SUR 110 THE OPERATING ROOM MILIEU

1. SUR 110 THE OPERATING ROOM MILIEU

2. Physical Environment • Sterile area in the OR room: This area is the area surrounding anything that is sterile including the tables, equipment, and patient once those areas have been aseptically prepared Anyone not sterile should keep a distance of more than 18 inches from sterile areas The scrub tech will monitor this utilizing aseptic principles

3. Sterile team members: Surgeon Assistants to the surgeon Scrub person

4. Unsterile areas: Any area where there are not sterile items in the periphery of the sterile field Includes work area for the circulator and anesthesia areas Unsterile team members must be aware of aseptic principles as well as the scrub person

5. Unsterile team members: Circulator Anesthesia person Others such as X-ray technician, EEG technician, or perfusionist

7. Who’s Who?Tell me the role of each person

8. Traffic Patterns • Unrestricted: Areas outside the operating room suite that lead to the individual operating rooms Includes: locker rooms/rest rooms offices (director, anesthesia, surgeon’s dictation rooms) lounge areas Street clothes are permitted in these areas

9. Semi-restricted: Includes immediate areas surrounding the actual OR rooms such as the control desk, center supply/sterile core, janitor closets, storage closets, decontamination room, some offices, and the hallways surrounding the actual operating rooms

10. Semi-restricted- Must have on the following to enter: Surgical hats Scrub suit/scrubs Shoe covers (varies with policy) Mask (varies with policy)

11. Restricted: These are the individual operating rooms where the surgeries actually take place Also areas where the steam sterilizers or autoclaves are kept

12. Restricted continued- Must have on the following to enter: surgical hat scrub suit/scrubs shoe covers mask eye protection

13. Environmental Safety • Regulatory agencies: • CDC (Centers for Disease Control) • NFPA (National Fire Protection Agency) • OSHA (Occupational Safety & Health Act) • NIOSH (National Institute for Occupational Safety & Health) • ASTM (American Society for Testing & Materials)

14. Environmental Safety Categories • Physical • Biological • Chemical

15. Environmental Safety Concerns • Patient and staff safety comes first • Safety training and prevention education is paramount

16. Physical • Air Handler System/Temperature/Humidity • Ergonomics • Fire Prevention/Safety • Electrical Safety • Radiation Safety • Protection of OR Team Member & Patient

17. Air Handler • Positive laminar flow (air pressure is greater in the OR room than in the hall) • 20 air exchanges per hour • 20% of the 20 exchanges per hour are fresh outside air • Removes toxic odors and vapors • HEPA filter removes microorganisms 0.5 to 5 micrometers

18. Temperature • 65 to 75 degrees Fahrenheit (exception will be neonatal/pediatric cases )

19. Humidity • No higher than 55% and no lower than 50%

20. Ergonomics • Definition: The science dealing with fitting a person’s job to that person’s physical and mental well-being that it promotes efficiency.

21. Body Mechanics • Good posture • Proper lifting • Proper movement

22. Posture • Stand up straight • Don’t slouch • Relax shoulders • Knees slightly bent • Feet shoulder width apart • Change weight distribution often • Stand close to working area • Keep work at right height

23. Posture continued • Sit up straight • Sit with buttocks against back of chair • Sit with feet flat on the floor or resting on a stool • Can put a roll behind your lower back and chair

24. Lifting • If you can’t lift something alone, get help • Bend knees, keep object close to you • Use legs for lifting, not your back • Don’t bend over to lift • Never turn or twist while lifting • Turn with feet after lifting complete

25. Moving • Push, don’t pull • Use step ladders for objects out of reach • Do not stand on chairs, especially ones with wheels • Use lift devices when available

26. Fire Prevention/Safety • Fire components: Fuel-any combustible material Heat-enough to raise fuel to ignition Oxygen-sustains combustion (Without all components, there is no fire)

27. Fire Classification • Class A-Occur with ordinary combustibles • Class B-occur with flammable liquids • Class C-occur with electrical devices • Class D-occur with combustible metals

28. Fire Prevention • Maintain equipment, report defects • Do not overload outlets • Keep work areas clean • Know where extinguishers are kept and their type • Use cotton blankets • Cover patient’s hair • Report spills

29. In Event of a Fire • RACE acronym • R-Rescue anyone in immediate danger • A-Alarm closest to you should be activated • C-Contain fire and smoke • E-Extinguish using appropriate extinguisher. OR extinguishers are generally of the ABC-Dry chemical variety and can be used on all types of fires. • If you cannot extinguish, evacuate per policy of your institution

30. General Fire Rules • Remain calm • Do not use elevators • Close doors as you leave areas • Feel doors before opening them • Do not enter thick smoke • Cover self and patient with wet towels • Stay with your group

31. Electrical Safety • Do not use electrical equipment while touching water or metal • Do not use water on electrical fires • Maintain electrical equipment/report defects • Keep electrical equipment clean, but only clean when unplugged • Do not use extension cords

32. Electrical Safety Continued • Use red outlets in the OR/They are connected to the generator should power fail • Use only three pronged plugs • Cords should be rubber coated • Unplug equipment by pulling on the plug, NOT the cord • Do not block outlets • Tape cords to floor to prevent tripping

33. Radiation Safety • Radiation exposure can result in body cell mutations which can cause cancer and genetic defects in pregnant women • Radiation in the OR occurs with exposure to intra-operative X-rays and fluoroscopy

34. 3 Radiation Factors • Time - the less time you are exposed, the less radiation you absorb • Distance - stand at least 6 feet from the radiation source/leave the room if possible • Shielding - when radiation is used, wear a lead apron -add a thyroid shield for fluoroscopy - wear x-ray badge per policy on the outside of your lead apron for accuracy

35. Dosimetry Badge • Should be worn on the outside of your lead to gather accurate readings. • Provides a permanent • record of your exposure.

36. Radiation safety Best protection is lead shielding • Lead gloves • Lead shield • Lead apron • Lead Glasses ($$$) • Lead thyroid shield

37. Biological Hazards • All body fluids should be treated as infectious • Wear gloves at all times when dealing with body fluids • Additional PPE may be needed • All facilities have standard isolation rules that must be followed for your protection • Use facility policy for handling sharps • Report exposures immediately

38. Chemical Hazards • Chemical exposure ranges from skin and mucous membrane irritation to genetic damage that can cause cancer and death • Familiarize yourself with all chemicals used in your area • All departments keep a book of MSDS (Materials Safety Data Sheets) that give detailed information about all chemicals in their departments

39. Most Common OR Chemicals • Methylmethacrylate (MMA)-bone cement • Formalin-used to preserve tissues/specimens that are sent to pathology for analysis • Gluteraldehyde (Cidex)-used for disinfection and sterilization of heat sensitive items • Ethylene Oxide (EtO)-used in gas sterilization on heat sensitive items

40. Summary • Physical environment • Traffic patterns • Environmental safety regulatory agencies ergonomics fire safety electrical safety radiation safety biological hazards chemical hazards