Chemical Safety in the Operating Room – Flashcards

National Institute for Occupational Safety and Health (NIOSH): -federal agency responsible for ensuring that workers have a safe and healthful working environment -establishes occupational health standards Occupational Safety and Health Administration (OSHA): -responsible for enacting: job health standards, investigating work sites to detect violation of standards, and enforcing the standards by citing violators -OSHA requires verification that employee chemical exposures are kept below permissible exposure levels -frequent monitoring is used to verify that hazardous chemicals remain at safe levels in the OR -there are many chemicals that are periodically monitored in the OR -essential to stay below the Permissible Exposure Limit (PEL) - PEL's are regulatory limits set by OSHA on the amt or concentration of a substance in the air. -also designated as parts per million (PPM) -Label ALL chemical containers -Keep file of MSDS for all chemicals used

TOXICITY: the ability of a chemical substance to cause harm HAZARD: -likelihood a material will cause harm under the conditions of use -with proper handling, even highly toxic chemicals can be used safely -less toxic chemicals can be extremely hazardous if handled improperly

-OR's should have a MSDS book or online list for all chemicals in the work area -LSUBMC list all chemicals on website -Standard operating procedures (SOP) -Exposure control measures -fume hood and personal protective equipment (if used) -Information and Training. Chemicals that require prior planning and approval -Operating room plan for emergencies. Spills and exposure

-Flammable: catches fire easily and burns rapidly -Combustible: will burn under most conditions -Explosive: will explode/detonate releasing hot gases -Oxidizer yields oxygen to enhance combustion, may cause ignition of combustibles with no external source -Organic peroxide uniquely hazardous, potentially explosive -Unstable tends to decompose during normal handling and storage -Water reactive reacts with water to release flammable gas, causes fire or presents a health hazard

Carcinogen: cause cancer or suspected to cause cancer Toxic Agent poisonous/cause acute or chronic effects Reproductive toxin (teratogenic) could have harmful effect on male or female reproductive system or on developing fetus Irritant can cause inflammation of skin or eyes Corrosive cause irreversible damage to living tissue Sensitizer cause exposed person to develop allergies to the substance Target organ specific agents hazardous to specific organs in body (lungs, liver, blood, kidneys, nervous system)

-inhalation/breathing most common route, gases/vapors can pass to blood, solid particles inhaled into lungs -absorption through the skin many solids, liquids, vapors and gases can be absorbed through the skin -ingestion/swallowing while not intentional, failure to wash hands, eating in contaminated environments -injection accidents handling glass, sharps, etc -eye contact either physical damage absorption

dose: amount of chemical absorbed depends upon chemical strength/concentration, exposure duration, frequency of exposure acute effects: occurs rapidly following brief exposure (acid burn) chronic effect: develops/recurs slowly, over long period following repeated, long-term, low-level exposure (benzidine linked to bladder cancer) Individual variability: not all people exhibit the same signs and symptoms (esp to chronic effects)

-methyl methacrylate -halothane -latex -glutaraldehyde (cidex) -formaldehyde (formaln) -caviwipes

-bone cement -strong odor -risk for surgical pts and most common in the ageing *CVS- PE, hypotension, bradycardia, and cardiac arrest -can cause bone cement implantation syndrome -cause of intra op mortality and morbidity in pts undergoing cemented hip/knee arthroplasty -can cause hypoxia and confusion post op -occupational exposure effects *allergic rxn, asthma, dermatitis, eye irritation, corneal ulceration, HA, and neurological signs and symptoms -can cause significant lower limb neuropathy after repeated occupational exposure to methyl methacrylate OSHA GUIDELINES: -8 hour exposure of 100 ppm -peak environmental concentrations can be decreased by 75% when scavenging devices are properly used -a negative pressure ventilated room should be used

symptoms: -hypoxia, hypotension, or both -unexpected loss of consciousness occurring around the time of cementation, prosthesis insertion, reduction of the joint or , occasionally, limb tourniquet deflation in a pt undergoing cemented bone surgery

Grade 1: -moderate hypoxia (SpO2, 94%) -fall in SBP 20% Grade 2: -severe hypoxia (SpO2, 88%) -fall in SBP 40% -Unexpected loss of consciousness Grade 3: -cardiovascular collapse requiring CPR

-Fall in ETCO2 concentraion MAY BE THE 1ST INDICATION OF CLINICALLY SIGNIFICANT BCIS -Increase FiO2 to 100% and supplementary O2 should be continued into the post op period -it has been suggested that CVS collapse in the context of BCIS be tx as RV failure -AGGRESSIVE RESUSCITIATION WITH IVF HAS BEEN RECOMMENDED -Central venous catheter may be indicated for the admin of inotropic drugs -alpha adrenergic agoinist or mixed alpha and beta receptor agonist

-halothane hepatitis -repeated bouts of hepatitis in anesthesia providers, have been attributed to hypersensitivity reaction to halothane -halothane exposure was associated with an increased prevalence of autoantibodies to CYP P450 enzymes and hepatic endoplasmic reticulum proteins

-is a complex substance composed of polyisoprenes, lipids, phospholipids, and proteins -additional substances include cornstarch and talc -the protein content of latex is responsible for the vast majority of generalized allergic reactions -Powder enhances the potential of latex particles to aerosolize and spread to the respiratory system -common source of allergic reactions -prevalence of sensitivity to anesthesia providers is =12.5-15.8%

-irritant contact dermatitis -type 4- delayed hypersensitivity -type 1- immediate hypersensitivity, localized contact urticaria (hives, rash) and generalized rxn

s/s: scaling, drying, cracking of skin cause: direct skin irritation by gloves, powder, soaps management: -identify reaction, avoid irritant, possible use of glove liner, use of alternative product

S/S: -itching, blistering, crusting (delayed 6-72 hours) cause: -chemical additives used in manufacturing such as accelerators management: -identify offending chemical, possible use of alternative product without chemical additive, possible use of glove liner True allergic rxn present as T-cell mediated contact dermatitis or as IgE-mediated anaphylactic reaction

-localized Contact Urticaria * immediate hypersensitivity -S/S: -itching, hives in area of contact with latex, runny nose, swollen eyes, generalized rash, bronchospasm -immediate Cause: -protein found in latex -Management **antihistamines, topical/systemic steroids

s/e can occur when the amt in the air is about 0.1 ppm -maximum exposure limit is 0.2 ppm -IN CASE OF EYE CONTACT, IMMEDIATELY RINSE THE EYES WITH WATER FOR 15 MIN AND THEN SEEK MEDICAL ATTENTION -BRONCHOSPASM -asthmatics are sensitive -can effect reproductive system -use gloves and aprons made of nitrile or butyl rubber

-high level disinfectant -non corrosive -flammable and highly toxic -used in endo -if swallowed rinse with water, drink water or milk followed by a raw egg if available

-isopropanol=400 ppm -ethylene glycol monobutyl ether = 50 ppm

-simple spill one which you can safely clean up yourself -major emergency or high hazard spill one which you can not safely clean up yourself