Prevention of Accidents in An Operation Theatre Part 2-NURSING

This contains a detailed information about what causes accidents in an operation theater,its preventive measures and what else to be done to prevent such hazards taking place in an OT

1. PREVENTION OF ACCIDENTS IN AN OPERATION THEATRE Anitta M Shaju NIMHANS

2. Introduction Operation theatre differs from other areas of hospital and care should be taken to prevent accidents by physical , chemical or biological means. Accident is an unexplained, unexpected and undesired event. Objective:To identify the hazards present in the operating rooms and to list actions that can be taken to minimize these hazards.

3. Why should we avoid accidents in an operation theatre? Every patient has the right to be treated using the safest technology available in health facilities. This requires two main aspects knowledge and well trained caring heath care workers and validated systems in operating theatres and sterile services that will ensure safety for the patients and to reduce harm

4. Classifiaction of Hazards in an OT Hazard :A situation that posses a level of threat to life , health,property or environment. Hazards in an operating room:are potential sources of harm or adverse health effects that occur in the operating room. They are of three types : 1)Physical Hazards 2)Chemical Hazards 3)Biological Hazards

5. 1) Physical hazards and safeguards A physical hazard is a type of occupational hazard that involves environmental hazards that can cause harm with or without contact.Most common type of hazard in an OT. Engineering controls are often used to mitigate physical hazards The physical facility is designed to control traffic pattern , decrease contamination, facilitate handling of equipment's and supplies and to provide a working environment.

6. a)Environmental hazards Temperature control Ventilation Lighting Colour Noise

7. Preventive Measures Maintain adequate ventilation through AC Maintain adequate temperature through AC Lighting should be without shadow and glare Wall, ceiling and curtain should have light green or light blue Provision for soft music which is relaxing for both patient and OT personnel

8. b)Improper Body mechanics Standing for prolonged period in an awkward position cause low back pain. Weight bearing on particular body part cause additional strain. Improper height cause back injury or low backache

9. Preventive Measures OT table should be adjusted to best working height. Maintaining an erect posture Surgical team member should stand with feet apart. Surgical team member should wear soft leather with back open. Surgical team member should remain close to the OT table.

10. c)Electrical hazards Short circuit Improper electrical devices cause risk for both patients and personnel. Inadequate knowledge of handling electrical devices.

11. Preventive measures Periodical checking and checking before using of electrical sockets, equipment's and devices All electrical equipment's should be properly insulated. Equipment's should be turned off when not in use. Surgical team should use cotton gowns. Cotton blankets should be used for patients.

12. d)Fire hazards Fire is caused by short circuit,anaesthesia machines, oxygen cylinders and other inflammable items. Preventive measures Periodic checking of electrical sockets,lines . Anaesthesia machines should be kept away from source of heat. OT should be strictly no smoking zone. OT should have fire extinguisher ,fire alarm.

13. e)Irradiation hazard When x-ray is taken. When fluoroscopy and image intensifying apparatus are used. Implantation or removal of radioactive elements.

14. A) Patient Safety B )Personnel Safety .Time .Distance .Shielding

15. Preventive measures Minimum exposure to fluoroscope , image intensifier and x-ray machine. Unsterile members should leave OT during procedures. Sterile team members should keep atleast 2m distance. Lead aprons should be worn inside sterile gown by sterile and unsterile members.

16. 2)Chemical hazards and safeguards Health care providers are exposed to many chemical hazardous daily. The hazards of these chemicals include irritation of eyes or mucous membranes, contact dermatitis or burns, toxicity that causes renal or liver diseases and exposure to carcinogens or mutagens. a) Anesthetic gases Health hazards include risk for spontaneous abortion , cancer, hepatic and renal diseases. .Chronic exposure to nitrous oxide leads to neurologic problems.

17. b) Sterilizing agents The c hemicals agents which are used to sterilize heat sensitive items can be toxic and can vaporize to emit noxious fumes that are irritating to the eyes and nasal passages, even at low levels of exposure >Ethylene Oxide >Formaldehyde > Glutaraldehyde

18. Ethylene Oxide EO is used in a gaseous form for sterilization and is a known mutagen and a carcinogen. The residual products can be toxic if there is direct contact with the skin or the gas is inhaled. Exposure can cause dizziness, nausea and vomiting. All porous items sterilized with EO should be aerated to dissipate the gas.

19. Formaldehyde Formaldehyde may be used in the gaseous or liquid form.The vapors are toxic to the respiratory tract. Formaldehyde is a potent allergen, mutagen and carcinogen and it can cause liver toxicity.

20. Glutaraldehyde Glutaraldehyde is the least toxic of the three sterilizing agents, but the fumes may be irritating to the eyes, nose and throat. Contact dermatitis and hives have been reported.

21. C)DISINFECTANTS Some of the disinfectants used to clean or decontaminate equipment and furniture can be irritating to the skin and eyes. Gloves and goggles should be worn while using these chemicals ,and the agents should be used in proper dilution. The fumes from some agents can irritate the nasal passages.

22. D) Methyl Methacrylate Commonly referred to as bone cement, polymethylmethacrylate (PMMA) is a mixture of liquid and powder polymers and it is important to double check patient allergies before use. The vapors released during mixing are irritating to the eyes and can damage gas-permeable contact lenses. It also irritates the respiratory tract, and they can cause drowsiness. The fumes are flammable.

23. Contd …. PMMA may be a mutagen, a carcinogen , or toxic to the liver. PMMA has an exothermic effect. A scavenging system should be used to collect the vapors during mixing and to exhaust it to the outside air or absorb it through activated charcoal.

24. Drugs and Other Chemicals Antineoplastic cytotoxic drugs(carcinogenic and mutagenic) used for chemotherapy can be hazardous ,as can laser dyes and other pharmaceuticals.It can cause local and/allergic reactions. Prevention; The air is continually filtered through activated charcoal and a smoke evacuator to protect the operating room from aerosolization of the drug.

25. Preventive measures Ventilation through AC Proper dilution Mask ,goggles and gloves for protection Handwashing

26. 3)Biologic hazards and safeguards Transmission of infection and disease is a concern for personnel. Biologic hazards do exist in the environment ,and every effort should be made by health care providers to protect their patients and themselves. a)Infectious Waste The EPA defines infectious waste as a waste-containing pathogens with enough virulence and quantity that exposure to them could result in an infectious disease in a susceptible host .

27. Contd … The presence of pathogenic organisms in sufficient numbers to be capable of causing infection in living beings .Many micro-organisms are incapable of causing infection. The presence of a portal of entry into a susceptible host. A cut ,needlestick,puncture wound ,or skin lesion provides a portal of entry ,but not all living beings are susceptible hosts to infectious diseases.

28. Contd … Potentially infectious waste is considered to be blood and blood products ,pathologic waste ,microbiologic waste, and contaminated sharps.This includes items contaminated by blood ,such as sponges ,drapes , gowns, and gloves.These items should be segregated from general waste . Infectious waste is placed in leakproof containers or bags strong enough to maintain integrity during transport.These bags should be closed and either labeled or color coded Waste can be steam sterilized or decontaminated with microwaves before compaction and disposal in a landfill,or it can be incinerated.

29. b) Blood-borne diseases A p enetrating injury(needle stick ,cut) or a splash(into the eye ,onto mucous membranes) with fluid contaminated with blood must not be ignored. If exposure to blood or body fluid occurs. The following procedures to be performed: Stop the activity immediately and step back from the point of contamination. Squeeze skin around the needle stick or cut to expel blood and contaminants Cleanse puncture site Report the incident and seek medical attention promptly Follow the protocol established for follow up

30. c)Latex Allergy Allergy to latex items. Lead to anaphylactic shock and even death.

31. Management of hazards Administration Prevention Correction Education Documentation

32. a)Administration Regulation,recommendations,guidelines and laws should be enforced to prevent disastrous consequences of occupational hazards. Policies and procedures should be written reviewed and updated periodically. Protective attire and safety equipment’s should be made available to the employees Employee health services should be provided for immunisations

33. b) Prevention s Routine preventive maintenance should be provided for all potentially hazardous equipment C) CORRECTION Faulty or malfunctioning equipment should be taken out of serve immediately Unsafe conditions should be reported.

34. c)Education Orientation Use of emergency equipments Protective garments D) DOCUMENTATION Incident reports regarding injuries to personnel and patients should be filed with the administration of facility .

35. Conclusion Prevention of injuries is vital to maintain a safe environment. Each caregiver should seek instruction when needed and follow safety and control measures established by facility policies and procedures.

36. Bibliography Operating room techniques ,11 th edition Berry and Kohn Operation theatre Nursing Prof. Sunanda S Roy