• IU Health & Circle of Care Perioperative Symposium:Collaborative Approach to Reducing HAIs Industry Partners!

    Click Here to View Circle of Care’s Industry Partner Line-Up!!

    Join us as we explore and examine the best practices, ideas, and topics pertaining to the prevention of Healthcare Acquired Infections (HAIs). The symposium will create a forum to share ideas and collaborate in new ways that will result in better patient outcomes. This program is hosted by IU Health and Circle of Care.
    Click Here To Register for the Event Today

    We will be offering both Continuing Medical Education and Continuing Education Units for the following disciples:

    • Physicians
    • Surgeons/Anesthesiologist
    • Perioperative Clinical Educator
    • OR Nurses/Managers/Directors
    • Surgical Technologists
    • Surgical Assistants
    • Sterile Processing Technicians
    • Sterile Processing Managers/Directors
    • Infection Control Practitioners
    • Hospital Administrators

    The IU health Perioperative Symposium: A Collaborative Approach to Reducing HAIs has been approved for the following continuing education credits:

    8.0 AMA

    8.0 IAHCSMM,

    8.0 CBSPD

    8.25 AORN, APIC

    7.5 AST (pending approval)

    Why should I attend:Circle of Care (CoC) is determined to explore and examine the best practices, ideas, and topics pertaining to the prevention of Healthcare Acquired Infections (HAIs). It is our mission to heighten awareness through actively hosting collaborative educational conferences on a regional and local level with industry organizations such as IAHCSMM, AORN, APIC, and AST. Our programs act as a forum for healthcare workers from various disciplines to share ideas and collaborate in new ways that will result in better patient outcomes. We share a vision with our industry partners to improve team-based care, health care system performance and overall patient care by closing the gap in health care delivery and translating the best science and knowledge into effective professional training & development. As a result of this program, health systems will benefit better care and system performance by narrowing the gaps in health care delivery and translating the best science and knowledge into effective professional training & development.

    What will I gain from attending this perioperative interprofessional symposium?1. Hear expert advice from industry leaders (including the FDA and CDC)!

    2. Cultivate interprofessional collaboration and communication to improve healthcare delivery, quality and safety.

    3. Collaborate and share your professional expertise with other members of the perioperative team to appropriately assess and address the healthcare needs of the patient.

    4. Network with industry partners to discover cutting edge products and services.

    5. Earn more than just continuing education credits.

    Symposium fees:
    $75 – Physicians
    $45 – Allied Health
    $65 – IP/RN/Managers

    Breakfast/refreshments and lunch included.


    In support of improving patient care, this activity has been planned and implemented by Indiana University School of Medicine, IU Health and Circle of Care. Indiana University School of Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

    Indiana University School of Medicine designates this live activity for a maximum of 8.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Indiana University School of Medicine (IUSM) policy ensures that those who have influenced the content of a CE activity (e.g. planners, faculty, authors, reviewers and others) disclose all relevant financial relationships with commercial entities so that IUSM may identify and resolve any conflicts of interest prior to the activity. All educational programs sponsored by Indiana University School of Medicine must demonstrate balance, independence, objectivity, and scientific rigor. *Indiana University School of Medicine (IUSM) defines a commercial interest as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.



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  • Burnout And Bullying


    interprofessional barriers of inter-professional communication


    Among perioperative nurses, they are sometimes referred to as the “killer B’s”: burnout and bullying. Both of these B’s have resulted in added stress, job frustration, dissatisfaction and sleepless nights for many OR nurses.

    In fact, bullying and burnout are inextricably linked – because bullying can be a major factor leading to burnout. Given this, it’s critical that health care organizations and nurse managers do everything they can to reduce instances of bullying in order to help reduce levels of burnout among OR nurses.

    OR Bullying is Common

    The statistics with regard to bullying in the OR are not encouraging. According to a study conducted by the Association of periOperative Registered Nurses (AORN), about six out of 10 (59 percent) perioperative nurses and surgical technicians said they had witnessed coworker bullying on a weekly basis.

    Also, more than three out of 10 (34 percent) OR nurses in the survey said they had witnessed at least two bullying acts per week.

    In a survey conducted by employment agency RNnetwork, nearly half (45 percent) of nurses said they have been verbally harassed or bullied by other nurses. Also, 41 percent said they’ve been verbally harassed or bullied by managers or administrators and 38 percent said they’ve been verbally harassed or bullied by physicians.

    According to Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CRP, the literature is consistent that health care organizations experience among the highest incidences of workplace bullying of any employment sector.

    “These disruptive behaviors have the industry and all of its stakeholders on high alert,” Fink-Samnick says.

    The Joint Commission has identified bullying as a Sentinel Event. It defines bullying as intimidating and disruptive behaviors that include “overt actions such as verbal outbursts and physical threats, as well as passive activities such as refusing to perform assigned tasks or quietly exhibiting uncooperative attitudes during routine activities.”

    The Workplace Bullying Institute defines bullying as “the repeated, health-harming mistreatment of one or more persons (or targets) by one or more perpetrators.” Bullying behavior is marked by abusive conduct that is threatening, humiliating or intimidating or leads to interference that prevents work from getting done.

    Bullying behavior in the OR can be overt – like threats, physical violence or verbal harassment – or more subtle. Sometimes referred to as “incivility,” subtle harassment includes things like sabotage, exclusion, unequal treatment, unfair assignments and withholding information.

    The Pecking Order of Bullying

    Fink-Samnick says that many experts view bullying in the OR as a direct reflection of the power that stems from the traditional hierarchical stratification that is a hallmark of many health care organizations.

    “The individuals at the top of the hierarchy – like c-suite and department leaders and surgeons – have the power to bully those below them solely by virtue of their position,” she says.

    Some researchers believe that good old-fashioned competition tends to pit nurses against each other and lead to bullying. Their theory is that competition among mostly female nurses has shifted from attracting a man to achieving status and respect in their job as perioperative nurses.

    Adds Fink-Samnick: “Most nurses can share at least one story reflecting the well-known stereotype that they ‘eat their young.’ ”

    A study conducted by the Robert Wood Johnson Foundation determined that younger OR nurses are especially susceptible to being bullied by older and more experienced colleagues.

    “Bullying in the OR grossly impacts patient quality and safety and traumatizes the workforce,” says Fink-Samnick. “The intimidating and disruptive behaviors associated with bullying fuel medical errors and lead to preventable adverse outcomes.”

    For example, more than 75 percent of disruptive behaviors lead to medical errors, she says, while 30 percent of disruptive behaviors lead to patient deaths.

    Factors Leading to Burnout

    There are many factors that can lead to burnout among OR nurses, with bullying being just one of them. High stress, long shifts and physical exhaustion can also lead nurses to the point of what

    Beth Genly MSN, the co-author of “Save Yourself From Burnout: A System to Get Your Life Back,” calls “soul-deep exhaustion.”

    “Burnout among OR nurses can lead to withdrawal from work and life, as well as deep doubts about one’s ability to make a difference,” adds Genly. “It typically has three dimensions: emotional fatigue, cynicism and inefficacy.”

    According to Erin Kyle, DNP, RN, CNOR, NEA-BC, Perioperative Practice Specialist with AORN, researchers have found relatively high rates of burnout syndrome among OR nurses.

    “In the 2017 AORN Salary Survey, the vast majority of OR nurses who are planning to leave health care cited dissatisfaction with their work environment or culture,” says Kyle. “While this survey didn’t address burnout explicitly, some conclusions may be drawn from this response data about burnout.”

    Kyle says there are both intrinsic and extrinsic factors that influence burnout among OR nurses. She identifies five intrinsic personality factors that place nurses at increased risk for burnout: neuroticism, agreeableness, conscientiousness, extraversion and openness to experience.

    “Perioperative nurses who have personality traits that make them more susceptible to burnout are at increased risk to experience it when they are faced with extrinsic factors,” says Kyle. Extrinsic factors include things like the fast pace of the OR environment, minimal rest between on-call, moral dilemmas and ethical issues, and a harsh work culture.

    There are several burnout risk factors that are unique to perioperative nursing, Kyle adds. “One is the fact that perioperative nurses are largely unknown to patients and their families because they are hidden behind the ‘double doors’ leading into the operating room.”

    “Another is the increasing demands presented by rapid technology advances,” she adds.

    “OR nurses are expected to have a vast knowledge base, be extraordinarily flexible and adaptive to change, and be critical thinkers,” says Kyle. “They’re also expected to balance what they see as the best care for patients with organizational demands to contain costs.”

    “Over time, these pressures combined can drive excellent perioperative nurses into distress and eventually burnout,” Kyle concludes.

    Five Areas of Focus

    Genly has identified five specific areas where OR nurses should focus their efforts to avoid burnout:

    1. Self-care: This is about whether you are taking care of the basic functions that keep your body going. “Self-care includes eating, sleeping, hydration and elimination – all of the functions that become troublesome if they are regularly interrupted or ignored,” says Genly.

    2. Reflection and recognition: “This looks at your level of awareness of your own feelings and values, whether the people around you recognize your accomplishments, and whether you allow yourself to observe things for what they are,” says Genly.

    3. Capacity: This has to do with how much stress you can take and your awareness of how close you are to this limit. “In other words, have you spread yourself too thin?” says Genly. “And if you have, are you aware of it?”

    4. Community: This reflects the social elements in your life. “Do you feel connected with a community of people who share your values and have good intentions for your well-being?” says Genly. “If you do, are you having enough interaction with them?”

    5. Coping skills: This looks at what types of coping methods you tend to use and whether they are helping or hurting you. “Included here are elements of how you actively deal with stress, as well as unconscious habits that you may not realize are types of coping methods,” says Genly.

    A Shared Responsibility

    Kyle says that OR nurses and health care organizations share responsibility for recognizing the risks of burnout and helping reduce this risk.

    “Cultural problems like pervasive bullying sometimes exist in the perioperative setting that can affect not just one nurse, but the entire perioperative team,” says Kyle. “Health care organizations are responsible for cultivating a work environment that is supportive of perioperative nurses and other health care professionals.”

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  • Point-of-Use Cleaning Position Statement-Lisa Wakeman

    Earlier this year, I was invited to work on a project for our healthcare system involving standards for point-of-use cleaning practices. The mission of our work group was to establish minimal expectations as a prevention effort, in order to further reduce the risk of infections, and improve overall quality for patients. During the project, I wrote a position statement to share my perspective on why, in my professional opinion, point-of-use cleaning is a critical area for healthcare facilities to focus improvement initiatives. Bellow you will find my rationale for taking this stance:

    Healthcare systems pride themselves on being a leader in best practice. Organizations influence one another on a national level and should operate in a way that promotes others to view them as an entity that exudes expertise, quality, and safety.

    The evidence for the value of point-of-use cleaning, as a prevention effort, is high and well documented. According to AORN Guidelines for Perioperative Practice Edition 2018: Guideline for Cleaning and Care of Surgical Instruments Recommendation III – Instruments should be cleaned and decontaminated as soon as possible after use, “Instruments should be kept free of gross soil during the procedure. [2: High Evidence] Periodically during the procedure, the scrub person should use sterile water to irrigate instruments with lumens. [1: Strong Evidence]”.

    Point-of -use cleaning is not a new concept and has been recommended as a best practice standard of care for many years. Surgical technological schools implement this training into their programs by following AST Guidelines for Decontamination of Surgical Instruments, Standards of Practice for the Decontamination of Surgical Instruments Effective April 16, 2009, which states that, “The cleaning of instruments should begin during the surgical procedure to prevent drying of blood, soil and debris on the surfaces and within lumens”.

    In addition AST’s publication entitled Guidelines for Best Practices for Breaking Down the Sterile Field, approved October 20, 2008 and revised June 1, 2018 provides further support for consistent point-of-use cleaning practices but also discusses rationale for continuing education and overall responsibilities of the scrub. Guideline II Section C states, “The principles of “point-of-use (POU) decontamination” of instruments should be applied by the CST; POU decontamination is the beginning of the cleaning process of instruments. POU decontamination is important because it assists in lengthening the life of instruments by preventing blood and saline from corroding the finish on instruments. Additionally, blood and body fluids that are allowed to dry on instruments are difficult to remove versus when they are kept moist. The CST should try to handle the contaminated instruments as little as possible while breaking down the sterile field.”

    Should we only elevate our expectations when accreditation surveyors are looking to score against a particular area? Absolutely not! Having the backing and support of any accreditation survey organization is helpful in holding facilities accountable to best practice, however, it is not necessary. Who is to say we as healthcare systems should not go above and beyond to ensure that we are following the evidence outlined in the standards and guidelines that are recommended by AORN, AST, AAMI, etc…

    There is a lack of consistency among manufacturer’s instructions for use (IFU’s). While some OR staff may monitor IFU’s, most do not and it is difficult to expect clinical staff to remember which devices state POU cleaning and which ones do not, without much more sophisticated systems in place for data delivery. The idea of limiting point of use cleaning only to manufacturers who have specifically mentioned to do so, is setting ourselves up for undue risk. As manufacturers catch up and revise their IFU’s, we will find that more and more outline this expectation. Similarly to Universal Precautions, implementing a standard precaution into work instructions for POU cleaning can allow facilities to remain ahead of the curve. (See bellow for IFU examples.)

    We can be certain that there is a movement going toward POU cleaning as an expectation in the future, as more awareness is generated from the public through incidents that make media attention. We must prevent our facilities from being exposed to this vulnerability by creating interventions in our practice that promote the safest outcomes for our patients.

    The main obstacle to feasibility in POU cleaning is the current culture in the OR for case turnovers and scheduling. Transitioning to more efficient means of turnovers and scheduling caseloads would have an additional impact on the surgical services value stream related to instrument availability, instrument processing time, and the reduction of IUSS, which drives ultimately the SSI rates. The argument of time as a limitation can be overcome with the adoption of creative solutions such as surgical turnover kits, which can significantly reduce the time it takes for turnovers. In addition, if surgical scrubs are proficient in wiping while they go, the practice is built in and hardwired into their day to day practice.

    We understand that it is a collaborative effort and commitment between all stakeholders to ensure that our system is delivering on our promise to our communities. We must do everything within our power to create an environment that fosters healing by ensuring that we maintain conditions that are conducive to reducing the risk of infection. HAI’s are preventable, and POU cleaning is one piece of the whole picture that contributes to a prevention effort that reduces the opportunity for harm.

    Developing guardrails that are approved by a multidisciplinary risk assessment team, Perioperative Administrative Council, and Sterile Processing Leadership Committee for healthcare settings can ensure that appropriate measures are taken. The standard that we set forth is to prevent Immediate Jeopardy and establish a benchmark of excellence. Organizations can take a stand with the support of executive leadership and shape the future of infection prevention from a collaborative and comprehensive approach.

    By Lisa Wakeman MBA, CRCST, CIS, CHL, MBTI

    Circle of Care National Director of Education


    • AORN; (2018). Guidelines for perioperative practice Edition 2018: aorn guideline for cleaning and care of surgical instruments. Published by AORN. Denver, CO.
    • AST; (2019). Guidelines for best practices for breaking down the sterile field.Retrieved January 4, 2018.
    • AST; (2019). Standards of practice for the decontamination of surgical instruments. Retrieved January 4, 2018.

    IFU Examples:

    1. Smith & Nephew:

    “Preparations at the point of use prior to processing

    Keep instruments moist after use to prevent soil from drying on them. Follow Universal Precautions for handling and transporting contaminated instruments to the designated cleaning area. Contaminated instruments should be transported to the area for cleaning in a way that avoids contamination of personnel and hospital.

    Prior to cleaning, gross soil should be removed from the surfaces, crevices, mating surfaces, cannulas, joints and all other hard-to-clean design features. Dried on soil is difficult and sometimes impossible to remove with automatic washing.

    Instruments should be cleaned as soon as possible after use to prevent blood from drying on the devices. (A four-hour dry time is used for cleaning validations of Smith & Nephew Orthopaedics reusable devices.)” p.4



    2. Stryker:


    After use (within a maximum of 2 hours post-operatively) remove gross soil using absorbent paper wipes. Intensive rinsing of the reusable device with fluent water or transfer of the medical devices into a bath with an aldehyde-free disinfectant solution is highly recommended..” p.6


    3. Zimmer:

    “• At point of use, soiled instruments must be removed from metal or polymer trays and moistened to prevent debris from drying before transportation to the reprocessing area for manual and/or automated cleaning procedures. Do not clean soiled instruments while in polymer or metal trays. Single-use devices must be cleaned separately from soiled instruments.” p.7

    “D. Point-of-Use Preparation for Reprocessing

    • Remove excess body fluids and tissue from instruments with a disposable, non-shedding wipe. Place instruments in a basin of distilled water or in a tray covered with damp towels. Do not allow saline, blood, body fluids, tissue, bone fragments or other organic debris to dry on instruments prior to cleaning.

    Note: Soaking in proteolytic enzyme solutions or other precleaning solutions facilitates cleaning, especially in instruments with complex features and hard-to-reach areas (e.g. cannulated and tubular designs, etc.). These enzymatic solutions as well as enzymatic foam sprays break down protein matter and prevent blood and protein based materials from drying on instruments. Manufacturer’s instructions for preparation and use of these solutions should be explicitly followed.

    • For optimal results, instruments should be cleaned within 30 minutes of use or after removal from solution to minimize the potential for drying prior to cleaning.” p. 8


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  • CS Certification Gains Momentum



    IMG_0297In light of the recent news articles making headlines across the country in regard to improperly sterilized reusable medical devices, the issue of requiring certification of Central Service (CS) technicians has become more important than ever.

    Click Here and Register Now for the next class! We can help you Get Certified. You owe it to yourself !

    As Steven J. Adams, RN, BA, CRCST, CHL, IAHCSMM president-elect and IAHCSMM Advocacy Committee member, explained, preventing infections from a CS professional perspective requires personnel to be focused and pay attention to details. “This does not come easily and re-quires education and ongoing training for CS professionals to become – and remain — proficient in these skills. There should be no question but to require certification of CS technicians across the nation in order to further promote patient safety.”

    Click Here and Enroll Today! We can help you Get Certified.


    Click here to read the full article from infection control today

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  • Number of deadly infections from dirty scopes is far higher than previously estimated

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    The number of potentially deadly infections from contaminated medical scopes is far higher than what federal officials previously estimated, a new congressional investigation shows.

    As many as 350 patients at 41 medical facilities in the U.S. and worldwide were infected or exposed to tainted gastrointestinal scopes from Jan. 1, 2010, to Oct. 31, 2015, according to the Food and Drug Administration.

    A separate Senate investigation released in January found 250 scope-related infections at 25 hospitals and clinics in the U.S. and Europe. That probe looked at a narrower period, from 2012 to 2015.

    The FDA supplied the new information in response to a yearlong inquiry by Rep. Ted Lieu (D-Torrance) and staff of the House Oversight and Government Reform committee. The FDA says federal law prohibits the agency from naming the medical facilities in the 41 incidents it disclosed. But the device manufacturers weren’t identified either. The full report is expected to be released Friday.


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