Bacteria can grow in gallon jugs of scrub and in the tubing.
We know that it's not advisable to use prep solution from a large bottle that was opened several days ago and has been sitting around the OR ever since. As infection prevention professionals warn us, an opened bottle and its unused product are an invitation for bacterial colonization. In fact, the Joint Commission recommends strict monitoring of how long prep solution bottles have been open.

But do you extend the same cautions to your hand scrub products? Many soaps don't provide a contact kill like alcohol does, and they can grow bacteria in their containers and in their dispensers' tubing. Particularly in foot-pump or knee-pump activated dispensers, which are supplied by gallon jugs of scrub product (the longer an opened container sits around, the more likely it is that something will grow in it) and employ long amounts of tubing (which is nearly impossible to clean properly).

It's an issue that's often overlooked and, admittedly, we hadn't considered it ourselves until we read a study that explained how infrequently the dispensers for cleaning hands get cleaned themselves. Our solution? We switched to smaller dispensers. A quart-sized container of scrub sits around for less time, and a hand-operated wall dispenser means less tubing to clean during our periodic thorough-cleaning efforts. Also, we use a container until it's empty, then dispose of it. Topping it off means some of the old — and potentially contaminated — solution is still inside.

Mary C. Wilson, BSN, RN, CNOR
Clinical Preceptor
West Virginia University Hospitals
Morgantown, W. Va.
[email protected]

Complying With the New ASC Conditions for Coverage
ASCs must meet several new Medicare requirements, called Conditions for Coverage, to be certified to participate in Medicare. Here's advice for meeting the 2 more challenging requirements:

• Patient rights. The patient rights condition could have been a lot more onerous than it is. Still, it will require you to revamp your admission process and paperwork for patients so that you can make sure they've been advised, in advance of the date of surgery, of their rights and the ownership of your facility. This seemed to preclude the possibility of same-day surgery for urgent or emergent patients, but last-minute instructions from CMS allowed for the practice, as long as the surgeon signs a statement of medical necessity. Be sure to track all of these true same-day surgeries, as the Medicare surveyor will want to know how many times this has occurred and for what reasons.
• Infection control. This CfC requires you to write policies, implement a comprehensive infection control program, and designate "in writing, a qualified licensed healthcare professional who will lead the facility's infection control program." The use of the term "licensed" means that this person must be licensed by the state — a requirement that, depending on the state you are in, may not permit use of scrub techs or medical assistants to perform the function. Additionally, this person must maintain a record of classes, meetings and other training he's received.

Dan Simonson, CRNA, MHPA
The Spokane Eye Surgery Center
Spokane, Wash.
[email protected]

Licorice Licks
Post-op Sore Throat
Patients who gargled with a licorice solution before surgery were less likely to suffer post-op sore throats than patients who didn't, says a study published in the July issue of the journal Anesthesia & Analgesia. Researchers at Sanjay Gandhi Post Graduate Institute of Medical Sciences in Lucknow, India, observed 40 elective lumbar laminectomy patients who were intubated for general anesthesia, 20 of whom gargled with 30mL of diluted licorice solution (0.5g licorice in water) and 20 who gargled with 30mL of water for 30 seconds 5 minutes before induction. Two hours after surgery, only 25% of the licorice patients reported having a sore throat, while 75% of the water patients did. Soreness was also reportedly less severe among the licorice patients. The researchers note that licorice includes compounds that have been employed in anti-inflammatory, anti-irritant and anti-cough remedies.

Save Big by Trimming Recurring Charges
We hold a money-saving contest every year for our staff. The person who saves the most money in a year gets a check for 50% of the savings. Last year's winner saved us about $5,500 (and received a check for $2,750) by trimming such recurring charges as:

• Shipping charges. We order breast implants as far in advance as possible to avoid paying hefty overnight delivery charges. The key here is making sure your patients are content with what you order — and that your vendor has a free-return policy.
• Postage. We have a postage machine in our office, but sometimes it's cheaper to use a stamp if all you're mailing is a letter. Remember, the postage meter vendor gets a fee every time you use the machine. Another way to save with the postage meter: Buy off-label ink-jet printer cartridges.
• Water. We went green when it comes to water, canceling our contract with our water bottle vendor and getting rid of all Styrofoam cups. We bought every employee a reusable aluminum water bottle.

Roy Kim, MD
Plastic Surgeon
San Francisco Surgery Center
San Francisco, Calif.
[email protected]

4 Quick Money-saving Tips

• Use reusable cautery pencils and bipolar cords. They work great and usually cost pennies per use, whereas new pencils cost $4 to $8 each.
• Don't let your docs wear the more expensive arthroscopy gowns for routine scopes. They should wear them only for ACLS or other high-fluid cases.
• Reprocess shaver blades through a nationally approved company. This will cut the cost of blades in half.
• Don't schedule high-dollar implant cases unless you're assured of reimbursement.

Karen Bennett, RN, ONC
ASC Administrator
Academy Orthopedics
Cumming, Ga.
[email protected]

Let Your Ace Bandages
Do Double Duty
We put the 4-inch Ace bandages that come in our orthopedics packs to work for us before and after the case. First, we use the bandage to exsanguinate the arm before inflating the tourniquet. We then take it off and use it at the end of the procedure as a dressing. It's a safe and easy way to conserve and save.

Pam Neiderer, RN, BSN
Clinical Services Manager
Surgical Center of York
York, Pa.
[email protected]