Safety in the OR

1. Safety in the OR Staff Safety Patient Safety Peggy Robinson RN Hope Austin RN

2. Good Morning • Please take at least one 3x5 note card and write ANY question you have about the OR or Perioperative Nursing on it • When you are finished please deposit it in the basket • We’ll review the questions together at the end of class

3. Overview • Chemical and infectious agents that pose a risk to patients and personnel • Biological Hazards • High Risk equipment used in the OR • Techniques to reduce the risk of injury or infection to patients and personnel

4. Factors that impact Safety • Increasing regulations • Public scrutiny • Rising patient acuity • Staff Shortages • Increased workloads and responsibilities • Fear of injury and infections • Joint Commission NPSG

5. Creating a Culture of Safety • Involves the entire team • Policies clear and understood • Zero tolerance for non-compliance for non-reporting • No blaming or shaming, data used for improvement purposes

6. Factors Supporting Safety • Senior management support • Absence of workplace barriers • Cleanliness and order • Good communication • Frequent training and feedback • Availability of equipment

7. National Patient Safety Goals

8. 2017 Hospital National Safety GoalsThe Purpose: To improve patient safety The Goals focus on problems in health care safety and how to solve them • Identify Patients Correctly • Improve Staff Communication • Use Medicines Safely • Use Alarms Safely • Prevent Infection • Identify Patient Safety Risk • Prevent Mistakes in Surgery

10. Universal Protocol • Correct Surgical Schedule • Verbal Verification with the patient • Correct Consent • Site Marked • “Time-Out” Performed • All Aspects Documented

11. Other Hazards--Patient • Patient Transportation/Identification • Wrong-Site Surgery (Time-Out) • Skin Integrity (prepping, positioning, tourniquet use)

12. Chemical Hazard in the OR

13. Hospital Hazard Material • Agents with the potential to affect a persons health or cause death if injury • Identified on Safety Data Sheet • Identified with cautionary product label • Unknown hazards

14. Chemical Hazards Included, but not limited to: Anesthetic Agents Detergents Disinfectants Sterilants Latex Plume Methyl Methacrylate (bone cement)

15. Phenolics and QuaternaryAmmonium Compounds • Primarily for housekeeping • Skin and eye irritation • Use PPE as directed • Comply with label instructions

16. Preservative– Formaldehyde • Carcinogen • Primary Safety Precautions • Minimize exposure • PPE • Spill Plan

17. Chemotherapeutic Agents • Bladder Instillations • Brain “Wafers” Written Precautions and procedures for handling, preparing, administering, disposing of cytotoxic agents in your facility should be followed

18. Patients undergoing chemo • Routine use of ‘chemo precautions’ for 48 hours post chemo • Double flush the toilet or hopper when emptying body fluids • Cover with a chux or drape to prevent splashing • Wear regular gloves when handling body fluids • If linens get soiled, place them in a yellow bag (from EVS) • Empty chemo directly into a chemotherapy waste bin (yellow)

19. Biological Hazards Blood Body Fluids Tissue Specimens

20. Blood Borne • HIV, HBV, HCV, West Nile Virus, CJD A penetrating injury or splash (into the eye, onto the mucus membranes) with fluid contaminated with blood or body fluid must not be ignored! • Stop activity immediately, and step back • Squeeze the skin around the needle stick or cut to expel blood and contaminants. • Clean the puncture site or flush the eye with cool water. Flush the cut with alcohol or iodine preparation. • Report the incident according to your facility P&P and seek medical attention.

21. Contact MRSA, VRE, Small Pox, C-diff • Methicillin-resistant Staphylococcus aureusis a bacterium responsible for several difficult-to-treat infections in humans. that has developed resistance to antibiotics, which include the penicillins and the cephalosporins. • Vancomycin-Resistant Enterococcus is usually spread by direct contact with hands, environmental surfaces or medical equipment that has been contaminated by the feces of an infected person. • Small Pox spreads easily from one person to another from saliva droplets. It may also be spread from bed sheets and clothing. • C. difficile spreads mainly on hands from person to person, but also on cart handles, bedrails, bedside tables, toilets, sinks, stethoscopes, thermometers — even telephones and remote controls.

22. Airborne TB, Influenza, Varicella, Measles, Mumps • Transfer of particles 5 microns or less in size into the air, either as airborne droplets or dust particles containing the infectious microorganism; can be produced by coughing, sneezing, talking or procedures such as bronchoscopy or suctioning; can remain in the air for up to several hours; and can be spread widely within a room or over longer distances. • Special air handling and ventilation are needed to prevent airborne transmission.

23. Regulations • CDC – Transmission based precautions • Hospital P&P ( contact, droplet and airborne) • HAND WASHING!!! Before and After Each Patient Contact • Find out where PPE are kept • Don’t be afraid to ask questions

24. Equipment Hazards in the OR • Electro surgery • Lasers • Electrical Equipment • Radiation/ X-Ray

25. Staff Safety Considerations • Lifting • Body Substances Exposures • Radiation Exposure • Latex Allergy

26. New Focus Area • Workplace Violence and its effect on patient and staff safety

27. Perioperative RN Role You are your Patients advocate Keep your patients safe Keep yourself safe