com

EXECUTIVEINTERVIEW

Green cash flowManufacturer financing for immediate cash flow boost.By Francesco Pompei

Francesco Pompei is Founder and CEO of ExergenCorporation, and holds 60 US patents in non-invasive thermometry for medical and industrialapplications. Earning BS and MS degrees fromMIT, and an SM and a PhD from Harvard, Pompeialso holds an appointment as Research Scholarin the Department of Physics at Harvard incancer research.

Howdoesmanufacturer-financednewtechnol-ogyincreaseimmediatecashflowforcash-shorthospitals?Francesco Pompei. First, a new technology mustcost less and deliver improved patient care. In thecurrent climate, unless both criteria aremet, a newtechnologymaynot be a gooddeal for the hospital,or for the patient. Second, out-of-pocket cost of ac-quisitionof thenew technologymust be lower thanwhat it replaces on day one. Thismeans that effec-tive new technologymust be financed in somewayto allow the hospital to gain its benefits immediate-

Exergen Corporation Ed:26 June 31/7/09 14:51 Page 62

www.exergen.com/s

Access clinical studies:

For more information, pleasecall 617-923-9900 x6234,email: [email protected],or visit: www.exergen.comExergen Corporation - 400 Pleasant Street - Watertown, MA 02472

1601-Exergen.indd 2 12/11/2015 11:41:33 AM

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January 2016 • HEALTHCARE PURCHASING NEWS • hpnonline.com2

SPECIAL FOCUS6 Newswire/Fast Stats

10 C-SUITE: SUPPLY CHAIN MORE THAN ‘STOREROOM STEWARDS’2016 S.U.R.E. Awards: Hospital and healthcare system CEOs juggle a plethora of responsibilities from atop their perch in the C-suite, but should supply chain be one of them?

OPERATING ROOM14 CALLS FOR SAFE PATIENT HANDLING GROWING LOUDER

Nurses and other caregivers who manually lift and move patients should not suffer injuries and become patients themselves.

INFECTION PREVENTION18 EVIDENCE-BASED INFECTION-PREVENTION PROTOCOLS, PRODUCTS CAN REDUCE CAUTIS

Why don’t healthcare providers use a universally accepted evidence-based tool to reduce catheter-associated urinary tract infections? They don’t have one.

18 Prevention Update

CS CONNECTION22 SMART WASHER TECHNOLOGY OPTIMIZES WORKFLOW, IMPROVES SAFETY AND QUALITY

Washers are rapidly evolving to engage CS/SPD professionals in cleaning, drying and decontaminating devices better, faster and with less waste.

22 Instrumental News26 Self Study Series

Rinsing: the most misunderstood step in reprocessing by Michele McKinley

30 CS Solutions IUSS cycle frequency; differentiating sanitization, disinfection and sterilizationby Ray Taurasi

31 IAHCSMM ViewpointCS Professionals must answer the call of professionalismby Julie E. Williamson

PRODUCTS & SERVICES 32 REDESIGNING THE HOUSE THAT SUPPLY CHAIN BUILT

A well-oiled supply chain and an effi ciently organized storeroom or warehouse both demonstrate core competency in supporting clinicians to care for patients.

32 New Technology

EXPERT EXCLUSIVES4 Fast Foreward36 People & Opinions

Can patient satisfaction be purchased via PO? by Elizabeth Morgan

36 Worth Repeating38 Standard Practices

Making “systems thinking” standard practice by Karen Conway

40 Back Talk Maximize your GPO relationship as landscape shiftsby David S. Kaczmarek

39 Advertiser Index/Classifi ed

January 2016 • Volume 40, No. 1

10

18

22

32

IN THIS ISSUE...

14

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Copyright 2015 by KSR Publishing Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage-and-retrieval system, without permission in writing from the publisher. Healthcare Purchasing News is a registered trademark used herein under license.Offi ce of publication: Periodicals Postage Paid at Sarasota, FL 34242 and at additional mailing offi ces. Postmaster: Send address changes to: Healthcare Purchasing News, P.O. Box 17517, Sarasota, FL 34276-9801.

KSR Publishing Inc.

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EDITORIALPublisher/Executive Editor Kristine Russell [email protected] Senior Editor Rick Dana Barlow [email protected] Managing Editor Valerie J. Dimond [email protected] (941) 927-9345, ext. 202 Contributing Editors Kara Nadeau [email protected] Susan Cantrell [email protected]

ADVERTISING SALES East Coast Blake and Michelle Holton (407) 971-6286 Midwest Donna Boatman-Riley (815) 393-4624 West Coast Blake and Michelle Holton (407) 971-6286

ADVERTISING & ART PRODUCTIONAd Contracts Manager Tiffany Coffman (941) 927-9345, ext. 203 Graphic Design Tracy Arendt MAILING LIST RENTALS Laura Moulton (941) 927-9345, ext. 201

CORPORATE President Kristine Russell Healthcare Purchasing News (ISSN: 1098-3716) is published monthly by KSR Publishing Inc., 2477 Stickney Point Road, Suite 315B, Sarasota, FL 34231, Phone: (941) 927-9345, Fax: (941) 927-9588, www.hpnonline.com, Business hours: 8:00 a.m.-5:00 p.m. EST.

EDITORIAL ADVISORY BOARDJoe Colonna, Vice President, Supply Chain, Piedmont Healthcare, Atlanta, GA; Karen Conway, Executive Director, Industry Relations, GHX, Louisville, CO; Michele De Meo, CRCST, (Ret.); Dee Donatelli, RN, CMRP, CVAHP, Navigant, Wichita, KS; Mary Beth Lang, Vice President, HC Pharmacy and SCM Commercial Services, UPMC, Pittsburgh, PA; John Mateka, FAHRMM, Executive Director of Supply Chain Operations, Greenville (SC) Health System; Melanie Miller, RN, Manager Central Processing/Supply Chain/Materials Management, Cedars-Sinai Medical Center, Los Angeles, CA; Dennis Orthman, Senior Director, Strategic Marketplace Initiative (SMI); Jean Sargent, CMRP, FAHRMM, Vice President, Healthcare Strategy and Implementation, USDM Life Sciences, Santa Barbara, CA; Rose Seavey, RN, BS, MBA, CNOR, ACSP, Seavey Healthcare Consulting Inc.; Richard W. Schule, MBA, BS, FAST, CST, FCS, CRCST, CHMMC, CIS, CHL, AGTS, Director, Clinical Education, STERIS Corporation; Robert Simpson, CMRP, President and CEO, LeeSar Regional Service Center and Cooperative Services of Florida, Fort Myers, FL; Barbara Strain, Director, Value Management, University of Virginia Health System, Charlottesville, VA; Deborah Petretich Templeton, R Ph., MHA, Chief of Care Support Services, Geisinger Health System, Danville, PA; Ray Taurasi, Eastern Regional Director of Clinical Sales and Services, Healthmark Industries; Brian Viele, R.N., BSN, CCRN, Director, ICU/ BHU/Clinical Consultants/Inpatient Cardiopulmonary, Mid Coast Hospital, Brunswick, ME

SUBSCRIPTION RATESU.S.: $74.00 for one year (prepaid orders only)Canada: $90.00 Single copies: $7.00Foreign: $122.00 Industry Guide: $49.95Special issues and back issues: $11.00 per copy, prepaid. Certain individuals qualify for free subscriptions.

CHANGE OF ADDRESSSubscribers: For change of address, send your old and new addresses to Healthcare Purchasing News, 2477 Stickney Point Road, Suite 315B, Sara-sota, FL 34231. Fax: (941) 927-9588, Email: [email protected]. Allow 4 to 6 weeks for correction. All other inquiries, call Tiffany Coffman at (941) 927-9345, ext. 203.

Physician push vs. pullOne of the noteworthy pleasures of interviewing supply chain-focused hospital and healthcare system CEOs for more than a decade and

sharing their thoughts with Healthcare Purchasing News readers is getting to know these esteemed and high-ranking C-suite executives behind their corporate fortress walls.

HPN considers it a privilege that the 37 men and women profi led in these pages each January carve valuable time out of their busy schedules to participate. They must receive countless requests from a variety of media outlets to educate or enlighten the public about some cause or to promote some health-related or system-related issue. No doubt these media requests represent welcome exercises in community relations as opposed to explaining some bad news or reacting to negative publicity.

The CEOs who “Support, Understand, Recognize and Empower” supply chain operations that we choose to honor with our annual SURE award don’t lip-sync their support of the profession. They remain actively engaged and involved in a way that should be emulated by the majority who don’t seem to mind supply chain operations nearly as much, if at all.

What inspires and provokes us to continue offering this annual feature is how dedicated and die-hard these SURE CEOs are to the function and process as they demonstrate how they connect the dotted line between the storeroom or warehouse (and even farther back to the suppliers) to the clinician and the patient.

One tidbit we love to learn from SURE CEOs is what question Supply Chain profession-als ask them the most — even if Supply Chain does not occupy a seat in the C-suite. Very early on we started to spot a common theme. Marveling that CEOs even acknowledged Supply Chain’s questions and that Supply Chain pros bothered to ask, we noted that many times Supply Chain pros asked CEOs about how to work with physicians.

That inspired us further. Were there any supply chain-minded physicians in the industry — those that countered the stereotypical doctor screaming at the nurse for handing him the wrong product or belittling the materials manager who denies him the higher-cost device from his favorite supplier that showers him with swag?

We weren’t limiting our unoffi cial background research to the proliferation of value analysis/management programs that recruited physician support. Those that were pulled into the process for a variety of reasons were commendable. But those that pushed their way into the process represented more of a curiosity. Were they “switching sides” legiti-mately or merely infi ltrating operations to infl uence decisions for their own ends? We fi nd the former becoming a welcome reality in healthcare even as cinematic and television melodramas feature the latter.

Among the trifl e of supply chain executives from the hospitality, manufacturing, retail and other industries migrating into healthcare positions we now see a handful of physi-cians taking more active supply chain leadership roles in some of the top-tier medical institutions. In fact, educational sessions about physician-led or physician-driven supply chain operations punctuated the annual AHRMM conference in Indianapolis last summer and inspired us to accelerate our efforts to unwrap a simmering brand extension of our SURE awards this summer.

In July, HPN will roll out its fi rst annual PURE awards where we honor and profi le “Physicians Understanding, Respecting and Engaging” Supply Chain professionals to enhance their clinical practices and the patient care they deliver.

We feel this represents a fresh new frontier for HPN to explore even as we continue to monitor other supply chain trends around data standards, GPO consolidation, sourcing innovations, sterile processing and surgical/critical care and infection prevention business practices, as well as keep a wary eye on payers maneuvering into the supply chain realm.

This just reinforces the weathered axiom: Change is here, change is deep; embrace that future and your job you’ll keep.

FAST FOREWARD


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January 2016 • HEALTHCARE PuRCHAsing nEWs • hpnonline.com6

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HPN announces recipient of the 2015 Jeannie a. akridge scholarship Healthcare Purchasing News is proud to an-nounce that Jo M. Wood is the Jeannie A. Akridge Scholarship win-ner for 2015. Jo will receive $1,000 for her expenses and tuition for the annual 2016 IAHCSMM conference this year in San Antonio. Jo, the Central Processing Department Compliance & Education Supervisor at Boston Medical Center, Boston, MA, wrote the winning essay on how her Central Pro-cessing Department makes a difference and how important they are in providing safe healthcare.

Jo entered the sterile processing industry six years ago as an entry-level technician. Through self-study and self-motivated clini-cal practice, she passed the CRCST exam be-fore her 6-month anniversary. Jo was quickly promoted to Central Processing Technician II where she refined her clinical skill set and focused her energies on this key principle, “We can do this better.”

After fours years as a technician, she was promoted to the Compliance Supervisor, which quickly evolved into her present role as the Compliance & Education Supervisor. She currently focuses on recommending change based on the data she collects, the practices she sees, and the ever-expanding industry guidance she reviews. This has lead to the development of best practice pro-grams for technician training, sterilization and high-level disinfection record keeping, physical space maintenance, tray quality assessment, endoscope reprocessing, and validation testing just to name a few.

Jo is committed to moving the profession forward outside of her organization. She is very active in the IAHCSMM Massachusetts Chapter for Central Service Professionals where she holds the position of Govern-ment Affairs Liaison. In this capacity, she leverages her significant political connec-tions to garner support for a bill currently in legislation that would mandate certification for central sterile technicians in the Com-monwealth of Massachusetts. Her work on this initiative has helped produce dramatic increases in support for the program.

Intermountain Healthcare President and CEO, Charles W. sorenson, MD to retire Intermountain Healthcare president and CEO, Charles W. Sorenson, MD, has an-nounced that he will retire as CEO in October of 2016. Dr. Sorenson has been a member of Intermountain’s Management Committee

since 1998—first as executive vice president and COO from 1998 through 2008, and then as president and CEO of Intermountain since early 2009. Dr. Sorenson, age 64, also practices urologic surgery, focused primarily in oncology.

“Under Dr. Sorenson’s leadership, Inter-mountain has advanced its local, national, and international reputation as an industry leader in evidence-based medicine,” notes Intermountain board chair, Scott Anderson, president and CEO, Zions First National Bank.

Dr. Sorenson will continue this work to raise quality while keeping costs sustainable as the founding director of a new Intermoun-tain Healthcare Leadership Institute after he retires as CEO. The Institute will house the world-renowned Institute for Healthcare De-livery Research developed by Brent James, MD, Intermountain’s chief quality officer, which attracts healthcare professionals from around the nation and around the globe. Par-ticipants come to learn from Intermountain’s experience in quality improvement. The new Institute will also provide specialized leader-ship training programs for physicians and other clinical and operational leaders who have, or are capable of assuming, broader administrative responsibilities locally, na-tionally, and internationally.

Intermountain Healthcare’s Board of Trustees will conduct a national search for Dr. Sorenson’s replacement.

aaBB and the Joint Commission to Partner on Patient Blood Management CertificationAABB and The Joint Commission are proud to announce a collaborative partnership to provide a joint hospital certification program for patient blood management. This volun-tary certification, which will be available in early 2016, is based on the AABB Standards for a Patient Blood Management Program and will help hospitals realize the maximum benefits of establishing a comprehensive patient blood management program.

“AABB has been a pioneer in patient blood management innovation through its stan-dard setting, educational programming and advocacy work,” said Miriam A. Markowitz, AABB CEO. “We are very pleased to partner with The Joint Commission to provide a hospital certification program that creates an innovative and thorough approach to estab-lishing and measuring the effectiveness for patients and the hospitals that serve them.”

An evidence-based, multidisciplinary ap-proach to optimizing the care of patients who might need transfusion, Patient Blood Man-agement encompasses all aspects of patient evaluation and clinical management sur-rounding the transfusion decision-making

Jo M. Wood

$3 TRiLLionis how much healthcare spending grew in 2014, a growth rate of 5.3% after five

years of historically low growth. the new growth is attributed primarily to coverage

expansions under the affordable Care act (aCa).

$9,523is an estimate of how much was spent

per person on healthcare in 2014.

17.5%was health spending’s share of the

nation’s gross domestic product (GDP) in 2014, which increased from 17.3% the

previous year.

8.7 miLLion more people had health coverage in

2014, increasing the insured share of the population from 86% in 2013 to 88.8% in

2014, the highest share since 1897.

$991 biLLion was spent by private health insurance which accounted for one-third of total

national healthcare expenditures. Contributing factors include increased

enrollment and faster growth in spending for retail prescription drugs, physician and clinical services, and hospital care.

12.2%was the growth rate of retail prescription drug spending in 2014. the nearly $298

billion spent represents the largest increase since 2002.

4.1%was the growth rate of hospital spending in 2014 – nearly $972 billion. the higher

growth rate is attributable in part to increased use and intensity of hospital services due to coverage expansion,

which was reflected in the faster growth of Medicaid and private health insurance

spending.

Source: Health Affairs; Office of the Actuary at the Centers for Medicare and Medicaid Services, December 2014.

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process. It can reduce the need for allogenic blood transfusions and reduce healthcare costs, while ensuring that blood components are available for the patients who need them.

“Blood transfusion continues to be one of the most frequently performed procedures in hospitals, and although great strides have been made to make blood usage as safe as possible, transfusion complications and adverse outcomes can still occur,” said Mark G. Pelletier, COO, Accreditation and Certification Operations of The Joint Commission. “Our goal in collaborating with AABB on this certification is to help ensure that patient blood management programs maximize their potential to reduce risk to patients and help organizations save on costs through more structured blood management.”

The AABB-Joint Commission Patient Blood Management Cer-tification promotes patient safety and quality by combining an internationally accepted quality management system structure with appropriate Patient Blood Management technical requirements. This new certification program adheres to the same quality framework as other AABB Standards.

For Patient Blood Management educational resources visit www.aabb.org/pbm.

HLAC details how visit to laundry provider helps to ensure healthcare textiles arrive free of contamination Visiting a potential healthcare laundry is a must for professionals charged with ensuring that clean textiles arrive at a facility free of contamination, says Gregory Gicewicz, board president of the Healthcare Laundry Accreditation Council (HLAC).

In a newly published article, “Plant, Personnel, Process: Evaluating the Healthcare Laundry,” Gicewicz writes that such visits “should include relevant representatives from environmental services and infection prevention. During the visit, focus on the 3P’s: the plant, the personnel and the process.”

HLAC is a nonprofit organization formed for the purpose of in-specting and accrediting laundries processing healthcare textiles for hospitals, nursing homes and other healthcare facilities.

In his article, published in EXPLORE Magazine (Association of the Healthcare Environment), Gicewicz outlines pertinent questions that need to be addressed within each category. For example, regarding the plant, he looks at matters ranging from workflow to policies and procedures for cleaning and maintaining the plant and its equip-ment. Discussing personnel, he emphasizes the need for employees at all levels to be focused on patient safety and service quality. And, regarding the process, he recommends learning how the provider ensures that washed healthcare textiles become hygienically clean.

The newly revised standards document received the Association of periOperative Registered Nurses (AORN) Seal of Recognition. The AORN Seal of Recognition confirms that the content of the document has undergone thorough review by AORN and meets the guidelines of the “AORN Perioperative Standards and Recom-mended Practices.”

Comprehensive detail on what to look for during a visit to a laun-dry provider can be found in the newly revised HLAC document, “Accreditation Standards for Processing Reusable Textiles for Use in Healthcare Facilities - 2016 Edition,” which is now available for viewing and downloading at www.hlacnet.org. The new standards go into effect Jan. 1, 2016. HPn

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Hospital and healthcare system CEOs juggle a plethora of responsibilities from atop their perch in the C-suite.

These include planning, directing and coordi-nating daily operations; overseeing employee and organizational performance; setting strategic direction and policies; establishing and reinforcing a productive corporate and clinical culture; maintaining relationships with medical and payer organizations, re-ferring physicians, public communities and the media.

Separately and independently, supply chain need not be one of them.

Yet that does not mean CEOs cannot — or should not — be involved in some way with supply chain activities. A small number of CEOs that Healthcare Purchasing News has profi led in the past may have spent a portion of their earlier career in supply chain so they are familiar with the profession’s myriad id-iosyncrasies and nuances. The vast majority, however, have not booked any direct supply chain experience, save for hiring the right people to handle a function that represents a signifi cant portion of a provider organization’s expense stream — and growing each year.

At best, these CEOs rely on their supply chain leaders, group purchasing organizations and suppliers to help make and shape decisions about their operations. Among this group are those who “Support, Understand, Recognize and Empower” the Supply Chain department and its leadership to make optimal strategic and tactical decisions for the organization’s ongoing success and ultimately to enhance patient care delivery.

Eleven years ago, HPN launched an annual campaign to identify and honor these hospital and health system CEOs with its SURE award. This year, HPN honors three more to join 34 others already profi led.

C-Suite: Supply Chain more than ‘storeroom stewards’CEOs recognize expanded, expanding impact on clinical delivery, performanceby Rick Dana Barlow

HPN’s 2016 SURE CEOs are John Finan Jr., President & CEO, Franciscan Missionar-ies of Our Lady Health Sys-tem (FMOL), Baton Rouge, LA; Richard Statuto, CEO, Bon Secours Health System, Marriottsville, MD; and Kar-en Teitelbaum, CEO, Sinai Health System, Chicago.

Finan embraced a five-phase, multi-year supply chain strategic plan to elevate FMOL’s clinical resource, fi nancial and op-erational performance. Those five phases include developing clinically driven strategic sourcing, clinical resource utilization, consoli-dated distribution and supply management, inventory management performance improve-ment through data standards, “perfect order” principles and point-of-use processes, and value chain interoperability and best-practice implementation. Since 2012, FMOL has booked a 7 percent reduction in Supply Expense per Adjusted Discharge.

As a valued member of FMOL’s C-suite alongside Finan, Vice President of Materials Management William Mosser spearheaded these initiatives, which involved the opening of the FMOL Health System’s Logistics One Supply Distribution Center in April 2015 and an upcoming (at press time) supply data standards playbook designed to help health-care organizations adopt and implement GS1 healthcare standards. These initiatives also inspired HPN to recognize FMOL as one of 11 “Supply Chain Operations Worth Watching” (See December 2015 HPN).

Statuto recognized how supply chain op-erations “impacted not only the margin to support the mission, but also the outcomes of the patients that they serve.” Overseeing

a healthcare organization that spans 15 acute care facilities (owned, managed and via joint ventures) and more than 450 nonacute care facilities in six states pri-marily on the East Coast, Statuto, along with Vice President of Enterprise Re-

source Planning and Supply Chain Operations David Mc-

Combs, reached out to physicians to recruit and integrate them into Bon

Secours’ clinical transformation initiatives. Fortifi ed with variable cost-per-case data that included product usage, physicians were able to see how their practice and performance impacted patient outcomes, which motivated them to improve their costs per case.

When Teitelbaum assumed the CEO position at Sinai in 2014, she faced a number of challeng-es common for safety net hospitals that hinged on expense reduction strategies and tactics and meant re-evaluating the status quo. Teitelbaum initiated a considerable cultural change for an organization that included four hospitals and other nonacute care facilities covering the west and southwest sides of Chicago’s community.

Within a year, she appointed a system-wide Supply Chain director, Justin Schneider, Pharm.D., Vice President, Clinical Opera-tions, centralized supply chain operations and tackled the “historically diffi cult” category of physician preference item conversions, which has generated value-driven success to date. With her background knowledge of supply chain processes and healthcare procurement challenges, Teitelbaum has inspired clinicians and administrators to work together, empha-sizing the overall fi nancial and quality impact of supply chain effi ciency and effectiveness and not just cost reduction alone.

John Finan Jr., President & CEO, Franciscan Missionaries of Our Lady Health System (FMOL), Baton Rouge, LA

Nominated by: William Mosser, Vice President, Materials Management

Karen Teitelbaum, CEO, Sinai Health System, Chicago

Nominated by: Justin Schneider, PharmD, Vice President, Clinical Operations(encompasses Pharmacy, Cardiology, Stroke and Supply Chain Services)

Richard Statuto, CEO, Bon Secours Health System, Marriottsville, MD

Nominated by: David McCombs, Vice President, Enterprise Resource Planning and Supply Chain Operations

1601-SF-SURE_short.indd 10 12/14/2015 12:12:12 PM

hpnonline.com • HEALTHCARE PuRCHAsing nEWs • January 2016 11

2016 suRE AWARdsHPN’s traditional wide-ranging interview

explore how FMOL’s Finan, Bon Secours’ Statuto and Sinai’s Teitelbaum interact with supply chain operations, as well as provide insights for Supply Chain leaders to develop credibility and influence.

HPN: What motivates your interest in supply chain management and how hands-on should you be?FINAN: An obvious interest is our supply spend, which has traditionally exceeded 20 per-cent of total expense and now trending down. (We’re currently at 18 percent and targeting 16 percent within the next 18 months.) More importantly, supplies and services, as well as procurement and distribution processes, have a direct impact on quality and satisfaction.

STATUTO: Bon Secours Health System has a strong history of serving those who are poor, sick or dying as the key mission of our spon-sors. As a result, we serve a disproportional amount of the poor in our communities. The financial challenges of our mission require that we be exceptionally diligent in delivering optimal outcomes with the lowest cost pos-sible. Supply Chain has a key role in not only cost management of variable costs but also insuring our caregivers have the necessary and prompt access to supplies, equipment and ser-vice for the most efficient care process possible. This critical support requirement is growing as we extend our care responsibilities across the full continuum of care to our communities.

How can/does a supply chain manager/direc-tor/executive/leader influence you?FINAN: By exhibiting behaviors which are con-sistent with our mission, performance which exceeds expectations, and presenting ideas which improve quality, satisfaction and cost.

STATUTO: First is to ensure that every Sup-ply Chain strategic initiative and effort brought forward for consideration is aligned with our mission and key goals as expressed in our Strategic Quality Plan. Second is to provide insight in what are both the causes of variation of performance issues and most importantly what are proposed solutions.

What are some of the attributes/character-istics of an effective supply chain director/executive/leader?FINAN: We have defined eight characteristics of effective leaders in Foundational (remember the mission), Service (be of service), and Stew-ardship (take care of our resources) categories. These apply also to Supply Chain leaders:

1. Relies on spiritual grounding2. Demonstrates integrity3. Extends hospitality4. Builds relationships5. Responds to needs6. Sustains priorities

7. Seeks excellence in performance8. Achieves measurable resultsSTATUTO: In today’s healthcare landscape a

Supply Chain leader must have excellent criti-cal thinking and analytic skills, and must also think strategically and anticipate future sce-narios for which the Supply Chain model must be positioned. An effective leader must also be able to communicate and interact with clini-cal leadership and operating executives with a compassionate approach to put themselves in the shoes of our caregivers and patients.

TEITELBAUM: More and more I am seeing the need for the Supply Chain leader to think strategically. We have moved beyond the tra-ditional purchasing and distribution functions of supply chain, and are asking our Supply Chain leaders to seek out unique contracting, partnership and affiliation opportunities. Un-derstanding how these unique relationships can deliver stronger value to our health system, and ultimately to our patients, allows us to better position ourselves to provide a higher quality of care at a lower cost.

The supply chain leader must also be highly collaborative. With numerous vendors, new products, and constantly updated outcomes data, the Supply Chain leader must be able to collaborate with clinicians to determine what the most cost-effective products are for our institutions and our patients. It is critical to engage physicians and other clinical staff in the assessment and selection of products and supplies for successful buy-in and implementa-tion, especially in physician preference items.

How can consulting firms, distributors and GPOs contribute to the performance of your internal supply chain management expertise without overshadowing the department or usurping control?FINAN: Outside parties can best serve our mis-sion when services provided add clear value aligned with our strategies and goals.

STATUTO: Distributors play a key direct role to insure the most efficient supply chain pro-cesses by eliminating costly waste and insuring that key critical supply items, such as solutions, key drugs, vaccines, etc. are always avail-able even in periods of market shortages. Consulting firms are effective when key and objective expertise is needed to assess a com-plex issue and provide insight into solutions. However, consulting should be considered as augmenting core Supply Chain capabilities as opposed to performing key core functions. GPOs historically have served to aggregate buying power and to influence development of key products and services on behalf of their members. Bon Secours Health System’s partici-pation with our GPO [Premier Inc.] is changing to become a relationship based on them serving as a total performance improvement partner and a comprehensive resource to our team.

TEITELBAUM: We are always seeking the best overall value in how we provide care and how we conduct our business. We expect the same of external partners. Whether you are a consultant, a distributor, a vendor or GPO, you need to continuously demonstrate the value your relationship with the health system provides. Organizations cannot expect to have expertise in every facet of supply chain, so we lean on our external partners to provide a cer-tain level of expertise. As long as this expertise complements or enhances our internal supply chain team’s work, instead of complicating it, the partnership will be held in high regard.

What’s the biggest misunderstanding CEOs have with supply chain professionals and how should they both solve that disconnection?FINAN: It may relate to a perceived definition of supply chain as “purchasing and delivery of items” versus “procurement of all non-labor items and services.” Effective supply chain teams can add great value through the latter.

STATUTO: Supply Chain has historically been fairly narrowly viewed as the storeroom stewards and contracting support resource. In the past decade the advancement of clinical value analysis programs, databases linking purchases to actual clinician utilization and growing standardization of clinical care pro-tocols involving key supply device has posi-tioned Supply Chain to be a major contributor to clinical and cost performance improvement. It is important to involve Supply Chain on the broader strategies and discussions about the evolving healthcare model, and to expect Supply Chain to step up and perform at even higher levels to contribute to the progress in cost and outcome improvement.

What do you believe is the most innovative thing supply chain management has accom-plished that exceeded your expectations?FINAN: Two in recent periods are the creation of highly effective product assessment com-mittees (PACs) with high levels of physician engagement, and development of our Central Distribution Center. These have and will con-tinue to be great contributors to our success.

STATUTO: In the past several years our Supply Chain has made tremendous progress in developing a formulary model with key clinicians to help control the runaway cost inflation we were experiencing with physician preference items, such as implants. This has come about by creating credible and trusting relationships with clinicians, and developing the formulary approach so it is co-owned. We have reigned in the cost factor and still are able to support innovation and growth where supported by an evidenced-based approach to evaluation of new products. This formulary model positions us to be successful with the

Page 12



2016 suRE AWARdsgrowing bundled payment and value based purchasing reimbursement programs.

TEITELBAUM: I have been impressed with how supply chain leadership has looked beyond our health system’s traditional GPO and vendor relationships in order to partner with local and national supply chain collab-oratives. In a recent collaborative partnership, we achieved an overall supply savings of 8 percent without disruption to our organization. Aside from the significant cost savings, this al-lowed us to drive product standardization and streamline vendors, which can only improve quality and safety for our patients.

How do you ensure that the clinicians get along and work together with supply chain management so that the processes for rev-enue generation, expense reduction and high-quality patient care are not disrupted (e.g., refereeing disputes, building consensus)?FINAN: Clinicians are passionate about our mission, strategies, and goals, and bring won-derful insights and perspectives to our supply chain processes. Interactions are most effective when the organization is transparent with factual data and the clinician’s contribution is respected and applied in solutions.

STATUTO: A key factor is to align the Supply Chain efforts for cost/process improvement with the major clinical and efficiency improve-ment initiatives that are most important to clinicians. Clinicians clearly want to improve care outcomes and control costs. Supply Chain must understand and address the key clinician concerns while simultaneously providing ac-curate data to support the recommendations for supply cost improvement actions.

TEITELBAUM: The Supply Chain team must be able to effectively collaborate with clinicians. All parties need to keep open minds when ap-proaching decisions which may impact clinical operations, overall expenses and revenue gen-eration in clinical areas. Open communication, positive or negative, is very important so the adoption of change is supported and effective.

What’s one lesson you learned or piece of career advice you’d like to share with supply chain professionals to be successful?FINAN: Embrace changes that lead to improve-ment with enthusiasm and confidence.

STATUTO: Learn about all aspects of busi-ness. You need a strong foundation in finance, human resources, operations, strategy, etc., to be a trusted partner/resource to the CEO/executive team for supply chain strategy, action and improvement.

TEITELBAUM: My counsel is the same for supply chain managers as it is for anyone I coach. If you see a gap in leadership, meaning a problem that needs to be tackled, step up, take it on and follow the “under promise and over deliver” adage.

What can supply chain leaders do to earn a seat at the senior/executive management table in the C-Suite — or at the very least an open door?FINAN: Successful organizations always engage highly effective leaders in critical deci-sions. We expect effective, high performance from all of our leaders. Strategic and innova-tive thinking, collaborative leadership and the ability to achieve goals in ways which are consistent with our values are all criteria we’d expect from our supply chain and any leader in our organization.

STATUTO: Become fully knowledgeable of the organization’s strategic goals and direc-tion, and gain expertise of how Supply Chain is evolving in healthcare to provide solutions to contribute to these goals. Also develop per-formance metrics about costs, utilization and supply impact on clinical outcomes and share with leadership routinely.

What are your thoughts about payers of-fering supply chain services to healthcare provider organizations, specifically in the area of implants and physician preference items? Do you see it as assisting a hospital’s supply chain department (outsourcing these tasks so that supply chain can focus on other areas) or usurping supply chain’s authority and ef-fectiveness in working with physicians? Why?FINAN: It depends. Historical roles and skills of payers in assessing and assuming insurance risk are very different from those required to effectively deliver care. Supply chain services are a sophisticated, important and distinct dis-cipline requiring skills and systems not easily developed. However, the potential value of the concept to the provider would lie in the payer retaining the economic risk of high-cost items.

STATUTO: The farther away you get from the provider/patient direct relationship the more difficult it is to develop and implement an effective care/cost optimal model. Care and cost decisions are best made by the providers and clinicians working together within the pa-rameters of value-based purchasing programs as administered by payers. The key is that you have to understand and take into consideration the entire procedure or care process and the specific circumstances of the facility or clinical program. Payers can provide a significant con-tribution by developing and sharing evidence of outcomes and correlation to preference items usage to these outcomes. Our industry is really lacking in this kind of data from which to make good decisions.

Some provider C-suites are empowering physi-cians and/or the CMO to get more involved with supply chain. Do you see this as a wise move even if it removes the CEO from the process to focus on other issues? Why?FINAN: CMOs need to be engaged in supply chain strategy and implementation to a much

greater degree than the CEO because supply chain is a critical support function.

STATUTO: Facilitating greater engagement and accountability of physicians and clinical leaders is definitely a wise move. However, the CEO must still be significantly involved. As healthcare provider organizations continue to work to remove unnecessary variation in care process and develop clinical programs to serve entire communities, supply and equip-ment strategies to support these efforts become very important. You cannot grow a program or work towards greater efficiencies without also having a supporting technology and sup-ply strategy.

Your organization has made significant strides in adopting and implementing data standards for product identification (GS1, UDI) and reimbursement. What have been the results to date? And what motivated your organization to develop what should be a helpful how-to roadmap for others to follow to facilitate their own adoption and implementation efforts?FINAN: Although we’ve made positive strides with Data Standards, we’re still at the beginning of our journey. We’ve had success with several trading partners in using Global Locator Numbers (GLN) and Global Trade Identification Numbers (GTIN) in our daily transactions. In each of these instances we’ve seen fewer procurement discrepancies and we’re able to meet our payment terms to gain discounts. We’re now implementing use of the GTIN in our distribution center (Logistics One) and will soon be redesigning our Operat-ing Room supply chains to use GTIN to meet the Universal Device Identification (UDI) requirements.

We decided to develop and offer the road-map for others to follow to help energize the provider community in implementing these standards in their own environments. Our industry has been debating the merits of data standards since the mid-1990s with few organizations taking the lead to drive broader use. In general, we all have a sig-nificant amount of waste, both in our internal data management efforts and in our transac-tional areas with trading partners. Providers, suppliers, and the payer community have all built their own numbering schemes to identify things that are used in clinical care. Few of these schemes align with each other and the amount of redundant work we all have in creating and maintaining this data in supply chain, revenue cycle, claims and medical records is no longer acceptable. We, as providers, need to drive the use of data standards and the work we’re doing here at Franciscan Missionaries of Our Lady Health System is focused on helping to build that common voice and approach. HPn


Congratulations

Thank you for your vision to Support, Understand, Recognize and Empower supply chain.

Mr. John Finan, Jr.President & CEO

Franciscan Missionaries of Our Lady Health System

We consider it a privilegeto serve as your partner.

roiscs.com/joinus

Join a movement of innovators.

1601-ROi.indd 13 12/11/2015 2:26:17 PM


OPERATING ROOMSafe patient handling: calls for support growing louderby Valerie J. Dimond

Nurses and other caregivers who manually lift and move patients often become patients themselves. Unless given the right tools and best practice

standards to handle patients safely, healthcare workers are in serious risk of suffering musculoskeletal injuries, chronic pain, absenteeism, fi nancial hardship and emo-tional distress.

According to an American Nurses Association (ANA) survey, the problem is pervasive, with 42 percent of nurses reporting a signifi cant level of risk to their safety from lifting or repositioning patients. More than 50 per-cent say they regularly experience shoulder, neck, back and arm pain while working.

And it doesn’t stop there. When nurses suffer, everyone suffers — patients and facilities alike. According to the Occupational Safety and Health Administration (OSHA), patient handling claims account for about 25 percent of all workers’ compensation claims which average $15,600 per claim. Worker wage replacement accounts for the largest portion of that fi gure. Patients also risk falling and/or developing hospital-acquired pressure ulcers and other complications when nurses lack adequate support to lift and move them safely.

A louder call for reformAssistant Secretary of Labor for Occupational Safety and Health at OSHA, Dr. David Michaels, says it’s time healthcare facilities get serious about implementing safe patient handling and mobility (SPHM) programs.

“There are feasible solutions for preventing these hazards and now is the time for employers to implement them,” stated Michaels in a press release last summer.

So far, 11 states have enacted safe patient handling laws and congress is now looking at the 2015 Nurse and Health Care Worker Protection Act. OSHA will also start inspecting facilities more aggressively to determine if SPHM programs are in use and penalizing those that don’t have them.

To assist healthcare facilities and encourage compli-ance, the ANA also introduced national SPHM standards in 2013. Susan Gallagher, PhD, RN, board member of the Association of Safe Patient Handling Professionals, says it’s those standards, rather than looming regulatory action, that will most likely infl uence reform.

“I think that is really driving a lot of interest in health-care organizations because we fi nally have national standards of what it should look like. We didn’t have that before. We didn’t know how to quite interpret all of this,” said Gallagher, author of “Safe Patient Handling and Mobility: Interprofes-sional National Standards Implementation Guide,” a companion book to the ANA standards that facilities can use to incorporate them properly. “I know

we’re looking at national legislation but I really think seeking to address safe patient handling compliance through OSHA is ambiguous at best. I’m not sure that will be the driving piece.”

Yet, movement appears to be slow. According to a 2014 white paper by the Risk Authority - Stanford and Atlas Lift Tech, only a fraction of the nation’s healthcare facili-ties have moved forward to integrate a comprehensive SPHM program.1

“Within the United States there are approximately 5,400 hospital facilities that would require an SPHM program of one form or another,” the authors wrote. “In discussions with the American Nursing Association it has been estimated that of these 5,400 U.S. hospital facilities, 11 percent or approximately 600 facilities, have implemented their own ‘successful’ safe patient handling programs. Of these facilities that have SPHM programs, it is estimated that only 10 percent of those safe patient handling programs (roughly 60 hospitals) include in-house “lift teams” implying, some 1 percent of the total market has dedicated staff to lifting programs.”

The white paper highlights the success of a one-year pilot study conducted at Stanford Hospital and Clinics and the Lucile Packard Children’s Hospital in which the facilities implemented the “lift coach” model. Pro-fessionally trained lift coaches provided repeated and comprehensive bedside instruction on how to lift/move patients safely until nursing staff could achieve a high level of competency on their own. The effort was a suc-cess and also gave the facilities a unique and encouraging return on their investment (ROI). They experienced fewer staff injuries, increased employee retention, better clinical outcomes, including lower incidence of pressure ulcers, increased patient safety, satisfaction, and more referrals.

The Veteran’s Health Administration Safety Patient Center is another successful example of how SPHM programs are worth the time and money. After introduc-ing them in seven facilities, the VA saw a net savings of $200,000 per year with a return on investment achieved in about four years. 2

Shifting attitudes, removing barriers So why aren’t more facilities doing the same? Gallagher suggests one reason may be that healthcare leaders feel inundated and stretched thin by too many competing interests.

“If they look at each one of their initiatives individually, it’s overwhelming,” said Gallagher. Conversely, SPHM programs can actually lessen the overall burden. “I’ve spoken with members of executive leadership teams who say they really don’t have the time to talk about safe patient handling right now; ‘I really have to bring the costs of the registered staff down at my hospital.’ I said well then we’re talking safe patient handling. We

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talk about the cost of the program but we don’t talk about the cost of not having a program. For example, what are the costs of hospital-acquired pressure ulcers? We know that it’s just more than cost of liability and claims. ”

Linda Bowman, Vice President, Guldmann Inc., a manufacturer of lifts and other patient mobility products, underscores Gallagher’s point and says doing nothing can be a big, costly mistake.

“When you consider the cost of fi nding, hir-ing and employing caregivers plus the cost of workers’ compensation insurance premiums, treatment of injuries, plus the cost of possible patient injuries from falls, it is self-evident that the cost of furnishing the facility with patient lifts is minimal by comparison,” Bowman as-serted. “Ceiling-mounted patient lift systems move patients from bed to bath to chair; lift and reposition patients in the Operating Room, Burn Unit, Ob-Gyn, CT Scan and other departments; as well as provide body support in rehab and gait training. When suspended in the lift, the patient can be moved throughout the track system with ease and dignity and the caregiver is protected from musculoskeletal injury.”

Gallagher says in some instances expensive equipment isn’t always necessary, particularly for Ob-Gyn departments where a small investment in some basic tools and training can go a long way in preventing falls and injuries.

“In that area, postpartum, the women may be weak from giving birth so, for many, they simply need a walker, which costs about a dollar a day,” Gallagher said. “Or maybe they need a sit-to-stand. It’s a really awesome product where the patient’s feet are placed on a plate and it’s very easy to help the patient stand up. It’s a low-budget product, easy to store and easy to use. And they may need a device to get a patient from the bed to the gurney or the delivery table to the gurney (lateral transfer). That may be all they need — a walker, a sit-to-stand and some type of lateral transfer device — and that’s it. ”

Marko Cikara, Product Manager, Sage Prod-ucts, wonders also if some hospitals feel dissatis-fi ed with the investments they’ve already made because of low compliance.

“Hospital leaders looking for the one-size-fits-all approach to this problem will be dis-appointed,” Cikara said. “Partnering with a company, like Sage, will enable you to implement ANA SPHM Standards and promote a culture of safety.”

Sage’s Prevalon Liftaem Mobile Patient Transfer System has a cushion of air that moves patients laterally from surface to surface with signifi cantly less pulling and no lifting required. The Prevalon Turn & Position System reduces the amount of exertion needed to turn patients by 90 percent, and the Prevalon Seated Position-ing System makes it easier to glide patients to an upright-seated position without any lifting. All of Sage’s products come with unlimited hands-on education and training.

OPERATING ROOMDavid Daisher, Regional Sales Director —

West & International, TransMotion Medical, a Division of Winco Manufacturing LLC, says employing proper body mechanics when moving patients — back straight, knees bent, etc. — is fundamental to preventing injury but it’s not enough.

“The ergonomics involved when moving/lifting a box are different than moving a patient; healthcare workers move patients — there are no handles, no square edges and the distribution of weight is not consistent,” said Daisher, also a Lean Six Sigma Black Belt. “Purchasing objec-tives of the organization are often not in tune with risk management objectives. Healthcare facilities need to look at patient handling from a value stream perspective, eliminate patient movement as much as possible by implement-

ing multiuse equipment that eliminates the need to transfer a patient and then inject patient handling equipment where transfers cannot be eliminated.”

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OPERATing ROOmone device — from admission to discharge,” said Daisher.

John McAuley, BSET, President, McAuley Medical Inc., says SPHM equipment and train-ing does cost money but “rather than try to fund an entire program all at once, many have found success by addressing one patient handling task at a time showing success and then asking for more funding to address another high-risk task. This demonstrates to senior management that an investment in safe patient handling really does pay off in injury reduction and reduced workers’ comp costs.”

McAuley Medical’s Rollboard for Lateral Transfer greatly reduces the friction between patient and surface so that the transfer can be accomplished without lifting and the associated compression force that it puts on the spine. “Lat-eral transfer is a high-risk task that takes place in almost every department in a hospital, said McAuley. “The investment in equipment to assist with lateral transfer costs far less than mechanical lifting technology, training takes minutes and the return on investment can be immediate. ”

A heavier task With today’s swelling obesity population — 40 percent of middle-aged Americans are obese according to the latest CDC figures — moving patients has become an even weightier task than before.

“Lifting a 250-pound patient 10 times is the equivalent of lifting 2,500 pounds, even with proper body mechanics the human body wasn’t intended for that much weight,” said Steve Dunn, Product Manager, AliMed, a manufacturer and distributor of rehabilitation and ergonomic prod-ucts. “Imagine losing a leader among the staff because they are unable to perform 20 percent of their duties due to an injury. This leads to de-creased morale, which affects patient outcomes, reducing payouts from insurance. ”

Dunn says in a perfect world, every room would have a ceiling lift but in reality, few facili-ties can afford such an expense. However, there are affordable alternatives that can still do the job well.

“Mobile Hydraulic Lifts are a cost cutting measure that most any facility can get backing for, one for each floor or even each wing,” said Dunn. “Rollerboards and patient shifters, placed in high-visibility areas help to ensure their imple-mentation. Once they are being used consistently they will become habit.”

Education, training keyDunn suggests that organizations make a greater effort to publicize SPHM successes and educate and encourage their own staff to emulate them. “Make the studies and results of implemented programs more visible, though blogs, PDF’s and printed materials, to show that injuries can be avoided,” he said.

Gallagher adds that to make SPHM programs stick there also needs to be a task force actively

in place — champions who can provide train-ing at the bedside, repeatedly, until the staff is competent enough to operate the equipment independently.

“My facility might have everything in sight but if I’m not comfortable using the technol-ogy then we’re going to do it manually; I think that’s the feeling of most providers,” she said. “Of course there’s a learning curve and I think we need to recognize that. That’s one of the bar-riers. People think it takes so much time to use the equipment but just like anything, once you become comfortable with the technology — and it’s the right technology — then it is used. What happens when we move a patient manually and that patient falls to the floor? Do you have time for another occurrence report, to have to assess the patient for injury, transfer the patient if the patient is injured? If we begin to think about it even purely from a patient safety aspect and balance that around time, it just makes sense.”

Larry Baumann, Executive Director, Corporate Communications, Hill-Rom, understands that hospitals are juggling numerous priorities with limited budgets.

“We’re sympathetic to the challenge of mar-shalling resources for multiple needs; that’s why we have made it a priority to do more than pro-vide products,” Baumann said. “You also need the right people and the right program. With support, implementing a safe patient handling program can be straightforward, cost-effective and ease some of the burden on hospitals. Hill-Rom’s Safe Transfers and Movement Program provides built-in resources to help achieve a safe lifting environment. We provide a collection of customizable tools, industry-standard resources, and educational materials to support them.”

Preserving dignity and comfort is also an important consideration., according to a recent suvey from Hill-Rom of hospital patients. Heavier patients are more likely to experience embarrassment, self-consciousness and dis-comfort compared to lighter-weight patients. Hill-Rom’s Compella Bariatric Bed features powered transport, length and width expansion, and on-board skin and lung therapies to provide a comfortable, dignified and clinically advanced care environment.

New technologies can help Lindsey Ellis, Marketing Director, LINET, America, says facilities can prevent problems as-sociated with embarrassment and worker stress and strain by replacing outdated equipment with newer, more innovative solutions.

“Traditional repositioning methods such as draw sheets, slide sheets, ceiling and mobile lifts, which use slings, are cumbersome to use and re-quire two to six caregivers to operate, depending on the size of the patient, all which can take up to 20 minutes,” said Ellis. “Additionally, if these products are not readily available to the nurse, she is more likely to move the patient manually in essence of time.”

LINET’s patient room beds, which have mobi-lization features built into the frames, can be used in place of lifting systems. The Mobi-Lift has a built in cane-like device that assists nursing staff in getting the patient in and out of bed, while the Lateral Tilt system activates the entire bed frame to assist in patient turning and mobilization. LINET also partners with The Morel Company which manufactures the Hercules Patient Repositioner, a push-button tool that automatically boosts the patient up in bed.

“The LINET bed with the Hercules Patient Repositioner makes routine nursing activities safer, easier, and faster, for enhanced nursing efficiency — it’s like having an extra set of hands at all times,” said Ellis.

Steve Schmutzer, Co-founder, Director of Clini-cal Programs, Firefly Medical, maker of the IVEA patient mobility solution, says having supports in place that enable patients to ambulate on their own should also play into a good SPHM program.

Introduced last year, the Edison Award-winning IVEA — designed by nurses and other healthcare professionals — functions like an IV pole at the bedside, consolidating equipment and supporting patient ambulation. Reducing the need for additional staff, not only does it free up caregiver time but research shows patients who ambulate as soon as possible have better clinical outcomes.

“We’ve been impressed by the number of safe-patient-handling programs that have reached out to us in recent months,” said Schmutzer. “Decisions to purchase it have been quickly sup-ported by leaders and committees focused on value analysis, falls, risk mitigation, and work-place safety. Caregivers instantly recognize it as a solution to the myriad challenges around safe patient mobility.

“You can give eight guys shovels and tell them to dig a ditch; they’ll get it done, but one guy with a small excavator will get the same job done more quickly,” Schmutzer remarked. “We think that relatively soon the hospital without a safe-patient-handling program, the proper equipment to implement it, and specially-trained professionals to manage it will be the exception.”

Just notice how the dots connect. You’ll begin to see how vital SPHM programs are to succeed-ing in today’s changing healthcare environment.

“What I would challenge healthcare provid-ers to think about is how patient handling and mobility is the common thread in so many of our safety initiatives — pressure ulcers prevention and reduction, fall-related injuries, surgical site infections, readmission within 30 days,” said Gal-lagher. “All of these quality indicators that we’re measuring indirectly link back to patient handling and mobility. So thinking of it as a completely separate initiative just seems to be counterintuitive in the way we’re moving forward with collabora-tive practice models in hospitals.” HPn

Visti www.hpnonline.com/inside/2016-01/1601-OR-PatientHandling.html for full story and references.

1601-OR-PatientHandling.indd 16 12/15/2015 4:17:59 PM

1601-BBraunInt.indd 17 12/10/2015 12:50:36 PM


infECTion PREvEnTionPrevention UPdate

Catheter-associated urinary tract infection (CAUTI) numbers are astronomical: 560,000-plus patients

develop CAUTI each year,1 resulting in more than 13,000 deaths.2 According to the National Healthcare Safety Network, UTIs are the most common type of healthcare-associated infection3 (HAI), accounting for thirty percent of infections reported by acute-care hospitals.4

The Centers for Medicare and Medicaid Services’ Partnership for Patients (PfP) and the Centers for Disease Control and Prevention (CDC) report that CAUTI rates are rising.1 The problem is not that cath-eters carry excessive risk of infection; it is the sheer volume of catheters used across the nation on a daily basis that pumps up the numbers. Approximately fifteen to twenty-five percent of patients are catheterized during their hospital stay.3 Approximately seventy-five percent of UTIs acquired in the hospital are associated with a urinary catheter.1,3

I t is est imated that seventy percent of UTIs—380,000 cases and 9,000 deaths—could be prevented through consistent application of infection-control best practices.1,5 The greatest risk factor for acquiring a UTI is prolonged use.3 The longer the catheter dwells in the body, the more likely bacteria and yeast will travel up the catheter and result in a CAUTI. The risk, on a daily basis, of ac-quiring a CAUTI is three to seven percent.6

Clearly, urinary catheters’ use should be limited only to when absolutely necessary, should be subjected to exquisite care, and should be removed as soon as possible.

Oddly enough, there is no universally accepted evidence-based tool to reduce CAUTI. Recognizing this tool gap, the American Nurses Association, a partner of PfP, developed an evidence-based, user-friendly tool to help prevent CAUTI in hospitals.1 The one-page tool, “Streamlined

CaUti PrecautionsEvidence-based infection-prevention protocol and products are best tools for controlby Susan Cantrell, ELS

Evidence-Based RN Tool: Catheter As-sociated Urinary Tract Infection (CAUTI) Prevention,”7 is based on the CDC’s 2009 “Guideline for Prevention of Catheter-Associated Urinary Tract Infections.4 This evidence-based tool incorporates an algorithm used to determine whether it is appropriate to employ a urinary cath-eter, when alternative means of resolving retention and incontinence issues may be appropriate, and timely removal. A checklist on catheter insertion is included, with cues for essential maintenance and post-removal care.7

The CDC provides the “Catheter-asso-ciated Urinary Tract Infection (CAUTI) Toolkit.”8 The toolkit outlines costs related

to CAUTI: two to four extra days’ stay at the hospital, unnecessary antimicro-

bial use, and increased costs to the tune of up to 0.5 billion per year

nationally.8

Nathan McHugh, Prod-uct Manager, Skin Care,

Sage Products, ad-dressed the costs of CAUTI. “CAUTI is

a costly and common condition resulting in

patient discomfort and hospital-discharge delays.

It is gaining attention now be-cause the Centers for Medicare &

Medicaid Services (CMS) no longer reimburse hospitals for the extra cost of

caring for patients who develop CAUTI.”“As the only class of HAIs not declin-

ing over the last few years, CAUTIs are the greatest HAI challenge to healthcare providers today,” stated Steve Woody, CEO, Avadim Technologies. “With new CMS reimbursement penalties focusing on central-line–associated bloodstream infection and CAUTI, the potential for lost reimbursement and increased costs continues to rise. Not only is CAUTI a ‘never event,’ resulting in the lost cost of unreimbursed care but CAUTI is an increasing factor in the hospital-acquired conditions penalty and the value-based

Page 20

Fda offers guidance for blood establishments during ebola outbreaksThe US Food and Drug Administration (FDA) has released new recommendations for blood establishments to implement additional screen-ing measures during Ebola virus outbreaks.

While WHO has spearheaded the international response to the outbreak, several US agencies including FDA, the National Institutes of Health (NIH) and Centers for Disease Control and Prevention (CDC) have also played a role in the response to the epidemic.

For its part, FDA has issued 10 emergency use authorizations (EUAs) for products to treat or diagnose Ebola.

The FDA says its new draft guidance, Recom-mendations for Assessment of Blood Donor Suitability, Donor Deferral and Blood Product Management in Response to Ebola Virus, is intended to be used when there is an ongoing Ebola outbreak with "widespread transmission in at least one country."

While Ebola symptoms typically present within 21 days of infection, recent analyses have dem-onstrated that some patients may not become symptomatic till much later. Additionally, scien-tists have discovered that infectious Ebola virus and viral RNA can remain present in certain parts of the body and bodily fluids for months after symptoms have resolved. Other reports have sig-naled the possibility of asymptomatic infection, which could in theory lead to infection of others.

For these reasons, FDA is recommending blood establishments implement additional screening measures when the CDC declares there is widespread Ebola transmission in one or more countries.

Facilities that collect blood or blood compo-nents are instructed to ask potential donors about any history of Ebola infection, travel or residence in any country effected by an outbreak or contact with infected persons in the previous eight weeks.

FDA says that blood establishments should indefinitely defer donors who have had Ebola virus. The agency also recommends deferring donation by eight weeks for any donors who traveled to or lived in an effected country, or were in close contact with an infected individual.

WHO has identified convalescent plasma, or plasma gathered from recovered Ebola patients, as a potential treatment for the disease. While some uncontrolled studies have been conducted to investigate the use of convalescent plasma to treat Ebola, such uses are still considered investigational by FDA and WHO.

Visit FDA for the guidance at www.fda.gov/downloads/BiologicsBloodVaccines/Guidance-ComplianceRegulatoryInformation/Guidances/Blood/UCM475072.pdf

1601-IP-CAUTIs.indd 18 12/14/2015 11:22:27 AM

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purchasing withhold, and it can have an impact on the readmissions penalty. Poor CAUTI scores can potentially lose hospitals more than three percent of total CMS reim-bursement. Unreimbursed costs of care can exceed $10,000 per infection.”9

“CAUTI has been associated with in-creased morbidity, mortality, hospital cost, and length of stay,” added Timothy O’Halla, President and CEO, Eloquest Healthcare Inc. “Although there has been modest improvement in CAUTI rates, progress has been much slower than other device-associated infections.”5

Products that help reduce risk of CAUTIClearly, it is important to use every tool in the bag to prevent CAUTI. In addition to evidence-based infection-prevention mea-sures, other tools to thwart CAUTI are to be found in related products. In its CAUTI toolkit, the CDC mentions that use of alter-native and supplemental means can help.

O’Halla described the benefits of us-ing Eloquest Healthcare’s alternative to indwelling urinary catheters (IUCs) for males. “Among the multiple evidence-based recommendations for CAUTI pre-vention, eliminating the risk associated with unnecessary IUC days is emphasized. The preventive role of the ReliaFit Male Urinary Device is its use as an alternative to IUCs in appropriate male patients. As a direct result of its non-invasive design, ReliaFit can reduce the risk of CAUTIs. Ad-ditionally, ReliaFit is one-size-fits-all and can reduce device leakage and healthcare-acquired skin injuries seen with other external devices.

“The cost avoidance associated with Reli-aFit extends from the prevention of CAUTI and improved patient satisfaction, which may positively impact the value-based purchasing model and total performance score. ReliaFit’s one-size-fits-all feature eliminates the need to stock several dif-ferent sizes and, by doing so, can reduce SKU counts.”

O’Halla related the experience of one long-term acute-care hospital, located in the Southwest, that used ReliaFit with suc-cess. “It was part of a quality-improvement initiative. During its implementation, the

infECTion PREvEnTion

CAUTI rate fell to zero, and a significant decrease in IUC device-days was achieved. No complications or adverse events were reported as a result of the device interven-tion.”

Dale Medical Products offers a urinary-catheter–securement product, the Hold-N-Place Foley Catheter Holder. Josh Brezack, Urology Product Manager, explains how it works to prevent CAUTIs. “Our Hold-N-Place Foley Catheter Holders come in both a leg-band and a short-term adhesive version that, together, offers a wide range of applications and options. Our holders do not allow ‘pistoning’ of the catheter, keeping it in place to reduce urethral traumas such as dislodgement and ero-sion of the bladder neck or urethra. These conditions are two of the leading causes of CAUTI. Our adhesive holder is gentle on the skin, breathable, and highly versatile. Our leg band is soft and supple, great for long-term catheterized patients or for skin-sensitive or diapho-retic patients. Dale also offers a large leg-band holder, ideal for bariatric patients or for placement around the waist to secure suprapubic catheters.”

Brezack referred to a pub-lished scientific study that supports the ef-ficacy of the Hold-N-Place Foley Catheter Holder. “In 2007, a study was conducted that found the average CAUTI cost the hospital a minimum of $758 to treat.10 This amount is a nonreimbursable cost to the hospital system. With proper protocols and use of a Dale Foley holder, a hospital can save substantially over the risk of having to treat CAUTIs regularly.

“Organizations such as the Society of Urologic Nurses and Associates, CDC, and the Wound Ostomy and Continence Nurses Society all recommend use of a Foley securement device to lessen the potential for CAUTIs,” Brezack pointed out.

Skin care and CAUTIHealthy skin is the first line of defense in preventing infections.

McHugh, Sage Products, highlighted the importance of good hygiene in preventing CAUTIs. “The Association for Profession-als in Infection Control and Epidemiology (APIC) and the Society for Healthcare Epidemiology of America (SHEA) are leading the fight to reduce CAUTI. They both have produced guidelines and rec-ommendations that include meatal care as part of CAUTI reduction. APIC’s Guide to Preventing Catheter-Associated Urinary Tract Infections, 2014,11 states, ‘Provide routine hygiene for meatal care,’ whereas the SHEA Practice Recommendation: Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals: 2014 Update12 states, “Employ routine hygiene; cleaning the meatal area with antiseptic solutions is unnecessary.”

McHugh explained that standards for proper meatal cleansing are, unfortunately, not well-defined, leading to significant process variation. “Sage Products’ new M-Care Meatal Cleansing Cloths for the Foley Catheterized Patient can be used as part of the patient cleansing protocol, to improve hygiene and adherence to infection-control

policy. M-Care Meatal Cleansing Cloths provide a rinse-free, hygienic al-ternative to soap, basins, and hospital tap water.”

Basins have been prov-en to increase the

risk of HAIs; so, removing basins and standardiz-ing a cleaning p r o c e d u r e i s

important, stated McHugh. “In a study analyzing the basins

from 88 hospitals across the U.S., 62 percent were contaminated with at least one patho-gen commonly associated with HAIs.”13

McHugh related the experience of a hospital located in the Northeast that illus-trated eliminating basins reduces CAUTI risk factors. “When basins were completely eliminated from two medical-surgical units of a 370-bed facility located in the North-

east, CAUTI rates dropped to zero within one month and remained at zero for five months.”14 Mc Hugh concluded, “By eliminating basins, and following APIC and SHEA guidelines, the impact of CAUTI can be reduced at your facility.”

Another product de-signed to help maintain skin integrity is Theraworx from Avadim Technologies.

New M-Care Meatal Cleansing Cloths for the Foley-catheterized patient, from Sage Products

The ReliaFit Male Urinary Device, from Eloquest Healthcare Inc.

The Dale Hold-n-Place Foley Catheter Holder, from Dale Medical

Theraworx Specialty Care Pack, used prior to Foley insertions, from Avadim

Technologies.

1601-IP-CAUTIs.indd 20 12/14/2015 11:22:29 AM

InfectIon PreventIonWoody described how Theraworx helps to promote healthy perineal skin. “Theraworx technology is a patented, broad-spectrum hygiene formulation with patent-pending protocols for topical skin application. It is nontoxic and mucous-membrane safe. We are seeing tremendous interest in the re-ductions in CAUTI rates being realized by hospitals implementing use of Theraworx for insertions and perineal care of catheter-ized patients.

“The key to Theraworx helping reduce CAUTI,” explained Woody, “is its abil-ity to help optimize the acidic mantle of the outer layer of the skin, the stratum corneum.” Woody referred to a study by Elias that described how the normal acidic pH of stratum corneum, around 5.0, allows normal healthy flora to flourish but is deadly to pathogens.15 “If pH rises, infection-causing pathogens can survive and grow,” said Woody.

Woody explained how Theraworx differs from soap and water. “Almost all hospitals clean the perineum of catheterized patients with soap and water, typically at a pH of 9 or higher. In so doing, the antimicrobial acidic mantle of the skin likely is degraded, opening the door for pathogenic growth and infection. Theraworx provides a broad-spectrum hygiene, mucous-membrane safe perineal alternative, optimizing the acidic mantle rather than degrading it.

“We can cite numerous positive out-comes,” noted Woody, “but one of the best is the experience of Little Company of Mary Hospital and Health Care Centers in Chicago.” They had thirty-seven CAUTIs in 2013 and twenty-nine in 2014. In late 2014, they implemented Theraworx pro-tocols and have seen only five CAUTI so far this year. hPn

References

1. American Nursing Association. ANA CAUTI Prevention Tool. http://nursingworld.org/ANA-CAUTI-Prevention-Tool. Last ac-cessed December 1, 2015.

2. Allen-Bridson K. NHSN catheter-associated urinary tract infec-tion surveillance in 2015. http://www.cdc.gov/nhsn/pdfs/train-ing/2015/cauti-2015-w-answers.pdf. Last accessed December 1, 2015.

3. Centers for Disease Control and Prevention. Catheter-associated urinary tract infections (CAUTI). http://www.cdc.gov/HAI/ca_uti/uti.html. Last accessed December 1, 2015.

4. Gould CV, Umscheid CA, Agarwal RK, et al. Guideline for prevention of catheter-associated urinary tract infections 2009. http://www.cdc.gov/hicpac/pdf/CAUTI/CAUTIguideline2009fi-nal.pdf. Last accessed December 1, 2015.

5. Association for Professionals in Infection Control and Epide-miology, Inc. APIC implementation guide: guide to preventing catheter-associated urinary tract infections. http://apic.org/Resource_/EliminationGuideForm/0ff6ae59-0a3a-4640-97b5-eee38b8bed5b/File/CAUTI_06.pdf. Last accessed December 1, 2015.

6. Lo E, Nicolle L, Classen D, et al. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008 Oct;29(Suppl 1):S41-S50.

7. American Nurses Association. Streamlined evidence-based RN tool: catheter associated urinary tract infection (CAUTI) prevention. http://nursingworld.org/MainMenuCategories/

ThePracticeofProfessionalNursing/Improving-Your-Practice/ANA-CAUTI-Prevention-Tool. Last accessed December 1, 2015.

8. Gould C. Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention. Catheter-associated urinary tract infection (CAUTI) toolkit. Activity C: ELC prevention collaboratives. http://www.cdc.gov/HAI/pdfs/toolkits/CAUTItoolkit_3_10.pdf. Last accessed December 1, 2015.

9. Hoffman C. Trial without error: calculating the actual cost and benefits of a CAUTI therapy. Healthcare Purchasing News. 2015 July:39(5):44-45.

10. Anderson DJ, Kirkland KB, Kaye KS, et al. Underresourced hospital infection control and prevention programs: penny wise, pound foolish? Infect Control Hosp Epidemiol. 2007 Jul;28(7):767-773.

11. Association for Professionals in Infection Control and Epide-miology, Inc. APIC releases updated guide to preventing catheter-

associated urinary tract infections. Am J Infect Control. 2014 Aug;42(8):819.

12. Lo E, Nicolle LE, Coffin SE, et al. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 up-date. Infect Control Hosp Epidemiol. 2014 Sep;35(Suppl 2):S32-S47.

13. Marchaim D, Taylor AR, Hayakawa K, et al. Hospital bath basins are frequently contaminated with multi-drug resistant human pathogens. Am J Infect Control. 2012;40:562-564.

14. Stone S, Chaffee D, Rowin K, et al. Removal of basins to reduce catheter-associated urinary tract infections. Poster presented at Association for Professionals in Infection Control and Epidemiol-ogy, Inc; New Orleans, LA; July 2010.

15. Elias PM. The skin barrier as an innate immune element. Semin Immunopathol. 2007 Apr;29(1):3-14.


Instrumental news Cs ConnECTion

The New Year is a great time to take a look back on where you’ve been and where you are going with regards to your central sterile/sterile processing department (CS/SPD). What better place to start than your cleaning and decontamination processes and equipment?

Washers are rapidly evolving to take the burden off CS/SPD professionals with innovative features that promote ease of use, efficiency and safety.

In this article, we explore advancements in washers, factors the CS/SPD should take into consideration when selecting a washer, the emergence of “smart” washer technologies, the move toward automation, and tips for overcoming the challenges of drying.

today’s washers: smarter, friendlier and more efficientIn a world where the CS/SPD is expected to do its job better and faster with less waste, washer manufacturers have developed new technologies to meet those needs. While the skills and knowledge of the user will always be critical to effective instrument cleaning, washers equipped with advanced sensors and software provide CS/SPD professionals with information to help them make informed decisions in their fast-paced and high-pressure working environment. Furthermore, user-friendly controls and greater automation help staff do their jobs more effectively and efficiently.

Intelligent designAccording to John Nies, Product Manager for Belimed, there are now washers that can communicate with data logging and documentation software packages, as well as instru-ment tracking systems. Some will even connect to the Web and allow information to be sent to the manufacturer’s service department to improve the service response.

“Washers, like everything else in today’s world, are getting smarter,” said Nies. “Tra-ditionally, washers have run the wash cycle and are done. The move to having them incorporate more data collection and sharing will be the next big trend.”

Mike Cain, Senior Product Manager, Marketing, Getinge USA, notes how some of the newest innovations and trends for medical washers/disinfectors are coming to the U.S. from Europe. These include:• Ao Disinfection Value: Washer programs can be set to compute and display the Ao disin-

fection value based on the cycle’s exposure temperature and contact time. Per ISO 15883-1, Ao is a correlation of the washer’s effectiveness, based on heat and exposure time, to inactivate pathogenic, vegetative microorganisms, producing safe-to-handle goods.

• Pump Pressure Sensor: Washers can be fitted with water pressure sensors for their wash pumps. When pump pressure drops, spray action is reduced and cleaning outcome declines. A root cause of pressure loss is foaming caused by detergents. The controls will interrupt the cycle when pump pressure is too low, to protect the pump from damage due to possible cavitation.

• Detergent Flow Control: Accurate dosing of detergent additives is critical for good cleaning results. Standard pump delivery lines can become clogged and interrupt dispensing without warn-ing. Optional flow control uses a flow meter to ensure positive, accurate flow of detergents to the washer pump. The cycle is interrupted if the flow meter does not register the correct flow of detergent in each line.

• Spray Arm Monitoring System: A spray arm supervision system monitors the rotation speed of each spray arm on the load cart and sends an alarm if the rotation deviates from set limits. This system helps ensure effective cleaning by alerting the operator to anything that disrupts the normal rotation of the spray arms. When spray arms are not rotating

Complete cycle of cleanSmart washer technology optimizes workflow, improves safety and qualityby Kara Nadeau

Getinge 8668 fully automatic, microprocessor-

controlled mechanical washer/disinfector

CBsPD announces Flexible endoscope reprocessor Certified management certifications The Certification Board for Sterile Processing and Distribution Board of Directors (CBSPD) announces that the CBSPD Flexible Endoscope Reprocessor (CFER) and Certified in Sterile Processing Manage-ment (CSPM) certifications have each received a five-year accreditation from the National Commis-sion for Certifying Agencies (NCCA).

NCCA accredited standards help to ensure the health, welfare and safety of the public. Accredita-tion provides third-party validation that CBSPD cer-tification programs meet recognized national and international credentialing industry standards for development, implementation and maintenance of certifications that assess professional compe-tency. The CFER is the only accredited certification program of this type. (http://sterileprocessing.org/info.htm)

CBSPD, formerly the NICHSPDP, is a non-profit Certification Board which plans, develops and administers competency-based “International” cer-tification examinations for personnel performing cleaning, disinfection, sterilization and inventory management activities, regardless of the setting.

missing nora wikanderIt was with great sadness that Healthcare Purchas-ing News learned of the passing of Nora Wikander on October 17, 2015. Nora was one of the found-ers and long time board member of the CBSPD. She graduated from Hackensack School of Nursing and worked as a floor nurse, nursing team leader and charge nurse at Paterson General Hospital and St. Joseph Wayne Hospital in New Jersey.

In 1984, she accepted a position as the Director of Central Service/Sterile Processing at St. Joseph Wayne where she retired in 2011. Nora was active in the field of sterile processing as a member and officer of the NJ CSA and one of the authors of the American Association for the Advancement of Medical Instrumentation (AAMI) Sterilization documents utilized all over the United States, and was an editor of the textbook, The Basics of Sterile Processing.

Nora was actively involved with the education of sterile processing personnel and also served as a Board Member and chairperson of the continuing education committee of the National Institute for the Certification of Sterile Processing Personnel since its inception in 1991. HPN had the honor of working with Nora for many years on Central Service/Sterile Processing education articles for CEU credits.

The CBSPD is a non-profit Certification Board which plans, develops and administers competen-cy-based “International” certification examinations for personnel performing cleaning, disinfection, sterilization and inventory management activi-ties, regardless of the setting. Since its inaugural examination in 1991, the CBSPD has credentialed over 31,000 personnel internationally. There are currently over 13,500 active certificants.

Page 24

1601-CS-WasherDryers.indd 22 12/14/2015 11:47:46 AM

www.steelcospa.com | [email protected] | phone 561-791 8313

Washer Disinfectors - Cart Washers - Automatic Transfer System Ultrasonic Cleaning - Drying Cabinets - Bedpan Washers


1601-Steelco.indd 23 12/10/2015 12:51:36 PM


Cs ConnECTionand not delivering cleaning solutions to all areas of the load, the decontamination process will be compromised.

•Conductivity Control: When the quality of the finalrinsewaterneedstobemonitoredandcontrolled, this option is used to measure the conductivity of the water. High levels of chloride and metals in the water allow electrical current to easily pass through the water.Thewasherwillrepeatthefinalrinseup to three times using fresh DI/RO water attempting to achieve a measurement of 500 µS/cm or less. After three consecutive rinses, the control system alerts the operator if the conductivity remains too high.

Reliability, ease of use and safety“We consistently hear that reliability and easeofusearethetwomostsignificantconsiderations,” said Nies. “Down time is costly, in many ways, so a reliable washer makes a huge difference in the activities of the SPD and the OR. With the almost universal acceptance of electronics such as smartphones, and their intuitive use, users expect an easy to use washer – select the cycle and go.”

Tobias Brodowski, Group Product Man ager for Washing Systems, STERIS Corporation, points out how intuitive controls are critical to eliminating the risk of improper operation that leads to insufficientcleaning.

“If the interface is too complicated to choose the correct cycle, it can cause staff frustration,” said Brodowski. “STERIS offers truecolor touch screens with large icons to select cycles to guide users through the decision making process. A cycle can be started with a single click, and once initiated the most important information, including the remaining cycle time, is displayed in large digits.”

For ease of use, he recommends CS/SPD staff select washers featuring manifold racks thatallowuniquewaterflowandcompleteloading from either side. With this feature, staff can load every shelf entirely from any side. STERIS manifold racks feature cooltouch handles that allow the handling of the racks immediately after the cycle is complete. The chambers can be emptied safely without risk of injury to staff, even when the handles are hot.

The STERIS AMSCO 7053L is the only washer/disinfector offering the full load capacity of a long, rectangular chamber, while providing corner coverage on each level of the rack. Combine this coverage with its outstanding drying system, AMSCO 7053L has a cycle time of less than 30 minutes. It is a

time-efficientunitwithoptimizedutilityconsumption, including low waterusage spray armsandanefficientdryingsystem.

“Technology advancements have increased the effectiveness, efficiency and safety of today’s washers,” said Tina Cole, Marketing Manager for Medisafe America. “Detailed traceability provides the staff with the reassurance that the instruments are safe to handle on the clean side. Some systems are able to notify the user if any part of the cycle parameters is not met. Load carrier recognition assists the staff on program selection for the carrier being loaded.”

Medisafe’s Niagara SI PCF simplifiesdailyprocessesanddramatically reduces cleaning time, (reprocesses 144 complex instruments in as little as 29 minutes), increases staff safety, productivity and saves on overall reprocessing costs. The Niagara SI PCF has a built in ultrasonic chamber for Sonic Irrigation cleaning of 48 lumened

or 20 robotic instruments. Its unique delivery system ensures highpressure fluidisfedtoeachandeverylumenedinstrument, while the unique combination of Sonic Irrigation and conventional washing coupled with the company’s Pulsed Flush System achieves an exceptionally high standard of cleaning.

For the CS/SPD that requires a solution for cleaning da Vinci robotic instruments, Geddis offers its patented SurgiSonic 1211X dual hookup method, whichutilizes twodifferent typesofsuction chambers and two indepen

dent suction systems. It was developed to independently address the cleaning needs of the distal jaw/pulley end and the shaft/control box end of a da Vinci robotic instrument, which are separated from one another by a tight seal. The SurgiSonic dual cleaning method independently cleans both segmented areas of a robotic instrument at the same time, including the Xi.

AutomationImplementation of automated loading and unloading systems for instrument washers is growing as facilities seek to boost productivityandmaximizeexistingresources,says Christopher Sillet, Managing Director of Steelco USA. He notes how automated washers facilitate standardizedprocesses,reduce manual steps and save space by minimizingaccess requirements.Further

more, automated program selection reduces false alarms.

The Steelco US 1000 Ultrasonic Washer ultrasonically cleans surgical instruments prior to loading them into the washer/disinfector via mechanical automation. With loaded multilevel instrument racks from

the washer/disinfector, the US 1000 executes a fully automated ultrasonic cleaning of up to 15 instrument trays in a 10minute cycle. Once the cleaning cycle is completed, the rack will automatically load into the washer/disinfector. Each wash rack has magnetic coding which identifies the need for an ultrasonic washing phase. When no ultrasonic cleaning is required, the US 1000 will bypass that rack automatically without manual input by the operator.“Automationplaysa significant

part in every CSSD, and as it continues to evolve it will allow staff to focus on added value actions including inspecting instruments or assembling sets,” said Brodowski. “Conveyor belts are being used today to allow staff to manage peak times most effectively. Here, finished racks can continue the process even when all washer/disinfectors are in use, without delaying staff from completing their tasks.”

According to Cole, there is a growing need for automation as more complex instruments come to market:

“Reprocessing these items manually is timeconsuming. An automated way of reprocessing these new complex instruments is abenefitforthestaffandtheirdepartment.”

Nies feels automation is very useful in the right situation. He has seen more medium to larger facilities transitioning to automation, most often with washers. He states:

“The workload in the decontamination side of the sterile processing department is not steady so an automated washer system, with a queue, allows personnel to preclean and load instruments on the wash rack without being slowed down by washers that are full

and running.”

Overcoming the challenges of dryingEnsuring instruments are dried effectively isasignificantchallenge to theCS/SPDasinstruments become more complex, feature hard to access components, and are comprised of various materials that cannot withstand high temperatures. We asked manufacturers to provide their advice on how to facilitate proper drying. Here are their responses:

STERIS AMSCO 7053L washer/disinfector

Medisafe Niagara SI PCF

Geddis SurgiSonic 1211X dual cleaning method for da Vinci instruments




CS CONNECTION

Steelco’s advanced loading automation for its instrument washers with integrated pre-cleaning and the US 1000 module

“Drying is the big challenge,” said Nies. “Just like those hard to dry plastic food storage containers in your home dishwasher, medical washers are now seeing more low heat con-ductive materials, such as plastics, that need to be washed and dried. We often see special longer dry time cycles set up in the washers and advise personnel to sort the instrument sets and try to load those with plastics together so only those loads need the longer cycle. That helps to reduce post washer hand dry-ing, which is ineffi cient and time consuming, without slowing everything down.”

“Process all metallic items together to get the maximum benefit from process tem-peratures - the hotter the goods, the easier they will dry,” said Cain. “Use treated water such as RO or DI water for fi nal rinsing, as this will reduce droplets or clinging water on loads. Utilize very hot water for the fi nal rinse (between 185°F – 190°F) just prior to drying to promote fl ash drying. Also, make certain HEPA fi lters are clean and air fl ow is not obstructed. I also suggest utilizing wash racks that force drying air through the spray arms and injectors.”

Cain notes how some washers/disinfectors now feature a drying sensor, which monitors humidity of the chamber air during the drying phase and controls drying time accordingly.

“Traditionally, drying is a preset time dura-tion programmed into the cycle parameters. Depending on the load, the preset time will be too long for partial loads and too short for heavy loads,” said Cain. “Drying by chamber/load humidity saves time and energy with partial loads and produces more consistent drying results across all loads.”

Cole stresses the importance of ensuring instruments are thoroughly dried both inside and out:

“Many washers out in the market can dry the outside of the instruments, but Medisafe’s Niagara SI PCF has Soft Shot Air Purge to dry the inside of the instruments,” said Cole.

According to Brodowski, highly effi cient drying systems recycle 90 percent of the air used, which shortens drying phases to fi ve-to-seven minutes with an exhaust of only 10 percent. These features reduce energy usage and impact on the facility’s ventilation system.

“Effective drying starts with a highly effi cient dry-ing system,” said Brodowski. “Our Rel iance Vision and 7053L Single Chamber washer/disinfector’s drying phases reach all instruments and optimize the evaporation of any remaining moisture. Correct loading of the washer/disinfector is also crucial. Double stacking or overloading of trays and the use of plastic inserts should be avoided whenever possible.” HPN

Visit www.hponline.com/inside/2016-01/1601-CS-Washers.html for the sidebar, “Tips for selecting a washer.”



January 2016The self-study lesson on this central service topic was developed by STERIS. The lessons are administered by KSR Publishing Inc.

Earn CEUsThe series can assist readers in maintaining their CS certifi cation. After careful study of the lesson, complete the examination at the end of this sec-tion. Mail the complete examination and scoring fee to Healthcare Purchasing News for grading. We will notify you if you have a passing score of 70 percent or higher, and you will receive a certifi cate of completion within 30 days. Previous lessons are available on the Internet at www.hpnonline.com.

Certifi cationThe CBSPD (Certifi cation Board for Sterile Processing and Distribution) has pre-approved this in-service for one (1) contact hour for a period of fi ve (5) years from the date of

original publication. Successful completion of the lesson and post test must be documented by fa-cility management and those records maintained by the individual until re-certifi cation is required. DO NOT SEND LESSON OR TEST TO CBSPD. For additional information regarding certifi cation contact CBSPD - 148 Main Street, Suite C-1, Lebanon, NJ 08833 • www.sterileprocessing.org.

I A H C S M M (International Association of

Healthcare Central Service Materiel Management) has pre-approved this in-service for 1.0 Continuing Education Credits for a period of three years, until December 2018. The approval number for this lesson is HPN 151412.

For more information, direct any questions to Healthcare Purchasing News (941) 927-9345, ext. 202.

LEARNING OBJECTIVES1. Identify and understand

implementation of the AAMI TIR34 2014, Water for the reprocessing of medical devices guideline

2. Identify the different stages of rinsing and when they should occur during the process

3. Distinguish different water quality types and treated water rinses and when/how each one should be used

Sponsored by:

SELF-STUDY SERIES Sponsored by

As we consider the reprocessing of medical devices, most facilities are diligent in following regulatory

guidelines and manufacturer’s instructions for use for cleaning and sterilization of re-usable medical devices. While most of the reprocessing in a facility takes place in a centralized department, there are many an-cillary areas that perform the same functions e.g., Endoscopy, Respiratory, Anesthesia, Clinics, Outpatient Centers, etc. That being said, if you were to poll your departments and ask about the steps of reprocessing, would rinsing even be mentioned in the reprocessing cycle?

Industry standardsMost of us are familiar with ANSI/AAMI

ST documents but how many are familiar with AAMI TIR (Technical Information Report) documents, in particular AAMI TIR34 2014 Water for the reprocessing of medi-cal devices? As you build the resource library for your facility, this document should be included along with the ANSI/AAMI Guideline documents.

ANSI/AAMI TIR34:2014 states, “The objective of this TIR is to provide guidelines to personnel involved in medical device reprocess-ing on the quality of water that should be used in various stages of medical device reprocessing. It is also intended to provide guidelines to water service maintenance personnel on establishing and monitor-ing water treatment systems.”

Water qualityLet’s think about the pro-cess and how often water is a component of everything we do: manual cleaning, automated cleaning, steam sterilization; and while equipment does have spe-cific water requirements that should be followed, how many facilities focus

Rinsing: the most misunderstood step in reprocessingby Michele McKinley, LVN, CRCST, CIS, CHL, AGTS, Senior Clinical Education Specialist, STERIS

on water quality for rinsing of medical de-vices? Most of us perform the rinse phase with little thought to rinsing being a critical phase in the reprocessing cycle. Let us take a look at the rinse phase and its importance in the reprocessing of medical devices.

In device reprocessing, water can impact patient outcomes and the life of medical in-strumentation. We no longer have to just be concerned with improper cleaning causing adverse patient outcomes, but we also need to understand the impact of how improper water quality affects rinsing.

Some examples of how rinsing can impact outcomes are: instrument malfunctions during a patient procedure, due to water deposits causing instrument damage, impacting the correct functioning of the instrument; toxic effects and tissue irritation occurring from residuals left on devices due to inadequate rinsing; and patient infections, occurring from using contaminated devices, due to cross contamination from rinsing in the decontamination sink and/or area.

There are two categories of water quality that are important for medical device repro-cessing and the level of water quality that may be needed: 1.) utility water (tap water) which may require further treatment to achieve recommended specifi cation, utility water is mainly used for fl ushing, washing and rinsing. 2.) Critical water (extensively

Automated endoscope reprocessor

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1601-CE-STERIS.indd 26 12/14/2015 3:48:35 PM


Sponsored by sELf-sTudy sERiEsSelf-Study Test Answers: 1. c, 2. d, 3. d, 4. A, 5. d, 6. d, 7. d, 8. b, 9. d, 10. A

treated water) which could include a carbon bed, softening, deion-ized (DI), or reverse osmosis (RO). While tap water can be used for rinsing to ensure a large volume of water is used to remove loosened debris and detergents, the final rinse should be performed with treated water that does not contribute to staining or contamination of the instrument.

While utility water may be used for general reprocessing, it is critical that device manufacturer’s instructions be followed for appropriate rinse water recommendations. It is also critical to en-sure you are following manufacturer’s instructions for equipment water recommendations e.g., washer decontaminators, automated endoscope reprocessors (AERs), etc., which may require the use of critical water for appropriate cleaning and rinsing.

Importance of rinsingWhile decontamination in the Central Sterile Processing Depart-ment is considered the centralized area to perform cleaning and rinsing functions, it is important to identify all areas in the facility, including outpatient and clinic areas that perform these functions in your facility, to ensure there is a standardized process and that the same standards that are adhered to in the CSPD are adhered to in the outlying areas.

While there may be awareness in the CSPD of the importance of appropriate rinsing, we may need to provide education to other areas that perform clean-ing tasks. As a component of a facility Quality Management System (QMS), a review of processes for standardization should include not only appro-priate cleaning per manufac-turer’s written instructions, but also appropriate rinsing.

At point of use the staff should be keeping devices free of gross debris and flushing lumens to prevent the formation of biofilm by allowing bioburden to dry on the devices. One of the challenges at the point of use is the type of solution that is used, saline is often the only solution opened onto the sterile field during a procedure. Staff need to be educated that saline is corrosive to the instruments and that sterile water should be the only solution used for point of use care and handling.

Decontamination of devices/instruments should be taking place in a room separate from the clean processes, or have spatial sepa-ration. Although decontamination is a dirty area, it is important to have a designated flow from dirty to clean to prevent cross contamination. Rinsing in the decontamination sink is a point of possible cross contamination; frequent cleaning and disinfection between cleaning of devices should be a routine process.

In the past it was common and probably still today to perform high-level disinfection, either manual or automated in the decon-tamination area. The challenge then becomes how do you remove and rinse the device without recontamination? When removing a device from manual high-level disinfection the device must be rinsed prior to patient-use and storage, if the high-level disinfec-tion takes place in the decontamination area where do you rinse the device? If you rinse in the decontamination sink you have re-

contaminated the device, if you use a separate soak basin in the decon-tamination area, is the basin covered and the lid disinfected to prevent cross contamination through aero-solization? While most automated reprocessors have a rinse cycle, there is still a risk of recontamination if removing the device in the decon-tamination area.

Page 28

DecontaminationAfter Manual Cleaning

Point of Use Care & Handling

After High-Level Disinfection

Mechanical Washing

There are multiple points in the process that require rinsing:

1601-CE-STERIS.indd 27 12/14/2015 2:24:24 PM


sELf-sTudy sERiEs Sponsored by

In mechanical washing the rinse phase is automated, and typi-cally there is a dual rinse with the last rinse being a thermal rinse to achieve thermal disinfection. It is important to understand the washer disinfector’s requirements for what type of water should be used to achieve the best outcomes for the instruments. Water quality differs in all locations. If you see staining, rusting etc. on your instruments as they exit the washer check to ensure the water source meets the required quality, that it is connected and turned on, and that tanks (if applicable) are not empty. Any residual left on a device or instru-ment is potential for irritation, inflammation, and/or infection when the device or instrument is used in a procedure.

Device design and point of careThere may be some devices such as flexible endoscopes that provide cleaning challenges due to the design of the device. Device design not only plays a role in cleaning but also in rinsing. All devices must have manufacturer’s written instructions for use available. Staff must be inserviced and competency assessed for appropriate cleaning. The competency should include appropriate rinsing. There are other instruments such as ophthalmology instruments that require a rinse with sterile or distilled water. If you do not have clear and concise manufacturer’s written instructions for cleaning and rinsing the facility should contact the manufacturer for clarification.

A review of the cleaning processes should be performed in all areas of the facility that perform cleaning. That review should in-clude appropriate rinsing, especially for those specialty devices that require special rinse water, or procedures. A simple auditing tool will assist in verifying compliance. Some examples of inappropriate

rinsing include: rinse basins/tubs labeled “change water daily” when water should be changed after every rinse; questioning staff on how many rinses the high-level disinfectant requires and how many are actually performed; and staff stating they change the rinse water when they change the high-level disinfectant which can be from 14 days to 21 days.

Support of quality management systemsStaff does not always know what they don’t know. Are there tools and resources available to assist in appropriate cleaning and rinsing of devices? Having the manufacturer’s written instructions, ANSI/AAMI Documents, facility work instructions, policy and procedures and competencies are all key components of staff education, but if the tools are locked in a manager’s office or outdated are they truly tools accessible to the staff? Get creative. Assign staff a guideline of the month to research and present, have staff review manufacturer’s instructions for use and present key points during staff meeting. Education should be ongoing not just a monthly in-service, staff should feel comfortable using the tools to enhance their performance and provide a positive outcome to all customers. HPn

References:

1. Association for the Advancement of Medical Instrumentation, Technical Information Report 34, Water for the reprocessing of medical devices, 2014.

2. AAMI Comprehensive guide to Steam sterilization and sterility assurance in health care facilities – ST79:2010. Arlington, VA: AAMI.

3. AAMI Chemical Sterilization and High-Level Disinfection in Healthcare Facilities – ST58:2013, Arlington, VA AAMI.

4. AAMI/ANSI ST91. Flexible and semi-rigid endoscope processing in health care facilities (2015).

1601-CE-STERIS.indd 28 12/14/2015 11:55:30 AM


Continuing eduCation test • January 2016

Sponsored by sELf-sTudy sERiEs

rinsing: the most misunderstood step in reprocessing

1. What resource document is available that discusses rinse water for the reprocessing of medical devices? a. ANSI/AAMI ST79 b. ANSI/AAMI ST58 c. TIR 34 d. ANSI/AAMI ST91

2. Poor rinsing can cause: a. Instrument damage b. Cross contamination c. Tissue irritation d. All of the above

3. types of treated rinse can include: a. Tap water b. Deionized water c. Reverse Osmosis water d. b & c

4. utility (tap) water may be used for flushing, washing and rinsing?a. True b. False

5. the following manufacturer’s written instructions should be followed: a. Device b. Materials Management c. Equipment d. a & c

6. Point of use customers should be performing: a. Flushing of lumens b. Soaking in saline c. Keeping devices free of gross contaminant d. a & c

7. after High-level disinfection the rinse water should be changed: a. Daily b. When HLD is changed c. Once per shift d. After each rinse

8. a proper work flow includes: a. Placing clean devices in the soiled drop off area b. A separation of clean and dirty c. Rinsing in the decontamination sink d. Cleaning in a sub sterile room

9. tools and resources can include: a. Work instructions b. Manufacturer’s written instructions for use c. Posters d. All of the above

10. all departments that perform reprocessing should be auditeda. Trueb. False

Circle the one correct answer:

request for scoringo I have enclosed the scoring fee of $10 for EACH test taken. (Payable to KSR Publishing Inc.

We regret that no refunds can be given. Multiple submissions may be submitted in bulk and paid with a single check for the bulk sum.)

Detach exam and return to:Continuing Education DivisionKSR Publishing Inc.2477 Stickney Point Road, Suite 315BSarasota, FL 34231PH: 941-927-9345 Fax: 941-927-9588

Please print or type. return this page only.

Name

Title

Hospital Name

Mailing Address

Apt/Suite

City, State, Zip

Daytime Phone

Email

The approval number for this lesson is HPn 151412.

Presented by

1601-CE-STERIS.indd 29 12/14/2015 11:55:31 AM


CS QUESTIONS • CS ANSWERSIUSS cycle frequency; differentiating sanitization, disinfection and sterilizationby Ray Taurasi

SUBMIT YOUR QUESTIONSemail: [email protected]: (941) 927-9345 ext. 202

Q How many Immediate Use Steam Ster-ilization (IUSS) cycles are acceptable

during a one-month timeframe? I have not been able to fi nd that information in any of the AAMI or AORN guidelines. In survey-ing my colleagues at various hospitals I have gotten a multitude of different answers. We have an accreditation inspection coming up and I don’t want to be cited for not following regulations.

A There are no regulations, guidelines or standards stating how many IUSS cycles

are acceptable to run during any specifi c time-frame. Sterilization process failures are a ma-jor concern and pose a serious risk to patient safety and well-being. It makes more sense to place great emphasis on each and every sterilization cycle regardless of whether the cycle is IUSS or a traditional terminal cycle.

It is imperative that every single step and detail in the reprocessing/sterilization pro-cess is performed precisely in accordance with the medical device and equipment manufac-turers’ instruction for use (IFU). There are absolutely no short cuts in the sterilization process. All policies and procedures must be followed for cleaning, disinfection, inspection, assembly, instrument positioning, packaging, loading sterilizer, sterilizer operation, cycle settings, monitoring, documentation, and adherence to aseptic techniques.

Clearly, sterilization is a complex and very precise process and one that cannot be rushed. For that reason all professional entities agree and recommend that the use of IUSS be reserved for true emergency and/or unanticipated events. Having inadequate instrumentation to meet surgical case load needs is not considered an emergency or un-anticipated event. Surveyors from CMS, TJC, and other accrediting bodies will be looking at the effi cacy of the entire sterilization pro-cess, not merely how many IUSS cycles are run. They will also assess your adherence to professional guidelines and standards relative to managing and monitoring all sterilization processing, including IUSS.

As a quality improvement initiative, you may want to consider benchmarking your own IUSS cycle rates against themselves to demonstrate that you are managing the pro-cess and implementing measures to reserve the use of IUSS to the unanticipated events.

Calculate your IUSS rates by dividing the number of IUSS cycles per month by the number of procedures per month.

Q Is it essential to sanitize all soiled items returned to CS, or is decontamination/

disinfection suffi cient prior to sterilization?

A It is important to realize that decontami-nation (cleaning), sanitization, disinfec-

tion and sterilization are each different and unique processes. The fi rst step in reprocess-ing involves thorough cleaning which is the removal of soil from used materials. The sec-ond step involves a microbicidal process such as sanitization, or disinfection. The objective of decontamination is to protect individuals from disease caused by contact with patho-genic organisms on soiled medical devices. Thorough cleaning, while an essential fi rst step, may not always be suffi cient to ensure that an item is safe to handle. Currently, there is no standard to measure just how “clean” or safe-to-handle an object must be. There-fore, to ensure that harmful microorganisms are destroyed, a microbicidal process may be employed. Medical devices that have been contaminated by blood, body fluids or large microbial populations must always be subjected to a microbicidal process after cleaning. Deciding which process to use is a risk-versus-benefi t decision for each item you process. Therefore, a clear understanding of these processes is imperative.

Sanitization is suitable for easily-killed microorganisms and can reduce the number of microbial contaminants on an inanimate surface to a relatively safe level. Following thorough cleaning, the objects are rinsed in hot water or steam-purged for a designated period of time depending on method used. Examples of sanitizing equipment include cart washes, steam guns, and dishwashers. Sanitization is adequate for items that only come in contact with the surface of unbroken skin. Disinfection provides a higher level of safety and can be used on work surfaces, medical devices and equipment that have come in contact with highly contaminated substances, body fl uids and blood. The disin-

fection process may be accomplished either by a thermal or chemical exposure. Pasteuriza-tion is an example of a thermal disinfection process. It involves exposing an object to a hot water bath at between 150 and 170 degrees Fahrenheit for 30 minutes. Contact with wa-ter at or above 180 to 205 degrees Fahrenheit for one minute can provide an intermediate level of disinfection. This is the process used in automated instrument washers during the fi nal rinse.

Chemical disinfection processes employ various liquid chemicals that contain agents such as quaternary ammonium compounds, iodophors, hydrogen peroxide, phenolics, chlorine compounds and glutaraldehydes. Chemical disinfection can be a complicated process, and careful selection of the appropri-ate chemical for each medical device or piece of equipment is imperative. Labeling will identify a chemical’s active ingredients and concentrations and provide the scope and spectrum of microbicidal activity. Directions for use must be followed precisely, including required contact time and temperature. It is essential to follow the device manufacturer’s IFU for proper cleaning and disinfection.

As noted previously, thorough cleaning is a critical step and if not done effectively, can impede the effi cacy of the disinfection pro-cess. To monitor the effi cacy of the cleaning process all automated washers (e.g., instru-ment washers, cart washers, ultra-sonics and automated endoscope reprocessor) should be tested weekly, preferably daily, in accordance with AAMI ST79 standards. There are specifi c testing tools and devices available for the various automated washers which verify the performance of the equipment. The cleaning effi cacy of medical devices can be verifi ed with testing devices that detect residuals of organic matter such as, blood, carbohydrates, and proteins. HPN

Ray Taurasi is Eastern Regional Director of Clini-cal Sales and Services for Healthmark Industries. His healthcare career spans over three decades as an Administrator, Educator, Technologist and Consultant. He is a member of AORN, AHA, SGNA, AAMI and a past president of IAHCSMM. Taurasi has been a faculty member of numerous colleges teaching in the divisions of business administration and health sciences.

1601-CSsolutions.indd 30 12/11/2015 1:10:41 PM


IAHCSMM VIEWPOINTCS Professionals must answer the call of professionalismby Julie E. Williamson

Some Central Service (CS) profession-als may assume that their chosen professional discipline provides them

with a secure “job.” The fact is, though, that the dynamic, fast-paced and ever-evolving realm of sterile processing offers a bona fi de career fi lled with exciting opportunities for growth and advancement.

With a growing emphasis on care qual-ity, patient safety and positive outcomes (and even cost containment), it stands to reason that healthcare organizations are more committed than ever to employing the very best professionals in each dis-cipline. While some CS departments are expanding their budgets to accommodate ongoing education and certification — and, in some cases, are willing to increase pay for their most committed and valued employees — that shouldn’t be the sole driving factor behind one’s willingness to raise the professional bar.

Career analysts stress that taking per-sonal responsibility of one’s career trajec-tory and taking calculated leaps to stay ahead of changes in the discipline will help healthcare workers achieve long-term suc-cess and greater job satisfaction. It will also help ensure that they’re well-equipped to function optimally and effi ciently, and de-liver the best possible service to healthcare customers and patients.

“Our pursuit of learning must never end,” stressed IAHCSMM President David Jagrosse, CRCST, CHL. “Knowledge is a very powerful thing and it’s absolutely necessary for those of us responsible for reprocessing devices. Devices, procedures, practices and standards continue to evolve and the only way for us to keep up is to stay educated and push ourselves beyond what we already know.”

Dedication pays big dividendsAccording to career analyst Brent Radcliffe, workers boost their career potential by developing and refi ning their professional capabilities. The more one knows about a particular job’s function or the more is

understood about a particular industry, the more valuable they become to an employer, he reasons.

Those who stay dedicated to their craft and deliberately avoid on-the-job compla-cency become front-runners for promotions and other opportunities to advance in the workplace. A good manager pays close at-tention to those who go the extra mile and routinely demonstrate competency and professionalism on the job. If a promotion isn’t feasible at the time, that employee may be pegged as a departmental mentor or, perhaps, an interdepartmental liaison. If a career ladder program is in place, these dedicated staff members may fi nd themselves scaling it quickly and opening themselves up to new professional oppor-tunities inside and outside the CS depart-ment. What’s more, if the employee’s own facility isn’t wise enough to recognize that hard word and professional dedication, the odds are good that a competing facility will.

Career ladder programs can go a long way toward enabling workers in health-care settings to attain on-the-job education and skills training. “We believe that em-ployees, at all levels in their healthcare ca-reer, deserve the opportunity to advance,” reasoned Rebecca Starr, Deputy Director of the Jobs to Careers Initiative. “Education and training is the key to advancement.”

Perhaps the greatest advantage of pursu-ing continuing educational opportunities and committing to knowledge advance-ment is the satisfaction that comes from de-livering the safest, highest quality service for patients and healthcare customers alike. Thanks to the many educational opportu-nities that exist today, CS professionals of virtually every background, title and tenure have the ability to become experts in their fi eld, and be respected as such.

“I defi ne ‘expert’ as someone who knows more about a specifi c subject than I do; in other words, someone I can learn from or learn with,” said IAHCSMM Education Director Natalie Lind. “When I have the op-portunity to learn, I always open the door.

The information I gather helps me grow with our fi eld and also helps others grow.”

Staying focused on information-sharing and knowledge-building is crucial in healthcare, especially in CS where tech-nology is always advancing and failure to stay abreast of those changes can negatively impact patient outcomes. “At work, not understanding everything about reprocessing a surgical instrument can be life-threatening. We must keep up with change.”

Lind recommends CS professionals take one step at time — beginning with taking responsibility for increasing one’s own knowledge and then sharing what was learned with others. This can occur through self-study, mentoring processes, or attending a class or educational confer-ence.

Lind recalled her fi rst IAHCSMM confer-ence where she not only learned a great deal from the expert speakers, but also from her fellow attendees. “I was able to forge relationships that have lasted more than 20 years. Those relationships were the start of a network of professionals where I could ask questions and share best prac-tices. Having access to their knowledge, insights and experience has helped me so much over the years.”

Whichever way a CS professional choos-es to pursue knowledge advancement and professional growth, one thing is clear: the efforts will pay off greatly for the em-ployee, customer, patient and facility. With quality service comes professional pride and satisfaction in knowing that one’s roles and responsibilities have a direct impact on others.

“As we prepare for the New Year, I en-courage every CS professional to set goals that will help them deliver even more value to their departments, customers, patients and organizations,” said Jagrosse. “Opportunities for advancement and other positive outcomes await us all. We just need to be willing to reach out and grab them.” HPN

1601-Viewpoint.indd 31 12/10/2015 1:08:17 PM


New TechNology PRoduCTs & sERviCEs

Arguably, the pre-eminent parameter for any storeroom or warehouse design plan is to ensure easy accessibility to any

product inside.If you can find it fast, stockpiling won’t last.Despite the best of intentions, however, the

mammoth scope of a storeroom or warehouse redesign effort may be enough to inspire pro-crastination in doing anything about it.

Sure, hospitals may not be in the warehousing business and supply chain not their “core com-petency” as some in the industry have posited at conferences and trade shows, but either excuse rings hollow and shallow if the core competency of caring for patients somehow is affected by a storeroom or warehouse design that enables stockouts or simply makes things hard to locate.

In fact, Donna Van Vlerah, Vice President of Supply Chain, Parkview Health, Fort Wayne, IN, respectfully rejected the diminish-ing notion that supply chain or warehousing is not a core compe-tency of a healthcare organization.

“At the core, a hospital is a busi-ness that specializes in healthcare, but it does not preclude us from the many disciplines of running a business [that include] Human Resources, Finance, Facility Maintenance ... and the list goes on to include Supply Chain/Materials Manage-ment,” Van Vlerah told Healthcare Purchasing News. “In order for a hospital to provide excellent care, they must have all disciplines within their core competencies. I believe the messaging that storerooms are not important advances the no-tion we are not critical to the healthcare mission.”

If anything, a well-oiled supply chain and an efficiently organized storeroom or warehouse both demonstrate competence for its core service, which is supporting clinicians to care for patients.

From the lights on the ceiling to the cleanliness and temperature of the air to the breadth and width of aisles to the arrangement of shelving to the order of products on shelves, design can make a difference in how a hospital delivers service.

How do Supply Chain teams determine whether their storehouse footprints need a re-design to improve throughput and workflow? What kinds of techniques and tools will enable the necessary improvements?

Redesigning the house that Supply chain builtHigh-tech help can hover, cover key performance indicators by Rick Dana Barlow

HPN reached out to a small group of provider and supplier supply chain experts for high-tech and low-tech practices and tools necessary for redesigning or reorganizing storeroom and warehouse space, as well as the danger/warning signs that a storeroom or warehouse needs an update, upgrade or complete overhaul.

In this edition, HPN spotlights high-tech strategies and tactics; an upcoming edition will feature low-tech strategies and tactics.

Automation articulationFor Van Vlerah, success can be found in a virtual world where storerooms and warehouses can be managed with sophisticated software tools. “These software tools enable the Supply Chain leader to have visibility of stocking levels in hun-dreds or thousands of locations,” she said. “With this aggregated virtual view, one can optimally manage obsolescence, expiration and right-size inventory through demand planning/forecast-ing. Today’s robust software packages enable the Supply Chain leader to manage items in the right unit of measure, too. Point-of-use systems tied to sophisticated software tools becomes a significant force multiplier. In order for a supply chain to operate in a Lean Six Sigma environment, management of ‘big data’ via an automated system is a critical element for today’s inventory management.”

Van Vlerah pointed to three options as “nirvana:” A warehouse management system (WMS), a demand forecasting system and a point-of -use system.

Mike Switzer, Vice President of Supply Chain & Support Services, North Mississippi Health Services Inc., Tupelo, MS, delineated the differ-ences he sees between storerooms and warehouses, which he con-siders to be two separate types of operations. Switzer spearheaded the design of a consolidated service center for his integrated delivery network that he currently manages.

“A storeroom is typically set up so that any nurse can find goods in the off hours,” Switzer noted. “In a storeroom like items are usually placed together. Things like needles will generally all be located together to make it easier for a nurse to find the goods. A warehouse

Donna Van Vlerah

Mike Switzer

Page 34

New bandage senses temperature changes, delivers medicineIn early November, scientists at the Massachu-setts Institute of Technology showed off a new hydrogel that is stretchable and can stick to surfaces with strength that was compared to tendon or cartilage connecting to bone.

The same research team has now used the hydrogel to develop a "smart wound dressing" that stretches with the movements of the body, keeping electronics intact that monitor tempera-ture and can deliver medication to patients either automatically or on demand.

Researchers at several institutions have de-veloped versions of hydrogel, a water-based substance that varies based on other chemicals used for its development.

The MIT version increased the strength and stickiness of previous versions. Researchers said their hydrogel adheres to surfaces stronger than the natural adhesives used by mussels and barnacles to attach to cliff faces and ship hulls.

In addition to the surface of the skin, scientists said the development may allow electronics to be safely used inside the body and may eventually allow for neural devices or other uses in the brain because of similarities between the hydrogel and brain tissue.

"Electronics are usually hard and dry, but the human body is soft and wet," said Xuanhe Zhao, an associate professor at MIT's Department of Mechanical Engineering, in a press release. "These two systems have drastically different properties. If you want to put electronics in close contact with the human body for applications such as healthcare monitoring and drug delivery, it is highly desirable to make the electronic devices soft and stretchable to fit the environment of the human body. That's the motivation for stretchable hydrogel electronics."

In the study published in Advanced Materials, MIT scientists show how they began exploring the potential of the new hydrogel by encapsulat-ing a titanium wire in it to test its ability to con-duct electricity, which maintained conductivity even while being stretched repeatedly. An array of LED lights also was embedded in hydrogel and, when attached to the body, including while being stretched and deformed around areas like the knee and elbow, the lights continued to work.

Combining the concepts, the scientists put electronic components into a sheet of hydrogel to create a wound dressing with regularly spaced temperature sensors and drug reservoirs, and pathways that allow medications to flow through the dressing. When the dressing was placed on skin, it successfully monitored temperature and released drugs based on its readings.

In addition to uses for burn patients or other skin conditions, Zhao said the hydrogel could eventually allow for electronics to be used inside the body to monitor glucose, or potentially could be used as neural probes.

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PRoduCTs & sERviCEsis — or should be — totally different. In a ware-house you should never place any two like items beside, above or below each other [because] this is a miss-pick waiting to happen.”

Like Van Vlerah, Switzer favors the use of a warehouse management system, which would track item location, proper stock rotation, lot numbers, expiration dates, receiving, shipping, routing personnel and even which size totes to take for an order, he indicated. This system also will enable managing inventory in multiple lo-cations within the warehouse — both dynamic and fixed — as well as handle cycle counts for a consistent, accurate inventory and allow you to measure the various [key performance indica-tors] to verify how well your systems and your people are doing, he added.

Warehouse management systems can help even the newest employees and intermittent personnel identify picking locations for fulfilling order selections and putting away stock, ac-cording to Jim Dickow, President, Dickow Consulting Group LLC, Milwaukee.

“Most warehouse management systems have some sort of system to rearrange the ‘picking ticket’ in the order most efficient for picking and/or packing,” he continued. “This would increase the pace and accuracy of the fulfillment process.”

A WMS also enables employee accountability and responsibility, Dickow insisted, “keeping track of who is filling a particular order, how much time it takes and how the performance compares to standards of operational practice,” he added.

“Inventory management begins with accurate tracking of original incoming inventory for use in manufacturing processes from raw materials, staging [and] kitting, through work-in-process to shipment of finished goods,” said Amy Flynn, OR/CS Market Manager, Hanel Storage Systems, Pittsburgh, PA. In fact, [materials resource plan-ning or enterprise resource planning] systems provide management visibility for all in-bound, in-storage and out-bound inventory, she added. “These systems assist in the planning of the manufacturing process to ensure that all needed components are on hand at the time of assembly or manufacturing,” she said. “The [stock-keeping unit] level tracking continues throughout the pro-cess to keep accurate stocking levels, create audit trails of employee interaction with inventory, identify obsolete inventory as well as identify shipping requirements.”

Flynn insisted that a comprehensive integrated system is vital for accurate inventory manage-ment in this age of accountable care, tighter bud-gets, leaner staffing and Six Sigma methodology, but lamented that “far too many hospitals are still utilizing a pen-and-paper system or a standalone software platform for inventory management.”

Switzer favors “wire guidance” in the floors to guide powered equipment, such as forklifts

or pickers. “This keeps your staff from running into the shelves and potentially damaging the shelving, the products, or even their cowork-ers,” he said.

Believe it or not, Supply Chain should design the building’s air conditioning system, too, Swit-zer insisted. “We use a type of system that uses no ductwork and allows you to store goods clear up top without having to worry about tempera-ture differences,” he said. “A typical warehouse with standard air conditioning would have about 100 roof penetrations — which can lead to leaks — and will have air stratification that can lead to a 15 to 20-degree difference from the floor to the ceiling in a warehouse. This is very important for temperature-sensitive items. It also has the ability to filter all of the air and remove all of the dust from the entire building. The only time we have to dust our goods is when we receive them.”

Visibility mattersSelecting the right technology hinges on many variables, according to Nancy Pakieser, Senior Director, Industry Development, TECSYS Inc., so the exercise can be a bit challenging.

“Our partners often work through the ‘people, process, technology’ methodology,” Pakieser said. “Once they have the right staff in place and have identified the workflows and processes needed to support patient care, then we can determine the right technology to put in place. As an example, in some clinical areas, bar-code readers work well, in other clinical ar-eas an RFID-enabled Kanban system is the best solution. In the perioperative setting there may be many technologies in place to support vari-ous aspects of the workflow, such as handheld devices to help build the case carts, 2-bin Kanban in the core, an RFID reader to capture data use in the operating room and then a bar-code reader to restock unused items.”

Technology merely gives supply chain the inventory visibility across the health system it serves, Pakieser noted. “Know-ing what you have and where you have it enables an organiza-tion to be nimble and responsive to fluctuations in care delivery needs and to shift items to areas of greater demand,” she said. “You can then leverage this data to right-size your inventory investment and imple-ment demand-planning practices. By leveraging the data from any mix of technology capture, you can improve your supply chain’s overall performance with definite business payback and better support of care delivery.”

Access to real-time data is critical for decision-making, according to Robert Jones, Director of Logistics, Medline Industries, Mundelein, IL. “At worst, most healthcare supply chains rely on gut feel, and at best, many cumbersome spread-sheets to merge data,” he said. “Forward-think-ing institutions should utilize modern database

strategies and business intelligence software to ensure optimal performance. Having real-time visibility of inventory performance, equipment locations and KPIs will have a significant posi-tive impact on service to clinical partners.”

Supply Chain must be able to visualize its workflow through a system of record for bin locations so that they can maintain a slotting strategy, Jones continued. “This slotting strategy should be evaluated with modern warehouse vi-sualization software, which allows for the ability to test what-if scenarios for warehouse layouts and slotting strategies,” he added.

Scott Nelson, Senior Vice President of Sup-ply Chain, Cardinal Health Inc., Dublin, OH, indicated that simulation tools would contribute here as they would allow Supply Chain “to see the impact of design changes and mitigate any un-foreseen bottlenecks or obstacles before moving any furniture.”

Nelson further recommended velocity/profiling tools as an-other essential element “to determine the opti-mal storage location for each product based on parameters such as velocity, size, and proximity to the outbound area.”

Velocity mattersGaining access to inventory velocity data can facilitate planning and forecasting, according to John Freund, CEO, Jump Technologies Inc., Eagan, MN, but hospitals tend to struggle with it.

Distributors and suppliers build this data by using technology such as carousel systems that organize, store and provide access to huge amounts of inventory, Freund indicated. “Be-cause these systems are extremely sophisticated, they not only learn the best way to organize the inventory, they also track every item requisi-tioned and over time, build accurate velocity data that supports the replenishment and on-going fulfillment processes,” he said. “As the system assimilates more data, it can reorganize the location of supplies for efficiency, set new reordering information based on actual velocity over time, and make recommendations to assist with planning.”

Historically, hospitals have found managing inventory velocity, or item-level usage data, dif-ficult to achieve and maintain for three reasons, Freund observed.

“First, there may not be a way to centralize consumption data for every item in each area of the hospital or health system,” he noted. “Second, hospitals must overcome the challenge of unit of measure, with some areas or sys-tems storing item data as ‘eaches’ and others reporting ‘boxes’ and ‘cases.’ Finally, reporting tools ac-cessible to the hospital may not be able to aggregate item usage data across multiple systems.”

As a result, hospitals rely on PAR replenish-ment, which involves “a technician visually as-

Jim Dickow

Nancy Pakieser

John Freund

Scott Nelson



PRODUCTS & SERVICESsessing items in a storage location to determine what needs to be replenished, using existing PAR levels to trigger a reorder rather than true velocity data,” Freund continued. “This method can become highly inaccurate over time, as a tech reports a number to trigger a reorder simply because some items look low and they don’t want to stockout.”

A lack of systems in place can hinder prog-ress, according to Kevin Hartler, Senior Direc-tor, Services & Solutions Development, W.W. Grainger Inc., Lake Forest, IL, which specializes in industrial supplies, MRO (maintenance, repair and operations) equipment, tools and materials used in environmental services and facilities management.

“The increase of slow-moving and inactive inventory is a uni-versal problem often caused by a desire to improve service levels,” Hartler said. “Items are added to inventory based on an assumption that if a part is needed today, odds are it will be needed again in the future, and therefore should be stocked for future needs. However, Grainger Consulting Services research has shown the majority of MRO items purchased by an organization meet infrequent needs that are unlikely to repeat. Many organiza-tions accumulate substantial inactive inventory as a result of mistaking infrequent, unplanned needs as the start of a repetitive need.”

Hartler noted that Grainger’s baseline analysis of more than 100 organizations across various industries — including healthcare, food and beverage, manufacturing and aerospace — found the following:• On average, an organization’s MRO inventory

turns one time annually• 50 percent or more of a typical organization’s

MRO inventory is “inactive,” having no issu-ances during the previous 12 months

• Average turns on MRO items only increases to 2.5 times annually after excluding “inactive” inventory

These fi ndings suggest MRO inventory provides a considerable opportunity for process im-provement, cost reduction, waste elimination and increased value, Hartler added.RFID should play a key role as it can “signal

when inventory levels are low or depleted, prod-uct hasn’t been ordered, and to help optimize replenishment cycles to right-size bin locations,” Cardinal’s Nelson noted.

Although RFID technology may not be economical for every item in a hospital supply chain, Medline’s Jones acknowledged, a smart implementation can reduce replenishment ac-tivity and improve performance by providing visibility to inventory and equipment locations, which is critical in a hospital setting.

Flynn recognized that healthcare orga-nizations, by and large, have been slow to use automated inventory systems. “While robotic surgical devices have gained wide-

spread use, hospitals have not embraced op-portunities to utilize automation to assist in daily inventory handling environments,” she said. “Early adopters, however, are realizing the signifi cant cost-reduction opportunities available to them.”

Flynn cited sterile processing departments at “several dozen” U.S. hospitals are using high-density storage in automated vertical carousels to manage sterile instruments, implants, soft goods and a variety of other stored inventory in the SPD and the OR, reducing the depart-mental footprint by 60 percent to 80 percent, and avoiding the need for costly renovations or construction projects to accommodate additional demand and volume.

“These systems utilize on-board inventory management control systems to track all inven-tory and then quickly bring the item to the SPD technician, rather than the technician traveling all over the SPD or OR to locate a tray of sterile instruments, while also delivering the items to the end user at an ergonomically correct height,” she noted.

Automated inventory management solu-tions that include an analytics platform and effi cient tracking mechanisms can reduce costs and increase effi ciencies by tracking location and usage, according to Jean-Claude Saghbini, General Manager of Inventory Management

Solutions, Cardinal Health Inc. “The solution ‘learns’ optimum inventory levels to eliminate over/under-stocking,” he added. “It also can provide an early alert to expiring products, offer an ability to easily scan and marry to patient records for appropriate charge capture, eliminate tedious and error-prone manual cycle counting and reduce clinician time spent on supply chain tasks so they can focus on patient care.”

Even as the industry migrates toward centralized inventory management within organiza-tions, however, Flynn sees value in the opposite remaining attractive, too.

“Manufacturers have wrestled with central-ized versus decentralized inventory manage-ment for decades,” she observed. “Where massive distribution centers once managed most of the largest retail and commercial suppliers of goods, today the concept of placing inventory near where it will be needed is more desirable. This storage decision, however, requires careful planning and implementation of tools to assist with inventory management.” HPN

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PEoPLE & oPinionsCan patient satisfaction be purchased via PO?Not if you focus on personal caregiving and process efficiencyby Elizabeth Morgan, R.N.

WOrth rePeating

i worked with a Vice President of Supply Chain of a large integrated delivery net-work who used to tell his value analysis

team, “Do you want stuff or staff?”This question has always resonated with

me, particularly when the conversation con-tinues to revolve around “stuff.” As a nurse, patient satisfaction was the most frustrating quality initiative to tackle. Catheter-associ-ated urinary tract infection (CAUTI) was a tangible goal I knew we could improve.

Patient satisfaction is purely subjective, not a tangible medical practice I could simply measure. As a value analysis pro-fessional I better understand the financial implications of improving these satisfac-tion scores, but I still struggle with how to get at the problem. The more I think about “products to boost patient satisfaction” I can’t help but wonder if products are really the answer to patient satisfaction? Do we really need more ... stuff?

According to a report published by Healthgrades, a leading online resource for physician and hospital information, “the personal impact of caregiving — like re-sponsiveness to needs, communication and pain control — is what is most important to patients.”1 The personal impact of caregiv-ing. I wonder where products fall into this impact. As a bedside nurse I spent most of my time in the ER, and I also spent a num-ber of years in the cardiac step-down unit. I saw very different aspects of “personal caregiving” as the patients on these two units had very different needs. However, looking back at both of those experiences, I can see how Healthgrades came up with their conclusion. Whether you are in a loud, crazy emergency department with people yelling and ambulances running in and out, or a quiet cardiac unit where the most noise comes from the constant beep of heart monitors, when a patient feels they are at-tended to, they will be satisfied.

Knowing that the personal impact is most important to patients, why are we looking to products to boost patient satis-faction? Rather, we should be asking how we can help nursing staff provide the “per-sonal impact of caregiving.” Do “products that boost patient satisfaction” really exist? I propose that we focus on processes to boost patient satisfaction instead.

When a patient receives a Hospital Con-sumer Assessment of Healthcare Provid-ers and Systems (HCAHPS) questionnaire they are asked about communication from physicians and nurses, timely pain control, understanding their care and hospital cleanliness. You won’t find a question about products, so why are we focusing so heavily on them?

Processes and practice is where the differ-ence is made for patients — not products. Yes, getting a nice-smelling name-brand lo-tion, a hospital-branded water pitcher and a single-brewed cup of coffee are nice, but if brewing me coffee is taking away the time you have to spend explaining my post-op care, you can keep it.

Yet, I have asked supply chain teams about these exact products and have been told it’s to “boost patient satisfaction.” You may as well be telling me “because I said so.” When we continue to provide and introduce new, fancy products in the name of patient satisfaction, we lose focus on what will really improve those HCSPHS scores — personal caregiving.

Supply chain powersConsider the bath-in-a-bag product. This item is advertised as a waterless bathing product to increase nursing and patient satisfaction, decrease nursing time and prevent nosocomial infections. Let’s think about this for a minute. Didn’t we just see evidence showing patients really respond to “the personal impact of caregiving?”

“We consistently hear that reliability and ease of use are the two most significant considerations. Down time is costly, in many ways, so a reliable washer makes a huge difference in the activities of the SPD and the Or. With the almost universal acceptance of electronics such as smartphones, and their intuitive use, users expect an easy to use washer — select the cycle and go.”

John Nies, Product Manager, Belimed

“as the only class of hais not declining over the last few years, CaUtis are the greatest hai challenge to healthcare providers today.”

Steve Woody, CEO, Avadim Technologies

“i’ve spoken with members of execu-tive leadership teams who say they really don’t have the time to talk about safe patient handling right now; ‘i really have to bring the costs of the registered staff down at my hospital.’ i said well then we’re talking safe patient handling. We talk about the cost of the program but we don’t talk about the cost of not having a pro-gram. For example, what are the costs of hospital-acquired pressure ulcers? We know that it’s just more than cost of liability and claims.”

Susan Gallagher, PhD, RN, board member of the Association of Safe

Patient Handling Professionals

“at the core, a hospital is a business that specializes in healthcare, but it does not preclude us from the many disciplines of running a business [that include] human resources, Finance, Facility Maintenance ... and the list goes on to include Supply Chain/Ma-terials Management.”

Donna Van Vlerah, Vice President of Supply Chain, Parkview Health, Fort Wayne, IN

“an obvious interest is our supply spend, which has traditionally exceed-ed 20 percent of total expense and now trending down. (We’re currently at 18 percent and targeting 16 percent within the next 18 months.) More importantly, supplies and services, as well as procurement and distribution processes, have a direct impact on quality and satisfaction.”

John Finan Jr., President & CEO, Franciscan Missionaries of Our Lady Health System

(FMOL), Baton Rouge, LA

1601-PnP-Blue-Point.indd 36 12/14/2015 1:38:02 PM


PEoPLE & oPinionsNosocomial infections acquired

from a bath are not from the type of cleanser being used. They are a result of re-infecting the patients with their own germs through incorrect bathing processes. Decreas-ing the nurse’s time with the pa-tient by giving a quick wipe down with pre-moistened cloths isn’t exactly providing personal nurs-ing care. Nurses want to spend time with their patients; they just aren’t given the opportunity in their busy day. Taking the time to give the patient a full, proper bed-bath allows the nurse to perform a head-to-toe assessment, talk to the patient, explain their plan of care, and collect the social and emotional information that is so important but easily overlooked. Communication happens during this time and that is what is mea-sured on the HCAHPS survey — not the type of bath you received.

There are even more potential downsides to this bath-in-a-bag, as well. Patients that would oth-erwise have gotten out of bed to bathe can now stay in bed and wipe themselves down instead. Sounds great, right? Except am-bulation and independence are important factors necessary for discharge. The patient walks less and his muscles weaken. He takes fewer deep breaths causing the lower airways to close and increasing his risk for pneumonia. All of a sudden you have a patient who can no longer ambulate as well, and has a potential for hospital-acquired pneumonia — affecting two other quality measures you would not necessarily relate to the bath-in-a-bag.

I left my bedside nursing career three years ago, opting for a change in scenery and perspective, and found myself on the supply chain and value analysis side of healthcare. From this viewpoint, I see what hospitals are purchasing in the name of boosting patient satisfaction, and more importantly, the value or lack thereof, of these purchases. I see hospitals spending $100,000 annually on these bath-in-a-bag products, but I am sorry to say patient satisfaction cannot be purchased on a purchase order. What a PO could do is replace that bath-in-a-bag with a lower-cost bathing product that can be used multiple times by the same patient and provide the waterless functionality for half the cost. Take the extra $50,000 and add a full-time eqiuivalent. Provide the nurse

with increased personnel to assist him or assign him one less patient so he can provide “personal caregiving.” Let’s use our supply chain powers to find the functionality in the newest products and see what else is out there offering the same function — without the bells and whistles and extra cost.

Beware the freebie geebiesWe should also remember the hidden costs of some of these new products. Admit it, we all like fancy freebies, and we want as many of them as we can get, whether we need them or not. I experienced this impulse first-hand when giving birth to my children. Per the advice of my nurse, I emptied the drawer full of the brand-name diapers daily so it would be continuously refilled.

By the end of my two day post-partum stay I had an entire case of free diapers at my house waiting for me. Turns out, my nine-pound baby boy only fit into the newborn diapers for two weeks, so I didn’t even use all of the diapers I hoarded. Would I have hoarded the generic brand? Probably not. How many bottles of the nice-smelling brand-name lotion do you think I asked

for? And I “lost” my water pitcher at least twice. Those bath-in-a-bag products provide so much convenience that when a patient needs their hands washed after dinner, guess what is being used — an eight-pack of pre-moistened washcloths. The overall theme be-ing that you are not only paying a few dollars and cents more for the bath-in-a-bag, a name-brand dia-per, or a fancy lotion, you will also be using more of them unnecessar-ily because the patients inherently want more of them, and the nurses are striving for better satisfaction scores, throwing anything they can at the issue. Not only have line-item costs increased, but the overall utilization of the product has skyrocketed as well, all the while providing little-to-no value to the patient or your HCAHPS scores.

In contrast, hourly rounding has become a standard of practice in hospitals today, requiring every patient to be checked on by staff at least once per hour. Research shows that hourly rounding leads to 52 percent reduction in falls, 37 percent decrease in call light use, and a 12 percent increase in patient satisfaction scores.2 Hourly

rounding substantially increased patient satisfaction in all of the Press Ganey and HCAHPS subscales.

Changing the personal impact of caregiv-ing has nothing to do with products, but has proven value. I challenge hospitals that are looking for “products to boost patient satisfaction” to stop and consider that the biggest factor in patient satisfaction is the “impact of personal caregiving.” Let’s look for ways to foster practices that provide the personal touch and instead of relying on products, find processes to boost patient satisfaction. HPn

1. “Healthgrades Announces 2014 Outstanding Patient Experience Award Recipients.” Healthgrades Announces 2014 Outstand-ing Patient Experience Award Recipients. Business Wire, 8 Apr. 2014. Web. 08 Sept. 2015. <http://www.businesswire.com/news/home/20140408005590/en/Healthgrades-Announces-2014-Outstanding-Patient-Experience-Award%E2%84%A2#.VhaonE2FMdX>.

2. Meade, Christine M. et al. “Effects on Nursing Rounds on Patients’ Call Light Use, Satisfaction, and Safety.” American Journal of Nursing, September 2006. 106 (9): 60.

Elizabeth Morgan, R.N., serves as Director of Clinical Utiliza-tion at Blue.Point.LLC.

1601-PnP-Blue-Point.indd 37 12/14/2015 1:38:03 PM


STANDARD PRACTICES

Making “systems thinking” standard practice by Karen Conway, Executive Director, Industry Relations, GHX

SUBMIT YOUR QUESTIONSemail: [email protected]: (941) 927-9345 ext. 202

As we begin a new year, I would like to take this opportunity to broaden the content that is presented each

month in Standard Practices. To date, the monthly column has focused on the adop-tion of global data standards for product, location and organization identifi cation. We will continue to cover these topics, especially with growing adoption of unique device identifi ers (UDIs) and a renewed interest in the value of global location numbers as one of the tools needed to reduce the complexity of contract administration. At the same time, I would like to think about standards and standard practices in the context of the larger healthcare system and efforts to improve the quality and lower the cost of care. I am a strong believer in applying more “systems thinking” in healthcare — in fact, it’s a primary reason I am back in graduate school studying the Science of Healthcare Delivery. As systems thinkers, it’s important to consider how the adoption of standards — for both data and processes — infl u-ences other aspects of the larger healthcare system and vice versa. Systems thinking is fundamental to creating a learning healthcare system that captures and shares accurate data and insights across boundaries (e.g., functional, professional, organizational, etc.) to understand what drives better and more cost effective healthcare.

The Institute of Medicine (IOM) developed the concept of a learning healthcare system in 2007 in response to earlier studies, including the 1999 To Err is Human report, which reported that an alarming number of patients were being harmed, rather than helped, by the U.S. health-care system as a result of preventable medical errors. The To Err is Human report was also the impetus for U.S. Food and Drug Administration (FDA) regulations requiring standards-based auto identifi cation carriers, e.g., barcodes, on the labels of pharmaceuticals and medical devices. The ability to capture data on the drugs and devices used in patient care is an important factor in the effort to establish a body of evidence on their real world performance, which can then be shared as part of a learning healthcare system. A 2012 IOM report, entitled Better Care at Lower Cost, highlighted the fact that there remains very little evidence for many of the care decisions made today. A learning healthcare system is designed to correct that.

While medical errors remain a serious problem, a report re-cently issued by the Agency for Healthcare Research and Quality found that there were 2.1 million fewer hospital-acquired condi-tions (HACs) between 2010 and 2014. That’s a 17 percent decline

resulting in nearly $20 billion in savings. Forty percent of the reductions were in adverse drug events, followed by a 28 percent reduction in pressure ulcers and 16 percent for catheter-associated urinary tract infections (CAUTI). Less frequent but

often more serious central line associated blood stream infections (CLABSI) dropped more than 70 percent.

Government offi cials could not point to the exact causal factors for the improvements, but they credit payment reforms that no longer reimburse hospitals for HACs and increased use of electronic health records (EHRs). Personally, I believe the former is probably the primary catalyst, but if we are to create a true learning system, we will need to document the specifi c steps taken by hospitals to reduce adverse events along with the results. I have high hopes that EHRs will help us achieve this but not until there is more interoperability and better clinical supply documentation. I am only surmising, but could the much larger drop in adverse drug events be related to the longer standing pharmaceutical barcode rule and meaningful use requirements related to capture of data on medications in EHRs? If so, then we should watch to see if in-creased adoption of UDIs supports improvements in adverse events

involving medical devices. That’s where standardization of data makes a difference. Standardization of process

is also critically important. Ideally, EHRs will be able to tell us how and when changes in clinical

practice contribute to better results. On a fi nal note, I would be remiss not to

mention the work being documented by the Association for Healthcare Resource and Materials Management (AHRMM) through its Cost-Quality-Outcomes (CQO) Move-ment. On the AHRMM website, you can fi nd

a number of leading practices and case stud-ies around the role of supply chain in reducing

CAUTIs, pressure ulcers and central-line associated bloodstream infections (CLABSI). In several of these

studies, the providers involved increased expenditures on supply bundles, which helped contribute to lower

infection rates and in turn a better patient experience and lower costs. If we can document these kinds of detailed studies in suffi cient volume, we can begin to compile the evidence needed to support continual learning and, most

importantly, changes in process, product and practice that will deliver a better healthcare system. Those are the kinds of topics I look forward to exploring with you in future editions of Standard Practices. If you have ideas for topics, I would like to hear from you. HPN

1601-SP.indd 38 12/10/2015 1:05:37 PM

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CLINICAL INTELLIGENCE FOR SUPPLY CHAIN LEADERSHIP

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3M Infection Prevention...........................BC 13 go.3m.com/endoscope

Avadim Technologies (Theraworx) ........... 21 14 www.theraworx.com

B Braun Interventional Systems ................ 17 1 www.bisusa.org

Contec Inc. .............................................. 25 2 www.contechealthcare.com

Exergen Corp .....................................COVER 3 www.exergen.com

Hanel Storage Systems ............................. 35 19 www.sterilestorage.com

Healthmark Industries ............................. IBC 6 www.crazy4clean.com

HealthTrust Purchasing Group .................... 9 11 www.healthtrustpg.com

Hovertech International ........................... 15 4 www.hovermatt.com

MHI ......................................................... 33 5 www.modexshow.com

Multisorb Technologies .............................. 5 15 www.multisorb.com

Olympus America ...................................... 3 7 preowned.olympusamerica.com

Parker Labs Inc. .......................................... 8 12 www.parkerlabs.com/a100singleuse

PDI .......................................................... 19 20 www.pdihc.com/everywhere

ROi .......................................................... 13 16 www.roiscs.com/joinus

Ruhof Corporation ..................................... 1 9 www.ruhof.com

Ruhof Corporation .................................. IFC 8 www.ruhof.com

Steelco ..................................................... 23 17 www.steelcospa.com

TECSYS Inc. ............................................... 7 10 www.tecsys.com

Winco Mfg. LLC (Transmotion Medical) ... 15 18 www.transmotionmedical.com

ADVERTISER INDEXAdvertiser Page RS# Web

Entries will be judged on elements in the following fi ve areas: Customer Service, Productivity, Teamwork, Education and Training, Strategic Outlook

For the nomination, highlight specifi c, measurable achievements and goals over the past year. Please also include department name, telephone number, number of full-time equivalents,

scope of responsibilities, and number of beds at the facility.

For your nomination to qualify, please be sure to comply with the fol-lowing rules:

1 – Any nomination must be original and exclusive to HPN and not have been submitted — either original or edited — to any other pub-lication or online media outlet currently or within the previous year.

2 – GPO, distributor, manufacturer, software company and con-sultant support is commendable, but we’re looking for internally driven details beyond those contributions.

3 – Any nominated organization must be willing to share infor-mation regarding surgical volumes and annual performance and

production details including number of instruments processed.

Submit your nomination to [email protected]

by Friday, March 4, 2016.

Get full nomination details at www.hpnonline.com/

Nominate/CSDOY.html

Nominate your team for HPN's next CS/SPD Department of the Year award

1601-Index.indd 39 12/14/2015 1:17:12 PM


BACK TALKMaximize your GPO relationship as landscape shiftsby David S. Kaczmarek

Almost every healthcare organization belongs to a group purchasing orga-nization (GPO). In fact, 96 percent

of all acute-care hospitals and 98 percent of all community hospitals hold at least one GPO membership, according to the Health-care Supply Chain Association (HSCA), a trade association that represents 16 GPOs. Further, more than 600 organizations in the United States participate in some form of group purchasing, HSCA reported.

The GPO landscape has changed sig-nifi cantly over the years. This started with formation of three large groups (including VHA, Premier, AmeriNet) in the late 1970s-early 1980s, continued as the market added alternative models (such as Tenet-driven Broadlane, HCA-driven HealthTrust, and MedAssets) at the end of the 1990s, and again in the last decade with the reemer-gence of smaller, more regional groups. Some organizations have even become their own GPOs. Most recently, we have seen three more major changes: Amerinet was acquired by its largest owner (Intermoun-tain Healthcare), VHA and UHC merged (now called Vizient), and MedAssets has decided to leave the fi eld by selling its GPO business to Vizient. If there is one constant evident it is that change will continue.

Where do these moves leave today’s healthcare organizations? In one sense, little has changed. An organization’s GPO should continue to be a resource, which is why it needs to maximize the effectiveness of the GPO relationship.

Belonging to a GPO is not the same as using that resource effectively and getting everything you can from it. There are four things to look for in the relationship and how to maximize it.• The fi nancial deal. Most GPOs receive an

administrative fee from suppliers based on the amount of purchasing volume fl owing through the contract. The per-centage varies from contract to contract, and the overall percentage varies from GPO to GPO. Most GPOs return a portion

of this to its members. This is called the “share back.” The amount of share back that members get is different between GPOs and is often different between members in the same GPO. Those GPOs that offer lower share back percentages contend that members get additional value through lower contract prices or other benefi ts. At minimum a healthcare provider organization should be receiv-ing a share back that is consistent with other similar members.

• The contracts and how you use them.The raison d’etre for the existence of GPOs is to provide its members pricing for goods and services that is better than pricing those members can get on their own. This is based largely on aggrega-tion of purchasing volume. But many members fi nd that they are able to beat the GPO price. This is often due to their ability to standardize and commit. Some organizations have addressed this short-fall by creating “mini-GPOs” that are still part of the national GPO but generate bet-ter pricing based on commitment. Other organizations individually renegotiate numerous GPO contracts to secure better pricing for their individual organization. If you are in a situation where you feel the need to renegotiate all the contracts you might question whether the GPO is the right one for you. Further, you should evaluate the benefi t you are gaining vs. the resources you are using.

• The resources that the GPO should be providing to help you. Every GPO should support you, as its member, in maximizing the value of their portfolio and assisting you with any issues you have in accessing the contracts. For larger organizations this can include regular, even full-time, on-site resources. Are you getting the support you need?

• Ancillary resources beyond the contract-ing. The major GPOs have all expanded their portfolio of offerings to include many useful technology products. These

include everything from price bench-marking to cost-per-case determination to quality indicators. Some of these are automatically included with membership but many others are provided to some, but not all members without cost. Organizations that have maximized their

relationship with their GPO are comfort-able that their fi nancial return is market competitive, use their GPO contracts as much as possible and/or belong to a sub-group that adds additional value through commitment, get all the support they need to maximize the contract portfolio, and get the technology offered by the GPO at little or no cost.

Organizations that are not currently max-imizing the relationship should consider their options. Certainly one option, and the most obvious, is to meet with the leadership from your current GPO to discuss your participation and relationship. Let them know your concerns and see how they will address them. Another option is to test the market to see if there is a different GPO that would better allow you to maximize the relationship. For larger organizations, perhaps it is time to consider establishing yourself as a GPO. This is a significant undertaking with many risks. But others have weighed the risks and embarked on this course.

Remember that you are the GPO’s customer and you should be treated as a customer. If you are not getting every-thing you should from your GPO, take steps to see that you do. It is a valuable and important resource that should not be squandered. HPN

David S. Kaczmarek, FAHRMM, CMRP, is a senior director at Chicago-based Huron Healthcare. Kaczmarek has more than 40 years of experience in healthcare administration and supply chain, including director positions at several hospitals and systems. He can be reached via email at [email protected].

1601-BackTalk-DK.indd 40 12/10/2015 1:06:32 PM

CRAZY FOR CLEAN, THAT IS!We‛re like you, crazy for clean. We all know if an instrument is not clean it‛s not sterile. And when it comes to surgical instruments used in the vasculature, blood is the greatest challenge to cleaning.

So when we designed a challenge test for cleaning, we modelled our test on the number one soil you are trying to clean: blood from stainless steel instruments.

The TOSI is dried blood soil on a stainless steel coupon. It is just like dried blood on a stainless

steel surgical instrument. We mount the plate in a plastic holder with a graduated

gap. This is just like the areas on a surgical instrument which are blocked from direct spray action, such as the box locks.

The TOSI aligns perfectly with Be in the Know: HealthmarketDigest.com

BLOOD SOIL ON A STEEL PLATE?THAT’S CRAZY!

FDA, AAMI, AORN and other regulatory recommendations for a surrogate testing device: utilize the same kind of soil on the same type of surface and with the same kind of physical challenge as the instrument itself when reprocessed.

Are you crazy for clean? Join us at CRAZY4CLEAN.com. There you can share your experiences with thousands of colleagues and learn more about the science behind the TOSI.

HPN-2016-01.indd 1 11/13/2015 5:29:57 PM


1601-Healthmark.indd 41 12/10/2015 12:53:35 PM

3M, Clean-Trace and Steri-Vac are trademarks of 3M Company, used under license in Canada. © 2015 3M. All Rights Reserved.

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New challenges in endoscope reprocessing require new approaches. Protecting patients from potentially fatal infections requires a higher standard of care.

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It’s time to make every endoscope safe for every patient. Find out how at go.3m.com/endoscope.

3M™ Clean-Trace™ ATP Monitoring System3M™ Steri-Vac™ Sterilizer/Aerator GS Series

1601-3M.indd 42 12/10/2015 12:54:20 PM