The Operating Theatre journal April 2021

THE THE

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SEPTEMBER APRIL 2020 2021 2020 ISSUE NO. NO. 360 360 367 ISSN 0000-000X 1747-728X

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Leading medical organisations publish new surgery

guidance for the one in five patients who have had COVID

Guide lets patients know when to wait for surgery, as studies suggest 10-fold increase in death for adults with an active COVID infection

New standards will strive to make surgery as safe as possible

In a new guide published recently in the journal Anaesthesia, a leading group of professional medical organisations are calling for the NHS to use

new standards to manage surgical patients who have previously had COVID. The guidance produced by the Centre for Perioperative Care, the

Royal College of Anaesthetists, the Royal College of Surgeons of England, the Association of Anaesthetists and the Federation of Surgical Specialty

Associations advises patients to wait or risk higher mortality rates.

An estimated 15-20% of UK adults have contracted COVID during the pandemic. As the NHS begins to tackle the backlog of surgery, this guide will

help inform the decisions of those patients who need an operation in the near to medium-term future.

With some studies suggesting a 10-fold increase in death for adults having an operation1 around the time of getting an active COVID infection,

compared with non-COVID patients. It is vital that this group of patients receives surgery that is as safe as possible and appropriate for them.

The guidance is informed by academic studies and the latest data from the COVIDSurg group2.

Key Guidance points:

1. Emergency surgery, even for a patient without a PCR positive test should proceed with full COVID precautions.

2. For elective or planned surgery, a delay of seven weeks after infection is recommended, including for people who are otherwise asymptomatic

(but have had a positive test).

3. There should be an individual assessment and longer preparation time for COVID patients who have recently been treated with steroids or who

have had on-going or previously severe COVID symptoms.

4. Timing of surgery following a COVID infection should involve shared decision-making between the patient and their healthcare team – this

includes discussions about the risks and benefits of operating, alternatives to surgery, and doing nothing. This is particularly important as the

health of many patients may have deteriorated during the pandemic

5. All patients should use the time before their surgery to better prepare for their procedure, e.g. by gradually improving their fitness or by

stopping smoking, as this greatly reduces complications after operations, especially if they have other medical problems. It is important that

we change the patient’s perception, so they see this period not as waiting time but preparation time.

Mrs Scarlett McNally, Deputy Director of the Centre for Perioperative Care (CPOC) and Consultant Orthopaedic surgeon said:

“This guidance is invaluable for the teams trying to plan care. One in ten patients with COVID will need specialised input and the guide is clear on

who this affects. For all patients, we need to move towards a model

where ‘waiting lists’ for surgery become ‘preparation lists’ – where

patients use this time to get as fit as possible for their surgery.

“Evidence shows that simple interventions such as a daily walk,

practicing sit-to-stand exercises and having medication reviewed can

reduce complications by between 30%-80%. Patients who have had

COVID have been through enough – we now need to help empower

them through shared-decision making and making best use of their

waiting period to have the best possible outcome following their

surgery.”

Dr Kariem El-Boghdadly, Consultant Anaesthetist and lead clinician for

the guidance:

“We have a growing number of patients that need surgical care and a

growing number of patients who have had COVID-19. What we wanted

to do is ensure that these patients receive the safest surgical care

possible in the face of previous COVID-19 infection. We need to get

through the NHS waiting lists as safely as we can and we hope this new

guidance will help us achieve that for all our patients.”

Download guidelines here:

Patient Safety in Perioperative Practice

Tuesday 20 April 2021

#PSPP21

5 CPD credits

SARS-CoV infection, COVID-19 and timing of elective surgery.pdf

Link to guidelines here: doi.org/10.1111/anae.15464

Access a patient-facing resource here: www.cpoc.org.uk/patients

Reference

1. Delaying surgery for patients with a previous SARS-CoV-2 infection.

British Journal of Surgery 2020; 107: e601–e602.

2. CovidSurg was a platform of studies aiming to explore the impact of

COVID-19 in surgical cases and services. It can be accessed here:

https://globalsurg.org/covidsurg/

Venue: Online

Registration: Member/Fellow £160, Anaesthetist in Training/MTI Doctor £120, Senior

Fellows and Members Club £80, Non-members £215, Student £40

Clinical Content Leads: Dr Haresh Mulchandani & Dr David Selwyn

A joint event with the Centre for Perioperative Care (CPOC), this one day meeting will discuss

patient safety, including the barriers to delivering safe perioperative care and strategies on how to

overcome them.

Our aims are to build upon knowledge and practice to make systems, processes and organisations

safer. Through an understanding of the science of patient safety, different perspectives and

approaches, coupled with collaboration, education & quality improvement programmes we hope

to inspire delegates to make safety the golden thread of patient care.

The RCoA will make a donation of £5 to Lifebox for every delegate attending this event.

www.facebook.com/TheOTJ

2 THE OPERATING THEATRE JOURNAL www.otjonline.com

THE THE

THE

SEPTEMBER APRIL 2020 2021 2020 ISSUE NO. NO. 360 360 367 ISSN 0000-000X 1747-728X

SEPTEMBER 2020 ISSUE NO. 360 ISSN 0000-000X

The The Operating Theatre Theatre Journal

Journal

OTJONLINE.COM £2.00

OTJONLINE.COM

£2.00

The The Leading Leading Independent Print Print & Digital & Digital Journal Journal For For ALL ALL Operating Theatre Theatre Staff

Staff

The Leading Independent Print & Digital Journal For ALL Operating Theatre Staff

CS Medical is now Care Surgical

CS Medical have now completed our rebrand to Care Surgical. Over the

past 5 years CS Medical has become a trusted name in the operating

theatre and is widely known for our outstanding product quality

and customer service. Our first positioning solution, the Prone Plus

Helmet and Face cushion has now helped protect over a quarter of a

million prone patients worldwide. Although the CS name is well known and

respected among our many customers, we felt that it didn’t fully represent our

purpose and company philosophy.

So why Care Surgical?

Simple, our mission is to advance and improve patient Care in the Surgical environment.

Our commitment to enhance patient outcomes is our prime focus as well as the driving force behind

everything that we do. Correct positioning is essential for a positive surgical outcome and nowhere is this

truer than during prone procedures. From pressure related injury to nerve damage and even blindness prone

positioning poses a serious risk to the patient. For these reasons Care Surgical have not just developed single

products but full positioning solutions.

Our latest innovation, the CS Spine Frame, provides a comprehensive tabletop solution for prone positioning.

From the head to the arms, chest, hips, knee’s and feet we strive to ensure that the patient’s whole anatomy

is correctly and safely supported. The system gives you a patient position comparable to that of a specialist

spine table but at a fraction of the cost. In 2020 we partnered with Kyra Medical who’s innovative portfolio

of patient positioning devices are a perfect compliment to the existing Care Surgical products.

So what’s changed?

We’re the same company with the same experienced team, just with a new face! We feel our fresh new

brand better represents who we are and our position as innovative product engineers and reliable suppliers

of high quality, affordable positioning solutions. Visit our new website at www.care-surgical.com

Clinically-led changes result in savings of more than £450,000

annually for NHS trust

NHS Supply Chain has worked in partnership with a

hospital trust to help them save more than £450,000

annually after a change of supplier for hip and knee

products for orthopaedic surgery.

City Hospitals Sunderland NHS Foundation Trust and

South Tyneside NHS Foundation Trust who merged in

2019 decided to undertake the orthopaedic project

together with support from NHS Supply Chain category

manager and clinical engagement and implementation

manager.

This enabled them to move to one orthopaedic provider

for their hips and knees as soon as they had merged

to achieve the best value for the products across both

sites. Orthopaedic clinicians led the decision on the

new hip and knee providers.

As a result, South Tyneside and Sunderland NHS

Foundation Trust saved £458,060 against a previous

annual spend of £1,509,396 - a saving of 30 percent.

They achieved the savings by going from seven

different suppliers to one and rationalising the product

range for surgeons.

A trust spokesman said: “We worked closely with NHS

Supply Chain and the suppliers on this orthopaedic

project, to evaluate and rationalise the product

range. Their expertise relating to the pricing exercise

enabled the timescales to be reduced and the savings

were realised earlier than anticipated.”

Emmi Mitrunen, a Category Manager specialising in

orthopaedics at NHS Supply Chain, said: “It was very

important that the product alternatives were clinically

acceptable across both hospital sites.

We offered access to a breadth of products and

the ability to continue close working relationships

with suppliers whilst remaining compliant.”

The trust was supported through the project by

Emmi and Ben Harrington, a Clinical Engagement

and Implementation Manager who has specialist

knowledge of orthopaedic products and a

background in orthopaedics theatres.

“We supported the orthopaedic project by

working with the clinical teams to understand

which suppliers they would be willing to consider

as alternatives to their current hip and knee

providers,” said Emmi.

The clinicians agreed to look at five different

suppliers, who were all invited to present their

products at a supplier day. As a result, two

suppliers were identified as being able to supply

a full range of hips and knees across both sites.

Each supplier’s products were trialled at both

sites, with one supplier taking part at a time. This

enabled all clinicians to participate in the trials.

NHS Supply Chain was able to deliver products,

expertise and pricing available under the Total

Orthopaedic Solutions framework.

The standardised compliant process was managed

from beginning to end by NHS Supply Chain on

behalf of the trust, including providing product

analysis, organising meetings and supplier days,

providing contract documentation and ensuring

everyone involved was kept up-to-date with

developments.

Inside this issue

Over 100 UK medical

professionals registered for the

free COVID-19 courses

P4

NHS contact centre wins Gold

award at prestigious European

awards

P4

BAOMS President welcomes

RCSEng independent review

P4

Sustainable and fit-for-purpose

OMFS training, BAOMS President

pledges

P6

The Infection Prevention

Society is pleased to promote

educational covid-19 video

P10

Sheffield researchers

to lead major study

P10

RCoA Consultation into

regulation of Anaesthesia

Associates

P12

Pioneering £1.8m study to

investigate if pregnancy success

rates improved by removing

small fibroids

in womb

P16

From bomb disposal to

pioneering healthcare role

P18

The South West Cancer

Alliance’s moves towards

eradication of “TRUS” Prostate

Cancer Biopsy.

P19

Assuring Sterility in Surgical

Instruments Reprocessing

P21

How can Civility in the Operating

Theatre be Improved to Enhance

Patient Safety? (Part 1)

P22

Sheffield Teaching Hospitals

consultant elected as President

of prestigious national society

P24

FDA is Investigating Reports

of Infections Associated with

Reprocessed Urological

Endoscopes

P26

Why Men must researchtheir

Prostate Cancer treatment

options.

P29

Augmented reality could change

the way we carry out minimally

invasive surgery

P29

Find out more 02921 680068 • e-mail admin@lawrand.com Issue 367 April 2021 3

Over 100 UK medical professionals registered

for the free COVID-19 courses through

Incision Academy

Incision Academy is a fast-growing surgical e-learning platform from

Amsterdam, accredited by the Royal College of Surgeons of England.

Today (17.3.21), Incision announced they have welcomed medical

professionals from more than 100 British medical institutions to their surgical

learning platform, as a result of their recent entry in the UK market. With

the aim to uphold the relevancy of their platform, the surgical e-learning

platform has granted free

access to their essential COVID-19 learning modules. Research among Dutch

theatre nurses showed that 78% do not feel well-informed about what is

expected from them in a COVID-19 ward. A shocking 71% says they lack the

skills to support.

The high completion rate for Incision’s online COVID-19 courses suggests

that there is a need to prepare for the COVID-19 ward. The most popular

course is Intramuscular injection, with over 13,000 certificates granted.

“We are really proud that we can contribute in the shared battle to fight

the virus” says Kim Taylor, Marketing Director at Incision. “We welcome all

medical professionals from the UK to complete the COVID-19 courses for

free”

This news comes in the wake of many recent initiatives and accomplishments

of the company, including:

• Becoming the first online learning platform to receive the Surgical Centre

Accreditation from the Royal College of Surgeons in England

• Achieving the milestone of 500 surgical e-learning courses on the Incision

Academy for medical students, residents, nurse anaesthetists, and

theatre nurses.

“Sharing medical skills resonates even more in turbulent times like these.

It’s great to see so many grateful responses coming in” says Ritsaart van

Montfrans, CEO at Incision.

The COVID-19 learning modules from the surgical learning platform can be

accessed for free by registering: http://bit.ly/OTJIncision

NHS contact centre wins Gold award at

prestigious European awards

The NHS Business Services Authority (NHSBSA) contact centre has bagged

the Gold award for Contact Centre of the Year at European awards.

Last night (Tuesday 16 March 2021) NHS Business Services Authority

(NHSBSA) won the award at the European Contact Centre and Customer

Service Awards 2020 Virtual Awards Evening.

Over 2,000 people attended the virtual ceremony which is Europe’s most

prestigious awards programme in the industry.

The awards are celebrating their 20th anniversary as the most recognised

customer contact awards in Europe. There were over 1000 nominations from

over 30 different countries this year.

NHSBSA’s Head of Customer Operations, Dan Britton, said: “Immensely proud

of my amazing colleagues for the pride, passion and commitment over many

years but especially so in the last 12 months, supporting one another and

the UK’s response to the pandemic through a variety of important services.

I’m sure many lives have been saved and positive differences made by the

valuable contribution of our people.”

Brendan Brown, Director of Citizen Services at NHSBSA, commented: “To win

at these awards is no easy feat, our talented customer service professionals

can rightly take pride in being part of the very best call centre in Europe,

so we are incredibly proud of this achievement and how we support the

wider NHS.”

For more details on the awards visit: https://www.ecccsa.com

BAOMS President welcomes RCSEng independent

review into diversity and inclusion and reveals

how the specialty is facing the challenges

British Association of Oral and Maxillofacial Surgeons (BAOMS) President

Austen Smith has welcomed the Royal College of Surgeons of England

(RCSEng) independent review into diversity and inclusion, conducted by

Dame Helena Kennedy QC. He writes:

Given the impact of the RCSEng holding themselves up to a strong light

in their report An independent review on diversity and inclusion for

the Royal College of Surgeons of England: An exciting call for radical

change, it is clear that surgical disciplines in the UK owe it to present

and future colleagues to squeeze out any unfairness or unacceptable

labelling.

“As President of the British Association of Oral & Maxillofacial Surgeons

I am proud of what has already been achieved within our surgical

specialty.

“From the initiation of the Inclusion, Equity and Diversity policy by my

predecessor Sat Parmar in 2019, BAOMS has actively pursued a policy

of cultivating an atmosphere that recognises and acknowledges the

differences between individuals, without judgement.

“This has already resulted in the most diverse membership of BAOMS

Council, which steers and guides our association. Half of Council

members, for example, are women and from a range of different

backgrounds.

We have a publicly exhibited gallery on our website that illustrates the

wide variety of origins, backgrounds, cultures and standpoints from

junior doctors up to senior figures in the specialty.

“In 2023 our President will be Miss Daljit Kaur Dhariwal, our second

female President who is of British Asian/Indian origin. Her Presidency

will be clear proof that it is possible to have a satisfying family life, and

still achieve pre-eminence in the demanding world of clinical surgery

and medical politics.

“Council member Kanwalraj Moar, Cleft Oral Maxillofacial Surgeon and

Divisional Director for Women’s and Children’s Services at Addenbrookes

Hospital, has taken the BAOMS Diversity Lead portfolio. Her role is

to monitor our diversity and inclusion activities, communicate our

achievements and advise where we need to do better. In addition, she

is a founding member and Honorary Secretary for the Society of Women

in Maxillofacial Surgery (SWiMS), an independent Society that in healthy

collaboration with BAOMS represents the interests and mutual opinions

of female surgeons active in our speciality.

“Oral and maxillofacial surgery is rich with a diversity of skills,

characteristics and attributes that creates a vitality and strength. I

believe that the diversity of our members and leaders is an amazing

positive benefit to OMFS. And I hope those who gravitate to OMFS will

feel and be both supported and protected as they pursue their career

aspirations.

“But, is BAOMS doing enough? Clearly, we cannot be complacent, and

there are ingrained issues that will need to be aired and dealt with.

The RCSEng report gives us a topic-by-topic menu for addressing unfair,

biased or discriminatory issues. We must be positive and constructive in

parallel, and continue to extend our present solid achievements to the

credit of oral and maxillofacial surgery practice in the UK.”

• An independent review on diversity and inclusion for the Royal

College of Surgeons of England: An exciting call for radical change

https://www.rcseng.ac.uk/about-the-rcs/about-our-mission/

diversity-review-2021/

The next issue copy deadline, Monday 26th April 2021

All enquiries: To the editorial team, The OTJ Lawrand Ltd, PO Box 51, Pontyclun, CF72 9YY

Tel: 02921 680068 Email: admin@lawrand.com Website: www.lawrand.com

The Operating Theatre Journal is published twelve times per year. Available in electronic format from the website, www.otjonline.com

and in hard copy to hospitals throughout the United Kingdom. Personal copies are available by nominal subscription.

Neither the Editor or Directors of Lawrand Ltd are in any way responsible for the statements made or views expressed by the contributors.

All communications in respect of advertising quotations, obtaining a rate card and supplying all editorial communications and pictures to the Editor

at the PO Box address above. No part of this journal may be reproduced without prior permission from Lawrand Ltd. © 2021

Operating Theatre Journal is printed on paper sourced from Forest Stewardship Council (FSC) approved paper mills and is printed with vegetable based inks. All paper and ink waste is recycled.

Journal Printers: The Warwick Printing Co Ltd, Caswell Road, Leamington Spa, Warwickshire. CV31 1QD


AfPP has helped my career grow exponentially in terms of my knowledge,

my skills and my practice.

Nick, ODP and AfPP Member

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we’re passionate about supporting you and your career.

Membership of AfPP can help you develop your professional

skills, keep your knowledge up to date and acquire CPD hours.

You can access the latest thinking on perioperative practice,

network with other practitioners, and attend our regional study

days and annual conference at a reduced member rate. We’re always

on hand to provide you with specialist clinical support and advice.

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registered in England number 6035633. AfPP Ltd is a wholly owned subsidiary company, registered in England number

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Sustainable and fit-for-purpose OMFS training, BAOMS President pledges

MembershipAdvert_Half.indd 1 02/02/2021 15:02

British Association of Oral and Maxillofacial (BAOMS) Surgeons 2021 President Austen Smith is using his

Presidential Year to push for a more sustainable, shorter, fit-for-purpose and affordable training pathway for

an OMFS career.

“My aim is to reduce duplication and condense the acquisition of skills into a UK-wide, accessible and

consistent route to a career in OMFS,” the Sheffield Teaching Hospitals and Barnsley Hospital NHS Foundation

Trust-based OMFS Consultant said.

“Over 23 years of surgical practice in Sheffield and Barnsley I have come to appreciate how critical a good

training is in a challenging field of surgical care. I want to see straightforward, nationally applied and

sustainable training for those who are interested in and commit to this magical specialty,” he explained.

He remembers how much of a major life commitment, costly in tuition fees and time OMFS training was for

him: “I can remember being near-broke in the latter stages of my second degree and will always be grateful

to my local authority Kirklees for a student grant that at the time saved me – and also the bank of mum and

dad as with many students currently.”

Austen Smith says that historical barriers to improvements in the length of OMFS training have resulted in

expensive and overlong duplication of young clinicians’ education. He believes that some of the barriers to

change will now be removed because EU legislation will no longer affect medical and dental courses.

“BAOMS will encourage training bodies to see the sense and value in new proposals to streamline the overall

pathway from new graduate to OMFS consultant,” he said.

Austen T Smith, Consultant Oral &

Maxillofacial Surgeon, Sheffield &

Barnsley Hospitals

He is also committed to protect the interests of Fellows in Training, the BAOMS Associate Membership for junior OMFS trainees: “Junior colleagues

hold key roles in hospital OMFS departments across the UK. They are at an early stage in their careers, and a real change and improvement in the

training trajectory could make a real difference to them.”

Austen Smith plans to open what he has called a Heritage Hall that would recognise and celebrate the contribution all OMFS colleagues to

the specialty after their death: “This is not about the pre-eminent, well-published or those who’ve held high position, as it is so often. This is

about how we and families and friends record the contribution, life and achievements of clinicians working at every level who have given to the

development of OMFS in the UK,” he explained.

This initiative, and another to ensure the BAOMS website is rapidly updated with relevant news videos, is made possible with discretionary funds

available to BAOMS Presidents.

Austen Smith’s clinical work focuses primarily on head and neck cancer, reconstructive, maxillofacial trauma, laser and dentoalveolar surgery.

This is complemented by a wide range of specialty interests that include teaching and training and recruiting the next generation of surgeons.

“I don’t believe those committing to this critical NHS specialty should have to spend disproportionately in investing in their training. I want to see

a leaner, more efficient shape to OMFS training consistently applied across the UK, and that is what I have committed to initiate during my BAOMS

Presidency,” Austen Smith concluded.


Mediclean® Ultra Clean Ventilation with Continuous

Particle Monitoring (CPM)

The latest Mediclean® UCVs with CPM improve patient safety and surgical outcomes by providing unique monitoring feature

and automatic cleaning of surgical smoke and airborne particles.

Complanate (ceiling level) UCV

Complanate means, “to make level” or “to put into a single plane” which

describes perfectly how Mediclean® UCVs fit flush with the operating

theatre ceiling.

Air curtain technology

Mediclean® uses a unique air curtain technology to constrain the flow of

clean air within the clean zone and to separate it from entrainment by the

surrounding “dirty air” in the rest of the room.

No Side Screens, No Coanda Air Deflectors, No Protruding Enclosure

The diffuser surface is completely flush with the suspended ceiling,

without any protrusion from the UCV unit into the room. The air curtain

eliminates the requirement for side screens and coanda effect air flow

deflectors that would normally protrude below the ceiling. The clear

advantage is that Mediclean® does not obstruct the movement and

positioning of operating lights, medical pendants or medical imaging

equipment. It is easier for Designers to design ergonomic equipment

layouts, easier for staff to position equipment during surgery and damage

from collisions with the UCV side screens and air deflectors is eliminated.

Mediclean® makes “the Invisible Visible”!

Continuous Particle Monitoring (CPM)

Our patented Continuous Particle Monitoring (CPM) measures airborne particles in real-time and uses

simple visual alarms. Clinical staff can “see” when the air isn’t clean due to entrainment or surgical

smoke and can take steps to protect themselves and their Patients. It’s impossible to see clean air with

the naked eye, so CPM samples the air to accurately measure the number of particles present during

surgery and displays the results as visible signals.

Safer for Staff

Smoke from electro-surgery is known to be hazardous. It can contain as many as 72 harmful contaminants

including known carcinogens and intact viable DNA.

CPM detects harmful particles of smoke as well as dirty air. Mediclean® reacts with a visual warning of the risk to the surgical team and by

increasing the airflow to clear the smoke away from the clean zone, protecting surgeons and staff from inhaling smoke.

CPM supplements the annual UCV validation tests done in empty theatres to indicate that the UCV is working efficiently during real live operating

conditions.

Automatic Optimisation of Air Quality

When particles are detected, Mediclean® CPM systems automatically increase the airflow from the UCV to quickly flush the contamination

away from the safety-critical area, protecting both patients and surgical staff. The system automatically returns to normal operation when safe

operating conditions are restored.

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A £1.7M refurbishment of theatres at Whipps

Cross hospital in Leytonstone has created

a new state-of-the-art operating room with

clean air canopy, LED theatre lights and a

4-bed recovery room, all served by resilient

Bender Medical IT power systems.

Whipps Cross hospital is a large general

hospital and one of four major hospitals

operated by Barts Health NHS Trust; the others

are The Royal London, St Bartholomew’s,

and Newham. The Trust provides healthcare

services for 2.3 million east London residents.

On this particular Barts Health NHS Trust

project, Bender UK worked with Medical Air

Technology (MAT), which designed the theatre

and recovery room services. MAT provided a

full HTM 03-01 compliant critical ventilation,

controls and specialist equipment package,

including an ECO-flow ultraclean ventilation

canopy.

Bender UK designed and installed all the critical

care power and supplied and commissioned

Merivaara Q-FlowTM LED surgical lights and a

new CP924 glass theatre control panel.

Bender UK provides critical power, lights

and hygienic control panel for new

Operating Theatre at Whipps Cross Hospital

The distinctive circular Merivaara lights

work effectively with ECO-flow ultraclean

canopies, enabling an uninterrupted flow of

clean air over the operating table - protecting

the patient from airborne infection and

improving post-operative recovery rates. The

lights deliver market leading R9 99 and R13

99 colour rendering and offer unique shadow

reduction properties.

During the design phase, the team had to deal

with space constraints. Bender UK overcame

this by engineering a bespoke power solution

that delivered resilient Group 2 medical IT

power (IPS) and uninterruptible power (UPS)

that served the operating theatre and 4-bed

recovery room.

It incorporated split modular medical IT

Power, designed with remote transformers

and separate wall mounted distribution

boards installed local to the theatre. The

power system has both floor and wall mount

8kVA IPS units, incorporating EDS, 12 MCBs and

flush-mount fully programmable remote alarm

panel (MK243OS-11). A 20kVA 1:1 UPS rated

at 20 kVA for 60 minutes, including HTM 06

01:2017 compliant battery array, completed

the resilient critical power provision.

Inside the theatre, Bender installed a

CP924 theatre control panel with a remote

PLC interface box outside the area, which

means maintenance can be carried without

compromising theatre availability or infection

control.

The glass touchscreen is intuitive for clinical

staff to use, while delivering significant

benefits in terms of easy cleaning and infection

control. A 42-inch DICOM compliant PACS with

glass fascia, membrane keyboard and medical

PC was also installed.

MAT’s ECO-flow ultraclean ventilation (UCV)

system is a proven and effective way to clean

the air in operating theatres, dramatically

reducing the risks of surgical site infection

(SSI). When used in combination with preoperative,

intra-operative and post-operative

measures, UCV plays a critical role in the fight

against infection.

Inigo Contract Services Ltd was the main

contractor on the design and build project.

The original 1950s built two-storey annexe at

the hospital housed operating theatres 1 and

National ODP Day - 14th May 2021

Be sure to let us know how you and your team are

celebrating this year by sending us an email to:

admin@otjonline.com

We’ll share your information in our May issue.

If you would care to send photos and reviews of

your activities on the day, we’ll include in our

June issue.

2 on the first floor, with a plant room above.

An 18-week programme saw the team working

extraordinary hours to ensure the project was

delivered on time and to budget, to provide

urgently needed facilities for the hospital.

Glenn Reynolds led the project for Inigo

Contract Services. He explained: “The

location of the theatres in an annexe made

access to the working area easier, but we

were constrained by the fact that the ground

floor was still in daily use, and that meant

shutdowns of power or other services had

to be carefully timed so that they did not

interfere with clinical activity.

“Working on a live hospital site during the

pandemic presented other challenges, but

everyone on the project was conscious of

the important work we were undertaking to

support the NHS and rose to those challenges

to complete the project on schedule for

handover in December 2020.”

Rob Speight, Deputy Director of Estates

and Facilities at Whipps Cross Hospital,

commented: “We are always looking for better

and more efficient ways and technology to

help improve patient care and outcomes and

we are pleased to have collaborated with

Bender UK in providing these innovative

features as part of our service upgrades.

The project has been a great success and a

testament to the professionalism displayed by

Bender UK, MAT, Inigo Contract Services and

all of the companies involved in the project.”

Bender UK is the exclusive supplier of

Merivaara Q-Flow LED theatre lights for the

UK and Republic of Ireland, partnering with

MAT to deliver turnkey theatre solutions

incorporating UCV canopies.

For more information visit:

www.bender-uk.com/solutions/healthcare or

email: internalsales@bender-uk.com.

When responding to articles please quote ‘OTJ’


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Sheffield researchers to lead major study

seeking to understand what matters most

to patients with colitis and Crohn’s disease

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The Infection Prevention Society is pleased to have collaborated with

NHS England and NHS Improvement in developing this educational video

on managing the risk of COVID-19 in healthcare settings.

Hierarchy of Controls: how to keep yourself and others safe from

COVID-19 - to access the video see: http://bit.ly/managingcovidriskPR

The aim of the video is to translate national infection prevention

and control guidance into readily accessible information, enabling

healthcare staff to understand and put into action the right measures

to prevent transmission of COVID-19. The video is focused on the

Hierarchy of Controls, including engineering, administrative and PPE

controls, and how these need to be applied in healthcare settings to

protect both staff and patients from COVID-19. It uses animation to

convey the key principles underpinning the IPC guidance in a simple

but informative way.

Prof Jennie Wilson, IPS President said ‘Adhering infection prevention

and control guidance for COVID-19 is critical to assuring the safety of

both patients and staff but healthcare staff often have little time to

read long complex documents. This video is an ideal way for staff to

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Professor Alan Lobo (centre) and Professor Danny Hind (far right) outside the

Royal Hallamshire Hospital with nurses and practitioners from Sheffield’s

specialist inflammatory bowel centre

Sheffield Teaching Hospitals to lead £450,000 grant award that aims to

change the way healthcare services respond to the needs of those living

with inflammatory bowel disease

Researchers from Sheffield Teaching Hospitals NHS Foundation Trust are

to play a leading role in a major new study that aims to change the

way healthcare services respond to the needs of people living with

inflammatory bowel disease by putting the patient’s voice at the centre

of care.

The £450,000 grant award, which is being funded by the Health

Foundation’s Common Ambition programme, seeks to create

partnerships, led by people living with inflammatory bowel disease, to

co-design future services and improve care.

It is one of four national projects selected from over 350 national

applicants.

The research will be led by Professor Alan Lobo, Consultant

Gastroenterologist at Sheffield Teaching Hospitals in partnership with

the University of Sheffield and Crohn’s and Colitis UK.

It will build on previous research awards given to Professor Lobo and his

team at Sheffield’s inflammatory bowel disease centre that put patients

at the heart of decision-making.

The study evaluation will be led by Professor Dan Hind of the University

of Sheffield’s School of Health and Related Research, who are recognised

for their world leading health services research.

Advances in treatments of inflammatory bowel disease have been

rapid in the past few years, with more and more new drugs and

affordable therapies becoming available. This includes powerful drugs

that target the immune response and biosimilar drugs, newer versions

of original licensed biological drugs, that can be given to patients in

hospital through a drip or at home by injection pen. However, there

remain limitations in patients’ opportunities to express to healthcare

professionals what is important to them and to develop personalised

care.

During the three-year study, the team will actively engage with

lesser heard voices in the community, helped by independent charity

Voiceability, including those from ethnic minority backgrounds,

disadvantaged groups and women’s groups, to understand what matters

to them.

All 4,000 patients attending Sheffield’s specialist inflammatory bowel

centre will be invited to participate in a way that is accessible to them.

There will also be an app to deliver real time information from people

with inflammatory bowel disease to clinicians.

Professor Alan Lobo, Consultant Gastroenterologist at Sheffield Teaching

Hospitals NHS Foundation Trust and chief investigator of the study, said:

“This is a really exciting project which could represent a radical shift

in the way groups of healthcare services engage with patients. As one

of the largest inflammatory bowel disease centres in the country, this

is also excellent news #PSPP21 for Sheffield as we can recruit large numbers of

patients and engage with a huge and diverse population. We will be

communicating with all our patients about the study in due course, and

reaching out to lesser 5 CPD heard credits voices to further understand what matters

to them.”

Inflammatory bowel disease affects 300,000 people in the UK (or

roughly 1 in every 210 people). Crohn’s and colitis disease are the two

main forms of inflammatory bowel disease.



A simple solution for improving

communication in the operating theatre

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Smiths Medical Announces The ECRI

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Wireless Ambulatory Infusion System

Smiths Medical, a leading medical device manufacturer, announces the release of the

ECRI evaluation report for CADD®-Solis v4 with wireless communication Patient-Controlled

Analgesic (PCA) and epidural infusion pump.

ECRI is an independent non-profit organisation improving the safety, quality and costeffectiveness

of care across all healthcare settings worldwide (www.ecri.org). The report

highlights ECRI’s evaluation ratings, test results and purchasing recommendations for the

CADD®-Solis pump.

The CADD®-Solis v4 system is a continuation of Smiths Medical’s commitment to advance

patient care and help improve patient outcomes through leading-edge technology.

The CADD®-Solis pump maintains the advantages of an ambulatory pump for patient

mobility and provides a single system that effectively delivers IV PCA, epidural, peripheral

nerve blocks and subcutaneous from pump to patient.

For the hospital, the CADD®-Solis system is designed to enhance patient safety through

‘smart programming’ (use of medication safety software) and reduce the risk of tubing

misconnections, while providing a comprehensive and intuitive user experience for the

healthcare provider.

Glen Johnson, NordUK Senior Marketing Manager at Smiths Medical, says: “Smiths Medical

is committed to patient safety and adoption of smart infusion pumps.

The wireless bi-directional communication sets the foundation for integrating pain

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Bender UK expands with new business unit in Ireland

#PSPP21

Consultation

into regulation

of Anaesthesia

Associates critical to

delivering enhanced

patient care



5 CPD credits

Responding to the launch of

the Department of Health and

Social Care’s consultation on

the regulation of healthcare

professionals Professor Ravi

Mahajan, President of the Royal

College of Anaesthetists said:

“The Royal College of

Anaesthetists welcomes the

Department of Health and

Social Care’s consultation on

the regulation of healthcare

professionals.

A new Bender team has been formed in Ireland

to support increased demand for its products and

services in the region.

Bender Ireland is a business unit of Bender UK. The

UK team took over the management of the region in

2014, producing strong business performance ever

since.

We have called for the statutory

regulation of Anaesthesia

Associates Venue: Online for many years and

were pleased when the General

Registration: Member/Fellow £160, Worldwide, Anaesthetist Bender in Training/MTI Group has been Doctor renowned £120, Senior

Medical Council was appointed as for electrical safety technology since 1946 and is

the Fellows regulator. and Members Club £80, celebrating Non-members its 75th anniversary £215, Student this year. £40

Bender Ireland, in partnership with Mercury and

BAM Ireland, are providing all the specialist power

protection for the new Children’s Hospital, Dublin -

the largest medical project in Ireland for 20 years.

Chris’s team includes engineering, project

management and sales. Lesley Forward is the most

recent Bender Ireland appointment. As Business

Coordinator, Lesley is the main day-to-day contact

for all service clients and brings with her a wealth of

FM management experience..

Clinical Content Leads: Dr Haresh Mulchandani & Dr David Selwyn

Brian Coffey, Bender Ireland Project Manager said:

We believe this consultation is an The UK and Ireland team design, supply and install “Over the past twelve months we have provided

important step towards ensuring industrial and healthcare solutions incorporating critical support for our healthcare customers during

they A joint continue event with to provide the Centre high for Perioperative Bender technology. Care (CPOC), Their this turnkey one day hospital meeting projects will discuss the COVID pandemic and while these fast moving

quality, patient safety, care including as part of the a barriers include to delivering the safe design, perioperative commissioning, care and and strategies service on projects how to often present challenges, I am pleased to

multi-professional overcome them. team, led by a

consultant anaesthetist.

of medical IT power (IPS), uninterruptible power

supplies, Merivaara operating lights and tables,

say we have completed and met all schedule dates

as expected.”

Our aims are to build upon knowledge clinical and pendants, practice to theatre make systems, control processes panels and and PACS organisations Looking ahead the Bender Ireland team will continue

“As

safer.

we

Through

work to reduce

an understanding

the

of the consoles. science of patient safety, different perspectives and to expand their skills and local capabilities. The

elective surgery backlog, we

approaches, coupled with collaboration, Across education Northern & Ireland quality improvement and the Republic, programmes the we introduction hope of new products such as the CP9 24”

must reimagine the anaesthetic

to inspire delegates to make safety the Bender golden Ireland thread team of patient deliver care.

theatre control panel and the new PACS console

team and Anaesthesia Associates

entire projects from

further strengthen the ability to support medical

will become even more vital. start through to completion. The experienced team

support more than 100 NHS and private hospitals with professionals in Ireland. Both of these products have

Whilst The RCoA they will cannot make replace a donation their of £5 to Lifebox for every delegate attending this event.

technical advice, sales, installation and contractual already been selected for the latest theatre project

medical colleagues, they can and

annual 24/7 maintenance, rapid response call-out in Ulster and Musgrave Park Hospital in Belfast, due

do complement, and support,

and repair services.

to complete April 2021.

their work in service provision.

Merivaara operating tables, exclusively distributed

Chris Simmons, Country Manager, Bender Ireland

by Bender in Ireland, have been accepted onto

explains: “As a result of our efforts, Bender has

the HSE National Framework, ensuring a complete

seen substantial growth in Ireland over the past

clinical offering is available to all HSE customers.

decade and that looks set to continue, thanks to our

This framework has led to a noticeable increase in

excellent performance and strong relationships with

clinical trials of the operating tables and a rise in the

our customers.

number being purchased.

By becoming integrated within

the medical team, Anaesthesia

Associates, will help reduce

pressure on clinicians, thereby

helping to tackle fatigue and

burnout in the workforce and,

most importantly, ensuring

patients continue to receive safe,

timely care.

“We will be speaking to our

stakeholders and responding to

the consultation on the proposed

approach to introducing statutory

regulation. We encourage others

who will be affected by the

changes to do the same.”

THE

“With our growing customer base and support from

Gareth Brunton, Bender UK Managing Director, we

felt the time was right to establish Bender Ireland

and provide further investment locally to develop

a stronger presence here and to further improve

the speed of response and local specialist technical

knowledge.

“As a business unit, we have the autonomy to do

what is right for our customers, while having support

from Gareth and the team at Bender UK in Cumbria.”

The Bender Ireland team have worked on numerous

major projects. They upgraded operating theatres

at Beaumont Hospital with theatre control panels

and Merivaara Q-Flow LED operating lights. Based

on positive clinical feedback, Q-Flow operating

lights have since been installed across several

more hospitals in Ireland, with further installations

planned for 2021.

Demonstration stock for Q-Flow Operating lights and

the Grand Promerix Operating Table are available to

support theatre equipment purchasers and surgeons

who are keen to experience the award-winning

Merivaara product range before making a final

decision.

Currently, the main focus of the Bender Ireland

team is on healthcare, but the aim is to extend the

supply of electrical safety technology into industrial

markets including data centres, eMobility, process

and control applications.

For more information on the full range of Bender UK

visit www.bender-uk.com/solutions/healthcare.


Medical Air Technology (MAT) is the main contractor on Wansbeck

Hospital’s current refurbishment project, which sees the turnkey

upgrade of six operating theatres including recovery, clean corridor

and adjacent auxiliary areas. The theatres have been reconfigured for

better workflow, with new ventilation to HTM 03-01, medical gases,

electrical installation, doors, furniture, sanitaryware and finishes.

They will all be equipped with MAT’s flagship product, the ECO-flow

ultraclean ventilation (UCV) system, and a range of surgical equipment

from Bender UK including operating lights and theatre control panels.

Operated by the Northumbria Healthcare NHS Foundation Trust,

Wansbeck Hospital is a centre of excellence for planned and ongoing

care. It performs almost 7,000 operations every year, around half of

which are orthopaedic operations such as hip and knee replacements.

The refurbishment will provide the hospital with more ultraclean

operating theatres, enabling a wider range of surgery and improving

patient flow and other efficiencies.

Despite the pressures of working under the restraints of the coronavirus

pandemic, the project got off to a flying start. The phased delivery

programme is scheduled for completion in spring 2022, with Theatres 5

and 6 leading the way with expected handover in May 2021. The £5.5

million new facilities will further improve patient care and experience

at this already outstanding hospital.

Mr Scott Muller, Consultant Orthopaedic Surgeon and lead for the

project, says: “We have a highly skilled workforce who deliver

surgical care to people from across the region and beyond. With this

investment, our theatres will become a state-of-the art facility that

reflect the highest standards of care that our patients rightly expect.

This redevelopment will ensure the facility remains best in class

thereby cementing Wansbeck hospital as a major provider of elective

surgery for years to come.”

The MAT ECO-flow UCV System

The ECO-flow ultraclean ventilation system uses laminar airflow,

delivered via a canopy above the operating table and surgical team, to

create a clean zone around the patient. ‘Clean zone’ means it is free

from bacteria-carrying airborne particles, significantly reducing the

risk of surgical site infection (SSI). SSI occurs when a surgical incision

site becomes infected after a procedure. It is associated not only with

increased morbidity but also with substantial mortality and places a

massive clinical and financial burden on the NHS.

MAT WORKS WITH WANSBECK HOSPITAL TO

DELIVER £5.5M OPERATING THEATRE UPGRADE

MAT canopies are available in two standard models, depending on

the size of clean zone required. Wansbeck Hospital has selected the

ECO-flow 2.8m for Theatres 1-4, and the larger ECO-flow 3.2m for

Theatres 5-6. The theatre converts from general to ultraclean in under

an hour, allowing for greater flexibility of use. Ultraclean conditions

create the best environment for orthopaedic surgery and are specified

in HTM 03-01, Specialised Ventilation for Healthcare Premises.

A Specialist Contractor

MAT designs, manufactures and installs bespoke critical ventilation

systems and turnkey project solutions for new build and refurbishment

projects. As a specialist contractor with many years’ experience,

we are passionately committed to improving patient protection and

end-user safety in demanding clinical, research and drug production

arenas. We have extensive experience of working in live environments

and understand the challenges around delivering a project within an

operational scenario.

In addition, MAT FM provides a range of competitively priced and highly

effective service and maintenance packages for all core products and

turnkey solutions offered by MAT or other suppliers, ensuring that

equipment is maintained, serviced and validated correctly for optimum

performance.

Further information: Will Evans, 0844 871 2100

will.evans@medicalairtechnology.com

When responding please quote ‘OTJ’

NHS contact centre wins awards at two highly

acclaimed events in space of a week

NHS Business Services Authority’s (NHSBSA) Contact Centre has won

no less than three awards recently at the national Excellence Awards

organised by CCA Global, the professional customer services body.

NHSBSA won Gold for the Team of the Year Award category and Dan

Britton, Head of Customer Operations, won the Manager of the Year

Award. Dan Britton and Service Delivery Manager, Mark McMahon,

were also recognised as Members of the Year, for supporting other

organisations and sharing best practice in customer care. (19th March

2021)

The news follows another big success for NHSBSA’s contact centre which

won the ‘Contact Centre of the Year’ award at the European Contact

Centre and Customer Service Awards 2020 just earlier that week.

The CCA Excellence Awards recognise world-class professional

achievement in customer service and are judged by a panel of experts

from a range of sectors and specialisms, with final deliberation by a

fifty-strong peer judging committee.

NHSBSA, which has headquarters in Newcastle, was shortlisted for no

less than four awards by CCA Global this year. Manager of the Year (Head

of Customer Operations Dan Britton); Team of the Year; Outstanding

Homeworking Programme Award; and the Outstanding Team Award.

Brendan Brown, Director of Citizen Services, said: “It’s great to see the

outstanding efforts of our NHSBSA colleagues being acknowledged in so

many categories this year. I wish to praise everyone’s hard work and

amazing efforts, well done!”

Dan Britton, Head of Customer Operations, added: “I’m so proud

yet again of the recognition our teams are receiving through being

shortlisted for awards, and in this case a national award.”

CCA Chief Executive Anne Marie Forsyth said: “Many congratulations to

all the shortlisted entrants who truly represent the best in customer

service. Businesses in the CCA network have been working tirelessly

through incredibly challenging times to ensure they continue to provide

the best service possible for customers.”

“Many lessons have been learned and it is a real privilege to discover

the approaches taken to safeguard excellent practices, supporting

customers and employees through a significant period of uncertainty.”

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A stand-alone solution for prioritising

your surgical waiting list

To help hospitals and healthcare facilities overcome the challenges COVID-19

has brought, Getinge is presenting a new solution for prioritising the surgical

waiting list. Torin OptimalQ is built on well-proven capacity planning

functionality from Getinge’s OR Management solution, Torin, and works on

the simple logic of optimising surgery scheduling data.

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Pioneering £1.8m study to investigate if pregnancy success

rates improved by removing small fibroids in womb

• Researchers from Sheffield Teaching Hospitals NHS Foundation Trust

awarded £1.8m to assess if removing small fibroids and endometrial

polyps improves women’s chances of having a baby

• Study is the first to assess if there is clinical benefit in removing

fibroids and endometrial polyps, which are common in reproductiveage

women, in those with unexplained infertility

• Findings could help women make informed decisions as to whether

they should delay fertility to have these smaller fibroids and polyps

removed or leave them in place.

Fertility experts from Sheffield Teaching Hospitals NHS Foundation

Trust are to lead a pioneering study evaluating if removing smaller

fibroids and endometrial polyps improves women’s chances of a

successful pregnancy, and increases live birth rates, in those undergoing

treatments for infertility and recurrent miscarriages.

The multi-centre study, funded by the National Institute for Health

Research, which is to be run across 30 gynaecology and fertility

centres across the UK, will be the first to assess if removing fibroids

and endometrial polyps less than 3cm is an effective way to improve

women’s chances of having a baby.

Fibroids and endometrial polyps, or non-cancerous tumours of the

uterus, are very common, especially in reproductive-age women.

They are currently routinely diagnosed, treated and removed using an

internal investigation of the womb known as a hysteroscopy.

However, although these growths have long been linked to problems

associated with getting pregnant, there is limited clinical evidence to

demonstrate that their removal increases live birth rates and improves

fertility.

The findings of the £1.8m HELP Fertility? trial will help to determine

if smaller fibroids and endometrial polyps should be removed during

fertility treatment.

The grant award is the third successive multi-million pound grant

obtained by the team of gynaecologists and researchers based at

Sheffield Teaching Hospitals’ Jessop Wing in the past few years. The

research will be supported by the University of Sheffield’s Clinical

Research Trials Unit.

1,120 women are set to take part in the study, which is due to commence

on 1 April 2021.

Mr Mostafa Metwally, Chief Investigator and Consultant Gynaecologist

and Sub-specialist in Reproductive Medicine and Surgery at Sheffield

Teaching Hospitals NHS Foundation Trust, said: “We are delighted to be

leading this £2m study. Hysteroscopy is an optional additional treatment

offered to women with smaller fibroids and endometrial polyps as

part of their fertility treatment. Yet there is little clinical evidence to

support its use in those undergoing IVF or assisted conception.

Photo: Lead Research Nurse for the study Clare Pye and Chief Investigator

Mostafa Metwally at Jessop Fertility, the Assisted Conception Unit at

Sheffield Teaching Hospitals NHS Foundation Trust

“This gold standard study will provide women with much-needed

answers as to its benefit, enabling them to make an informed decision

as to whether they should delay fertility treatment to have these

smaller fibroids and polyps removed or leave them in place. As well as

demonstrating the clear benefit of hysteroscopy as an optional add-on

fertility treatment, we will also assess if there is a potential negative

impact on women’s fertility of hysteroscopy, which some women find

invasive and painful.”

The team, who recently demonstrated that the endometrial scratch did

not improve live birth rates in women undergoing IVF for the first time,

said the consecutive grant award underpinned their reputation as the

UK’s premiere research centre for reproductive health studies aiming to

improve the care of women who plan, provide or receive infertility care

and treatment from the NHS.

Clare Pye, Lead Research Nurse for the study at Sheffield Teaching

Hospitals NHS Foundation Trust, said: “All our research is designed

with patients in mind, so we are delighted to be at the forefront of

yet another major funding award which will provide women with the

high quality evidence they need to make informed decisions about their

care when they plan and receive fertility treatment.”

Around 20 to 40 percent of women with unexplained infertility are

found to have fibroids and around 15 to 20 percent endometrial polyps.

The study is expected to take around two and a half years, with initial

findings due to be published in summer 2025.


The Hospital of the Future

As a recent paper by Iqrar Ahmed examines, the concept of the Hospital

of the Future (HoF) has gained much traction in recent years. And,

as the global pandemic has highlighted significant further strains on

the acute healthcare setting, we’re seeing a collective attention on

resuming business “better than usual(1)”. This means enhancing the

way in which healthcare services are provided to patients, while also

optimising resource and protecting frontline workers.

There is an increased body of

evidence that noise can have

a very detrimental impact on

an individual’s performance

and wellbeing, from a lack of

concentration to stress. Within

an office environment, research

suggests workers can be up to

66% less productive when exposed

to just one nearby conversation.

Within a high pressure

environment such as an OR, the

implications of such noise related

stress are even more significant.

With staff under inordinate

amounts of pressure and a

focus on mental wellbeing, it is

essential to grasp any opportunity

to minimise stress; a challenge

that wireless communication is

proven to address(4).

Thinking beyond Boundaries

Tom Downes CEO Quail Digital

Wireless communication plays an important role in the HoF, as a means

of connecting people, processes, technology and premises in a seamless

communication highway. The ultimate aim, as Tom Downes, CEO, Quail

Digital says, is to provide the best possible healthcare to patients; and

balanced, safe and productive working conditions to hospital staff,

while operating in an efficient, cost-effective and sustainable manner.

Lessons from COVID

The early days of the pandemic rapidly highlighted the challenges

frontline workers faced as a result of PPE. Amongst those was the

reduced capability to communicate effectively.

According to Dr. Ziv Tsafrir(2), “Protective suits afford no ability to

communicate, so people resort to using sign language. When that

doesn’t work, fewer members of staff wear the suits, which risks

exposing them to the virus.” In other cases, front-line staff had to

physically leave their unit to resolve a communication issue, resulting

in wasted PPE and a loss of time to care.

Clearly, finding a way of improving communication without compromising

either healthcare workers’ own health and safety, or impacting patient

care, has been critical and will remain so as part of the NHS’ future

preparedness plans.

As Associate Professor Andrew Holden, Director of Northern Region

Interventional Radiology Service, Auckland City Hospital, New Zealand,

adds: “During the initial months of the Covid-19 global pandemic, our

department needed a communications system that not only enabled

clear communication but was also easily cleaned and portable.

“As an Interventional Radiology department, we also needed to enable

clear and safe communication between the designated ‘clean’ and

‘contaminated’ staff during operations on patients who are either

confirmed or suspect COVID-19 positive. Digital headsets solved

the immediate communications barriers we encountered, as well as

enhancing communication in our operation rooms and enabling us to

continue treating patients with the latest in innovative technologies.”

Care Beyond COVID

There is strong evidence pointing to the importance of effective

communication and teamwork in patient safety more generally(3).

Deficiencies in teamwork and communication contribute to adverse

events, highlighting that non-technical skills are as important as

technical surgical skills in preventing adverse patient outcomes.

Moreover, it is clear that such pressures on frontline staff are set to

remain high throughout most of 2021 as a result of the pandemic. This

is evidenced by new statistics from NHS England which show that more

than 200,000 patients across the country are now waiting more than

a year to receive hospital treatment, and that the number of people

waiting over a year for their treatment is now 150 times higher than

in 2019.

Within the concept of the Hospital of the Future, it is also important

to think beyond the physical boundary of the hospital site. As the NHS

moves towards the introduction of Integrated Care Systems, the HoF

concept might also involve home- or remote-care facilities, as well as

having the capability to connect multi-disciplinary teams regardless of

their physical location.

As Professor Holden explains, wireless communication is a great enabler

for this. “Before the Covid-19 global pandemic, our department often

hosted international teams with new devices, and trials,” he says.

“Now, with intense travel restrictions into New Zealand, we have begun

to utilise streaming capabilities to enable our patients to still have

access to the latest in advanced technologies. Digital communication

has been seamlessly integrated into our broadcasting system and we

are able to communicate with not only our own staff onsite, but also

with company representatives across the globe.”

Conclusion

As we begin to reconceive what the optimal care pathway might be in

a post-COVID – or always-present COVID – world, managing scarce acute

resources efficiently and sustainably is key, whilst also safeguarding

frontline workers and providing the best possible healthcare to patients.

Technology, such as digital and wireless communication, will play a

fundamental role in achieving this objective.

1. https://www.nuffieldtrust.org.uk/files/2020-06/nhs-returning-tonormal-nigeledwards-nuffield-trust.pdf

2. https://hmcisrael.com/doctor/ziv-tsafrir/

3. Gawande AA, Zinner MJ, Studdert DM, Brennan TA. Analysis of errors

reported by surgeons at three teaching hospitals. Surgery. 2003;

133:614–21. https://doi.org/10.1067/msy.2003.169 PMID: 12796727

4. Lingard L, Espin S, Whyte S, Regehr G, Baker G, Reznick R, et al.

Communication failures in the operating room: an observational

classification of recurrent types and effects. Qual Saf Health Care.

2004; 13:330–4. https://doi.org/10.1136/qshc.2003.008425 PMID:

15465935


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From bomb disposal to pioneering healthcare role

• Career change has led to a new healthcare role and the first of its

kind in a national healthcare group

• First in the country to have studies funded by an independent

healthcare advisor - qualification achieved via innovative University

of Plymouth course

• “He excelled in the programme… We hope that he is the first of many

ex-service personnel to study with us” (University of Plymouth)

• First to achieve new professional role without a previous degree, and

one of a very few with a military background

• “We saw this as a long term project that encouraged the development

of staff, but also allowed us to give greater flexibility in our hospital”

(Hospital Director)

A healthcare professional who changed career in the RAF from bomb

disposal to operating theatre practitioner, has taken on one of the

newest professions in the health sector.

James Potter from Practice Plus Group Hospital Plymouth (formerly

Peninsula NHS Treatment Centre) has recently qualified as a physician

associate (PA) – one of the newest health professions making him a

pioneer in this role and the first PA employed in the nationwide Practice

Plus Group, the first in the country to have their studies funded by

an independent healthcare provider, the first to study without a first

degree and one of just a handful to come from a military background.

While the role of physician associate is new in the UK, it is wellestablished

in other countries, such as the United States. Physician

associates are healthcare professionals who, while not doctors, work

to the medical model of clinical diagnosis, with the attitudes, skills

and knowledge base to deliver holistic care and treatment within the

general care team under defined levels of supervision. The role is

designed to supplement the medical workforce.

For James, the decision to follow a career in healthcare followed his

final tour of duty in Afghanistan in bomb disposal with the RAF. He

said: “In 2010 I returned from Afghanistan and felt that, after 10 years

in bomb disposal and with a wife and young family, I should change

direction so I decided to pursue a career in the RAF in healthcare.”

James trained as an operating department practitioner (ODP) and

worked in that area in the RAF in Peterborough. When the hospital

closed he was seconded to the Navy and was sent to practise at

Derriford Hospital in Plymouth. In 2017 he met with the theatre

manager at Practice Plus Group Hospital Plymouth and was offered a

job. He has been with the hospital ever since.

While with the hospital James had the opportunity to study to

become a PA on the University of Plymouth’s MSc Physician Associates

Studies programme. James was supported and funded in his studies

by Practice Plus Group. Mark White, Hospital Director at Practice Plus

Group Hospital Plymouth commented: “We were delighted to fund

James’s course. We saw this as a long term project that encouraged

the development of staff, but also allowed us to give greater flexibility

in our hospital. It is part of our commitment to ensuring our patients

have access to the best care available delivered by highly qualified and

proficient healthcare professionals, which is why we have led the way

in this instance.”

DEADLINE APPROACHING

The 2021 HealthWatch student prize

competition for critical appraisal of clinical

research protocols is underway!

Since 2002, HealthWatch has presented more

than £20,000 in prizes, and this year it could

be your turn to win up to £500. You now have

just three weeks to write, refine and perfect

your entry, but don’t leave it until the last

minute!

Cash prizes

There are two first prizes of £500 each,

one for medical and dental students and

one for students of nursing, midwifery and

professions allied to medicine. Up to five

runner-up prizes of £100 will be awarded

in each category. Winners will be invited

to attend the HealthWatch Annual General

James Potter, who is the first physician associate to have graduated

without a first degree and with financial support from an independent

sector healthcare provider Picture credit: University of Plymouth

For James it was the ideal opportunity to stretch himself and develop

his career. He said: “I loved being an ODP in theatres and would have

happily stayed there my entire working life. I just wanted to see if I

could progress. Live on the edge of the comfort bubble, so to speak,

instead of languishing in the centre of it risk-free. I wouldn’t have been

happy without at least giving it a go.”

Dr. Adele Hill, Associate Dean – Teaching and Learning Faculty of Health

and PA Programme Lead at the University of Plymouth, added, added:

“James was an ODP prior to studying with us, and though he doesn’t fit

the standard entry criteria for the programme, we saw that his skills

and his approach to medicine would make him a great fit. I am very

happy to say that James exceeded all expectations from day one. He

excelled in the programme, and went out of his way to support other

students and promote the role. We hope that he is the first of many exservice

personnel to study with us.”

She continued: “The Physician Associate programme allows graduates

and those with significant healthcare experience to work as part of

the multi-disciplinary team to support patient care and provide

clinical continuity. This non-traditional route into healthcare allows us

to support diversification of the NHS workforce, and at Plymouth we

actively seek to support students from all walks of life and backgrounds

who show they have the skills, knowledge, and aptitude to work in this

challenging and rewarding role.”

James now plays a vital role at the hospital, mainly in the Outpatient

Department where he operates between anaesthetists and nurses. He

is the resuscitation lead for the hospital and is involved in scheduling.

As a new role it is evolving every day.

www.plymouthpeninsulahospital.co.uk

HealthWatch Student Prize Competition 2021

Meeting in October to receive their prizes. If

for any reason large gatherings or travel are

restricted, the AGM may be held virtually, in

which case prize-winners will be invited to

attend remotely.

Winners can also add to their CV the honour

of having received a national award — which

could give the edge in a competitive post-

Covid jobs market.

We are grateful to the Royal College of

Surgeons of England for their generous support

of this year’s competition.

How to enter

The competition consists of four hypothetical

research protocols: your task is to rank the

protocols in order from that most likely to

provide a reliable answer to the stated aims of


the trial to that least likely to do so. You then

have to explain your ranking in no more than

600 words.

Please share with your fellow students,

organisations, colleges, universities.

Your entry must be received by 23:59 BST on

Friday 30 April 2021. Entries received after

that time will not be considered.

Find out more and enter here.

The full terms and conditions, with the

competition protocols for you to read, can be

found here.

Free student membership

Whether you enter the competition or not, if

you are a full-time student, please consider

taking advantage of our offer of free Student

Membership of HealthWatch.



Discovering the many more pages available online @ www.otjonline.com

THE SOUTH WEST CANCER ALLIANCE’S MOVES TOWARDS ERADICATION

OF ‘TRUS’ PROSTATE CANCER BIOPSY

Bristol Urological Institute at

Southmead Hospital eradicates all

transrectal biopsies in favour of

the latest method of transperineal

prostate cancer diagnosis

As part of a national campaign

(#TRexit) to completely remove

transrectal (TRUS) prostate

biopsies from the prostate

cancer pathway, the South

West of England has, during

2020, widely adopted the

PrecisionPoint Transperineal

Access System, which enables

freehand transperineal targeted

and systematic prostate biopsies

to be conducted under a local

anaesthetic in an outpatient

setting.

Since January 2020, Mr Stefanos

Bolomytis and Professor Raj

Persad, Consultant Urologists

at North Bristol NHS Trust, and

Mr Angus Maccormick, Somerset

NHS Foundation Trust, have

established a regional service

for the roll-out of transperineal

biopsies under local anaesthetic

(LA TP), with the initiative

supported and part-funded by

the South West Cancer Alliance’s

regional fund.

To date, 40 consultants and

clinical nurse specialists across

the region have been trained,

with outcomes including an

overall cancer detection rate

of 60.7%, significantly reduced

incidence of sepsis, as well as

total theatre time and overall cost

savings. Indeed, initial audit data

suggests theatre time savings of

450 hours and the potential to

achieve significant income and

resource benefits compared the

traditional TRUS method, are

readily achievable.

Professor Persad comments: “Our

data highlights the clear benefits

of LA TP over TRUS biopsy

methods, which include 0% sepsis

from the biopsies undertaken at

Southmead Hospital and improved

cancer detection. “Traditional

prostate biopsies involve using

a transrectal probe. We know

this would put some men off the

procedure. This is a thing of the

past at Southmead where biopsies

are now undertaken virtually

painlessly through the ‘perineum’.

“Moving biopsies out of the

operating theatre and into nurseled

local outpatient clinics also

frees up theatre time.”

Mr Stefanos Bolomytis adds: “The

evidence is clear: LA TP has a

vastly positive impact on both

patient experience and hospital

resources.”

“Along with improved accuracy

and reduced risk of infection, we

are working with scientists at the

University of Bristol to develop a

biopsy technique to surpass others

in accuracy, in turn reducing the

need for unnecessary biopsies.”

The TRexit initiative aims to

change the existing paradigm

of outpatient prostate cancer

diagnostics for transrectal

prostate biopsies to transperineal

biopsies. The initiative is currently

backed by leading urologists from

around the country, as well as

Prostate Cancer UK and the

British Association of Urological

Nurses (BAUN).

Since January 2019, when

Mr Bolomytis and Professor

Persad first started using the

PrecisionPoint Transperineal

Access System at the Bristol

Urological Institute, the team has

carried out 1100 LA TP biopsies.

Beatriz Mora is a Surgical Care

Practitioner at the Bristol

Urological Institute at Southmead

Hospital, who has undertaken

120 of these LA TP biopsies

during 2020. She explains: “My

role is both an interesting and

evolutionary one. I work in

clinical practice as a member of

the extended surgical team and

perform surgical intervention,

pre-operative care and postoperative

care under the direction

and supervision of a Consultant

surgeon.

It’s been a privilege to have the

opportunity to enhance patient

care and support the department

in maintaining our prostate cancer

services through LA TP during

the COVID-19 pandemic and lay a

foundation for a better prostate

cancer pathway moving forward.”

The South West Cancer

Alliances are made up of the

Peninsula Alliance covering

Devon and Cornwall and the

Somerset, Wiltshire, Avon and

Gloucestershire Alliance who aim

to have fully eradicated TRUS

biopsies by the end of the year,

with adoption of LA TP in all 13

Acute Trusts.

Sarah-Jane Davies, Programme

Manager at Peninsula Cancer

Alliance, who has supported the

adoption of the regional LA TP

service across the south-west

region, concludes: “The significant

benefits that transperineal

biopsies offer over TRUS have

been recognised for some time.

The challenge has been to adopt

them within an outpatient setting,

something that is now achievable

with the latest PrecisionPoint

methodology. We are delighted of

the progress the south-west has

made in making this technology

available to patients, healthcare

professionals and the local

healthcare economy.”


Assuring Sterility in Surgical Instruments Reprocessing

By Adebusola Owokole, Founder/President, The Operating Room Global (TORG).

https://www.operatingroomissues.org/

March, 2021

OVERVIEW: The delivery of sterile surgical instruments for use in

patient care depends not only on the effectiveness of the sterilization

process but also on the unit design, decontamination, disassembling

and packaging of the device, loading the sterilizer, monitoring, sterilant

quality and quantity, and the appropriateness of the cycle for the load

contents, and other aspects of device reprocessing. Sterility assurance

level (SAL) is the probability that a single microbe would remain on

an instrument after sterilization and is a cornerstone of a successful

infection prevention program. An effective sterilization protocol will

help ensure the delivery of safe care.

CLEANING: The first critical step to sterility assurance in reprocessing

is cleaning. Before instruments can be sterilized, they must be free of

bioburden and foreign material i.e., organic residue and inorganic salts

that interfere with the sterilization process by acting as a barrier to the

sterilization agent. Bioburden and debris can impede the sterilant from

reaching the surface. If cement is discovered on a surgical instrument

that has been reprocessed, removing the cement can expose a surface

that steam did not reach, and viable microorganisms could exist.

Several types of automated mechanical cleaning machines e.g., utensil

washer-sanitizer, ultrasonic cleaner, washer-sterilizer, dishwasher,

washer-disinfector may facilitate cleaning and decontamination of most

items. This increases productivity, improves cleaning effectiveness,

and decreases worker exposure to blood and body fluids. Delicate and

intricate objects and heat- or moisture-sensitive articles may require

careful cleaning by hand.

STERILIZATION CYCLE VERIFICATION: Sterilization process is verified

by running three consecutive empty steam cycles with a biological and

chemical indicator in an appropriate test package or tray, or with a

Bowie-Dick test in a pre-vacuum steam sterilizer. Each type of steam

cycle used for sterilization (e.g., vacuum-assisted, gravity) is tested

separately. The sterilizer is not put back into use until all biological

indicators are negative and chemical indicators show a correct endpoint

response. Once the cycle is complete, physical monitors of

time, temperature and pressure provide a real-time evaluation of the

sterilization process.

PHYSICAL FACILITIES: The central processing area(s) ideally should

be divided into at least three areas: decontamination, packaging,

and sterilization and storage. Physical barriers should separate the

decontamination area from the other sections to contain contamination

on used items. The recommended airflow pattern should contain

contaminates within the decontamination area and minimize the flow

of contaminates to the clean areas. The sterile storage area should be

a limited access area with a controlled temperature (may be as high as

75°F) and relative humidity (30-60% in all works areas except sterile

storage, where the relative humidity should not exceed 70%).

PACKAGE INTEGRITY: Package integrity should be verified after

the sterilization process, before instruments are stored, and again

immediately before opening the package for use. Once the sterilization

cycle is complete and the physical monitors have been verified, surgical

instruments should be allowed to cool and dry. If packages contain

moisture externally or internally after sterilization and appropriate

cooling, they should be considered contaminated. In addition to

moisture, packages should also be inspected for damage (e.g., tears,

stains, or improper seals). If such packs are found, they should be

reprocessed.

PACKAGING MATERIALS: There are several choices in methods to

maintain sterility of surgical instruments, including rigid containers,

peel-open pouches (e.g., self-sealed or heat-sealed plastic and paper

pouches), roll stock or reels (i.e., paper-plastic combinations of tubing

designed to allow the user to cut and seal the ends to form a pouch)

and sterilization wraps (woven and nonwoven). The packaging material

must allow penetration of the sterilant, provide protection against

contact contamination during handling, provide an effective barrier

to microbial penetration, and maintain the sterility of the processed

item after sterilization. In central processing, double wrapping can be

done sequentially or non-sequentially (i.e., simultaneous wrapping).

Wrapping should be done in such a manner to avoid tenting and gapping.

LOADING: Loading procedures must allow for free circulation of steam

(or another sterilant) around each item. There are several important

basic principles for loading a sterilizer: allow for proper sterilant

circulation; perforated trays should be placed so the tray is parallel

to the shelf; nonperforated containers should be placed on their edge

(e.g., basins); small items should be loosely placed in wire baskets; and

peel packs should be placed on edge in perforated or mesh bottom

racks or baskets.

STORAGE AND HANDLING: Safe storage times for sterile packs vary

with the porosity of the wrapper and storage conditions (e.g., open

versus closed cabinets). Heat-sealed, plastic peel-down pouches and

wrapped packs sealed in 3-mil (3/1000 inch) polyethylene overwrap

have been reported to be sterile for as long as 9 months after

sterilization. Supplies wrapped in double-thickness muslin comprising

four layers, or equivalent, remain sterile for at least 30 days. Any item

that has been sterilized should not be used after the expiration date has

been exceeded or if the sterilized package is wet, torn, or punctured.

Aseptic technique is used to prevent contamination following the

sterilization process. Sterile supplies should be stored far enough from

the floor (8 to 10 inches), the ceiling (5 inches unless near a sprinkler

head [18 inches]), and the outside walls (2 inches) to allow for adequate

air circulation, ease of cleaning, and compliance with local fire codes.

Sterile supplies should not be stored under sinks or in other locations

where they can become wet. Closed or covered cabinets are ideal but

open shelving may be used for storage. Any package that has fallen

or been dropped on the floor must be inspected for damage to the

packaging and contents (if the items are breakable). If the package is

heat-sealed in impervious plastic and the seal is still intact, the package

should be considered not contaminated. If undamaged, items packaged

in plastic need not be reprocessed.

BIOLOGICAL INDICATOR TESTING: The biological indicator (BI) test, the

most widely accepted method for monitoring steam sterilization, also

known as the spore test, provides a direct assessment of the sterilizer’s

lethality by killing highly resistant bacterial spores. Note that BIs only

test one aspect of instrument reprocessing. Biological indicators are

recognized by most authorities as being closest to the ideal monitors of

the sterilization process they measure the sterilization process directly

by using the most resistant microorganisms i.e., Bacillus spores, and

not by merely testing the physical and chemical conditions necessary

for sterilization.

CHEMICAL INDICATOR TESTING: Chemical indicators are convenient,

are inexpensive, and indicate that the item has been exposed to the

sterilization process. Chemical indicators are affixed on the outside

of each pack to show that the package has been processed through a

sterilization cycle, but these indicators do not prove sterilization has

been achieved. Preferably, a chemical indicator also should be placed

on the inside of each pack to verify sterilant penetration. Chemical

indicators usually are either heat-or chemical-sensitive inks that change

colour when one or more sterilization parameters (e.g., steam-time,

temperature, and/or saturated steam; ETO-time, temperature, relative

humidity and/or ETO concentration) are present. An air-removal test

(Bowie-Dick Test) must be performed daily in an empty dynamic-airremoval

sterilizer (e.g., pre-vacuum steam sterilizer) to ensure air

removal.

CONCLUSION

Sterility assurance practices require a comprehensive program that

ensures operator competence and proper methods of cleaning and

wrapping instruments, loading the sterilizer, operating the sterilizer,

and monitoring of the entire process. Together, these methods will

provide sterility assurance and peace of mind regarding reprocessed

instruments.

REFERENCES

1. van Doornmalen J, Kopinga K. Review of surface steam sterilization for validation purposes.

Am J Infec Control. 2008;36:86–92. Accessed 10th October, 2020.

2. Dion M, Parker W. Steam sterilization principles. Available at: www.ispe.gr.jp/ISPE/07_

public/pdf/201504_en.pdf.

3. Seavey R. High-level disinfection, sterilization, and antisepsis: current issues in

reprocessing medical and surgical instruments. Am J Infec Control. 2013;41:S111–S117.

4. Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic

Infectious Diseases (NCEZID), Division of Healthcare Quality Promotion (DHQP) Sterilizing

Practices: Guideline for Disinfection and Sterilization in Healthcare Facilities (2008).

Accessed 12th October, 2020.

5. Kelli C. Mack, and Daniel A. Savett (2016). Assurance in Dental Instrument Reprocessing.

Accessed 15th October, 2020.


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83 AUDIT REPORT Waitematā District Health Board Annual Report 2018/19


How can Civility in the Operating Theatre be Improved to Enhance Patient Safety?

By Amy L. Whitebrook ODP

Introduction

The operating theatre is a physically isolated environment in which

multidisciplinary practitioners must collaborate to solve high risk

and time-critical problems, demonstrating effective team working

as a key determinant of safety and efficiency (Coe and Gould, 2008).

Despite this, the present research identifies a pervasive issue with

incivility amongst professionals. Bullying in healthcare has been widely

examined, however, incivility is characterised by lower frequency

and intensity (Bambi et al., 2017), and therefore less explicitly

recognisable. Typically, incivility is defined as expressions of disruptive

or destructive behaviour, behaviours with ambiguous intent that yield

negatives outcomes, veiled actions disguised as civility, or the lack

of action including ignorance and isolation (DeMarco, Fawcett and

Mazzawi, 2018). Many formal definitions and listed examples have been

assimilated but are frequently too narrow to encapsulate the breadth

of the concept. As such, any action that undermines a practitioner’s

ability to provide patient care, excluding those who are advocating

for the patient or challenging the system, can be considered uncivil if

cognitively appraised as such (Villafranca et al., 2017). This behaviour

impacts the reputation of the National Health Service (NHS), as the

public’s trust in their practitioner’s proficiency is safeguarded by

displays of prosocial behaviour (Villafranca et al., 2019).

Primarily, eliminating workplace incivility upholds the Universal

Declaration of Human Rights (United Nations, 1948, p. 4-26) articles;

‘(1) recognition of the inherent dignity in all people’, ‘(3) freedom from

discrimination and arbitrary invasions of privacy’, ‘(5) freedom from

degrading treatment’, and ‘(12) freedom from attacks upon honour and

reputation’. However, due to the public-facing nature of healthcare,

incivility transcends the establishment’s responsibility to protect

employees by systemically affecting the patient experience. The human

factors approach adopted from the aviation industry has become

extensively accepted in healthcare and addresses how the individual,

the task, and the environment, intertwine to impact patient outcomes

(Timmons et al., 2015). As such, the review critically examines how

the published literature links practitioners as targets of uncivil actions

incurring psychological harm and depleted mental energy (Clark and

Kenski, 2017) and the escalating probability of conducting iatrogenic

mistakes (Riskin et al., 2015), failing to sustain patient care standards

and inducing a risk of harm or death. To then integrate the fragmented

knowledge already in the public domain, the review subsequently

provides a comprehensive proposal in strategies to improve operating

department civility, specially tailored to the underrepresented role of

the operating department practitioner (ODP), by formulating actionable

recommendations using evidence-based practice.

Prevalence, Sources, and Targets of Incivility

Primary experimental research begins by assessing the prevalence

of incivility in healthcare, which provides the foundation for further

investigations. Bradley et al. (2015) explored doctor’s experiences as

targets of ‘rude, dismissive and aggressive’ communications acted out

by fellow staff members across three NHS trusts. The survey found

that 31% of respondents felt subjected to incivility multiple times per

week, with 49% of these communications originating from adjunct

departments. Likewise, a similar retrospective questionnaire by

Klingberg et al. (2018) measured 77 emergency department physicians’

experiences of in-house incivility, with 36% reporting exposure once

a month, 26% once a quarter, and 20% once a year. Of these, 62% of

respondents defined the source as being from another division during

multidisciplinary consultations or referrals. As the operating room

is a central point of contact for many specialities and pathways, the

findings indicate that the increased amount of wider communication

needed may pertain to higher incivility levels.

A more recent study by Villafranca et al. (2019) asked 134 perioperative

organisations to distribute a questionnaire to a range of anaesthetists,

surgeons, ODPs, theatre nurses, and medical students, exploring

perceived exposure to uncivil actions from colleagues. Questions

were grouped into four domains and a Likert scale categorised replies

by frequency. The results revealed a substantial 97% of respondents

suffered or witnessed disruptive behaviour at least once a year.

However, opposing the findings of both Bradley et al. (2015) and

Klingberg et al. (2018), Villafranca et al. (2019) categorised the types of

disruptive behaviour in descending order as undirected, in-group, outgroup,

and personal. Furthering this theme, a survey by Coe and Gould

(2008) sent to a diverse spectrum of surgeons, theatre nurses, and ODPs

(Part One)

in 37 NHS surgical departments, identified 69% of all incivility as being

instigated by consultant surgeons. As patient awareness of the theatre

environment is the most shielded, reduced perceived accountability of

professional conduct could be presumed (Coe and Gould, 2008). Thus,

the prevalence of increased in-group incivility may be specific to the

operating department itself.

Another premise within the literature is to identify common

targets of uncivil actions. Survey results by Villafranca et al. (2019)

correlated respondent’s socio-demographic information relating the

characteristics of female, young, non-heterosexual, inexperienced, a

nurse by profession, or working in a privately funded clinic, with a

higher level of perceived exposure to incivility. Only 17% of institutions

approached responded, yet this equated to a large sample size of 7,465

individuals. Notably, many of these traits are known to be exposed to

marginalisation in general society (Villafranca et al., 2019), therefore, a

correlation could equally be due to an increasingly susceptible cognitive

appraisal of incivility. Furthermore, it is theorised that roles within the

multidisciplinary team are not explicitly understood; nurses and ODPs

believe their priority is to advocate for the patient, yet surgeons believe

that their goal is to care for them (Coe and Gould, 2008). The unique

and diverse structure of subsequent in-groups within the theatre team

is evidenced to be an interconnected rationale for the increased rate of

incivility, requiring further exploration of associated impacts.

Reasons uncovered for expressing incivility have been associated with

power demonstrations or to unload stress (Klingberg et al., 2018). The

doctors exposed to uncivil exchanges identified by Bradley et al. (2015)

were juniors in 43%, registrars in 38%, and consultants in just 18% of

cases. Comparably, the main targets of disruptive behaviours in the

operating theatre as identified by Keller et al. (2019) were registrars

or scrub practitioners. The research both indicates seniority as a

protective characteristic against enduring uncivil actions and presents

a hierarchical pattern of initiation and exposure (Bradley et al., 2015).

The task of surgery means that the most complex and demanding

responsibilities naturally fall to the surgeon, therefore, envisioning a

disconnection of the professional process from interpersonal conduct

may be the key to creating harmony within the team structure.

Causes of uncivil communications are also a common area of focus

within the body of published research, with Coe and Gould (2008)

identifying them as the over-running of operations, changes to the order

of the operating lists, and lack of staff and equipment. Endorsing Coe

and Gould (2008) but reducing convenience sampling and self-reporting

bias, an observational investigation by Keller et al. (2019) monitored

operating theatre team communications over 137 elective abdominal

surgeries, in which 340 tense exchanges were witnessed. This equated

to 2.48 per operation, however, varied by 24.01% depending on the lead

surgeon. The main trigger of these unpleasantries was largely found

to be due to coordination problems in 72% of incidences. However,

causation is not determined by the authors’ findings, as verbal tensions

could as credibly be the trigger for, rather than the result of, poor

handling of organisational issues. Supporting this concept, a simulated

emergency major haemorrhage scenario by Katz et al. (2019) assigned

anesthesiology trainees to either an experimental or control group of a

rude or a neutral surgeon, respectively. Independent anesthesiologists

then scored the trainees, yet neither were covertly informed of the

purpose of the study. The findings identified that 91.2% of trainees in

the control group performed at the level expected of them, compared

to just 63.6% in the experimental group. Binary logistic regression

discovered incivility to be the only item that negatively predicted

poorer participant performance. Therefore, the authors were able

to definitively demonstrate a direct line of causality. However, when

contrasted with the real-life scenario used by Keller et al. (2019),

participants of the study by Katz et al. (2019) had no previous working

relationship, which could have arguably skewed the data set.

On reflection of this primary survey of the evidence, a common tangent

found was that surgeons are often held accountable for a large extent of

the incivility in operating theatres. This was not unforeseen, yet being

based largely on survey data, generalisability is poor. Although it is

claimed that the surgical profession attracts individuals with an intense

persona (Page, 2011), to blanket an entire vocation with a distinct

personality is unwarranted. Fundamental attribution error argues

that people psychologically underestimate situational reasonings for

behaviour while exaggerating personality-based explanations (Klein,


2017), which could give a differing dynamic to how such findings are

analysed. Likewise, the results are reliant on the respondent’s memory

recall and subjective interpretation of events. Nonetheless, incivility’s

existence is bound to human perceptual processing (Kerber et al.,

2015), and so a purely objective study would be decontextualized

and unfeasible to achieve. Additionally, the anonymous freedom

of participation in voluntary surveys works to uphold ethical

responsibilities, by diminishing the possibility of personal psychological

harm relating to recollecting negative events (Villafranca et al., 2019).

Impacts of Incivility on the Individual and the Team

Incivility poses a threat to personal standing, with practitioners

affected experiencing psychological manifestations such as reduced

self-esteem, anxiety, and occupational depression (DeMarco, Fawcett

and Mazzawi, 2018). This can then advance into physical symptoms

including headaches and high blood pressure (DeMarco, Fawcett and

Mazzawi, 2018). Equally, maladaptive coping mechanisms have been

linked to polluting a practitioner’s home-life by reduced quality of sleep,

dysfunctional personal relationships, and substance abuse (Villafranca

et al., 2017). At its core, incivility impacts on an individual level; all

other repercussions of disruptive behaviours are a compounded causal

sequence of events (DeMarco, Fawcett and Mazzawi, 2018). A crosssectional

survey by Shi et al. (2018) of 696 new nurses’ experiences

discovered by a linear regression model that incivility positively

predicted anxiety, which ultimately caused professional burn-out, yet

resilience acted as a moderating factor. The study had a notable 77%

response rate; however, practitioners were asked to complete the

questionnaire on a mobile device during rest breaks, in which fatigue

could have impaired their cognitive decision-making process. The

authors’ conclusive recommendations for practice necessitated further

training should be undertaken to improve practitioners ‘emotional

toughness’, but arguably, this goes against the core values desired

of healthcare professionals. The data collected by Shi et al. (2018)

was then used by Zhang et al. (2018) to perform an additional linear

regression model, which identified that incivility negatively impacted

perceived job performance, with high career expectations acting as a

buffer. Using a distinct set of data for a new analysis is questionable

as the study omits if the second examination was consented for by

the respondents, but together the studies highlight a pertinent primary

issue in the mental energy that navigating incivility consumes.

Uncivil behaviour causes a shift in the practitioner’s attention, moving

from being focused on the task at hand to homing in on the perpetrator’s

actions (Riskin et al., 2019). This has been linked to reduced working

memory and situational awareness, leading to poorer co-ordination

and team working in the operating theatre (Keller et al., 2019). In an

experiment by Riskin et al. (2015), 72 diverse neonatal healthcare

professionals were randomly allocated into 2 groups and attended

an emergency scenario simulation, in which the observer acted

rudely or neutrally. A multivariate analysis of the results identified

both diagnostic and procedural team performance was negatively

affected by rudeness, with help-seeking and information sharing as

mediating factors. Although external validity to a real-world situation

is questionable when using simulations, the variable suggests only an

underestimate in the impact incivility could have on a genuine crisis.

This is evidenced in a similar study by Katz et al. (2019), in which 76

trainee anesthesiologists were randomly assigned to an experimental

or control group of a rude or neutral surgeon as they attended a major

haemorrhage scenario. The results found that 91% of trainees in the

control group performed at the level expected of them, compared to

only 64% in the experimental group. A binary logistic regression model

identified incivility as the only item that negatively affected participant

performance, with trainee scores impacted in the domains of decision

making, vigilance, communication, and teamwork. Ultimately, such

experiments using a role-play are likely to give the utmost achievable

data, as the direct influence on the patient’s care would make true-life

situations unethical and immoral to manipulate.

The results of the above studies pose some gaps in the literature; a

failure to examine situations in which a team are familiar with each

other, the Hawthorne effect of being observed (Landsberger, 1958),

any follow up on the ethical consideration relating to psychological

repercussions of negative scenario experiments, and the limited

investigations specific to practice in the United Kingdom (UK). This

makes extrapolation of the effects of incivility trust-wide difficult

to predict, however, the application of single study results across a

multitude of environments is never recommended. Incivility is an issue

that fundamentally impacts first at a personal level (DeMarco, Fawcett

and Mazzawi, 2018), therefore, considering each article independently

provides valuable insight into a focused area of practice. The depth

of this understanding does not need to apply to a whole community

to uphold its significance; all experimental research results are

constricted to the encapsulated situation, and regardless of its calibre,

further trials will always need to be conducted before organisational

approval is given to adjust practice (Bennett et al., 2012).

Consequences of Incivility on Patient Safety

The mental state of depletion associated with a practitioner’s

experience as a target of incivility undoubtedly impacts optimum

decision making, which increases the likelihood of iatrogenic mistakes

(Riskin et al., 2019). This is evidenced by Riskin et al. (2019), in which

160 physicians and nurses from across 18 hospital departments in the

United States of America (USA), were asked to respond to questions

using a smartphone application at 2 points during a single shift. The

first questionnaire measured exposure to incivility, and four hours

later, a second questionnaire measured cognitive resources. Using

multivariate analysis, increased measures of incivility positively

correlated with decreased hand hygiene compliance and increased

reported adverse events, yet these did not reach statistical significance.

However, incorrect medication preparation and reduced information

sharing measures produced a robust association. The study provides

contextual real-time results and recognises the short-term effects of

incivility exposure; though incivility occurs at random and disruptive

events are not limited to the start of a shift, therefore no causal order

can be confirmed. Nonetheless, the intervention holds significance in

broadening the spectrum of concepts in which incivility and patient

safety are entwined.

Expanding the ideology of the impact practitioner incivility has on

patient safety, Woo and Kim (2020) collated 192 questionnaire responses

from nurses in 10 hospitals in Korea, which identified by regression

analysis that incivility negatively impacted compassionate caregiving,

moderated by psychological capital. Compassion, as an awareness of a

patient’s suffering and the desire to help, is a key quality needed by

all healthcare professionals to uphold safety standards (Woo and Kim,

2020). As previously established, exposure to incivility decreases mental

wellness (DeMarco, Fawcett and Mazzawi, 2018), thus, psychological

capital is reduced, affecting the practitioner’s ability to sensitively

responded to another person’s needs. As such, Woo and Kim (2020) fail

to identify that increasing psychological capital to mediate the effect

of incivility is a cause-and-effect dilemma. Subsequently, Porath and

Erez (2009) during an observational study, identified that watching

rudeness directed at another stimulates a social contagion, in which

witnesses are affected comparably to the victim. Consequently, the

wider impact evidenced by the literature reveals how incivility breeds

further incivility, with the quality of the patient’s care at the end of

each chain of events.

Studies such as Riskin et al. (2019) and Woo and Kim (2020) rely heavily

on self-reporting methods, underpinned by practitioner’s honesty

in upholding their ethical responsibility not to hinder patient safety.

This presents one of the fundamental problems in highlighting the

consequences of incivility on patient safety as cognitive appraisal.

Namely, Rosenstein and O’Daniel (2006) surveyed 244 practitioners,

including surgeons, nurses, anesthesiologists, surgical technologists,

and operating room assistants in the USA, and found that 94% of

respondents believed disruptive behaviour could have a negative

influence on patient safety. When asked if they were aware of any such

event that could have seriously impacted the patient, 62% responded

yes, with 80% stating they believed any adverse outcome would have

been preventable. However, when lastly questioned as to whether they

could recall being involved in or witnessing a specific disruptive event

that compromised patient care, only 19% of participants answered

yes. The low percentage results of the final question may be due to

answering truthfully becoming a progressively more difficult task, as

feelings associated with being the victim of incivility can begin in the

subconscious, are often fluid in nature, and pose damage to the ego

(Vahle-Hinz, 2019). This evidences that the respondent needs to be

able to interpret the sensory information obtained from an event and

then accept a place in the causal sequence for accurate reports to be

obtained. Until there is a break in the system; awareness of the negative

effects of incivility is commonplace and accountability is upheld, the

research could be stuck in a recurring cycle of underreporting then

underreacting.

References are included with Part two.


First Total Shoulder

Arthroplasty Using the Smart

Space Cubit Intraoperative

Guidance System

LimaCorporate achieves an important

landmark in the development of its digital

platform designed to assist surgeons in

delivering improved outcomes with an

accessible and sustainable economic model,

following the milestone-based acquisition

of TechMah Medical LLC. TechMah Medical

LLC was founded by Dr. Mohamed Mahfouz,

Professor of Biomedical Engineering at the

University of Tennessee, in 2014.

On March 25, 2021 Shelden Martin, MD

performed the first successful total shoulder

arthroplasty in Scottsdale, AZ using the

Smart SPACE 3D Virtual Planner and the

Shoulder Cubit Guidance digital platform.

Upon completion of the procedure Dr. Martin

stated that, “I am very pleased that our first

shoulder arthroplasty utilizing Smart SPACE

Cubit Guidance went extremely well. I was

impressed with the seamless and efficient

integration of the instrumentation into my

normal procedural workflow, resulting in

minimal deviations from normal technique

and no additional procedural time. Most

importantly, the final component positioning

precisely matched our patient-specific preoperative

surgical plan. I am very excited

about the future promise of this unique

technology.”

Smart SPACE is LimaCorporate’s digital

platform and features novel technology

and a rich pipeline of landscape-changing

applications. Smart SPACE is a new

environment designed to further enable the

surgeon and enhance the predictability of

surgical outcomes providing peace-of-mind

to the physician. In particular, the Shoulder

Cubit Guidance is designed to deliver accurate

anatomy and instrument tracking without the

challenges and disruptions of optical surgical

navigation. The Shoulder Cubit Guidance is the

perfect complement to the Smart SPACE 3D

Virtual Planner, which is powered by advanced

AI algorithms developed by TechMah Medical,

LLC. The Smart SPACE 3D Virtual Planner and

Shoulder Cubit Guidance are innovative and

fundamental cornerstones of the Smart SPACE

ecosystem.

This pioneering digital platform is intended

to allow surgeons to develop a complete preoperative

plan, through the Smart SPACE 3D

Virtual Planner and execute the plan precisely

using a combination of patient customized 3D

Positioners and the Cubit Guidance System with

its proprietary sensor technology. Surgeons

will receive real time feedback regarding

instrument and implant positioning, all while

maintaining their desired OR and patient

set up. The Smart SPACE Shoulder system is

currently in Controlled Release within the

United States and Europe and is scheduled for

full commercial release in Q4 2021.

Luigi Ferrari, LimaCorporate CEO, stated: “The

successful completion of the first Shoulder

Cubit guided surgery is a significant milestone

in Digital Transformation at LimaCorporate

and signals the completion of the first phase of

the Smart SPACE roadmap. I’m excited about

the positive impact that this groundbreaking

technology will have in the daily lives of our

surgeons and their patients.”

For additional information on the Company,

please visit www.limacorporate.com

Sheffield Teaching Hospitals consultant elected

as President of prestigious national society

A consultant haematologist who has been at

the forefront of advancing treatment and care

for patients needing bone marrow or stem cell

transplantations has taken up the role of the

President of the British Society of Blood and

Marrow Transplantation and Cellular Therapy.

Professor John Snowden, who is based at

Sheffield Teaching Hospitals’ specialist

haematology unit and is Director of the

Bone Marrow Transplantation Programme in

Sheffield, was elected into the prestigious

national leadership role by members of the

professional society.

The role, which he will hold until December

2022, will see him use his significant

experience and expertise to improve outcomes

for patients undergoing bone marrow or stem

cell transplantations.

Bone marrow or stem cell transplantations

are intensive treatments which involve

replacing damaged blood cells with healthy

cells that are taken from the patient’s own

blood or from a donor’s blood. These are then

transplanted into the body following a course

of radiotherapy and chemotherapy. The

treatments are often lifesaving for people with

blood-related conditions such as lymphoma or

leukaemia.

Professor Snowden, who was also appointed as

the Secretary of the European Society for Blood

and Marrow Transplantation last year, has

played a pivotal role in helping to develop new

treatments, services and national standards

for patients undergoing bone marrow or stem

cell transplantations, acting as Clinical Lead

for various NICE Guidelines and Chair of the

NHS England Clinical Reference Group from

Bone Marrow Transplantation between 2016

and 2020. Most recently he has been actively

involved in helping to develop critical Covid-19

guidance for patients who have received a

bone marrow or stem cell transplant.

He was also a co-investigator for the landmark

‘MIST’ trial, which was the first to show

that autologous stem cell transplantation,

a complex procedure used to treat blood

cancers for many years, could reverse multiple

sclerosis in patients with the relapsing

remitting form of the disease. Sheffield was

the sole UK site involved in the international

trial.

Internationally he has also advocated high

quality patient care through his long association

with the European Group for Blood and

Marrow Transplantation and JACIE – The Joint

Accreditation Committee of the International

Society for Cellular Therapy and the European

Group for Blood and Marrow Transplantation,

who accredit and assess haematopoietic stem

cell transplantation facilities.

He is the author of over 250 specialist

publications and book chapters on bone

marrow transplantation, haematologyoncology

and autoimmunity, and has been at

the helm of many clinical trials, grant awards,

educational meetings, teaching, supervision,

examination, journal editorship and scientific

peer review. He has been awarded honorary

professorships from The University of Sheffield

and University College London.

Professor John Snowden, consultant

haematologist at Sheffield Teaching Hospitals

NHS Foundation Trust and Director of the

Bone Marrow Transplantation Programme in

Sheffield, said: “I am delighted and honoured

to be elected into this prestigious role,

which in tandem with my role as Secretary

of the European Group for Blood and Marrow

Transplantation will enable me to act as an

ambassador for patients receiving bone marrow

or stem cell transplants at the highest national

level. I look forward to using the experience I

have gained in Sheffield as part of a leading

centre for the diagnosis and treatment of

blood cancers and a regional specialist centre

for stem cell transplants to innovate and

exchange ideas and best scientific practice to

the benefit of both patients and the Society at

this pivotal time.”

Sustainability in Surgery: Disposable vs Reusable

This webinar hosted by the Royal College of Surgeons of England, will look

at the use of disposable vs. reusable materials within surgery and provide

information on how to make important future changes in clinical practice.

Hear from our Sustainable Surgery

fellow, Miss Chantelle Rizan, RCS

council member and Vice-chair of

the RCS sustainability in surgery

committee, Ms Victoria Pegna, and

Consultant in ENT Surgery, Professor

Mahmood Bhutta.

• 28 April 6pm, register here:

http://bit.ly/OTJSUS421


Leading provider of healthcare buildings Kier

wins £87m project at Musgrove Park Hospital

Kier, a leading provider of healthcare facilities, has been appointed

by Somerset NHS Foundation Trust to deliver a new surgical centre for

Musgrove Park Hospital. The £87m transformation project will provide

a new building and state-of-the-art amenities to support the Trust’s aim

of improving its patients’ experience.

Procured through the Department for Health & Social Care’s P22

framework, the new surgical centre will include eight operating

theatres, six endoscopy rooms with a patient recovery and clinical

support area as well as a critical care unit with 22 beds, specifically

catering for level 2 and 3 critical care patients.

Kier is already on site carrying out enabling works for the surgical centre

and will commence the construction of the sterile services department

in February 2021, which is the first phase of the works leading to the

development of the surgical centre that will start in 2022.

Working collaboratively with Somerset NHS Foundation Trust, Kier is

also delivering a new Acute Assessment Hub at the hospital as part of

its Musgrove 2030 plan, which aims to radically transform the hospital’s

estate.

Anthony Irving, managing director of Kier Regional Building Western

& Wales, states: “We are delighted the green light has been given to

construct the new Surgical centre at Musgrove Park. Over the past two

years, we have worked collaboratively with Somerset NHS Foundation

Trust to develop this scheme that will provide first-class facilities.

“We will utilise our vast experience within the healthcare sector to

deliver both the Surgical Centre and the Acute Assessment Hub at

Musgrove that will support the Trust in providing important services for

the people of Somerset.”

Commenting on the green light for the surgical centre, Health and

Social Care Secretary Matt Hancock said: “I’m delighted to give plans

for the new Taunton Surgical Centre the green light. The new £87

million centre will replace the oldest operating theatres still in use in

England with state of the art new theatres and critical care facilities.

“This is great news for staff and local residents, who will also benefit

from the new Musgrove Park Hospital which we are backing as one of

the 40 new hospitals which will be built by 2030. This is all part of our

plan to build back better - by investing in NHS buildings for the long

term my ambition is for local people to benefit from world-class NHS

facilities for many years to come.”

Dr Daniel Meron, chief medical officer at Somerset NHS Foundation

Trust, which runs Musgrove Park Hospital, said the news was a huge

boost for people in Somerset.

“We are delighted that funding for the new surgical centre has been

fully approved by the government,” he said. “This will be a huge boost

to the people of Somerset.

“This is an exciting news and the start of our ambitious plans as part

of the Musgrove 2030 programme, which will allow us to progress the

next stage of the development under the new hospital build programme

“The quality of care provided to our patients is something we are very

proud of and we want to support people to stay as well as possible and

have the right services in place to support them in the community.

“We want to support our excellent clinical and non-clinical teams to

further improve the outstanding care they provide to our patients and

we are very excited at the prospect of being able to care for and treat

our patients in state-of-the-art operating theatres and critical care

facilities.

“Work has already started on the site to clear older buildings ready for

the main construction phase and we currently estimate the new centre

will be open for patients in 2024.”

Nick Fairham, principal at architecture practice BDP, who has been

carrying out design work for the Musgrove 2030 modernisation

programme since it began including the hospital’s Jubilee Building

which opened in 2014, said:

“In line with the wider modernisation and transformation of Musgrove

Park Hospital, patient, staff and visitor experience is at the heart of

the new surgical centre’s design. This includes everything from creating

high dependency and recovery space immediately adjacent to the

theatres so that patients remain within the care of their specialist team

after their surgery, to maximising opportunity for daylight and views of

the gardens. The centre will be connected to both the Concourse and

Jubilee buildings by glazed links overlooking landscaped and planted

courtyards helping patients to move from one area to another, enabling

easy access for visitors and improving efficiency for staff.”

This award win reinforces Kier’s position as a leading provider of

healthcare facilities, with other live projects including the £98m

transformation programme at Heatherwood Hospital and the £97.1m

scheme for Heartlands Hospital in Birmingham.

Congratulations, you are now reading, the extended OTJ


Discovering the many more pages available online @ www.otjonline.com


FDA is Investigating Reports of Infections Associated with

Reprocessed Urological Endoscopes

Agency is taking action to remind health care providers about the proper way to clean certain devices for reuse

Today, 1st April 2021 the U.S. Food and Drug Administration announced

it is investigating numerous medical device reports (MDRs) describing

patient infections and other possible contamination issues associated

with reprocessing urological endoscopes, including cystoscopes,

ureteroscopes and cystourethroscopes—devices used to view and

access the urinary tract. Reprocessing these types of medical devices

involves both cleaning and high-level disinfection or sterilization so the

devices can be reused.

“The FDA is investigating potential causes and contributing factors

associated with reported infections and contamination issues from

reprocessed urological endoscopes. We are very concerned about the

three reported deaths—outside of the United States—associated with

these infections, and we’re acting fast to communicate with health

care providers and the public about what we know and what is still an

emerging issue,” said Jeff Shuren, M.D., J.D., director of FDA’s Center

for Devices and Radiological Health. “While some reports indicate

the potential causes could be inadequate reprocessing or device

maintenance issues, we’re also evaluating other possibilities, including

device design or the reprocessing instructions in the labeling. Although

we believe that the risk of infection is low based on available data,

we’re reminding health care providers how important it is to follow the

labeling and reprocessing instructions to properly clean and reprocess

the devices, including accessory components. We take all reports of

adverse events seriously, and we encourage prompt reporting to the

FDA to help us identify and better understand the risks associated with

reprocessed medical devices.”

Cystoscopes, cystourethroscopes and ureteroscopes are urological

endoscopes that allow health care providers to see and access the

urinary tract (e.g., urethra, bladder, ureters and kidneys) during

diagnostic and therapeutic procedures.

From Jan. 1, 2017 through Feb. 20, 2021, the FDA received over 450

MDRs describing post-procedure patient infections or other possible

contamination issues associated with reprocessing these devices. In

those reports that provided the name of the device manufacturer,

either Olympus Corporation or Karl Storz were cited. MDRs can be

submitted by mandatory reporters, such as manufacturers, importers

and device user facilities, or by voluntary reporters.

Olympus submitted three reports citing patient death from a bacterial

infection that occurred outside of the U.S. Two of those reports were

associated with a forceps/irrigation plug, an accessory component

used to control water flow and enable access to the working channel of

the endoscope. Lab tests confirmed the same infectious bacteria was

present in both the forceps/irrigation plug and in the patient with the

infection. The third patient death report involved a cystoscope that did

not pass a leak test, indicating possible damage to the device, which

could have been an underlying factor in the infection. It is unknown

whether or to what degree the reported infections or patient comorbidities

contributed to the patient deaths.

It is important to note that MDRs are not, by themselves, definitive

evidence of a faulty or defective medical device and cannot be used to

establish or compare rates of event occurrence. The FDA is continuing

to investigate these reports, but, at this time the agency has not

concluded that any specific manufacturer or brand of these devices is

associated with higher risks than others.

The Letter to Health Care Providers issued today provides

recommendations for reprocessing and using these devices, including

following the reprocessing instructions, not using a device that has

failed a leak test, developing schedules for routine device inspection

and maintenance, and discussing the potential benefits and risks

associated with procedures involving reprocessed urological endoscopes

with patients.

Ensuring the safety of reprocessed medical devices, which are used

in multiple patients, is a shared responsibility among the FDA and

other federal agencies, public health systems, state and local health

departments, medical device manufacturers, health care facilities,

professional societies and others. The FDA is actively engaged to better

understand the causes and risk factors for transmission of infectious

agents and develop solutions to minimize patient exposure.

The actions the FDA is taking on urological endoscopes today were

informed by the agency’s experience with duodenoscopes. Since 2015,

the FDA has communicated about and taken action on infections related

to reprocessing of duodenoscopes, including requiring postmarket

safety studies and updating sampling and culturing protocols. The

agency also updated its 2015 guidance to include more device types

that need reprocessing validation data. The FDA has issued Warning

Letters to manufacturers and safety communications to the public and

health care providers and held a public Advisory Committee meeting

seeking information on how to effectively reprocess medical devices. In

addition, the FDA has encouraged manufacturers to transition to devices

with features that eliminate the need for reprocessing and helped

manufacturers modify and validate their reprocessing instructions.

The problems the FDA has identified with urological endoscopes and

duodenoscopes may apply to similar devices. Therefore, the agency is

also reviewing information on other types of endoscopes.

The FDA will continue to keep health care providers and the public

informed if new or additional information becomes available on adverse

events and other issues related to reprocessing urological endoscopes.

The FDA, an agency within the U.S. Department of Health and

Human Services, protects the public health by assuring the safety,

effectiveness, and security of human and veterinary drugs, vaccines

and other biological products for human use, and medical devices. The

agency also is responsible for the safety and security of our nation’s

food supply, cosmetics, dietary supplements, products that give off

electronic radiation, and for regulating tobacco products.

Sustainable Operating Theatres Network Co-managers wanted!

We have two volunteer positions available for one surgeon

or surgical trainee and an operating department practitioner

or theatre nurse to become our National Sustainable

Operating Theatres Network Co-Managers.

The aim of the Sustainable Operating Theatres Network is to

embed environmental sustainability into operating theatres

and surgical pathways around the UK.

Learn more about the role and how to apply,

http://bit.ly/OTJSOT321


New Modular Ophthalmology Centre at

Musgrove Park Hospital

Press Release: New Modular Ophthalmology Centre at Musgrove Park Hospital

For Release – Embargo until 7 th April 2021

Headline

Somerset NHS Foundation Trust continues partnership with leading modular healthcare specialist

ModuleCo with the development of a new state-of-the-art, modular Ophthalmology Centre

Copy

ModuleCo are just weeks from installing a state-of-the-art Ophthalmic Operating Theatre Suite for

the Somerset NHS Foundation Trust providing improved ophthalmology services for patients at

being installed by ModuleCo at Musgrove Park Hospital

their Musgrove Park Hospital site.

Somerset NHS Foundation Trust continues partnership with leading modular healthcare specialist ModuleCo with the development of a new

state-of-the-art, modular Ophthalmology Centre

The new modular facility will be one part of a standalone Ophthalmology Theatre Suite with dedicated

ophthalmic operating theatres and linking to the rear of the existing Day Surgery Centre. The eye unit is

the Hospital’s busiest department, carrying out over 2,000 operations every year and providing nearly

contractors.”

50,000 outpatient appointments.

ModuleCo are just weeks from installing a state-of-the-art Ophthalmic

Operating Theatre Suite for the Somerset NHS Foundation Trust

providing improved ophthalmology services for patients at their

Musgrove Park Hospital site.

The new modular facility will be one part of a standalone Ophthalmology

Theatre Suite with dedicated ophthalmic operating theatres and linking

to the rear of the existing Day Surgery Centre. The eye unit is the

Hospital’s busiest department, carrying out over 2,000 operations

every year and providing nearly 50,000 outpatient appointments.

This development provides the Trust with additional operating LinkedIn pages. space, recovery space and dedicated

patient areas allowing them to feel more comfortable when receiving care. Patients will be able to access

the centre directly from the car park, without the need to pass through the main hospital. The Trust hope

that the additional capacity and forming of a dedicated Ophthalmology Centre will help reduce waiting

times for routine treatment.

This development provides the Trust with additional operating space,

recovery space and dedicated patient areas allowing them to feel more

comfortable when receiving care. Patients will be able to access the

centre directly from the car park, without the need to pass through the

main hospital. The Trust hope that the additional capacity and forming

of a dedicated Ophthalmology Centre will help reduce waiting times for

routine treatment.

Mr Pradeep Madhavan, orthopaedic consultant at Somerset NHS Foundation Trust, said:

“This new unit will be a modern facility that will allow ophthalmic patients to continue with their surgical

treatment safely and in time without being unduly affected by conditions in the rest of the hospital and

community.

Mr Pradeep Madhavan, orthopaedic consultant at Somerset NHS

Foundation Trust, said:

“This new unit will be a modern facility that will allow ophthalmic

patients to continue with their surgical treatment safely and in time

without being unduly affected by conditions in the rest of the hospital

“The project is moving at pace and is a tribute to the team spirit within the department of ophthalmology

and expertise and leadership in various parts of our NHS trust.”

and community.

“The project is moving at pace and is a tribute to the team spirit within

the department of ophthalmology and expertise and leadership in

various parts of our NHS trust.”

A bespoke design has been developed, consisting of multiple modules of varying sizes to maximise the

available site space, making up a 484m 2 footprint. The facility will be the first part of a specialist

Ophthalmic Theatre with ceiling mounted microscope and Why laser do we equipment. need this? This is supported by an

integral scrub, lay-up prep, anaesthetic room, dirty utility, 15-patient day ward, consultation rooms, and

people with diabetes:

various ancillary and staff areas.

1. Hospital acquired hypoglycaemia

A bespoke design has been developed, consisting of multiple modules of

varying sizes to maximise the available site space, making up a 484m2

footprint. The facility will be the first part of a specialist Ophthalmic

Theatre with ceiling mounted microscope and laser equipment. This is

supported by an integral scrub, lay-up prep, anaesthetic room, dirty

utility, 15-patient day ward, consultation rooms, and various ancillary

and staff areas.

ModuleCo’s team are now in the midst of the factory assembly phase, and by completing 80% of the

construction and fit out in the factory this minimises the disruption to the hospital estate. In just a matter

overall care.

of weeks this cutting-edge facility will be being installed on site.

ModuleCo’s team are now in the midst of the factory assembly phase,

and by completing 80% of the construction and fit out in the factory

this minimises the disruption to the hospital estate. In just a matter of

weeks this cutting-edge facility will be being installed on site.

Sales and Marketing Director for ModuleCo and project sponsor,

Jonathan Brindley, said:

Sales and Marketing Director for ModuleCo and project sponsor, Jonathan Brindley, said:

“All of us at ModuleCo take great pride in our continued partnership

with Somerset NHS Foundation Trust and supporting them to deliver

specialised care to their communities. This will be our 4th facility

delivered to Musgrove Park and our project team has welcomed the

opportunity to work the Hospital’s brilliant team once again. This

theatre marks the 108th Operating Theatre that we have installed in

External 3D render depicting the state-of-the-art Ophthalmic Theatre Suite

the UK, a number that is a testament to the world-class quality of

our facilities and the expertise of our designers, project managers and

Live project updates from the scheme, and others critical schemes

being delivered, can be found on the ModuleCo’s website, Twitter and

Headquartered in Cheltenham, ModuleCo is part of the BladeRoom

Group of companies which have delivered more than £500 million worth

of mission-critical modular facilities to the UK and overseas markets,

including data centres, healthcare and pharmaceutical facilities. The

group manufactures its industry-defining facilities at their 110,000sqft

factory in Mitcheldean, Gloucestershire.

For further information about this story, please contact the ModuleCo

Sales & Marketing Team at salesteam@moduleco.com

National audit has demonstrated three distinct harms that continue to occur in hospitalised

2. Hospital acquired DKA

3. Drug errors and errors associated with insulin infusions.

CPOC was tasked with producing a national joint standard and policy for the multidisciplinary

management of patients with diabetes who require surgery to limit these harms and improve

What does it contribute?

True ‘whole pathway’ guidance with authors including representatives from primary care,

pharmacists, geriatric medicine, diabetes inpatient specialist nurses, patient groups,

diabetologists, surgeons and anaesthetists.

“All of us at ModuleCo take great pride in our continued pumps partnership and blood sugar targets. with Somerset NHS Foundation

Advice on guidance implementation, without which patient care and outcomes will not

Trust and supporting them to deliver specialised care to their communities. This will be our 4th facility

improve.

delivered to Musgrove Park and our project team has welcomed the opportunity to work the Hospital’s

Practical recommendations including the management of individual diabetes drugs, insulin

Comments and feedback are welcomed



WINNERS ANNOUNCED: Medical Robotics for Contagious

Diseases Challenge 2020 – UK Robotics Week

Top global robotics teams named for inventions including telerobotics for remote control of medical equipment and automated disinfection

The EPSRC UK-RAS Network, organisers of the annual UK Robotics

Week, is pleased to announce the winners of its inaugural Medical

Robotics for Contagious Diseases Challenge 2020, recognising the

outstanding innovation of leading global robotics research teams in

developing solutions to tackle the COVID-19 health crisis and future

global pandemics.

The three winners in each category were unveiled at a virtual award

ceremony held today, with each winning team receiving prize money of

£5000 generously donated by The Wellcome Trust and Intuitive Surgical.

The winners and runners-up are:

Best Application

‘UVC-PURGE: A Semi-autonomous Virus Disinfection Robot’ by the team

at Military Institute of Science & Technology (MIST).

Runner Up: ‘Teleoperated wheelchair with isolation hood’ by the team

at Amrita Viswa Vidyapeetham (Amrita University).

Best Innovation

‘Telerobotics for Remote Control of Medical Equipment in Contagious

Environments’ by the team at Johns Hopkins University.

Runner Up: ‘Towards Affordable Soft Robotic Bronchoscopy’ by the

team at Imperial College London and Institut Teknologi Bandung.

Best Design

‘An Intelligent Robotic System for Automated Precision Disinfection in

Public Spaces’ by the team at Leeds University.

Runner Up: ‘A master-slave robotic system for both endotracheal

intubation and bronchoscopy for the treatment of COVID-19’ by the

team at Tianjin University.

This unique challenge attracted 21 entries from 13 countries –

Bangladesh, China, Colombia, Germany, India, Indonesia, Iran, Israel,

Mexico, Pakistan, Uganda, UK and USA – and the winners were decided,

from a shortlist of 17 exceptional submissions, by a prestigious judging

panel, including Professor the Lord Darzi of Denham, Co-Director of

IGHI, Professor of Surgery at Imperial College London,

UK; Simon Di Maio, Director, Research at Intuitive Surgical, USA; Prof.

Russell H. Taylor, John C. Malone Professor at John’s Hopkins University,

USA; and Dr. Thomas Neff, Manager Software Medical Robotics at KUKA

Deutschland GmbH, De.

The competition – which was run as part of the EPSRC UK Robotics

& Autonomous Systems (UK-RAS) Network’s annual UK Robotics Week

celebrations – took place entirely online, offering flexibility for remote

working during the pandemic.

Professor Robert Richardson, Chair of the EPSRC UK-RAS Network

commented: “The engagement of the world’s leading robotics

researchers with this Challenge has been nothing short of incredible,

and the quality of the entries we received really underscore the vital

contribution that is being made by robotics platforms during this

pandemic in delivering solutions for the global community. The entire

UK-RAS team and our superb judging panel offer our congratulations

to the winners, runners-up, and all the teams who took part in this

unique competition, which is going to provide an important launchpad

for pandemic response innovations as we look beyond the immediate

crisis to addressing future public health challenges.”

The UK Robotics Week is being revamped this year. The network plans

to launch a 3-month Robotics Summer Showcase to run from May to

July this year, which will feature events aimed at engaging academics,

industry and other stakeholders within the RAS community. Nestled

within the Summer Showcase programme, a 7-day UK Robotics Festival

will run from 19th – 25th June with a focus on public-facing events.

The EPSRC UK-RAS Network was established in 2015 with the aim

of bringing together academic centres of excellence, industry,

government funding bodies and charities, to strategically grow the UK-

RAS research base, acting as a portal to interface with industry and

deliver technological advances for translational impact.

A highlight video compilation of the 17 shortlisted entries is available

now on the EPSRC UK-RAS YouTube Channel: https://www.youtube.

com/watch?v=vrH1XW_pVxY

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WHY MEN MUST RESEARCH THEIR PROSTATE CANCER TREATMENT OPTIONS

Growing clinical evidence-base highlights long-term side effects and

risks associated with the most popular prostate cancer treatments

There is currently no consensus as to the optimal treatment for localised

prostate cancer, and urologists and radiation oncologists continue to

debate the relative merits of therapies. Most men and their partners

ultimately choose a therapy based on how well informed they are about

the various options, their respective side effect profiles and personal

lifestyle choices, and recommendation from their consultant.

Yet, for many men, this is a confusing and worrying time. Men diagnosed

with localised prostate cancer have numerous management options,

including active surveillance, androgen-deprivation (hormone) therapy,

and definitive therapy with the intent to eradicate or cure the cancer.

Among patients who are offered these curative-intent treatments,

the vast majority are offered either radical prostatectomy (surgery

to remove the prostate) or radiation therapy. Radiation therapy,

however, includes a range of treatments and dosing including externalbeam

based therapies, high-dose-rate (HDR) or low-dose- rate (LDR)

brachytherapy, and combinations of beam and brachytherapy, with or

without hormone therapy. Choosing amongst these can be a daunting

task.

However, there is a growing clinical evidence-base which suggests

certain standard-practice treatment options and doses may not be as

effective, and / or have significant long-term clinical side effects that

clinicians and patients alike should be aware of.

Urinary Adverse Events after High- versus Low-Dose-Rate Brachytherapy

with or without Radical (External-beam) Radiotherapy

A 2016 study comparing the incidence of severe urinary adverse

events (UAEs) after low-dose-rate (LDR) and high-dose-rate (HDR)

brachytherapy, as well as after LDR plus external beam radiation

therapy (EBRT) and HDR plus EBRT, found no statistically significant

toxicity differences were observed between LDR and HDR. However,

combination radiation therapy (either HDR plus EBRT or LDR plus EBRT)

increases the risk of severe UAEs compared with HDR alone or LDR

alone.

Single-dose High-Dose-Rate Brachytherapy

Most recently, a 2021 study by Shreya Armstrong et al of the Mount

Vernon Cancer Centre, Northwood, UK, undertook a retrospective

review of treatment records of patients who received single-dose

(fraction) HDR-B, concluding that long-term follow up of single dose

HDR-B for localised prostate cancer has revealed higher than expected

rates of biochemical and local failure and should therefore not be used

as a monotherapy for intermediate- and high-risk cancer patients.

This is further backed up by a 2019 study from Leeds Teaching Hospitals

NHS Trust comparing men with intermediate and high risk prostate

cancer treated using LDR–EBRT and HDR–EBRT, which concluded that

patients treated with HDR–EBRT were more than twice as likely to

experience biochemical progression compared with LDR–EBRT.

Moreover, recent advances in the development of LDR Brachytherapy,

such as 4D Brachytherapy, mean that the treatment is now available as

a one-stage implant technique that can normally be performed within

45 minutes. Improved dosimetry and clinical outcomes together with

reduced side effects have been demonstrated over traditional twostage

approaches.

Saheed Rashid, Managing Director, BXTAccelyon, comments: “While the

importance of men and their families researching all the treatment

options available to them and discussing these with their consultant

must be emphasised, there is an increasing body of evidence to

suggest that, of the curative-intent treatment options, Low-Dose-Rate

Brachytherapy as a mono- or combination therapy, has favourable

outcomes and fewer adverse side effects.

“As a treatment, this option has been proven for over 25 years, and

advancements such as 4D brachytherapy and NHS England supported

toxicity barriers have further improved the patient experience.”

Augmented reality could change the way we carry

out minimally invasive surgery

Over the last few decades, minimally invasive surgery (MIS) has replaced open surgery as the preferred method across many medical fields.

However, the relatively restricted field of view in MIS poses challenges when performing procedures that require three-dimensional visualization,

such as correct device placement or removal of sensitive tissues.

Previous technological attempts at expanding the view during MIS have involved adopting surgical scene reconstruction techniques. However,

most existing techniques have yet to demonstrate consistent performance capabilities. Consequently, greater emphasis has recently been directed

towards developing the pre-existing technology of augmented reality (AR).

AR allows the user to see the real world overlaid with a layer of digital content. It can address the visual shortcomings of MIS by expanding the field

of view for surgeons. Furthermore, as healthcare systems globally are still overburdened with the additional pressures of the COVID-19 outbreak,

new hospital measures of limiting viral transmissions between physicians and patients are highly sought after. Surgeons opting for MIS could

strongly benefit from AR when performing procedures that would normally have been an open surgery. Advancements and wide-spread adoption

of AR in MIS can thus limit patient exposure to aerosolized viral particles.

AR will improve the planning and mapping of MIS

AR could be one of many approaches to reducing this burden on hospitals by indirectly controlling the spread of the coronavirus. MIS reduces

surgeons’ exposure to aerosolized coronavirus particles. Open surgery also typically involves a longer hospital stay, which may increase nosocomial

virus transmission and increase pressure on resources and hospital bed capacity.

Research from the University of Alberta and the University of Salento found AR could be particularly useful in laparoscopic surgery and surgical

planning. The integration of AR into MIS means surgeons would not solely rely on endoscopes. Instead, AR projections of scans can be superimposed

on patients in real-time to aid planning and increase accuracy when placing devices. For patients, this could reduce the chances of trauma and

scarring while also accelerating postoperative recovery.

AR may not be embraced across all surgical procedures, as its use is strongly dependent on the rigidity of the organs or tissues involved in the

operation. For example, AR has found relative success in neurosurgery for both the brain and spine as the structures are rigid, which helps the

surgeon differentiate between the augmentation and the actual scene. On the other hand, AR and other types of image-guided surgery are unlikely

to be used for abdominal MIS as organs and tissues are less rigid. Instead, traditional endoscopic views will continue to be relied upon for these

procedures.

The future of MIS

AR has the potential to improve the accuracy of minimally invasive procedures, and in turn, reduce surgical errors. Worth nearly $4bn in 2018, the

global AR market will reach $76bn by 2030, growing at a compound annual growth rate (CAGR) of 24%, according to GlobalData estimates. AR in MIS

is currently still being researched. ProjectDR is one of the software platforms exploring how AR can improve visualization in the operating theatre.

ProjectDR projects medical scans directly onto a patient body and can even provide segmented images if the surgeon selects this function. AR’s

use for MIS is still in the early stages, but GlobalData expects this technology to significantly impact the healthcare industry over the next few

years.

Source: Medical Device Network


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The Operating Theatre journal April 2021

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