Dr. Fiala's OR aces AAAASF inspection

Having a top-quality office surgery center like we do means that, every third year, there is a detailed and thorough inspection process that must be passed to retain our certification.  An independent inspector, typically another plastic surgeon, is assigned to check our facility with a long checklist of safety and quality standards.  It's a big deal, and one we take very seriously.

We had this inspection yesterday.  A great deal of time and effort on our part went into preparing for it...and believe me, we were ready.

So, I'm very pleased to report that we achieved a score of 100% in each of the 10 separate categories evaluated.  A big "Thank you" to my staff for a job well done!!

This brings me to my second point of this blog entry.  As a patient, it's important to choose a facility that has gone through and passed this rigorous process, and maintains an up-to-date certificate.  Then you will know that they have the safety equipment, training, facility standards and protocols in place to protect you during your surgery, and in case of the unexpected.

There are only 3 organizations that are accepted nationally - and all have long acronym names.

- AAAASF
- AAAHC
- JCAHO

We're certified by AAAASF.  Check for the certificate - it should be proudly on display at the hospital, surgery center or office OR.  If it's not there...then you shouldn't be, either!

Cool new online practice tour

Check out this new online tour of our Altamonte Springs, Florida facility. You'll see our offices and our AAAASF-certified surgery center.

Click on the yellow arrows to go to the next room, and move the mouse around to look left and right. Clicking on a video screen with a yellow border will start a hidden message! Have fun!

Click Here to Open Fiala Aesthetics Tour/Video. 

Latex allergies and plastic surgery

Allergic reactions to latex are becoming more common. Today, about 3 to 6% of people are found to be allergic to latex...and in the worst case, the reactions can get pretty serious. Prevention, rather than treatment after the fact, is really the key to success.

Latex is the milky fluid from the rubber tree, Hevea brasiliensis, found in Malaysia, Indonesia, Thailand, and South America. In addition to the organic polymer that gives it the characteristic stretchy properties, latex sap also contains more than 200 allergenic proteins.

In terms of surgical history, William Halstead was the first to use latex surgical gloves, back in 1890. Recently, as we've become increasingly aware of the need for protection against blood-borne pathogens, the use of latex gloves has skyrocketed. Simultaneously, the incidence of allergic reactions to latex began to rise in both patients and especially in health care workers.

Latex exposure is associated with 3 distinct clinical syndromes.

1) irritant dermatitis. This is the most common cause of latex-induced skin rashes. It is not associated with allergic complications.

2) contact dermatitis. Symptoms usually develop in a delayed fashion, within 24-48 hours of cutaneous or mucous membrane exposure to latex in a sensitized person.

3) immediate hypersensitivity. This is the least common, but most serious type, and is a classic allergic reaction against latex proteins. Symptoms generally begin within minutes of exposure. Symptoms range from rash and itching, runny nose and watery eyes all the way to bronchospasm, hypotension and full blown anaphylaxis.

Interestingly, certain other tropical fruits can have an allergic cross-reactivity with latex allergy: avocado, banana, chestnut, kiwi, papaya, peach, or nectarine. People who are allergic to one are more likely to allergic to the other.

So, what do we do if someone says they have a latex allergy? First, as best as possible, we try to learn the story, and get the details of what happened. What kind of reaction did they have? Was it immediate or delayed? If there are further unanswered questions, evaluation by an Allergy specialist is helpful.

Fortunately, with the increased awareness of this problem, most operating rooms (including our own) have the ability to use a latex-free set-up. There is no latex whatsoever in the anesthesia equipment set-up, the rubber syringes, IV tubing, the surgical gloves and gowns, surgical tapes and dressings. By avoiding any exposure to even the smallest bit of latex, the patients can do very well, and have a safe operation. Also, breast implants do not contain any latex - so they don't have the potential for a latex reaction.

If you think you might be allergic to latex, please mention it to your surgeon. With proper preparation, latex allergy issues can be avoided.

Say "Yes" to an accredited Operating Room

Recent articles in the Wall Street Journal (link) have pointed out the need for a more uniform standard in office operating rooms - namely accreditation by one of the three national OR inspection agencies.

I couldn't agree more. Improving safety standards for patient care is a good thing.

Accreditation of an operating room, whether it's in the hospital or at an office, ensures that the facility meets important standards, like:

- appropriate facility design and safety equipment
- suitable cleaning & instrument sterilization standards
- proper patient monitoring devices
- appropriate back-up power supply
- suitable staff credentialing and training requirements for the surgeon, anesthesiologist and nurses
- suitable protocols and staff training for emergencies

Several years ago, the American Society of Plastic Surgeons (ASPS) made it a mandatory membership requirement: all ASPS members (like me) can only operate in accredited facilities, whenever any significant anesthesia is used.

Our facility, for example, is accredited by the American Association for the Accreditation of Ambulatory Surgery Facilities (AAAASF) - which is one of the "big three" national agencies, along with AAAHC and JCAHO. This means we meet 100% of the standards that AAAASF has formulated, and have gone through an on-site inspection by an independent examiner. We also meet or exceed all Florida state standards for office surgery.

However, non-ASPS members and "wanna-be" cosmetic surgeons have less stringent requirements. Some of these offices may not have any semblance of adhering to accreditation safety standards at all.

Bottom line: always ask two questions regarding the facility, eespecially if it's a doctor's office- "Is this an accredited surgical facility?" and "Which certification agency?".

The only acceptable answers are "Yes, it is", and one of either JCAHO, AAAHC, or AAAASF.