Prevention of unusual incidence in Operation theatre. Critical error

1. PREVENTION OF UNUSUAL
INCIDENCES IN OPERATION
ROOM
Seminar by
ARUNMOZHI. P
PBD in OR Nursing
JIPMER.

2. INTRODUCTION
Operation theater (OT) is a specialized world
where ignorance or inadequate safety measures may
cause many hazards that can affect the patient and
the operating team as well.

3. CLASSIFICATION OF HAZARDS
Hazards in OR environment can be classified as follows:
(a) physical hazards.
(b) chemical hazards.
(c) biological hazards.

4. PHYSICAL HAZARDS
It includes fall, noise pollution, irradiation,
electricity, and fire.
CHEMICAL HAZARDS
It includes anesthetic gases, toxic fumes from
gases and liquids, cytotoxic drugs, and cleaning
agents.
BIOLOGICAL HAZARDS
It includes patient, infectious waste, cuts or
needlestick injuries, surgical plume, and latex
sensitivity.

5. PHYSICAL HAZARDS
ROOM DESIGN: Modern room design emphasizes on
nonporous floor, wall, and ceiling.
TEMPERATURE: Inside the OT, it is ideally to be
maintained at 18°C–21°C with a relative humidity of
50%–55% to prevent the patient from the possible
occurrence of hypothermia.
ANESTHESIA AND THE PATIENT: It incorporates
different components of anesthesia machine,
ventilator and resuscitator, where misconnections
may lead to life-threatening hazards to the patient.

6. LIGHTING:
Adjustable ceiling OT lights, Use of head lamps with
fiber-optic lighting which are free of glare and are
nonreflective, should be kept at a height that can give proper
illumination to the surgical field.
AIR FLOW:
Unidirectional laminar airflow into the OT is ideal that,
at the entry point, gets filtered by high-efficiency particulate
air filter. Hygiene of OT should be maintained by an efficient
gas scavenger system.
NOISE:
More the noise, more stress for the team. Extreme noise
from drills, motors and other source can be annoying and
potentially dangerous to patients and personnel. According
to standard recommends that noise level in hospitals not
exceed 45 decibels during day time.

7. ELECTRICAL HAZARDS:
It consist of macro-shock, micro-shock, and burn.
Macro-shock to any OT personnel may occur due to
faulty electrical connections.
Micro-shock or skin burn to the patient may occur
due to inadequate diathermy machine grounding or
defect in insulation.This can even cause ventricular
fibrillation when the electric current instead of the
grounding pad travels through electrogadiography
leads or pacemaker catheter.

8. RADIATION HAZARDS:
Radiation cannot be seen or felt, the effect of
radiation is directly related to the amount and length of
time of exposure. Exposure to radiation also can cause
cancer, catracts, tissue necrosis, spontaneous abortion,
genetic mutation and congenital anomalies.
PERMISSIBLE DOSE OF RADIARION
whole body, icluding blood forming organs, bone
marrow and gonads: 5 rem.
lens of eyes: 15 rem.
other organs and tissue: 50 rem
fetus in utero: 0.5 rem in any one month of gestation
during pregnancy. Exposure should not exceed 10 rem per
week.

9. PRECAUTIONS
Lead aprons with a material of 0.25 mm reduces
radiation by 90% and 0.5 mm by 99% as per as the
occupational exposure is concerned. But the best way is
physical separation because the intensity of scattered
radiation is inversely proportional to the square of the
distance from the source. A recommended distance is 3
feet from the source.

10. NONIONIZING RADIATION
It is produced by laser. The fume is infrared/UV
or visible. It is harmful because of its intensity and the
substance released during the treatment. Chances of
eye injury by direct or reflected radiation are there to
the person operating it.

11. ACCIDENTAL HAZARDS
Related to Patient:
The possibilities are faulty operative procedures,
fall from OT table, injury due to improper
positioning, and wrong patient having identical
names.
Related to Team:
Slip and fall on wet floor, cuts from blades,
needle prick, and pain due to long hour of standing or
handing of patients.

12. PRECAUTION
● Proper identification of the patient and the surgical
procedure is a must.
● Check for patient’s comfort in the intended position of
surgery before induction of anesthesia whenever practical.
● A caution sign for wet floor, slip-resistant shoes to prevent
against fall.
● Disposal of wastes in earmarked containers.
● Use of personal protective equipments.
● Do not squeeze blood from the needle pricked part, wash
in running water with antiseptic solution, use first aid, and
report to the hospital’s infection control committee.

13. CHEMICAL HAZARDS:
● Hazardous materials are the substances that on contact cause
harm to a person or the environment. These hazards can be the
following:
● Solid: found primarily in the chemical disinfectants.
● Liquid: used as medication, for tissue preservation, as agents in
sterilization process.
● Gas/vapor: usage is associated with anesthesia, sterilization, and
disinfection process of both the surgical equipment and the OT.
● For the Patient
● Faulty connection or labeling of anesthetic gas cylinders and
wrongly calculated dose of anesthetic agents.
● For the Team
● Dermatitis and eczema to the extent of T–cell-mediated delayed
type IV or IgE-mediated type I reaction with gloves powder,
handwashing sterilizing agents, local anesthetics as procaine,
xylocaine, and tetracaine solution, and cement or acrylic monomer
used in joint replacement surgery.

14. PRECAUTION
Repeated pre-use verification of all anesthetic
equipments and drugs.
NIOSH recommends steps against latex gloves use.
Avoid all agents that cause itching on contamination.
Wash hands after handling cytitoxic agents and all
items that have been in contact with them.
Place all cytotoxic waste in sealed leak proof bags or
containers.

15. BIOLOGICAL HAZARDS
Related to Patient
Nosocomial infection from a carrier in the OT team or
seedling of microflora from the OT environment can cause
postoperative surgical site infection.Patient may acquire
infection of HIV, HbsAg, HCV, and even Legionella
pneumophila present on air-conditioner duct from OT itself.
Related to Team
Blood-borne diseases such as HbsAg, HCV, and HIV can
be caused from known infected patient through accidental
needle prick. New strains of tuberculosis, vancomycin and
methycillin-resistant bacteria, and prion disease protein,
which are resistant to standard sterilization processes, are
threats to the team. Increased incidence of miscarriage
among lady personnel is also recorded.

16. PRECAUTION
● The practice of universal precautions for protection.
● Linen and contaminated theater clothes must be
changed at the end of case and sent for proper
disposal or decontamination.
● The endoscope and accessories are to be sent to a
central reprocessing unit following use.
● Periodic surveillance and OT fumigation and
sterilization with recommended agents at regular
intervals and swab culture confirmation for no
contaminant help in early detection of any organism.

17. FIRE HAZARDS
Fire should be a matter of prime concern in the
operation room.
Factors leads to fire hazards:
Flammable gases( ethylene oxide, alcohol, ether,
methane from the bowel), dry sponges are flammable.

18. PRECAUTIONS
● Minimizing or avoiding an oxidizer-enriched
atmosphere near the surgical site.
● Safe management of ignition sources and fuels.
● Equipment for managing a fire should be readily
available in every procedural area where a fire triad
consisting of fuel, oxygen, and ignition may exist.
● Formation of a safety code.
● Education of the OT personnel about the safe and
proper use of electrical goods.
● Mock fire drill that is defined as a formal and periodic
rehearsal of the OT team’s planned response to a fire.

19. CONCLUSION
● Regular inservice programs should be conducted to
employees about hazards and safeguards.
● A checklist for potential hazards to be prepared and
followed up through meetings at a regular interval for
the betterment. Well-designed plans and staff
education will prepare the healthcare personnel to
reduce the probability of unwanted incidents and
permit safe, efficient, effective, and high standards of
care to all patients at all times thus controlling
hazards in OT.

20. THANK YOU...!