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Physical Environments and Safety Standards - Chapter 5 (Nicola)

front 1

Physical design of surgery department

back 1

Easily accessible to ICU, ED, L&D
Must be in an area that can be limited to traffic and public access

front 2

Basic design types of surgery include:

back 2

Race Track Plan
Hotel Plan
Specialty Grouping Plan

front 3

The “race track” plan

back 3

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.

front 4

The “hotel plan”

back 4

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.

front 5

The “specialty grouping” plan

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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.

front 6

Room that typically contains sinks for gross decontamination, an ultrasonic washer, and a washer-sterilizer to decontaminate instruments and equipment

back 6

decontamination room

front 7

The standard size of an OR has traditionally been at least

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400–600 ft2

front 8

OR that is specifically designed for trauma patients may be at least

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800 ft2

front 9

The majority of ORs contain both

back 9

110-volt and 220-volt outlets

front 10

What are designated in red and are connected to the hospital’s backup generator system in case of power outage

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Emergency outlets

front 11

Each OR must have at least .....suction outlets

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Two
One for the surgical team and one for anesthesia

front 12

What color is the outlet for compressed air

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yellow

front 13

What color is the outlet for oxygen

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green

front 14

What color is the outlet for nitrous oxide

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blue

front 15

Surgical lights should be freely adjustable in both the

back 15

horizontal and vertical planes

front 16

What are routinely displayed on the view boxes

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Radiographs, isotope, and computed tomography (CT) and magnetic resonance imaging (MRI)

front 17

Points in the operating table that indicate where a section can be moved up or down

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Breakpoints at the knee, waist, and head

front 18

The operating table is maneuvered by an electrical control system by either the

back 18

circulator or anesthesia provider

front 19

Many procedures are .... critical

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time

front 20

Surgical equipment ...... are ceiling-mounted, articulating arms that contain a variety of surgical equipment, such as electrical, gas, and communication devices.

back 20

Booms

front 21

OR should be equipped with a standard set of furniture

back 21

Operating table
back table
one or more Mayo stands
ring stands
and a kick bucket

front 22

Large movable table that is covered with a sterile drape for placement of sterile instruments, supplies, and equipment for surgical procedures

back 22

Back table

front 23

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

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Mayo stands

front 24

A stand that is designed with one or two circular bands at the top to hold sterile basins

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Ring stands

front 25

The walls of the OR should have the following characteristics

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Nonglare
Fireproof
Nonporous
Waterproof
Nonreflective
Pleasant in color
Easy to clean with antimicrobial solution

front 26

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.

back 26

Ring stand basins

front 27

The unidirectional positive-pressure flow of air that captures microbes to be filtered

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laminar air flow

front 28

The ventilation system in the OR should

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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.

front 29

Transported or spread by air; the surgical technologist is primarily concerned with airborne bacteria

back 29

airborne bacteria

front 30

A 1940's studied lead to the creation of

back 30

positive-pressure air supply in the OR

front 31

What airflow she be created in the OR

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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

front 32

How many air changes should there be in the OR

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A minimum of 15 per hour with a recommended range of 20 to 25 per hour.

front 33

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

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High-efficiency particulate air (HEPA) filters

front 34

CDC guidelines recommend that at least .... of the air change per hour be from fresh outside air.

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20%

front 35

The temperature in the OR is kept between

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68° and 73°F.

front 36

The recommended range for relative humidity is

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20% to 60%

front 37

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.

back 37

Substerile area

front 38

This is the area the patient is directed and admitted to on arrival at the hospital.

back 38

Preoperative or “Same-Day” Check-in Unit

front 39

A designated room where patients wait within the surgery department before entering the OR

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Preoperative holding area

front 40

What happens in a pre-op room

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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

front 41

Area where immediate postoperative care of the patient takes place before transfer to the hospital room or ICU

back 41

postanesthesia care unit (PACU)

front 42

What is performed in the PACU when the patient has regained consciousness and can breathe unassisted.

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extu-bation - same day surgery

front 43

PACU cubicle has the following equipment for patient care:

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Pulse oximeter
Blood pressure cuff
Wall suction and tubing
Wall oxygen and tubing
Electrocardiographic (ECG) monitor

front 44

The individual responsible for running and maintaining the cardiopulmonary bypass machine during open heart procedures

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perfusionists

front 45

What is a study of moving body structures—similar to an X-ray "movie."

back 45

Fluoroscopy

front 46

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

back 46

surgical technologist

front 47

Process by which energy either directly or indirectly induces ionization of radiation-absorbing material or tissues; X-rays

back 47

ionizing radiation

front 48

It important for surgical technologists to wear

back 48

lead shields such as leaded aprons and/or thyroid shields to prevent exposure to ionizing radiation

front 49

The department responsible for testing and processing specimens, tissues, and body fluids to obtain a diagnosis

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pathology department

front 50

Permanent specimens are usually sent to the pathology laboratory in

back 50

formalin solutions and frozen sections are sent dry.

front 51

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

back 51

Standard Precautions

front 52

Noise, ionizing radiation, electricity, injury to the body, fire, explosion, and injuries from sharps

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Physical hazards

front 53

Laser and electrosurgical plume pathogens found in body fluids, latex sensitivity

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Biological hazards

front 54

Disinfecting agents, waste anesthetic gases, and vapors and fumes from chemical agents

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Chemical hazards

front 55

Organization whose mission is to reduce the frequency of fires through the establishment of fire prevention standards, research, and public fire safety education.

back 55

National Fire Protection Agency (NFPA)

front 56

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.

back 56

National Institute for Occupational Safety and Health (NIOSH)

front 57

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

back 57

American National Standards Institute ANSI

front 58

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.

back 58

American Society for Testing and Materials ASTM

front 59

Organization that establishes standards in the health care field, including sterilization, electrical safety, levels of device safety, and use of medical devices.

back 59

Association for the Advancement of Medical Instrumentation AAMI

front 60

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 60

Surgical lights

front 61

Back injury and/or pain is usually the result of

back 61

Lifting with the back bowed out
Bending and reaching with the back bowed out
Jerking or twisting at the hips
Obesity
Loss of strength and flexibility
Poor nutrition

front 62

Proper body mechanics helps prevent injury and discomfort

back 62

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

front 63

The Association for the Advancement of Medical Instrumentation (AAMI) recommends

back 63

a 25-pound weight limit on instrument trays and sets

front 64

Nitrous oxide, which itself is nonflammable, supports combustion in the presence of

back 64

oxygen

front 65

Three components of fire:

back 65

fuel, source of ignition, and oxygen

front 66

Sources of ignition

back 66

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)

front 67

Fuel that can start a fire

back 67

flammable chemical gas, vapor, or liquid such as ethyl alcohol and skin prep solutions containing isopropyl alcohol; surgical drapes; disposable surgical supplies

front 68

laser is an acronym for

back 68

“light amplification by the stimulated emission of radiation.”

front 69

The process in which light energy is produced and the device that generates the laser energy or beam

back 69

Laser

front 70

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

back 70

Sterile water - keep sponges wet
portable fire extinguishers
laser-retardant drapes - or place wet towels on drapes

front 71

The anesthesia provider must use a ....... . During oral or laryngeal surgery, when a laser is in use

back 71

nonexplosive anesthetic agent

front 72

Patient precautions for laser use surgery

back 72

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

front 73

Nd:YAG laser is absorbed by and damages the retina, causing.

back 73

blindness

front 74

the CO2 laser is absorbed by the corneal and can cause

back 74

corneal burns

front 75

Mechanical device that produces an electric current that is converted into thermal energy (heat) for the purpose of cutting or coagulating tissue

back 75

electrosurgical unit (Bovie)
uses a grounding pad

front 76

Used in ENT cases, must not be pointed at drapes as it can smolder and set on fire

back 76

Fiberoptic Beam

front 77

Pressurized water; suitable for fires involving solid materials, e.g., wood, paper, or textiles

back 77

Class A

front 78

Carbon dioxide or dry chemical for fires involving flammable liquids, oils, and gas

back 78

Class B

front 79

Halon for electrical or laser fires

back 79

Class C

front 80

The PASS mnemonic is used when operating a fire extinguisher

back 80

Pull
Aim
Squeeze
Sweep

front 81

The three main concerns if a fire should occur in the OR are to

back 81

Protect the patient
Contain the fire if possible
Move the anesthesia equipment as far away as possible from fire source

front 82

RACE

back 82

Remove/Rescue
Alert/sound
Contain the fire
Extinguish/evacuate

front 83

Who has developed safety standards for electrical equipment used in the OR

back 83

AAMI and The Joint Commission

front 84

What prevents the passage of the electrical current through the patient by directing the current to the ground,

back 84

Grounding

front 85

If the patient return electrode is not firmly affixed, the patient could suffer

back 85

first-, second-, or third-degree electrical burns

front 86

What are two processes by which static charge buildup can occur

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Friction between two surfaces; the second is by proximity to an electrostatic field.

front 87

The three most important factors to remember concerning the safety of the surgical technologist and ionizing radiation are

back 87

Time, shielding, distance

front 88

If fluoroscopy will be used throughout the surgical procedure what should the ST wear

back 88

The lead apron is worn under the sterile gown and must be donned prior to scrubbing.

front 89

Surgical technologists who are a part of the sterile team and cannot leave the room should stand

back 89

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.

front 90

Standard Precautions were defined by the

back 90

CDC in 1996

front 91

Standard Precautions apply to

back 91

blood and all body fluids, secretions, and excretions
***except sweat***

front 92

Two basic microbiological concepts govern the transmission of disease:

back 92

A sufficient number of microorganisms must be present in order to cause infection.
The microorganisms must have a path for entry into the host.

front 93

Prevention of a disease or condition

back 93

prophylaxis

front 94

HIV PEP The patient is evaluated for HIV infection, viral load, and risk factors for infection

back 94

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.

front 95

What has been shown to prevent HIV transmission in humans (as of this writing).

back 95

zidovudine (ZDV)

front 96

PEP follow-up counseling and postexposure testing and evaluation

back 96

should be performed at 6 weeks, 12 weeks, and 6 months postexposure.

front 97

Studies have not been conclusive but have proved that the laser plume contains

back 97

water, carbonized particles, and intact strands of DNA

front 98

When the tip is held within 1 cm of the impact site,

back 98

approximately 98% of the plume is removed. If this is moved to 2cm then this is cut in half

front 99

Two types of latex allergic responses have been identified: .

back 99

Type I and Type IV

front 100

Which is the least serious latex allergy

back 100

Type IV is the less serious, more localized reaction characterized by skin irritation and discomfort.

front 101

Type I latex allergy

back 101

is immu-noglobulin E (IgE) mediated and is the most serious reaction, possibly leading to respiratory arrest

front 102

Chronic exposure to anesthesia gases could pose health hazards such as .

back 102

cancer, hepatic and renal complications, nerve and brain damage, and spontaneous abortion

front 103

Chemical compound composed of a mixture of liquid and powder used for cementing prostheses during total joint arthroplasties; also referred to as bone cement

back 103

Polymethyl methacrylate (PMMA)

front 104

PPMA The vapors released from the mixture

back 104

are noxious and irritating to the eyes and mucous membranes of the respiratory tract and can damage soft contact lenses, thus damaging the eyes

front 105

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

back 105

Formalin

front 106

Exposure to the gas can cause nausea, vomiting, and vertigo
mutagenic and carcinogenic

back 106

Ethylene Oxide