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Health Assessment Spring 2019 > OR safety > Flashcards

OR safety Flashcards

1
Q

What are some hot topics for a culture of safety?

A
  • Clear communication/ team building
  • Clinical events checklists for entire team (AI)
  • Timeouts
  • Retained guide wires
  • Wrong site surgery
  • Central line infections
  • Medication errors
  • Workspace contamination
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2
Q

What are some general safety issues?

A
  • Patient
  • Anesthesia providers
  • Surgical team
  • Perioperative workers
  • Pregnancy
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3
Q

What are some exposures in the OR? (11)

A
  • Anesthetic Gases
  • Infections
  • Chemical
  • Radiation
  • Magnetic fields
  • Lasers
  • Electricity
  • Fire
  • Noise
  • Light
  • Personal hazards
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4
Q

What are some considerations with exposure to Nitrous oxide?

A
  • Only anesthetic gas shown to be teratogenic
  • Nitrous oxide- inactivates vitamin B12 dependent enzyme methionine synthetase involved in DNA production, myelin sheath assembly, and methyl substitution in neurotransmitters
  • Leads to anemia, polyneuropathy
  • Increase infertility (difficulty with conception)
  • Increase rate of spontaneous abortions
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5
Q

What are some consideration with exposure with Halogenated agents?

A
  • Studies inconclusive
  • Reproductive
  • Infertility (difficulty with conception)
  • Spontaneous abortion higher incidence
  • Premature labor and/or delivery
  • Bone marrow depression
  • Numbness, tingling, and muscle weakness
  • Liver disease
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6
Q

What is the standard by the National Institute for Occupational Safety and Health (NIOSH), Occupational Safety and Health Administration (OSHA)?

A
  • Nitrous oxide less than 25 ppm
  • halogenated agents less than 2 ppm OR 0.5 ppm when combined with nitrous
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7
Q

How are anesthetic gases managed? (equipment, practice, ect)

A
  • scavenge
  • routine machine maintenance
  • airway management
  • vaporizer (filling)
  • adequate air exchange in OR
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8
Q

Whats included in needle safety?

A
  • One Needle, One Syringe, and Only One Time
  • Don’t recap
  • Needle-less systems
  • Dispose of properly
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9
Q

What are some considerations with HIV infections?

A

•Greatest risk is needlestick injuries, deep cutaneous injury with a large hollow needle

  • Can also occur with a small break in skin or splatter in mouth

•0.3%-0.4% seroconversion rate after single exposure needlestick

  • occurs within 6-12 weeks
  • retested 6-12 weeks and at 6 mos after exposure
  • postexposure antiretroviral prophylaxis regimens
    • started <24hours after exposure
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10
Q

What are some consideration with Hep B and Hep C infections?

A

Hepatitis B

•Hepatitis B is the most serious occupational health danger facing anesthesia providers

  • 20-49% providers have markers of previous exposure to Hep B
  • Risk of infection after HBV-contaminated percutaneous exposure is 37-62%
  • Vaccination
  • Virus remains active 1 week in dried blood

Hepatitis C

•Predominantly from transfusion

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11
Q

What are some other infections to consider? (3)

A
  • Herpes
  • Rhinovirus
  • Tuberculosis
  • Spread by airborne droplets
  • 10% chance of developing after exposure
  • DC has the highest incidence
  • Isolation, filters, protective equipment, fit-tested NIOSH-approved N95 or higher level respirator, annual skin tests
  • Treatment: Isoniazide, rifampicin
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12
Q

What are the policies/regulation regarding the CDC- Universal precaution, OSHA Guidelines, and 2002 Needlestick Safety and Prevention Act?

A

CDC - Universal precautions

  • gloves
  • eyewear
  • gowns
  • masks
  • handwashing
  • needles
  • isolation

OSHA – Guidelines to minimize occupational exposure to blood-borne pathogens (employer’s responsibilities)

2002 Needlestick Safety and Prevention Act

  • Do not recap
  • Needleless systems
  • Other exposure control plans (ie. puncture resistant containers)
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13
Q

Who are at risk for Latex exposure?

What are the symptoms?

What are the allergy association?

How do you manage exposure to Latex?

A

•People at risk:

  • Patients with frequent exposure (spina bifida, urologic patients)
  • Health care workers with frequent exposure
  • Symptoms- dermatitis, urticaria, rhinitis, conjunctivitis, asthma, laryngeal edema, anaphylactic shock
  • Associated with allergy to avocado, potato, banana, tomato, chestnuts, kiwi, papaya
  • Management- reduce undue exposure, hand washing after exposure, consider pretreatment
  • Latex free equipment
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14
Q

What are the risk, recommendations, and management for Methylmethacrylate?

A
  • Acrylic cement used for prostheses
  • Supplied as liquid and power components that are mixed and produce toxic vapors
  • Risks-
  • Patient- hypotension, bradycardia, cardiac arrest
    • ***effects can last up to 5 days
  • Health care providers- dyspnea, wheezing, coughing, rhinorrhea, hypertension, erythema, headache
  • Caution with pregnancy

•Recommendations (NIOSH)

  • Maximum 8-hour exposure to 100 ppm

•Management

  • Patient – hydration, vasoactive support
  • Health care providers- adequate ventilation, scavenge

•

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15
Q

What are some Chemical and Biological Weapons and treatments? (7)

A

Nerve Agents (Sarin gas)

  • Irreversible inhibition of acetyl & butyryl-cholinesterase
  • Hypersecretions, bradycardia, AV block, bronchospasm, seizures, resp. depression, paralysis
  • Treatment: Atropine and OXIMES

Vesicant agents (“mustard gas”)

  • “blistering agents”
  • Treatment: respiratory support, fluid therapy

Choking agents (chlorine/ phosgene)

  • Laryngospasm, pulmonary edema
  • Treatment: respiratory support, limit inflammation

Blood agents (cyanide)

  • Inhibits cytochrome oxidase enzymes
  • Hypoxia
  • Treatment: Sodium thiosulfate

Toxins (botulinum toxin)

  • Inhibits release of acetylcholine
  • Treatment: antiserums

Biologicals (anthrax)

  • Pulmonary edema, widened mediastinum
  • Antibiotics, vaccine

Ricin

  • Inhaled, injected, or ingested
  • Respiratory distress, chest tightness, pulm edema
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16
Q

What are the risks, policies/regulations, and management with Ionizing radiation?

A
  • Risks - rapidly replication cells
  • Greatest risk for us from fluoroscopy
  • Policies/regulations
  • Max. yearly exposure < 5 rem (during pregancy <500 mrem)

•Management

  • Distance- minimum of 3 feet (6 ft air = 9 inches concrete = 2.5 mm lead)
  • Protection (aprons, lead shields, walls)
  • Exposure: eyes, reproductive organs, thyroid
17
Q

What are are the considerations and risks with Magnetic Fields (MRI)?

A
  • MR imaging does not require ionizing radiation, but high radiofrequency power
  • Risk- magnetic fields may be changed to electric fields (by connection of two circuit elements by a wire or resistor)
  • Dangerous with pacemakers or implanted stimulators, vascular clips, or any other ferromagnetic metal
  • Noise
  • Small space
  • NO METAL ALLOWED!!!!!
  • Unknown effects on pregnancy
18
Q

What does LASERS stand for?

What do they emit?

What are the risk and protection needed for using Lasers?

A

•Light Amplification by Stimulated Emission of Radiation

  • CO2
  • Nd:YAG
  • argon

•Eye injury – cornea, retinal burns, destruction of macula, caracts

  • protective eye wear

•Vapors and debris – infections (HVP- human papilloma virus, HIV)

  • plume evacuator system, high filtration masks
19
Q

What’s part of a fire triad?

What are some precautions to take to prevent fires?

A

•Fire triad

  • Oxygen/nitrous, fuel, ignition source
  • Use lowest concentration of oxygen possible, avoid nitrous oxide, avoid paper drapes, beware of oil-based lubricants and alcohol based preps, use special ETT and fluid in cuff
  • Beware of tenting, too much sedation
  • Know location of nearest fire extinguisher, oxygen shut-off valves
  • Fire drills:
  • ERASE: extinguish, rescue, activate, shut (doors), and evaluate
20
Q

What do you do if theres an OR fire?

What do you do if theres an airway fire?

A

If fire:

  • remove drapes and burning material
  • douse flames with normal saline
  • assess for smoke inhalation

If airway fire:

  • remove ETT
  • turn off all gases
  • extinguish fire/ pour saline into airway
  • remove burning materials
  • mask ventilate, assess injury, replace ETT, bronchoscopy
21
Q

OR Fire Algorithm

A
22
Q

What are the considerations and risk with Electricity?

A

•From: equipment (surgical, anesthesia), monitors, bed

  • *defibrillation, electroconvulsive therapy

•Risk of Shock – electric shock occurs when current flows through the body due to contact with 2 conductors @ different voltages

  • even small amounts of electrical current can disrupt muscle and nerve function (macroshock, microshock)
  • Other risks- burns, explosions, arrhythmias, pacemaker disruption, FIRE!
23
Q

Whats Macroshock?

A
  • Large voltage of electricity flowing through a person from skin contact
  • Response depends on amplitude and frequency of current.
  • 1 mA = perception threshold
  • 5 mA = maximal harmless current intensity
  • 10-20 mA = “let-go” threshold, then sustained muscle contraction
  • 50 mA = pain & mechanical injury
  • 100-300 mA = ventricular fibrillation
  • >6000 = sustained myocardial contraction, temporary respiratory paralysis, burns
24
Q

Whats Microshock?

A

•Direct application of very small amounts of electric current in a patient who has an external conduit that is in direct contact with heart

  • cardiac pacing wires
  • invasive monitoring catheters
  • Equipment maximum leakage allowed = 10 uA
  • A current as low as 50-100 uA can be fatal (ventricular fibrillation)
  • An intact equipment ground wire is the most important factor in preventing microshock; LIM cannot protect against microshock
25
Q

Explain grounding of electrical current and isolated/ungrounded electrical current.

A

Grounded electrical current

  • One of the 2 wires is connected to earth ground
  • provides low-resistance pathway for currents to ground
  • dissipates leakage current

Isolated or ungrounded electrical current

  • the current is isolated from ground potential
  • Requires use LIM
26
Q

Explain Line Isolation Monitor

A
  • Device that continuously monitors the integrity of an isolated power system and helps reduce the risk of shock in the OR
  • LIM alarms at 2-5 mA or an impedance of <60,000 ohms
  • Device will change system to a conventional grounded system if a faulty piece of equipment is connected to the isolated power system
  • If alarms, check gauge:
  • If between 2-5 – too many pieces of electrical equipment plugged in
  • If >5 – faulty piece of equipment, unplug
27
Q

What is Electrocautery?

Explain Unipolar vs. Bipolar.

A

•Cutting or coagulation combining high resistance with high current

Unipolar- most common

  • Current applied via cutting/coagulation electrode (generates heat in a very small area).
  • Second electrode = ground pad outside surgical field.
  • Proper application of return plate very important
  • Appropriate amount of gel
  • Intact return wire
  • Place close to operative site
  • Caution with flammable preps
  • If pacemaker, place below thorax and prepare for treating dysrhythmias, including magnet, defibrillator, external pacemaker
  • Can have reprogramming and microshock

Bipolar

  • Two pencil-point electrodes applied to site and current flows between them.
  • Generates less power than unipolar
  • Recommended for patients with pacemakers.
    • But, pacemaker still at risk of program disruption
28
Q

What are some consideration with Noises?

A
  • MRI, ESWL, drills, monitors, surgical equipment, alarms, music
  • Hazardous noise when >90 decibels (dB) for 8 hours/day
  • Interferes with work performance, vigilance, fatigue, irritability, hormonal stress response
29
Q

What are some consideration with lighting?

A
  • Surgical lights
  • Laparoscopic equipment
  • Dark
30
Q

What are some personal hazard of our profession?

A
  • Physical - injury, temperature, sleep deprivation/fatigue, illness, aging
  • Psychological- substance abuse, stress, interpersonal, economic, distractions
  • Policies/regulations- AANA, COA, departmental
31
Q

What are the types of Medication errors?

A

Types of Errors:

  • Omission — drug not given
  • Repetition — extra dose of an intended drug
  • Substitution — incorrect drug instead of the desired drug; a swap
  • Insertion — a drug that was not intended to be given at a particular time or at any time
  • Incorrect dose — wrong dose of an intended drug
  • Incorrect route — wrong route of an intended drug
  • Other — usually a more complex event not fitting the categories above
32
Q

When and if an error occurs?

A
  • Reporting
  • Systems approach to analysis
  • CQI/QA
  • Disclosure- What do we tell the patient??
  • Legal Ramifications
33
Q

What is part of provider wellness?

A
  • Professional self-care is influenced by the ability of practitioners to manage their lifestyles and happiness through personal choices and behaviors.
  • CRNAs and students have the responsibility, accountability, and competence to make positive choices and improve their physical, mental and spiritual well-being.
34
Q

What makes an impaired provider?

A
  • Abuse- use of a psychoactive substance in a manner detrimental to the individual or society
  • Addiction- a primary, chronic DISEASE
  • Characterized by:
  • Impaired control over drug use
  • Compulsion or craving
  • Continued use in spite of adverse consequences
35
Q

What is the scope of the problem of an impaired provider?

A
  • Incidence @ 10%
  • Opioids drug of choice
  • Fentanyl
  • Alcohol
  • Cocaine
  • Propofol
  • Inhalational agents, esp Sevo
36
Q

What are some patterns of behavior and consequences associated with substance misuse and dependency?

A
  • Comes to work during scheduled time off and loiters around departmental drug supply
  • Isolates and withdraws from peers
  • Takes frequent bathroom breaks or disappears while on duty
  • Expresses desire to take extra call
  • Increasing or unexplained tardiness or absenteeism
  • Gradual decline in work performance
  • Consistently signs out more narcotics than peers
  • Displays patterns of inappropriate drug choices and dosages
  • Increasing mood liability with frequent, unexplained anger and overreaction to criticism
  • Increasing difficulty with authority
  • Becomes forgetful, unpredictable, confused, and lacks concentration
  • Suffers from frequent illnesses or physical complaints
  • Exhibits dishonesty, often over trivial or unimportant matters
  • Makes elaborate excuses
  • Suffers from tremors or “Monday morning shakes”
  • Reveals evidence of alcohol or drug use, such as odor of alcohol on breath, heavy perfume or mouthwash, wearing long sleeves
  • Appears intoxicated at social functions
  • Is discovered comatose or dead

Health Assessment Spring 2019 (8 decks)

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