Transcript Recommendations

Ambient
Environmental
Hazards in the OR
Kay Ball, RN, MSA, CNOR, FAAN
Lewis Center, OH
[email protected]
Red Team – April 17, 2007
Objective
Discuss control measures
for inhalation hazards
in the OR.
Inhalation Hazards
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Transmissible diseases
Toxic fumes
Anesthesia gases
 Glutaraldehyde
 Surgical smoke

Spaulding’s Classifications
Critical
(Sterilize)
Semi-critical (Disinfect)
Non-critical (Clean)
Glutaraldehyde
Glut History
 Tanning
agent for leather
 Tissue fixative
 Preservative in cosmetics
 Therapeutic agent for warts &
other infections
 X-ray processing solution & film
emulsion
Glutaraldehyde Disinfection
Broad spectrum antimicrobial “cold” disinfectant
Glut action – bonds protein
Device preparation – thorough cleaning and rinsing
Efficacy monitoring
Soak time controversy
Controversy
FDA
45 min soak
25 degrees C.
Prof. Org
20 min soak
Room temp.
Glut Hazards
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Skin & mucous membrane hazards
Ingestion hazards
Respiratory hazards
Chronic exposure hazards
Exposure Levels
 0.04
ppm Detect odor
 0.2 ppm Exposure level
 0.3 ppm Irritant
 0.4 ppm Pouring
Ventilation
Vent
Glut
Processing Area
Spill Procedure
Ammonia
AAMI Document
“Safe use and handling of
glutaraldehyde-based products
in health care facilities”
Glut Advantages
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Effective for HLD
Highly compatible
Sterilization with long soak times
Low cost, convenient
Glut Limitations
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Unstable - Effective life 2-4 weeks
Thorough rinsing - mandatory
Skin, respiratory hazards
Glut bonds proteins
Options for alternatives: Other soaking
solutions (Cidex OPA) or sterilization methods
Cidex - OPA
ORTHO-PHTHALDEHYDE
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HDL in 10 min at 20 degrees C
Ortho-phthaldehyde (.55%) + insert
ingredents (99.45%)
No sterilant claims
Reuse 14 days (test strip)
Endorsed by many manufacturers
Stains skin, eye & resp irritant, causes
headaches
Sterilization Options
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Sterilize
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Steam
Ethylene Oxide
Peracetic Acid
Gas Plasma
Ozone
The Effects of
Miners – Air Problems
OR Team Serving as the Biological Indicator for Poor Air Quality
AORN RP
 Personnel
working with an ESU or
laser should avoid exposure to smoke
plume generated during tissue
cutting and coagulation.
Surgical smoke causes headaches, watery eyes,
respiratory problems in healthcare workers
NIOSH
 1988
 “Smoke
generated during laser
surgery presents a potential
health hazard.”
NIOSH
 1985
 “There’s
a potential hazard from
smoke generated by
electrosurgical knives.”
Research
Tomita et al, 1989
Laser: 1gm tissue
3 unfiltered cigarettes
ESU: 1gm tissue
6 unfiltered cigarettes
Laser and ESU smoke are very similar!
Hazards of Plume
Odor
Particulate
Matter Size
Viability
Endoscopy
concerns
Odor from Toxic Gases
*Polycyclic aromatic
hydrocarbons
*Benzene
*Toluene
*Formaldehyde
*Acrolein
ODOR
Toxic Fumes and Vapors
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Acrolein
Benzene
Formaldehyde
Possible carcinogens!!!!
Particulate Matter
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American College of Surgeons:
5 microns = bacterial colonization
Regular surgical mask:
5 micron filtration
Research - 77% of surgical smoke is 1.1
microns in size and smaller (Mihashi et al., 1975)
Particulate ends up in the alveoli of your
lungs
Research
Baggish et al, 1988
Rats breathed unfiltered & filtered plume
Unfiltered plume: Rats developed hypoxia,
pulmonary problems
Filtered plume: No changes
Viability Research
Garden et al, 1988
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Used CO2 laser on cow papillomavirus
Found intact viral DNA in plume
Injected viral DNA from plume into cow
Grew same viral lesion
Potential of transmission of viable
viral contaminants
Transmission of virus to Dr.
Hallmo et al, 1991
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44yo laser Dr developed laryngeal
papillomatosis
Lesions show same DNA type as
anogenital condyloma from patients
Endoscopy
Ott et al, 1993
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Laparoscopy & plume
Increase methemoglobin &
carboxyhemoglobin
(methemoglobin-O2 carrying
capacity of RBCs)
Delay in healing?
Recommendations
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AORN
All say to evacuate
ANSI
surgical smoke!
NIOSH
CDC
OSHA
Global recommendations
Solutions
Appropriate smoke
evacuation system
In-line Filter
For small amounts of plume use
in-line filter
Correct positioning needed
Wall
Suction
Patient
AORN Pilot Survey: Most popular method
Wall Suction
Corrodes pipes
 Contaminates building
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Flow may not be high enough
to capture surgical smoke
Wall suction 2 cfm
Evacuator 30-50 cfm
Smoke Evacuator
Needed when larger amounts of
smoke created
Critical Features
 Efficiency
 Filtering
capability
Charcoal filter – removes odor
 ULPA filter – removes small
particulate (.1 microns, 99.999%
efficiency)

 Suction
power
Filter Changing
Occupational Hazard NOT
Environmental Hazard
Follow manufacturer’s
recommendations when
changing
Solutions
Position smoke tube close to the
tissue impact site
Automatic
On/Off
System
Evacuation during endoscopy
Choices
Solutions
High Filtration Masks
0.1
micron
filtration
Not the first line of defense
Questions???
www.becomenasti.com
Nurses Advocating Smokefree
Theatres Immediately