Ambient Environmental Hazards in the OR

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Ambient Environmental Hazards in the OR

• Kay Ball, RN, MSA, CNOR, FAAN
• Lewis Center, OH
• Kayball_at_aol.com

Red Team April 17, 2007
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Objective

• Discuss control measures for inhalation hazards
  in the OR.

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Inhalation Hazards

• Transmissible diseases
• Toxic fumes
• Anesthesia gases
• Glutaraldehyde
• Surgical smoke

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Spauldings Classifications

• Critical (Sterilize)
• Semi-critical (Disinfect)
• Non-critical (Clean)

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Glutaraldehyde
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Glut History

• Tanning agent for leather
• Tissue fixative
• Preservative in cosmetics
• Therapeutic agent for warts other infections
• X-ray processing solution film emulsion

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Glutaraldehyde Disinfection

• Broad spectrum antimicrobial cold disinfectant
• Glut action bonds protein
• Device preparation thorough cleaning and
  rinsing
• Efficacy monitoring
• Soak time controversy

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Controversy

• FDA
• 45 min soak
• 25 degrees C.

• Prof. Org
• 20 min soak
• Room temp.

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Glut Hazards

• Skin mucous membrane hazards
• Ingestion hazards
• Respiratory hazards
• Chronic exposure hazards

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Exposure Levels

• 0.04 ppm Detect odor
• 0.2 ppm Exposure level
• 0.3 ppm Irritant
• 0.4 ppm Pouring

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Ventilation
Vent
Glut
Processing Area
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Spill Procedure
Ammonia
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AAMI Document

• Safe use and handling of glutaraldehyde-based
  products in health care facilities

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Glut Advantages

• Effective for HLD
• Highly compatible
• Sterilization with long soak times
• Low cost, convenient

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Glut Limitations

• Unstable - Effective life 2-4 weeks
• Thorough rinsing - mandatory
• Skin, respiratory hazards
• Glut bonds proteins

Options for alternatives Other soaking
solutions (Cidex OPA) or sterilization methods
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Cidex - OPA
ORTHO-PHTHALDEHYDE

• HDL in 10 min at 20 degrees C
• Ortho-phthaldehyde (.55) insert ingredents
  (99.45)
• No sterilant claims
• Reuse 14 days (test strip)
• Endorsed by many manufacturers
• Stains skin, eye resp irritant, causes headaches

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Sterilization Options

• Steam
• Ethylene Oxide
• Peracetic Acid
• Gas Plasma
• Ozone

Sterilize
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The Effects of
Surgical Smoke
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Miners Air Problems
OR Team Serving as the Biological Indicator for
Poor Air Quality
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AORN RP

• Personnel working with an ESU or laser should
  avoid exposure to smoke plume generated during
  tissue cutting and coagulation.

Surgical smoke causes headaches, watery eyes,
respiratory problems in healthcare workers
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NIOSH

• 1988
• Smoke generated during laser surgery presents a
  potential health hazard.

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NIOSH

• 1985
• Theres a potential hazard from smoke generated
  by electrosurgical knives.

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Research

• Tomita et al, 1989
• Laser 1gm tissue
• 3 unfiltered cigarettes
• ESU 1gm tissue
• 6 unfiltered cigarettes
• Laser and ESU smoke are very similar!

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Hazards of Plume

• Odor
• Particulate Matter Size
• Viability
• Endoscopy concerns

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Odor from Toxic Gases
Polycyclic aromatic hydrocarbons Benzene
Toluene Formaldehyde Acrolein
ODOR
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Toxic Fumes and Vapors

• Acrolein
• Benzene
• Formaldehyde
• Possible carcinogens!!!!

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Particulate Matter

• American College of Surgeons
  5 microns bacterial colonization
• Regular surgical mask
  5 micron filtration
• Research - 77 of surgical smoke is 1.1 microns
  in size and smaller (Mihashi et al., 1975)
• Particulate ends up in the alveoli of your lungs

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Research

• Baggish et al, 1988
• Rats breathed unfiltered filtered plume
• Unfiltered plume Rats developed hypoxia,
  pulmonary problems
• Filtered plume No changes

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Viability Research

• Garden et al, 1988
• Used CO2 laser on cow papillomavirus
• Found intact viral DNA in plume
• Injected viral DNA from plume into cow
• Grew same viral lesion
• Potential of transmission of viable viral
  contaminants

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Transmission of virus to Dr.

• Hallmo et al, 1991
• 44yo laser Dr developed laryngeal papillomatosis
• Lesions show same DNA type as anogenital
  condyloma from patients

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Endoscopy

• Ott et al, 1993
• Laparoscopy plume
• Increase methemoglobin carboxyhemoglobin
• (methemoglobin-?O2 carrying
• capacity of RBCs)
• Delay in healing?

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Recommendations

• AORN
• ANSI
• NIOSH
• CDC
• OSHA
• Global recommendations

All say to evacuate surgical smoke!
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Solutions

• Appropriate smoke evacuation system

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In-line Filter

• For small amounts of plume use in-line filter
• Correct positioning needed

Wall Suction
Patient
AORN Pilot Survey Most popular method
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Wall Suction

• Corrodes pipes
• Contaminates building
• Flow may not be high enough to capture
  surgical smoke
• Wall suction 2 cfm
• Evacuator 30-50 cfm

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Smoke Evacuator
Needed when larger amounts of smoke created
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Critical Features

• Efficiency
• Filtering capability
• Charcoal filter removes odor
• ULPA filter removes small particulate (.1
  microns, 99.999 efficiency)
• Suction power

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Filter Changing
Occupational Hazard NOT Environmental Hazard
Follow manufacturers recommendations when
changing
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Solutions

• Position smoke tube close to the tissue impact
  site

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Automatic On/Off System
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Evacuation during endoscopy
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Choices
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Solutions

• High Filtration Masks

0.1 micron filtration
Not the first line of defense
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Questions???
www.becomenasti.com
Nurses Advocating Smokefree Theatres Immediately