Annual blog review time

Parts of this Blog are now looking pretty rusty!

As soon as we figure out how to remove them, we will - generally, the likes of Twitter, Facebook and all the other rant and rave places now available seem to have rather overtaken the need (if there ever was one?) for a blog?

What do you think?  Let us know ........... and in the meantime be sure to visit our eStore/website for latest news (www.azream.us or http://azream.us)

SafeSEAL® & GELSeal™

Gosh, how time flies!  We haven't posted in quite a while, but we thought we'd take this opportunity to help out all the folks still searching for SafeSEAL® Stethoscope Diaphragms & GELSeal™ Eartips.

Sadly, you won't find them ............

Both products were originally manufactured by Doctors Research Group (DRG), and were extremely popular. In 2006, Trimline Medical Products acquired DRG and through them we distributed the products wordwide, together with Puretone™ and Symphony™ Stethoscopes, and of course Trimline's fine range of blood pressure systems.


In April 2010, Trimline were themselves acquired by Welch Allyn and unfortunately the products were discontinued. We understand that Welch Allyn have retained the intellectual property rights and so, at the time of writing, nobody else will be manufacturing these products in the forseeable future.


It's a shame, and we were sorry to see them disappear from the market; for many years, they had been among our best selling products - deservedly so, for their innovation and contributions towards both infection control and user/patient comfort.

Rest assured, if the situation changes, we'll let you know!

(be sure to register for Product Updates and Newsletters at our eStore so that we can; www.azream.us).

Mercury Sphygmomanometers becoming Dinosaurs

Following our post of just under a year ago, alas for may of us the decision to purchase Mercury/Aneroid/Digital Blood Pressure Machines has already been made by Government and/or State intervention worldwide - Mercury sphygmomanometers, in fact any products containing mercury, are increasingly being outlawed.

This is despite the concerns about the accuracy of some alternative devices, both aneroid and digital, and with nothing have been initiated to prevent the flood of cheap inferior products to be found in increasing numbers in hospitals, medical offices and the home environment.

Both Trimline and Riester have now withdrawn their mercury column sphygmomanometers from sale, but fortunately both these fine manufacturers do provide high quality alternatives, aneroid and digital, and fortunately, AZReam has a long-established working relationship with both of them, so that we are well placed to serve our customers' needs (that's the Blatant Advertising bit!).

Read below for our earlier thoughts on this subject, and do please take advantage of the new "Live Help Desk" to be found at our eStore (www.azream.us) if you have any questions.

Weighing & Measuring Correctly

Determining your own body weight and size is child's play. Just stand on a working scale and read the displayed weight. Or, adjust a measuring rod, apply the measuring tongue and read the result. However, even with such simple operations errors can creep in that can falsify the result up or down.

Determine exact body weight
Body weight fluctuates during the course of the day by about one kilogramme for children and two kilogrammes for adults. If you want to know if and how much you have lost or gained, observe the following tips:

Place the scale on a solid base.
Always leave the scale at the same place.
It is best to weigh yourself in the morning after getting up.
Do not eat or drink anything before you weigh yourself.
Wear no clothes when weighing yourself.
Stand on the scale quickly and evenly, stand still and read the weight.

If you stand on the scale with clothes and do not need an absolutely accurate measurement result, you can deduct the following values:

Jeans: approx. 700 g
T-shirt: approx. 250 g
Shirt/blouse: approx. 250 g

Determine exact body size
Body size also changes during the course of the day. The same person can be three centimetres taller than in the evening. There is a natural explanation for this. The constant load on the spinal column means that the spinal discs are compressed during the course of the day and with 23 spinal discs, that can mean two or three centimetres. At night, the spinal discs regenerate by absorbing nutrients from their environment.
Observe the following to ensure a precise determination of body size:

Push the measuring tongue into a horizontal position according to the person to be measured.
The person to be measured stands with his back against the measuring rod.
The feet must stand closed on the foot positioner.
The back must be straight.
The head must be straight according to the "Frankfurter Linie". The "Frankfurter Linie" is an imaginary horizontal from the ear to the beginning of the nose.
The caliper gauge is pushed on the head so that the measuring tongue rests without sagging.
Read the result.

Further Reading:-

seca Weighing & Measuring range
Things to know about weighing
seca technical terms
Ask the Experts
Measuring Quiz
seca FAQ

MRSA - what is it?

Staphylococcus is a family of common bacteria - many people naturally carry it in their throats, and it can cause a mild infection even in a healthy patient.  MRSA stands for methicillin-resistant Staphylococcus aureus, but is shorthand for any strain of Staphylococcus bacteria which is resistant to one or more conventional antibiotics.  Each year, thousands of people who go into hospital get an infection there.  MRSA is one example of this.

 

Experts have so far uncovered 17 strains of MRSA, with differing degrees of immunity to the effects of various antibiotics. Two particular strains, clones 15 and 16, are thought to be more transmissible than the others, and account for 96% of MRSA bloodstream infections in the UK.  At present, these strains are thought to be rare in other countries, but are spreading.

Antibiotics are not completely powerless against MRSA, but patients may require a much higher dose over a much longer period, or the use of an alternative antibiotic to which the bug has less resistance.

What are the symptoms?
MRSA infections can cause a broad range of symptoms depending on the part of the body that is infected. These may include surgical wounds, burns, catheter sites, eye, skin and blood.  Infection often results in redness, swelling and tenderness at the site of infection. Sometimes, people may carry MRSA without having any symptoms.

Why does MRSA exist?

It's all about survival of the fittest - the basic principle of evolution, and bacteria have been around a lot longer than us, so they're pretty good at it.  There are countless different strains of a single type of bacteria, and each has subtle natural genetic mutations which make it different from the other.  In addition, bacterial genes are constantly mutating - some strains' genetic makeup will give them a slight advantage when it comes to fighting off antibiotic attack. So when weaker strains encounter antibiotics, they die, while these naturally resistant strains may prove harder to kill.  This means that next time you encounter Staph, it is more likely to be one which has survived an antibiotic encounter, i.e. a resistant one.

The advice from doctors who give you antibiotics is always to finish the entire course - advice which many of us ignore.  When you don't finish the course, there's a chance that you'll kill most of the bugs, but not all of them - and the ones that survive are of course likely to be those that are most resistant to antibiotics.

Over time, the bulk of the Staph strains will carry resistance genes, and further mutations may only add to their survival ability.  Strains that manage to carry two or three resistance genes will have extraordinary powers of resistance to antibiotics.  The reason that hospitals seem to be hotbeds for resistant MRSA is because so many different strains are being thrown together with so many doses of antibiotics, vastly accelerating this natural selection process.

Why is it so dangerous?

It is a fact of life that hospital patients are at higher than normal risk of picking up a Staph infection on the wards.

This is for two reasons - firstly, that the population in hospitals tends to be older, sicker and weaker than the general population, making them more vulnerable to the infection.
 
Secondly, conditions in hospitals, which involve a great many people living cheek by jowl, examined by doctors and nurses who have just touched other patients, are the perfect environment for the transmission of all manner of infections.

Staph infections can be dangerous in weakened patients, particularly if they can't be cleared up quickly with antibiotic treatments.  MRSA infections can prove tough to treat because they are resistant to treatment, making them more dangerous than a simple case of Staph.

What is likely to happen in the future?
Doctors are very worried about what the future holds for MRSA.  The number of reports of MRSA infections rises year by year - and the latest evidence suggests that deaths due to MRSA are increasing at a similar rate.

What about new superbugs?
Already, the spectre of a bug resistant to all antibiotics is approaching.

VRSA, or vancomycin resistant Staphylococcus Aureus, has acquired resistance to a drug considered the "last line of defence" when all other antibiotics have failed.  The UK has already seen several cases of GISA, or glycopeptide intermediate Staphylococcus aureus, a kind of "halfway house" between MRSA and VRSA, which has developed a resistance to antibiotics of the vancomycin family.

Experts are also concerned a new killer 'superbug' is emerging, called Panton-Valentine leukocidin (PVL) MRSA.  Not all types of Staph that make the PVL toxin are dangerous or so difficult to treat, but PVL MRSA appears to be particularly virulent.

Cases of another bug, Clostridium difficile, are also cropping up in both  UK and US hospitals. It is not a "superbug", and can be treated relatively easily. However, the bug forms spores which means it can survive for long periods in the environment, such as on floors and around toilets, and spread in the air.  C. difficile can cause illness when certain antibiotics disturb the balance of 'normal' bacteria in the gut.

Rigorous cleaning with warm water, detergent and modern surface cleaning technologies is the most effective means of removing spores from the contaminated environment and the hands of staff, say experts.

Worryingly, infections are cropping up in healthy people in the community, rather than among sick people in hospital.  Schools and daycare centers, restaurants and hospitality suites, airports and aircraft, have all become targets and areas of concern.

Although new antibiotics are being developed all the time, pessimistic experts believe it is only a matter of time at current rates until virtually every weapon in the pharmaceutical arsenal is nullified.  Nihilists suggest that there could come a point at which bacteria retake the upper hand, and doctors, as in previous centuries, have no answer to some bacterial infections.  It should be noted, they say, that humans have only had the upper hand over bacteria for a handful of decades - we have no right to expect that situation to last forever.

What can we do about it now?
Government agencies are already trying to at least slow down the apparently relentless march of the bacteria.

One of the main reasons behind their swift evolution into "superbugs" is the overuse of antibiotics, both in human and veterinary medicine.  Until recently, patients visiting their doctor with a viral infection might demand, and be given an antibiotic prescription - despite the fact that antibiotics have no effect on this.  All those patients were doing was strengthening the communities of bacteria in their bodies, so Doctors have now been told to cut antibiotic prescribing.

Hygiene is another tried and tested way of at least protecting the most vulnerable patients from the most dangerous strains.  Hand washing between patients should be a must for doctors and nurses, or they are simply doing more harm than good in their trips around the wards.  Products, such as SafeSEAL Stethoscope Diaphragms and Blood Pressure Cuffs with antimicrobial treatment, are in increasing use to prevent the transfer of bacteria from patient to patient.  Single-patient use/disposable blood pressure cuffs are also seeing increased usage, though of course there are cost and, in the long term, environmental implications.

Facilities/Hospitals are trying to improve overall standards of hygiene – perhaps in the UK by reintroducing the concept of the ward matron, with responsibility for cleanliness.   Simple solutions are often with easy reach – the provision of cabinets, dispensers and organizers for Personal Protective Equipment (PPE) for both staff and visitors, to encourage and enforce compliance with Infection Control procedures.

Whether a dirty ward rather than a dirty hand is a reservoir for Staphylococcus is a matter of debate, in all likelihood it is a combination of both, but MRSA patients are also increasingly being treated in isolation where possible – and hence the introduction from certain manufacturers of Blood Pressure Cuffs and other items specifically for use in Isolation Areas.

In the long run, many experts suggest it may take a breakthrough akin to the discovery of penicillin before humans can regain a temporary upper hand over the bugs again.  In the meantime, it's a matter of cleaning, hygiene, and good use of the products we already have available to minimise the impact and spread of bacteria

aoljpictureUpload, aoljpictureUpload_1

Mercury, or not Mercury .... that is the question

Aneroid sphygmomanometers are comparable to mercury sphygmomanometers in cost, technique and performance. However, some medical professionals hesitate to adopt aneroid blood pressure devices because of conflicting statements they have heard about aneroid gauge performance.

 
What are the concerns about aneroid sphygmomanometers?

Obtaining accurate blood pressure measurement is a foremost concern in the selection of sphygmomanometers. Once calibrated, there is no expected difference in performance between aneroid and mercury sphygmomanometers manufactured by the reputable companies we feature in our eStore (Trimline, Riester and MDF). All sphygmomanometers need routine calibration checks and regular preventive maintenance. The procedures are different for mercury and aneroid sphygmomanometers, but are otherwise equivalent in frequency, complexity and the amount of attention required. In practice, aneroid and mercury sphygmomanometers require different calibration techniques but otherwise proportionate amounts of attention.

Some medical professionals have concerns that aneroid sphygmomanometers are easily damaged during use, resulting in inaccuracy due to the device being dropped or bumped and knocked out of calibration. This is perceived to be less of a concern for mercury sphygmomanometers due to the mercury column's rigid mounting requirements. Because the mercury column must be perfectly vertical in its mounting and the mounting perpendicular to the floor for accuracy, most mercury devices are either wall mounted or mounted on robust mobile stands, or in metal casings. Concerns about dropping aneroid devices can be alleviated by purchasing aneroid sphygmomanometers as either wall-mounted units or mounted on mobile stands, comparable to the mercury sphygmomanometers, rather than selecting portable aneroid devices – or of course many gauges (for example, Trimline’s Bainbridgeâ and HaderÔ models) can be fitted with a guard for extra protection.


Comparative Characteristics of Sphygmomanometers

Sphygmomanometers are introduced to the marketplace only after thorough testing and evaluation. Sphygmomanometers sold in the United States are regulated and must be approved by the Food and Drug Administration (FDA). The FDA approval process requires companies to show that new sphygmomanometers are substantially equivalent to models already on the market and to demonstrate accuracy through a clinical validation study. The FDA recognizes ANSI/AAMI SP-9 (a voluntary standard) as a performance standard and both aneroid and mercury sphygmomanometers meet this standard. This Standard covers functionality, accuracy and safety, including requirements and suggested tests to verify compliance.

Many United States hospitals have eliminated mercury sphygmomanometers. Hospitals interviewed in a recent survey reported that the alternatives perform satisfactorily. There are many more hospitals that have not completely eliminated mercury sphygmomanometers but have phase out programs underway. (EPA, HCWH)

Both mercury and aneroid sphygmomanometers require routine maintenance. Key issues for mercury gauges include: verify (and adjust if necessary) the zero level of mercury, replace air filter, verify that column is perpendicular in its unit and vertical to the ground, check for oxidation of mercury (making column appear dirty and difficult to read) and clean tube if necessary. Key issues for maintenance of aneroid gauges include: check needle for smooth rotation, and test accuracy at several intervals against a reference meter or mercury manometer.

In addition to managing the maintenance and calibration of the sphygmomanometers themselves, hospitals that use mercury gauges must also maintain the capability to safely handle mercury and respond to a mercury spill. Mercury spill capability includes personnel trained to respond to a spill on a 24-hour, 7 day per week basis, a mercury spill kit (for example, Trimline’s “Quick-Up Mercury Recovery Kit”), hazardous waste resources for decontaminating a spill area and removing the mercury, and the financial resources for the spill response and liability associated with mercury exposure.

Increasingly hospital Group Purchasing Organizations (GPOs) are voluntarily supporting pollution prevention efforts.


Mercury Sphygmomanometers
 
Considerations for selecting sphygmomanometers include purchase price, ease of use, accuracy, reliability, maintenance requirements, and health/environmental impact.
 
In practice, both mercury and aneroid sphygmomanometers are widely used because of their low purchase price. When both units are in proper working order, either will give acceptable results. Both styles require calibration checks at regular intervals (at least annually), but for aneroid devices, the procedure requires adjusting calibration at several pressure points, not just at zero like a mercury device.
 
Although simpler to calibrate, mercury sphygmomanometers have some inherent disadvantages when compared with the aneroid sphygmomanometer.

• Mercury is a toxin that threatens humans and wildlife. As a result, spills require careful and costly cleanup.
   
  
• It requires excellent technique to read the meniscus of a mercury column. Even if both types are in good working order, the aneroid dial is easier and requires less effort to read than a mercury column.
   
  
• Maintenance of mercury devices is cumbersome. For accuracy, the mercury tube must be perfectly perpendicular in its unit and perfectly vertical to the ground. The more off-vertical, the greater the inaccuracy.
   
  
• Each mercury sphygmomanometer has a vent or filter allowing outside air to be drawn in. Without frequent filter replacement, the mercury column experiences lag. "Lag" is a delay in the mercury response, which may result in an inaccurate reading.
   
  
• Oxidized mercury can make the column appear dirty, making it difficult to read the true mercury level.
  

To put this in perspective, a recent study of mercury sphygmomanometers (in a hospital setting) found many faults and concluded "the majority of the mercury sphygmomanometers...had serious problems which would give rise to major errors in blood pressure measurement".
 
In either case, mercury or aneroid, maintenance is key.

However, many hospitals have made the switch to aneroid sphygmomanometers. Once these hospitals had accepted the challenge of eliminating mercury, many were pleasantly surprised to find that good quality aneroid sphygmomanometers are accurate and reliable without the many hidden drawbacks of mercury sphygmomanometers.

Tips for Procuring Aneroid Sphygmomanometers
 

Many hospitals are replacing mercury sphygmomanometers with cost-competitive aneroid sphygmomanometers. An aneroid sphygmomanometer is a mechanical gauge with a round dial and needle that rotates to indicate pressure from 0-300 mm Hg. On the inside, a bellows and spring mechanism senses and transmits the blood pressure measurementto the dial.

Aneroid units have several features that are appealing to healthcare professionals:

• The dial of an aneroid gauge is much easier to read and requires considerably less effort than the meniscus of a mercury column, which requires awkward head movement to do a good job.
  
• It is easy to see if the aneroid needle is off zero when not in use. This provides a good indication of whether the gauge has been damaged or needs maintenance, and is an easy check each time a reading is taken.
  
• It is easy to check the needle for smooth rotation, another way of verifying that the aneroid device is in good working order.
  

When procuring new sphygmomanometers, a few considerations up front can make things easier in the long run:

• Verify that all components are latex free.
  
• When you buy the aneroid devices, ask the manufacturer to accept intact mercury sphygmomanometers for recycling. If this is negotiated in the contract, it saves the expense of disposing of mercury devices.
  
• Consider the need for spare units. For offsite calibration, extra units allow a swap with instruments in current use. These spares keep the hospital running while allowing the use of more cost efficient ground shipment to and from calibration.
  
• When you receive newunits, consider bar coding them. This allows you to track reliability and performance, calibration status, and inventory status.
  

Consider the cuff size and options, provided – you will need a selection of sizes (color coding can be immensely useful), and they should have range markings, also be latex free, and comply with your facility’s infection control program.  Few clinicians also realise that traditional cuffs are arm specific – a balanced bladder cuff (such as that manufactured by Trimline) is essential for accurate blood pressure reading.  This applies to both reusable and disposable cuffs.

Where to begin?

Let's start with shipping;  We want to say "Shipping costs, there's no way round it, get over it", but we're not that rude!

However, it doesn't cost that much to most places unless you need to send it really quickly.

We'd love to be able to absorb the cost of shipping on all our orders, but it just can't be done.  You can't sell a product for $5 or less, with a profit margin of just $1 or so, and ship it across the country (or the world) for free.

So what's the answer?  Well the alternatives are to either charge the exorbitantly high prices for products that you'll see elsewhere, or we could charge a reduced shipping amount on a per item basis.

We don't think either of those works well.  If we sell at a higher price, nobody will buy anything in the first place.  If we charge per item, and you want 2 or 3 of those $5 products, you'll end up paying more.

We think we have a reasonable solution - we charge a flat rate for small orders, sufficient to cover our costs in most (not all) cases, and for orders over $100 it's free for most items (unless they happen to be bulky or heavy),  We offer $10 off a second order for $25 or more when you place your first order - giving new purchasers (in the U.S.) the opportunity to spread the cost, even over a relatively small dollar purchase.  And we DON'T charge per item!  We've seen online stores that will charge you more if you spend more.  That's crazy!

So that's shipping covered - and yes, sometimes we lose money on the deal - but that's okay, we just want our customers to keep coming back for more.