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condition that will not cause injury or harm to the employee, patient and other people in the health care facility
safety
-
injuries can be caused by?
- faulty equipment
- using equipment improperly
- exposing oneself or others to toxic or irritating agents
- coming into contact with harmful agents
-
classifications of hazards
- physical - back injury, fall, etc.
- chemical - gases, fumes, etc.
- biologic - cuts or needle sticks, etc.
-
radiation produces
positively and negatively charged particles that can change the electrical charge of some atoms and molecules in cells
-
radiation changes can alter?
enzymes, proteins, cell membranes and genetic material
-
causes of exposure to radiation
cancer, cataracts, bone marrow injury, burns, tissue necrosis, genetic mutations, spontaneous abortion, congenital anomalies
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reducing radiation exposure
- fluoroscope should be turned off when not in use
- x-ray should be last resort on counts
- body areas should be shielded from radiation
-
radiation overexposure time avoidance
- personnel should rotate during radiation procedures
- should not be in procedure when pregnant
- turn machines off when in use
- limit time around patient with radioactive elements
-
radiation distance
- leave room if not sterile
- if can't leave, stand 6 feet away
-
radiation shielding
- wear lead aprons
- if apron does not wrap around body, stand facing radiation source
- never fold apron
-
monitoring exposure
- all personnel should wear monitoring device to measure rems of accumulated exposure
- film badges contain photographic film sensitive to radiation
- monitor should be worn outside of lead apron
-
electrons to move through material in one direction and causes current to flow
voltage
-
measurement of opposition to the flow of electron through material
resistance
-
rate of flow of electrons through a conductor, measured in amps
current
-
types of current
- DC direct current - battery and low voltage
- AC alternating current - 110-220 volt line - 3 times more powerful than DC
-
designed to discharge any harmful electricity directly to the ground without including the patient
grounding (Bovie pad)
-
when does electrocution occur?
when individual becomes the component that closes a circuit through which a lethal current may flow
-
when does electric shock occur?
when current is large enough to stimulate nervous system or large muscle area
-
severity of shock depends on?
magnitude of current flow and path taken through body
-
2 types shock
- macroshock - large surface of skin - high voltage
- microshock - small contact area of skin
-
gaseous form of sterilization and known to be mutagen and carcinogen
ethylene oxide
-
ethylene oxide exposure can cause?
dizziness, nausea, vomiting
-
formaldehyde vapors
toxic to respiratory tract
-
glutaraldehyde
- least toxic of 3 agents
- fumes irritating to eyes, nose and throat
- only be used in closed container and well ventilated areas
-
what should be worn when using disinfectants?
gloves and goggles
-
generated by thermal destruction of tissue or bone
surgical plume
-
what should be used to suction laser and ESU plumes?
smoke evacuator
-
male reproductive hazards
can cause abnormal sperm numbers, shapes and motility
-
female reproductive hazards
can cause spontaneous abortion or congenital fetal anomaly
-
4 essential elements of risk management
- administration
- prevention
- correction
- documentation
-
standards for cleanliness
- patients are entitled to clean environment for their surgical procedures
- any contamination encountered should be contained and confined
- between-case cleanup should reestablish cleanest environment possible
- procedure rooms and utility areas to be cleaned daily
- scheduled routine cleaning
- sanitation processes defined by facility policy and procedure
-
duties to be performed before first case of the day
- arrange furniture and remove unnecessary furniture
- damp-dust light, arms, furniture, tables, equipment, starting higher and working down
- damp-dust sterilizer and/or washer-sterilizer and countertops in substerile room
- inspect for dirt and debris, damp-mopping as needed
-
are vinyl gloves acceptable for cleaning?
nope - not reliable and may not protect from environmental contamination
-
special considerations for patients with known respiratory-borne diseases (TB, rubeola)
- air exchanges should be 99% complete before next patient is brought into room - takes 20-30 minutes on a 15- to 20-air change per hour cycle
- staff should wear filtration masks during cleaning
-
special considerations for patients with known endospore-forming bacterial contamination
hypochlorite-based disinfectant should be used for cleaning
-
how long do endospores survive in the environment?
- 5 months
- have been cultured in ORs 40 days after the patient has used the room
-
special considerations for patients with known or suspected transmissible spongiform encephalopathies (CJD)
disposable equipment, instrument, linens and supplies should be used
-
primary principles of cleaning procedures
to confine and contain contamination and physically remove microorganisms as quickly as possible
-
primary cause of accidental cuts and punctures to personnel
disposal of surgical sharps at the end of the surgical procedure
-
where are basins and trays too large for the case cart placed?
put into plastic bags for transport to the decontamination area
-
how would you dispose of solutions and suction bottle contents?
dispose of them in a flushing hopper connected to sanitary sewer
-
what do you do with unused suture packets?
discard
-
when does scrub remove gown and gloves?
before taking case cart to processing area
-
technique used to remove gloves
glove-to-glove and skin-to-skin
-
what type of bottle should be used to spray disinfectant for cleaning?
squeeze bottle because spray bottles can cause particles to become aerosolized
-
how are floors cleaned?
in perimeter of 3-4 feet in circumference of surgical field, expanding in direction of visible soilage
-
how are mops used?
- one mop applies solution, one mop takes it up
- remove mop heads and place in laundry hamper
- mop handles cleaned with disinfectant
-
for cleanup, instruments are managed in what way?
- heavy instruments loaded in bottom of tray, hinged instruments opened, disassembling instruments taken apart, concave surfaces turned down
- glassware placed in separate tray
- detergent-disinfectant suctioned through lumens
- cart goes through automatic steam cart washer or manual power wash for terminal decontamination
-
average time the room will be ready for next patient
10-15 minutes
-
if patient is taken to OR but procedure is canceled...
tables should be torn down and room cleaned as if procedure had been performed
-
hazards related to medical devices and energy sources
technical risk factors
-
hazards related primarily to liquid, gas, and solid chemicals in the perioperative environment
chemical risk factors
-
hazards related to transmission of infectious disease
biological risk factors
-
3 components of fire
- oxygen
- fuel
- source of ignition
-
how much oxygen does normal air contain?
about 21%
-
environment that contains greater concentration of oxygen
oxygen-enriched atmosphere (OEA)
-
when are oxygen molecules produced?
when nitrous oxide decomposes in presence of heat
-
what are oxygen and nitrous oxide considered?
oxidizers
-
how much alcohol do most skin prep solutions contain?
70%
-
are surgical drapes and gowns flame resistant or flammable?
flame resistant
-
gases normally produced by intestines (potentially causing fires)
- hydrogen
- oxygen
- nitrogen
- carbon dioxide
- methane
-
how much of gases are contained in large bowel?
40%
-
concentration at which methane is explosive?
5-15%
-
fuel sources at surgical site
- oxygen-rich environment
- dry sponges and drapes
- ET tube and other flammable anesthesia equipment
- volatile prep solutions
- lanugo
- petroleum-based products
- suction catheter and other PVC devices
- smoke plume evacuator tip
- GI gas
-
how many surgical fires involve lasers?
approximately 13%
-
how hot can an active electrode reach in ESU?
1292 F (700 C)
-
how many patient fires occur in the airway?
21%
-
how many patient fires occur on the face?
44%
-
how many patient fires occur inside the patient?
8%
-
how many patient fires occur on the skin?
26%
-
how do you stop the progression of the fire?
triangle of fire must be broken
-
3 steps immediately taken to protect patient and stop fire
- shut off flow of all gases to the patient's airway
- remove burning objects from surgical site
- assess patient for injury and respond appropriately
-
4 actions of hospital fire plan
- R - rescue patients in the immediate area of fire
- A - alert other people to the fire so they can assist in patient removal and response - activate fire alert system
- C - contain the fire - shut all doors and shut off valves
- E - evacuate personnel in the areas around the fire
-
types of fire extinguishers used in the OR
- water-based
- carbon dioxide
- dry powder
-
preferred type of fire extinguisher in OR
carbon dioxide
-
how do you activate the fire extinguisher?
- P - pull ring from handle
- A - aim nozzle at base of the fire
- S - squeeze handle
- S - sweep fire with tank contents
-
risk reduction strategies have been developed by what organizations?
-
what are oxygen portable tanks used for?
when in-line systems are not available or when patients are transported
-
what are compressed nitrogen tanks used for?
as a power source for instruments such as drills, saws, and other high-speed tools
-
what is argon used for?
during laser surgery
-
what is nitrous oxide used for?
as anesthetic gas
-
what is carbon dioxide used for?
insufflation during laparoscopy or pelviscopy
-
2 types of hazards associated with compressed gas cylinders
- physical - related to high pressure in cylinder
- chemical - related to flammability or oxidative qualities/toxicity
-
how many valves do gas cylinders have?
- one opens the cylinder and allows gas to flow to the regulator
- one is located on regulator and controls the flow from the regulator to the power instrument
-
what does right hand valve of a gas cylinder do?
displays pressure in cylinder
-
what does left hand valve of a gas cylinder do?
displays pressure in power hose connected to the instrument
-
do not use a gas tank if pressure is what?
less than 500 psi
-
regulators are specific to what?
gas specific and are not interchangeable
-
leading cause of hospital fires in US
electrical malfunctions
-
characteristics of electricity
- current
- voltage
- impedance (resistance)
- grounding
-
rate of electrical flow
current
-
low voltage that originates from battery
direct current (DC)
-
current transmitted by a 220- or 110-V line, normally found in wall outlets
alternating current (AC)
-
available power is much higher with which current?
AC
-
driving force behind moving electrons
voltage
-
ability of a substance to stop flow of electrons
impedance (resistance)
-
examples of nonresistant materials
-
discharge of electrical current from source to ground where it is dispersed and rendered harmless
grounding
-
most effective method of blocking radiation
lead shields
-
most important parameters determining risk and protection
- distance from radiation source
- duration of exposure
- quality of shielding
-
which direction should workers face during use of ionizing radiation?
face the radiation exposure because many lead aprons shield only front of the body
-
what other lead gear should be worn?
- lead glasses
- neck shield
- lead-impregnated gloves
-
where should nonsterile team members be during radiation exposure?
step outside the range of exposure
-
safest place for nonsterile workers during radiation exposure?
- maintain distance of at least 6 feet from patient
- stand at a right angle to the beam on the side of the radiograph machine or origin of radiation beam
-
what is used to measure the cumulative radiation dose for those who are often exposed to radiation?
dosimeters
-
primary risk when MRI is used?
presence of metal
-
how can toxic chemicals enter the body?
- through respiratory tract
- by direct skin contact
- by splash contact
- by ingestion
-
how is exposure to airborne chemical measured?
by concentration in parts per million (ppm) or milligrams of substance per cubic meter of air (mg/m3)
-
smoke created during laser surgery and electrosurgery that contains toxic chemicals, vapors, blood fragments and viruses
smoke plume
-
set of recommendations responding to the concern of workers contracting or transmitting blood-borne diseases in course of their work
Universal Precautions
-
behaviors and methods of working in the healthcare setting that reduce exposure to blood and body fluids
Standard Precautions
-
what kind of soap do you use for routine handwashing?
plain soap, not antimicrobial
-
most common means of transmission of blood-borne pathogens to health care workers
sharps injuries
-
special set of regulations for handling and disposing of sharps
Blood-Borne Pathogen Rule, issued by OSHA
-
method of transferring sharp instruments on the surgical field without hand-to-hand contact
neutral zone (no-hands) technique
-
risk reduction strategy used after exposure to blood or other body fluids
postexposure prophylaxis (PEP)
-
when are PEP drugs most effective?
when given within 24 hours after exposure
-
PEP for HBV
- HBV surface antigen and immunization series initiated
- if incident involved mucous membrane, blood or body fluid exposure and worker has not been previous immunized, hepatitis B immune globulin
-
PEP for HIV
regimen of antiviral drugs followed by regular testing
-
how long do antibodies generally take to appear on HIV tests?
25 days to 3 months
-
how long does HIV PEP regimen usually last?
1 month
-
precautions implemented when patient is known or suspected to have highly infectious disease and Standard Precautions are insufficient to prevent transmission to others
- Transmission-based precautions
- used in addition to Standard Precautions
-
precautions to reduce the risk of transmission of airborne agents by droplet nuclei up to 5 um in size
airborne transmission precautions
-
during transport, patient with disease that can be spread by airborne transmission must wear what?
surgical mask
-
health care personnel must wear respiratory protection when they are within what distance from patient with disease that can be spread by airborne transmission?
within 3 feet
-
diseases for which airborne transmission precautions must be taken
- measles
- varicella
- tuberculosis
-
traveling distance of droplets
3 feet
-
distance between patients with droplet precautions and other patients
3 feet
-
infections for which droplet precautions should be implemented
- invasive infection with H. influenzae type B
- invasive infection with N. meningitidis
- Streptococcal pharyngitis
- Rubella
-
when are contact precautions implemented?
when patients are known or suspected to harbor infection transmitted by direct contact
-
steps for contact precautions
- hands washed and gloves worn before contact
- protective gowns worn
- items that come in contact must be disinfected or sterilized
-
conditions in which contact precautions should be implemented
- herpes simplex virus infection
- impetigo
- noncontained abscesses, cellulitis or decubitus ulcers
- disseminated herpes zoster
- C. difficile infection
- infection with any multidrug-resistant bacterium
-
agencies associated with regulating various aspects of medical waste
-
naturally occurring sap obtained from rubber trees
latex
-
abnormal immune response to a substance
true allergy
-
cell-mediated response
hypersensitivity
-
if latex reaches bloodstream in a patient with latex allergy, what happens?
large amounts of chemical mediators are released, causing severe bronchial obstruction, pulmonary edema and death
-
amount of physical effort needed to perform a task, such as moving an object
exertion
-
excessive direct pressure against a sharp edge or hard surface
contact stress
-
classifications of causes of musculoskeletal injuries
- exertion
- posture
- repetitive motion
- contact stress
-
where should heavy items (instrument trays) be stored to prevent injuries?
elbow height
-
body mechanics when lifting an object
- keep object close to your body
- bend at the knees
- never lock knees or bend over to pick object up
-
class A fire extinguisher
wood, paper, cloth
-
class B fire extinguisher
carbon dioxide, flammable liquids
-
class C fire extinguisher
electrical or laser
-
class D fire extinguisher
metals
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