HEPA Filtered CLEAN AIR

Potential Airborne Contamination

HEPA Filtered CLEAN AIR

Containment Zone

web wwwhoworthgroupcomemail infohoworthgroupcom

HCAI containment in just 24 hoursBioGenTM 10-6 biological decontamination in less than 4 hours

BioSphereTM from Howorth Air Technology

August 2014 Issue No 287 ISSN 1747-728XThe Leading Independent Journal For ALL Operating Theatre Staff

2 THE OPERATING THEATRE JOURNAL wwwotjonlinecom

BIOSPHEREtrade - HCAI CONTAINMENT IN JUST 24 HOURSHoworth Air Technology is famous for its Exfl owtrade ultra clean ventilation canopy which has now featured in over 3500 installations worldwide Th e company has recently added a relocatable permanent or semi permanent ldquoisolation roomrdquo to its portfolio of products - BioSpheretrade With BioSpheretrade hospitals can safely contain HCAI (Healthcare Associated Infections) and provide absolute biological decontamination in just 24 hours

A BioSpheretrade unit can be erected around a single bed quickly and easily and requires no remedial works to any existing services ensuring minimal facility downtime A ward can have a single unit or as many as needed BioSpheretrade creates an individually contained and managed mini-environment around each patient care zone which operates under a negative airfl ow system designed to contain pathogens and potential sources of HCAI

BioSpheretrade delivers HEPA fi ltered air into the patient care zone to reduce the risk of airborne contamination Th e air that is recirculated into the general surrounding area is fully conditioned with all particulates removed by 99995 to 03μ (H14) and further fi ltered using advanced activated carbon to remove any odours or chemical contaminants Th is means the air that exits the BioSpheretrade unit is purer than the standard air in the ward so it also has a positive eff ect on the surrounding environment

Th e BioSpheretrade patient protection zone can be fully decontaminated via three standard options each using Howorthrsquos unique Dry Vaporised Hydrogen Peroxidetrade (DVHPtrade) biological decontamination system (10-6 reduction) Integrated BioGentrade BioGentrade A (a portable DVHPtrade system) or by Howorthrsquos dedicated site services team that can be quickly deployed to take care of everything on the hospitalrsquos behalf When a patient arrives in BioSphere they can be confi dent that cross-contamination and HCAI reduction is a priority in the hospital where they will receive their treatment BioSphere is an unobtrusive addition to the ward and provides a positive private and reassuring environment that promotes well-being and encourages healing

Each BioSpheretrade unit is fully stand-alone and requires no installation to any other HVAC or remedial works to any existing services It is designed to allow retrospective installation to any facilities from HDU to general Nightingale wards and is custom fabricated using the very latest CNC technology with accuracy to 05mm

Benefi ts of BioSpheretrade

bull HCAI containment in just 24 hoursbull Cost-eff ective isolation containment HCAIinfection management and

decontaminationbull Available as a single unit or as many as requiredbull Combines the visibility of a ward with the containment and privacy of a

single roombull Minimal disruption and all work carried out by Howorth engineersbull Ultra-low power consumption with no power upgrades requiredbull Intuitive airfl ow management system requiring minimum user inputbull Lighting system fully compliant to all healthcare standards with

3 programmable operational models and touch controlsbull No special training required ndash BioSpheretrade is simple and easy to operatebull Fully customisablebull Each installation is fully tested and compliant with COSHH regulations

For more information contact Darren Hughes on 07772 894196 DarrenHugheshoworthgroupcom or infohoworthgroupcom

When responding to articles please quote lsquoOTJrsquo

Bioquell bio-decontamination equipment featured on BBC News WalesSuperbugs - like persistent C diffi cile and MRSA - threaten hospitals all around the UK where infection control is a high priority area Many hospitals have introduced C diffi cile reduction targets or have had these mandated by government bodies or regulators When it comes to eliminating doubt hospitals need effi cient secure and time-saving solutions to protect patients from infection risks Th e challenge of infection control and successful outbreak management is one that the Bioquell team have chosen to take onAfter Betsi Cadwaladr Trust failed to control Clostridium diffi cile (C diff ) at Glan Clwyd hospital in Bodelwyddan and had to apologise for it in 2013 the trust set up a structured cleaning plan involving Bioquellrsquos bio-decontamination equipment Th ree of the trustrsquos main hospitals based in Wrexham Bodelwyddan and Bangor are now equiped with Bioquell Q-10s or lsquorobot cleanersrsquo to deep-clean their wards and reduce infections caused by pathogensAccording to Prof Brian Duerden emeritus professor of medical microbiology at Cardiff University therersquos been ldquosignifi cant progressrdquo in the past year but therersquos still more to be done Healthcare associated infections (HCAIs) are ldquostill too highrdquo in North Wales ldquocompared with elsewhere in Wales and comparators in Englandrdquo Th e targets set by the Welsh government to reduce HCAIs are still to be reached and represent a ldquovery signifi cant challengerdquoTh e Bioquell Q-10 relies on hydrogen peroxide vapour (HPV) to eradicate bugs within an enclosure including hopstial wards or rooms Th is technology assures complete eradication of a large range of bacteria viruses and fungi such as C diff or MRSA on all surfaces Using a simple process HPV is vaporised and delivered into a room to deactivate micro-organisms Th e process leaves no residue and no waiting period to use the room after the cleaning process Bioquellrsquos HPV process is eco-friendly safe and repeatable for the sterilisation of rooms buildings equipment and sensitive electronics Effi cacy is backed up through scientifi c publications plus use of Geobacillus stearothermophilus biological indicators guaranteeing 6-log reduction Chemical indicators ndash CIs ndash allow immediate visual confi rmation of cycle success Source BBC News Wales - Robot cleaners used cut hospital infection in north Wales ndash 29072014 - httpwwwbbccouknewsuk-wales-28530906

Find out more 02921 680068 bull e-mail adminlawrandcom Issue 287 August 2014 3

The next issue copy deadline Tuesday 26th August 2014All enquiries To the editorial team The OTJ Lawrand Ltd PO Box 51 Pontyclun CF72 9YY Tel 02921 680068 Email adminlawrandcom Website wwwlawrandcomThe Operating Theatre Journal is published twelve times per year Available in electronic format from the website wwwotjonlinecomand in hard copy to hospitals throughout the United Kingdom Personal copies are available by nominal subscriptionNeither the Editor or Directors of Lawrand Ltd are in any way responsible for the statements made or views expressed by the contributors All communications in respect of advertising quotations obtaining a rate card and supplying all editorial communications and pictures to the Editor at the PO Box address above No part of this journal may be reproduced without prior permission from Lawrand Ltd copy 2014

Operating Theatre Journal is printed on paper sourced from Forest Stewardship Council (FSC) approved paper mills and is printed with vegetable based inks All paper and ink waste is recycled

Journal Printers The Warwick Printing Co Ltd Caswell Road Leamington Spa Warwickshire CV31 1QD

New Report Lack of NHS Engineers Is Putting Lives at Riskbull Th e low priority given to NHS

engineers is leading to problems caused by faulty medical equipment cancelled operations and poor value for money for taxpayers

bull In 2013 over 13000 incidents were reported to the UK regulator relating to faulty medical equipment which led to over 300 deaths and almost 5000 serious injuries

With the increasing importance and complexity of technology used in hospitals the Institution of Mechanical Engineersrsquo new report Biomedical engineering advancing UK healthcare is calling for urgent action to prioritise the role of engineers in the NHS and introduce a Chief Biomedical Engineer in every NHS acute trust

Boosting the number as well as the infl uence of engineers in the NHS would help cut the number of incidents caused by faulty medical equipment In 2013 13642 incidents related to faulty medical equipment were reported to the Medicines and Healthcare products Regulatory Agency (MHRA) leading to 309 deaths and 4955 people sustaining serious injury Th ese incidents can vary from faulty pace-makers to faulty equipment like CT or MRI scanners used to diagnose patients Th is faulty equipment or the unavailability of it is also one of the major causes of cancelled operations

As the technology used in hospitals becomes increasingly complex the danger of improperly calibrated and validated equipment is also increasing Indeed there are huge implications to the mis-calibration of even basic equipment such as weighing scales - in 2008 a medical devices alert was issued warning of incorrectly calibrated weighing scales which led to a number of patients being given the incorrect dosage of medication Furthermore lsquoequipment failureunavailabilityrsquo is cited as a major reason for cancellation of operations in NHS hospitals

Dr Patrick Finlay lead author of the report and Chairman of the Institution of Mechanical Engineersrsquo Biomedical Engineering Association said ldquoGovernment and the NHS need to take urgent action to prioritise the role engineers play in hospitals and trusts

ldquoTechnology is leading to huge advances in healthcare but this technology is dependent on the work of biomedical engineers who are inadequately recognised and in short supply in most hospitals

ldquoClinicians and engineers need to work in partnership to ensure that advances in medical technology are applied in the best interest of patients Th e benefi ts of hospitals having a designated Chief Biomedical Engineer responsible for healthcare technology are clear

ldquoIt is vital that engineers are at the heart of the planning procurement use and maintenance of high value equipment as well as its calibration It is only with engineers that properly informed choices on these issues can be made in the best interests of patients and taxpayers

ldquoTh is report demonstrates some of the exciting ways engineers can revolutionise healthcare through for example new low invasive treatments to sense measure and manipulate the human body or by developing novel ways of tracking and monitoring personal health through mobile phone apps But in order to reap the full benefi ts that technological advances can off er UK healthcare and the NHS specifi cally the people who design make maintain and use these pieces of equipment need to be heardrdquo

Biomedical engineering advancing UK healthcare features key case studies from UK academia and industry in the areas of regenerative medicine medical imaging and robotics cardiopulmonary engineering orthopaedic implants physiological monitoring m-health and e-health assistive technology rehabilitation and independent living

According to the report the UK is one of the leading countries in academic research in the area of biomedical engineering and has an excellent record in inventing

and researching new medical devices But often the results of this excellent research are then sold to international corporations for development and marketing because of the lack of long-term domestic venture capital Th e development of many technologies and in particular m-health and e-health are also being hampered by a lack of international consensus on standards practices and patents

Th e Institution of Mechanical Engineers therefore makes four key recommendations

1 Every NHS acute trust should have a designated Chief Biomedical Engineer

2 A single dedicated funding programme for biomedical engineering research should be established in UK Research Councils

3 Industrial and taxation policy should promote long-term investment in biomedical engineering to encourage domestic development and manufacturing

4 International consensus should be pursued for global standards a common device regulatory and approvals regime and harmonisation of patent legislation in medical devices Named UK leads should be agreed for these policy roles

NHS staff are too fat says Simon StevensNHS chief executive Simon Stevens says the health service has to ldquoget its own act togetherrdquo on obesity by helping staff lose weight

It could mean less junk food in canteens weight-loss competition cycling facilities and more gym in NHS buildings

Stevens told Th e Sun which claims that more than half of the NHSrsquos 13 million staff are overweight or obese ldquoItrsquos hard for the NHS to talk about how important this is if we donrsquot get our own act together I think the NHS has got to take an example in helping our own staff and hopefully other employers will follow suit

ldquoA lot of the food in hospital canteens not just for patients but for staff is chips and burgers Th e NHS as an employer for our own nurses and other staff could we off er positive incentives Yes I think we could And some hospitals have begun doing thatrdquo

Almost three-quarters of people aged 45 to 74 in England are either overweight or obese Source National Health Executive

EBOLA - AnalysisDoctors have been told to remain vigilant for possible cases of Ebola ldquoimportedrdquo to the UK

Th e medical director of Public Health England said it was ldquounlikely but not impossiblerdquo that travellers infected in West Africa could develop symptoms on their return According to Dr Ben Neuman a virologist at Reading University the chance of the virus spreading in the UK was ldquovery very smallrdquo

He said border staff are already trained to deal with illnesses of this kind and anyone showing signs of fever from an outbreak area would be stopped quarantined and treated in containment facilities if the infection were confi rmed

He said the virus itself is ldquodelicate and ineffi cient - you have to pick it up from bodily fl uidsrdquo But he said it was sensible to be prepared given the situation in West Africa

By Helen Briggs Health Editor BBC News website

4 THE OPERATING THEATRE JOURNAL wwwotjonlinecom

Crash course for students AfPP at 50 product news and so much more

Th eatre Equipment Specialist Anetic Aid has just published the latest edition of its magazine lsquoInside Th eatrersquo

Among the headlines are the AfPP at 50 ndash with a guest article by Chief Executive Dawn Stott in which she looks back at the organisationrsquos history ndash and forward to its plans for the future

Also in the news is East Kent Hospitals University NHS Foundation Trust Always working to minimise manual handling for staff the Trust has recently purchased powered QA4s for day surgery units in three diff erent hospitals

Th ere are also articles about Anetic Aidrsquos own expansion plans the fi rst an update on the move of its maintenance sales and distribution teams from their existing site in Guiseley to a new 15000 sq ft facility at a business park in Baildon West Yorkshire

And secondly therersquos a feature on the newly opened factory extension at their Portsmouth manufacturing facility ndash a development which will enable increased production capacity in the future and has already led to the creation of new jobs

Th e factory is where Anetic Aidrsquos QA3 Patient Trolley System QA4 Day Surgery System and all of its stainless steel furniture range is made Th e casing and stand for the new AT4 Tourniquet System is also designed and built at the two acre site

Th e AT4 is one of the key products featured in lsquoInside Th eatrersquo along with Anetic Aidrsquos recently expanded range of tourniquet cuff s Th ere are regular and special six-use versions available Th e spotlight is also turned on their extensive range of Allen Amatech high quality patient positioning devices

Another item in the magazine is about Birmingham City Universityrsquos simulated lsquoaccidentrsquo event ndash an exercise brilliantly choreographed by the Faculty of Health to give students from diff erent disciplines the opportunity to experience how they will need to work together in their professional lives Anetic Aid supported the role play with the provision of a number of QA3 trolleys

Copies of lsquoInside Th eatrersquo are currently being mailed to hospital departments all over the country so look out for it ndash or if you would like to request a copy please call 01943 878647 or email salesaneticaidcom

Sepsis kills tens of thousands a year but Trusts are recording only one in four casesResearch by the All Party Parliamentary Group on Sepsis reveals an astonishing number of hospital Trusts are not properly recording the killer illness sepsis which kills 37000 people a year in the UK

In England there are at least 112000 cases of severe sepsis and septic shock each year Th is is a fi gure nearly 4 times higher than the total reported by Trusts in response to Freedom of Information requests

Trusts recorded a total of 23368 cases of severe sepsis and 5016 cases of septic shock ndash a total of 28384 (25) of the 112000 total Th ese fi gures come despite the fact that 64 of Trusts reported that they have mechanisms in place for recording both forms of sepsis 43 Trusts admitted to having no mechanisms in place at all

Th e data also reveals that less than a third of Trusts (30) frequently give patients the critical antibiotics for severe sepsis within the fi rst hour of hospital care

Dr Ron Daniels co-author of the report and CEO of the UK Sepsis Trust which provides secretariat to the All Party Parliamentary Group on Sepsis said lsquoTh ere is a pressing need to improve the way sepsis is recognised recorded and reported Sepsis is a frighteningly common condition accountable for as many admissions to hospital as heart attacks Appropriate resources must be available to deliver immediate and ongoing care to patients and relativesrsquo

Sarah Newton MP Chair of the All Party Parliamentary Group on Sepsis said ldquoSepsis is a major killer and the fi rst step to fi ghting it is recording it properly Th ere is huge room for improvement in how Trusts record sepsis and sepsis deathsrdquo

Th e key fi ndings of the report arebull Th ere is a pronounced recording error in hospitals for dealing with Sepsis 64

of Trusts have mechanisms for recording severe sepsis but in 201213 only 260 cases of severe sepsis were recorded on average per Trust nationwide Th is fi gure is signifi cantly lower than international population fi gures and data from UK studies

bull 72 out of 121 Trusts (60) say they audit the time taken for patients to receive antibiotics in the fi rst hour of hospital care but data show that only 36 (30) from 121 Trusts give patients antibiotics for severe sepsis frequently (75 or more) Data from other sources brings this into question

bull Individual Trusts recorded as few as 31 patients to as many as 170 patients diagnosed with septic shock in 201213

bull Th e 17 London Trusts who responded reported an average of 69 cases of septic shock over the 2010 to 2014 period suggesting a total of 1805 cases recorded by all 26 London Trusts Th is is an extremely low fi gure for a population of over 8 million which would imply around 80000 cases ndash 44 times as many - over this four year period

bull Yorkshire and the Humber has the lowest percentage of Trusts regionally with a mechanism for recording Sepsis at 42

bull In the North East only 168 patients were diagnosed with septic shock in the four year period reviewed this number is too low for a population of over 25 million

bull In the North West 5 Trusts have no data at all for the number of patients diagnosed with severe sepsis or septic shock and 8 have no recording mechanism

bull In the South East 14 Trusts do not have Sepsis on the Trusts risk registerbull In the East Midlands half the Trusts who responded 3 lack a mechanism for

recording incidents of severe sepsis and septic shockbull In the South West 71 of Trusts responded to having a mechanism for

recording severe sepsis and septic shockbull West Midlands has the highest percentage of Trusts regionally with a mechanism

for recording severe sepsis and septic shock at 85Does your Trust have a mechanism for recording incidents of severe sepsis and septic shock Yes No YesWest Midlands 11 2 85North East 3 1 75South West 10 4 71Eastern 10 4 71North West 16 8 67London 10 7 59South East 10 7 59East Midlands 3 3 50Yorkshire and the Humber 5 7 42 78 43 64

When responding to articles please quote lsquoOTJrsquo

Procurement atlas shows variations in NHS purchasing

Th e NHS Procurement Atlas of Variation shows diff erences in the amount hospitals pay for everyday items including catheters gloves and needles in a move hoped to improve purchasing costs

Th e new online NHS Procurement Atlas of Variation will help hospitals to compare prices and identify where they need to drive down costs so they can invest in more doctors and nurses to care for patients as well as in frontline care

Health Minister Dr Dan Poulter said ldquoTh e NHS budget has been increased but the reality of an ageing population rising patient demand and more expensive treatments means our NHS needs to spend money wisely in order to direct every penny into frontline patient care

ldquoWe are delivering on our promise to improve the way our NHS buys goods equipment and services to make sure taxpayersrsquo money is spent effi ciently and more money is available to look after patients

ldquoOur new league tables will make the NHS a more open and better place in which to do business for small and medium sized businesses Improving procurement practices is about making sure that money is going where it needs to on patients and not down the drainrdquo

Source Integrated Care Today

Find out more 02921 680068 bull e-mail adminlawrandcom Issue 287 August 2014 5

Fukuda Denshi publish handy pocket guide on their Critical Care range

Fukuda Denshi is a leading supplier of advanced patient monitoring and user-confi gurable clinical information management systems as well as cardiac monitoring and imaging technology Th e company recently published a full colour handy pocket guide on their range of critical care solutions

Th e 16 page critical care guide is a perfect pocket companion to furnish users with comprehensive product information on Fukuda Denshirsquos critical care range including

bull Th e new DS-8200 transportable and powerful 10rdquo touch screen monitor with optional 12-lead ECG analysis

bull Th e new DS-8100 compact lightweight integrated monitor with 10rdquo colour display and touch screen

bull Th e DS-8500 with 15 or 19rdquo display options and modular design for a better fl exible confi guration

bull Th e DS-7700 system with multiple display confi gurations Arrythmia analysis and convenient option for bed-transfer between central station and team nursing

Key product specifi cations including dimensions weight and key features are all provided within the pocket guide along with product images For a copy of Fukuda Denshirsquos Critical Care product guide telephone Fukuda Denshi on 01483 728065

Fukuda Denshi Healthcare bound by technologyFor more information visit wwwfukudacouk

Martindale Th e Complete Drug

Reference 38th EditionDespite the rapidly changing world of pharmaceuticals Martindale continues to be internationallyrecognized as the essential reference for pharmacists in all areas of practice and research To retain this leading position major changes are made to each edition ensuring the resource continues to meet needs of practitioners researchers and academics

Signifi cant updates can be summarized as followsbull Th e pages have been completely

redesigned to make them easier to read

bull Th e layout of the monographs have been restructured giving more space to Uses and Administration

bull New content includes over 200 new monographs

bull Th e coverage of proprietary preparations has been increased to 43 countries and regions including China

bull Th e abstracts on porphyria have been extensively revised

For further information visit httpwwwpharmpresscomproduct9780857111395martindale38

Contact us to organise a trial in your department today

Tel 0117 972 8888 Email salesp3-medicalcomwwwp3medicalcom

Distributed by

The worldrsquos rstUltrasound System

with wirelesstranducers

SIEMENS

P3 Medical

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bulldf

bullmAoc

P r odu c t Gu i de

CRITICAL CARE

20132014

Patient Monitoring System

P r odu

CRITICAL

When responding to articles please quote lsquoOTJrsquo Please quote lsquoOTJrsquo

ASA launches national Perioperative Surgical

Home learning collaborative (USA)

Th e American Society of Anesthesiologistsreg (ASAreg) announced on the 2th July the launch of its ASA Perioperative Surgical Home (PSH) Learning Collaborative a national initiative designed to improve the patient experience before during and after surgery More than 40 leading health care organizations from across the country will participate in the collaborative which will convene for the fi rst time at the ASArsquos PSH Learning Collaborative Launch July 25-26 in Schaumburg IllTh e PSH collaborative participants will create a network where interested organizations can learn from each other and from recognized experts Working together these healthcare facilities will proactively pursue care redesign strategies to enhance the patientrsquos experience of surgical and procedural care improve quality and outcomes and reduce costs Th e long-term goal is to create an evidence-based ldquoroad maprdquo for health care organizations to spread knowledge and best practices of the PSH modelldquoTh e collaborative brings together health care organizations to defi ne develop pilot and evaluate the PSH model to improve care for patients undergoing surgeries or procedures from planning through recovery discharge and beyondrdquo said ASA President Jane CK Fitch MD ldquoFrom academic and non-profi t institutions to hospitals and medical centers we are excited to launch this innovative project with such a diverse group of the nationrsquos top health care organizationsrdquoCurrently preoperative intraoperative postoperative and post-discharge are treated as discrete episodes of care In many instances care is neither integrated nor coordinated between clinical microsystems potentially compromising quality and safety for the patientTh e PSH is a patient-centered multidisciplinary physician-led team-based model of coordinated care that guides the patient throughout the entire surgical or procedural experience With the PSH model the perioperative episode is fully coordinated as one continuum of careUltimately the PSH can improve outcomes and the quality and safety of care enhance the patientrsquos experience and reduce costs by eliminating cancellations and delays in surgery lowering complication rates and readmissions and reducing length of staysIn fact preliminary fi ndings from the PSH model at the University of California Irvine and the University of Alabama found improved patient outcomes and effi ciencies in their PSH programs

6 THE OPERATING THEATRE JOURNAL wwwotjonlinecom

B Braun takes surgical simulation into a new dimension with 3D equipmentA state-of-the-art donation from healthcare company B Braunrsquos Aesculap Division to the Royal College of Surgeons (RCS) could see junior surgeons experiencing the latest 3-D insights into the future of surgery

Aesculap has presented the RCS with lsquoEinsteinVisionrsquo ndash a pioneering 3D imaging system designed to revolutionise conventional endoscopic laparoscopy procedures

Th e EinsteinVision 3D Imaging System combines full HD visualisation with the latest in 3D technology to improve usersrsquo hand-eye coordination and improve surgical results

EinsteinVision will be trialled by the College in its state-of-the-art Education and Simulation Centre Th e Collegersquos experts will assess the most eff ective way to integrate the equipment into its specialist teaching particularly in surgical simulation programmes

Having the lsquoEinsteinVisionrsquo onsite means surgeons attending specialist programmes will have the opportunity to familiarise themselves with this state-of-the-art 3-D imaging equipment and the ways it could aid surgery

Hans Hux Group Chief Executive of B Braun Medical Ltd said ldquoItrsquos an honour to supply this specialist technology to the College and provide such an innovative tool to aid the teaching of existing and future surgeons We are very grateful for the donation initiated by the Chairman of Aesculap Professor Hanns-Peter Knaebel

ldquoWe have a long-standing relationship with the College and are totally committed to supporting the advancement of surgical and medical training Th is donation and our ongoing partnership with the RCS is testimony to this and symbolises B Braunrsquos commitment to the goal of sharing expertiserdquo

RCS spokesperson Professor Jonathan Beard Professor of Surgical Education at the Royal College of Surgeons said ldquoTh e Royal College of Surgeons of England is delighted to be working with B Braun Th e companyrsquos generous supply of equipment has played a signifi cant role in helping us to equip and maintain our state-of-the-art Education and Simulation Centre at the heart of our educational facilities

ldquoOur partnership with B Braun is a fantastic example of how the College and Industry can work together in the interest of advancing surgical standards supporting surgeons to achieve and maintain the highest standards of patient carerdquo httpwwwbbrauncouk When responding to articles please quote lsquoOTJrsquo

New HC Skills hospital procurement courseSELF-DEVELOPMENT coach and author Michael Smith is joining medical training company HC Skills International to head up a team that will transform the commercial training that medical device company employees receive to ensure that they are optimally aligned with new hospital procurement processes in the United KingdomHis vast knowledge of the medtech industry and his experience as a sales marketing and motivational instructor are seen as critical to the development of new ldquofi t-for-purposerdquo courses that address the needs of both the healthcare industry and hospitals A new course will be added to HC Skillsrsquo existing list of respected training programmes in order to equip these external workers with verifi able competence that will meet the requirements of hospital procurement managers who are working to increasingly strict budgetary controlsTh e course ndash Principles of Congruent Selling in Clinical Procurement for Healthcare Industry Professionals ndash is designed for medical device company employees who provide equipment and technical support to clinical teams in patient-sensitive areasIn the past medical device companies were permitted to have direct contact with surgical teams to promote technical equipment but this is no longer acceptable

Hospital procurement departments now have sole responsibility for equipment purchases and associated technical support so medical device companies will have to adapt their way of working to meet new requirementsFurthermore new Department for Health rules governing procurement processes ndash which apply across the United Kingdom ndash have been introduced and will have to be observed by companies and employees who sell to health authorities and who provide back-up for that equipmentTh is has led to confusion over credentialling schemes that are now being introduced by individual hospitals how they will be implemented and who will be permitted access to patient-sensitive areasUnder the prevailing legal conditions in the UK no law is broken when medical device company representatives are present in hospital clinical areas However they may pose an unquantifi able legal risk to the hospital their employers and themselves Th ese individuals are required to know and understand the protocols which apply in clinical areas including those pertaining to patient safety inoculations background checks drug tests infection control data protection and other relevant factorsTh e Principles of Clinical and Procurement Selling for Healthcare

Industry Professionals course is the fi rst of its type in the UK and is designed specifi cally for those in commercial roles HC Skills who are based at the Golden Jubilee National Hospital in Clydebank near Glasgow will host the fi rst course at Weetwood Hall Hotel amp Conference Centre Leeds on June 26 amp27 2014Michael Smith whose company Developed Edge has created a range of dynamic sales and leadership programmes established a successful career in the medical device industry which saw him appointed to numerous senior roles with multi-national companiesHe said ldquoWe will ensure that medical device reps can sell the way hospitals want to buy through a comprehensive understanding of the processes involved ldquoWersquore delighted to be part of this new and unique programme Our vision at Developed Edge is to become international leaders in the delivery of training and development programmes for individuals groups and teams and so partnering with HC Skills International provides a unique opportunity to not only work with a renowned and respected training provider but also to make a diff erence in an industry which is especially close to our heartsrdquoHC Skills CEO Diane Irvine said ldquoOur new course will produce what hospitals want ndash sales professionals who are well-informed and who are

clinically professionally and credibly qualifi edldquoProcurement managers take control of the cost and risk to the hospital ndash wersquoll take the headache away of unqualifi ed workers who lack the requisite knowledgerdquo All HC Skills courses result in government-recognised externally validated competence-based qualifi cations which ensure that medical technology companies and their representatives are not compromised and that the legal position of hospitals is protectedHC Skills which has led training and qualifi cation access programmes for more than 7000 industry professionals in a host of disciplines is a training partner of the Royal College of Physicians and Surgeons of GlasgowIn February 2014 the Association of Anaesthetists of Great Britain and Ireland which is the professional body that represents more than 10500 anaesthetists across the British Isles offi cially recognised a new training course developed by HC Skills for industry organisation Barema Barema is the premier UK organisation representing the interests of companies providing anaesthetic and respiratory medical device support to clinicians and has worked in partnership with HCS to develop a training programme that meets requirements specifi c to its fi eld of expertise

For further information01244 660 954

wwwmelydmedicalcom

copy 2014 Allen Medical Systems Inc All Rights Reserved D-770691-A2

Distributed By

Ideal for Use With

bull Gyneocology Procedures

bull Urology Procedures

bull Robotic Surgical Procedures

bull Colorectal Procedures

bull Cholecystectomies

bull Designed for easy forearm access to IV lines

bull Patient weight capacity 227 kg (351frasl2 stone)

bull Secure positioning in steep Trendelenburg

bull Integral straps secure device to operating table rails

bull Quick and easy set-up

bull Disposable cover for easy clean-up

bull Saves positioning time

bull No continuous suction required

Safely and Comfortably Holds Patients in Steep Trendelenburg

Ideal for Use With

bull Gyneocology Procedu

bull Urology Procedures

bull Robotic Surgical Proce

bull Colorectal Procedures

bull Cholecystectomies

bull Designed for easy for

bull Patient weight capac

bull Secure positioning in

bull Integral straps securetable rails

bull Quick and easy set-up

bull Disposable cover for

bull Saves positioning tim

bull No continuous suctio

S f l d C f t bl H ld P ti t i St T d l

IDEAL FOR USE WITH ROBOTICS PROCEDURESTry The Allenreg Hug-U-Vacreg Steep Trend Positioner

Allen Hug-U-VacSteep Trend Positioner

Integral Straps Safety Vacuum Valve Waterproof Disposable Cover

Hug-U-Vac Steep Trend Positioner

8 THE OPERATING THEATRE JOURNAL wwwotjonlinecom

View the journal online wwwissuucomlawrandOTJ Back issues are also available to view

Registration is Free wwwotjonlinecom

ODPs Theatre Anaesthetic amp Recovery NursesYour Favourite Journal is available ONLINE

(Simple Free Registration)

Jobs News Study Days Books Clinical Articles

Register Today at wwwotjonlinecom

Jobsitewwwoperatingtheatrejobscom

Get Your Personal Copy

Hepatitis C annual report progress made but much more to doNew fi gures from Public Health England (PHE) reveal hospital admissions liver transplants and deaths from hepatitis C (HCV) have all risen in the UK

Hospital admissions from hepatitis C-related end stage liver disease have risen from 608 in 1998 to 2390 in 2012 while deaths have risen from 98 in 1996 to 428 in 2012 Liver transplant fi rst registrations where post-hepatitis C cirrhosis was an indication for transplant have quadrupled from 45 in 1996 to 188 in 2013 Th ese fi gures are released as part of the PHE annual report on hepatitis C in the UK published today World Hepatitis Day (July 28)

Most recent national estimates suggest that around 214000 individuals are chronically infected with HCV in the UK Injecting drug use continues to be the most important risk factor with around 50 of people who currently inject drugs thought to be infected Also at risk are those who have injected drugs in the past even if only once Other people who may have been infected include those who have received blood transfusions in the UK prior to September 1991 as well as anyone who has received medical or dental treatment in countries where HCV is common and infection control may be poor

Although antiviral treatments that will successfully clear HCV in the majority of patients are available and approved for use in the UK only an estimated 28000 patients in England were treated between 2006 and 2011 ndash just 3 of those chronically infected per year

Statistical modelling suggests that nearly 10850 individuals are currently living with HCV-related cirrhosis or liver cancer in England and predicts that this fi gure will rise to 13590 in 2025 if low coverage of current treatments is maintained If we could rapidly scale up standard treatment to complete coverage over the next 15 years modelling predicts that over 4100 fewer people could be living with HCV-related liver cirrhosis and cancer by 2025

Approximately the same reduction could be achieved by using new more eff ective treatments and just doubling the number treated over the next 10 years In the best-case scenario if rapid scale-up to complete coverage and more eff ective treatments were implemented 8340 less people could be living with HCV-related cirrhosis and liver cancer by 2025 However if standard treatments continue at their current low levels the number of patients with severe HCV-related disease will continue to rise resulting in loss of life and a substantial future burden on healthcare resources

Dr Helen Harris a hepatitis C expert at PHE who led the publication of the report said ldquoOur latest hepatitis C in the UK report highlights where national

progress in tackling the infection has been made but it also shows the scale of the challenge ahead Transmission amongst risk groups continues and signifi cant numbers remain undiagnosed and untreated With many new and improved treatments on the horizon it is increasingly important to raise awareness of the infection so that more individuals can be diagnosed and treated

ldquoAs well as encouraging more testing and treatment there is an urgent need for better monitoring and reporting of treatment outcomes as well as expansion of treatment into non-traditional settings such as primary care drug treatment centres and prisons Such measures must go hand-in-hand with eff ective prevention activity like drug treatment and safe injecting practices for people who inject drugs if we are to tackle hepatitis C and the disease it causesrdquo

Dr Paul Cosford Director for Health Protection and Medical Director at PHE said ldquoWhile this report demonstrates we are making progress there is much more that can and should be done to prevent more deaths and serious illness caused by hepatitis C Th e landscape of hepatitis C treatment is changing rapidly and an era of vastly improved treatment is potentially on the way In the meantime disease burden is rising and there is still a pressing need for infected patients to be treated as soon as possible

ldquoPHE is committed to working in partnership with other organisations to tackle hepatitis C and arrest the future burden of hepatitis C-related disease Our recent work with NHS and the National Off ender Management Service to expand hepatitis C screening to prisons is a signifi cant step and shows the benefi t of a partnership approach to tackling hepatitis C in Englandrdquo

Charles Gore Chief Executive of Th e Hepatitis C Trust said ldquoDespite the examples of good practice and the availability of eff ective treatments we must accept that the rising hospital episodes and deaths the poor diagnosis rate and the shockingly low level of treatment means we are failing patients

ldquoWhat this report highlights is the pressing need for immediate scale-up of the whole response to hepatitis C from prevention through diagnosis and into treatment To achieve this we need a muti-sectoral partnership approach Th e new screening initiative in prisons is a fi ne example of such an approach in practice and we are delighted to be working with PHE and NHS England to extend this into a properly comprehensive plan for scale-up across England Deaths from hepatitis C are now eminently preventable It is up to us to see that we do prevent themrdquo

Find out more 02921 680068 bull e-mail adminlawrandcom Issue 287 August 2014 9

Smiths Medical Launches Underbody Warming Blanket with Arm Openings

for Cardiac Surgery PatientsSmiths Medical a leading global medical device manufacturer has launched a new Snuggle Warmreg Underbody Convective Warming Blanket to help maintain a patientrsquos body temperature during and after cardiovascular surgery Th e blanket helps to reduce complications during and after surgery

Th e Snuggle Warmreg patient warming blanket with arm openings is ideal for cardiac surgeries because it allows full access to the patientrsquos chest while warming from the sides and bottom It also has pre-opened arm and head openings to save time and eff ort when placing on a patient and its two hose ports allow fl exible placement of the warming unit Th e blanket accommodates a wide variety of patient positions ndash prone lateral or supine with arms extended or tucked Made of soft fl exible durable material Snuggle Warmreg blankets conform to patient anatomy for maximum heat retention and comfort and also resist tears and punctures

Convective warming blankets are designed to help surgical patients arrive in recovery normothermic (normal body temperature) Inadvertent Perioperative Hypothermia (IPH) occurs when the bodyrsquos temperature falls below 36 degrees C Research has shown a correlation between IPH and a higher incidence of adverse events in surgical patients A typical average stay in hospital for intermediate surgery is one day and four days for major surgery Hypothermia during or after surgery increases the risk of surgical wound infections (SWI) and can result in an increase in the average length of a hospital stay bull Patients with even mild IPH are three times more likely to acquire surgical

site infections than patients with normal temperatures (normothermic)1 bull Adverse outcomes from IPH can result in prolonged hospital stays and costs

the NHS approximately pound339 per patient per day 2

For more information on the Snuggle Warmreg blankets contact Glen Johnson UK Marketing Manager at Smiths Medical on 01303 260 551 or log on to wwwsmiths-medicalcomReferences1 Kurz A Sessler DI Lenhardt R Perioperative normothermia to reduce the

incidence of surgical-wound infection and shorten hospi-talization New England Journal of Medicine 1996334 1209- 1215

2 Clinical practice guideline Th e management of inadvertent perioperative hypothermia in adults National Collaborating Centre for Nursing and Supportive Care commissioned by National Institute for Health and Clinical Excellence Costs and QALY impact of each health consequence

Are You Linkedin Join our Group

The Operating Theatre Journal in TM

When responding to articles please quote lsquoOTJrsquo

First NHS Total Orthopaedic Solutions procurement collaborationHot on the heels of the fi rst successful outcome of collaboration between the four NHS procurement hubs (the launch on 14th May of a framework agreement for the supply of nursing and nursing-related staff nationally) comes the decision to develop a Total Orthopaedic Solutions framework agreement

Th e four Hubs - North of England Commercial Procurement Collaborative (NOECPC) NHS London Procurement Partnership (LPP) NHS Commercial Solutions and East of England NHS Collaborative Procurement Hub (EOE CPH) - plan to develop award and deliver this next initiative by 1st January 2015

Keith Rowley NOE CPC Managing Director points out that ldquoa key objective of this collaboration is to build on the ground breaking work we have collectively undertaken in other NHS procurement categories and continue to avoid duplication of eff ort thereby addressing one of the main areas of concern raised by the DH in its 2013 publication Better Procurement Better Value Better Carerdquo

As LPPrsquos Medical Surgical and Supply Chain senior workstream lead Marc Osborne says ldquoWe are seeking to award a total solutions framework agreement that for the fi rst time will see contract coverage across the hubsrsquo membership including product areas not previously taken to market Our priority will be to deliver benefi ts and solutions for our respective hub members but we will be structuring the framework agreement so that it can apply nationally further simplifying procurement in this categoryrdquo

Th is activity is as Alyson Brett Chief Executive of NHS Commercial Solutions says ldquodemonstrating best practice for NHS procurementrdquo

Th e scope of the project is now being developed by a new cross-hub group established to run this collaboration Th e group anticipates that the framework agreement will include a number of lots including

bull Orthopaedic Lower Limb Arthroplasty ndash Hip and Knee Primary amp Revision joint replacement including bespokecustom made implants

bull Orthopaedic Extremities ndash Shoulder Elbow and Ankle Joint Reconstruction and fracture management through prosthetic implantation including bespokecustom made implants

bull Orthopaedic Trauma Implants and Consumables ndash All Trauma implants by way of emergency trauma and elective non-recon congenital correction implants external fi xation devices and consumables Trauma will also include Maxillo-Facial products

bull Spine ndash Orthopaedic spinal implants and consumables including spinal bone substitutes

bull Arthroscopy Sports Medicine ndash All capital and consumable items required for arthroscopic surgery including all stack systems and hardware for resection ablation etc All specialist instrumentation disposables and Implants for soft tissue repair and mobilisation

bull Orthopaedic Power Tools and Consumables ndash Large bone Trauma and High Speed power tools including all associated consumables and maintenance

bull Bone Preparation ndash Bone cement Mixing Systems Pulse Lavage Bone substitutes associated products

bull Enhanced recovery systems

Th e Framework will also look to address solutions with regards to

bull Managed Services solutions

bull Value added proposals

David John Chief Executive of EOE CPH concludes that rdquoBy working together and combining national buying power with our strong regional and local engagement we can deliver highly competitive agreements that really meet the needs of the NHS of suppliers and above all of patientsrdquo

10 THE OPERATING THEATRE JOURNAL wwwotjonlinecom

ETHICON LAUNCHES HARMONIC ACEreg+7 SHEARS WITH ADVANCED HAEMOSTASIS

AT TRIPARTITE COLORECTAL MEETING

Breakthrough technology redefi nes ultrasonic energy with HARMONICreg promise of precision now combined with larger vessel sealing

First purely ultrasonic device with a 7mm vessel sealing indication1

Ethicon part of the Johnson amp Johnson Family of Companies announces the UK and Ireland launch of HARMONIC ACEreg+7 Shears with Advanced Haemostasis (HARMONIC ACEreg+7) the fi rst purely ultrasonic device with a 7mm sealing indication HARMONIC ACEreg+7 combines the precision and multi-functionality expected of HARMONICreg with reliable large vessel sealing a benefi t combination that does not exist in any other product representing a true breakthrough in ultrasonic energy technology

Th e HARMONIC ACEreg+7 is setting a new standard in ultrasonic energy by demonstrating larger vessel sealing strength using the Advanced Hemostasis mode Benchtop testing shows

bull Greater 5 to 7 mm vessel-sealing reliability than LigaSureTM devices2

bull 140 higher median burst pressure vs LigaSureTM 5mm Blunt Tip when sealing 5 to 7 mm vessels in the Advanced Hemostasis mode3

bull 112 higher median burst pressure vs LigaSure AdvanceTM when sealing 5 to 7 mm vessels in the Advanced Hemostasis mode4

ldquoTh e majority of the vessels we need to divide in colorectal surgery are usually less than 5mm in size However the vast majority of surgeons would be hesitant to use an energy device alone on these vessels In addition the major colonic vessels are sometimes larger than 5mmrdquo explains Professor Timothy Rockall Consultant Surgeon at the Royal Surrey County Hospital in Guildford Professor of Surgery at Surrey University and immediate Past President of Th e ALSGBI

ldquoWith the new HARMONIC ACE reg+ 7 we now have the capacity to manage vessels up to 7mm so it will give many surgeons more confi dence when attempting to seal the larger colonic vessels and without the need for clips or other mechanical methodsrdquo

HARMONIC ACEreg+7 is designed for use in numerous procedures and specialties including General Colorectal Bariatric Gynaecology Th oracic and Urology enhancing surgeonsrsquo ability to handle multiple jobs with superior precision Th e new HARMONIC ACEreg+ 7 is best suited for cases which require dissection mobilisation and large vessel sealing

ldquoTh e HARMONIC ACEreg+7 represents a breakthrough in ultrasonic technology that now enhances surgeon choice Surgeons no longer need to trade off precision and multi-functionality for sealing strength It may in some cases also reduce the need for additional devices such as clips improving procedure effi ciencyrdquo said Kate Masschelein UK amp Ireland Sales amp Marketing Director for Ethicon Energy

Learn more at wwwethiconcom

1 Internal Claim Reference C0000001635 C00000015852 In benchtop test on 5-7mm porcine carotids that compared burst pressure failures under 240 mmHg

HARMONIC ACEreg+7 (2152 failures) versus LigaSuretrade 5mm Blunt Tip and LigaSuretrade Advance (15154 failures) (P = 0001) Data on fi le (PRC064872)

2 In benchtop test using 5-7mm porcine carotids that compared median burst pressure for HARMONIC ACEreg+7 (1419 mmHg) and LigaSuretrade 5mm Blunt Tip (591 mmHg) (plt 0001) Data on fi le (PRC064872)

3 In benchtop test using 5-7mm porcine carotids that compared median burst pressure for HARMONIC ACEreg+7 (1419 mmHg) and LigaSuretrade Advance (670 mmHg) (plt 0001) Data on fi le (PRC064872)

4 Internal sales data as of June 10 2013When responding to articles please quote lsquoOTJrsquo

Annual NHS national sickness absence rate declines to lowest level in ve years

Regional data available from this report

Annual NHS national sickness absence rates in England are at their lowest point since 2009-10 when they fi rst started being recorded by the Health and Social Care Information Centre (HSCIC) (2)

Th e latest fi gures show that NHS workers on average had one day off sick out of every 25 (1482 days a year) in 2013-14 a 406 per cent absence rate Th is is a decrease in the number of days off sick from 2012-13 when the sickness absence rate stood at 424 per cent one day off out of every 24 (1552 days a year)

Th e NHS Sickness Absence rates report looks at the fi ndings for the last fi ve fi nancial years and in 2013-14 relates to about 106 (3) million full time equivalent (FTE) workers (4) in the NHS in England (excluding GPs and practice staff )

Sickness absence rates are calculated using FTE headcount and are based on calendar days therefore including non-working days

Th e sickness absence rates for staff groups (5) in 2013-14 showed

bull Ambulance staff had the highest sickness absence rate at 620 per cent compared to 655 per cent in 2012-13 and 638 per cent in 2009-10

bull Hospital doctors had the lowest sickness absence rate at 122 per cent compared to 125 in 2012-13 and 121 per cent in 2009-10

bull Qualifi ed nursing midwifery and health visiting staff had a sickness absence rate of 450 per cent compared to 472 per cent in 2012-13 and 483 per cent in 2009-10

bull Infrastructure support staff (6) (which includes clerical estates and managerial staff ) had a sickness absence rate of 358 per cent of staff compared to 375 per cent in 2012-13 and 392 per cent in 2009-10

Regionally (7) staff in the North West had the highest sickness absence rate of 460 per cent compared to 469 per cent in 2012-13 and 486 per cent in 2009-10 Th e lowest rate was in North Central and East London at 336 per cent compared to 345 per cent in 2012-13 and 350 per cent in 2009-10

HSCIC chair Kingsley Manning said ldquoTh e NHS workforce is diverse in terms of the occupations and skills needed compared to many other business sectors Staff can be faced with situations that are physically and psychologically demanding which could increase the risk of illness and injury

ldquoTodayrsquos report shows that NHS staff absence rates have decreased over the last fi ve years with one day out of 25 being lost due to illness

ldquoIt is important that NHS organisations are able to monitor absences at all levels to ensure that they have a full picture of the health and well-being of the NHS workforce that provides care to patients seven days a week 365 days of the yearrdquo

Th e report is at httpwwwhscicgovukpubssickabsratemar14

ISO 9001 ACCREDITED

TELEPHONE 01652 657200 FAX 01652 657009 WEB wwwoakmedicalservicescouk EMAIL infooakmedicalservicescouk

Oak Medical Services Ltd Unit 5A Albert Street Brigg North Lincolnshire DN20 8HQ

OAK MEDICALSERVICES LTD

All new TQ electronic tourniquetfrom Oak Medical Services Ltd

A gimmick free electronic tourniquet - Quick Quiet amp Easy to use

The TQ is manufactured by Oak Medical Services Ltd in the UK

Dual channel supply for bilateral procedures

Back up battery power supply

Height Adjustable utility cart with Utility baskets

Antistatic castors

We pride ourselves on qualityOur commitment to quality is an ongoing process con rmed by our ISO134852003 status Even after the product is delivered our aftercare service ensures the machine is kept in good condition

Prevee-Prep

Dispozee-Cuff

All our products are manufactured in England

TM

Display rotary tilt function

Push click cuff pressure Rotary knobs for easy preset pressure selection adjustment and de ation

Digital display Pre-set pressure cuff pressure in ation time

Range of safety features to maintain cuff in ation pressure

Dual channel audio amp visual alarms Cuff check low battery service due

Easily programmable surgical time tracking

List-Cuff

10 uses per cuff

100 uses per pack

Strike through tags

Additional tear off tracker tags

Extended size range

Free tourniquet machines on usage amounts

12 THE OPERATING THEATRE JOURNAL wwwotjonlinecom

Tristel helps the charity Facing Africa eliminate post-operative infections

Infection prevention company Tristel has been helping the charity Facing Africa fi ght post-operative infections Facing Africa provide reconstructive facial surgery to suff erers of Noma (cancrum oris) an acute and ravaging gangrenous infection aff ecting the face

Tristel is donating supplies of their Trio Wipes System a practical and highly eff ective three-part decontamination system for medical devices Trio employs Tristelrsquos patented Chlorine dioxide chemistry and can be used anywhere without a water supply

Trio is therefore ideally suited to the needs of Facing Africa who have seen a dramatic reduction in post-operative infection since using the Wipes for instrument decontamination

Facing Africa has been sending surgical teams to Ethiopia since 2007 providing free facial reconstructions and post-operative care Challenged by the lack of disinfectants and availability of decontamination equipment for medical instruments Chris Lawrence founder of Facing Africa contacted Tristel for a solution

Tristel have since been donating their Trio Wipes System which provides high-level disinfection for medical devices in a matter of minutes Chris said

ldquoFor the fi rst time ever on our last trip to Ethiopia in October 2013 we had no post-operative infections or complications Th is is down to a combination of measures taken together with the co-operation of Tristelrdquo

Th e Tristel Trio Wipes System is used extensively for the decontamination of non-lumened medical instruments Using the companyrsquos patented Chlorine dioxide chemistry the wipes are rapidly eff ective against bacteria fungi viruses mycobacteria and most crucially spores

Consisting of Pre-Clean Sporicidal and Rinse Wipes Trio was developed specifi cally to meet the needs of hospital wards clinics and healthcare practices Gro Hotvedt an anaesthetist assistant who has been on many missions with Facing Africa commented ldquoMany infection control products are diffi cult to understand so are not used correctly

Tristel Trio Wipes are easy to use and make my work much easier

Th e chemistry within the Wipes is also non-corrosive and so safe for instruments staff and patients alikerdquo

Paul Swinney CEO of Tristel said ldquoWe are proud to be supporting Facing Africa and admire the work they undertake providing facial reconstructions to victims of Noma in challenging circumstancesrdquo He went onto say ldquoWe are thrilled that since using the Wipes Facing Africa has seen no post-operative infectionsrdquo

For more information regarding Facing Africa visit wwwfacingafricaorg

Tristelrsquos Chlorine dioxide-based disinfection products are sporicidal mycobactericidal virucidal fungicidal and bactericidal

For more information visit wwwtristelcom

When responding to articles please quote lsquoOTJrsquo

Friends and Family Test set for roll out to all NHS servicesNHS England has taken next step towards expanding the Friends and Family Test (FFT) to all NHS services

Th e roll out of the FFT will mean every patient will have the opportunity to provide feedback on the services they have received enabling the public to make better informed choices about the services they use

It also means providers will be able to design care services based on the feedback and around the needs of patients

As it sets out to expand FFT NHS England has today published comprehensive guidance for use by hospital trusts and the providers of NHS funded services helping them to implement FFT most eff ectively for both patients and staff Th is includes advice on how to make the FFT more inclusive allowing people of all ages and from all parts of our community to provide feedback

Th e new guidance ndash which is interactive and contains advice videos supporting materials and case studies ndash has been compiled after an in-depth NHS England review of the FFT in AampE and inpatient services since it was introduced in April 2013

Tim Kelsey NHS Englandrsquos National Director for Patients and Information said ldquoTh e key aim in setting up the Friends and Family Test was for the results to be transparently published and available to inform patient decisions and choice

ldquoTh e FFT has already gathered more responses than any other feedback exercise ever undertaken Th e huge numbers of responses that have already been received many of which refl ect the positive experience of patients provide a key source of information to inform the decisions and choices patients make about their carerdquo Source Integrated Care Today

wwwOpera ngpera ngTheatreheatreJobscomobscomA one-stop resource for ALL your theatre related Career opportuni es

View the latest vacancies online

or Scan QR Code

DOWNLOADGet our App

for Android

Find out more 02921 680068 bull e-mail adminlawrandcom Issue 287 August 2014 13

Tel 01303 840 882 Fax 01303 840 969 enquiriessophiebellandassociatescouk

wwwsophiebellandassociatescouk

GREATER LONDONTHEATRE PRACTITIONERSBAND 5 - BAND 6 - BAND 7

This is a fantastic opportunity for RGNs or ODPrsquos to join one of the most dynamic amp respected Trusts Due to recent major expansion there is a need for enthusiastic amp motivated Practitioners to join

Inpatient Theatres or Day Surgery Current amp relevant experience is essential amp specialties include Gynaecology Vascular General Surgery Laparoscopic Surgery Maxillo-facial Orthopaedic Urology Paediatric Cardiac Neuro Trauma amp Emergency Surgery They are building on their global reputation

for teaching amp clinical excellence Therefore this is the best time ever to join our Clients supportive team to discover for yourself why they are such an innovative amp rewarding place to work

Tel 01303 840 882 Fax 01303 840 969 enquiriessophiebellandassociatescouk

wwwsophiebellandassociatescouk

KENTTHEATRE PRACTITIONERS ndash RGN or ODP This busy department has two theatres and they can provide high dependency care The facilities combined with the latest in technology and on-site support services enables the

consultants to undertake a wide range of procedures from routine investigations to complex surgery Theatre Practitioners with either strong anaesthetic skills or scrub experience in a

mixture of specialities are required Competent orthopaedic scrub practitioners are of particular interest There is also a vacancy for an HCA who has current UK theatre experience Good

communication skills (verbal and written) are essential You will need to be an enthusiastic and exible team player who is most importantly patient focused

Looking to hire state-of-the-art facilitiesContact us

FIND OUT MORE AND BOOK

wwwrcsengacuksurgeonseducationfacilitieseducationrcsengacuk

020 7869 6300

Cadaveric workshopClinical Skills AreaMIS RoomTeam Skills Training TheatreAnatomy demonstration room

The Royal College of Surgeons of England

Th e ECG Workbook2nd edition

ldquo Straightforward and systematic approach to ECG interpretation that utilises real life ECGs rdquo

ISBN 9781905539451 bull MampK Publishing bull A format 108pp bull pound2500

eBook version available from Apple iBookstore Google Play Amazon Kindle Kobo and for libraries from ebrary EBSCO MyiLibrary EBL Dawsonera

Many books on ECG interpretation use simulated ECG tracings Most of the traces that you fi nd in this book are from real people and of the quality that you will be expected to interpret from in practice Th e second edition of worldwide popular lsquoTh e ECG Workbookrsquo continues with a straightforward systematic approach to ECG interpretation and includes-

TWO NEW chaptersCommon Arrhythmias explains fi ve of the most common types of arrhythmia Atrial Fibrillation Atrial Flutter Ventricular Tachycardia Supraventricular Tachycardia and Ventricular Fibrillation and a whole chapter is devoted to Ectopics and Extrasystoles

Contents include Recording a readable electrocardiogram (ECG) bull Th e electrical conducting system of the heart bull A systematic approach to rhythm strip analysis bull Heart blocks bull Common Arrhythmias bull Ectopics and Extrasystoles bull Th e 12 lead ECG bull Axis deviation bull Ischaemia injury and necrosis bull Sites of infarction bull Bundle branch blocks bull Chamber enlargement bull A systematic approach to ECG interpretation

Enhanced by real-life ECGsMany books on ECG interpretation use simulated ECG tracings Most of the traces that you fi nd in this book are from real people and of the quality that you will be expected to interpret from in practice

Our Code set to highlight care for the dying - NMC

People in their fi nal days of life can expect to receive the high standard of care given to any personIn response to the 2013 report More care less pathway A Review of the Liverpool Care Pathway we have incorporated its fundamental care standards into our draft revised CodeJackie Smith our Chief Executive and Registrar said ldquoAnyone training to be a nurse in the UK is required to demonstrate that they can deliver care safely competently and with compassion

Following the publication of More care less pathway in 2013 we published our standards for competence to make the public aware of the fundamental standards of care that a nurse is expected to be able to doldquoIn addition as part of the review of our Code we have incorporated these standards into the draft to make sure that all nurses registered in the UK regardless of where they trained understand what the public expects from themrdquoMore information about our response to the report can be found on our websiteTh e draft revised Code is now open for public consultation Please take part and share your views with us httpwwwnmc-ukorg

Please quote lsquoOTJrsquo

14 THE OPERATING THEATRE JOURNAL wwwotjonlinecom

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Itrsquos easy to subscribe just visit our website at wwwotjonlinecom and pay via Card or Paypal

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Itrsquos easy to subscribe just visit our website at wwwotjonlinecom and pay via Card or Paypal Subscribeto the OTJ

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Name ___________________________________________Address ___________________________________________ ___________________________________________Town ___________________________________________County ___________________________________________Postcode ________________Tel_________________________ Please enclose cheque made payable to ldquoLawrand Ltdrdquo and return to Lawrand Ltd PO Box 51 Pontyclun CF72 9YY

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Subscribing to the OTJ costs pound1400 per year for delivery in the UK or pound2100 overseas Alternatively just ll in your address details below and return with a cheque

Too much intervention makes patients sickerA culture of over-investigation and over-treatment is now one of the greatest threats to western health

A few weeks ago my mum was admitted to hospital with a life-threatening pneumonia induced by an immuno-suppressive medication she was taking for her rheumatoid arthritis When the chest x-ray revealed infection in both lungs my father and I both doctors understood that her condition was serious But we also knew that if anyone could fi ght this it was one of the toughest and inspirational individuals a woman who 10 years ago survived a brain haemorrhage

But after several days into her stay once the markers in her blood and oxygen levels started to improve I was particularly concerned when she became uncharacteristically negative and tearful saying ldquoJust let me go Irsquove suff ered enoughrdquo Several days of eating unpalatable hospital food and sleeping poorly had started to have an adverse eff ect on her physical and psychological condition Despite starting to recover from the acute cause of her admission she was now being put at risk of an affl iction that aff ects thousands of hospitalised patients daily

Writing in the New England Journal of Medicine last year Dr Harlan Krumholz professor of medicine at Yale described a syndrome that starts to develop close to discharge from hospital Physiological systems are impaired reserves are depleted and the body cannot eff ectively mitigate health threats It is instructive to note that this syndrome ndash created by the stressful hospital environment ndash is a signifi cant contributor to hospital re-admissions It is estimated that 10-20 of patients discharged from hospital in the UK and US will be re-admitted within 30 days often with a condition entirely unrelated to their original admission

Poor sleep and inadequate nutrition have an adverse eff ect on physical performance and co-ordination cognitive function immunity and even cardiac risk Th e elderly are particularly vulnerable to being re-admitted with falls and infection with one study revealing that a fi fth of hospitalised patients over 65 had an average nutrient intake of less than 50 of their daily requirements

Within days of feeding my mum home-cooked food which wersquod brought in and asking the nurse to not wake her up in the night for unnecessary ldquoroutinerdquo blood pressure checks insisting that she didnrsquot need to be jagged with a needle for blood every day and getting her to wear her own clothes my mum was smiling again and was able to regain enough strength to be discharged a week later

A culture of over-investigation and over-treatment is now one of the greatest threats to western health In the US it is estimated that a third of all healthcare activity brings no benefi t to patients Examples include excessive use of antibiotics imaging for non-sinister headaches use of surgery when watchful waiting is better and unwanted intensive care for patients at the end of life who would prefer hospice and home care In the US a fee-for-service model encourages high volume and expensive procedures But we should be alert to similar possibilities here the UKrsquos ldquopayment by resultsrdquo ndash which in reality is a payment-by-activity model ndash potentially incentivises ldquodoing morerdquo on the part of physicians

As a profession we have also been guilty ndash unwittingly or otherwise ndash of exaggerating the benefi ts of medications often perceived as magic pills by patients when their benefi ts are often modest at best Th is also detracts from more meaningful lifestyle interventions by giving the public the illusion of protection One recent study revealed that those taking statins consumed considerably more food and ended up heavier after several years compared to those not taking statins Our over-obsession with cholesterol-lowering by any means has become ldquothe end in itselfrdquo says Rita Redberg professor of cardiology at the University of California San Francisco ldquoWho cares about cholesterol lowering if it doesnrsquot benefi t the patientrdquo

Even respected medical guideline panels appear to be infl uenced by corporate interests Th e National Institute of Clinical Excellence has in successive weeks issued statements expanding the off er of weight-loss surgery to up to a million more obese patients with type 2 diabetes and suggested statins could be given to millions of healthy people

At best this is a contribution to over-medicalisation at worst this can seem like the behaviour of a sort of lobby group for the device and pharmaceutical industry (On Friday Nicersquos director of clinical practice Mark Baker said that allegations that eight of the 12 members of the guideline panel on statins had direct fi nancial ties to the industry were unjustifi ed)

Political interference often worsens the situation Jeremy Huntrsquos recent criticism tainting all GPs for not referring patients early enough for cancer diagnosis is totally unjustifi ed fuelling more defensive medicine through encouraging over-investigation Th is is the worst kind of medicine and goes against what I remember being taught in medical school ndash which was to treat patients according to clinical need

But therersquos a solution In an eff ort to curb the unsustainable healthcare costs estimated to reach a staggering $46trn by 2020 a campaign known as Choosing Wisely is gaining momentum in the US Part of the campaign involves communicating with patients that more expensive medicine doesnrsquot necessarily mean better medicine And this is refl ected by the evidence that four fi fths of new drugs are later found to be copies of old ones ndash not surprising perhaps when pharmaceutical companies spend twice as much on marketing new medications as on research

We need a more informed decision-making process that gives greater empowerment to patients Encouraging patients to ask specifi c questions will also help them understand that sometimes doing nothing is the best approach Questions such as do I really need this test or procedure What are the risks Are there simpler safer options What happens if I do nothing And even how much does it cost Th e Academy Of Medical Royal Colleges ndash led by Professor Terence Stephenson ndash will report by the end of the year its recommendations building on this theme We may discover billions of NHS money that does not add value to patient care

Refl ecting on my mumrsquos care and how she should have been treated from the moment she entered hospital Irsquom reminded of the words from the visionary American physician and social activist Hunter Adams ldquoWhen you treat a disease sometimes you win and sometimes you lose But I guarantee you when you treat a person whatever the outcome you always winrdquo Itrsquos time for real ldquowhole personrdquo care

Aseem Malhotra is a cardiologist and consultant clinical associate to the Academy of Royal Medical Colleges Source Th e GuardiantwittercomOTJOnline

Find out more 02921 680068 bull e-mail adminlawrandcom Issue 287 August 2014 15

wwwouhnhsuk

WEST WING amp JOHN RADCLIFFE THEATRES THE JOHN RADCLIFFE HOSPITAL

Theatre NursePractitionerJob Ref 321-AFPPRESIDENTIAL-YORK Salary Band 5 pound21478 - pound27901 pa pro rata Hours ft - pt

Some posts will be subject to criminal records bureau checks Equality of opportunity is assured and we are committed to improving your working life Our no smoking policy advances a healthier environment

PRACTICEPLUS

The Oxford University Hospitals NHS Trust is one of the largest NHS teaching trusts in the country and enjoys a national reputation for the quality of its services in healthcare The Trust comprises of four hospitals - the John Radcliffe Hospital Churchill Hospital and Nuffield Orthopaedic Centre in Headington Oxford and the Horton Hospital in BanburyAs a regional trauma vascular and paediatric centre these operating theatres offer a wide range of dynamic specialist clinical services and as a base for medical education training and research provides an exciting centre on which to build upon clinical experience in both anaesthetics and recovery practice and professional scrub practitioner experience in trauma orthopaedics vascular spinal neurosurgery ophthalmology craniofacial plastics and ENT surgeryThe Trust is looking for highly motivated Operating Department Nurses Practitioners and for both scrub and anaesthetic recovery roles Any prospective applicant requires good interpersonal skills the ability to provide specialised assistance in these clinical specialities and who enjoy working as team players A flexible attitude is required to service demands and demonstrate the ability to assess plan and implement care for perioperative patients

You will work collaboratively to promote the delivery of evidence based patient care Full time amp Part Time posts are available which includes a commitment to day night rotation Bank Holiday and weekend working and participation in an On Call rota

We will also be interviewing at the AfPP conference in York Come and visit our stand to apply

For further information please contact Fawzia Schrueder on 01865 226819 e-mail fawziaschruederouhnhsukClosing Date 13 August 2014 To apply and gain further details of this post go to httpjobsouhnhsuk and click on the Nursing amp Midwifery button

Social media lsquofuels risersquo in complaintsSocial media has catalysed a rise in complaints against doctors according to a report commissioned by the General Medical Council

Th e report suggested that complaints by the public against doctors doubled between 2007 and 2012

Complaints went up from 5168 complaints in 2007 to 10347 fi ve years later

Th e report insisted that a rise in complaints didnrsquot mean standards were slipping Instead it identifi ed a number of trends that it says have made the public more prone to making complaints about their doctors ndash including social media

Higher public education surrounding healthcare means patients have access to higher expectations Th e nature of social media ndash encouraging users to share ndash means they can refl ect experiences in public forums

Negative press coverage could be ldquochipping awayrdquo at the medical professionrsquos reputation the report said resulting in more people making ldquome toordquo complaints to the GMC

Dr Julian Archer lead author of the report from Plymouth University Peninsula Schools of Medicine and Dentistry said the report had produced ldquosome fascinating fi ndingsrdquo

He said ldquoTh ey show that the forces behind a rise in complaints against doctors are hugely complex and refl ect a combination of increased public awareness media infl uence the role of social media technology and wider changes in societyrdquo

Dr Archer added ldquoTh e report also indicated that there is much to do to improve the wider complaint handling system so that complaints made by the general public about their doctors are directed to the appropriate authoritiesrdquo Source Integrated Care Today

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