The technology behind the products: a Nursing Homes/Long Term Care Management sampling. (Product Design Showcase).

Long-term care is a product-rich service. It's possible that no other sector in healthcare uses such a wide array of products, ranging from high-tech cardiac-care devices to furniture to food to wound dressings. Often overlooked, though, is the sheer amount of research effort and expense that underlies many of these products. [For a look at a full-blown research lab devoted to incontinence pad research, for example, see the story on SCA Hygiene's operation: "How One Manufacturer Takes On the Challenge of Incontinence," August 1999, p. 50.]

Recently, Nursing Homes/Long Term Care Management focused on a sampling of particularly innovative new products and asked their manufacturers to describe the research-and-development process behind them. These are by no means the only products in the field deserving such attention, but they offer a powerful illustration of the thought and hard work that go into the long-term care technology that steadily improves resident care.

Caliwel Paint--Antimicrobial Wall and Ceiling Covering

Alis A. Yeterian, President, Alistagen Corp.: "Our chairman, Bryan Glynson, is of Greek-Italian descent, and I grew up in Istanbul, Turkey. Why is this relevant? Because in that area of the world, you very commonly see people whitewashing their homes. Whitewash contains calcium hydroxide, which acts as a disinfectant. I remember never being sick as a child because our father was always whitewashing our homes. The problem is that whitewash, or lime, turns to chalk in three weeks and loses its disinfectant effect. The question was, would it be possible to encapsulate calcium hydroxide so that the effect would last much longer? Many companies have tried, and the fact that we succeeded, I consider a gift.

"Using BNA (bioneutralizing agent) encapsulating technology, Caliwel maintains its antimicrobial activity for six years. We have been researching this with Southwest Research of San Antonio since 1995 and had our first breakthrough in 1997. Government research continues and, post-9/11, Caliwel was tested, and continues to be tested, against anthrax spores and was found to neutralize at least 70% of them in 48 hours; further testing is expected to yield even better results. Meanwhile, research continues on indoor air quality impact.

"Caliwel is effective against bacteria, viruses, mold, and mildew. It can be very effective for nursing homes that have odor problems; no disinfectants or sanitizers are needed for cleaning walls. We will eventually be including BNA technology in other products, including dental applications and heating, ventilation, and air-conditioning (HVAC) applications, including air-conditioning ducts."

For more information, phone [phone] or e-mail [e-mail].

The Carendo--Multi-Purpose Shower Chair

Greg Gale, Director of Marketing, Arjo, Inc.: "A few years ago our Netherlands-based company identified some serious ergonomic issues with resident showering procedures. Studies showed that postural loads on caregivers' backs increased to very high and dangerous levels when they were showering residents in standard PVC shower chairs. They had to do a lot of bending and reaching, and they had difficulty reaching such areas as the resident's feet or perineal areas. From the resident's standpoint, he or she typically had to be placed in bed to be undressed, transported to the shower in a robe or blanket, and then often strapped to the shower chair to avoid slumping over--in short, a lot of serious dignity and comfort issues.

"The Carendo is designed to lift and tilt the resident to the position needed for convenient cleansing of all body areas, easy drying off, easy dressing and undressing, and removal and insertion of incontinence pads during the showering process. Back strain is reduced by more than half, and only one caregiver is needed. Residents can undergo this process in comfort and dignity.

"Industrial designer Per Nylander, who worked with Arjo on the Carendo in a three-year development process, said he tried to 'associate the shape of this with the classic chair to help the elderly feel safe and secure in spite of all the techniques involved with this product.' Other uses have emerged for the Carendo, as well, including expediting dental procedures, catheter insertion, and foot care."

For more information, phone [phone], e-mail [e-mail], or visit www.arjo.com.

DuraShock[TM] Integrated Aneroid Sphygmomanometer--Shock-Resistant Blood Pressure Monitor

Tom Grant, Director of Marketing, Welch Allyn, Inc.: "A problem with the traditional blood pressure monitor has been that it is relatively delicate. Simply dropping it on the floor can throw it significantly out of calibration. The reason is that the device has a complex movement requiring several gears and springs that are easily thrown out of line. Our engineers invented a new aneroid--meaning without liquid--technology that replaces this complex mechanism with a simple one, a very small helical spring that directly drives the pointer around the dial. The spring is perhaps the size of a human hair, and the resultant light weight of the device also contributes to its shock resistance. It is the only one that meets AAMI SP-9 shock-resistance specification, e.g., it can be dropped from a height of 30 inches on to a hard surface and remain in calibration. This product has won several industrial design awards, including a prestigious R&D 100 Award, marking it as one of the 100 most important inventions of 2002 i n any field--not just medical."

For more information, phone [phone] or visit www.welchallyn.com.

Londura--Smooth, Slip-Resistant Flooring

Tony Sain, Marketing Manager, Lonseal, Inc.: "After years of producing embossed safety flooring, which employs raised traction-control patterns, skid-resistant materials, and moisture-channeling properties, our product designers here and at our Japanese parent company began to notice an increased demand for smooth safety floors and began work on a new smooth-surface safety sheet that incorporated all of the benefits of our embossed safety floors. The result of that effort is Londura.

"One of the difficulties of manufacturing a smooth safety surface is that you are forced either to rely solely on the skid-resistant nature of the material itself (such as rubber or smooth vinyl floors) or to embed a skid-resistant material with traction-enhancing grit (such as carborundum or aluminum-oxide chips) that stand a hair's breadth above any moisture to 'claw' into the shoes of passersby, helping to reduce the risk of slips and falls. The result is that you either end up with a floor that is only slip-resistant when there is minimal exposure to moisture or a floor that is slip-resistant only so long as the traction chips remain in the surrounding floor material--a prospect that becomes more risky as routine cleaning, snags, and wear-and-tear tend to rip the traction chips out of the floor over time.

"Our Lonseal Flooring designers were unwilling to sacrifice durability in the pursuit of smooth safety, so they developed a polymer traction chip to embed in our smooth-surface floor. These polymer chips meld into the surrounding vinyl, virtually eliminating the risk of the disintegration and traction degradation that carborundum- and aluminum-oxide-based safety sheets tend to undergo. Because these chips are slightly harder than the surrounding vinyl, they stand out more under foot pressure (as the vinyl sinks), giving Londura a particular edge in reducing slips and falls in moisture-prone environments, such as hydrotherapy rooms, bathing areas, locker rooms, kitchens, and indoor swimming area decks. In fact, this flooring product increases its coefficient of friction when wet, meaning that unlike other safety surfaces, it is even more slip-resistant when wet than when dry. In addition, its sheet construction makes installation simpler and permits the creation of sterile seams. Londura has a soft resilience that is comfortable even under bare feet, is durable, and comes in an array of attractive colors."

For more information, call [phone] or visit www.lonseal.com.

Stanley[R] AccessPRO[TM] Door Automation System

Matthew Hurley, National Account Manager, Senior Technologies, a subsidiary of Stanley Works: "The idea for the AccessPRO came from a member of Stanley's board of directors whose mother was having difficulty getting into and out of her room in a nursing home. This is a common problem in long-term care facilities that are required by law or fire codes to have spring-hinged doors or hydraulic door closers on resident-room doors. Many residents--because they use wheelchairs, scooters, or walkers; because they have physically debilitating conditions or visual impairment; or simply because the doors are too heavy for them--face this difficulty. Our team felt there was a need for an affordably priced, total-package automatic door system. We wanted to create a system that would give people better quality of life and a sense of independence.

"One challenge we faced was meeting UL requirements for the equipment's longevity. Before we could introduce it to the market, AccessPRO had to undergo UL testing equivalent to opening and closing a door 50 times a day for 12 years. In addition, it had to meet FCC radiofrequency regulations, so that the remote-control opener would not interfere with any other electronic equipment or devices in its vicinity. We also had the challenge of designing a system that would fit on existing doors.

"The AccessPRO improves security via its automatic electric latching function and its rolling-code technology. Residents can open doors from as far as 30 feet away, but they're safe even if they stand too close, because the door will stop if it meets an obstruction. In addition to increasing residents' independence, this product reduces the amount of staff time needed to assist residents into and out of their rooms/apartments and saves maintenance costs for repairs to doors and trim damaged by residents struggling through doorways in wheelchairs or on scooters."

For more information, call [phone] (STANLEY) or visit www.stanleyworks.com.

[V.A.C..sup.[R]ATS] (Vacuum Assisted Closure--Advanced Therapy System) and [V.A.C..sup.[R]FREEDOM][TM]

Lynne Sly, Vice-President of Marketing, Kinetic Concepts, Inc. (KCI): "The invention of the original V.A.C.[R] device was a classic case of late-night inspiration. Plastic surgeon Louis C. Argenta, MD, had been working with research scientist Michel J. Morykwas, PhD, of Wake Forest University on devising a new method of treating complex, hard-to-heal wounds, such as pressure sores and diabetic ulcers. Dr. Argenta awoke in the middle of the night with an idea: He envisioned placing a sterile foam dressing onto a wound, sealing the wound site with an adhesive drape, and then running a tube from the dressing to a controlled vacuum unit, to remove infectious and other unwanted materials, such as interstitial fluid, from the site. Removal of these materials promotes vascularization and wound granulation, which are essential to the healing process. This method also maintains a moist environment, which is conducive to wound healing. V.A.C. therapy is designed for the treatment of complex wounds, such as stage III an d IV pressure ulcers, that are difficult and expensive to heal with standard therapy.

"After it was developed, the V.A.C. device was subjected to extensive testing under strict U.S. Food and Drug Administration guidelines to see if it would work. It did. What makes this system unique is the use of specialized foam dressings and the application of controlled vacuum pressure to the wound; it's a simple but powerful concept. A great deal of effort was invested in finding the right balance--e.g., the correct pressures to apply to wounds, and for how long.

"This year we've launched two new systems. The first of these, the [V.A.C..sup.ATS], has a large (500 ml) canister for collecting the suctioned material, necessitating fewer changes. It is particularly well suited for heavily exudating wounds and in acute-care settings. The [V.A.C..sup.FREEDOM] is a portable, lightweight (3.5 lb) model that can be worn in a discreet carrying case, either over the shoulder or around the waist, allowing the wearer to return to daily activities. The devices are equipped with a safety feature called a 'smart alarm' that signals when the canister is full or if the tubing becomes blocked.

"Currently 11 randomized, controlled studies using the V.A.C. device are under way. We are researching the use of specific types of dressings for specific wounds and plan to add more wound-monitoring features."

For more information, call [phone] (WOUNDVAC) or visit www.woundvac.com.