This document discusses various hazards present in operating theatres. It defines hazards as dangers or risks and classifies operating theatre hazards into physical/accidental, chemical, biological, fire, and other hazards. For each category, specific hazards are identified and precautions are recommended. The document emphasizes the importance of recognizing potential hazards through awareness, constant vigilance, and following standard operating procedures to ensure a safe operating theatre environment for patients and staff.

1. OPERATION THEATRE HAZARDS
R N HOTA
RESIDENT
ANAESTHESIA

2. It is better to be safe than to be sorry…

3. Best way to be safe is not to take the risk…

4. “Risk management is a more realistic term
than safety. It implies that hazards are ever-
present, that they must be identified,
analyzed, evaluated and controlled or
rationally accepted.”
– Jerome F. Lederer

5. OUTLINE
• INTRODUCTION
• DEFINITION
• CLASSIFICATION
• PRECAUTIONS

6. Introduction
• Operation theater 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.
• Recognition of these potential hazards through
awareness and constant vigilance can control the OT
environment and make it a safe place.

7. DEFINITION
• Hazard: “Danger or Risk”
• A situation that poses a level of threat to life, health,
property or environment.
• Anesthesia and surgery are conducted in
technologically intense environment which is
potentially hazardous.

8. CLASSIFICATION
A. Physical and accidental hazards
B. Chemical hazards
C. Biological hazards
D. Fire hazards
E. Other hazards.

9. CLASSIFICATION
A. Physical and accidental hazards
B. Chemical hazards
C. Biological hazards
D. Fire hazards
E. Other hazards.

10. Physical and accidental hazards
• Architectural
– Room design
– Lighting arrangements
– Air flow
• Electrical Hazard
• Radiation
– Ionising
– Nonionising
• Acoustic
• Accidents
- Patient related
- Staff related

11. Physical and accidental hazards
• Nonporous floor, wall, and ceiling.
• Easy movement of the team
personnel.
• Sufficient space for necessary
equipments.
• Tele communication
• Temperature and humidity
regulated
• Architectural
– Room design
– Lighting
arrangements
– Air flow
• Electrical Hazard
• Radiation
– Ionising
– Nonionising
• Acoustic
• Accidents
– Patient related
– Staff related

12. Physical and accidental hazards
• Architectural
– Room design
– Lighting
arrangements
– Air flow
• Electrical Hazard
• Radiation
– Ionising
– Nonionising
• Acoustic
• Accidents
– Patient related
– Staff related
• Use of head lamps with fiber-optic
lighting for confined space surgery
makes room in the operation table area.
• Adjustable movable ceiling OT lights,
free of glare, nonreflective, at
appropriate height for adequate
illumination.
• Caution : Falls, burns, short circuits,
injury

13. Physical and accidental hazards
• Architectural
– Room design
– Lighting
arrangements
– Air flow
• Electrical Hazard
• Radiation
– Ionising
– Nonionising
• Acoustic
• Accidents
– Patient related
– Staff related
• 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.
• Caution : Infection, pollution,
allergens

14. Physical and accidental hazards
• Architectural
– Room design
– Lighting
arrangements
– Air flow
• Electrical Hazard
• Radiation
– Ionising
– Nonionising
• Acoustic
• Accidents
– Patient related
– Staff related
• Two types
• Macro shock – due to faulty
connections
• Micro shock – skin burns due it
improper insulation requied for use
of electrocautery

15. Physical and accidental hazards
• Architectural
– Room design
– Lighting
arrangements
– Air flow
• Electrical Hazard
• Radiation
– Ionising
– Nonionising
• Acoustic
• Accidents
– Patient related
– Staff related
• Lead aprons
• 0.25 mm thickness reduces radiation by
90%
• 0.5 mm thickness by 99%
• As the intensity of scattered radiation is
inversely proportional to the square of the
distance minimum of 3 feet distance from the
X-ray source is recommended.

16. Physical and accidental hazards
• Architectural
– Room design
– Lighting
arrangements
– Air flow
• Electrical Hazard
• Radiation
– Ionising
– Nonionising
• Acoustic
• Accidents
– Patient related
– Staff related
• 16% of the disabling hearing loss in adults is
attributed to occupational noise.
• Orthopedic procedures
• Occupational Safety and Health Administration
(OSHA) recommends protective devices where
exposure of continuous sound intensity is > 80dB for
>8h.
• Precautions : Ear plugs, Ear canal caps, Least verbal
communications, Soft Music

17. Physical and accidental hazards
• Architectural
– Room design
– Lighting
arrangements
– Air flow
• Electrical Hazard
• Radiation
– Ionising
– Nonionising
• Acoustic
• Accidents
– Patient related
– Staff related
• Related to Patient
• Faulty operative procedures
• Fall from OT table
• Improper positioning
• Wrong patient having identical names.
• Precaution : Safety check list, Proper padding
during positioning, care during shifting,
Adequate size of OT table & Trolley for obese
patients

18. Physical and accidental hazards
• Architectural
– Room design
– Lighting
arrangements
– Air flow
• Electrical Hazard
• Radiation
– Ionising
– Nonionising
• Acoustic
• Accidents
– Patient related
– Staff related
• Related to Team
• Slip and fall on wet floor
• Cuts from blades
• Needle pricks
• Prolonged standing
• Precaution : Caution sign for wet floor,
antiskid shoes/slippers, proper waste
disposal, Use of personal protective
equipments.

19. CLASSIFICATION
A. Physical and accidental hazards
B. Chemical hazards
C. Biological hazards
D. Fire hazards
E. Other hazards.

20. Chemical hazards
• Hazardous materials are the substances that
on contact cause harm to a person or the
environment.
• Chemical hazards form the broadest category
among the potential hazards in the OT.

21. Chemical hazards
• Solid : found in some chemical disinfectants/
containers.
• 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.

22. Chemical hazards
• For the Patient
– Faulty connection or labeling of anesthetic gas cylinders
– Wrongly calculated dose of drugs
• For the Team
– Allergic reaction to powdered gloves, hand washing agents,
cement or acrylic monomer used in joint replacement surgery.
Precaution : Repeated pre-use verification of all anesthetic
equipments and drugs, avoid agents that cause itching on
contamination.

23. CLASSIFICATION
A. Physical and accidental hazards
B. Chemical hazards
C. Biological hazards
D. Fire hazards
E. Other hazards.

24. Biological hazards
• For the Patient
– Nosocomial infections 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.

25. Biological hazards
• For the Team
– Blood-borne diseases from infected patient through
accidental needle prick.
– New strains of various microbe from infected patients
that may be multidrug resistant.
– Increased incidence of miscarriage among lady health
care workers has been reported.

26. Biological hazards
Precaution
• Follow Universal Safety precautions
• 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.

27. CLASSIFICATION
A. Physical and accidental hazards
B. Chemical hazards
C. Biological hazards
D.Fire hazards
E. Other hazards.

28. Fire hazards
• Operating room fire is defined as fire that
occurs on or near patients who are under
anesthesia care.
• It includes
– surgical fire
– airway fire
– fire within the airway circuit.

29. Fire hazards
• Adverse outcomes are
– Major or minor burns
– Inhalation injuries
– Infection
– Disfigurement or disability
– Death.
• Related adverse outcomes may include psychological
trauma, prolonged hospitalization, delay or
cancellation of surgery, additional hospital resource
utilization, liability and legal issues.

30. CLASSIFICATION
A. Physical and accidental hazards
B. Chemical hazards
C. Biological hazards
D. Fire hazards
E. Other hazards.

31. OTHER HAZARDS
Organizational
– Heavy operational theater workload
– long working hours
– Multiple night shifts
– sleep deprivation
– fatigue from handling the patients
– stress on managing the very sick patients

32. OTHER HAZARDS
• These occupational hazards that can have
adverse effect on
– Skill
– Reaction time
– Vigilance
– Interpersonal relationship among the OT
personnel.

33. OTHER HAZARDS
Psychological
– Exposure to severely traumatized patients
– Irreversible cardiac arrest of a patient
• Both may lead to postoperative stress
syndrome to the caregivers of the OT.

34. OTHER HAZARDS
Atmospheric
• Debris or the fumes and small particles produced using
carbon dioxide laser ray have shown pulmonary lesions in
experimental animals.
• HIV provirals have been demonstrated in the HIV-positive
laser smoke.
• Release of waste anesthetic gases inside OT can cause
decreased mental alertness and motor skill, tiredness and
slowing of reflexes of the OT personnel.

35. OTHER HAZARDS
Atmospheric
• Teratogenicity in OT team member and
malignancy of reticuloendothelial system, liver
and kidney disorder have been reported.
• Inflammable anesthetic gases such as diethyl
ether, ethylene, and fluroxane are no longer
used.

36. OTHER HAZARDS
• Precautions
– Proper Scavenging, use of Air purifiers, adequate
ventilation and air flows
– NIOSH has recommended the upper limit of nitrous
oxide as 25 ppm
– For halogenated anesthetics as 2 ppm in the OT
atmosphere.

37. Conclusion
• SOPs and Checklists for OT etiquette is to be
prepared and followed precisely to minimize
the risk of random inappropriate practice.
• Educating the staff about potential hazards,
regular checks and audits, incidence reporting.
• Well-designed evacuation plans in case of fire

38. Conclusion
• Proper biomedical waste management at
source
• 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.

39. THANK YOU