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How does exposure to waste gas occur ?
- Vapours may be breathed while working around anesthetic machines that are in use,
- Emptying or filling anesthetic vaporizers may cause exposure to high levels of waste, especialy if spilled
- Anesthetic machines and their components, such as rubber reservoir bags and hoses
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What is "waste gas" ?
Refers to the vapours of halothane, methoxyflurane, isoflurane, or sevoflurane that are present in room air.
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How much waste gas is present in a vet hospital ?
- Vary in different locations at different times.
- Highest levels of cantamination are due to spills
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What are the type of Vaporizers?
- Standard filler port
- Key safety filler system
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What is the silent danger ?
- People believe that if they cannot smell anesthetic gas the room air is "safe"
- But...
- the human nose can only smell halothane when the concentration is at least 30 ppm which is 15 times higher thant he max recommended level.
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What are some factors that determine the actual level of anesthetic gas?
- 1. Duration of anesthetic: the longer the machine is in use, the higher the waste gas concentration in the room air.
- 2. Flow rate of carrier gas: Higher flow rate may lead to more waste gas
- 3. Scavenging system: The scavenger works to expel gas safely outside.
- 4. Technique used: Mask inductions and eanesthetic hambers release high levels of waste gas, as air can leak around the mask or be released when the chamber is opened.
- 5. Ventilation of surgery room: Rooms with a ceiling fan, wall fan, or other ventilating devices have lower levels of waste gas.
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How can levels of waste gas be detected?
- Dectector badges
- Dosimeters
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What are the Short term effects of waste anesthetic gas?
- Drowsiness
- Headache
- Fatigue
- Nausea
- Pruritis
- Depression
- Irritability
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What are the Long term effects of waste anesthetic gas?
- Reproductin disorders
- Liver or kidney damage
- Chronic nervous system disorders
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Explain the Reproductive disorders
- there is a 33% increased risk of spontaneous abortion when exposed to waste anesthetic gas.
- it also has been linked to an increase in congenital abnormalities.
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Explain Liver or Kidney damage
- Halothane: recognized to be hepatotoxic; fatal "halothane hepatitis" is occasionally reported in humans anesthetized with this
- Methoxyflurane: waste exposure is suspected tobe associated with a higher risk of renal disease.
- THESE ARE NO LONGER PRODUCED
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Explain chronic nervous system disorders
Nitrous Oxide: chronic exposure to gas has been associated with increased risk of neurologic disease, including muscle weakness, tingling sensations, and numbness
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What is the safe level of exposure to waste gas?
- Has not been determined.
- Recommended that the concentraion of halothane, methoxyflurance or isoflurane not < 2ppm in room air.
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How can you check that waste anesthe gas levels are lower than 2ppm ?
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How can exposure to waste gas be minimized?
- Install an effective scavenging system
- Technicians should test the anesthetic machine for gas leaks regularly
- Utilize anesthetic techniques that reduce waste gas release
- Properly use and maintain anesthetic equipment
- Use protective equipment when exposure is unavoidable
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What are techniques that reduce waste gas release?
- Avoid chambers and masks
- Cuffed ET tube
- Minimum air flow
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What are some Protective spill clean-up equipment ?
- Lab coats , Rubber apron more preferable
- Rubber gloves or latex surgical gloves
- Wear a respirator
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What is the Spill clean-up procedure?
- 1. Everyone should leave the area, unless they are involved in the cleanup
- 2. Increase ventilation as much as possible by opening outside doors and windows and using fans
- 3. Pour absorbment material such as kitty litter on the spill, and use a broom to sweep up the litter, dispose in airtight container outside the clinic
- 4. If the spill is large or if protective quipment is not available, all personnel should leave the building and the local fire department should be notified
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What precautions should be used when handling compressed gases ?
- 1. Store cylinders in a dry, cool well-venitlated area, away from other chemicals.
- Keep away from heat
- keep away from flammable material
- 2. Cylinders should be moved with care
- should be moved on trolley cart and tied down
- 3. Secure cylinders well
- store on a flat surface , secured to wall
- should have the valve cap on when not in use
- 4. Cylinders should be labeled
- know if the tank is full, in use or empty
- use oldest first
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How do chemicals enter the body ?
- Inhalation
- Ingestion
- Absorption (eye + skin)
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How can inhalation of chemicals cause immediate or long term harm?
- Direct irritation of the eye and respiratory tract
- Absorption from the lungs, enter the bloodstream, and affect internal organs
- A few gases can cause asphyxiation
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How can you protect yourself from inhaltion gases, vapours and dusts?
- Increase ventilation
- Wear protective clothing, especially a respirator: surgical masks, disposable respirator, cartridge respirators
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How do you prevent ingestion of chemicals ?
- food and drinks should not be stored close to chemicals
- food or other items that are suspected to have been contaminated by a chemical should be discarded
- wash hands immediately after handling chemicals, and before eating
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What can absorption of chemicals cause?
- skin irritation
- rashes
- allergic dermatitis through skin contact
- Eyes and nose are particular sensitive to chemicals
- when enter the blood stream can affect almost any organ
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How can you prevent absorption of chemicals?
- Personal protective equipment:
- Lab coats
- Closed toe shows
- Rubber boots, rubber or plastic apron
- Gloves
- Goggles
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What are Acute effects of chemicals ?
- Quick onset of effects
- Single large dose or exposure
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What are chronic effects of chemicals ?
- More decitful
- Repeated small doses over a long period of time
- Symptoms may not show for years
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How should chemicals be stored?
- 1. Separate storage areas for each group of hazardous chemicals
- 2.Areas should be tidy, with good access to all materials without climbing over boxed or reaching
- 3. Purchase the smallest quantity needed, as there will be less material to spill or catch fire
- 4.Some type of absorbing agent, such as kitty litter, should be readily availbable for spill clean-up
- Corrosives should not be stored above shoulder height or in aisles or hall ways
- 6. Flammable materials and compressed gases should not be stored near exposure to heat, sunlight or a source of combustion
- 7. All containers should have a purchase and expiry date written on the lavel, and stock should be reviewed at least annually.
- 8. Caps should be immediately replaced on chemical bottles after use
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How to properly dilute and mix chemicals..
- Chemicals shouldnt be mixed together unless the label or MSDS states that the chemicals are compatible.
- When diluting with water always start with the water first, and add chemical gradually
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How do you properply package waste materials?
- Solvents, oils, grease, paints, and other flammables should be placed in covered metal containers.
- Broken glass must be placed in a puncture - proof container or a sharpes container
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What are some hazardous chemicals common in Vet. Hospitals?
- Pesticides
- Dark room (x-ray) chemicals
- Disinfectants
- Formaldehyde + Formalin
- Pharmaceuticals
- Ethylene oxide
- Mercury
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What are Pesticides?
Any chemical that is used to control pests
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What are the 5 classes of pesticides?
- Rodenticides
- Fungicides
- Herbicides
- Fumigants
- Insecticides
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What type of pesticide is most common in vet. hospitals?
Insecticides. In the form of flea and tick sprays, collars, repellents, shampoos, dips, foams.
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What may Insecticides contain ?
- Organophosphates
- Carbamates
- Pyrethrins
- Insect growth regulators
- Amitraz
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What are the Signs and Symptoms of pesticide exposure ?
- Signs can be subtle and non-specific (nausea, dizziness, headache)
- Depends on exposure amount. Low= mild signs, high= more serious
- Any symptoms suggestive of pesticide toxicity should seek medical attention
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What are some safety precautions with pesticide use?
- know the chemical being used and dthe class of insecticide to which it belongs
- follow the label directions
- pregnant women should avoid pesticide exposure
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What routes are pesticides absorbed ?
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How do you avoid absorption of pesticides through the skin?
- Rubber gloves and a lab coat whn apply foams or liquid
- Aprons when applying insecticidal shampoos or dips
- Wash hands after applying the pesticide if didnt wear gloves
- Goggles when pouring or mixing concentrated solutions
- Eye washes should be available
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How do you avoid inhaltion of pesticides?
- Use all pesticides only in areas with good ventilation
- If ventilation is poor, doors and windows should be opened, use portable fans
- Wear a face shield when working around pesticide mists
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How do you avoid ingestion of pesticides?
- Wash hands
- Do not leave open containers of food, beverages, cigarettes, where insecticides are being used
- Do not eat, drink or smoke when using insecticides
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When should protective equipment be worn when dealing with xrays.?
- Hand-developing x-rays
- Replenishing x-ray fluid
- Cleaning or maintenance of automatic processors
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What are signs and symptoms of darkroom chemical exposure ?
- Severe eye irritation, including permanent corneal damage if liquid is splashed into eye
- Respiratory tract irritaion and burning if concentrated vapours are inhaled
- Skin irritaion if there is direct contact with skin
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What are some safety precautions of darkroom chemical use ?
- WHIMIS labels should be posted near the developing tanks
- When hand-developing films, wear glovesThe clinic should be quipped with and eyewash fountain
- Tanks should be covered when not in use and the xray room should have good ventilation
- Use of automatic processors greatly reduce the exposure to developing chemicals
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What are some signs and symptoms of disinfectant exposure ?
- Skin irritation, red, peeling, dry, cracked appearance
- Most dermatitis quickly resolves without treatment
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What are the effects of Isopropyl alcohol ?
- Irritation to the eyes and nose, may cause dry skin
- Ingestion may be fatal
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What are the effects of Sodium Hypochlorite (bleach) ?
- Irritaion to the hands, eyes respiratory tract
- Bleach should NEVER be mixed with any disinfectant containing ammonia
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What are the effects of Idoine - containing solutions ?
- irritaion to the skin, eyes and nose
- May cause headaches and breathing difficulty if inhaled
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Effects of Quatemary Ammonium Compounds ?
- Relatively non-toxic at low concentrations, nasal irritation
- concentrations greater than 10% may produce chemical burns when spilled on skin
- Oral ingestion is poisonous
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What are safety precautions of disinfectant use ?
- wearing PPE
- less exsposure you have ,lower risk of becoming sensitized
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What are signs and symptoms of formalin and formaldehyde exposures ?
- Acute exposure to full strenght formaldehy causes intense irritaion to the yes and skin, causing burning and tearing. Ingestion, causes severe abdominal pain, vomiting. May be fatal
- Chronic exposure to formalin or sm amount of formaldehyde may cause red, sore, cracked and blistered skin, soft brown fingernails
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What drugs may be harmful when ingested or absorbed through the skin ?
- Xylazine (rompun) : can cause bradycardia
- Prostaglandins (Lutalyse) : may cause miscarriage
- Duragesic patch (fentanyl) : may cause serious respiratory depression
- Nitroglycerin gel/cream : may cause serious hearty arrhythmia
- Cytotoxic drugs: most hazardous.used in cancer chemo.
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What are safety precautions of Pharmaceutical use ?
- be aware of any drugs that may be harmful
- wash hands after filling prescriptions
- wear gloves when preparing or applying medications to pets
- use caution with syringes and needles
- Do NOT recap syringes !
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What is Ethylene Oxide ?
A gas sterilization agent, most commonly known in vet clinics as the "blue box" sterilization system.
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What are hazrads associated with ethylene oxide use ?
- 1. Flammable, ptentially explosive
- 2. Causes severe burns on the skin, eye irritation, corneal injury
- 3. Gas ethylene oxide may cause acute irritaion of the resp. system, heachache, nausea, vomiting
- 4.Potential carcinogen
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How does excessive levels of ethylene oxide occur?
- Accidental breakage, ampule spills or breathing gas from broken ampule
- Breathing vapours from a box opened before sterilization is finished
- Breathing vapours given off by newly sterilized loads
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What are the safety precautions of Ethylene oxide use ?
- All employees who handle ethylene oxide must be properly trained
- Planned emergency procedures including evacuation must be in place
- Written procedures should include Proper loading and unloading of the sterilizer
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What are the signs and symptoms of mercury exposure ?
- Chronic exposure may lead to emotional instability, gingivitis, weight loss, renal damage
- Inhalation of mercury vapours is a serious hazard
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Safety precautiosn for mercury spillage ?
- Specialized clean up kits are available
- Wear gloves when cleaning up mercury spills
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How do you properly clean up mercury?
- put on gloves and use a stiff paper or cardboard to gently push the mercury droplest together
- use a syringe or pipette to pick up tiny droplets
- captured mercury should then be placed in a sealed container and disposed as hazardous waste
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What should a person do if a chemical is splashed into the eyes?
- Call for help first
- Remove contact lenses if present
- Flush Both eyes continously for 15mins with lukewarm or cold water, using eyewash fountain or bottle.
- Seek medical attention, bring the labeled bottle or MSDS
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What should you do if a toxic chemical is ingested?
- Seek medical attention immediately
- Call the posion control center for advice
- The MSDS sheet or label should be sent with the person seeking medical help
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What should you do if toxic vapours are inhaled ?
- Go into a well ventilated area, outdoors is best
- Call for help and seek medical attention
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What must extinguishers be inspected for , to ensure?
- Properly charged
- Properly mounted
- Free of obstructions
- Seals and pins are in place
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What should you do if a fire occurs ?
- Call for help
- Ensure that all persons in the building are immediatly informed and evacuated
- Oxygen tanks and natural gas lines should be turned off
- Evacuation of animals may be possible depending on location and size of fire
- If small fire, use fire extinguisher. Dont attempt to fight a fire if: Spreading beyond immediate start area, could block your escape route
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Steps for cleaning chemical spills
- Spill kits
- Small amount - absorb and sweep up, dispose in airtight container
- If spill gives off potentially hazardous vapours - open all doors and windows, leave the area
- If contact with ethylene oxide - contaminated clothing should be removed, skin should be flushed
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How do you properly prepare staff for emergencies ?
- All persons should undergo fire safety training
- Have an evacuation plan
- Emergency telephone numbers should be posted at every phone station
- Every employee must know the location of all the extinguisher, spill kits, eye wash fountains, PPE
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What are some sources of energy emissions ?
- Ultra violet light
- Lasers
- Microwave ovens
- Video display terminals (computer screens)
- Ultrasound machines
- X-ray machines
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What is Electromagnetic Radiation ?
Consist of photons of energy traveling at the speed of light. Microwave ovens, light bulbs, x-ray machines all produce it.
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What is Non-ionizing Radiation ?
- Does not penetrate tissues very well. Ex. Light. If it does penetrate tissures like radio waves it will pass with minimal effects.
- Very high doses can damage tissue (ultraviolet radiation)
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What are some sources of Non-ionizing radiation ?
- Lasers (surgical)
- Ultraviolet lamps (woops lamp)
- Videos display terminals
- Ultrasounds
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What is Ionizing radiation ?
Causes the formation of ions and free radicals as it passes through tissues. May cause chromosomal damage and other serious effects
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What are sources of Ionizing radiation?
- X-ray machines
- Fluoroscopy
- Anglography equipment
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Why can x-rays be hazardous?
- Cannot be detected by human senses
- They are able to penetrate human tissue, could damage the skin and underlying organs
- Causes chromosomal damage and sometimes cell death
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What are some commonly observed problems in a vet clinic dealing with x-rays ?
- Inadequate collimating of the x-ray beam
- Routinely taking x-rays without PPE, or using protective equipment that is damaged
- Staff allowing bare hand to be exposed to the direct x-ray beam. Most damaging
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How do you protect yourself from x-ray radiation ?
- Avoid unecessary exposure
- Decrease exposure time
- Increase distance from source
- Shield yourself from exposure (lead PPE)
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What are the 2 ways radiation exposure can occur ?
- Contact with the primary beam. Most serious.
- Scatter radiation. Radiation bounces off of the object being radigraphed rather than penetrating it.
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What are the precautions when taking xrays?
- Dont take more xrays than you have to
- Use the least amount of radiation possible
- Stand as far from the beam as possible
- Wear PPE
- Special precautions for portable units
- Monitor exposure levels
- Monitor the machine
- Designate a radiation safety person
- Special precautions for fluorscopy
- Developing films
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