Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Operation room hazards AND PATIENT SAFETY

9,018 views

Published on

OR HAZARD, OR RISKS, ANESTHESIA HAZARD, ANESTHESIA RISKS, OPERATION ROOM HAZARDS, OPERATION ROOM RISKS,

Published in: Health & Medicine
  • Be the first to comment

Operation room hazards AND PATIENT SAFETY

  1. 1. OPERATIONROOMHAZARDS BY ABAYNEH BELIHUN AKSUM UNIVERSITY DEPARTMENT OF ANESTHESIOLOGY
  2. 2. Definition • Hazard: a situation that poses a level of threat to life, health, property, or environment. • A hazard does not exist when it is not happening. • Anesthesia and surgery are conducted in technologically intense envt……potentially hazardous.
  3. 3. The most common hazards in OR • Fires and Explosion • Static Electricity • Electrical Hazards • Radiation Injury • Air Pollution and • Power Failure
  4. 4. Fires explosions • Both of these can cause death or injury to the patient. • Only occur if we have 3 things: – spark or a hot surface, – flammable substance and – source of oxygen
  5. 5. Sources of sparks or heat – Static electricity – Faulty electrical switches and apparatus, e.g. saws, plaster cutters and drills – Foreign matter, e.g. dirt or grease in the oxygen or nitrous oxide cylinders – Diathermy – Open flames. • Flammable substances: Includes ether, ethyl chloride and solution in sprits. The addition of oxygen increased flammability.
  6. 6. Static electricity 1 • Electricity present in the atm. • Occurs if two materials which conduct electricity poorly are brought into contact and then separated. • If there is friction or movement between the two, a spark is produced and a spark, of course, can produce an explosion.
  7. 7. Static electricity 2 • EX. Woolen fabrics, non-conducting rubber, and synthetic materials such as nylon. • Should be avoided in the OR, using graphite impregnated yellow coded rubber instead.
  8. 8. OTHER PRECAUTIONS TO REDUCE STATIC ELECTRICITY 1 • Conductor floor (Concrete or conductive rubber or plastic, placed on floors) • Avoid wool, plastic and nylon fabrics and wear cotton or other anti-static outer clothes instead. • Wear aprons of conductive rubber. • Wear anti-static boots or conductive canvas overshoes. • Maintain humidity of 60%. Static sparks are more frequent when the air is dry.
  9. 9. OTHER PRECAUTIONS TO REDUCE STATIC ELECTRICITY 2 • Ventilation- Anesthetic gases are heavier than air and tend to collect at ground level. • Regular inspection of electric switch & apparatus • Firefighting equipment should always be available • Smoking and open flames must be forbidden
  10. 10. Electrical hazards 1 • They may occur when patients are: – In contact with faulty electrically-operated medical equipment – Accidentally connected to electric circuits by spillage of blood or saline – Dependent on electrical equipment to replace or support vital organ functions – Exposed to fire or explosions – Undergoing treatment when safe levels of electrical energy are exceeded.
  11. 11. Electrical hazards 2 Electric shock: • When the body actually becomes part of an electrical circuit with significant current • Wiring defects, faulty equipment components and deteriorated insulation • Lack of maintenance and misuse are the usual causes.
  12. 12. Electrical hazards 3 Macroshock • Most common • occurs when the body conducts an electric current which does not pass directly through the heart. • Mild sensory stimulation@5 to 10 mA • @50 to 60mA- muscular contraction • @100mA- breathing becomes extremely difficult. • Somewhere above this level respiratory paralysis, cardiac arrest and severe burning occur.
  13. 13. Electrical hazards 4 Microshock • When very tiny currents, such as 100µA, are intentionally passed directly thru heart muscle – e.g. direct cardiac catheterization, CO measmt
  14. 14. Electrical hazards 5 • High frequency currents above 50 hertz are less likely to produce electric shock but can cause burns and interference with other devices such as pacemakers. • DC is less likely to cause VF than high frequency AC (above 50Hz) but can cause muscle contraction. • Nerve damage often occurs with high currents. • The SC may be involved by large currents passing from head to foot or from arm to arm.
  15. 15. Electrical burns and electrically initiated burns • Three types – Carbonization of skin (from burns at very high temperatures of 1,000°C) – Flame burns – Direct heating of tissues produce coagulation and necrosis at entry and exit points and associated injury in muscle and BV.
  16. 16. Electrosurgical units • Diathermy are arranged so that current from the active electrode flows through the patient and back to the generator • Don’t use electric blankets in conjunction with electro-surgery.
  17. 17. Air pollution 1 • RISKS – Spontaneous miscarriage, – Congenital abnormalities and – Liver disorders. • Waste anesthetic gases escape from: – Faulty valves – The ventilator – Poorly fitted components in the breathing circuit – Spilt anesthetic drugs – Expired gases from the spill valve of the anesthetic breathing system – Gases exhaled by the patient
  18. 18. Remedies • This pollution can be reduced by – Regular thorough inspection of all anesthetic equipment – Limit or avoid the use of inhalational gases and agents e.g., circle system, TIVA and RA – An efficient scavenging system. – Closed circuits – Anti spill devices
  19. 19. POWER FAILURE!!!
  20. 20. Power failure • Critical areas employing electrically driven equipment such as respirators (Ventilators) and dialysis machines require standby equipment (i.e. generators).
  21. 21. ANESTHESIA RELATED HAZARDS/ RISKS
  22. 22. RISK • Risk is the potential that a chosen action will lead to a loss or an undesirable outcome. • Risk is a ubiquitous, natural part of life, because everything we do, including doing nothing, poses uncertain outcome. • Occasionally the term refer to the outcome itself (e.g., death as one risk of anesthesia).
  23. 23. Anesthesia risk and accidents • Accident is an unplanned, unexpected, and undesired event • Because there are no standard methods for assigning causality yet, no accurate estimates of the rate of adverse out-come • Errors related to AW mgt, monitoring, and sudden cardiac arrest during SA, equipment failures, or nerve injuries.
  24. 24. Adverse respiratory events • The most serious hazards in anesthesia. • Causes of death and brain damage are inadequate ventilation, esophageal intubation, and difficult ETI. • Cases in the first 2 causes were judged to have been preventable if better monitoring had been employed. • Anticipated difficult ETI- refer to better institution or surgical AW should be performed before anesthesia.
  25. 25. Failure to monitoring • An important contributor to anesthesia adverse events. • There are numerous ways in which pulse oximetry, capnometry, and automated blood pressure monitors can give false information, leading to missed or incorrect diagnoses.
  26. 26. Medication errors • The most frequent error in anesthesia, and in healthcare practice in general. • Similarity of drug names, containers, and label colors
  27. 27. Medication errors • Dosing errors related to the frequent need for individual • Error in numerical calculations when drawing and mixing drugs for bolus administration or IV infusion. • Wrong drug (e.g., among various insulin formulations) • Flushing a catheter with a solution containing another potent drug, • Confusion in the programming of infusion pumps
  28. 28. Recommendation • Read the label carefully 3 times!
  29. 29. Errors in diagnosis • Especially during the management of critical events.
  30. 30. Equipment errors and failures • Current anesthesia machines and associated technology incorporate substantial safety features. • Frequent and can occur in many ways, but rarely causes injury directly. • Equipment associated injury; it is more likely to be from misuse than from overt failure of a device.
  31. 31. lack of standard practice and unusual situations • Accidental dislodgement of ETT during transportation • Undiluted phenytoin by rapid IV infusion - refractory HN, arrhythmias, and death. • Undiluted K+ by rapid IV infusion - VF and cardiac arrest. • Neostigmine given without an antimuscarinic cause asystole/severe bradycardia and AV block, and can be fatal.
  32. 32. lack of standard practice and unusual situations • Inadvertent IV injection of LA- neurologic and cardiac toxicity, which can be fatal (especially with bupivacaine). • Air embolism during the placement or removal of central venous catheter • Limb necrosis if the tourniquet is left on the patient for a prolonged period
  33. 33. Summary of Risk Management RISK IS UBIQUITOUS RISK ASSESSMENT Stratification, prioritization and intervention
  34. 34. WHAT IF YOU FAIL TO DO ALL THIS?
  35. 35. Enhancing patient safety 11/23/2015 OR Hazard and strategies to enhence PS 35 • Avoidance, prevention, and amelioration of adverse outcomes or injuries • Quality of care: Extent to which health services for individuals and populations increase likelihood of desired health outcomes and are consistent with current professional knowledge.
  36. 36. ………… • Patient safety is focused on prevention of injury. • Quality assurance generally deals with the broader spectrum of quality, including the success of treatments. • Risk management is focused on proactive patient safety, based on the principle that prevention of injuries via error reduction and system improvements
  37. 37. Practical elements 1 • Avoidance of unnecessary risk taking • Almost unending anticipation of what might go wrong, • Projection of actions in anticipation of failure and, above all, mindfulness • Being patient centered……..PATIENT IS ABOVE OUR EGO!
  38. 38. Practical elements 2 Maintaining vigilance: • The anesthesia provider must maintain alertness and be aware of, compensate for, and counteract the forces working against vigilance. • Fatigue and sleep deprivation are probably the most common causes of lapses in vigilance.
  39. 39. Practical elements 3 • Practice in a system of care • Teamwork • Preparation • Monitoring • Control for human factors: organized arrangement of supplies and drugs, esp labeling, and establishing and adhering to local standards.
  40. 40. Practical elements 4 • Care to keep IV cannula and monitoring cables orderly, lighting, and reducing clutter, noise, and distractions • Infection Control • Antibiotic administration in the perioperative interval reduces postoperative wound infection. • Surgical wound infection rates are increased 3-fold by hypothermia.
  41. 41. Anesthesia crisis management 11/23/2015 OR Hazard and strategies to enhence PS 41 • Seek assistance early and quickly inform others • Establish clarity of roles for each person involved in mgt. of event (event manager) • Use effective communication processes • Use resources effectively and identify what additional resource (people, supplies, equipment, transportation) are available to manage situation.
  42. 42. 11/23/2015 OR Hazard and strategies to enhence PS 42 CRISS MANAGEMENT DURING ANESTHESIA C1 Circulation Adequacy of peripheral circulation (rate, rhythm, and character of pulse). If pulse is absent (CPR) C2 Color Note saturation. Examine for evidence of central cyanosis,Pulseoximetry O1 Oxygen Check rotameter settings; ensure inspired mixture is not hypoxic. O2 Oxygen analyzer Adjust inspired oxygen concentration to 100% Check that oxygen analyzer shows a rising oxygen concentration distal to common gas outlet. V1 Ventilation Ventilate lungs by hand to assess breathing circuit integrity, airway patency, chest compliance, and air entry by “feel,” careful observation, and auscultation. Also inspect capnograph’s trace if available V2 Vaporizer Check all vaporizer filler ports, seating’s, and connections for liquid or gas leaks during pressurization of the system. Consider possibility of wrong agent being in vaporizer.
  43. 43. 43 CRISIS MANAGEMENT DURING ANESTHESIA (CONT…) E1 ETT check ET tube (if in use) Ensure no leaks or kinks or obstructions. Check capnograp, oximeter for possible endobronchial position E2 Elimination Eliminate anesthetic machine and ventilate with self-inflating (e.g., Ambu) bag with 100% R1 Review monitor Oxygen analyzer, capnograph, oximeter, blood pressure, ECG, temperature and NMJ monitor) R2 Review all other equipt Review all other equipment in contact with or relevant to patient (e.g., diathermy, humidifiers, heating blankets, endoscopes, probes, prostheses, retractors…
  44. 44. 44 CRISIS MANAGEMENT DURING ANESTHESIA (CONT…) A Air way Check patency of non-intubated airway. Consider laryngospasm, FB, blood, gastric contents, or nasopharyngeal or bronchial secretions B Breathing Assess pattern, adequacy, and distribution of ventilation. Consider, examine, and auscultate for bronchospasm, pulmonary edema, lobar collapse, and pneumo- or hemothorax C Circulatio n Repeat evaluation of peripheral perfusion, pulse, BP, ECG, and filling pressures and any possible obstruction to venous return, raised intra thoracic pressure (e.g., inadvertent PEEP) D Drugs Review intended (unintended) drug or substance administered Consider whether problem may be a consequence of an unexpected effect, a failure of administration, or wrong dose, route, or manner of administration of drug
  45. 45. HAZARDS FOR ANASTHETISTS • Fire & explosions • Electrical accidents • Pollutions by anesthetic agents • Radiations • Infections • Incompatibilities / allergies • Stress • Chemical dependence OR
  46. 46. Infections • Physical spread-HSV,CMV • Blood borne-HIV,HBV,HCV • Air borne-Mtb
  47. 47. Infections • Blood borne diseases thro’ Needle stick injuries- HIV:0.3%, HBV:3%, HCV30% • 32% had at least 1 NSI in the preceding 12M.(only half of them took treatment). • More risk with hollow-core & large bore • NSI more in non dominated hands • NSI more during disposal of contaminated needles. • Anesthesiologists have risk for occupational infection during 30years of exposure-0.045-4.5%
  48. 48. Infections-HIV • Health care workers contribute 5% of total cases • 4% of emergency department pts are unidentified cases. • Pts considered infective if both screening (ELISA) & confirmatory (western blot, indirect fluorescent ab) tests are positive.
  49. 49. Infections-HIV • 54 reported cases of occupationally acquired HIV(1998). • 88% of them had H/O NSI • ? Quantity of inoculums- ( a case report :100-200µml of blood thro” i.v. produced HIV). • Risk for the pts- 6 cases reported.
  50. 50. Infections-HBV • Non immunized HCW- higher risks • 17.8% 0f seropositive among anesthesiologist • 30% became positive after 11 years of exposure • Disinfectants & gloves are not completely protective- viruses viable for >14 days in needles, gloves, & surfaces.
  51. 51. Infections-HCV • No immunization available • No specific treatment available • Advice: serologic monitoring for HCV & LFT 3- 6 monthly.
  52. 52. Infections Management of occupational infections. SAFE PRACTICE 1. Protective equipments 2. Washing methods 3. Disposal methods
  53. 53. Infections - CDC recommendations Universal precautions-1980 -considering as all pts, blood & body fluids are infective. Isolation precautions-1996 -2 tier recommendations 1. Standard precautions -to be followed for handling all pts as infective. 2. Transmission based precautions -for handling pts known to be / suspected of being risks.
  54. 54. Infections -CDC recommendations Transmission based precautions • Based on properties of specific pathogens • Airborne precautions [measles, varicella, Tb] -to prevent from small particles<5µm by specific filters air handling devices.- HEPA, Negative pressure environment • Droplet precautions [HBV, mycoplasma, streptococcal pharyngitis, rubella]-to prevent from large particles>5µm, keep distance>1m • Contact precautions [HAV, HSV, viral conjunctivitis]
  55. 55. Incompatibilities / Allergies Latex allergy • Type IV/ type I • Risk groups : 1. Spina bifida, 2. Urogenital abnormalities , 3. HCW, 4. Rubber factory workers.
  56. 56. Latex allergy Managements 1. Identification of risk groups 2. Use latex free objects-latex free environment 3. Tests: RAST[radio-allergo-sorbent test] SPT Sr.histamine Urinary histamine Sr.IgE Sr.compliments Sr.tryptase Tests for anaphylaxis Screening tests
  57. 57. Latex allergy Managements-drug regimens • Preoperative protocol: 1. Dipenhydramine -1mg/kg,po/iv,q 6hr at 13,7,1hr before surgery 2. Prednisolone -1mg/kg,po/iv,q 6hr at 13,7,1hr before surgery or hydro cortisone 4g/kg 3. Ranitidine - 2mg/kg po, 1mg/kg iv,q 12hr at 13,1hr before surgery • Postop protocol -drugs to be repeated for 12hrs
  58. 58. Stress • Inevitable, universal phenomenon to which no one is immune • Job related stress are unavoidable but may be controlled • 2 types-Unavoidable & Avoidable • Unavoidable-professional stress • Avoidable-sleep related
  59. 59. Stress Unavoidable Stress • Professional Stress • Co-worker relationships • Work load • Litigations • Peer review • Professional dissatisfaction • Administrative responsibilities
  60. 60. Stress Avoidable Stress • Sleep related-altered sleep pattern, sleep deprivation • Coincide with natural sleep peaks • Identification of sleep disturbances • Regulations of working hours
  61. 61. Chemical dependence Self administration of drugs & suicide rates are high among anesthesiologist. • Addiction :compulsive, continued use of drugs inspite of adverse, a chronic, relapsing condition resulting from long term effects of drugs on brain, due to molecular, structural, cellular, & functional changes. • Dependence: physical / psychological inability to control drug use • Abuse :use of drugs in detrimental way but not to the point of addiction. a pre addiction level, can easily quit. a voluntary act.
  62. 62. Chemical dependence Causes • Stress • Availabilities • Curiosity for experimentation • Drug potency • Others-genetic predisposition
  63. 63. Chemical dependence Management • Identification • Intervention • Referral • Rehabilitation
  64. 64. References 11/23/2015 OR Hazard and strategies to enhence PS 64 • Safe anesthesia –third edition • Ronald D Miller and Manuel C Pardo, Jr • Airway management in emergencies, George Kovacs and J. Adam Law, 2008 • Clinical Anesthesiology, 4th Edition, G. Edward Morgan, Jr., Maged S. Mikhail, Michael J. Murray • Clinical Anesthesia, 5th Edition by Barash, Paul G.; Cullen, Bruce F.; Stoelting, Robert K. 2006 • Miller’s Anesthesia, 7th edition by Ronald D. Miller, 2010 • Decontamination of medical equipment, update in anesthesia content number 7, 1997

×