Going Green Pays Off

If hospitals nationwide worked to reduce their energy use, waste and surgical supply inefficiencies, total healthcare savings would total $15 billion over the next decade, according to collaborative research supported by the Healthier Hospitals Initiative and Health Care Without Harm.

Operating rooms are large consumers of energy and waste management resources and account for 33% of all hospital supply costs, say the researchers. In their study, hospitals that sent single-use devices out for certified reprocessing and bought them back at a fraction of the price of new saved $12 per procedure, not including the resulting waste disposal savings. Extrapolated over 5 years and across all hospitals in the United States, those per-case savings would total $2.7 billion, according to the study.

The researchers also identified custom supply packs as sources of significant waste, as well as opportunities for substantial savings. Hospitals that asked suppliers to remove routinely unused supplies from packs saved $4.33 per procedure. If all hospitals reformulated their custom packs, say the researchers, savings would top $1 billion over 5 years.

In addition, the study stressed the importance of recycling, segregating non-infectious trash from medical waste and energy-reducing strategies such as lighting upgrades, installing occupancy sensors in public areas and lowering OR ambient temperatures.

"This research turns on its head the belief that introducing environmental sustainability measures increases operating costs," says Blair Sadler, JD, senior fellow at the Institute for Healthcare Improvement, one of the study's authors and the former CEO of Rady Children's Hospital in San Diego, Calif. "With little or no capital investments, significant operating savings can be realized."

Daniel Cook

Soothing Sounds Can Reduce Cataract Patients' Anxiety

An audio therapy known as binaural beats can significantly reduce patients' anxiety during cataract surgery, according to a study by Thai researchers presented at the 116th Annual Meeting of the American Academy of Ophthalmology, jointly conducted this year with the Asia-Pacific Academy of Ophthalmology.

Binaural beat audio therapy consists of 2 tones, each pitched at a specific, slightly different frequency, and delivered to a separate ear via headphones. The technique evokes alpha-frequency brainwaves, which are linked with relaxation and reduced perception of fear and pain. The study's researchers combined binaural beats with soothing music and nature "soundscapes" (such as ocean and forest sounds).

The study was conducted using 3 groups, each consisting of 47 patients, matched for age, gender, cataract type, and other health factors. The binaural-music patients had less anxiety, slower heart rates and significantly reduced systolic blood pressures. The music-only patients saw an improvement only in blood pressure. The third group of patients heard the usual sounds of the surgical suite. Researchers measured patients' heart rates and blood pressures pre- and post-op, and assessed all patients before and after surgery using the State-Trait Anxiety scale for diagnosing anxiety.

Stephanie Wasek

Is Ultrasound Gel an Infection Risk?

When it's thought about at all, ultrasound transmission gel is generally seen as a benign and harmless substance, if a bit messy (and cold on patients' skins). Under some circumstances, however, it may be an overlooked source of surgical site infections. A team of Michigan epidemiologists has drafted guidelines aiming to prevent such risks.

The researchers pursued the issue after witnessing a gel-triggered outbreak at the Beaumont Health System and discovering that little guidance had previously been published.

In December 2011, the health system's infection control surveillance efforts detected a cluster of Pseudomonas aeruginosa in the cardiovascular surgery ICU. The outbreak was linked to ultrasound gel used in intraoperative transesophageal echocardiography, which had been contaminated during its manufacture (and resulted in a national recall).

While ultrasound gel contains substances that inhibit bacterial growth, the researchers note, it is not an antimicrobial substance and could transmit bacteria to patients. They recommend taking the following precautions:

  • Using sterile, single-dose containers of gel when scanning new wounds, non-intact skin or during invasive procedures.

  • Using sterile, single-dose containers when scanning newborn or critically ill children.

  • While non-sterile, multi-dose containers can be used on intact skin, they should be sealed when not in use.

  • Multi-dose containers should be discarded and replaced, not refilled, when empty.

    The proposed guidelines appear in the December issue of the journal Infection Control and Hospital Epidemiology.

    David Bernard

  • InstaPoll: Who Has the Authority to Cancel a Case?

    Who in your facility has final authority to approve a patient for a case or cancel that case? Is it the surgeon, anesthesia, medical director or administrator? Tell us in Outpatient Surgery Magazine's InstaPoll.

    "Ambulatory surgery" best describes what you do, according to 61% of the 460 respondents to last week's poll question. Coming in second with 27% of the vote was "outpatient surgery," followed by "same-day surgery" (10%) and "day surgery" (2%).

    Dan O'Connor

    News & Notes
  • Does HD matter? Not when it comes to detecting adenomas or polyps during colonoscopies, according to study findings presented at the American College of Gastroenterology's annual meeting. The researchers say high-definition provides brighter and sharper images in a wider field of view than standard-definition displays, but adenoma detection (54% in HD, 50% in SD) and polyp detection (30% in HD, 33% in SD) are merely comparable.

  • Knee replacement outcome surprises Lower-income patients do better after total knee arthroplasties than higher-income patients, and morbidly obese patients also do better than expected after the procedure, according to studies presented at the American College of Rheumatology's annual meeting in Washington, D.C. The first study found that patients who make $35,000 a year or less reported less pain and better knee function at their 2-year checkups than wealthier people did. The second study found that patients who are morbidly obese have similar pain and function outcomes as patients who do not fall into this weight category.

  • Mindray recalls anesthesia machine Medical device manufacturer Mindray is recalling its A3/A5 Anesthesia Delivery System. An improperly seated CO2 absorbent canister gasket in the system may result in a leak and an unintended increase in gas flow. The affected machines were shipped between May 31, 2011, and July 15, 2012, says the company.