Operative Suite Flashcards
Does the OR have more positive pressure in relation to corridors?
yes
Is there a higher pressure in the OR than there is in the halls?
yes
What is the difference between antechamber and OR?
there is no difference between the pressures so it won’t mess up the laminar air flow
How many air changes happen per hour in the OR?
20 changes per hour
How many air exchanges occur with the outside air?
4
If hospital not meeting NIOSH standards for air flow, what happens?
then NO federal funding
How were old air handlers as far as time of air exchanges for percentages?
28 minutes of air exchanges for 99.9% bacterial/viral free
How are new air handlers as far as time of air exhanges?
15 minutes of air exchanges for 99.9% bacterial/viral free
What is the point of air changes/hour?
to remove anesthesia gases
What is used to identify laminar air flow area?
colored tile
Why do we need to have air exchanges in the Or?
because of leaking anesthesia circuits because they are not completely airtight
When a patient exhales sivofluarane where are they going?
The patient exhales and it goes into the soda lime, soda lime removes the CO2, and then the anesthesia machine delivers the exact same couple of breaths of sevofluarane over and over again.
Good traffic control practices prevent what?
cross contamination
What are the 3 surgical areas?
- unrestricted
- semi-restricted
- restricted
What does an unrestricted area mean?
unrestricted areas. street clothes
What are examples of unrestricted areas?
PACU, preop, lounge, waiting room
What does semi-restricted area mean?
have to have scrubs on and hair covered but don’t need to have mask up
What are examples of semi-restricted areas?
OR desk, peripheral corridors, sterile processing area, storage
What is restricted area?
somewhere that sterile supplies are opened
What do you have to have on in restricted area?
mask
Only what should be in restricted and semi-restricted areas?
necessary personnel
Supplies should be transported in what?
covered carts with solid bottoms to semi-restricted/restricted areas
Flow of sterile supply is what?
from clean clore through the OR to peripheral corridor!
What is the first rule of nursing with transmission-based precautions?
don’t get any on you
What is required with transmission-based precautions?
PPE and frequent hand washing
How should specimens be handled to prevent transmission?
- leakproof container
- biohazard bag
Don’t do what with needles to prevent transmission?
don’t recap needles
What actions should not be done in the Or?
eating, drinking, handling contacts, applying lip balm
What does the 2000 needle-stick safety and prevention act say?
this is a law that says that healthcare facilities have to have a plan to reduce exposure (sharps injuries) in their staff
In the first 14 years after the passing of 2000 needle-stick safety and prevention act, what was the percentage of decrease in injury in the nonsurgical setting
31.6% decrease
In the first 14 years after the passing of 2000 needle-stick safety and prevention act, what was the percentage of increase in injury in the surgical setting?
6.5% increaseW
What is the best thing you can do to prevent a needlestick injury?
eliminate the sharp (i.e. go to stapler and dermabond)
What is the most common injury with sharps injuries in the OR?
the assistant getting stuck with a suture
What is the 2nd most effective thing to prevent sharps injury?
engineering controls
What are engineering controls?
something that is manufacturered to reduce sharps injuries
What is an example of engineering controls?
blunt tip suture, angiocath with sheath, sheath blades
What is the 3rd most effective thing to reduce sharps
work practice
What are examples of work practice?
sharps education. Neutral zone
What is the 4th most effective thing to reduce sharp injuries?
administrative
What are administrative controls?
a policy with peer review
What is the 5th most effective thing for reducing sharps?
PPE
What is an example of PPE?
double gloving (first glove removes about 75% of the contaminate from the surface of the sharp, second glove removes 75% of the contaminate)
What is OSHA?
to protect workers of companies
What does OSHA require for sharps safety? (hint: it is now a law and then came up with it)
blood borne pathogens exposure control plan
What happens with the blood borne pathogens exposure control plan?
annual review
Describe the containers that we dispose sharps in:
puncture and leak resistant containers
where should be puncture and leak resistant containers be?
visible in proximity to point of use! Be recognizable
What should we do before decontam to protect personnel
remove sharps
What are 4 things perioperative RNs can do to serve as role models for other team members in sharps safety?
- follow regulations
- PPE
- timely reporting and treatment of injury
- Hep B immunization
Should you have a routine case that is an airborne precautions case?
no; unless emergent STAY OUT
Why is it bad for airborne precautions patients to come to the OR?
Because the OR is positive pressure, not negative
What is the PPE required for airborne precautions?
N95 mask that you get fit tested for
Where should a patient with airborne precautions be intubated?
in isolation room.
What is on the ETT that helps protect anyone from airborne patients?
bacterial filter on the ETT
If a patient shows up not intubated to the OR what do you need to do?
have a portable industrial grade HEPA filter within the patient’s breathing zone
What is a PAS-HEPA (antechamber)?
this is the tent that is outside the doors. It is a negative pressure temporary antechamber.
If you have airborne precautions patients, how many air exchanges do you have?
air exhanges as usual. 20 per hour, 4 with the outside air
How long should the room stand if you have an airborne precautions?
guidelines say 28 minutes after case. If you have the new air handler it is 15 minutes
Can you make the OR negative pressure?
NO
What is droplet?
bacteria that lives in spittal. It can be released during coughing, sneezing, and talking 3 feet away.
Do droplet disease remain suspended in the air?
NO
when do you need to start wearing PPE with droplet precautions patients?
within 3 feet of the patient
When do you need to wear your PPE with contact precautions?
If you are coming into contact with the patient, or with blood or body fluid YOU NEED TO WEAR YOUR PPE
During transport of any patient with precautions, what kind of isolation do you need to follow?
reverse isolation (i.e. the patient wears the mask)
True or false: you should have bare hands when transporting a precautions patient.
true
Adequate disinfectant and cleaning after infected case is what?
regular turnover cleaning (we are taking standard precatuions)
What are prions?
it is a protein that replicates itself; do not have DNA. SCARY
What is the most common prion disease?
CJD (creutzfeldt-Jakob Disease)
Where is CJD present in the body?
brain, spinal cord, CSF, cornea
Is CJD present in low concentration in other tissue?
yes
What kind of instruments should we use for prion cases?
disposable instruments - toss them
Why should we use disposable instruments for prion cases?
because our regular sterilization and cleaning parameters don’t work!
What is a fail safe for instruments that have been in contact with prions and sterilization?
they can be steam sterilized
prevac - 18 minutes
gravity displacement - 60 minutes
What products can be used to clean the area after a CJD case?
bleach (sodium hypochlorite) or lye (sodium hydroxide)
What is contact time for disinfectant in the OR after CJD case?
15 minute contact time
What is contact time for instruments after CJD case?
1 hour in bleach!
What 4 areas does terminal cleaning occur?
- includes restricted and semi-restricted areas in the OR
- preoperative patient areas
- postoperative patient areas
- sterile processing department
What is the temperature of unrestricted?
70-75 degrees
What is the temperature of semi-restricted?
less than or equal to 75 degrees
What is the temperature range for decontam?
60 to 73 degrees
What is the temperature range for restricted areas?
68 to 75 degrees
Everywhere in the surgical area what should the humidity range be?
20-60 percent
Anything below 20% humidity is considered what?
a fire hazard. Arching and sparking from the electrical
Anything above 60% humidity can cause what?
mold growth
What is the first thing we do during turnover cleaning?
remove contaminated instruments and garbage
What are we using to clean in a turnover clean?
cleaned with a hospital grade germicidal agent
What needs to be cleaned with a hospital grade germicidal agent?
- patient transport vehicles
- equipment
- OR furniture
What are 5 things to consider when mopping the floor during turnover?
- new or freshly laundered mop head
- new or ‘never double dipped’ water
- hospital grade germicidal agent
- move the OR table
- clean to dirty
Who is on the environment of care committe?
perioperative nurses, sterile processing, environmental services, and infection prevention personnel
What is environment of care?
multidisciplinary team responsible for the education and competency of people that are doing the cleaning.
2. make sure the policy and procedure of environmental cleaning are up to date
3. ongoing quality improvement project
Any item that touches the floor must be what?
disinfected before patient use
What are items that need to be disinfected before patient use?
leads, safety strap
If an item in the OR will not withstand disinfectant or is difficult to clean use what?
a barrier or cover (i.e. keyboard)
Insects and vermin that live in healthcare setting carry what?
pathogens with antibiotic resistance
What are 7 pathogens that stay in the environment longer, difficult to control, and increase morbidity and mortality?
- MRSA
- VRE
- Vancomycin resistant staph aureus
- C. diff
- Carbapanem resistant enterobacteriaceae
- klebsielle Pneumoniae
for enhanced environmental precautions we want to make sure?
we are cleaning with effective products
What is enhanced cleaning?
if you know the patient has an MDRO you are going to pay special attention to high touch high contamination areas.
What does enhanced cleaning involve?
cleaning high touch high contamination areas
ALWAYS CHOOSE ENHANCED CLEANING FOR PATIENTS WITH STRONG PATHOGENS
When is terminal clean done?
performed daily when the areas are being used
Terminal cleaning is completed where?
in all restricted and semi-restricted areas in the pre, intra and post op and sterile processing
Terminal cleaning should not occur in sterile processing when?
when personnel are actively decontaminating instruments
What do we use during terminal cleaning?
hospital-grade germicidal agent
What do we clean with terminal cleans?
- surgical lights and tracks
- fixed ceiling mounted equipment
- furniture and equipment
- handles of cabinets and push plates
- computer/work station
- anesthesia equipment
- ventilation faceplates
- horizontal surfaces
- sub-sterile areas
- hallways
- scrub and utility areas and scrub sinks
- wheels
- telephones
What is cycle cleaning?
according to an established schedule with policy. Follow manufacturer’s instruction for cleaning.
What are things that are cycle cleaned?
- clean and soiled storage
- sterile storage
- shelving pad and storage bins
- stairwells, corridors, elevators
- ceilings
- closets
- warming cabinets
- pneumatic tubes carriers
- aerators on faucets
- sinks and eye wash station
- sterilizers
- refrigerators
- ice machines
- walls
- offices
- lounges
- lavatories
- locker rooms
- privacy curtains
- ventilation ducts and filters
- linen chutes
Policies for cleaning must be in what kind of form?
written
Policies need to be reviewed when?
annually
Policies need to be readily what?
readily available to staff
