UOG

1. Hazards of working in the
Operation theatre

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. 1. Objectives
 is to identify hazards present in operating rooms and to list
actions that can be taken to minimize these hazards.

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. 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. 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.  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. 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.  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.  The persons at risk
 Patient
 Anesthetist
 Surgeon
 Other staffs : nurses ,janitors , technicians
 Expected approach to hazards: Anticipation….Recognition
….Evaluation …control/ intervention

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. Hazards for anesthesiologists /Anesthetists
 Fire & explosions
 Electrical accidents
 Pollutions by anesthetic agents
 Radiations
 Infections
 Incompatibilities / allergies
 Stress
 Chemical dependence
OR

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. 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.  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.  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. 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. Pollution by anesthetic agents
Recommendations
 Upper limits
N2O 25ppm
Halogenated agents 2ppm
Halogenated agents
with N2O
0.5ppm

19. Pollution by anesthetic agents
 How to Reduce Air Contamination in Operating Theaters?
 Scavenging systems.
 Closed circuits.
 Anti spill devices .

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. 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. 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.  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.  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.  Tuberculosis :
• Personal protective measures
• Special type of mask
• avoid any contaminated air way equipments .

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. Radiation hazards
Risks
 Ionizing radiation- X-ray, radioactive isotopes
 Formation of free radicals, ionizing molecules
 Damage/destruction of cells, Ch anomalies, malignancies.

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.  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. 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. 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.  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.  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. 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. 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. Causes of Chemical dependence
 Stress
 Availabilities
 Curiosity for experimentation
 Drug potency
 Others-genetic predisposition