Trend #4: Born Earlier and Living Longer

Neonatal nurses have witnessed a flood of premature babies in the past several years, a trend that is likely to continue in 2004. The increase in prematurity is partly a consequence of the popularity of assisted reproductive technology (ART). In 2000, 53% of infants born through ART were twins, triplets, or higher-order multiples compared with 3% of the general population.[15] Twins and other multiples are more often premature and/or of low birth weight, and often require neonatal intensive care. As a group, the number of premature infants may be getting larger, but individually, it seems that premature infants are getting smaller all the time -- the phenomenon of "the incredible shrinking preemie." Though it is extremely difficult and heart-wrenching at times, neonatal nurses and physicians cannot shrink from the question of how small is too small. It is a question that has been asked for decades now, and still has no easy answer. Decades of research and experience in perinatology and neonatology have convinced us that the best approach is to prevent preterm labor if at all possible. The focus in 2004 will be on the prevention of prematurity in a broad sense, instead of focusing on more high-tech ways to save the lives of increasingly immature newborns. Look for a high-profile media campaign from the March of Dimes aimed at both professionals and the general public so that everyone gets the message -- babies are better off born at term.[16] On the other end of the life spectrum, people are expected to live longer (77.2 years, in 2001). [17] The "over 85s" are the fastest growing segment of the older population. [17] In fact, the whole population is getting older. The percentage of people over the age of 65 years in the United States is now 12%, compared with 8% just 50 years ago.[17] We can expect this to rise further as the first of the baby boomers enter their sixties just 2 years from now.

Study Confirms Safety of Forced-Air Warming

The use of forced-air warming to maintain patient normothermia and help prevent surgical site infections (SSIs) and other complications does not disturb laminar air flow in operating rooms or compromise the protection of the surgical site, a newly published study has concluded. The addition of this research to the significant body of existing science should leave no doubts regarding the safety of forced-air warming when used in laminar flow conditions, says Bob Buehler, vice president of 3Ms patient warming business. While makers of competing technologies continue their efforts to deceive heathcare practitioners and disrupt our business, we will rely on the evidence and our 24-year history of safe, effective care to speak on our behalf. This is positive news for orthopedic surgeons, a group especially vigilant about contaminants entering the surgical site. They often perform surgery in suites equipped with laminar air flow ventilation systems. Laminar air flow is designed to reduce airborne bacteria that may cause SSIs by dispensing highly filtered air over the surgical field. At least six independent, peer-reviewed studies have demonstrated that forced-air warming does not increase bacteria dispersion near the patient. Independent randomized control studies have shown that perioperative temperature management with forced-air warming actually decreases SSI risk in patients. A peer-reviewed study published online ahead of print by Anesthesia & Analgesia extends those results by showing that forced-air warming systems do not impair operating room air quality, with or without laminar flow ventilation. The authors evaluated the effect of forced-air warming on laminar air flow performance in class 1a operating rooms at two hospitals in the Netherlands. The testing methodology met a rigorous European standard, DIN 1946-4:2008-12, that includes quantitative testing of particle counts and was conducted by an independent organization. Two forced-air warming blankets were tested: a 3M Bair Hugger model 522 upper-body blanket and a 3M Bair Hugger model 635 underbody blanket. At the same time, the concentration of particles at the surgical site was assessed at a test point just above the volunteers abdomen. Use of the 3M Bair Hugger blankets caused no statistically significant difference in particle counts, regardless of whether the forced-air warming unit was set to off, ambient air or high heat settings. In all cases, the particle concentration at the test point was reduced 3-log to 5-log (1,000x to 100,000x) compared to background particulate levels in the room. This far surpassed the 2-log reduction required by the European performance standard. The authors also deployed a vapor generator to assess airflow patterns above the patient with the forced-air blower set to high and the laminar flow system activated. Neither the forced-air warming blanket nor the forced-air blower generated upward air that interfered with the normal unidirectional stream of the laminar air flow system. The studys conclusions align with published computational fluid dynamic models that show the downward stream of laminar air flow effectively reduces particle concentrations around the operative site. The authors conclude by confirming that, activation of forced-air warming does not reduce operating room air quality, even during laminar flow ventilation.

Surgical wound care products dress up to heal Dressing for success is vital in achieving healing of surgical wounds. Were talking light years past
blowing on the boo-boo and slapping on a Band-Aid, a zillion light years beyond simple gauze and tape. These days, wound dressings can do more than just cover the incision to protect it from contact and contamination; they also can contribute to the healing process and actively fight infection. Postsurgical wounds present an assortment of challenges: they come in all shapes and sizes, may involve damaged or sensitive skin or body parts, and may be quite wet even when not infected. Industry is continuously hard at work developing products used for care of postsurgical wounds in a variety of situations. It is an evolving process as new materials and more sophisticated technology become available. Trends Healthcare Purchasing News talked to some experts on products used to care for surgical wounds about some of the trends in this evolving field. Gareth Clarke, chief executive officer, IrriMax Corporation, Lawrenceville, GA, addressed the overall picture, recognizing that conditions contributing to surgical-site infections (SSIs) begin well before the cut: "There is clearly a greater emphasis on preventing SSIs with more comprehensive protocols addressing the process from admission through discharge." Clarke believes this is due to "a growing realization of the impact of SSIs in terms of outcomes for the patient, additional costs, and reduced reimbursement for the provider." Postoperative wound care has become the subject of increased attention in recent years. Kevin Leach, director, marketing, wound therapeutics, ConvaTec, Skillman, NJ, explained why: "Postoperative wound care has gained heightened attention recently as Congress attempts to rein in runaway costs by proposing that hospital-acquired infections (HAIs) should not be eligible for Medicare reimbursement. Surgical-site infection is now the second most common HAI and the most common HAI among surgery patients.1" Observations by Brent Ashton, global marketing operations manager, advanced wound care, 3M, St. Paul, MN, focused on trends in products: "Current trends focus on low cost in use, ease of use, and patient comfort. One way to keep costs lower is to design products that extend wear time, reducing the cost of labor while preserving quality of care, as does 3M Tegaderm High Performance Foam Adhesive Dressing." Marcello Napol, global business director, skin integrity, added: "3M recently updated the Cavilon line of professional skin-care products with new packaging to make them easier to identify based on need and is also releasing fragrance-free products with no added scents to aid patient comfort." Fragrance-free products no doubt will appeal to the ever-increasing number of people who find themselves sensitive or allergic to scents. Products HPN asked vendors to get specific about the advantages of their products in caring for postsurgical wounds. They had some interesting things to say. IrriMax IrriSept is the first and only FDA-cleared wound-debridement and -cleansing system containing the antimicrobial chlorhexidine gluconate (CHG), noted Clarke. "IrriSept provides hospitals an effective alternative to saline irrigation. The 0.05% CHG concentration in IrriSept has been shown effective in laboratory testing against a variety of bacteria and fungi, including methicillin-resistantStaphylococcus aureus (MRSA). Instead of cleansing a wound with saline, healthcare professionals can apply IrriSept with CHG directly to surgical or deep traumatic wounds; burns; abrasions; lacerations; skin and softtissue infections, including abscesses; delayed closures; dehiscence; pilonidal cysts; and infected

wounds. IrriSept is designed for use in operating rooms, wound care, emergency departments, burn units, and other healthcare settings." "The IrriSept system comes ready to use," said Clarke. "Through simple manual bottle compression, the patented IrriSept system delivers 450 mL of solution in less than 30 seconds to effectively loosen and remove wound debris and bacteria." IrriMax did their homework, noted Clarke. "The development of IrriSept has been guided by a rigorous scientific and clinical approach. Initial development work, independent laboratory studies, and testing laid the foundation for the product. Case studies demonstrate better and faster healing across a variety of woundhealing challenges, from MRSA-infected abscesses to postsurgical treatment of MRSA-infected breast wounds with implants. Surgeons implementing IrriSept are reporting reduced SSI rates. Institutional Review Board-approved clinical trials are currently underway."
IrriSept is the only FDA-cleared wound debridement Clarke also indicated there could be financial benefits to using and cleansing system containing CHG IrriSept. "In addition to their potentially devastating effect on patients, SSIs have a major adverse impact on the financial performance of healthcare facilities. With average SSI costs of $30,000, $60,000 for MRSA SSIs, and with IrriSept O.R. costing only $60, implementing the IrriSept system, with its potential to reduce SSIs, could produce significant economic benefits."

3M Ashton, 3M, expounded on the virtues of their dressings: "In June 2010, 3M introduced 3M Tegaderm High Performance Foam Adhesive Dressing, which provides total fluid management by combining fast wicking, high absorbency, and exceptional breathability. It is scientifically formulated to adapt to changing wound environments, facilitating the bodys dynamic wound-healing process. It is designed for longer wear time and may be worn up to 7 days. Like our previous dressing, this new dressing incorporates the patented spoke design to deliver fast, easy, one-handed application." Napol talked about 3Ms Cavilon line: "3M has 3M Tegaderm High Performance Foam Adhesive Dressing over 60 pieces of clinical evidence to support the efficacy and cost-effectiveness of Cavilon No Sting Barrier Film. Its a liquid barrier film that forms a flexible, breathable, and transparent coating on the skin. It protects intact or damaged skin from body fluids, adhesive trauma, and friction. It is alcohol-free, so it will not sting even when applied to damaged or denuded skin, and it wont affect the adhesion of tapes or dressings. The film comes in three convenient deliverieswipe, two sizes of wand, and a spray bottleand is hypoallergenic and noncytotoxic. It will not interfere with skin or wound healing. Its 3M Tegaderm High Performance Foam Adhesive Dressing also CHG-compatible. CHG can react with anionic materials, becoming insoluble and potentially losing antimicrobial effectiveness. Some barrier films contain anionic materials, but Cavilon No Sting Barrier Film does not."

3M Kind Removal Silicone Tape was just introduced at the 2011 Wound Ostomy and Continence Nurses Society (WOCN) conference in June. The 3M Kind Removal tape features a new, silicone-based, adhesive technology that provides an optimal balance of securement and gentleness. This repositionable tape is easy to use and satisfies a long-unmet need for clinicians seeking reliable adhesion and gentle, atraumatic removal, minimizing the likelihood of tape-related skin injury, noted the company. The unique properties of the tapes silicone adhesive work with skin in a different way than acrylate adhesives, found on most traditional medical tapes. This allows tape with silicone adhesive to be removed with minimal disruption of 3M Kind Removal Silicone Tape fragile skin layers or pulling of hair, without compromising securement. The skin-friendly characteristics of 3M Kind Removal Silicone Tape are particularly important for patients with sensitive, compromised or at-risk skin, or those who may require repeat taping to anchor dressings or secure light-weight tubing.

ConvaTec

Leach described important aspects of ConvaTecs AQUACEL Ag SURGICAL cover dressings. "In a study of 462 patients, the AQUACEL Ag SURGICAL cover dressing, compared to a competitors dressing, was shown to reduce infection by 67% and reduce the incidence of blisters by 88%.2 Blisters are often an underreported event and can lead to superficial infections, which, in turn, often lead to deep infections at the surgical site. AQUACEL Ag SURGICAL cover dressing alleviates blistering through its skin-friendly hydrocolloid technology that flexes and stretches naturally with the skin during body movement and does not cause sheer stress like other dressings." "Another common postoperative challenge is persistent wound drainage," said Leach. "The patented Hydrofiber Technology in ConvaTecs AQUACEL Ag Dressing features AQUACEL Ag SURGICAL cover Hydrofiber Technology with ionic silver dressing absorbs and locks in fluid and kills bacteria through a unique gelling mechanism of action. The Hydrofiber Technology micro-contours to the wound bed, which prevents dead space, a known breeding ground for bacteria. The silver ions are activated upon contact with blood or wound exudate and kill the bacteria rapidly and for up to 7 days, as demonstrated by in vitro studies."3
ConvaTecs AQUACEL Ag SURGICAL Cover "Surgical-site infection in joint arthroplasty, especially in knee and Dressing hip procedures, is a concern. Among patients who have had knee or for incisions at risk for infection hip surgery, 1% to 2% go on to develop a postoperative infection.4 These infections have been found to increase treatment costs by $35,000 to $90,000 per patient in the U.S.5; therefore, prevention of infection is a paramount concern for healthcare professionals and hospital administrators."

Smith & Nephew Patricia Burns, RN, MSN, CWOCN, vice president, clinical affairs, North America advanced wound management, Smith & Nephew, Tampa, FL, described one of their wound-care products. "Smith & Nephews ACTICOAT Post-Op is a silver-coated antimicrobial barrier dressing designed to help manage risk of infection following surgical procedures. With a proprietary nanocrystalline silver wound-contact layer, an absorbent foam layer, and a waterproof top film, it provides potent bactericidal activity to protect the wound site from bacterial contamination and promote faster wound closure by maintaining a moist wound environment. The dressing is easily applied and has a 7-day wear-time, reducing the need for dressing changes and providing confidence in barrier protection." Burns cited a report comparing ACTICOAT to a conventional dressing: "A study published in the Annals of Vascular Surgery found a 64% reduction in overall wound complications using an ACTICOAT-based dressing versus a conventional dressing, Smith & Nephews ACTICOAT antimicrobial suggesting that ACTICOAT offers a potentially useful, cost-effective dressings help protect wound sites from adjunct to reduce open surgical leg revascularization wound contamination complications."6 Education Vendors are often a really wonderful source of information. They have already done much research on the topic and are ready and willing to share. For example, 3M has wound-related educational programs online. Clarke, IrriMax, noted: "Our company employs clinical-support personnel to interact directly with facilities interested in using IrriSept." "Smith & Nephew recently introduced Classroom to Bedside, a new multi-media educational resource for medical professionals," said Burns. "The program provides thoughtful teaching modules, training DVDs, online tools, and educational guides to promote better use of Smith & Nephews line of woundcare products, promote cost savings, and ensure patients receive optimal care." Coming Often, companies are reluctant to reveal specifically what they have in the works, and understandably so. Sometimes they are willing to speak in more generic terms as to what is on the horizon. One of 3Ms claims to fame is constant innovation, particularly in the development of new products, noted Ashton: "For the postsurgical wound-care market, as with other markets 3M serves, we intend to continue close collaboration with customers to identify their pain points as we develop new solutions that make progress possible in wound care." Clarke, IrriMax, did not comment on whats in the works but did say he believes that IrriSept will become more widely used to prevent SSI. "The unique and simple premise of the IrriSept product line, applying an FDA-cleared solution containing a well-known antimicrobial directly to the wound site, will become an increasingly popular and cost-effective solution." Burns, Smith & Nephew, talked about the evolution of negative-pressure wound therapy (NPWT): "The use of NPWT continues to be an important therapy in wound care, and technologies are continuously evolving. Future innovations will make NPWT systems easier to use, more compact, mobile, include different ways to manage exudate, and be indicated for a variety of wounds, including surgical incisions."