Six Surface Disinfection Concepts
The puzzle of superior surface disinfection is never solved....
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By: Gabrielle White
Published: 10/10/2007
With 16 surgeons performing more than 3,100 surgical procedures annually in our two-OR orthopedic ASC, we have reached capacity. So, we are planning to add two new ORs, and we want to take this opportunity to offer more services - like pain management, 23-hour post-op care and more complex procedures like single-level cervical discectomies, lumbar discectomies, unicompartmental knee arthroplasties and, possibly, hip arthroplasty. With this in mind, I recently headed off to the American Academy of Orthopedic Surgeons (AAOS) Annual Meeting in San Francisco to evaluate the newest orthopedic surgical products. I focused my efforts on big-ticket items that I think will be important for our new center - namely, autoclavable scopes and cameras and integrated digital OR suites. Here's what I discovered.
Autoclavable scopes and cameras
Our volume of arthroscopic procedures is likely to double, and autoclavable scopes and cameras can save processing and set-up time. I evaluated four features of these systems: Compatibility with existing equipment, image quality, user-friendliness and warranty coverage. Although I do not outline the detailed terms of each system's warranty in this article, I recommend taking a close look at the terms before you buy. I learned that autoclavable scope and camera technology is still approximately five years "young," and factors like sudden temperature changes and steam in the camera head can significantly hinder optics. In addition, warranties may become void if you do not comply with the manufacturer's user instructions, so check to be sure the instructions are practical for your facility. In addition, in their instructions, some manufacturers recommend limiting the number of autoclave cycles.
Many of these manufacturers are integrating new imaging technologies into their autoclavable systems, so it's not just a matter of evaluating durability, reliability and user requirements. It's also a matter of evaluating image quality and determining if the improvements offer value to your surgeons. For example, manufacturers say state-of-the-art digital cameras produce a digital signal and send that signal across the cables to the monitor providing a clearer high-resolution picture. Other newer cameras convert analog signals into digital output, which is also an improvement.
Here's a brief rundown of what I learned from some makers of these systems.
Most systems also offer optional voice-, touch-screen and/or hand-held controls, as well as centralized panels in which users store each surgeon's preferences to expedite set-up. I see both of these technologies, which add to the cost of the systems, as potentially useful for busy facilities, especially those with staffing limitations. For example, the circulator could be completing other patient care or documentation tasks while the surgeon controls the equipment using voice-activation. In addition, the centralized controls could allow staff to automatically adjust settings for the surgeon and procedure, a potentially valuable tool for busy multi-specialty facilities that perform back-to-back knee surgeries and laparoscopies, for example. For our facility, these high-end options may not be justified. Finally, many systems offer an internal automated system that adjusts light intensity to the procedure and specific light conditions, thereby optimizing visibility.
Orthopedic integrated digital OR suites
Integrated digital OR suites will be very important for us because they can substantially improve efficiency. Here are some examples. Surgeon pre-sets may save five to ten minutes that we now spend setting up equipment for each case. Digital image capture, archive and transfer will enable us to transfer pre-op images like CTs, MRI scans and X-rays to the OR suite, display the images on a monitor, capture new images and transfer everything back to the physicians' offices simply by touching the buttons. This would obviate the need to physically chase down and transport images back and forth while ensuring that we capture and keep the images we need. Voice activation and touch-screen controls will allow surgeons to zoom cameras, control shavers, take pictures, tweak the tables and lights, and even dictate operative notes while closing the patient. Overhead cameras in the OR routed outside will allow the control nurse to monitor cases and know when to send for patients without having to call into the OR for updates. Integrated digital OR suites will also allow surgeons to transfer images to other doctors for conferencing or consultation and allow us to broadcast procedures via the Internet or teleconference for educational purposes.
At the AAOS meeting, I evaluated these systems' digital transfer capabilities, purchasing options, user-friendliness, support and training services and reliability. I was especially concerned about reliability and technical support because, with so much technology at our fingertips, we will need technical support to assist with trouble-shooting or provide back-up in case of equipment failure. Here's a rundown of what I discovered:
ConMed and Stryker also offer digital integrated OR suites, and all five firms provide a team of experts to help create a plan and install the system. Services include engineering, architecture, construction and training. I recommend choosing your firm early and getting this team involved with your own planners. For example, we are not yet sure if we will opt for the integrated electronic boom set-up - in which the electronics and cables are all neatly housed within the boom - but we will install the steel ceiling frames, cable conduits and other structural necessities during construction so we don't have to undergo an expensive retrofitting process in the future.
While evaluating integrated digital OR suites, ask potential vendors to take you, your surgeons and other key staff members to facilities in which their equipment is in use. Don't hesitate to ask lots of questions. One of my particular concerns, for example, is how easy (or difficult) it is to make repairs when an electronic-boom system loses power or components need replacement. Unlike conventional cart systems, these integrated boom systems can't be moved from the OR for service. For our center, versatility will be key, as we want to move equipment from room to room if needed.
Since manufacturers predicate the cost of a digital integrated OR suite - which can start at $100,000 and exceed $500,000 with all the bells and whistles - on your commitment to use their disposables, the cost and quality of disposables can become the deciding factor, especially if you find that equipment quality, user-friendliness and service are comparable between two or more vendors. If you're as dependent as we are on supplies like irrigation set-ups, pump tubing, insufflation tubing, shavers and ablation probes, I recommend paying close attention to these contracts. Some factor in consumable upcharges and/or minimum usage levels. Avoid getting locked into a long-term contract that commits you to products your physicians may not prefer, or breaks your disposable supply budget for the next three to five years. Finally, go with a company committed to technological advances and product improvements, since the contracts will lock you in for as many as five years.
So much more
At the AAOS this year, I also explored many of the other staple products we will need, like OR lights, orthopedic tables, equipment booms and orthopedic C-arms. I began the exciting process of planning the equipment needs for our expanded center. Thanks to this experience, I have come to believe that investing in many of the new high-technology products - like autoclavable arthroscopes and integrated OR suites - will make our facility more productive than ever.
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