SUR 102 - Periop care/injuries
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condition that will not cause injury or harm to the employee, patient and other people in the health care facility
injuries can be caused by?
- faulty equipment
- using equipment improperly
- exposing oneself or others to toxic or irritating agents
- coming into contact with harmful agents
classifications of hazards
- physical - back injury, fall, etc.
- chemical - gases, fumes, etc.
- biologic - cuts or needle sticks, etc.
positively and negatively charged particles that can change the electrical charge of some atoms and molecules in cells
radiation changes can alter?
enzymes, proteins, cell membranes and genetic material
causes of exposure to radiation
cancer, cataracts, bone marrow injury, burns, tissue necrosis, genetic mutations, spontaneous abortion, congenital anomalies
reducing radiation exposure
- fluoroscope should be turned off when not in use
- x-ray should be last resort on counts
- body areas should be shielded from radiation
radiation overexposure time avoidance
- personnel should rotate during radiation procedures
- should not be in procedure when pregnant
- turn machines off when in use
- limit time around patient with radioactive elements
- leave room if not sterile
- if can't leave, stand 6 feet away
- wear lead aprons
- if apron does not wrap around body, stand facing radiation source
- never fold apron
- all personnel should wear monitoring device to measure rems of accumulated exposure
- film badges contain photographic film sensitive to radiation
- monitor should be worn outside of lead apron
electrons to move through material in one direction and causes current to flow
measurement of opposition to the flow of electron through material
rate of flow of electrons through a conductor, measured in amps
types of current
- DC direct current - battery and low voltage
- AC alternating current - 110-220 volt line - 3 times more powerful than DC
designed to discharge any harmful electricity directly to the ground without including the patient
grounding (Bovie pad)
when does electrocution occur?
when individual becomes the component that closes a circuit through which a lethal current may flow
when does electric shock occur?
when current is large enough to stimulate nervous system or large muscle area
severity of shock depends on?
magnitude of current flow and path taken through body
2 types shock
- macroshock - large surface of skin - high voltage
- microshock - small contact area of skin
gaseous form of sterilization and known to be mutagen and carcinogen
ethylene oxide exposure can cause?
dizziness, nausea, vomiting
toxic to respiratory tract
- least toxic of 3 agents
- fumes irritating to eyes, nose and throat
- only be used in closed container and well ventilated areas
what should be worn when using disinfectants?
gloves and goggles
generated by thermal destruction of tissue or bone
what should be used to suction laser and ESU plumes?
male reproductive hazards
can cause abnormal sperm numbers, shapes and motility
female reproductive hazards
can cause spontaneous abortion or congenital fetal anomaly
4 essential elements of risk management
standards for cleanliness
- patients are entitled to clean environment for their surgical procedures
- any contamination encountered should be contained and confined
- between-case cleanup should reestablish cleanest environment possible
- procedure rooms and utility areas to be cleaned daily
- scheduled routine cleaning
- sanitation processes defined by facility policy and procedure
duties to be performed before first case of the day
- arrange furniture and remove unnecessary furniture
- damp-dust light, arms, furniture, tables, equipment, starting higher and working down
- damp-dust sterilizer and/or washer-sterilizer and countertops in substerile room
- inspect for dirt and debris, damp-mopping as needed
are vinyl gloves acceptable for cleaning?
nope - not reliable and may not protect from environmental contamination
special considerations for patients with known respiratory-borne diseases (TB, rubeola)
- air exchanges should be 99% complete before next patient is brought into room - takes 20-30 minutes on a 15- to 20-air change per hour cycle
- staff should wear filtration masks during cleaning
special considerations for patients with known endospore-forming bacterial contamination
hypochlorite-based disinfectant should be used for cleaning
how long do endospores survive in the environment?
- 5 months
- have been cultured in ORs 40 days after the patient has used the room
special considerations for patients with known or suspected transmissible spongiform encephalopathies (CJD)
disposable equipment, instrument, linens and supplies should be used
primary principles of cleaning procedures
to confine and contain contamination and physically remove microorganisms as quickly as possible
primary cause of accidental cuts and punctures to personnel
disposal of surgical sharps at the end of the surgical procedure
where are basins and trays too large for the case cart placed?
put into plastic bags for transport to the decontamination area
how would you dispose of solutions and suction bottle contents?
dispose of them in a flushing hopper connected to sanitary sewer
what do you do with unused suture packets?
when does scrub remove gown and gloves?
before taking case cart to processing area
technique used to remove gloves
glove-to-glove and skin-to-skin
what type of bottle should be used to spray disinfectant for cleaning?
squeeze bottle because spray bottles can cause particles to become aerosolized
how are floors cleaned?
in perimeter of 3-4 feet in circumference of surgical field, expanding in direction of visible soilage
how are mops used?
- one mop applies solution, one mop takes it up
- remove mop heads and place in laundry hamper
- mop handles cleaned with disinfectant
for cleanup, instruments are managed in what way?
- heavy instruments loaded in bottom of tray, hinged instruments opened, disassembling instruments taken apart, concave surfaces turned down
- glassware placed in separate tray
- detergent-disinfectant suctioned through lumens
- cart goes through automatic steam cart washer or manual power wash for terminal decontamination
average time the room will be ready for next patient
if patient is taken to OR but procedure is canceled...
tables should be torn down and room cleaned as if procedure had been performed
hazards related to medical devices and energy sources
technical risk factors
hazards related primarily to liquid, gas, and solid chemicals in the perioperative environment
chemical risk factors
hazards related to transmission of infectious disease
biological risk factors
3 components of fire
- source of ignition
how much oxygen does normal air contain?
environment that contains greater concentration of oxygen
oxygen-enriched atmosphere (OEA)
when are oxygen molecules produced?
when nitrous oxide decomposes in presence of heat
what are oxygen and nitrous oxide considered?
how much alcohol do most skin prep solutions contain?
are surgical drapes and gowns flame resistant or flammable?
gases normally produced by intestines (potentially causing fires)
- carbon dioxide
how much of gases are contained in large bowel?
concentration at which methane is explosive?
fuel sources at surgical site
- oxygen-rich environment
- dry sponges and drapes
- ET tube and other flammable anesthesia equipment
- volatile prep solutions
- petroleum-based products
- suction catheter and other PVC devices
- smoke plume evacuator tip
- GI gas
how many surgical fires involve lasers?
how hot can an active electrode reach in ESU?
1292 F (700 C)
how many patient fires occur in the airway?
how many patient fires occur on the face?
how many patient fires occur inside the patient?
how many patient fires occur on the skin?
how do you stop the progression of the fire?
triangle of fire must be broken
3 steps immediately taken to protect patient and stop fire
- shut off flow of all gases to the patient's airway
- remove burning objects from surgical site
- assess patient for injury and respond appropriately
4 actions of hospital fire plan
- R - rescue patients in the immediate area of fire
- A - alert other people to the fire so they can assist in patient removal and response - activate fire alert system
- C - contain the fire - shut all doors and shut off valves
- E - evacuate personnel in the areas around the fire
types of fire extinguishers used in the OR
- carbon dioxide
- dry powder
preferred type of fire extinguisher in OR
how do you activate the fire extinguisher?
- P - pull ring from handle
- A - aim nozzle at base of the fire
- S - squeeze handle
- S - sweep fire with tank contents
risk reduction strategies have been developed by what organizations?
what are oxygen portable tanks used for?
when in-line systems are not available or when patients are transported
what are compressed nitrogen tanks used for?
as a power source for instruments such as drills, saws, and other high-speed tools
what is argon used for?
during laser surgery
what is nitrous oxide used for?
as anesthetic gas
what is carbon dioxide used for?
insufflation during laparoscopy or pelviscopy
2 types of hazards associated with compressed gas cylinders
- physical - related to high pressure in cylinder
- chemical - related to flammability or oxidative qualities/toxicity
how many valves do gas cylinders have?
- one opens the cylinder and allows gas to flow to the regulator
- one is located on regulator and controls the flow from the regulator to the power instrument
what does right hand valve of a gas cylinder do?
displays pressure in cylinder
what does left hand valve of a gas cylinder do?
displays pressure in power hose connected to the instrument
do not use a gas tank if pressure is what?
less than 500 psi
regulators are specific to what?
gas specific and are not interchangeable
leading cause of hospital fires in US
characteristics of electricity
- impedance (resistance)
rate of electrical flow
low voltage that originates from battery
direct current (DC)
current transmitted by a 220- or 110-V line, normally found in wall outlets
alternating current (AC)
available power is much higher with which current?
driving force behind moving electrons
ability of a substance to stop flow of electrons
examples of nonresistant materials
discharge of electrical current from source to ground where it is dispersed and rendered harmless
most effective method of blocking radiation
most important parameters determining risk and protection
- distance from radiation source
- duration of exposure
- quality of shielding
which direction should workers face during use of ionizing radiation?
face the radiation exposure because many lead aprons shield only front of the body
what other lead gear should be worn?
- lead glasses
- neck shield
- lead-impregnated gloves
where should nonsterile team members be during radiation exposure?
step outside the range of exposure
safest place for nonsterile workers during radiation exposure?
- maintain distance of at least 6 feet from patient
- stand at a right angle to the beam on the side of the radiograph machine or origin of radiation beam
what is used to measure the cumulative radiation dose for those who are often exposed to radiation?
primary risk when MRI is used?
presence of metal
how can toxic chemicals enter the body?
- through respiratory tract
- by direct skin contact
- by splash contact
- by ingestion
how is exposure to airborne chemical measured?
by concentration in parts per million (ppm) or milligrams of substance per cubic meter of air (mg/m3)
smoke created during laser surgery and electrosurgery that contains toxic chemicals, vapors, blood fragments and viruses
set of recommendations responding to the concern of workers contracting or transmitting blood-borne diseases in course of their work
behaviors and methods of working in the healthcare setting that reduce exposure to blood and body fluids
what kind of soap do you use for routine handwashing?
plain soap, not antimicrobial
most common means of transmission of blood-borne pathogens to health care workers
special set of regulations for handling and disposing of sharps
Blood-Borne Pathogen Rule, issued by OSHA
method of transferring sharp instruments on the surgical field without hand-to-hand contact
neutral zone (no-hands) technique
risk reduction strategy used after exposure to blood or other body fluids
postexposure prophylaxis (PEP)
when are PEP drugs most effective?
when given within 24 hours after exposure
PEP for HBV
- HBV surface antigen and immunization series initiated
- if incident involved mucous membrane, blood or body fluid exposure and worker has not been previous immunized, hepatitis B immune globulin
PEP for HIV
regimen of antiviral drugs followed by regular testing
how long do antibodies generally take to appear on HIV tests?
25 days to 3 months
how long does HIV PEP regimen usually last?
precautions implemented when patient is known or suspected to have highly infectious disease and Standard Precautions are insufficient to prevent transmission to others
- Transmission-based precautions
- used in addition to Standard Precautions
precautions to reduce the risk of transmission of airborne agents by droplet nuclei up to 5 um in size
airborne transmission precautions
during transport, patient with disease that can be spread by airborne transmission must wear what?
health care personnel must wear respiratory protection when they are within what distance from patient with disease that can be spread by airborne transmission?
within 3 feet
diseases for which airborne transmission precautions must be taken
traveling distance of droplets
distance between patients with droplet precautions and other patients
infections for which droplet precautions should be implemented
- invasive infection with H. influenzae type B
- invasive infection with N. meningitidis
- Streptococcal pharyngitis
when are contact precautions implemented?
when patients are known or suspected to harbor infection transmitted by direct contact
steps for contact precautions
- hands washed and gloves worn before contact
- protective gowns worn
- items that come in contact must be disinfected or sterilized
conditions in which contact precautions should be implemented
- herpes simplex virus infection
- noncontained abscesses, cellulitis or decubitus ulcers
- disseminated herpes zoster
- C. difficile infection
- infection with any multidrug-resistant bacterium
agencies associated with regulating various aspects of medical waste
naturally occurring sap obtained from rubber trees
abnormal immune response to a substance
if latex reaches bloodstream in a patient with latex allergy, what happens?
large amounts of chemical mediators are released, causing severe bronchial obstruction, pulmonary edema and death
amount of physical effort needed to perform a task, such as moving an object
excessive direct pressure against a sharp edge or hard surface
classifications of causes of musculoskeletal injuries
- repetitive motion
- contact stress
where should heavy items (instrument trays) be stored to prevent injuries?
body mechanics when lifting an object
- keep object close to your body
- bend at the knees
- never lock knees or bend over to pick object up
class A fire extinguisher
wood, paper, cloth
class B fire extinguisher
carbon dioxide, flammable liquids
class C fire extinguisher
electrical or laser
class D fire extinguisher
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