CSFA Operating Room Safety and Environmental Hazards — Questions and Answers
Question 1: Which three elements make up the surgical fire triangle?
- Heat, smoke and electricity
- Ignition source, fuel and oxidizer (Correct answer)
- Oxygen, nitrogen and alcohol
- Laser, drapes and suction
Correct answer: Ignition source, fuel and oxidizer
A surgical fire needs an ignition source (for example an electrosurgical unit or laser), a fuel (drapes, alcohol-based prep, hair, gauze) and an oxidizer (oxygen or nitrous oxide). Prevention means controlling each of these, for instance letting alcohol prep dry and keeping FiO2 low near the airway.
Question 2: To limit occupational radiation exposure during intraoperative fluoroscopy, the first assistant should rely primarily on which three principles?
- Time, distance and shielding (Correct answer)
- Speed, angle and filtration
- Lead gloves, goggles and dosimeter only
- Distance, humidity and ventilation
Correct answer: Time, distance and shielding
ALARA (as low as reasonably achievable) relies on minimizing time near the beam, maximizing distance (exposure falls with the inverse square of distance) and using shielding such as lead aprons and thyroid collars.
Question 3: Before a laser is activated near the airway during ENT surgery, which precaution is most important?
- Increasing the FiO2 to 100%
- Using a laser-resistant endotracheal tube with a saline-filled cuff and keeping wet sponges nearby (Correct answer)
- Using alcohol-based skin prep immediately before activation
- Turning off room suction
Correct answer: Using a laser-resistant endotracheal tube with a saline-filled cuff and keeping wet sponges nearby
Airway fires are a major laser hazard. A laser-resistant tube with a saline-filled (often dye-tinted) cuff, the lowest safe oxygen concentration, and moist sponges or towels around the field all reduce fuel and ignition risk.
Question 4: Surgical smoke plume produced by electrosurgery is best controlled with which method?
- Standard wall suction held near the field
- A smoke evacuator with ULPA filtration and the capture device within about 2 inches of the source (Correct answer)
- A regular surgical mask alone
- Opening the OR door to improve airflow
Correct answer: A smoke evacuator with ULPA filtration and the capture device within about 2 inches of the source
Surgical plume can contain toxic gases, viable viral material and particulates. A dedicated smoke evacuator with ULPA filtration, placed close to the site, removes plume effectively. Wall suction and standard masks are inadequate.
Question 5: When passing and handling sharps during closure, which practice best reduces percutaneous injuries to the surgical team?
- Hand-to-hand passing of loaded needle holders
- Using a designated neutral zone for passing sharps (Correct answer)
- Recapping hypodermic needles with two hands
- Leaving needles on the Mayo stand unprotected
Correct answer: Using a designated neutral zone for passing sharps
A neutral (hands-free) zone, where sharps are set down and picked up rather than passed hand to hand, is a recommended practice for reducing needlestick and sharps injuries. Other recommended measures include blunt suture needles and one-handed recapping devices.
Question 6: A patient with spina bifida is scheduled for surgery. Which allergy precaution is most important for the team to plan for?
- Iodine allergy
- Latex allergy, requiring a latex-safe environment (Correct answer)
- Penicillin allergy
- Shellfish allergy
Correct answer: Latex allergy, requiring a latex-safe environment
Patients with spina bifida have repeated early exposure to latex through catheterization and surgeries, which gives them a very high risk of latex sensitization and anaphylaxis. The room should be set up latex-safe, ideally as the first case of the day.
