ANES 1501 - Module 7 PPT: Safety

1. Physical Environment and
Safety Standards
Introduction to Anesthesia Technology
ANES 1501
Module 7
Part 2

2. Overview
1. Surgery Department Physical
Design
2. Areas of the O.R.
3. Additional Rooms
4. Physical Components of the
Operative Suite
5. Standard O.R. Furniture
6. Surfaces in the O.R.
7. Cabinets and Doors
10. Ventilation System
11. Air Filtration
12. Temperature
13. Humidity
14. Substerile Area
15. Direct Support Services
16. Hazards
17. Safety Precautions
18. Personal Protective Equipment
(PPE)

3. Physical Design of the Surgery Department
Single Corridor (“Hotel”)
The Single Corridor (or “Hotel”) model involves travel
of all supplies (clean and used) as well as patients (pre
and post operative) in one main corridor. There is
ongoing debate as to the suitability of this approach.
However, this option is considered suitable provided:
• the main corridor is sufficiently wide in order to
permit separation of passage of goods and services;
• handling of clean supplies and waste is carefully
managed to avoid cross contamination
A major disadvantage of this planning model is that a
patient awaiting surgery may be exposed to post
operative patients

4. Physical Design of the Surgery Department
Dual Corridor
The Dual Corridor (or “Race Track”) model allows for all
the operating rooms to be accessed from an external
corridor for patients and directly from a central Set
Up/Sterile Stock Room for sterile goods. This model
aims to separate ‘dirty' from 'clean’ traffic by
controlling the uses of each corridor. In this design,
there must not be cross traffic of staff and supplies
from the decontaminated/ soiled areas to the sterile/
clean areas. In this model, stock and staff can be
concentrated in one location, preventing duplication of
equipment stock and staff.

5. Physical Design of the Surgery Department
Cluster
In this model Operating Rooms may be clustered
according to specialty, with a shared Sterile Stock
and Set-Up Room for each group or cluster.
Disadvantages of this model include:
• additional corridor and circulation space required
for corridors around clusters of rooms, which
reduces the available space for stock;
• potential duplication of stock and additional staff
requirements may result in increased operating
costs.

6. Question to consider
• Could you explain the reasons behind each of the
three designs?
?

7. Areas of the O.R.
Unrestricted
• Street clothes are
permitted, and the
area to have control
point for monitoring
entry for patients,
staff, and materials
Semi-Restricted
• Surgical attire is required,
and traffic is limited to
authorized personnel.
Storage and work areas for
processing of instruments
and corridors leading to the
restricted areas are
included.
Restricted
• These areas include the
operating room, clean core
and scrub sinks. Surgical
attire and hair covering is
required, along with masks
where open sterile supplies
are utilized.

8. Additional Rooms

9. Physical Components of the Operative Suite
• Equipment
• Electrical outlets
• Suction outlets
• Gas outlets
• Lights
• View box
• O.R. tables
• Other items

10. Standard O.R. Furniture
1. Backtable
2. Mayo stand
3. Ring stands
4. Kick buckets
5. Linen hamper
6. Trash container
7. Suction sets
8. Anesthesia carts
1 2 3 4
85 6 7

11. Surfaces in the O.R.
Operating Units should have the following
finishes:
• floors that are smooth, non-slip impervious
material laid in a continuous washable
material and graded where necessary to fall
to floor waste; floor material that resists
staining is recommended
• wall finishes which are seamless,
impervious and washable
• ceilings which are smooth and impervious
• intersections of walls and architraves to be
rendered watertight junctions.

12. Cabinets & Doors
Cabinets
Recessed wall storage cabinets, if requested, should be
in addition to the square footage noted for each
Operating Room. These cabinets should be used for
storage of routine supplies only. When the provision of
substantial numbers of storage cabinets in each
Operating Room is the desire of the local staff, then the
space in the clean core reserved for exchange carts
with sterile supplies on them can be reduced.
Doors
The entrance from the semi-restricted corridor, from which patients are
moved in and out of the operating room, should be at least 6' wide with a
pair of doors. Corridor doors should be located in such a way as to permit
the bed or gurney to move as directly as possible from the corridor to the
side of the operating room table. For this reason, these doors are best
located toward the foot of the operating table away from the anesthesia
equipment. If lead lining in the walls of any/or each of the operating rooms
is required by a qualified physicist, then it is mandatory that the doors into
these rooms have automatic door openers. Automatic doors must be
swinging doors operated by push plates.

13. Ventilation Systems
Supply Air
In addition to keeping the remaining Operating
Room as clean as possible, the air supply system
must be designed to minimize the entrance of
airborne bacteria into the sterile field as well as the
area occupied by the anesthesiology staff. Air
supplied to the Operating Room should be
supplemented with additional clean air entering the
Operating Room from the clean core. Operating
Rooms and Clean Corridors shall both be maintained
under positive pressure.
Exhaust Air
During an operation, all of the space from the floor itself to a distance
15'' (380 mm) above is considered contaminated. Therefore, all
exhaust/return grilles must be positioned low on the wall
approximately 18'' (460 mm) above floor. The Operating Room exhaust
system should include a minimum of two low exhaust/return air grills
located in opposite corners to minimize recirculation of contaminated
air within the Operating Room.

14. Air Filtration
• Filtration Proper air filtration for the surgical
suite ultimately requires at least a 90 percent
final filter in accordance with ASHRAE
Standard 52-76. Many surgical suites
incorporate the use of high-efficiency
particulate filters (HEPA). Most airborne
microorganisms are in the 0.5m to 5.0m
diameter range.
• HEPA filters efficiently remove particles up to
0.3m and provide virtually bacteria free air to
surgery. However, 90 percent filters are equally
effective if maintained properly. These final
filters should be located as close to the air
destination (operating room) as possible. HEPA or
90 percent final filtering may not be the only
filtering necessary. If odors are present, there
may be a need for activated charcoal or
electronic filters. The amount of pre-filtering
depends upon the intake environment of the air
handler.

15. Temperature
• Along with humidity, temperature plays an important role in comfort, but has not been indicated to
be a direct factor in infection control. Rather, a comfortable environment in the operating room can
reduce hazards created by misusing or abusing the operating room environment.
• It is recommended the surgical suite temperature be maintained in a range of 68 degrees F to 75
degrees F, with controls for selecting any desired temperature within this range. In practice, for
small rooms filled with personnel and heat emitting equipment, achieving the low end of this range
can be difficult and may require dedicated chiller units.

16. Humidity
• Operating room humidity is the most important comfort factor recognized by surgeons. A relative humidity
of at least 50 percent is recommended. This level helps to dissipate electrostatic charges, which can be
hazardous in an oxygen-rich environment. This level also controls airborne bacteria.
• Humidity lower than 35 percent may cause drying of mucous membranes and hypothermia of patients
during lengthy procedures. Additionally, 1996 NFPA 99, paragraph 5-4.1.1 states "floating particulate
increases in conditions of low relative humidity, and the fact that the incidence of would infections may be
minimized following procedures performed in those operating rooms in which the relative humidity is
maintained at the level of 50 to 55 percent" are advantages.
• Humidity much above 55 percent causes undue sweating by surgeons and operating personnel.
Unfortunately, when surgeons become uncomfortable, operating room personnel have been known to open
windows or leave doors open. This, obviously, places the patient at a higher risk of infection.

17. Substerile Area
• This is a room accessible from the
operating room(s) it serves. It may
be located between two ORs or a
group of adjacent ORs. This room
contains a sink, a counter top, and a
steam sterilizer for the purpose of
immediate use (“flash”) sterilization.

18. Direct Support Services
• Preoperative or “same-day” check-in
unit
• Preoperative holding area
• Postanesthesia care unit (PACU)
• Laboratory department
• Radiology department
• Pathology department
• Environmental services
• Central sterile supply and processing

19. Hazards
Physical Hazards
• Scalding steam and heated exterior surfaces do pose a potentially serious risk of
injury to OR staff. Appropriate training for handling heated instrumentation, trays,
and autoclave surfaces should be a part of any OR safety program. Temperatures of
an idle autoclave can be as high as 240ºC. Thus, loading instruments into an autoclave
poses a risk for injury. Instruments being removed from flash sterilizers can have
extremely hot water, capable of scalding unsuspecting staff, pooled on their surfaces.
• A facility's design should address the thermal hazard of an autoclave. The design of a
new facility should create appropriate traffic patterns around autoclaves. There
should be adequate room to pass by the autoclave when the door is open. Another
source of physical hazards is the high-pressure gases used in the OR to run air-driven
surgical equipment. Healthcare workers have experienced dental, facial, and blunt
trauma injuries when pressurized apparatus were handled incorrectly or inattentively.
Biological Hazards
• Biological hazards are responsible for some of the greatest changes in
current healthcare practice. Potential exposure can be acute or
chronic. Illness resulting from exposure can lead to autoimmune
disease, liver disease, respiratory disease, neurological disease, and
death. The emergence of AIDS in the mid 1980s led to the
recommendation by the CDC in 1985 and implementation by OSHA in
1991 of the practice of universal precautions for protection from fluid
and bloodborne pathogens. The implementation of these standards
has impacted no area of the healthcare industry as broadly as the OR
divisions of hospitals. However, fluid and bloodborne pathogens are
not the only biological concerns of OR personnel.

20. Hazards
Chemical Hazards
• Chemical hazards represent the broadest category of potential risk to OR personnel.
Chemical hazards come in solid, liquid, and gas/vapor forms. Potential exposure can be
acute or chronic. Injuries associated with chemical hazards can include thermal injury,
blunt trauma, acute toxicity, allergic sensitivity, mutagenic changes, cancer, birth
defects, loss of vision, neurotoxicity, and death. Solid chemical hazards are found
primarily in the form of chemical disinfectants, which must be premixed with water
before they can be used as cleansers in the OR. Liquid chemical hazards are used
primarily in disinfection, sterilization, medication, and tissue preservation in the OR.
Gas/vapor chemicals are primarily associated with anesthesia, disinfection, sterilization,
and surgical equipment in the OR.

21. Safety Precautions
Universal Precautions
• Universal Precautions is an approach to infection control to treat all human blood and
certain human body fluids as if they were known to be infectious for HIV, HBV and
other bloodborne pathogens. Bloodborne Pathogen Standard 29 CFR
1910.1030(d)(1) requires employees to observe Universal Precautions to prevent
contact with blood or other potentially infectious materials (OPIM).
• Under circumstances in which differentiation between body fluid types is difficult or
impossible, all body fluids shall be considered potentially infectious materials. Treat
all blood and other potentially infectious materials with appropriate precautions such
as:
• Use gloves, masks, and gowns if blood or OPIM exposure is anticipated.
• Use engineering and work practice controls to limit exposure.
Standard Precautions
• Standard Precautions apply to: 1) blood; 2) all body fluids,
secretions, and excretions, except sweat, regardless of
whether or not they contain visible blood; 3) non-intact
skin; and 4) mucous membranes. Standard precautions are
designed to reduce the risk of transmission of
microorganisms from both recognized and unrecognized
sources of infection in hospitals.
• Standard precautions includes the use of: hand washing,
appropriate personal protective equipment such as gloves,
gowns, masks, whenever touching or exposure to patients'
body fluids is anticipated.

22. Personal Protective Equipment (PPE)
• The dress code for the Operating Rooms, other invasive procedural areas,
and support areas with designated semi-restricted and restricted areas
shall be in accordance with Medical Center Policy No. 0051, based on
AORN Recommended Practices for Surgical Attire, and this policy.
• Personal protective equipment (PPE) (gloves, gowns, masks, eyewear, and
disposable, fluid resistant shoe covers) is available to all personnel at risk
of exposure to potentially infective materials. PPE must be worn in
accordance with guidelines as listed in the local area Exposure Control
Plan Protective coverings/PPE (masks, gowns and shoe covers) must be
removed prior to leaving the surgical or procedural area.