SUR 110 THE OPERATING ROOM
MILIEU
Physical Environment• Sterile area in the OR room: This area is the area surrounding
anything that is sterile including the tables, equipment, and patient once those areas have been aseptically prepared
Anyone not sterile should keep a distance of more than 18 inches from sterile areas
The scrub tech will monitor this utilizing aseptic principles
• Sterile team members: Surgeon Assistants to the surgeon Scrub person
• Unsterile areas: Any area where there are not
sterile items in the periphery of the sterile field
Includes work area for the circulator and anesthesia areas
Unsterile team members must be aware of aseptic principles as well as the scrub person
• Unsterile team members: Circulator Anesthesia person Others such as X-ray technician,
EEG technician, or perfusionist
Who’s Who?Tell me the role of each person
Traffic Patterns• Unrestricted: Areas outside the operating room suite that lead to the individual operating
rooms Includes: locker rooms/rest rooms offices (director, anesthesia, surgeon’s dictation rooms) lounge areas Street clothes are permitted in these areas
• Semi-restricted: Includes immediate areas
surrounding the actual OR rooms such as the control
desk, center supply/sterile core, janitor
closets, storage closets, decontamination room, some offices, and the hallways surrounding the actual operating rooms
• Semi-restricted- Must have on the following to enter: Surgical hats Scrub suit/scrubs Shoe covers (varies with policy) Mask (varies with policy)
• Restricted: These are the individual operating
rooms where the surgeries actually take place
Also areas where the steam sterilizers or autoclaves are kept
• Restricted continued- Must have on the following to enter: surgical hat scrub suit/scrubs shoe covers mask eye protection
Environmental Safety• Regulatory agencies:• CDC (Centers for Disease Control)• NFPA (National Fire Protection Agency)• OSHA (Occupational Safety & Health Act)• NIOSH (National Institute for Occupational Safety & Health)• ASTM (American Society for Testing & Materials)
Environmental Safety Categories• Physical• Biological• Chemical
Environmental Safety Concerns• Patient and staff safety comes first• Safety training and prevention
education is paramount
Physical• Air Handler
System/Temperature/Humidity• Ergonomics• Fire Prevention/Safety• Electrical Safety• Radiation Safety• Protection of OR Team Member &
Patient
Air Handler• Positive laminar flow (air pressure is
greater in the OR room than in the hall)
• 20 air exchanges per hour• 20% of the 20 exchanges per hour
are fresh outside air• Removes toxic odors and vapors• HEPA filter removes microorganisms
0.5 to 5 micrometers
Temperature• 65 to 75 degrees
Fahrenheit (exception will be
neonatal/pediatric cases )
Humidity• No higher than 55% and no lower
than 50%
Ergonomics• Definition: The
science dealing with fitting a person’s job to that person’s physical and mental well-being that it promotes efficiency.
Body Mechanics• Good posture• Proper lifting• Proper movement
Posture• Stand up straight• Don’t slouch• Relax shoulders• Knees slightly bent• Feet shoulder width
apart• Change weight
distribution often• Stand close to working
area• Keep work at right
height
Posture continued• Sit up straight• Sit with buttocks
against back of chair
• Sit with feet flat on the floor or resting on a stool
• Can put a roll behind your lower back and chair
Lifting• If you can’t lift
something alone, get help
• Bend knees, keep object close to you
• Use legs for lifting, not your back
• Don’t bend over to lift• Never turn or twist
while lifting• Turn with feet after
lifting complete
Moving• Push, don’t pull• Use step ladders
for objects out of reach
• Do not stand on chairs, especially ones with wheels
• Use lift devices when available
Fire Prevention/Safety• Fire components: Fuel-any
combustible material
Heat-enough to raise fuel to ignition
Oxygen-sustains combustion
(Without all components, there is no fire)
Fire Classification• Class A-Occur with ordinary
combustibles• Class B-occur with flammable liquids• Class C-occur with electrical devices• Class D-occur with combustible
metals
Fire Prevention• Maintain equipment, report defects• Do not overload outlets• Keep work areas clean• Know where extinguishers are kept and
their type• Use cotton blankets• Cover patient’s hair• Report spills
In Event of a Fire• RACE acronym• R-Rescue anyone in immediate danger• A-Alarm closest to you should be activated• C-Contain fire and smoke • E-Extinguish using appropriate
extinguisher. OR extinguishers are generally of the ABC-Dry chemical variety and can be used on all types of fires.
• If you cannot extinguish, evacuate per policy of your institution
General Fire Rules• Remain calm• Do not use elevators• Close doors as you leave areas• Feel doors before opening them• Do not enter thick smoke• Cover self and patient with wet
towels• Stay with your group
Electrical Safety• Do not use electrical equipment
while touching water or metal• Do not use water on electrical fires• Maintain electrical equipment/report
defects• Keep electrical equipment clean, but
only clean when unplugged• Do not use extension cords
Electrical Safety Continued• Use red outlets in the OR/They are
connected to the generator should power fail
• Use only three pronged plugs• Cords should be rubber coated• Unplug equipment by pulling on the plug,
NOT the cord• Do not block outlets• Tape cords to floor to prevent tripping
Radiation Safety• Radiation exposure can result in body
cell mutations which can cause cancer and genetic defects in pregnant women
• Radiation in the OR occurs with exposure to intra-operative X-rays and fluoroscopy
3 Radiation Factors• Time - the less time you are exposed, the less radiation you absorb• Distance - stand at least 6 feet from the radiation source/leave the room if possible• Shielding - when radiation is used, wear a lead apron -add a thyroid shield for fluoroscopy - wear x-ray badge per policy on the outside of your lead apron for
accuracy
Dosimetry Badge• Should be worn on the outside of
your lead to gather accurate readings.
• Provides a permanent• record of your exposure.
Radiation safetyBest protection is lead shieldingLead glovesLead shieldLead apronLead Glasses ($$$)Lead thyroid shield
Biological Hazards• All body fluids should be treated as
infectious• Wear gloves at all times when dealing with
body fluids• Additional PPE may be needed • All facilities have standard isolation rules
that must be followed for your protection• Use facility policy for handling sharps• Report exposures immediately
Chemical Hazards• Chemical exposure ranges from skin and
mucous membrane irritation to genetic damage that can cause cancer and death
• Familiarize yourself with all chemicals used in your area
• All departments keep a book of MSDS (Materials Safety Data Sheets) that give detailed information about all chemicals in their departments
Most Common OR Chemicals• Methylmethacrylate
(MMA)-bone cement• Formalin-used to
preserve tissues/specimens that are sent to pathology for analysis
• Gluteraldehyde (Cidex)-used for disinfection and sterilization of heat sensitive items
• Ethylene Oxide (EtO)-used in gas sterilization on heat sensitive items
Summary• Physical environment• Traffic patterns• Environmental safety regulatory agencies ergonomics fire safety electrical safety radiation safety biological hazards chemical hazards