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4.hazards of working in the operation room

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4.hazards of working in the operation room

  1. 1. Hazards of working in the Operation theatre
  2. 2. Outline 1. Objective 2. Introduction 3. Pollution by anaesthetic agents 4. Biological / Infectious hazard 5. Physical hazard 6. Electrical hazard 7. personal hazard
  3. 3. 1. Objectives  is to identify hazards present in operating rooms and to list actions that can be taken to minimize these hazards.
  4. 4.  Every patient has the right to be treated using the safest technology available in health facilities.  This requires two main aspects, knowledgeable and well trained caring healthcare workers, and validated systems in operating theatres and sterile services that will ensure safety for the patients and to reduce harm.  Therefore, all health-care professionals and institutions have obligations to provide safe and quality health care and to avoid unintentional harm to patients.
  5. 5. 2. Introduction  The operation theater environment is charged with multiple inherent risks.  The Operation room team and the patient brought for surgical treatment may come across various hazards.  The practice of Anaesthesia is not without risks to the anesthesiologist/anesthetists.  Inadequate safety measures thus can result in multiple ill effects.
  6. 6. 2. Introduction  The operating theatre in which anesthesiologists spend most of their working time is regarded as  an unhealthy workplace due to the potential risks it offers.  Cause the high-stakes nature of the practice.  This setting is unique among workplaces
  7. 7.  Constant • Vigilance , Awareness with Timely intervention • Maintenance of a specific operative procedure, and an educated team culture can make the OT environment a safe haven for the patient as well as for the theater team.
  8. 8. 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 env’t……potentially hazardous.  Un avoidable dangerous event or risk ,even though often foreseeable / anticipated.
  9. 9.  Risk  The potential that a chosen action will lead to a loss or an undesirable outcome.  Occasionally the term refer to the outcome itself (e.g., death as one risk of anesthesia).
  10. 10.  The persons at risk  Patient  Anesthetist  Surgeon  Other staffs : nurses ,janitors , technicians  Expected approach to hazards: Anticipation….Recognition ….Evaluation …control/ intervention
  11. 11. Classification  According to their nature 1. Physical Hazards and Accident Hazards 2. Chemical Hazards 3. Biological Hazards /infectious agent 4. Electrical Hazards 5. Psychosocial, organizational factors and Atmospheric .
  12. 12. Hazards for anesthesiologists /Anesthetists  Fire & explosions  Electrical accidents  Pollutions by anesthetic agents  Radiations  Infections  Incompatibilities / allergies  Stress  Chemical dependence OR
  13. 13.  Some hazards, have been extensively studied.  Epidemiologic surveys have been conducted to assess the health of anesthesia personnel.  Awareness of the problems and the use of proper precautions, will minimize the potential health risks of the surgical team.
  14. 14. 3. Pollutions by anaesthetic agents  N2 O & Halogenated agents  The exposure of anesthetists to inhalational anesthetics is higher as compare to other operational theatre personals .  Chronic exposure to halogenated agents and nitrous oxide have potential to develop  Sensitivity to Hepatitis  Headaches  Nausea and vomiting  Drowsiness ,fatigue and irritability.
  15. 15.  Chronic exposure to halogenated agents and nitrous oxide have potential to develop  Sensitivity to Hepatitis  Headaches  Nausea and vomiting  Drowsiness ,fatigue and irritability.  Once these lipid soluble agents are metabolized into the body, their metabolites can potentially cause Hepatic , Renal ,Pulmonary toxicity and Decrease on psychomotor efficiency on chronic exposure.
  16. 16.  Issues have been raised about the teratogenic effects , congenital abnormalities in the new born as well as higher rate of spontaneous abortion among female anesthesiologists/anesthetists but nothing conclusive has been established yet.  The currently used anesthetics have no mutagenic, carcinogenic or clinically significant genotoxic effects.
  17. 17. Causes of operating room contamination o Failure to disconnect flow control valves o Flushing of breathing circuit ,filling vaporizers o Tracheal tubes without cuffs o Pediatric respiratory system/open circuits o Sidestream sampling of gas analyzers o Occlusion of suction system
  18. 18. Pollution by anesthetic agents Recommendations  Upper limits N2O 25ppm Halogenated agents 2ppm Halogenated agents with N2O 0.5ppm
  19. 19. Pollution by anesthetic agents  How to Reduce Air Contamination in Operating Theaters?  Scavenging systems.  Closed circuits.  Anti spill devices .
  20. 20. 4. Biological Hazards /infection  Blood borne-HIV,HBV,HCV  Air borne- Mtb  The incidence of such hazards varies from hospital to hospital and from country to country and results in clinical asymptomatic carrier state to over fatal infection.
  21. 21. Infections  Blood borne diseases thro’ Needle stick injuries- HIV:0.3%, HBV: 3%, HCV 30%  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%
  22. 22. Preventive measures and precautions  Hepatitis B vaccine  Using personal protective devices like gloves , masks  Avoiding reinsertion of needle into its cap  Dressing of all abrasions and cuts  Disposing of the contaminated materials in meticulous manner  Sterilization of anesthesia equipment and apparatus
  23. 23.  HIV • The risk of acquiring HIV after an occupational exposure to HIV – infected blood is low. • The risk for HIV transmission after percutaneous exposure to HIV – infected blood in health care setting is 0.3%. • After a mucocutaneous ,the risk is 0.03% and if intact skin is exposed to HIV-infected blood there is no risk of HIV transmission .
  24. 24.  Prevention and prophylaxis  Rapid HIV testing  The site of exposure should be washed immediately with with plain water and soap.  Post-exposure prophylaxis has been shown to be maximally effective if taken with an hour after exposure ,but benefit may remain if commenced up to 2 weeks after exposure.
  25. 25.  Tuberculosis : • Personal protective measures • Special type of mask • avoid any contaminated air way equipments .
  26. 26. 5. Physical and accidental hazards  Injuries to part of body  Slips, trips and falls on wet floors  Stabs and cuts from sharp objects, needle-pricks and cuts by blade ,ampoules .  Fire and explosions  Cautery burns and scalds
  27. 27. Radiation hazards Risks  Ionizing radiation- X-ray, radioactive isotopes  Formation of free radicals, ionizing molecules  Damage/destruction of cells, Ch anomalies, malignancies.
  28. 28. Radiation hazards Risks  Non-Ionizing radiation –laser  Disruption of electrons from one orbit to others, but with in cells  Tissue damage , Laser plums formation (contain viable bacteria ,abnormalities on DNA )
  29. 29.  Protective measures  Use of barriers such as lead aprons down to knees( gonadal protection) .  Glasses with protective lenses to protect the retina and cervical collars to protect the thyroid.  Maintaining a minimum distance of 90 cm from primary source of ionizing radiation emission promotes a complete reduction of primary radiation exposure.
  30. 30. 6. Electrical accidents  Unsafe electrical configurations  It consists 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/electro surgical Cautery machine grounding or defect in insulation.
  31. 31. Electrical accidents  Macro shock : Large voltage current  Causes  Tissue damages  Burns  Explosions 1ma perception 5ma harmless 10-20ma Muscular contraction 50-100ma Pain, fainting 100-2500ma VF >6000ma Resp.arrest
  32. 32.  Micro shock  Direct application of very small voltages to the heart thro’ electrodes  Allowable leakage thro’ electrodes 10µA  >50 µA-VF occurs Electrical accidents
  33. 33.  Safe practices 1. Proper grounded equipment's 2. Don’t connect the pt to the OR grounding sources 3. Electro Cautery: large grounding pads, to be kept well away from electrodes 4. Use bipolar 5. Good maintenance of equipments
  34. 34. 7. Personal Hazards  Stress, fatigue ,drug addiction , Chronic systemic Hypertension , depression and abuse of drugs and alcohol  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
  35. 35. Chemical dependence  Self administration of drugs & suicide rates are  Substance misuse : use of drugs in detrimental way but not to the point of addiction. a pre addiction level, can easily quit. a voluntary act.  Addiction : compulsive continued use of drugs in spite 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
  36. 36. Causes of Chemical dependence  Stress  Availabilities  Curiosity for experimentation  Drug potency  Others-genetic predisposition

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