physical environment & safety standards

Concorde Career College, Department of Surgical Technology

1

Recognize and understand the designs of the OR suite

Determine the physical components of the OR Learn OR furniture and their names and functions Review the type of air-handling system required

in the OR Indicate cleaning procedures Distinguish among the support services that work

with the OR Recognize the hazards in the OR Analyze the role of the ST in the protection of self

patients and others from the hazards of the OR

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The location of the OR in the hospital is made to be easily accessible to and from surgical patient support departments

It is located and designed in an area where traffic is limited and the general public does not have access

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HOTEL – ORs are arranged along a central corridor

SPECIALTY – variation of the racetrack or hotel

RACETRACK – involves a series of ORs around a clean central core

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RESTRICTED Proper O.R. attire required Mask required

SEMI-RESTRICTED Proper O.R. attire required

UNRESTRICTED Street clothes allowed

Separated by walls, doors, and red lines

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Semirestricted areas

Restricted areas Scrub suit Hair cover Shoe covers

and/or mask may be required

Jewelry, cosmetics, artificial nails are restricted

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Semi-restricted

Unrestricted

Restricted

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Red Line = semi restricted and restricted

Green Line = Unrestricted

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ELCTRICAL OUTLETS – 110/220, must be 5’ above the floor. Explosion proof, red outlets are connected to the emergency generator

SUCTIONS OUTLETS – each OR must have at least 2 suction outlets; one for the surgical team, one for anesthesia

GAS OUTLETS (color coded) – oxygen – green; nitrogen –nitrogen – blackblack, nitrous oxide – blue, air- yellow, carbon dioxide – grey; outlets--- walls, ceiling, or mobile tanks; emergency shut off valve in exterior hall

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LIGHTS – regular overhead, OR spot lights VIEWING BOX – to view diagnostic images OPERATING TABLE – narrow, padded and

flexible, traditional beds are manual, modern is electrical, mobile; features: Break points or bendable – knee, waist, and

head Removable sections at the head and foot Height can be adjusted Wide base to prevent tipping Rails along side for attachments ▪ Other OR beds- cysto, fracture- radiolucent

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CLOCKS AND TIMERS – wall mounted, easily readable face, and a sweeping second hand; additional timer

COMMUNCATION SYSTEM – telephone; intercom system for intra-department (room to room; front desk) and inter-department use (pathology, radiology) some are foot operated

COMPUTER TERMINAL – for the circulator to fill out intra-op record, lab reports, order supplies for the room

OTHER – closed circuit TV

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MAYO STAND – usually spans across patient; holds immediate necessary instruments; two wheeled and can be used to set up gowns and gloves.

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KICKBUCKET – four wheeled stands very low to the floor; can be maneuvered by a foot; lined with biohazard bags; holds soiled counted

sponges; NOT FOR TRASH!

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RING STAND – four wheeled with one or two rings waist high; used to hold basins; basins hold case related sterile fluids

Used for skin prep, urinary catheterization, medical handling, etc.

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SUCTION SETS – low wheel based stands which hold suction canisters; sterile tubing form the surgical field will be hooked up to this by the circulator; the suction sets is hooked up to a wall suction outlet

Monitoring equipment

Supplies

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LINEN HAMPER – holds soiled linensTRASH CONTAINER – may be 2 per

room; one lined with a clear trash bag for clean trash and one lined with a biohazard bag for contaminated trash; some facilities are equipped with a metal detector to find instruments that may have been discarded accidentally

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SMOOTH, POUROUS FREEEASY TO CLEANNON REFLECTIVEPLEASANT IN COLOR WATERPROOFFIREPROOFNONGLARE

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DOORS RECESS INTO WALL (if poss.)

DOORS SHOULD BE KEPT CLOSED

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Provide clean airRemove air-borne contaminates that

are produced in the roomRemove waste anesthesia – besides

scavenger line Remove toxic fumes and vaporsComfortable working environment

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Produces positive pressureUnidirectional flow of air20 air exchanges per hourFiltered by High-efficiency

Particulate Air (HEPA) FiltersAt least 20% of the air change per

hour be fresh outside air

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An air exchanger system pulls air from the outside of the OR and pushes stale air from inside the OR out at frequent intervals thus becoming the air exchanger system.

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TEMPERATURE – should be kept between 65 and 75°F

RELATIVE HUMIDITY - should be kept between 20-60%

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SAME DAY or DAY SURGERY – patient arrives here, changes clothes, awaits surgery

LABORATORY – perioperative lab values

RADIOLOGY – x-ray films, fluroscopePATHOLOGY – processing specimensENVIRONMENTAL SERVICES-

cleaning 45

Within the surgical services department

Entrance to OR suite for patientsShould be shielded from noise and

views of the ORs IVs startedPreop interviews

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Patient is recovered from anesthesia and surgery

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Usually above or below surgical services, or adjacent

Decontamination of soiled instruments

Assembly of instrument sets Sterilization of instrumentation andDistribution of supplies

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ERGONOMICS

SLIPPERY FLOORS

STANDING STOOLS

CROWDED O.R.’S

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Physical Noise, ionizing radiation, electricity,

injury to body, fire, explosionBiologic

Laser/electrosurgical plume, pathogens, latex sensitivity, sharps injury

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Chemical Disinfecting agents, waste anesthetic

gas, vapors and fumes

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OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION- OSHA

AMERICAN SOCIETY FOR TESTING AND MATERIALS - ASTM

ASSOCIATION FOR THE ADVANCMENT OF MEDICAL INSTRUMENTATION – AAMI

NATIONAL FIRE PROTECTION AGENCY - NFPA

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SOURCES X-ray machines▪ Portable▪ Fluoroscope (C-ARM)

PROTECTION – Time, shielding, and distance ▪ Lead aprons▪ Lead gloves▪ Lead glasses▪ Thyroid shield▪ Radiation badge

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LASER Light Amplification by the Simulated

Emission of Radiation Laser plume

Found to contain DNA of HPVCO2 laser can cause corneal burns

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Nd: Yag laser can cause retina blindness

High filtration mask and appropriate goggles are worn to protect the OR team

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Fire Laser and Bovie burns

R.A.C.ER- rescue, A-alert, alarm, C-contain, E-

extinguish,evacuate

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Ignition

Fuel

Oxygen

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Ignition

ESU

Laser

Fiber-Optic Beam

Static Electricity

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Class A – water

Class B- dry chemical

Class C- halon

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Protect the patient

Contain the fire

Move anesthesia machine

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Electrical current

Electrical burns

Static electricity

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SOURCES Any body fluid or any item contaminated

with body fluids

PROTECTION PPE

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Universal precautions Applies to blood, certain fluids that contain

blood Standard states that blood and all body

fluids should be treated as potentially infectious

PERSONAL PROTECTIVE EQUIPMENT – PPE▪ Gloves▪ Masks▪ Eye protection

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SHARPS Suture, hypodermic needles, blades,

bovie tips, sharp instruments

CAUSES▪ Loading and passing suture, unsecured

sharps on field, recapping needles, catching falling items, poor sharp container management

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PREVENTION▪ Assume responsibility for you own safety▪ PPE▪ Never losing track of a sharp▪ Secure needles ▪ Leaving needles in package until use▪ Secured in a needle holder▪ Placed properly in needle board

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MANAGEMENT Postexposure prophylaxis –PEP

▪ Prophylaxis- prevention of a disease or condition

▪ Antibiosis- making the environment hostile to an organism

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Smoke from burning tissue

Precautions

▪ High volume smoke evacuator

▪ Laser face masks

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Patient and personnel allergies

Latex free cart Patients with Spina Bifida are high risk

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Polymethyl Methacrylate (PMMA) Bone Cement

Formalin: preservative for specimens in pathology

Glutaraldehyde (Cidex): liquid disinfectant and sterilizing agent

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