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Chapter 5 Flashcards

Physical Environment and Safety Standards (87 cards)

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1
Q

Where is the general location of the surgical department?

A

In an area that is easily accessible to departments such as ED, L&D, ICU, CSPD, along with areas with limited traffic and the general public does not have access.

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2
Q

What is the goal of surgical department designs?

A

quickly providing each operating room (OR) with the necessary supplies during and after each case, while keeping clean and contaminated traffic patterns separate.

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3
Q

What are the different surgical department designs?

A

Race track plan.

Hotel plan.

Specialty grouping plan.

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4
Q

What does the race track plan look like?

A

A series of OR’s around a clean central core. the front entrance to each OR is from the outer corridor, and supplies are retrieved through a rear entrance to the room leading to the central-core storage and work areas. The soiled entrance areas are situated outside this central-core area to allow for separation of the two areas and related traffic. Scrub sinks are also situated in the outer corridor with easy access through the main entrances to the OR.

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5
Q

What does the hotel plan look like?

A

the ORs are situated along a central corridor, with separate clean core and soiled work areas. The primary difference in this plan is that all traffic enters and exits the surgery department through a single entrance or a primary entrance and holding area entrance situated along the same corridor.

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6
Q

What does the specialty grouping plan look like?

A

ORs are grouped by specialty (e.g., neurosurgery, general surgery), each with its own closely associated clean storage areas and, in some cases, each with its own soiled instrument work area.

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7
Q

What are some proper storage techniques?

A

Not placing sterile packs too close to ceilings or floors

Temperature should be between 68-78 degrees

Relative humidity should be from 20-60 percent (defined by ANSI)

Separate storage rooms are used for large equipment such as OR tables

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8
Q

What can you wear in an unrestricted area

A

Street clothes

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9
Q

What can you wear in a semi-restricted area?

A

Scrubs and hair cover

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10
Q

What do you have to wear in a restricted area?

A

Everything plus mask

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11
Q

What are some unrestricted areas?

A

Registration- health history is reviewed, additional testing is completed, pt questions are answered

Pre-op holding- Pt is prepped for holding; IV’s/lines are established, regional blocks are administered, and room is shielded from view of OR

PACU- pt is transported to recover from surgery

Lab

Radiology

Pathology- Specimens are sent for diagnosis.

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12
Q

What are some semi-restricted areas?

A

Decontamination and assembly rooms- contaminated supplies are sent to be washed

Central Supply and Processing (CSPD)- Supplies are sterilized and instruments are put into sets or packs.

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13
Q

What are some restricted areas

A

OR Suite

Substerile room- contains a sink and an autoclave steam sterilizer for cleaning and immediate use steam sterilization

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14
Q

What are components of electrical outlets in the OR?

A

They are kept higher up to prevent fluids splashing, some are red (connected to generator), and extension cords should never be used.

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15
Q

What connects to the two suction outlets in the OR?

A

Anesthesia will use one and the surgical team will use the other

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16
Q

How are gas outlets color coded?

A

Oxygen is green

Nitrous oxide is blue

Compressed air is yellow

nitrogen is black

(there must be emergency shut off valves outside the OR)

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17
Q

What are some components of surgical lights in the OR?

A

Provide a range of intensity and focus, horizontal and vertical range, provide glare-free illumination, light handles allow you to adjust, focal point should not leave a dark center in the middle, easily accessible for cleaning

-Non glare (blue/white beam)
-Non reflective instruments (ebony)
-Non-reflective colors (blue/green to prevent eye fatigue)

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18
Q

What are some restrictions for the supply room/core

A

12-18 floor/ceiling requirements
Temperature 68-73 degrees
Humidity 20-60% (regulated by ANSI)
separate storage for large equipment

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19
Q

What are some components of electrical outlets in the OR?

A

Mounted above the floor to prevent splashing
On a GFI system (110v or 220v)
Red outlets are connected to generators
Extension cords should never be used

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20
Q

What ventilation system is used in the OR/Why is it used?

A

Positive uni-directional (Laminar)

It removes airborne contamination, removes anesthetic gases/ toxic fumes, and provides a comfortable working environment

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21
Q

How many air exchanges must happen within the OR?

A

20-25 per hour

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22
Q

How much air in the OR must be fresh (come from outside)

A

20%

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23
Q

Which filter is used in the OR?

A

High efficiency particulate air filters (HEPA) filters. They remove particles as small as .5-5 micrometers

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24
Q

What should the temperature in the OR be kept at?

A

68-73 degrees; 69 is optimal

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25
What should the humidity in the OR be kept at?
20-60% (for comfort, decrease of static discharge, and infection control)
26
What are some components of doors in the OR?
Should be kept close during all procedures and traffic going in and out should be limited.
27
What are some components of computers in the OR?
They are used to chart, view labs, access DPC's, and for the family to receive patient update status
28
What are some components of viewing boxes in the OR?
They are mounted in the OR so they can be seen by the sterile team
29
What are some components of cabinets in the OR?
They are mounted in the wall to prevent buildup.
30
What is a surgical boom?
They are articulating arms that are mounted from the ceiling containing shelving for equipment, monitors, and outlets.
31
Know OR Equipment
32
What are some components of OR tables?
There are a wide variety (fracture, urology, wilson frame); They are narrow, padded, flexible, and cleanable; They have breakpoints and the knees, waist, and head; It has removable sections at the head and foot; Adjustable height.
33
Back Table
large table on which a back table pack is placed and opened to create a sterile field. Sterile equipment, instruments, and supplies are then placed on this table for the CST in the first scrub role to arrange for use during the surgical procedure. The back table also serves as an area for the circulator to open additional sterile supplies that are needed during the surgical procedure.
34
Mayo Stand
small stand that is moved up to the operative field and extends across the patient. The height is adjustable and it is draped with a sterile Mayo stand cover. The CST in the first scrub role obtains the surgical instruments that will be used most often from the back table and places them on the Mayo stand.
35
What is ionizing radiation and why is it a risk?
Excited electrons that collect in dense tissue to produce an image. Can be used for therapies but long term can cause changes in cell membranes, enzymes, protein, and genetic material. (X-rays, fluoroscopy, O-arms.
36
What are some therapeutic doses of ionizing radiation?
Cancer (bone, thyroid, gondola), cataracts, spontaneous abortion, genetic defects.
37
What are the three strategies used to protect from ionizing radiation?
Time- wear x-ray badge, when not in use turn off Shielding- wear led apron (make sure to not fold so it doesn't crease and crack) Distance- If possible, leave the room. Should stand as far away as possible (behind someone or a portable led shield)
38
Who makes the regulations for electric precautions in the OR?
AAMI, Joint Commission, (JAHCO)
39
What are some precautions to take for electric hazards?
All electrical equipment must be grounded (most commonly the three prong plug) Grounding pad must go over a large muscle group and not come in contact with any jewelry Active electrode should be placed in a holster and NOT secured with metal pin.
40
What are some concerns about static electricity
Ignition source leading to explosion. (especially in presence of oxygen and anesthesia gases) Towels and plastic drapes can be a source
41
What is static electricity?
Electrons are passed from one surface to the other and when the two surfaces are separated, one surface loses electrons and becomes positively charged. Other surface is negatively charged. Separate the surfaces and you get a spark
42
What is a commonly used gas that supports combustion in the presence of oxygen?
Nitrous Oxide
43
What are the most common locations for fire sites?
Pt airway, head or face, or elsewhere on the pt's body
44
What has reduced fire hazards?
Introduction of halogenated anesthetic agents and elimination of flammable cyclopropane
45
What are the three components required for combustion?
1. Ignition source (ESU, laser, fiber optic, defibrillator, sparks from burs, metal objects) 2. Oxygen (O2 and NO2- can build up under drapes) 3. Fuel- chemical gas, vapor, liquid, hair, drapes
46
What are the standard fire precautions?
Sterile basin of water on the field and fire extinguisher in the department.
47
What are the three classes of fire extinguishers?
Class A: pressurized water (solid material) Class B: CO2/Chemicals (Liquids, oils, gas) Class C: Halon (Electric or laser)
48
What are the three main concerns if a fire were to occur in the OR?
1. Protect the patient 2. Contain the fire 3. Move anesthesia as far away as possible
49
How do you operate a fire extinguisher?
P- Pull the pin A- Aim S- Squeeze handle S- Sweep at base of fire
50
What are some fire safety guidelines?
-Monitor fiber optic light cords -No extension cords -Test equipment -Inspect cords -Movement around head should be kept at a minimum -Only cotton blankets
51
What does laser stand for?
Light amplified by the stimulation emission of radiation.
52
What are some Laser safety precautions?
-Eye protection for patient and staff (each laser has different optical density so need different glasses) -High filtration masks (N95) -Reflective instruments should be ebony dipped -Sterile water on the field -Fire retardant drapes/ wet towels covering drapes -Halton fire extinguisher should be available -Nonexplosive anesthesia -Head and neck precautions -Anorectal area should be packed with wet sponges -Test on tongue depressor
53
What are the main causes of ergonomic injury?
-Obesity -Poor nutrition -Jerking/twisting hips -Loss of strength/flexibility -Lift/bend with bowed out back
54
What are some guidelines for good body mechanics?
-Legs shoulder width apart -Back straight -Push over pull -Lean with hips -Don't bow back when lifting
55
What is some equipment to watch out for in the OR?
-Lights/boom (don't hit head) -Cords (don't trip; cover with mat/tape) -Foot pedals (don't activate/trip) -Stools (don't fall)
56
Who/when were the standard precautions for biological hazards made?
In 1996 by the CDC
57
What are the standard precautions for biological hazards
-Apply to all bodily secretions (except sweat) -All fluids should be treated like they are infectious -Reduce risk of transmission by protecting skin and mucous membranes -Potential pathogens are Hep B, C, D; HIV, TB -Wear PPE -Practice Sharp Safety
58
What percentage of healthcare workers have a latex allergy?
8-17%
59
Who is at risk for latex allergies?
Spina bifida patients/multi-surgery
60
What is type 1 latex allergy?
Most serious, immunoglobin E (igE) mediated. In seconds to minutes: hives, edema, hypotension, bronchospasms, respiratory arrest
61
What is type 4 latex allergy?
less serious: skin irritation and discomfort
62
What are some steps to take with patients who have latex allergies?
-scheduled first -notify other departments -remove latex products -signage -allergy alert on wristband and in chart only true treatment is to avoid
63
What are some hazards associated with plume?
Offensive odor, watery eyes, respiratory irritation
64
How do you protect yourself from plume?
N95 (.1-.3 laser mask) Eye protection side shields Smoke evacuator (removes .1-.5 um HEPA/Charcoal filter Suction close to field
65
What are some sharp safety strategies?
-Have extra PPE available -Double glove (w indicator) -Never recap a needle -One hand cap -Choose appropriate suture needle -Designate sharp central -Load needles prior to use
66
What is a neutral zone?
Magnetic/rubber pad that allows safe transfer of sharps
67
What is post exposure prophylaxis?
Prevention or treatment of disease or condition -Contaminated items should be removed from field -Scrub broken skin -Flush eyes, nose, mouth -Incident report
68
What happens when exposure does happen?
Risk of infection is assessed -what body substance -the route of exposure -risk factors Declining PEP -post exposure testing is done at 6 weeks, 12 weeks, and six months. -Counseling is provided in high risk cases
69
When should prophylaxis of HIV start?
Must be started within 2 hours
70
Where should biohazardous materials be disposed of?
Biohazard bags, sharps container.
71
What is a Material Safety Data Sheet (MSDS)
Sheet that contains information about the chemical and what to do if it spills.
72
What are waste anesthetic gases and what are the risks?
Waste anesthetic gases are vapors that escape from the anesthesia machine and tubing. Studies have indicated that chronic exposure to the gases could pose health hazards such as cancer, hepatic and renal complications, nerve and brain damage, and spontaneous abortion. OSHA enforces NIOSH recommendations
73
What are some techniques which should be employed regarding waste anesthetic gases?
A gas scavenging system (removes wasted gas to be filtered then dispersed) Blue beans OR ventilation system
74
What is Polymethyl methacrylate (PMMA) and what are the risks?
chemical compound composed of a mixture of liquid and powder. The common name of PMMA used in surgery is bone cement. It is used for cementing metal prostheses in place during total joint arthroplasties. Damages soft contacts, mutagenic, carcinogenic and hepatic disorders, vapors permeate gloves causing contact dermatitis
75
How do you minimize the complications of PMMA
-self contained vapor evacuation systems -Increasing the inspired oxygen concentration prior to injecting the PMMA cement -Maintaining normovolemia in the patient by close monitoring of blood loss -Surgically venting the distal femur to relieve intramedullary pressure -Using uncemented prostheses
76
What is formalin and what are its risks?
commonly used preservative for tissue specimens to be sent to the pathology department. The vapors from the liquid are an irritant to the mucous membranes of the respiratory tract. It is known to be a mutagen, a carcinogen, and toxic to the liver. Both OSHA and NIOSH have established standards for the permissible exposure limits (PEL) in the surgery department
77
How should formalin be handled to reduce risk?
Used in a well ventilated area with a mask.
78
What is Ethylene oxide and what are its risks?
liquid chemical converted to a gas for sterilization purposes. Surgical equipment and instruments that are heat sensitive may be sterilized with the use of EtO. The hazards associated with the use of EtO are as follows: Exposure to the gas can cause nausea, vomiting, and vertigo. Ethylene oxide is known to be highly mutagenic and carcinogenic. If EtO combines with water, the toxic byproducts ethylene glycol and ethylene chlorohydrin will form. (Ethylene glycol is easily absorbed through the skin, causing systemic difficulties.) Avoid direct contact with skin
79
What is Glutaraldehyde (Cidex) and what are its risks?
liquid disinfectant and sterilizing agent. the fumes can be irritating to the eyes and mucous membranes
80
How do you manage the risks of Glutaraldehyde (Cidex)
Keep covered, use fume hood (GUS), well-ventilated area, wear gloves, eye protection, and mask * Rinse instruments well that come into contact with patient.
81
Who are the agencies regulating safety in the OR?
OSHA (Occupational Safety and Health Administration)-federal agency for safety in the work place. Protects the health of workers legally enforceable rules. Based on other org. findings. Regulates noise, radiation, laser, fire. * NIOSH (National Institute for Occupational Safety and Health)-research for OSHA established permissible exposure limits for gases and chemical vapors, arm of the CDC. * ANSI (American National Standards Institute)-set standards in technical fields. Promote voluntary consensus standards * ASTM (American Society for Testing and Materials)-set standards and test medical equipment. Also voluntary consensus standards * AAMI (Association for the Advancement of Medical Instrumentation)-standards for sterilization, electrical safety, levels of device safety, and use of medical devices. Across the board standards. * NFPA (National Fire Protection Agency) mission to reduce frequency of fires through the establishment of fire prevention standards by education.
82
What are the risks of PMMA for the pt?
-Can cause Bone Cement Implantation Syndrome. * Intramedullary hypertension as it expands and hardens in the canal of the long bone. * This cause micro-embolization of fat, bone marrow, PMMA cement, and air into femoral venous vessels that can be transported to the lungs. -Vasodilation * Decreased systemic vascular resistance * Hypoxia (increased pulmonary shunt) * Hypotension * Cardiac arrhythmias * Cardiac arrest * Pulmonary hypertension * Decreased cardiac output
83
Ring Stand
four-wheeled, metal stands that can have one or two rings at the top that are used to hold sterile basins.
84
Prep Stand
Provides another area for sterile supplies, specifically, easy access for preparation tools such as sponges and catheters.
85
Kick Bucket
They are lined with a biohazard bag. Sterile team members toss soiled, counted sponges into the bucket. Other waste should not be discarded into the bucket; it should only be used for counted sponges.
86
Linen Hamper
trash containers are large, ringed stands that are lined with color-coded bags indicating what is disposed of in them
87
Sharps Container
disposable or nondisposable sharps container can be found either on the floor or hanging from the wall. Needles, blades, trocars, and any other sharps must be deposited inside

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