AP - Lec 1 Questions First (Hazards) Flashcards
3 main hazards anest. are presented with
chemical vapors, ionizing radiation, infectious agents
3 additional hazards anest. are faced with
phsychological stress, occupational rx abuse, suicide (wat?)
NIOSH acronym
National institute for occupational safety and health
NIOSH responsibilities
education, research, health standards, publish documentation
OSHA Acronym
Occupational Safety & Health Administration
OSHA Responsibilities
enacting job health standards by investigating violations and enforcing standards
Physical Hazards
Trace anesthetic gases can cause: ^ risk spontaneous abortion, birth defects, decreased fecundability
Physical Hazards 2
lifting heavy weights, >46 hour work weeks, changing work shift
Trace gas cancer risk
1.3-2x increase in females. no risk in males
What is methylmethacrylate?
cement type substance used in hip/knee reconstruction
Methylmethacrylate risks
exposure for factory workers <8 hours. Can cause: respiratory (asthma) cutaneous genitourinary ellergic sensitizer
Halothane (hepatitis) stats
1:35k adults, 1:200k children
What are some chemical hazards?
Methylmethacrylate, halothane, chemotherapy
Chemotherapy protocols
special gown, mask, shoe covering
Radiation situations for exposure (4)
radiographs (angiography), fluoroscopy, radiation therapy, PACU
Proper Precautions (PPE) for radiation hazards
lead aprons & shield, dosimeters, maintaining distance: e=1/d^2
Lazer Hazards
thermal burns, eye injury, electrical hazards, fire & explosion
Lazer Plume Hazards
can contain viral DNA and toxic chemicals: HPV, HIV, HBV
Laser Protection Gear
high-efficiency laser mask
Hazards of long work hours
error attributed to fatigue: 64%, impaired health, emotional problems, performance decline
Infection transmission of agents require (6):
source, stabile pathogen, adequate numbers, infectivity of agent, appropriate vector, portal of entry
Respiratory transmission (2)
Aerosolization: Small particle aerosolize by coughing, sneezing Self innoculation: direct oral, nasal, or conjuctival exposure
Aerosolization risks
influenza, measles, rhinovirus, tuberculosis
self inoculation risks
rhinovirus, respiratory syncital virus
Influenza
orthomyxoviridae
Influenza facts:
Easily transmitted, us 36k deaths, 200k hospitalization morbidity rare in healthy individuals, respiratory isolation, precautions: immunized annually (new strains)
h1n1 spanish flu A
Most common in ages 25-34
Rubeola & Rubella
Paramyxoviridae
Rubeola aka measles transmission
Aerosolization
Rubeola/measles info
highly infective (90% of households), rash & spots, fever and 3 cs
3 c’s
cough, coryza, conjuctivitis
Coryza
cold’ of upper respiratory tract
Conjunctivitis
eye infection,pinkeye
Rubeola complications
diarrhea, pneumonia, encephalitis M 1:1000, 30% immunosuppressed
Rubella is known as
german measles
rubella facts
most adults immune, miscarriages 1st trimester, cause birth defects or fetal death, congenital rubella syndrome, health care worker is at increased risk 13x.
mumps known as
epidemic parotitis
how is mumps spread
airborn droplets
symptoms of mumps
swelling salivary & paratid glands Not severe in children most often children 5-9 yo
Respiratory Syncytial Virus (RSV) latin name
paramyxoviridae
RSV impact on children
most common cause of lower respiratory disease 60% infants 100% 2-3 yo
RSV spreads how?
self-inoculation
RSV active on surface for
6 hours
RSV is shed after __ days
7
RSV after infection
can cause asthma symptoms in young kids for up to 6 months
Rhinovirus facts
most common viral infective agents in humans, and major cause of the common cold
Rhinovirus transmission:
self-inoculation and/or aerosolized
Rhinovirus types
110 serologic virus types responsible for approx 50% of all cases of common cold
Herpes Virus, varieties & number
8 varieties VZV varicella-zoster, HSV 1&2, CMV
Vericella-zoster
chickenpox & shingles
Vericella-zoster communicability
1-2 days before and 5-6 days after
Vericella-zoster titer
necessary for unknown history
Herpes Symplex Type 1 symptoms
Severe oral lesions fever adenopathy
Herpes Type 1 transmission
self inoculation or direct contact
Herpes Type 1 Encephalitis
70% mortality w/o Tx
Herpes Type 1 Ocular
blindness
Herpes Type 1 Asymptomatic %
5%
CMV Occurrence
40-90% have antibodies, occurs during childhood
CMV transmission
direct contact (unlikely aerosols)
CMV & pregnancy
infection during pregnancy can cuase 2.5% fatal infection, 10% congenital CMV syndrome.
CMV
No greater risk of infection than personel with no pt contact
Hepatits Source of Virus
A feces B fluids C fluids D fluids E feces
Hepatitis Roule of Transmission
A fecal-oral B percutaneous permucosa C percutaneous permucosa D percutaneous permucosa E fecal-oral
Hepatitis Chronic infection
A no B yes C yes D yes E no
Hepatisis Prevention
A pre/post-exposure immunization B pre/post-exposure immunization C blood donor screening; risk behavior modification D pre/post-exposure immunization, risk behavior modification E ensure safe drinking water
Hepatitis B Prevalence
3-5% in US Seroconversion up to 30% 5% develop chronic hepatitis which develops into ESLD 1% develop fulminant hepatitis (<70% mortality)
Hep B Transmission
sexual contact, shared needles/syringes, perinatally
Hep B primary prevention
HBV vaccines
Hep C: Liver
leading cause of liver disease in US, 9k cases per year
HCV prevalence
3% in us 60% HCV infected pts will have chronic heptatitis, cirrhosis seroconversion 1.8%
HIV %’s
Seroconversion .3% Percutaneous exposure, 0. 1% mucous membrane exposure
HIV risks
visible blood on device deep injury needle placed intravascular terminal illness (death within 2 months)
Tuberculosis transmission
bacilli on airborn particles 1-5 microns
Tuberculosis infection/mortality rates
7-8 million infected per year, 8000 die per day
TB groups with high risk
personel contacts with active TB immigrants alcoholics homeless iv users
TB Protection
N95 mask
TB immune response to limit spread
2-10 weeks
TB detection
skin test PPD
TB & surgery
should be delayed until pt is no longer infectious non elective procedures should be sched for end of day wear high efficiency filter (99.7% particles)
TB & the OR
TB pt should be transported from isolation room wearing a mask OR door should be closed with minimal traffic Few # of other pt’s in OR optimal End of day, use bacterial filter btw anesthesia circuit and airway.