Clinical Safety

  1. 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
  2. What is "waste gas" ?
    Refers to the vapours of halothane, methoxyflurane, isoflurane, or sevoflurane that are present in room air.
  3. 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
  4. What are the type of Vaporizers?
    • Standard filler port
    • Key safety filler system
  5. 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.
  6. 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.
  7. How can levels of waste gas be detected?
    • Dectector badges
    • Dosimeters
  8. What are the Short term effects of waste anesthetic gas?
    • Drowsiness
    • Headache
    • Fatigue
    • Nausea
    • Pruritis
    • Depression
    • Irritability
  9. What are the Long term effects of waste anesthetic gas?
    • Reproductin disorders
    • Liver or kidney damage
    • Chronic nervous system disorders
  10. 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.
  11. 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.
  12. 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
  13. 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.
  14. How can you check that waste anesthe gas levels are lower than 2ppm ?
  15. 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
  16. What are techniques that reduce waste gas release?
    • Avoid chambers and masks
    • Cuffed ET tube
    • Minimum air flow
  17. What are some Protective spill clean-up equipment ?
    • Lab coats , Rubber apron more preferable
    • Rubber gloves or latex surgical gloves
    • Wear a respirator
  18. 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
  19. 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
  20. How do chemicals enter the body ?
    • Inhalation
    • Ingestion
    • Absorption (eye + skin)
  21. 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
  22. 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
  23. 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
  24. 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
  25. How can you prevent absorption of chemicals?
    • Personal protective equipment:
    • Lab coats
    • Closed toe shows
    • Rubber boots, rubber or plastic apron
    • Gloves
    • Goggles
  26. What are Acute effects of chemicals ?
    • Quick onset of effects
    • Single large dose or exposure
  27. What are chronic effects of chemicals ?
    • More decitful
    • Repeated small doses over a long period of time
    • Symptoms may not show for years
  28. 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
  29. 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
  30. 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
  31. What are some hazardous chemicals common in Vet. Hospitals?
    • Pesticides
    • Dark room (x-ray) chemicals
    • Disinfectants
    • Formaldehyde + Formalin
    • Pharmaceuticals
    • Ethylene oxide
    • Mercury
  32. What are Pesticides?
    Any chemical that is used to control pests
  33. What are the 5 classes of pesticides?
    • Rodenticides
    • Fungicides
    • Herbicides
    • Fumigants
    • Insecticides
  34. What type of pesticide is most common in vet. hospitals?
    Insecticides.  In the form of flea and tick sprays, collars, repellents, shampoos, dips, foams. 
  35. What may Insecticides contain ?
    • Organophosphates
    • Carbamates
    • Pyrethrins
    • Insect growth regulators
    • Amitraz
  36. 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
  37. 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
  38. What routes are pesticides absorbed ?
    • Skin
    • Inhalation
    • Ingestion
  39. 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
  40. 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
  41. 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
  42. When should protective equipment be worn when dealing with xrays.?
    • Hand-developing x-rays
    • Replenishing x-ray fluid
    • Cleaning or maintenance of automatic processors
  43. 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
  44. What are some safety precautions of darkroom chemical use ?
    • WHIMIS labels should be posted near the developing tanks
    • When hand-developing films, wear gloves
    • The 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
  45. What are some signs and symptoms of disinfectant exposure ?
    • Skin irritation, red, peeling, dry, cracked appearance
    • Most dermatitis quickly resolves without treatment
  46. What are the effects of Isopropyl alcohol ?
    • Irritation to the eyes and nose, may cause dry skin
    • Ingestion may be fatal
  47. 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
  48. What are the effects of Idoine - containing solutions ?
    • irritaion to the skin, eyes and nose
    • May cause headaches and breathing difficulty if inhaled
  49. 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
  50. What are safety precautions of disinfectant use ?
    • wearing PPE
    • less exsposure you have ,lower risk of becoming sensitized
  51. 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
  52. 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.
  53. 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 !
  54. What is Ethylene Oxide ?
    A gas sterilization agent, most commonly known in vet clinics as the "blue box" sterilization system.
  55. 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
  56. 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
  57. 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
  58. 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
  59. Safety precautiosn for mercury spillage ?
    • Specialized clean up kits are available
    • Wear gloves when cleaning up mercury spills
  60. 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
  61. 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
  62. 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
  63. 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
  64. What must extinguishers be inspected for , to ensure?
    • Properly charged
    • Properly mounted
    • Free of obstructions
    • Seals and pins are in place
  65. 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
  66. 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
  67. 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
  68. What are some sources of energy emissions ?
    • Ultra violet light
    • Lasers
    • Microwave ovens
    • Video display terminals (computer screens)
    • Ultrasound machines
    • X-ray machines
  69. 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.
  70. 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)
  71. What are some sources of Non-ionizing radiation ?
    • Lasers (surgical)
    • Ultraviolet lamps (woops lamp)
    • Videos display terminals
    • Ultrasounds
  72. 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
  73. What are sources of Ionizing radiation?
    • X-ray machines
    • Fluoroscopy
    • Anglography equipment
  74. 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
  75. 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
  76. 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)
  77. 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.
  78. 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
Card Set
Clinical Safety
Clinical safety test # 2, waste anesthetic gas - radiation