SUR 102 - Periop care/injuries

  1. condition that will not cause injury or harm to the employee, patient and other people in the health care facility
  2. 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
  3. classifications of hazards
    • physical - back injury, fall, etc.
    • chemical - gases, fumes, etc.
    • biologic - cuts or needle sticks, etc.
  4. radiation produces
    positively and negatively charged particles that can change the electrical charge of some atoms and molecules in cells
  5. radiation changes can alter?
    enzymes, proteins, cell membranes and genetic material
  6. causes of exposure to radiation
    cancer, cataracts, bone marrow injury, burns, tissue necrosis, genetic mutations, spontaneous abortion, congenital anomalies
  7. 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
  8. 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
  9. radiation distance
    • leave room if not sterile
    • if can't leave, stand 6 feet away
  10. radiation shielding
    • wear lead aprons
    • if apron does not wrap around body, stand facing radiation source
    • never fold apron
  11. 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
  12. electrons to move through material in one direction and causes current to flow
  13. measurement of opposition to the flow of electron through material
  14. rate of flow of electrons through a conductor, measured in amps
  15. types of current
    • DC direct current - battery and low voltage
    • AC alternating current - 110-220 volt line - 3 times more powerful than DC
  16. designed to discharge any harmful electricity directly to the ground without including the patient
    grounding (Bovie pad)
  17. when does electrocution occur?
    when individual becomes the component that closes a circuit through which a lethal current may flow
  18. when does electric shock occur?
    when current is large enough to stimulate nervous system or large muscle area
  19. severity of shock depends on?
    magnitude of current flow and path taken through body
  20. 2 types shock
    • macroshock - large surface of skin - high voltage
    • microshock - small contact area of skin
  21. gaseous form of sterilization and known to be mutagen and carcinogen
    ethylene oxide
  22. ethylene oxide exposure can cause?
    dizziness, nausea, vomiting
  23. formaldehyde vapors
    toxic to respiratory tract
  24. glutaraldehyde
    • least toxic of 3 agents
    • fumes irritating to eyes, nose and throat
    • only be used in closed container and well ventilated areas
  25. what should be worn when using disinfectants?
    gloves and goggles
  26. generated by thermal destruction of tissue or bone
    surgical plume
  27. what should be used to suction laser and ESU plumes?
    smoke evacuator
  28. male reproductive hazards
    can cause abnormal sperm numbers, shapes and motility
  29. female reproductive hazards
    can cause spontaneous abortion or congenital fetal anomaly
  30. 4 essential elements of risk management
    • administration
    • prevention
    • correction
    • documentation
  31. 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
  32. 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
  33. are vinyl gloves acceptable for cleaning?
    nope - not reliable and may not protect from environmental contamination
  34. 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
  35. special considerations for patients with known endospore-forming bacterial contamination
    hypochlorite-based disinfectant should be used for cleaning
  36. how long do endospores survive in the environment?
    • 5 months
    • have been cultured in ORs 40 days after the patient has used the room
  37. special considerations for patients with known or suspected transmissible spongiform encephalopathies (CJD)
    disposable equipment, instrument, linens and supplies should be used
  38. primary principles of cleaning procedures
    to confine and contain contamination and physically remove microorganisms as quickly as possible
  39. primary cause of accidental cuts and punctures to personnel
    disposal of surgical sharps at the end of the surgical procedure
  40. where are basins and trays too large for the case cart placed?
    put into plastic bags for transport to the decontamination area
  41. how would you dispose of solutions and suction bottle contents?
    dispose of them in a flushing hopper connected to sanitary sewer
  42. what do you do with unused suture packets?
  43. when does scrub remove gown and gloves?
    before taking case cart to processing area
  44. technique used to remove gloves
    glove-to-glove and skin-to-skin
  45. what type of bottle should be used to spray disinfectant for cleaning?
    squeeze bottle because spray bottles can cause particles to become aerosolized
  46. how are floors cleaned?
    in perimeter of 3-4 feet in circumference of surgical field, expanding in direction of visible soilage
  47. 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
  48. 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
  49. average time the room will be ready for next patient
    10-15 minutes
  50. if patient is taken to OR but procedure is canceled...
    tables should be torn down and room cleaned as if procedure had been performed
  51. hazards related to medical devices and energy sources
    technical risk factors
  52. hazards related primarily to liquid, gas, and solid chemicals in the perioperative environment
    chemical risk factors
  53. hazards related to transmission of infectious disease
    biological risk factors
  54. 3 components of fire
    • oxygen
    • fuel
    • source of ignition
  55. how much oxygen does normal air contain?
    about 21%
  56. environment that contains greater concentration of oxygen
    oxygen-enriched atmosphere (OEA)
  57. when are oxygen molecules produced?
    when nitrous oxide decomposes in presence of heat
  58. what are oxygen and nitrous oxide considered?
  59. how much alcohol do most skin prep solutions contain?
  60. are surgical drapes and gowns flame resistant or flammable?
    flame resistant
  61. gases normally produced by intestines (potentially causing fires)
    • hydrogen
    • oxygen
    • nitrogen
    • carbon dioxide
    • methane
  62. how much of gases are contained in large bowel?
  63. concentration at which methane is explosive?
  64. 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
  65. how many surgical fires involve lasers?
    approximately 13%
  66. how hot can an active electrode reach in ESU?
    1292 F (700 C)
  67. how many patient fires occur in the airway?
  68. how many patient fires occur on the face?
  69. how many patient fires occur inside the patient?
  70. how many patient fires occur on the skin?
  71. how do you stop the progression of the fire?
    triangle of fire must be broken
  72. 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
  73. 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
  74. types of fire extinguishers used in the OR
    • water-based
    • carbon dioxide
    • dry powder
  75. preferred type of fire extinguisher in OR
    carbon dioxide
  76. 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
  77. risk reduction strategies have been developed by what organizations?
    • TJC
    • AORN
  78. what are oxygen portable tanks used for?
    when in-line systems are not available or when patients are transported
  79. what are compressed nitrogen tanks used for?
    as a power source for instruments such as drills, saws, and other high-speed tools
  80. what is argon used for?
    during laser surgery
  81. what is nitrous oxide used for?
    as anesthetic gas
  82. what is carbon dioxide used for?
    insufflation during laparoscopy or pelviscopy
  83. 2 types of hazards associated with compressed gas cylinders
    • physical - related to high pressure in cylinder
    • chemical - related to flammability or oxidative qualities/toxicity
  84. 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
  85. what does right hand valve of a gas cylinder do?
    displays pressure in cylinder
  86. what does left hand valve of a gas cylinder do?
    displays pressure in power hose connected to the instrument
  87. do not use a gas tank if pressure is what?
    less than 500 psi
  88. regulators are specific to what?
    gas specific and are not interchangeable
  89. leading cause of hospital fires in US
    electrical malfunctions
  90. characteristics of electricity
    • current
    • voltage
    • impedance (resistance)
    • grounding
  91. rate of electrical flow
  92. low voltage that originates from battery
    direct current (DC)
  93. current transmitted by a 220- or 110-V line, normally found in wall outlets
    alternating current (AC)
  94. available power is much higher with which current?
  95. driving force behind moving electrons
  96. ability of a substance to stop flow of electrons
    impedance (resistance)
  97. examples of nonresistant materials
    • metal
    • water
    • human body
  98. discharge of electrical current from source to ground where it is dispersed and rendered harmless
  99. most effective method of blocking radiation
    lead shields
  100. most important parameters determining risk and protection
    • distance from radiation source
    • duration of exposure
    • quality of shielding
  101. which direction should workers face during use of ionizing radiation?
    face the radiation exposure because many lead aprons shield only front of the body
  102. what other lead gear should be worn?
    • lead glasses
    • neck shield
    • lead-impregnated gloves
  103. where should nonsterile team members be during radiation exposure?
    step outside the range of exposure
  104. 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
  105. what is used to measure the cumulative radiation dose for those who are often exposed to radiation?
  106. primary risk when MRI is used?
    presence of metal
  107. how can toxic chemicals enter the body?
    • through respiratory tract
    • by direct skin contact
    • by splash contact
    • by ingestion
  108. 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)
  109. smoke created during laser surgery and electrosurgery that contains toxic chemicals, vapors, blood fragments and viruses
    smoke plume
  110. set of recommendations responding to the concern of workers contracting or transmitting blood-borne diseases in course of their work
    Universal Precautions
  111. behaviors and methods of working in the healthcare setting that reduce exposure to blood and body fluids
    Standard Precautions
  112. what kind of soap do you use for routine handwashing?
    plain soap, not antimicrobial
  113. most common means of transmission of blood-borne pathogens to health care workers
    sharps injuries
  114. special set of regulations for handling and disposing of sharps
    Blood-Borne Pathogen Rule, issued by OSHA
  115. method of transferring sharp instruments on the surgical field without hand-to-hand contact
    neutral zone (no-hands) technique
  116. risk reduction strategy used after exposure to blood or other body fluids
    postexposure prophylaxis (PEP)
  117. when are PEP drugs most effective?
    when given within 24 hours after exposure
  118. 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
  119. PEP for HIV
    regimen of antiviral drugs followed by regular testing
  120. how long do antibodies generally take to appear on HIV tests?
    25 days to 3 months
  121. how long does HIV PEP regimen usually last?
    1 month
  122. 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
  123. precautions to reduce the risk of transmission of airborne agents by droplet nuclei up to 5 um in size
    airborne transmission precautions
  124. during transport, patient with disease that can be spread by airborne transmission must wear what?
    surgical mask
  125. 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
  126. diseases for which airborne transmission precautions must be taken
    • measles
    • varicella
    • tuberculosis
  127. traveling distance of droplets
    3 feet
  128. distance between patients with droplet precautions and other patients
    3 feet
  129. infections for which droplet precautions should be implemented
    • invasive infection with H. influenzae type B
    • invasive infection with N. meningitidis
    • Streptococcal pharyngitis
    • Rubella
  130. when are contact precautions implemented?
    when patients are known or suspected to harbor infection transmitted by direct contact
  131. steps for contact precautions
    • hands washed and gloves worn before contact
    • protective gowns worn
    • items that come in contact must be disinfected or sterilized
  132. 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
  133. agencies associated with regulating various aspects of medical waste
    • EPA
    • FDA
    • OSHA
    • NRC
  134. naturally occurring sap obtained from rubber trees
  135. abnormal immune response to a substance
    true allergy
  136. cell-mediated response
  137. 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
  138. amount of physical effort needed to perform a task, such as moving an object
  139. excessive direct pressure against a sharp edge or hard surface
    contact stress
  140. classifications of causes of musculoskeletal injuries
    • exertion
    • posture
    • repetitive motion
    • contact stress
  141. where should heavy items (instrument trays) be stored to prevent injuries?
    elbow height
  142. 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
  143. class A fire extinguisher
    wood, paper, cloth
  144. class B fire extinguisher
    carbon dioxide, flammable liquids
  145. class C fire extinguisher
    electrical or laser
  146. class D fire extinguisher
Card Set
SUR 102 - Periop care/injuries
Periop care/injury