7. Operating room hazards.class notes pptx

summary notes

1. HAZARDS IN THE OPERATING ROOM

2. Presentation Outlines Introduction Definition of terms Classification of hazards Causes of hazards and their safety measures Risk management Conclusion Video links

3. Introduction Surgery has the absolute purpose to save lives but a number of hazards are lurking in operating theatre rooms. Nurses, surgeons, anesthesiologist and theatre technicians working in surgical environment put themselves at risk every day in their careers. Patients are also exposed to the risks/hazards in theatre.

4. Intro cont. Perioperative staff utilize a variety of different equipment to assist in surgical procedures. This entails working in a semi-enclosed environment, coming into contact with dangerous medical tools and substances. These include sharp objects such as scalpels and syringes, anesthetic gases, drugs, and sterilizing chemicals.

5. Intro cont. There are a variety of safety precautions theatre staff and institutions use in the OR to prevent injuries. Basic methods include comfortable non-slip shoes, handling sharp objects with caution, and having equipment routinely monitored for signs of breakdown or unsafe conditions. Proper ventilation is also important in an O.R. setting to ensure that the anesthetic gases and other airborne substances are not trapped in the room.

6. Definition of Terms Hazard : is a situation that poses a level of threat to life, heath, property or environment. It can also be defines as a potential source of harm or having adverse health effects on a person. Hazards in the operating room are potentials sources of harm or adverse health effect that occur in the operating room. Occupational hazard are risks or dangers connected to a particular job.

7. Classification of Hazards OR hazards can be classified as: physical/accidental hazards, biological hazards, chemical hazards and other such as organizational & psychological hazards. Physical/accidental Hazards : These hazards includes but not limited to cuts, pricks, electrical shocks, burns, falls and noise pollution. A surgical team member could accidentally injure himself or herself using surgical equipment, slips and fall if a wet floor, fall from OT table, injury due to improper positioning, wrong surgery on patient having identical names and pain due to long hour of standing or handling of patients.

8. Biological Hazards : People working in the operating room regularly come into contact with blood and other body fluids. They can easily be exposed to a number of diseases such as HIV and hepatitis. Biological hazards include the patient (as a host for or source of pathogenic microorganism) infectious waste, cuts or needle stick injuries, surgical plumes and latex sensitivity. Chemical Hazards : Hazardous materials are substances that, on contact cause harm to a person or the environment. They include anesthetic gases, toxic fumes from gases and liquid, cytotoxic drugs, disinfectants and cleaning agents.

9. Organizational hazards Heavy operational theater workload, long working hours, night shift and sleep deprivation, fatigue from handling the patients, and stress on managing the very sick patients are the occupational hazards that can have adverse effect on mental skill and reaction time, vigilance, and interpersonal relationship among the OT personnel. Psychological hazards Exposure to severely traumatized patients, irreversible cardiac arrest of a patient may lead to postoperative stress syndrome to the caregivers of the OT. Surgical team members are under a great deal of stress overtime, this stress can wear down a person’s metal health causing anxiety, depression and burnout.

10. Causes of hazards and their safety measures Perioperative nurses are the team leaders of the OT must be familiar with the OT environments, effects of commonly used gadgets, chemicals and medications. PONs can take appropriate and quick action to reduce morbidity and prevent mortality when patients and other theatre users are exposed to hazards.

11. Fall/Slips causes Water on the floor or wet floor Wrong theatre shoes Oil spillages Empty paper foils & suture wraps Trailing cables Unstable theater stools and so on Safety measures include: Proper cleaning in between list. Prompts mopping or wet vacuuming of flooded theatre floor. Avoidance of trailing electric cables. Use of ideal theatre shoes. Careful arrangement of operational room equipment and furniture’s. Dutiful use of kick about and waste buckets. Faulty stools and platforms should be removed from circulation and be brought back only after they have been repaired.

12. Trauma causes Careless handling of sharps Uncoordinated speed Falls Inexperience of the care provider Safety measures include: Provision and use of disposable bags for disposable sharps e.g. blades, needles etc. Careful handling of sharps e.g. the use of forceps to mount blades on bard parker handles Careful arrangement of instrument and sharps on the instrument and mayo trolleys Extreme care where speed is required. Caution and extreme precision in handling instrument. Avoidance of slips and falls

13. Electrocution causes Faulty electrical equipment Poor maintenance culture Wrong handling techniques Unfamiliarity Safety measures include: Prompt and proper maintenance of equipments. Careful attention to electrical contacts used on patients. Appropriate responses to alarm signals. Proper insulation of equipment Do not coil the return electrode cable while in use

14. Radiation causes Inadequate protection from X-ray Intraoperative radiological procedures. Safety measures include: There are two types of radiation used in operating room areas namely: Ionizing & Non-ionizing radiations *Ionizing radiation e.g. X-rays *Non-ionizing radiation e.g. lasers light amplification by stimulated emission of radiation). The wall of room with fixed radiation equipment should be lined with lead. Sterile and unsterile team members should wear lead aprons. Lead impregnated rubber gloves can attenuate (reduce the intensity) rays by 15% to 25%. Lead glasses should be worn to protect the eyes from cataract formation during laser surgeries.

15. Radiation Safety measures cont. Lead shield should be tested routinely by the radiology department every 6 months and whenever damage is suspected defect may not be visually detected. Radiation Exposure: this should be monitored with film badges or pocket dosimeters, these must be checked monthly by the radiology protection officers.

16. Burns causes Steam sterilizer Electricity Autoclaves Hot water bottles Diathermy machine. Safety measures include: Careful handling of autoclaves and steam sterilizers. Provision of hand gloves for transferring sterile hot H 2 O bottle. Careful handling of diathermy points Avoidance of using immediately autoclaved items or metals from hot air oven on operation sites

17. Burns safety measures cont. Ensure that all equipment, including cables, surgical instrumentation and patient plates are fully insulated and that any faulty equipment is removed immediately and reported as per hospital policy Always ensure that electrosurgical equipments are kept within an insulated container throughout the procedure

18. Heat/heat stroke Faulty ventilation devices Overcrowding Presence of heat generating equipment within the operative room. Safety measures include: Repair and maintenance of faulty ventilation devices Avoid overcrowding of the OR Maintain normal OR temperature of 16-20 0C

19. Infection causes Contracting of HIV & AIDS virus through needle stick, splashing of blood contact to the eyes Hepatitis A& B and other organism Failure to maintain aseptic technique Poor ventilation Unreliable cleaning and decontamination Dirty operation room attire. Use of non-theatre equipment

20. Infection safety measures include: Proper maintenance of aseptic technique Careful handling of infections or contaminated cases. Standard precautions are a necessity (i.e. treating all body fluids and materials as infectious). Reliable routine cleaning programme Proper ventilation Adequate decontamination and sterilization of appropriate equipments /objects. Screening of staff for infections and communicable diseases. Personal and patient hygiene Identification/separation of high risk patients Utilize safe zone during each surgical procedure

21. Infection safety measures cont. Dispose of sharp in sharps container immediately after use Use of PPE For eye/face exposures: Use an eyewash station and rinse for about 15 minutes For a needle stick: wash with soap/water or use betadine if available Report exposures immediately to Hospital PEP committees for proper evaluation and recommendations Employers must ensure that the appropriate protective equipment is available and that employees are trained to wear and use it.

22. Causes of inadvertent deposit of items in patient’s cavities Failure to conduct counts Impatience during counts Poor monitoring of used swabs Inexperience Poor handing and taking over techniques Removal of counted items from the sterile field or operating room without notice. Safety measures include: Counting of instruments, swabs and other items should be done properly by the scrubs and the circulating nurse. The items should be recorded by the circulating nurse. Counting should not be interrupted Proper handing and taking over of instruments and swabs by the PONs

23. Air pollution Leaking of ambient gases (gaseous mixture mainly nitrogen and oxygen) Septic cases Safety measures include: Gas cylinders should be checked for leakages every morning. Closed circuits anesthetic administration should be encouraged to reduce the theater level of composed gases. Check corrugated tubes for leakages and recent gas leakage from other sources to reduce the theatre level of ambient gases. Avoid sparks or active fire out break Avoid overcrowding in the operation room.

24. Air pollution safety measures cont. Empty waste bucket promptly. Provide a different theatre for septic cases Execute an efficient cleaning programe to prevent rodent infestation death or decomposition. Noise should be reduced to bearest minimal. The environmental protection agency (EPA) recommends that noise levels in hospital should not exceed 45 decibels during the day hours.

25. Fire outbreak/sparks causes Lack of training for precaution and fire fighting Naked flames in the theatre Excessive heat Lack of fire prevention inbuilt in the OR Safety measures include: The three basic elements of surgical fires constitute the fire triangles which are: Ignition Source includes electro-surgical equipment, surgical laser, electrocautery equipment, fiber optics light source and defibrillators. Oxidizers include oxygen enriched atmosphere nitrous oxide medical air.

26. Fuel includes operating theatre materials like mattresses sheet, gowns, drapes and dressings.

27. Ways of minimizing ignition risks During electro-surgery the pencil should be placed in a quiver or holster when it is not in active use and the active electrode should be activated only when the tip is under the surgeon’s direct vision. Elimination of Fuels Avoids the use of flammable gases e.g. ether or cyclopropane gases. Provision of a good ventilation system to diffuse the concentration of flammable gas, vapour or liquid. Safe keeping of flammable items.

28. Ways of Elimination of Sparks Ensuring that the theatre floor most especially, around the operation and anesthetic rooms is spark resistant. Theatre flooring should be of terrazzo/marble laid upon a metal mesh to conduct currents away. Patients on whom diathermy machine is used must be adequately guarded. Avoid creating frictions on two metallic surfaces. Stools, buckets, trolleys, equipment stands etc. should have antistatic properties Shoe covers or shoes worn must have soles and heels impregnated with non conductive properties.

29. Ways of Elimination of Sparks cont. All electrical cords must be rubber coated. Avoid naked flames as this literally set up an ignition, very hot objects like lights, and sources of heat etc. should be at least one meter away from the anaesthetic machine or any flammables agent or item. There must be no smoking The position of fire extinguishers in the theaters should be well marked and fire routes and assembly points should be known by all personnel. Regular fire drills should be done to improve on awareness.

30. Ways of minimizing oxidizer Risks/ Ways of minimizing fuel risk Ways of minimizing oxidizer Risks During oropharyngeal surgery, suctioning of potential breathing gas leak should be done as a means of scavenging gases from oropharynx of an intubated patient. Wet gauze should be used with uncuffed tracheal tubes to minimize leakage of gases into the oropharynx all gauze, sponges and pledgets and their strings should be kept moist throughout the procedure to render them ignition resistant. Ways of minimizing fuel risk During skin preparation, the surgeon should avoid pooling or wicking of flammable liquid preps (Spirit containing). The flammable liquid preps should be allowed to dry fully before draping.

31. Classes of Fire Extinguishers Class A fire: This comprises of solids such as carbonaceous materials like paper wood and their derivatives. It should be extinguished with water. Class B Fire This involves liquids and liquefiable solids e.g oil, fat, petroleum products, parading wax, etc. they should be extinguished with sodium bicarbonate powder, CO 2, incombustible sheet or foam materials Class C Fire : This involves propane, butane; methane i.e. liquefied gases they are extinguished with water on their containers. Class D Fire: This involves metals. H2O (water) must not be used instead carbon dioxide, dry sand should be utilized.

32. When a fire extinguisher is used the acronym PASS may aid in the remembering how to operate the device. *P- Pull the safety ring out of the handle. *A- Aim the nozzle. *S- Squeeze the handle *S- Sweep the spray over the base of the fire.

33. Responding to surgical fire during surgery If fire should occur in the operating room during a surgical procedure, the first concern is the safety of the patient and personnel. To prevent explosion, the burning article is removed immediately from the proximity of the oxygen source and the anaesthetic machine or outlet of piped-in gases. The fire on the field is smothered with wet towels and burning drapes are removed from the patient. The shut-off values for piped in gases are turned off and electrical power cords are unplugged.

34. The acronym RACE may aid in preventing panic and should enable the team to act quickly in the event of fire anywhere within the perioperative environment: R- Rescue anyone who is in immediate danger. A- Activate the fire alarm. C- Contain the fire if possible. E- Evacuate from the area.

35. Injury during surgery A penetrating injury (e.g. needle-stick) or a splash (e.g. into the eye mucus membrane) with fluids, contaminated with blood or body fluid must not be ignored if exposure to blood or body fluids occurs. The following procedures should be performed: Stop activity immediately, and step back from the point of contamination. Cleanse the puncture site or flush the eye with cool water. Flush out or the puncture site with alcohol or iodine preparation Report the incident according to security policy and procedure and seek medical attention promptly Follow the particular protocol established by the facility for follow up

36. Safety measures in preventing chemical hazard Improper handling of chemicals can result in injury to health care workers and patients. All chemical containers must have proper labeling indicating contents, safe use and associated hazards. This also applies to secondary containers. Potential hazards associated with the use of chemicals, in the practice setting should be identified, and safe practices should be established. Injuries may result from exposure to any portion of the body, including the integumentary or respiratory systems. Perioperative staff can protect themselves by keeping containers and basins tightly covered, use in well ventilated areas, wear PPE, and in case of skin or eye contact, flush with water for 15 minutes.

37. Safety measures in preventing chemical hazard cont. In the OR, information about the physical characteristics, storage, cleanup, disposal, and toxicity of chemical substances, as well as first aid for chemical exposure, can be found in Material Safety Data Sheets (MSDS). This information is developed and provided by the suppliers of potentially hazardous chemicals. The MSDS is a detailed information bulletin prepared by the manufacturer of a chemical that describes the physical and chemical properties, routes of exposure, precautions for safe handling and use, emergency and first-aid procedures, and control measures.

38. Safety measures in preventing chemical hazard cont. Information on a MSDS assists in the selection of safe products and helps prepare health care systems and employees to respond effectively to daily exposure situations as well as to emergency situations. Hospitals must maintain a complete and accurate MSDS for each hazardous chemical that is used in its facility

39. Causes of deaths on the table (DOT) Pre operative patient’s condition Inexperienced personnel’s Lack of monitoring devices Cardiac arrest Respiratory arrest imbalanced anaesthesia Severe hemorrhage Prolonged anaesthesia Lack of resuscitating equipment Lack of resuscitative drugs

40. Safety measures of Preventing DOT Discourage operation on moribund patients. Good induction technique and maintenance of balance anaesthesia . Provision of good monitoring devices/resuscitating drugs and equipment. Identify high risk patient Supervision of less competent hands. Prevention of undue blood loss and provision for fluid level maintenance. Avoidance of unduly prolonged anaesthesia and surgery time.

41. Risk management Risk management is a process that identifies, analyses and treats potential hazards within a given setting. The risk management programme of a hospital is designed to “enhance the safety of patients, visitors and employees and minimize the financial losses through risk detection, evaluation and prevention.

42. Risk management cont. Risk management consists of four (4) related elements: Administration; prevention; correction and documentation. To be more effective in the hospital setting, risk management involves a multidisciplinary and proactive approach.

43. Administration Regulation, recommendations, guidelines and laws should be enforce to prevent disastrous consequences of occupational hazards. Policies and procedures should be written, reviewed periodically and updated as appropriate Protective attires and safety equipments should be made available to employees as appropriate Monitoring devices should be used in all hazardous location as recommended by regulatory agencies Employees health services should be provided for immunization, and in the event of injury for e.g. PEP

44. Prevention Regular in-service training programs should be conducted to keep employees informed about hazards and safeguards measures Employee should be taught how to use and care for new equipments before its been put to use Employee must know the location and the use of emergency equipments such as fire extinguishers and shut-off valves Employee must wear PPE as appropriate Routine preventive maintenance should be provided for all potentially hazardous equipments.

45. Correction Faulty or malfunctioning equipments should be taking out of services with immediate effect to prevent harm to the patients and the users Any form of injury should be reported, with medical attention sought for, as soon as possible Unsafe conditions should be reported.

46. Documentation Record all information about equipment in the theatre A well planned orientation program for newly employed staff or students in OR should be organized Incident report regarding injuries to health care giver and patients should be filed in line with the facility procedures.

47. Incident Reporting Incident reports provide the basis for a larger process with goals to prevent patient and employee harm, and determine how to decrease the number and type of incidents that occur in the health care facility. The process called risk management includes reporting of all patient safety events such as sentinel events, near misses etc. A patient safety event is an event, incident, or condition that could have resulted or did result in harm to a patient. A sentinel event is a patient safety event that reaches a patient and results in any of the following: Death Permanent harm Severe temporary harm

48. …Incident Reporting An adverse event is a patient safety event that resulted in harm to a patient. A no-harm event is a patient safety event that reaches the patient but does not cause harm. A near miss (or “close call” or “good catch”) is a patient safety event that did not reach the patient. A hazardous (or “unsafe”) condition(s) is a circumstance (other than a patient’s own disease process or condition) that increases the probability of an adverse event.

49. … An incident report or sentinel event report is a document submitted to the operating room supervisor or other designated manager describing an incident or sentinel event—that is, an event that causes injury, harm, or death, or one in which there was a “near miss” of any of these events. Incidents may also be reported for cases of internal conflict on the team during surgery, bullying, sexual harassment, and other forms of coercion.

50. … Writing an Incident Report Incident reports are completed in writing on the hospital’s designated form. The forms include a place to list the personnel involved and the date, location, and time of the incident. A section is included in which the incident must be described by the person making the report in his or her own words. The statement must include who was involved, where the incident occurred, when it took place, and how it happened. A witness should also be present when the report is completed.

51. … These guidelines can be followed in writing the narrative part of the report Write and submit the form as soon as possible after the event. State only the facts and do not give your opinion about the incident. Use professional and precise language whenever possible. Write in the first person. Do not be intimidated by others who want to protect individuals. Take your time in writing the report. Submit the incident report directly to the operating room supervisor or other designated personnel. Remember that the report may be subpoenaed for legal action.

52. Conclusion It is better to be safe than to be sorry. Inadequate safety measures thus can result in multiple ill effects in the OT. Constant vigilance, awareness with timely intervention, regular maintenance of operative procedure tools, and an educated team culture can make the OT environment a safe heaven for the patient as well as for the theater users. The standard operative procedure for OT etiquette is to be followed precisely to minimize the risk of accidental, inappropriate practice. The prevention of injuries is vital to maintaining a safe environment; therefore, it’s the responsibility of all the theatre users.

53. Video links Operating room fire safety https://www.youtube.com/watch?v=oxjF4ctFD2M Anaesthesia machine safety checks https://www.youtube.com/watch?v=cbRF4t3swvY