Physical Environment & Safety Standards

1. Concorde Career College, Department of Surgical Technology Physical Environment & Safety Standards

2. Objectives • Recognize and understand the designs of the OR suite • Determine the physical components of the OR • Learn OR furniture and their names and functions • Review the type of air-handling system required in the OR • Indicate cleaning procedures • Distinguish among the support services that work with the OR • Recognize the hazards in the OR • Analyze the role of the ST in the protection of self patients and others from the hazards of the OR

3. Physical Design of the OR Suite • The location of the OR in the hospital is made to be easily accessible to and from surgical patient support departments • It is located and designed in an area where traffic is limited and the general public does not have access

4. PHYSICAL LAYOUT HOTEL – ORs are arranged along a central corridor SPECIALTY – variation of the racetrack or hotel

5. PHYSICAL LAYOUT • RACETRACK – involves a series of ORs around a clean central core

6. AREAS OF THE OR • RESTRICTED • Proper O.R. attire required • Mask required • SEMI-RESTRICTED • Proper O.R. attire required • UNRESTRICTED • Street clothes allowed Separated by walls, doors, and red lines

7. OR Attire • Semirestricted areas • Restricted areas • Scrub suit • Hair cover • Shoe covers and/or mask may be required • Jewelry, cosmetics, artificial nails are restricted

8. Physical Design Semi-restricted Unrestricted Restricted

9. Red Line = semi restricted and restricted Green Line = Unrestricted

10. PHYSICAL COMPONENTS

11. PHYSICAL COMPONENTS • ELCTRICAL OUTLETS – 110/220, must be 5’ above the floor. Explosion proof, red outlets are connected to the emergency generator • SUCTIONS OUTLETS – each OR must have at least 2 suction outlets; one for the surgical team, one for anesthesia • GAS OUTLETS (color coded) – oxygen –green; nitrogen –black, nitrous oxide –blue, air- yellow, carbon dioxide –grey; outlets--- walls, ceiling, or mobile tanks; emergency shut off valve in exterior hall

13. PHYSICAL COMPONENTS • LIGHTS – regular overhead, OR spot lights • VIEWING BOX – to view diagnostic images • OPERATING TABLE – narrow, padded and flexible, traditional beds are manual, modern is electrical, mobile; features: • Break points or bendable – knee, waist, and head • Removable sections at the head and foot • Height can be adjusted • Wide base to prevent tipping • Rails along side for attachments • Other OR beds- cysto, fracture- radiolucent

15. PHYSICAL COMPONENTS • CLOCKS AND TIMERS – wall mounted, easily readable face, and a sweeping second hand; additional timer • COMMUNCATION SYSTEM – telephone;intercom system for intra-department (room to room; front desk) and inter-department use (pathology, radiology) some are foot operated • COMPUTER TERMINAL – for the circulator to fill out intra-op record, lab reports, order supplies for the room • OTHER – closed circuit TV

16. OR Furniture

17. BACK TABLE – used to create sterile field

18. Specialty Orthopedic Back Table

19. MAYO STAND – usually spans across patient; holds immediate necessary instruments; two wheeled and can be used to set up gowns and gloves. MAYO STAND

20. KICKBUCKET – four wheeled stands very low to the floor; can be maneuvered by a foot; lined with biohazard bags; holds soiled counted sponges; NOT FOR TRASH! KICKBUCKET

21. RING STAND – four wheeled with one or two rings waist high; used to hold basins; basins hold case related sterile fluids RING STAND

22. Prep Stand • Used for skin prep, urinary catheterization, medical handling, etc.

23. SUCTION SETS – low wheel based stands which hold suction canisters; sterile tubing form the surgical field will be hooked up to this by the circulator; the suction sets is hooked up to a wall suction outlet SUCTION SETS

24. Sponge Counter

25. Amsco Operating Room Table

26. OSI Jackson Table

27. Andrews Spine Table

28. Fracture Table

29. OR Lights

30. C-Arm (Fluoroscope)

31. X-Ray Light Box

32. ANESTHESIA MACHINE • Monitoring equipment • Supplies

33. Anesthesia Cart

34. Crash Cart

35. Pyxis Medstation

36. Malignant Hyperthermia Cart

37. SCRUB SINKS

38. Other OR Furniture • LINEN HAMPER – holds soiled linens • TRASH CONTAINER – may be 2 per room; one lined with a clear trash bag for clean trash and one lined with a biohazard bag for contaminated trash; some facilities are equipped with a metal detector to find instruments that may have been discarded accidentally

39. SURFACES • SMOOTH, POUROUS FREE • EASY TO CLEAN • NON REFLECTIVE • PLEASANT IN COLOR • WATERPROOF • FIREPROOF • NONGLARE

40. CABINETS AND DOORS • DOORS RECESS INTO WALL (if poss.) • DOORS SHOULD BE KEPT CLOSED

41. VENTILATION SYSTEM • Provide clean air • Remove air-borne contaminates that are produced in the room • Remove waste anesthesia – besides scavenger line • Remove toxic fumes and vapors • Comfortable working environment

42. Laminar Air Flow • Produces positive pressure • Unidirectional flow of air • 20 air exchanges per hour • Filtered by High-efficiency Particulate Air (HEPA) Filters • At least 20% of the air change per hour be fresh outside air

43. Air Exchanges • An air exchanger system pulls air from the outside of the OR and pushes stale air from inside the OR out at frequent intervals thus becoming the air exchanger system.

44. VENTILATION SYSTEM • TEMPERATURE – should be kept between 65 and 75°F • RELATIVE HUMIDITY - should be kept between 20-60%

45. DIRECT SUPPORT SERVICES • SAME DAY or DAY SURGERY – patient arrives here, changes clothes, awaits surgery • LABORATORY – perioperative lab values • RADIOLOGY – x-ray films, fluroscope • PATHOLOGY – processing specimens • ENVIRONMENTAL SERVICES- cleaning

46. Pre-op Holding Area • Within the surgical services department • Entrance to OR suite for patients • Should be shielded from noise and views of the ORs • IVs started • Preop interviews

47. POST ANESTHESIA CARE UNIT – PACU- • Patient is recovered from anesthesia and surgery

48. Central Sterile Supply and Sterile Processing • Usually above or below surgical services, or adjacent • Decontamination of soiled instruments • Assembly of instrument sets • Sterilization of instrumentation and • Distribution of supplies

49. SAFETY HAZARDS • ERGONOMICS • SLIPPERY FLOORS • STANDING STOOLS • CROWDED O.R.’S

50. Hazard Categories • Physical • Noise, ionizing radiation, electricity, injury to body, fire, explosion • Biologic • Laser/electrosurgical plume, pathogens, latex sensitivity, sharps injury