Physical Environments and Safety Standards - Chapter 5 (Nicola)
Physical design of surgery department
Easily accessible to ICU, ED, L&D
Must be in an area that can be limited to traffic and public access
Basic design types of surgery include:
Race Track Plan
Specialty Grouping Plan
The “race track” plan
Series of OR's around a clean 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 “hotel plan”
ORs are situated along a central corridor, with separate clean core and soiled work areas. 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.
The “specialty grouping” plan
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.
Room that typically contains sinks for gross decontamination, an ultrasonic washer, and a washer-sterilizer to decontaminate instruments and equipment
The standard size of an OR has traditionally been at least
OR that is specifically designed for trauma patients may be at least
The majority of ORs contain both
110-volt and 220-volt outlets
What are designated in red and are connected to the hospital’s backup generator system in case of power outage
Each OR must have at least .....suction outlets
One for the surgical team and one for anesthesia
What color is the outlet for compressed air
What color is the outlet for oxygen
What color is the outlet for nitrous oxide
Surgical lights should be freely adjustable in both the
horizontal and vertical planes
What are routinely displayed on the view boxes
Radiographs, isotope, and computed tomography (CT) and magnetic resonance imaging (MRI)
Points in the operating table that indicate where a section can be moved up or down
Breakpoints at the knee, waist, and head
The operating table is maneuvered by an electrical control system by either the
circulator or anesthesia provider
Many procedures are .... critical
Surgical equipment ...... are ceiling-mounted, articulating arms that contain a variety of surgical equipment, such as electrical, gas, and communication devices.
OR should be equipped with a standard set of furniture
one or more Mayo stands
and a kick bucket
Large movable table that is covered with a sterile drape for placement of sterile instruments, supplies, and equipment for surgical procedures
Small portable stand with a tray on top that is covered with a sterile drape and on which the instruments, equipment, and supplies that are most frequently used for the surgical procedure are placed; it is most often positioned over the patient’s legs
A stand that is designed with one or two circular bands at the top to hold sterile basins
The walls of the OR should have the following characteristics
Pleasant in color
Easy to clean with antimicrobial solution
In some cases, such as cardiac cases, these basins may be used to hold a sterile ice/slush solution for hypothermia in the absence of a slush machine.
Ring stand basins
The unidirectional positive-pressure flow of air that captures microbes to be filtered
laminar air flow
The ventilation system in the OR should
provide a supply of clean air; remove airborne contamination that is produced within the room; remove waste anesthetic gases, toxic fumes, and vapors; and provide a comfortable working environment for surgical personnel.
Transported or spread by air; the surgical technologist is primarily concerned with airborne bacteria
A 1940's studied lead to the creation of
positive-pressure air supply in the OR
What airflow she be created in the OR
positive laminar air flow, a unidirectional positive-pressure flow of air that captures microbes to be filtered. This means that the air pressure in the OR is kept by ventilation at a higher level than that of the surrounding corridors
How many air changes should there be in the OR
A minimum of 15 per hour with a recommended range of 20 to 25 per hour.
Filter that is capable of removing bacteria as small as 0.5–5 mm; utilized in the operating room to aid in preventing the patient from acquiring a postoperative wound infection
High-efficiency particulate air (HEPA) filters
CDC guidelines recommend that at least .... of the air change per hour be from fresh outside air.
The temperature in the OR is kept between
68° and 73°F.
The recommended range for relative humidity is
20% to 60%
In which room is this statement reffering to - Positive air pressure is defeated in this case because adjacent rooms also are under this same system.
This is the area the patient is directed and admitted to on arrival at the hospital.
Preoperative or “Same-Day” Check-in Unit
A designated room where patients wait within the surgery department before entering the OR
Preoperative holding area
What happens in a pre-op room
IV's can be inserted
Anesthesia preoperative interview, regional blocks such as epidural anesthesia may be administered For pediatric cases, this room may have a rocking chair for the parent
Area where immediate postoperative care of the patient takes place before transfer to the hospital room or ICU
postanesthesia care unit (PACU)
What is performed in the PACU when the patient has regained consciousness and can breathe unassisted.
extu-bation - same day surgery
PACU cubicle has the following equipment for patient care:
Blood pressure cuff
Wall suction and tubing
Wall oxygen and tubing
Electrocardiographic (ECG) monitor
The individual responsible for running and maintaining the cardiopulmonary bypass machine during open heart procedures
What is a study of moving body structures—similar to an X-ray "movie."
Other departments have little awareness of aseptic principles and techniques, and it is therefore the duty of the .........to supervise personnel movement around the sterile field
Process by which energy either directly or indirectly induces ionization of radiation-absorbing material or tissues; X-rays
It important for surgical technologists to wear
lead shields such as leaded aprons and/or thyroid shields to prevent exposure to ionizing radiation
The department responsible for testing and processing specimens, tissues, and body fluids to obtain a diagnosis
Permanent specimens are usually sent to the pathology laboratory in
formalin solutions and frozen sections are sent dry.
Guidelines established by the Occupational Safety and Health Administration and the Centers for Disease Control and Prevention to reduce the risk of disease transmission from blood and body fluids
Noise, ionizing radiation, electricity, injury to the body, fire, explosion, and injuries from sharps
Laser and electrosurgical plume pathogens found in body fluids, latex sensitivity
Disinfecting agents, waste anesthetic gases, and vapors and fumes from chemical agents
Organization whose mission is to reduce the frequency of fires through the establishment of fire prevention standards, research, and public fire safety education.
National Fire Protection Agency (NFPA)
Organization whose responsibilities are similar to OSHA but tends to be more research oriented in establishing permissible exposure limits (PELs) for chemical vapors and gases. ****It is an arm of the CDC that is under the U.S. Department of Health and Human Services.
National Institute for Occupational Safety and Health (NIOSH)
Organization who promote and facilitate voluntary consensus standards in technical fields. An example is the laser safety standard that is intended for use by all health care facilities that use lasers in the treatment of patients
American National Standards Institute ANSI
Similar to ANSI, it is also an organization of industry experts who develop and provide voluntary consensus standards for medical equipment by testing the equipment.
American Society for Testing and Materials ASTM
Organization that establishes standards in the health care field, including sterilization, electrical safety, levels of device safety, and use of medical devices.
Association for the Advancement of Medical Instrumentation AAMI
What emits a blue-white beam that still adequately illuminates the surgical site yet produces little glare and approximates the color intensities of normal sunlight
Back injury and/or pain is usually the result of
Lifting with the back bowed out
Bending and reaching with the back bowed out
Jerking or twisting at the hips
Loss of strength and flexibility
Proper body mechanics helps prevent injury and discomfort
Stand with legs approximately shoulder width apart
Avoid weight bearing on one foot 3.The surgical Stand next to the OR table in an erect manner with arms relaxed from the shoulder down
Sit in an erect fashion with the spinal column straight.
Do not lean forward from the shoulders, but from the hips.
Push equipment, not pull
The Association for the Advancement of Medical Instrumentation (AAMI) recommends
a 25-pound weight limit on instrument trays and sets
Nitrous oxide, which itself is nonflammable, supports combustion in the presence of
Three components of fire:
fuel, source of ignition, and oxygen
Sources of ignition
electrosurgery, electrocautery, lasers, fiber-optic light sources, defibrillators, sparks from dental or orthopedic burs, or sparks from metal hitting metal (e.g., two metal retractors coming into contact)
Fuel that can start a fire
flammable chemical gas, vapor, or liquid such as ethyl alcohol and skin prep solutions containing isopropyl alcohol; surgical drapes; disposable surgical supplies
laser is an acronym for
“light amplification by the stimulated emission of radiation.”
The process in which light energy is produced and the device that generates the laser energy or beam
Fire prevention is critical during laser surgery. The surgical team must be aware of the precautions to follow to prevent a fire, and supplies needed
Sterile water - keep sponges wet
portable fire extinguishers
laser-retardant drapes - or place wet towels on drapes
The anesthesia provider must use a ....... . During oral or laryngeal surgery, when a laser is in use
nonexplosive anesthetic agent
Patient precautions for laser use surgery
The patient’s hair should be covered with wet sponges or towels to prevent ignition if close to the laser site. The patient should be given preoperative instructions not to use hair spray that can easily ignite
Nd:YAG laser is absorbed by and damages the retina, causing.
the CO2 laser is absorbed by the corneal and can cause
Mechanical device that produces an electric current that is converted into thermal energy (heat) for the purpose of cutting or coagulating tissue
electrosurgical unit (Bovie)
uses a grounding pad
Used in ENT cases, must not be pointed at drapes as it can smolder and set on fire
Pressurized water; suitable for fires involving solid materials, e.g., wood, paper, or textiles
Carbon dioxide or dry chemical for fires involving flammable liquids, oils, and gas
Halon for electrical or laser fires
The PASS mnemonic is used when operating a fire extinguisher
The three main concerns if a fire should occur in the OR are to
Protect the patient
Contain the fire if possible
Move the anesthesia equipment as far away as possible from fire source
Contain the fire
Who has developed safety standards for electrical equipment used in the OR
AAMI and The Joint Commission
What prevents the passage of the electrical current through the patient by directing the current to the ground,
If the patient return electrode is not firmly affixed, the patient could suffer
first-, second-, or third-degree electrical burns
What are two processes by which static charge buildup can occur
Friction between two surfaces; the second is by proximity to an electrostatic field.
The three most important factors to remember concerning the safety of the surgical technologist and ionizing radiation are
Time, shielding, distance
If fluoroscopy will be used throughout the surgical procedure what should the ST wear
The lead apron is worn under the sterile gown and must be donned prior to scrubbing.
Surgical technologists who are a part of the sterile team and cannot leave the room should stand
6 ft or more from the patient, avoiding the direct beam of ionizing radiation. Stand behind the x-ray machine if possible, behind a portable lead screen, or behind someone wearing a lead shield.
Standard Precautions were defined by the
CDC in 1996
Standard Precautions apply to
blood and all body fluids, secretions, and excretions
Two basic microbiological concepts govern the transmission of disease:
A sufficient number of microorganisms must be present in order to cause infection.
The microorganisms must have a path for entry into the host.
Prevention of a disease or condition
HIV PEP The patient is evaluated for HIV infection, viral load, and risk factors for infection
PEP should not be delayed while information is gathered. It is better to start PEP and stop it later than not to have started it within the time window recommended.
What has been shown to prevent HIV transmission in humans (as of this writing).
PEP follow-up counseling and postexposure testing and evaluation
should be performed at 6 weeks, 12 weeks, and 6 months postexposure.
Studies have not been conclusive but have proved that the laser plume contains
water, carbonized particles, and intact strands of DNA
When the tip is held within 1 cm of the impact site,
approximately 98% of the plume is removed. If this is moved to 2cm then this is cut in half
Two types of latex allergic responses have been identified: .
Type I and Type IV
Which is the least serious latex allergy
Type IV is the less serious, more localized reaction characterized by skin irritation and discomfort.
Type I latex allergy
is immu-noglobulin E (IgE) mediated and is the most serious reaction, possibly leading to respiratory arrest
Chronic exposure to anesthesia gases could pose health hazards such as .
cancer, hepatic and renal complications, nerve and brain damage, and spontaneous abortion
Chemical compound composed of a mixture of liquid and powder used for cementing prostheses during total joint arthroplasties; also referred to as bone cement
Polymethyl methacrylate (PMMA)
PPMA The vapors released from the mixture
are noxious and irritating to the eyes and mucous membranes of the respiratory tract and can damage soft contact lenses, thus damaging the eyes
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
Exposure to the gas can cause nausea, vomiting, and vertigo
mutagenic and carcinogenic