Assessment of electrical safety in the operating room As practised by the anesthesia practitioners at the Kenyatta national hospital

Abstract

Objective - To assess the practices on electrical safety in the operating room by the anesthesia practitioners at the Kenyatta National Hospital (KNH) during anesthesia and surgery Setting - Kenyatta National Hospital Operating Rooms Target population - Anesthesia practitioners working in the KNH operating rooms Methodology - The anesthesia providers were picked by purposive sampling method and they were provided with questionnaires which most of them filled within a week. Various aspects of electrical safety were assessed including their knowledge on electrical devices and their classification, the harmful effects of electrical current, their experience of power outages and backup, knowledge of combustible agents used within the operating room and their daily practices and difficulties experienced in achieving electrical safety within the operating room. Results - Most anesthetists (95.8%) had experienced power outages within the operating room. Substances that can be ignited by a spark of electricity were indicated as halothane (29.2%), surgical spirit (87.5%), ether (79.2%), and oxygen (70.8%). There were mixed responses as to the use of line isolation monitors and ground fault circuit interrupters within the operating room. All the anesthesia providers gave the correct responses concerning the harmful effects of electricity in the operating room. The laryngoscope, cardiac pacemaker and nerve stimulator were correctly identified by 91.6%, 29.2% and 54.2% respectively of the respondents as low risk devices using less than 24V of electricity. The electro surgical unit, defibrillator, x-ray machine and anesthesia machine were correctly classified as earthed by 62.5%, 50%, 75%, and 45.8% respectively of the respondents. Sixty six point seven (66.7%) disagreed that electrical extension cords are not desirable while 33.3% agreed they are not desirable within the operating room. A well gelled grounding pad and the area in contact with the patient were each indicated by 70.8% of the respondents as very important safety practice. Distance of the grounding pad from the operative site and pacemaker wires were indicated as important safety practice by 20.8% and 62.5% of the respondents respectively. Against the distance from the operative site 62.5% indicated it made no difference. The distance from ECG wires was indicated as making no difference by 37.5% of the respondents while only 16.7% indicated it to be an important safety practice, and the rest 45.9% indicated that it made no difference. Concerning patients with implanted pacemakers, 75% of the respondents indicated preoperative evaluation was a very important safety practice and documentation of the type of pacemaker used and availability of x drugs for the treatment of heart block were indicated as important safety practice by 66.7% and 70.8% of the respondents respectively. All the respondents indicated that they would immediately report a potential electrical hazard in a machine. Electrical extension cord was reported as desirable within the operating room. Among the drawbacks lack of safety guidelines was indicated by all the anesthesia practitioners as a drawback. Others were faulty electricity outlets (95.8%), faulty equipment (91.7%), lack of sensitization of operating room personnel (91.7%), not considered part of anesthetist's job (70.8%) and long response time from biomedical technicians/electricians (66.7%) Conclusion - All the anesthesia practitioners know the dangers associated with electrical current to the body. The hospital has good power backup plan. Most anesthesia providers are familiar with the combustible substances used in the operating room. Classification of devices as per the electrocution risk is not clear to a number of anesthesia providers. The dangers of using an electrical extension cord are not known to most anesthesia providers. Not all safety measures related to the ESU grounding pad are observed. Most anesthetists know what to do when there is a potential electrical hazard. Routine safety measures are observed by most anesthetists. There is an apparent lack of team work among operating room personnel. Electrical safety guidelines are either lacking or are not displayed.