OR Environment

Question 1

Exam treatment room

Answer 1

High level disinfection, sterile instruments

Question 2

Procedure

Answer 2

High level disinfection, sterile instruments SOME OR controls

Question 3

OR

Answer 3

High level disinfection, sterile instruments, Environmental controls, capability for aseptic field

Question 4

Unrestricted area

Answer 4

Traffic not limited, if in scrubs you need a lab coat.

Question 5

Semi restricted area

Answer 5

Traffic limited, so scrubs and cap needed

Question 6

Restricted area

Answer 6

Traffic only to necessary personnel. Unwrapped sterile supplies

Question 7

Standard OR temp

Answer 7

68-75 degrees F

Hypothermia associated with : increased wound infection, impaired coagulation, increased blood loss, prolonged hospitalization

Question 8

Standard humidity levels OR

Answer 8

30-55%

<30- increased fire, alters sterile indicator strip, increased infection risk (flying debris)

> 55%- increased risk of infection, mold/mildew, uncomfortable for staff

Question 9

Ventilation in OR?

Answer 9

Engineered to decrease turbulent flow and be unidirectional. Not part of waste anesthesia gas system,

Maintains a small amount of positive presure

Fresh air introduced near ceiling with return near floor

25 air exchange/hr, remove 90% particles in air

Question 10

Fresh air standard for OR

Answer 10

80/20 mixture of recycled/fresh air

Question 11

Needed air exchanges/hr

Answer 11

25

Question 12

Necessary percentage for high efficiency particulate filters

Answer 12

90%

Question 13

Normal OR dB level

Answer 13

75-90

Question 14

Voice needs to be what dB level to be heard

Answer 14

20 above background

Question 15

Ionizing radiation

Answer 15

Enough energy to detach e from atoms, nuclear decay, gamma rays and X-ray, UV light

Question 16

Appropriate radiation exposure

Answer 16

ASARP (as little as reasonably possible)

Question 17

Law of inverse square

Answer 17

Amount radiation changes inversely with distance

Question 18

Macroschok

Answer 18

100-300 causes Vfib Current applied through body through skin

Question 19

Micro shock

Answer 19

Current applied directly to heart/internal organ. VF potential is 30 ma in humans

Question 20

LASER safety precautions

Answer 20

• Restrict access to area
  -Close all doors and windows
• post warning signs
  -eye protection for pt and people
  -cover all exposed skin
• remove bright reflective objects
  -maintain room lights as bright as possible
  =alarm to indicate use of laser
  -don’t leave laser unattended
  -keep laser beemabove/below normal line of sight
  -avoid looking into primary beam at all times

Question 21

Anesthesia gases during laser use

Answer 21

<30%O2. Avoid NO. Special ETT (laser approved). LMA sensitive to laser

Question 22

Eye trauma from lasers

Answer 22

May not be readily apparent. Color vision goes first. Depends on intensity and wavelength.

Question 23

Smoke plume

Answer 23

Pollution from cauterya nd laser six. Fine particulates in plume that may contain viruses, bacteria, tissue, fungus. Use protective masks o

Question 24

Ordinary protective mask

Answer 24

5 micrometers particulates

Question 25

High efficiency mask

Answer 25

0.1-0.3 micrometers

Question 26

Class 1 WOUND

Answer 26

Clean. No s/s infection. Risk infection <2%

Question 27

Class 2 wound

Answer 27

Clean-contaminated. No s/s infection. Repairing or removing an organ (appy) <10% risk of infection

Question 28

Class 3 wound

Answer 28

Contaminated. Open wound with blood/body fluids present. Up to 20% risk of infection

Question 29

Class 4 wound

Answer 29

Dirty. Infection already present. 40% risk of infection

Question 30

Low level disinfection

Answer 30

Kills vegetative bacteria and some fungus and virus but not TB and spores

Question 31

Intermediate level

Answer 31

Kills vegetative bacteria, fungus, virus, and TB but no spores

Question 32

High level disinfection

Answer 32

Kills all organisms and spores but not CJD

Question 33

Sterilization

Answer 33

State of being free from all organisms

Question 34

Steam sterilization

Answer 34

Time based on temp. Needs to dry at room temp, Can damage sensitive equipment

Question 35

Dry heat

Answer 35

Items that may be damaged by moisture. Time varies depending on temp

Question 36

Direct and indirect effects of radio action therapy

Answer 36

Direct- breaks down atoms of DNA and other genetic components Indirect-impairs protein, enzyme function

Question 37

LASER stands for?

Answer 37

Light amplification by the Stimulated Emission of Radiation

Question 38

4 classes of LASERS?

Answer 38

Class 1- CD player Class 2- Laser pointer/scanner 3- entertainment light shows 4- medical lasers (eye damage, fire hazard, airborne contamination)

Question 39

Precaution with ETT and lasers?

Answer 39

PVC easily ignites Rubber tubes are more resistant LASER approved tubes should be used (double cuff to prevent leaking of gas if cuff is ruptured)

Question 40

What do you do if fire in OR?

Answer 40

``` Turn off o2 and ignition source Remove ett/drapes Extinguish fire Ventilate with 100% Assess for damage Reintubatr ```

Question 41

Noise pollution in OR?

Answer 41

Can be as high as 125 dB with surgical saws and power tools.

Question 42

Complications of noise pollution

Answer 42

``` Inability to hear alarms Interfere with communications Increased level of endogenous catecholamins Irritability Increased BP HEARING LOSS ```

Question 43

Radiation Therapy

Answer 43

Harmful effect- direct breaks atoms of DNA and other genetic components Indirect - Impairs protein, enzyme function Exposure ASLARP Law of inverse squares (1/d2)

Question 44

LASER pulses can result in:

Answer 44

Tissue rupture and damage of retina Corneal photokeratitis Cataracts Loss of color vision

Question 45

Talk about equipment and various levels of sterilization?

Answer 45

``` Critical -sx instruments and implanted devices -sterilized Semi critical -anesthesia equipment (laryngoscopes/blades) -high level disinfection Non-critical -pulse ox, BP cuff, cables -low level Single use -Sterilized -Single pt use ```

Question 46

Various methods of sterilization?

Answer 46

Pasteurization (30 min 700 deg C) Steam (autoclaving) - time based on temp (15@120, seconds at 1500c) - needs to dry room temp - can damage sensitive equipment Dry head - items damaged by moisture - time varies based on temp Chemical -high concentration of low ph can damage equipment Gas sterilization Radiation

Question 47

Types of chemical sterilization

Answer 47

``` Quaternary ammonium compounds Alcohols Glutaraldehydes Hydrogen peroxide based compounds Formaldehyde Phenolic compounds Chlorine ```