Physical Environment and Safety Standards Objectives Identify and describe hazards to the patient in the operative environment. Identify support services that work with the OR team in the care of the patient. Understand the type of air-handling system required in the OR and the temperature and humidity required to maintain a sterile field. Objectives Identify cleaning procedures, traffic patterns, and routines required in the operative environment. Identify the role of the STSR in the protection of self, patients, and others from hazards. Identify the design types of the OR. Objectives Identify hospital departments that relate to surgical services. Understand the working environment of the OR. Identify the physical components of the OR. Hospital design usually allows for easy accessibility to the surgery department from other support departments. ICU L & D SPD ER Physical Design ICU SPD Key factor to location is limited traffic patterns and limited access. May be located on underground level. Design must include separating clean and dirty areas as well as controlling traffic patterns to prevent Surgical Site Infections (SSIs) Physical Design OR Designs Race Track Series of ORs arranged around a clean center core. Hotel Plan ORs situated along a central corridor with separate clean and dirty areas. Specialty Grouping Variation where ORs are grouped by specialty, with its own work area. OR Designs Each design plan is equipped with a sterile supply room located in the restricted area. Convenient storage of sponges, gloves, sterile packs, and instruments used on a daily basis. Proper storage includes floor and ceiling boundaries as well as environmental control. Areas of the O.R. Unrestricted areas Street clothes allowed. Semi-restricted areas Scrub suits, haircovers, and shoe covers. Restricted areas Sterile supplies are open. Masks required. Areas of the O.R. Instrument Room Storage of clean/nonsterile instruments and supplies. Reassembly area for instrument sets. Utility/Decontamination Room Dirty room for the cleaning and decontamination of instruments. Contains sinks, ultrasonics, and washer- sterilizers. Areas of the O.R. Physical Components of the O.R. Traditional standard size of operating rooms were ft 2. With increase of technology comes the need for more equipment, and the operating rooms of new are increasing size to accommodate. Equipment Each O.R. is equipped with standard equipment and supplies. Specialty rooms have extra equipment as needed. Equipment Electrical outlets Suction outlets Gas outlets Lights View box for images Wall mounted clock Intercom/phone Computer terminals Equipment Operating Table Narrow, padded, and flexible table with manual or electric controls. Moveable sections allow the patient to be placed in a variety of positions Connective rails allow the attaching of positioning gear. Surface must be able to be cleaned easily. Operating Table Standard O.R. Furniture Mayo stand Back table Ring stand Kick buckets Linen/Trash containers Suction Anesthesia equipment Standard O.R. Furniture O.R. Surfaces Walls Nonporous, easy to clean Nonglare, nonreflective, pleasant color Water and fire proof Floors Nonporous and waterproof Avoid tiled floors Cabinets and Doors Nonporous, waterproof and easy to clean. Swinging doors and recessed cabinets are preferred. Limit traffic in and out of the operating room to reduce possibility of contaminating the sterile field. Environmental Controls Ventilation Positive pressure system 20 air exchanges per hour HEPA filters Temperature and humidity 65 o -75 o F 50%-55% Supportive Areas of the O.R. Substerile Preoperative or Same-Day Check-in Preoperative Holding Area Post Anesthesia Care Unit PACU Laboratory Department Radiology Department Pathology Department Environmental Services Central Sterile Supply and Processing SPD Supportive Areas of the O.R. Any Questions? O.R. Hazards and Safety Standards Hazards Potential safety hazards can be placed in the following categories: Physical hazards Noise, radiation, electricity, fire, bodily injuries. Biological hazards Body fluids, plumes, latex allergies, sharps Chemical hazards Disinfectants, vapors and fumes, anesthetic gases. Hazards For a safe environment for the patient and the surgical team: Proper handling and operation of equipment. Proper training and education about safety measures. Knowledge of potential hazards and safety methods. Key Safety Agencies National Fire Protection Agency (NFPA) Fire prevention standards and education. Occupational Safety and Health Administration (OSHA) Safety standards in the workplace. National Institute for Occupational Safety and Health (NIOSH) Establishes PELs (Permissible Exposure Limits) Key Safety Agencies American National Standards Institute (ANSI) Laser safety American Society for Testing and Materials (ASTM) Medical equipment testing/standards. Association for the Advancement of Medical Instrumentation (AAMI) Sterilization, electrical, medical device safety. Safety Considerations Air-handling system Positive pressure, HEPA filters, temp and humidity. Surgical lights Nonglare to prevent eye fatigue. O.R. noise Distracting and beneficial. Ergonomics Proper posture and body mechanics can prevent lower back, knee, and feet injuries. Factors that Increase Back Injuries Lifting, bending, or reaching with the back bowed out. Jerking or twisting at the hips Obesity Loss of strength and flexibility Poor nutrition Proper Body Mechanics When Standing Legs shoulder width apart Avoid weight bearing on one foot for long periods Stand erect with arms and shoulders relaxed. When sitting for surgery, sit up straight. Push, dont pull gurneys or heavy equipment. Patient Lifting Squat, do not bend at the waist. Lift with the leg muscles. Keep the weight close to your body. Turn entire body with weight, do not twist. Bow in the lower back when lifting. Feet shoulder width apart. Fire Hazards Fire danger has been reduced by the replacement of flammable anesthetic agents with halogenated agents. Potential sources of combustion, along with the presence of oxygen and flammable gas or liquids pose a significant risk of fire. Sources of Ignition Lasers ESU Fiber optic light source Static electricity Electrical equipment Fire Safety The STSR should be familiar with fire procedures, alarms, extinguishers, and evacuation routes. Three main concerns: Protect the patient Contain the fire Move anesthesia equipment away Fire Safety Classes of fire/extinguishers: Class A Water Class B Dry chemical Class C - Halon Electrical Hazards Electrical Current Electrical Burns Static Electricity Ionizing Radiation Protection of the patient Protection of the surgical team Biological Hazards Universal Precautions/Standard Precautions Causes of injury Strategies for prevention Neutral zone Sharps techniques Waste disposal Biological Hazards Laser and ESU Plume Latex Allergy Chemical Hazards Waste Anesthetic Gases Methyl Methacrylate Formalin Ethylene Oxide Glutaraldehyde Any Questions?