Health Care Worker Safety in Surgery

How to protect yourself

6 types of injury risk specific to Periop environment

Biological Ergonomic Chemical Physical Psychosocial Cultural

IOM 2000 To Err is

Human

Many workplace safety issues that

directly affect the nurse also have an indirect effect on patient safety Nurses today routinely deal with critical issues however, they often do not pay attention to their own workplace safety issues.

Biological Risks

Biological Risks in Surgery

Blood Borne Pathogens
Splash, Sharps injury

Surgical Smoke
Electrosurgical/ Laser plume

Latex allergy
Chemical and Protein allergens

Stats (blood borne)

Nurses have the highest rate of blood/ body fluid exposure
Surgical nurses have highest rate of sharps injury
35.9% 48.6% overall 15.8% in OR

Stats (cont)
Risk of becoming infected with Hep B from single needle stick: 6-30% Risk of acquiring HIV from same situation: 0.3%
Get your Hep B vaccine- has lowered occupational infections by 95% since 1982

What to do after an exposure

Immediately wash the injured area with soap and water Flush splashes to nose, mouth with water Irrigate eyes with clean water, saline solution, or sterile irrigants (eye wash)

Surgical Smoke
Evidence that bio-aerosols generated by laser and bovie contain toxic gases No documentation of infection but potential especially for infectious viral fragments, particularly during venereal warts

AORN recommendations to reduce smoke injury

Use exhaust system with 0.1 filtration rate Wear high-filtration surgical mask (0.1 micron) Wear protective eyewear/gloves

Latex Allergy
Latex gloves were first introduced to the OR in 1890s 10% of health care workers have an allergy Only effective strategy- latex avoidance

Ergonomic Risks

Stats (ergonomics)
Nurses are one of the occupations with the most workplace related injuries
54%- musculoskeletal (back is #1) 27%- overexertion
Leading cause of injury: Patients #1, Falls #2

What causes ergonomic injury?

Repetitive motion Static/ Awkward posture Standing for long periods in one spot Heavy lifting
Obesity 350lb, Gender, Age

Prevention Strategies
Use tools when available (lateral transfer devices, sliding boards) Implement policies (weight limits on instrument trays) Use proper body mechanics (dont twist or bend at waist, push rather than pull) ** See safety board

Prevention Strategies (cont)

Wear nonskid foot wear (limit falls) Remove clutter, cover loose cords Clean up spills Keeps cabinets/drawers closed Plan ahead for adequate lifting personnel Maintain personal fitness

Chemical Risks

Chemical Risks
Cleaning agents Formalin Waste anesthesia gas

Prevention Strategies
Review MSDS for any new item
1-888-362-7476

Wear appropriate PPE Know spill protocol

Code Orange

Physical Risks

Physical Risks
Fire- manage fire triangle Electricity- avoid water, monitor equipment Radiation- dosimeter, time/distance/shielding Laser- keep in standby, proper eyewear Compressed gas- proper storage/handling

Psychological Risks

Psychological Risks
Long hours Mandatory OT Diversity Staffing shortages Call burnout Verbal/physical abuse (personal/work) Trauma Bullying

Prevention Strategies
EMC Code of Conduct ??
Ethical conduct Zero tolerance Patient confidentiality Customer Service Professional appearance

Cultural Risks

Cultural- Its just the OR

Abuse from Physicians Lack of respect from peers Lack of commitment from management to adhere to safety program Absence of code of conduct

Attributes of culture of safety

Open communication, Creativity Teamwork not individual work Support and trust among peers Resilient environment (flexible) Focus on workflow improvement

Food for thought

In a just culture, individuals are held accountable for what has been clearly defined as acceptable and unacceptable behaviors. Individuals are not held accountable, however, for systems that fail to provide safe working conditions- AORN