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OSHA
Occupational Safety & Health
Administration
OSHA

Government agency with the purpose of
protecting the working force

Divisions for Healthcare Wide and Surgical
Suite Specialties
Mission Statement

To prevent work-related injuries, illnesses,
and deaths.

Created in 1971, deaths have been cut by
62% and injuries down by 42%
Scope

In 2005 there were 4.2 million workrelated injuries and illnesses in the US

4.6 of every 100 employees were injured

5703 died from work-related accidents
Priorities






Imminent dangers-accidents about to happen
Fatalities or > 3 employees sent to the hospital
Employee complaints
Referrals from other governmental agencies
Targeted inspections-high injury sites
Follow-up inspections
Fines

Range from warnings to 70,000$
OSHA

Role is to assure safe and healthful
working conditions by authorizing
enforcement of the standards, assisting
states in enforcing healthful working
conditions, by providing research,
information, education, and training in the
field of occupational safety and health.
www.osha.gov
Services
2100 Inspectors
 Complaint investigators
 Engineers
 Physicians
 Educators
 Standard writers

Who OSHA Serves
Every working person except miners,
transportation workers, self-employed,
and public employees
 Plan-To stimulate management
commitment and employee participation in
workplace safety and health programs

Healthcare Wide Hazards
Bloodborne Pathogens
 Electrical
 Ergonomics
 Fire Safety
 Hazardous Chemicals
 Infection Exposure
 Latex Allergy

Healthcare Wide Hazards
Needle sticks
 Noise
 Mercury
 PPE
 Slips/trips/falls
 Stress
 Tb

Healthcare Wide Hazards
Universal Precautions
 Workplace Violence

Surgical Suite Concerns
Waste Anesthetic Gasses
 Bloodborne Pathogens
 Latex
 Compresses Gasses
 Static and Awkward Postures
 Smoke Plume
 Laser Hazards

Surgical Suite Concerns
Hazardous Chemicals
 Equipment Hazards
 Slips/trips/falls
 Radiation Exposure
 Tb

Waste Anesthetic Gasses
Includes N2O and all anesthetic gas
agents (NIOSH division)
 Cause LOC, nausea, dizziness, headaches,
fatigue, irritability, drowsiness,
coordination and judgment problems,
sterility, miscarriages, birth defects,
cancer, and liver or kidney disease

Waste Anesthetic Gasses
Occurs from poor management of the
airway by the anesthesia provider
 Leaking gas line connections
 Improper machine maintenance
 Patient exhaling gasses in the PACU

Waste Anesthetic Gasses
Prevention
-scavengers
- adequate ventilation in the OR room,
- (air exchange of 15 air changes per hour
with a minimum of 3 air changes of
outdoor air per hour)
PACU (6 per hour , 2 from outdoor)

Waste Anesthetic Gasses
Prevention
-periodic exams in the breathing zone near
the patient’s head
-PACU does personal sampling of the RN
caring for the patient
-Implement a routine ventilation system
maintenance program

Waste Anesthetic Gasses
OSHA Recommendations
Vaporizers off when not in use
 Proper fitting face masks
 Sufficient air in ETT tubes
 Prevention of spills
 Machine inspections at least every 4
months

Waste Anesthetic Gasses
OSHA Recommendations
Complete machine check every day
 Spill policy for clean-up
 Training for all working with waste gasses


NIOSH recommendation to OSHA: Workers
should not be exposed to an eight hour timeweighted average of > 2 ppm halogenated
agents (not > 0.5 ppm if nitrous oxide is in use)
or > 25 ppm nitrous oxide.
Bloodborne Pathogens
Hepatitis B (HBV)
 Hepatitis C (HCV)
 Human Immunodeficiency Virus (HIV)

Safer needles / Sharps
 Needleless IV connectors
 Proper Sharps containers

Bloodborne Pathogens
“No pass” instrument policies
 PPE always-impermeable
 Gloves any time hand contact is
anticipated
 Masks-with eye protection whenever
splashes, spray, splatter, or droplets of
blood or fluid may be generated

Bloodborne Pathogens
Dispose of used sharps immediately
 Sharps containers must be in close
proximity to usage
 Never bend, recap, remove, or reuse
needles
 Hand-washing-immediate or cleansing
cloths with hand-washing ASAP

Latex Allergy
Comes from exposure
 Must provide alternatives for diagnosed
employees
 Hypoallergenic are not necessarily latex
free
 Always avoid the use-best if none in the
department

Compressed Gasses
Fixed pipe gas or cylinders
 Fear fire, explosion, or toxicity
 Storage and transport are the concerns
 Store upright only
 Never allow to drop or hit

Static and Awkward positions
Height differences and long procedures
 Muscle fatigue and pooling of blood to the
lower extremities
 Stools when available
 Cushioned shoes
 Raise one foot

Smoke Plume
Laser units cause thermal damage of
tissue and create plume
 Plume contains toxic gasses and vapors
and dead cellular material including blood
and viruses
 See venereal wart transmission
 Research suggests cancer spread also

Smoke Plume
Smoke causes respiratory and ocular
irritation
 Use smoke evacuators, suction lines with
filters, all within 2 inches of the site
 Evacuate all smoke, no matter how little
 Smoke evacuator ON at all times in the
room with related procedures

Laser Hazards
Laser hazard is classified based on their
ability to cause eye and skin damage
 Class 1=no hazard to Class 4=serious
hazard
 Issues are eye damage from reflected
beams, skin burns from direct misguided
beams, and respiratory hazards from
breathing the generated contaminants

Laser Hazards
Protective eyewear specific to that laser
 All glasses must be marked with OD
(optical density) and laser wavelength
 Warning signs must be on the door
 Required laser maintenance and
calibration
 Smoke evacs on with filters
 Laser training and credentialing of users

CO2 Lasers

CO2 Laser (infrared wavelength, invisible
light)
– Strongly absorbed by water, blood, and tissue
(vaporizes)
– Negligible reflection and scatter
 (less damaging to surrounding tissue)
– Favored for precise incisions (upper airway)
– Most common in ENT surgery.
YAG

YAG Laser (neodymium-doped yttriumaluminum-garnet)
– Near Infrared wavelength (invisible light)
– Readily absorbed by dark tissue
– Special goggles needed
– Deepest penetration thus greater thermal
effect
– Best suited for coagulation & tumor debulking
KTP

KTP Laser (K+ titanyl phosphate)
– Green wavelength (visible light)
– Strongly absorbed by Hgb, melanin, pigments
– Special goggles needed
– Tonsillectomies (less blood loss & pain)
Argon

Argon Laser
– Blue/green wavelength (visible light)
– Special goggles needed
– Most commonly used in ophthalmology for
retinal procedures
Helium-Neon

Helium-Neon
– Red wavelength (visible light)
– Aiming beam for CO2 and YAG lasers
Hazardous Chemicals
Peracetic acid (PA) for cold sterilant and
methyl-methacrylate (MMA) for bone
cement
 Mix MMA in a closed system only
 Goggles with PA use
 MSDS Sheets available

Equipment Hazards
Burns or shocks
 Safety training
 Visual inspections of equipment
 Biomedical reviews
 Water spills with electrical equipment
 Cord damages
 Manufacturer’s recommendations
 Reporting plan

Slips /trips/ and falls
No open shoes, slip resistant
 Clean up spills immediately
 CORDS
 Clear passageways

Safety

Everyone’s responsibility
“Alert today, alive tomorrow”