Hazards in the OR: SDS, Spills, Smoke and Sharps

This is Unit Eight of Tech in Surgery Prep. Unit Seven ended with a recall in which every link held. This unit turns the safety lens around, from the patient to the team, because the room that protects patients also exposes the people who work in it. Carry one idea through this lecture. The rules and equipment protect you only if you use what they provide, and most hazard controls fail through small lapses, not missing equipment. A worked example near the end shows a scrub person whose report limited what one lapse caused. By the end you will be able to name the suite's hazards and explain the bloodborne pathogens rule. To handle sharps, exposures, spills and waste. To explain chemical, smoke, gas and latex hazards. And to protect yourself from strain, radiation and lifting injury.

Four entries on the hazards of the suite and the federal rule that protects workers from blood.

The hazards of the suite.

TSC 176 Hazards in the Surgical Suite

The surgical suite protects patients but exposes the team to hazards of its own. Federal workplace guidance lists blood and infectious disease, surgical smoke, waste anesthetic gases, chemicals, radiation, lasers, compressed gases, faulty equipment, slips and trips, and lifting injuries. Each has recognized controls, and the first protection is knowing which hazards a case brings.

The federal rule on blood.

TSC 177 The Bloodborne Pathogens Rule

The Bloodborne Pathogens Standard protects workers who can expect contact with blood or other potentially infectious materials. Bloodborne pathogens include hepatitis B, hepatitis C and HIV, and the other materials include cerebrospinal, pleural, peritoneal and amniotic fluid, and any fluid visibly bloody. The employer keeps a written exposure control plan. Engineering and work practice controls come first, backed by protective equipment. Hepatitis B vaccination is offered, training is given on assignment and yearly, and after an exposure a confidential medical evaluation is made available at once. Eating, drinking, cosmetics and contact lenses are prohibited where exposure is likely.

The written plan.

TSC 178 Exposure Control Plans

Every covered employer keeps a written exposure control plan saying how workers are protected. It is reviewed at least yearly, records the safer devices considered, and asks frontline staff for input. Ask where your facility's plan is kept; you are entitled to know what it says.

A vaccine, offered early.

TSC 179 Hepatitis B Vaccination

Workers with occupational exposure must be offered hepatitis B vaccination after training and soon after starting, within ten working days of initial assignment, unless they have completed the series. Hepatitis B can cause long-term liver disease, and vaccination is one of the strongest protections available.

Five entries on sharps, exposures, spills and waste, the hazards the scrub person handles most directly.

The most sharps anywhere.

TSC 180 Sharps Safety in the OR

Sharps injuries are a direct route for bloodborne infection, and the operating room uses more sharps than almost anywhere. Controls run in order of strength. Engineering: safer devices, blunt-tip suture needles where suitable, shielded or retracting scalpels. Work practices: needles are never bent, recapped by hand or broken, and go into a sharps container at once. Containers are kept close, never overfilled or reached into. A neutral zone or hands-free technique keeps sharps from passing hand to hand, and double gloving is advised. Most injuries happen during passing, loading and disposal, the moments the scrub person controls.

A place for sharps.

TSC 181 The Neutral Zone

A neutral zone is an agreed spot on the field where sharps are placed and picked up, so nobody passes them hand to hand. The scrub person sets a blade or needle holder there, and the surgeon picks it up and returns it. It works only if the whole team agrees before the case.

When a needle sticks.

TSC 182 After a Needlestick

After a needlestick or blood splash, clean the area at once and report immediately. Wash wounds with soap and water, and flush exposed eyes, nose or mouth with water; the employer then provides a confidential medical evaluation. Report every exposure, even a minor one, because treatment can be time-sensitive.

Blood on the floor.

TSC 183 Blood and Body Fluid Spills

Spills of blood or other infectious materials are cleaned promptly, to prevent infection and falls. Protect yourself with gloves, and more if splashing is possible. Contain the spill and keep people out of it. Clean up the material with tools, not hands, for anything that might be sharp. Decontaminate the surface with an appropriate disinfectant, discard the materials as regulated waste, and perform hand hygiene. Fluids on the floor are a leading cause of slips, so a spill is never left for later.

Waste that needs special handling.

TSC 184 Regulated Waste

Regulated waste includes liquid or semi-liquid blood or other infectious materials, and items soaked or caked with them. It goes into closable, leak-resistant containers carrying the orange biohazard label, or into red bags. Sharps never go in a bag, only in a puncture-resistant sharps container.

Six entries on chemical and airborne hazards: data sheets, sterilants and cement, surgical smoke, anesthetic gases and latex.

Information about every chemical.

TSC 185 Safety Data Sheets

A federal hazard communication rule requires employers to keep safety data sheets for hazardous chemicals. Containers must be labelled, workers trained when a new chemical arrives, and the sheets give handling, storage and disposal instructions. Before using an unfamiliar chemical, read its label and data sheet.

Chemicals in the suite.

TSC 186 Chemical Hazards in the Suite

Hazardous chemicals in the suite include sterilants, strong detergents and bone cement used in orthopedic surgery. Bone cement is mixed only in a closed system, and quick-drench eye and body flushing must be available where corrosives are used. Wear the protective equipment the label calls for, such as goggles and gloves.

What surgical smoke carries.

TSC 187 Surgical Smoke

Surgical smoke forms when lasers, electrosurgical units and similar devices destroy tissue with heat. It carries toxic gases such as carbon monoxide, and particles including cellular material and possibly viruses. Short exposure irritates eyes and airways and clouds the view, and its contents have shown mutagenic and carcinogenic potential in laboratory studies. Staff who breathe it daily carry the greatest risk, with headaches, eye watering, airway irritation, nausea and dizziness among the effects. Patients are exposed briefly; the team is exposed for a career, so smoke evacuation is a staff safety measure.

Capturing the plume.

TSC 188 Evacuating the Plume

Surgical smoke is captured at its source with a smoke evacuator or suction with an in-line filter. Keep the nozzle within about two inches of the site, run the evacuator whenever smoke is produced, and evacuate all of it. Used tubing and filters are treated as infectious waste.

Gases that leak.

TSC 189 Waste Anesthetic Gases

Waste anesthetic gases are gases and vapours that leak into the room. Sources include leaking connections, poorly maintained machines and patients exhaling afterwards; controls include scavenging systems, ventilation and daily equipment checks. Reported effects range from headaches and fatigue to reproductive harm, so leaks are reported, not tolerated.

When staff react to latex.

TSC 190 Latex Allergy in Staff

Repeated exposure to latex can make health care workers sensitive or allergic. Symptoms range from itching, rash and watery eyes to wheezing and difficulty breathing, and latex-free gloves such as nitrile or neoprene are used instead. A worker who notices symptoms reports them, because sensitivity can worsen with exposure.

Five entries on the body at work: strain, radiation and lifting, then two worked examples. The opening idea is paid off at the first.

The toll of standing.

TSC 191 Ergonomics and Fatigue

Long standing and repeated movements take a cumulative toll on operating room staff. Neck, back and shoulder problems are common, and adjustable equipment, ergonomic furniture and frequent posture changes reduce the strain. Psychological stress, from trauma and loss, is also a recognized hazard, and support resources exist for it.

Radiation during surgery.

TSC 192 Radiation in the OR

Staff are exposed to ionizing radiation when X-ray and fluoroscopy units are used. Apply three principles. Time: keep exposure as short as practical. Distance: step as far from the source as the work allows. Shielding: lead or lead-equivalent aprons, thyroid collars, leaded eyewear and mounted shields. Never put your hands in the primary beam, and wear a personal dosimeter where the facility requires it. The goal is exposure as low as reasonably achievable. Effects may appear years later, and research suggests no fully safe level; a heavy apron worn for hours also strains the back.

Moving patients safely.

TSC 193 Lifting and Moving Safely

Moving patients onto and off the table is a major source of back and shoulder injuries. Minimize manual lifting, use lateral transfer devices such as air mattresses and powered lifts, and add staff when equipment is unavailable. Good body mechanics alone do not prevent these injuries; equipment and enough hands do.

A splash late in a case.

TSC 194 A Splash at Closing

A worked example, constructed for this course, pays off the opening idea. Late in a long abdominal case, Riley has pushed protective glasses up onto a cap to see the suture in dim light. During irrigation, a spray of blood-tinged fluid reaches Riley's face, and a drop lands in one eye. Riley's instinct is to finish the closing count first. Instead, Riley says plainly that there has been a splash to the eye. A relief scrub person takes over and completes the count. Riley flushes the eye at the eyewash station and reports the exposure, and the facility's procedure follows: a report, a confidential evaluation, and source testing as policy allows. Removing the glasses created the exposure; reporting at once limited it.

Haze over the field.

TSC 195 A Smoky Room

A worked example, constructed for this course, follows a breast procedure using the electrosurgical unit almost continuously. Haze builds, the surgeon coughs, and Taylor, the scrub person, sees the evacuator nozzle has slipped back along the drape and the unit was left off after a pause. Taylor tells the team. The circulator switches it on, and Taylor repositions the nozzle within a couple of inches of the site and secures the tubing. The haze clears in minutes. Afterwards the tubing and filter go as infectious waste, and the team agrees the evacuator starts at the beginning of every energy case. The cause was ordinary, a switch and a drifting nozzle, which is how most hazard controls fail.

Look at what you can now do. You can name the hazards of the surgical suite, and explain the bloodborne pathogens rule, the exposure control plan and hepatitis B vaccination. You can apply sharps controls and the neutral zone, respond to a needlestick and a spill, and keep regulated waste and sharps apart. You can explain data sheets, chemical hazards, surgical smoke and its evacuation, anesthetic gases and latex allergy. And you can limit strain, radiation and lifting injuries, and report an exposure at once. Unit Nine turns to fire, lasers and emergencies in the room.