Re: "Should They Follow Your Lead?" (June, page 34) I got the feel for the OR while serving in the Navy as a hospital corpsman. After finishing my tour with the Navy, I took advantage of the GI Bill and returned to college to study nursing. Although my nursing instructors tried to talk me out of perioperative nursing, I knew in my heart that the OR is where I wanted to go. I have been in the OR since 1976 as a surgical tech, perioperative nurse and currently as a nurse manager. The OR is a tough unit, but at the end of the day it is the camaraderie that keeps the staff united: professional teams working together for the benefit of the patient. I always leave the doors open for students to walk in and experience the operating room environment. If they love it, they will be back. Your article balances the feelings about working in an environment that is stressful yet professionally fulfilling.

Baldemar J. Hidalgo, RN
Nurse Manager OR/PACU
McGuire VA Medical Center
Richmond, Va.
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Getting Paid for Implants
Re: "Managers Get Tough on Implants" (July, page 62). Great article. I"m glad to know that most other surgery centers have issues with reimbursement as well. I will use this as leverage when negotiating contracts with multiple payers.

Ranay Collins
Director of Managed Care
Symbion
Nashville, Tenn.
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O-armed and Ready
Re: "The Horizons of Intraoperative Imaging" (July, page 34). Thanks for the timely article. One of my neurosurgeons was just talking about the O-arm this morning. My newer surgeons are pushing for us to get the product. We're going to be working on that, that's for sure.

Valerie Ruby, RN, BSN, MBA, CNOR
Assistant Vice President for Perioperative Services
Martin Memorial Hospital
Stuart, Fla.
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For Those Who Don't Need High-Def
Your articles failed to mention a subset of video cameras and recording equipment for those who cannot or do not need to go HD. Cameras that mount on surgical headlights give surgeons a true view of the procedure without the shadows and heads that invariably crop up on overhead-mounted cameras. In addition, video recorders that aren't HD and therefore are less expensive can record surgeries from the aforementioned headlight cameras, overhead cameras and endoscopic or laparoscopic cameras. These systems allow the surgeon to record videos in MPEG2 format (DICOM approved) and edit said videos for teaching, training or patient records.

Rick Mahoney
Product Manager
Luxtec
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Joining Forces in the Fight Against Infections
As a member organization, we commend the Association of Professionals in Infection Control and Epidemiology (APIC) for last month's publication of a landmark study of Methicillin-resistant Staphylococcus aureus (MRSA) infections. Healthcare-associated infections such as MRSA have recently received increased attention as a public health concern. The study illuminates that the problem is far greater than originally anticipated.

MRSA is resistant to antibiotics and can remain viable on surfaces for extended periods of time. The study estimates that as many as 1.2 million hospital patients are infected with MRSA each year, almost 10 times more than previous estimates, and 48,000 to 119,000 patients a year may be dying from exposure to MRSA. These statistics illustrate the scale of the human toll and call attention to the economic impact on an already overburdened level of healthcare spending in the United States. A call to action is needed for healthcare institutions, member organizations, the public sector and private industry to partner more closely in a spirit of openness and collaboration towards identifying and applying innovative solutions.

A holistic approach to infection control is needed, from improved hand hygiene compliance to early detection and screening of MRSA carriers. Dr. Don Goldman of the Institute for Healthcare Improvement was quoted recently in the Chicago Tribune as recommending rigorous hand washing programs and robust programs for disinfecting medical equipment and patient rooms. Importantly, in our view, healthcare institutions should not ignore the dangers of drug-resistant organisms on surfaces throughout their environments. A mop and bucket should not be acceptable anymore to combat more resistant strains such as MRSA, Clostridium difficile, SARS or tuberculosis. The "next frontier" in infection control will be a more aggressive management of the hospital's entire environment.

Concurrent to the introduction of the MRSA study, an innovation in infection control was introduced at APIC. It was a promising component of a more comprehensive solution in the fight against infections - a U.S. EPA-registered sterilization process that has been proven effective at sterilizing all of the exposed surfaces in rooms such as those where vulnerable patients receive critical care.

While testing and validation may be required before this and other innovations are applied uniformly and daily in healthcare facilities, we urge all institutions to be open in their search for new technologies.

Les C. Vinney
President and CEO
Steris Corporation