BBI Contributing Writer

ANAHEIM, California — Nursing shortages and patient safety were underlying currents evident during this year's Association of periOperative Registered Nurses (AORN; Denver, Colorado) annual congress. So much so that both established and startup medical companies came forward to help. Major commitments were made by Johnson & Johnson (J&J; New Brunswick, New Jersey) and Sandel Medical Industries (SMI; Chatsworth, California). J&J's initiative will have long-term results. SMI aims for the short term.

In February, J&J launched a national recruiting campaign, the Campaign for Nursing's Future, to help reduce the nursing shortage. Developed in cooperation with national nursing organizations, spending on the campaign is estimated to exceed $20 million over the next two years. It addresses a shortage of registered nurses now estimated at 126,000 in hospitals and projected to increase to more than 400,000 in all healthcare facilities by 2020. According to 75% of Americans questioned in a recent nationwide poll, the nursing shortage raises concerns for the future of healthcare.

The incidence of medical errors resulting in patient death is intimately tied to and likely resulting from the growing shortage of qualified operating room personnel. In its 1999 study titled To Err is Human: Building a Safer Health System, the Institute of Medicine (Washington) reported that 44,000 to 98,000 deaths occur annually as a result of medical errors. These include medication errors, surgical mistakes and surgical complications. According to the report, the total national cost for medical errors is between $8.5 billion and $17 billion annually.

Addressing the organization's concern about the issue of medical errors, incoming AORN President Donna Watson reported the creation of AORN's Patient Safety First program. Sandel Medical simultaneously announced a $1 million contribution as the sponsor of this initiative.

The Patient Safety First program will determine strategies and initiatives-system solutions designed with safety as the first priority. AORN believes that medical errors, regardless of type, are system-related. Specific information will be obtained as to how surgical teams function, how team characteristics affect patient outcomes and how work design and flow, as well as environment, contribute to adverse events.

Dan Sandel, owner of Sandel Medical Industries, said, "It is SMI's intent to use the insight and experience of nurses and related medical professionals to identify issues and provide solutions in the form of innovative products and/or services. Sandel Medical is a company where nurses develop products for nurses." SMI was established in March to build a medical products business that focuses on the patient safety and nursing shortage issues. "The nursing shortage is due to three things," Sandel said, "the aging population, no new nurses coming in and nurses quitting the profession due to work stress. We believe we can empower the OR nurse look beyond complaints to ways to fix the problems."

Needlestick safety

Concurrent with the issue of patient safety is that of employee safety. More than 120,000 operating room needlesticks per year are reported to the Centers for Disease Control and Protection (CDC; Atlanta, Georgia). Of all hospital needlestick-caused AIDS cases, 20% result from the act of suturing. Two new products demonstrated during the AORN congress could have an impact on this problem. SuturTek (North Chelmsford, Massachusetts) showed its needle-protected FastClose device and Regent Medical (Norcross, Georgia) demonstrated its new Biogel Indicator Underglove.

SuturTek's Needle-Protected Suturing technology replicates the familiar technique and method surgeons have always used to suture by hand. The device allows surgeons to place both running and interrupted stitches using a sterile, single-use disposable cartridge containing a standard type needle and standard suture attached to the reusable FastClose device. The needle is contained entirely within the cartridge before, during and after the surgical procedure. This protects surgeons, operating room nurses and cleaning personnel from exposure to used needles. The FastClose needle is driven around inside its cartridge in a complete 360-degree arc. A completed stitch is placed each time the needle and suture are driven across the aperture and through tissue located within the aperture. Use of the device has the added advantage of allowing a one-handed closure — tissue forceps are unnecessary.

Needle punctures in surgical gloves often go unnoticed during surgery even though many surgeons and scrub nurses double-glove. Regent Medical introduced a new underglove to attack this problem. The Biogel Indicator Underglove is green. It is designed to be used in combination with other latex surgical gloves as a puncture indication system. Part of a patented system, the green color patch alerts wearers of punctures in the outer glove in the presence of fluid. The Underglove is recommended for use during procedures such as orthopedic surgery where there is high risk for penetration.

Trends to watch

The first step in a surgical team's preparation to operate is the traditional surgical scrub — typically described as a three- to 10-minute ordeal involving a ritual of soaping, scrubbing thoroughly with a brush and rinsing in a very careful way. The scrub sink area just outside the operating room is usually littered with piles of sterile and used brushes. This ritual may soon be obsolete. 3M's (St. Paul, Minnesota) new Avagard is one of the latest in a series of waterless, scrubless alternatives to prepare hands for surgery. It is advertised as fast-acting and effective, providing proven, persistent antimicrobial protection for up to six hours without water or scrubbing. 3M says the Avagard antiseptic hand prep provides rapid antimicrobial kill of a broad spectrum of microorganisms. Simultaneously the solution is formulated to maintain and protect the condition of the team's skin. The lotion base helps prevent dry, cracked hands, simultaneously protecting and maintaining skin barrier integrity.

Hundreds of thousands of medical devices are surgically implanted every year. These include pacemakers, artificial joints, heart valves and medication pumps. After implantation, these devices often require adjustment, repair, replacement or even recall. Tracking the devices is a major issue for device manufacturers. The VeriChip from Applied Digital Solutions (Palm Beach, Florida) may provide a solution for these tracking problems. The VeriChip is a miniaturized RF/ID transponder in a tissue-inert capsule. Handheld or portal readers sense the unit's signal from up to three feet away. The VeriChip can be inserted sub-dermally just above the implanted medical device, providing patients, providers and manufacturers with a rapid secure and noninvasive method for obtaining medically critical information about the device.

The 12 mm-by-2.1 mm radio frequency device contains a unique identification number and other data. Insertion is similar to an injection and can be performed in an outpatient or office setting using the company's sterile needle cartridge inserter. The chip is read when the pocket or fixed-position scanner emits radio energy. A signal passes through the skin and energizes the dormant VeriChip, which then emits a radio frequency signal containing the identification number. The Global VeriChip Subscriber Registry is a ready source of data about the patient such as name, emergency contact information, allergies to medications, as well as the medical device's model, serial number, required settings and other essential parameters.