Creating a safe environment of

care
Hazards in the OR:
• Biohazards
• Fire
• Chemical
• Electrical
• thermal
• Environmental
• Compressed gases
• Latex
• Noise and distraction
• Ergonomics
• Infection prevention
• Sanitation practices
• Access to the OR
o Vendors
o HIPAA
Risk reduction strategies:
Controls/plans in place to prevent or correct exposure to hazards:
• Administrative controls
o Develop a culture of safety
o Educate
o Appropriate staffing
• Engineering controls
o Use the right equipment
o Room and equipment set up
o Having access to the right equipment
• Behavioral controls
o Eliminate clutter and tripping hazards
o Clean up as you go
o Bundle and cover cords on the floor
Ergonomics:
Potential for injuries related to:
• Moving patients and equipment
o Pulling
o Pushing
o Lateral movements
• Carrying heavy instrument trays
o Positioning of instrument trays in storage

Too high

Too low
• Slips, trips and falls
o Cords
o Wet floors
o Inappropriate footwear
• Repetitive motions
• Static postures; standing in one place for hours
• Awkward postures; holding retractors, etc.
• Overexertion
Fire safety:
Fire triangle: three items required for a fire
• Oxygen or an oxidizer
o Oxygen
o Nitrous oxide
• Fuel
o Drapes
o Linen
o Hair
• Ignition source
o Electrosurgical active electrode
o Lasers
o Defibrillators
o Power equipment; drills, etc.
o Fiber optic light cords

Fire safety:
• Keep egress routes clear; do not place equipment on both sides of the
hall
• Know where the extinguishers, alarms, gas shut off valves are located
 • What is your evacuation plan? Route? What do you need if you have to
• Evacuate the area?
• What is your role in surgical fire prevention?
• What is your role if a surgical fire occurs?
• Do you perform a fire risk assessment prior to starting the procedure?

Electrical and equipment safety:

• Any new equipment brought into the OR must be checked out by clinical
Engineering prior to use
• Make sure that you know how to use the equipment. How are you
trained when
• New equipment is placed into service
• Ensure that critical equipment is plugged into your emergency
receptacles
• Check all equipment prior to use; this includes the OR table, OR lights,
etch
• Avoid the use of extension cords
• Check equipment for frayed or damaged electrical cords
• Avoid using liquids around electrical equipment
• If a piece of equipment is broken, what is your process for taking it out
of service; tag it with a defective tag, explaining the issue. Please don’t
just write “Broken”
Biohazards:
• Potential for exposure to blood and body fluids:
o Wear appropriate PPE
o Practice sharps safety

Blunt suture needles

Double gloving

Avoid recapping needles; if necessary, use one handed
recapping process

Use a neutral zone for sharps passing

Use safety scalpels

Use instruments to retract, not fingers

Isolate sharps to a puncture resistant container (needle
counter pad)
• Medications:
o Hazardous medications may be used; example: mitomycin may be
used for bladder instillation to treat bladder cancers

These medications require special handling and spills must be
cleaned up appropriately
o Chemicals

Cleaning solutions may contain irritants effecting eyes, skin, or
airways

Some chemicals can be carcinogenic; formalin
o Latex

Is your facility latex free?

Anticipate patient needs if patient is latex sensitive

Latex sensitive patient should be scheduled as the first case of
the day or the room should be kept late free for the time prior
to the case
Compressed gases:
• Safe handling:
o Do not carry tanks, transport them in a tank carrier
o Store empty tanks separately from full or partially full tanks
o A tank is considered empty when it is 500psi or lower
o Tanks can become a missile if the top is damaged or opened and the
tank is not secured
HVAC:
• OR room temperature
o 68-75 degrees
• OR humidity:
o 20-60 %
• Air flow
o Positive
• Air exchanges
o At least 20 per hour with at least 4 outdoor air exchanges
• Air quality checks
Clinical and alert alarms:
• Clinical alarms are patient specific and alert the staff member to a patient
related concern. E.g. esu alarm, cardiac monitor
• Alert alarms: connected to a system and alert staff to a system issue, E.g.
blanket or fluid warmer alarm
Noise and distractions:
• Induce stress
• Effect communication
• Include loud music, equipment noises and alarms
 • Alarm fatigue
• Linked to many errors
Thermal injuries:
• Potential for thermal injuries related to :
o Fluid and blanket warmers

Blanket warmers not higher than 130 degrees

Fluid warmers- see manufacturers’ recommendation for
temperature and time

Do not store IV fluids in any warmer except one specifically
designed to warm IV fluids
o Active warmers, i.e. Bair Hugger, etc.

Use only with the gown or blanket

Use without the blanket can result in severe burns to the
patient

Holster the active electrode (ESU) to avoid stray burns to the
patient
Waste:
• Recycling: what can be recycled?
o Kimguard (blue) wrap from instrument trays
o Table covers that are not saturated with blood or body fluids-check
your facility policy
o Boxes from disposable supplies
o Single use items- check you facility policy
• Suction containers and contents
o Disinfection and disposal
• Anesthetic waste gases
o Scavenging system should reduce the amount of waste gases released
in the OR
• Surgical smoke
o Contains viral and bacterial DNA
o Contains chemicals
o Is bio hazardous
o Should use smoke evacuators, HEPA filters
o Use appropriate PPE

Particulate masks like N95
Infection prevention and control:
• Hand hygiene is the single most important method to prevent the spread of
infection
• Use standard precautions for all patients
• Wear appropriate PPE for the situation
• Prevention of transmissible infections:
o Type of isolation is determined by the pathogen and its method of
transmission
o Maintain good isolation technique at all times
• Instrument and equipment decontamination:
o Instrument decon starts at the point of use
o Decontamination of equipment is determined by the Spaulding
Classification System:

Critical items: require sterilization
• Items that enter a sterile cavity, tissue or vasculature
o instruments

Semi-critical items: require high level disinfection
• Items that come into contact with non-intact skin or
intact mucous membranes
o Colonoscope
o Bronchoscope

Non-critical items: require low level disinfection
• Items that come into contact with intact skin
o Wheelchairs
o OR equipment
• OR sanitation practices
o Goal:

decrease the number of organisms found on surfaces

decrease the amount of dust, organic debris and microbial load
in the environment

provide patients with the safest possible environment

reduce the risk of SSI
o Timing:

Before cases start for the day
• Damp dust all room furniture, overhead lights and
equipment
• Check the ceiling above where the patient will be lying
and above the sterile field

During the procedure;
• Confine and contain
o Items removed from the sterile field
o Trash
o Suture pieced dropped on the floor
• Clean up spills or fluids on the floor
• Handle specimens correctly
 • Handle and contain contaminated items and sharps
safely
• Helps prepare the room for turnover

Turnover
• Cleaning the room between cases
• Containment and removal of all items associated with
the prior case
o Trash and linens
o Soiled instruments
o Specimens
o Patient ID labels
o All patient related paperwork
• Clean all horizontal surfaces, floor, kick buckets, ring
stands, etc.

Terminal cleaning:
• Occurs at the end of the day
o Thorough cleaning of :

Furniture

Walls

Vents

Equipment

Area around scrub sinks

Substerile and sterile area (core)
Construction and renovation:
• Multidisciplinary team should be involved in planning
• Infection control should help to monitor
• OR staff should be involved in design and planning
• Consider:
o Intended use for space
o Case/procedure volumes
o Potential for growth
o Advances in technology
o Utility needs
o Storage
o Traffic flow
o Location of support services
o Security
o Environmental impact