HEALTH HAZARDS ASSOCIATED WITH THE SURGICAL ENVIRONMENT
Safety issues in the OR include exposure to blood and body flu-ids, hazards associated with laser beams, and exposure to latex, ra-diation, and toxic agents. Internal monitoring of the OR includes the analysis of surface swipe samples and air samples for infectious and toxic agents. In addition, policies and procedures for mini-mizing exposure to body fluids and reducing the dangers associ-ated with lasers and radiation have been established.
The AORN has recommended practices for laser safety (AORN, 2002). While lasers are in use, warning signs should be clearly posted to alert personnel. Among the safety issues are the follow-ing: reducing the possibility of exposing the eyes and skin to laser beams, preventing inhalation of the laser plume (smoke and par-ticulate matter), and protecting the patient and personnel from fire and electrical hazards. Because several types of lasers are available for clinical use, perioperative personnel should be familiar with the unique features, specific operation, and safety measures for each type of laser used in the practice setting (Townsend, 2002).
Nurses and other intraoperative personnel working with lasers must have a thorough eye examination before participating in procedures involving lasers. Special protective goggles, specific to the type of laser used in the procedure, are worn. There is con-troversy about the protection needed to avoid the laser plume and effects of its inhalation. Smoke evacuators are used in some pro-cedures to remove the laser plume from the operative field. In re-cent years this technology has been applied to protect the surgical team from the hazards associated with the generalized smoke plume generated by standard electrocautery units.
Since the advent of the acquired immunodeficiency syndrome (AIDS) epidemic, OR attire has changed dramatically. Double gloving is routine, at least in trauma surgery where sharp bone frag-ments are present. In addition to the routine scrub suit and double gloves, some surgeons wear rubber boots, a waterproof apron, and sleeve protectors. Goggles, or a wrap-around face shield, are worn to protect against splashing when the surgical wound is irrigated or when bone drilling is performed. In hospitals where numerous total joint procedures are performed, a full bubble mask may be used. This mask provides full barrier protection from bone fragments and splashes. Safe ventilation is accomplished through an accom-panying hood with a separate air-filtration system.
Both the AORN and the American Society of Perianesthesia Nurses (ASPAN) have recommended standards of care for the patient with latex allergy (AORN, 2002; ASPAN, 2000). These recommenda-tions include early identification of the patient with a latex allergy, preparation of a latex allergy supply cart, and maintenance of latex allergy precautions throughout the perioperative period. Due to the increased number of patients with latex allergies, many latex-free products are now available. For safety, manufacturers and hospital material managers need to take responsibility for identifying the latex content in items used by patients and health care personnel.
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