Operative Suite Flashcards
The 15-year-old patient has mumps and is coming to surgery for an open reduction internal fixation of his tibia and fibula bones. What, if any, isolation precautions should be taken during the care of this patient?
Contact isolation is required
Mumps virus is transmitted via inhalation of infectious respiratory droplets, direct contact with infected droplets or saliva. Droplet precautions are required
Sodium Hypochlorite
Bleach
used to clean the room after C-diff or
Creutzfeldt-Jakob disease (CJD) (allow 15 minute contact time)
Sodium Hydroxide
Lye
also acceptable to use after a patient with CJD (60 minute contact time with instruments)
A patient with Creutzfeldt Jacob disease has just left the OR. How should the room be cleaned?
Clean the room and surfaces with Sodium
Hypochlorite or Sodium Hydroxide
How far should eye wash station be away from area working with hazardous materials?
10 seconds
Creutzfeldt-Jakob disease (CJD)
Prions=proteins found in cells
Harmless unless misshapen or folded
Can be sporadic, hereditary, iatrogenic (from exposure to tissue), or variant (eating infected beef, blood transfusion)
Single use instruments
Should be last case of day
Do not use IUSS (immediate use steam sterilization)
Injury reduction (effective to least effective)
-Elimination of the hazard
-Engineering controls,(ex: safety syringes)
-Work practice controls (ex: neutral zone)
-Admin controls (ex: policies, and procedures)
-PPE (ex: double gloving)
Unrestricted
Locker rooms, lounge areas, control desk, pre and postop areas
Street clothes
Semi-restricted
Storage for equipment and supplies, hallways with access to restricted areas to pre and postop, central processing
Clean scrubs, head covering, patient gowns, single use jumpsuits
Restricted
Operating rooms, clean core/substerile
Mask in addition to the clean scrubs and head covering, head covering for patients
How many times the air in a room is replaced?
20 air changes per hour
ACH in restricted area
OR:
Total 20
Outside 4
ACH in semi-restricted areas
Sterile storage: total 4, outside 2
Decontamination: total 6, outside 2
ACH in unrestricted areas
PACU: total 6, outside 2
Procedure room: total 15, outside 3
Endoscopy: total 6, outside 2
Humidity in all areas
20-60%
No recommendations for decontamination
Negative pressure
For decontamination and isolation rooms
Pressure in hallways greater than in room
Air current moves from hall to room
Laminar pressure
A type of positive pressure
Unidirectional, controlled from cleanest to less clean area of room
May be horizontal or vertical
Use for high-risk procedures (totals, transplants, hearts)
Temperature in restricted areas
OR: 68-75 F
Temp for semi-restricted areas
Sterile storage: none-75 F
Decontamination: 60-73 F
Temps for unrestricted areas
PACU: 70-75 F
Procedure room: 70-75 F
Endoscopy: 68-73 F
Cleaning for CJD (mad cow disease)
-Disinfect with sodium hypochlorite or sodium hydroxide dwell time 30-60 minutes
-Soak up solutions and discard per local/state/federal regulations
-Rinse treated surfaces with water
Cleaning for TB
Restrict room access for 28 minutes where 15 air exchanges will happen
Removes 99% of bacteria
2000 needle-stick safety and prevention act
A law for sharps safety
Airborne precautions
N95 mask
Intubated in isolation room
-Bacterial filter on the ETT
If not intubated: portable industrial grade HEPA filter, PAS-HEPA (antechamber)
Droplet precautions
Released during coughing, sneezing, and talking
PPE within 3 feet of patient
Regular mask
Precautions during transport: reverse isolation (pt with mask)
Example: influenza patient
Contact precautions
PPE
Maintain precautions during transport
Adequate disinfectant and cleaning
Example: patient with multi-drug resistant organism (MDROs)
MDROs examples
-MRSA
-VRE
-Vancomycin resistant staphylococcus aureus
-C.diff
-Klebsiella pneumoniae
-Carbapenem resistant Enterobacteriaceae
Policies
-Must be in written form
-Reviewed annually
-Readily available to staff
Disseminated herpes zoster (shingles) precautions
Airborne precautions
Airborne precautions examples
-Rubeola (measles)
-Varicella (chicken pox): contact as well
-TB
