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Ambient Environmental Hazards in the OR

Ambient Environmental Hazards in the OR. Kay Ball, RN, MSA, CNOR, FAAN Lewis Center, OH Kayball@aol.com. Red Team – April 17, 2007. Objective. Discuss control measures for inhalation hazards in the OR. Inhalation Hazards. Transmissible diseases Toxic fumes Anesthesia gases

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Ambient Environmental Hazards in the OR

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  1. Ambient Environmental Hazards in the OR Kay Ball, RN, MSA, CNOR, FAAN Lewis Center, OH Kayball@aol.com Red Team – April 17, 2007

  2. Objective Discuss control measures for inhalation hazards in the OR.

  3. Inhalation Hazards • Transmissible diseases • Toxic fumes • Anesthesia gases • Glutaraldehyde • Surgical smoke

  4. Spaulding’s Classifications • Critical (Sterilize) • Semi-critical (Disinfect) • Non-critical (Clean)

  5. Glutaraldehyde

  6. Glut History • Tanning agent for leather • Tissue fixative • Preservative in cosmetics • Therapeutic agent for warts & other infections • X-ray processing solution & film emulsion

  7. Glutaraldehyde Disinfection • Broad spectrum antimicrobial “cold” disinfectant • Glut action – bonds protein • Device preparation – thorough cleaning and rinsing • Efficacy monitoring • Soak time controversy

  8. FDA 45 min soak 25 degrees C. Prof. Org 20 min soak Room temp. Controversy

  9. Glut Hazards • Skin & mucous membrane hazards • Ingestion hazards • Respiratory hazards • Chronic exposure hazards

  10. Exposure Levels • 0.04 ppm Detect odor • 0.2 ppm Exposure level • 0.3 ppm Irritant • 0.4 ppm Pouring

  11. Ventilation Vent Glut Processing Area

  12. Spill Procedure Ammonia

  13. AAMI Document “Safe use and handling of glutaraldehyde-based products in health care facilities”

  14. Glut Advantages • Effective for HLD • Highly compatible • Sterilization with long soak times • Low cost, convenient

  15. Glut Limitations • Unstable - Effective life 2-4 weeks • Thorough rinsing - mandatory • Skin, respiratory hazards • Glut bonds proteins Options for alternatives: Other soaking solutions (Cidex OPA) or sterilization methods

  16. Cidex - OPA ORTHO-PHTHALDEHYDE • HDL in 10 min at 20 degrees C • Ortho-phthaldehyde (.55%) + insert ingredents (99.45%) • No sterilant claims • Reuse 14 days (test strip) • Endorsed by many manufacturers • Stains skin, eye & resp irritant, causes headaches

  17. Sterilization Options • Steam • Ethylene Oxide • Peracetic Acid • Gas Plasma • Ozone Sterilize

  18. The Effects of Surgical Smoke

  19. Miners – Air Problems OR Team Serving as the Biological Indicator for Poor Air Quality

  20. AORN RP • Personnel working with an ESU or laser should avoid exposure to smoke plume generated during tissue cutting and coagulation. Surgical smoke causes headaches, watery eyes, respiratory problems in healthcare workers

  21. NIOSH • 1988 • “Smoke generated during laser surgery presents a potential health hazard.”

  22. NIOSH • 1985 • “There’s a potential hazard from smoke generated by electrosurgical knives.”

  23. Research Tomita et al, 1989 Laser: 1gm tissue 3 unfiltered cigarettes ESU: 1gm tissue 6 unfiltered cigarettes Laser and ESU smoke are very similar!

  24. Hazards of Plume • Odor • Particulate Matter Size • Viability • Endoscopy concerns

  25. Odor from Toxic Gases *Polycyclic aromatic hydrocarbons *Benzene *Toluene *Formaldehyde *Acrolein ODOR

  26. Toxic Fumes and Vapors • Acrolein • Benzene • Formaldehyde Possible carcinogens!!!!

  27. Particulate Matter • American College of Surgeons: 5 microns = bacterial colonization • Regular surgical mask: 5 micron filtration • Research - 77% of surgical smoke is 1.1 microns in size and smaller (Mihashi et al., 1975) • Particulate ends up in the alveoli of your lungs

  28. Research Baggish et al, 1988 Rats breathed unfiltered & filtered plume Unfiltered plume: Rats developed hypoxia, pulmonary problems Filtered plume: No changes

  29. Viability Research Garden et al, 1988 • Used CO2 laser on cow papillomavirus • Found intact viral DNA in plume • Injected viral DNA from plume into cow • Grew same viral lesion • Potential of transmission of viable viral contaminants

  30. Transmission of virus to Dr. Hallmo et al, 1991 • 44yo laser Dr developed laryngeal papillomatosis • Lesions show same DNA type as anogenital condyloma from patients

  31. Endoscopy Ott et al, 1993 • Laparoscopy & plume • Increase methemoglobin & carboxyhemoglobin • (methemoglobin-O2 carrying • capacity of RBCs) • Delay in healing?

  32. Recommendations • AORN • ANSI • NIOSH • CDC • OSHA • Global recommendations All say to evacuate surgical smoke!

  33. Solutions Appropriate smoke evacuation system

  34. In-line Filter For small amounts of plume use in-line filter Correct positioning needed Wall Suction Patient AORN Pilot Survey: Most popular method

  35. Wall Suction • Corrodes pipes • Contaminates building • Flow may not be high enough to capture surgical smoke Wall suction 2 cfm Evacuator 30-50 cfm

  36. Smoke Evacuator Needed when larger amounts of smoke created

  37. Critical Features • Efficiency • Filtering capability • Charcoal filter – removes odor • ULPA filter – removes small particulate (.1 microns, 99.999% efficiency) • Suction power

  38. Filter Changing Occupational Hazard NOT Environmental Hazard Follow manufacturer’s recommendations when changing

  39. Solutions Position smoke tube close to the tissue impact site

  40. Automatic On/Off System

  41. Evacuation during endoscopy

  42. Choices

  43. Solutions High Filtration Masks 0.1 micron filtration Not the first line of defense

  44. Questions??? www.becomenasti.com Nurses Advocating Smokefree Theatres Immediately

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