Hazard Dewasa

Definition
• 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 environment potentially harzadous.
KLASIFIKASI HAZARD
• (a) physical and accidental hazards,
• (b) chemical hazards,
• (c) biological hazards,
• (d) fire hazards, and
• (e) other hazards.
a. Physical - Architectural
Room design
• Modern architectural design emphasizes on nonporous floor, wall, and ceiling. OTs are now designed for:
• Easy movement of the team personnel.
• Sufficient space for necessary equipments.
• Audiovisual arrangements to communicate with the concerned specialities as follows:
• Radiology/Pathology outside: This reduces traffic inside the OT and thus lessens contamination and risk of infection to the patient.
• Temperature: Inside the OT, it is ideally to be maintained at 18°C–21°C with a relative humidity of 50%–55% to prevent the patient from the possible occurrence
of hypothermia.
• Anesthesia and the patient: International Standard Organization described “gas pathways in direct connection with the patient” that incorporates different
components of anesthesia machine, ventilator and resuscitator, where misconnections may lead to life-threatening hazards.
• Lighting Arrangement
• Use of head lamps with fiber-optic lighting for confined space surgery makes room in the operation table area.
• Adjustable ceiling OT lights, which are free of glare and are nonreflective, should be kept at a height that can give proper
illumination to the surgical field and does not cause head injury to any personnel while moving around.
• Airflow
• Unidirectional laminar airflow into the OT is ideal that, at the entry point, gets filtered by high-efficiency particulate air filter.
Hygiene of OT should be maintained by an efficient gas scavenger system
Physical - Electrical Hazards

• It consist 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 machine grounding or defect in insulation.
• This can even cause ventricular fibrillation when the electric current
instead of the grounding pad travels through electrogadiography
leads or pacemaker catheter
Macroshock

• Electrical hazards 3
• Mostcommon
• occurs when the body conducts an electric current
• which does not pass directly through the heart.
• Mildsensorystimulation@5to10mA
• @50to60mA-muscularcontraction
• @100mA-breathingbecomesextremelydifficult.
• Somewhere above this level respiratory paralysis, cardiac arrest and
severe burning occur.
Microshock

• Electrical hazards 4
• • When very tiny currents, such as 100μA, are intentionally passed
directly thru heart muscle
• – e.g. direct cardiac catheterization, CO measmt
Physical - Electrical Hazards
• Highf requency currents above hertz are less likely to produce electric
shock but can cause burns and interference with other devices such
as pacemakers.
• • DC is less likely to cause VF than high frequency AC (above 50Hz)
but can cause muscle contraction.
• • Nervedamageoftenoccurswithhighcurrents.
• • The SC may be involved by large currents passing from head to foot
or from arm to arm.
Electrical burns and electrically initiated burns

Threetypes
• Carbonization of skin (from burns at very high temperatures of
1,000°C)
• Flame burns
• Direct heating of tissues produce coagulation and necrosis at entry
and exit points and associated injury in muscle and BV.
 Radiation
The potential radiological hazards can be categorized into thermal, as in
lasers, radioactive isotopes, as in brachytherapy and
radioimmunoscintigraphy procedures, and electromagnetic radiation as in X-
ray, gamma, and ultraviolet (UV) radiation
• Ionizing Radiation
• “National Council on Radiation Protection and Measurement” established a
maximum limit of X-ray for occupational exposure to be 5 rem/year10,11 except for
any personal medical requirement.
• Nonionizing Radiation
• It is produced by laser. The fume is infrared/UV or visible. It is harmful because of its
intensity and the substance released during the treatment. Chances of eye injury by
direct or reflected radiation are there to the person operating it.
Acoustical

• More the noise, more stress for the team. Significant hearing loss
during orthopedic procedures in orthopedic surgeons is associated
with elevated noise level that may go even higher than the intensity
of normal conversation which is 50 dBA
b. Accidental Hazards
• Related to Patient
• The possibilities are faulty operative procedures, fall from OT table, injury due
to improper positioning, and wrong patient having identical names.
• Related to Team
• Slip and fall on wet floor, cuts from blades, needle prick, and pain due to long
hour of standing or handing of patients
c. Chemical Hazards
HAZMAT or hazardous materials are the substances that on contact
cause harm to a person or the environment. Chemical hazards form the
broadest category among the potential hazards in the OT.
• For the Patient
• Faulty connection or labeling of anesthetic gas cylinders and wrongly
calculated dose of anesthetic agents.
• For the Team
• Dermatitis and eczema to the extent of T–cell-mediated delayed type IV or
IgE-mediated type I reaction with gloves powder, handwashing sterilizing
agents, local anesthetics as procaine, xylocaine, and tetracaine solution, and
cement or acrylic monomer used in joint replacement surgery.
oxygen
• Medical gas, a drug, it has its own side effects
• high flows of dry oxygen  dry and irritate mucosal surfaces of the
air passages as well as decrease mucociliary transport and clearance
of secretions.
• causes increased production of hydrogen peroxide, superoxide anion,
singlet oxygen and hydroxyl radicals  toxic to lipids and proteins in
biological membranes  In premature babies excess oxygen can
provoke eye injury(exp: retrolental fibroplasia
• Finally, any oxygen-enriched atmosphere constitutes a fire hazard.
b. Biological Hazards
• Related to Patient
• Nosocomial infection from a carrier in the OT team or seedling of microflora
from the OT environment can cause postoperative surgical site infection.
• Patient may acquire infection of HIV, HbsAg, HCV, and even Legionella
pneumophila present on air-conditioner duct from OT itself.
• Related to Team
• Blood-borne diseases such as HbsAg, HCV, and HIV can be caused from known
infected patient through accidental needle prick.
• New strains of tuberculosis, vancomycin and methycillin-resistant bacteria,
and prion disease protein, which are resistant to standard sterilization
processes, are threats to the team.
• Increased incidence of miscarriage among lady personnel is also recorded.
Infection

• Occupational exposure to a range of pathogens represents a serious risk to

anaesthetists.
• The risk of transmission of blood-borne pathogens, such as human
immunodeficiency virus (HIV) and hepatitis B and C, are well known
• For anaesthetists, the most likely source of an occupational exposure is self-
inoculation 
• a needle during the insertion and suturing of intravascular catheters
• the injection of intradermal anaesthesia2 or resheathing of used needles
• also occur after exposure to body fluids other than blood (amniotic fluid, cerebrospinal
fluid, pericardial fluid, pleural fluid, synovial fluid, unfixed tissues and organs, exudative
fluid from burns or skin lesions, vaginal secretions and semen).
d. Fire Hazards

• Operating room fire is defined as fire that occurs on or near patients who
are under anesthesia care.
• It includes surgical fire, airway fire, and fire within the airway circuit.
• A surgical fire is defined as a fire that occurs on or in a patient.
• An airway fire is a specific type of surgical fire that occurs in a patient’s airway.
• Airway fires may or may not include fire in the attached breathing circuit.
• Adverse outcomes associated with OT fires may include major or minor
burns, inhalation injuries, infection, disfigurement, and death.
• Related adverse outcomes may include psychological trauma, prolonged
hospitalization, delay or cancellation of surgery, additional hospital
resource utilization, and liability.
Fire Hazard
• Both of these can cuase death injury to the patient
• Only occur if we have 3 things :
• Spark or a hot surface
• Flammable substance
• Source of oxygen
Sparks or Heat
• Source
• Static electricity
• Faulty electrical switches and apparatus, eg saws, plaster cutters and drills
• Foreign matter, eg dirt or rease in the oxygen or nitrous oxide cylnders
• Diathermt
• Open flames
• Flammable substances: includes ether, ethyl chloride and solution in
sprits. The addition of oxygen oncreased flammability.
Diathermy and laser smoke inhalation
• Inhalation of smoke and vapour generated by the use of surgical diathermy
and lasers represents a potential hazard to anaesthetists.
• Pulmonary lesions have been demonstrated in laboratory animals after
inhalation of smoke from tissues treated with a carbon dioxide laser, and
the smoke plume generated by diathermy has been found to contain
carcinogens such as benzene.
• Other chemicals (e.g. toluene, styrene, carbon disulphide) identified in
diathermy smoke  cause corneal irritation, dermatitis, renal and hepatic
toxicity and affect the central nervous system.
• Viable bacteria, human papillomavirus DNA and HIV proviral DNA  also
found in laser smoke under experimental conditions.
e. Other Hazards

• Organizational
• Heavy operational theater workload, long working hours, night shift and sleep
deprivation, fatigue from handling the patients, and stress on managing the
very sick patients are the occupational hazards that can have adverse effect
on mental skill and reaction time, vigilance, and interpersonal relationship
among the OT personnel.
• Psychological
• Exposure to severely traumatized patients, irreversible cardiac arrest of a
patient may lead to postoperative stress syndrome to the caregivers of the OT.
e. Other Hazards
Atmospheric
• Debris or the fumes and small particles produced using carbon dioxide
laser ray can cause pulmonary lesions in experimental animals.
• HIV provirals have been demonstrated in the HIV-positive laser smoke.
• Release of waste anesthetic gases inside OT can cause decreased mental
alertness and motor skill, tiredness, and slowing of reflexes of the OT
personnel.
• Teratogenicity in OT team member and malignancy of reticuloendothelial
system, liver and kidney disorder have been reported.
• Use of flammable anesthetic gases such as diethyl ether, ethylene, and
fluroxane are no longer continued
• Anesth Essays Res. 2012 Jan-Jun; 6(1): 14–20. doi: 10.4103/0259-1162.103365
PMCID: PMC4173431 PMID: 25885495 Risk and safety concerns in anesthesiology practice: The
present perspectiveSukhminder Jit Singh Bajwa and Jasbir Kaur
• WORKPLACE – RELATED HAZARD
https://academic.oup.com/bjaed/article/6/5/182/336915
• OXYGEN
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3649741/
• Clinical Anesthesiology, 4th Edition, G. Edward Morgan, Jr., Maged S. Mikhail, Michael J. Murray
• Clinical Anesthesia, 5th Edition by Barash, Paul G.; Cullen, Bruce F.; Stoelting, Robert K. 2006
• Miller’s Anesthesia, 7th ed
• Control of Hazards in Operation Theater, SEN J*, SEN B† indian Journal of Clinical Practice, Vol. 24, No. 7,
December 2013