- Email: [email protected]
OR Fire Safety: A Triad of Prevention
JULY 1997, VOL 66, NO 1
for developing allergies to natural rubber latex and if they also should be managed with latex avoidance protocols. The purpose of this study was to determine if the spina bifida congenital anomaly is itself a risk factor for latex sensitization or if exposures to latex during multiple surgical procedures are the actual risk factor. The researchers also evaluated the children in this study for other latex sensitization risk factors, such as atopy (ie, inherited predisposition to allergies) and ethylene oxide (EO) sensitization. Sample. The sample consisted of 80 French children between ages one year and 16 years who were divided into three groups. Group A consisted of 29 children who had spina bifida. Group B consisted of 31 children who did not have spina bifida but who had undergone multiple surgical procedures. Group C consisted of 20 children who had either no exposure to general anesthesia or who had undergone general anesthesia once, and these children served as the control group. The children in the three groups were similar in age, gender, and atopic status. The number of previous surgical procedures and perioperative anaphylactic episodes was comparable between the group of children with spina bifida (ie, group A) and those who had undergone multiple surgical procedures but did not have spina bifida (group B). Methods. The researchers interviewed the children and their parents to identify previous reactions to products made of natural rubber latex (eg, balloons, bottle nipples). To diagnose atopy in the children, the researchers applied prick tests with four common inhalant allergens. They defined
atopic status as one or more positive tests to these allergens. They evaluated latex sensitivity in all 80 children by applying skin prick tests with a commercial extract of natural latex and measuring specific immunoglobulin E to latex with the radioallergosorbent test (RAST). The RAST was considered positive if the response was greater than 0.35 Pharmacia RAST U/mL. Any child who had a positive skin prick test or a positive RAST was considered sensitized to latex. The researchers also evaluated each child’s EO sensitization using the RAST. They performed positive and negative control tests with codeine phosphate and coca solutions, respectively. Prick tests were considered positive if wheals measured greater than half the wheal induced by the positive control and greater than the wheal induced by the negative control. Results. Fifty-nine percent of the children in group A and 55% of the children in group B were hypersensitive to latex; however, none of the children in group C was hypersensitive to latex. Ethylene oxide sensitization followed a similar pattern, with 44%of the children in group A and 19% of the children in group B being sensitive to EO and none of the children in group C being sensitive to EO. Ethylene oxide sensitization was associated with latex sensitization status but not with the number of previous surgical procedures. The incidence of atopy in the latex-sensitized children was twice that of children who were not sensitized to latex, underscoring the relationship between atopy and latex sensitization.
Perioperative nursing implications. This study should heighten 162 AORN JOURNAL
perioperative nurses’ awareness of latex sensitization in pediatric surgical patients. It also emphasizes the possibility that all children (ie, not just children with spina bifida) who undergo multiple surgical procedures may be at high risk for latex sensitization. Perioperative nurses play key roles in preventing children’s sensitization to natural rubber latex by minimizing these children’s intraoperative exposures to latex products. One perioperative nursing intervention is to ensure that powderless, lowallergen, latex surgical gloves are used routinely. For surgical patients who are at high risk for latex sensitization, perioperative nurses can institute latex avoidance precautions. Perioperative nurse educators need to provide inservice education programs about screening surgical patients for latex-sensitization risk factors and about nursing care for these high-risk patients. This study provides an impetus for perioperative nurses to conduct further research about latex sensitization, including studies to identify risk factors. Further research also may identify the prevalence of and risk factors for EO sensitization. VICTORIA M. STEELMAN RN, PHD(c), CNOR CHAIR NURSINGRESEARCH COMMITTEE FILM REVIEW
OR FIRE SAFETY: A TRlAD OF PREVENTKIN
T
his film begins by identifying the three components necessary to start a fire: oxygen source, heat, and fuel. The OR, by its very nature, contains all three of these elements and is
JULY 1997. VOL 66, NO 1
extremely vulnerable to the threat of fire. It is crucial. therefore, that all surgical team members know how to respond quickly and efficiently should a fire occur in the OR. The film also introduces the OR fire prevention triad: awareness, diligence, and planning. Awareness is knowing that there is a high fire potential in the OR and understanding that under the right conditions, everything in the OR can bum. Diligence is having and following OR policies and procedures on fire safety. This includes knowing what skin prep solutions may be flammable, checking biomedical equipment, and adhering to safe electrosurgical practices. The third part of the fire prevention triad is planning. If a f i e in the OR should occur, perioperative nurse managers should have a plan of action for staff members to follow. This 14-minute videotape and study guide is an excellent training tool for new OR staff members and a good refresher for experienced OR personnel, including anesthesia care providers, surgeons, nurses, and surgical technologists. The videotape costs $99 and is available from Johnson & Johnson Medical, Inc, (800) 4868247.
BOOK REVIEWS
EPIDEMIOLOGY FOR PUBLIC HEALTH PRACTICE By Robert H . Friis, Thomas A. Sellers 1996,430 p p $39 paperback
T
his book is a comprehensive introduction to the principles and practices of epidemiology, beginning with the most basic of epidemiologic concepts and progressing to more advanced topics, such as research design. This is a valuable addition for graduate students of both the health sciences and liberal arts because social, psychological, and biologic epidemiology is reviewed and discussed. Readers should have some basic understanding of statistics because the authors use results and application of common statistical tests. The chapters and content progress from one stage to the next, building from basic epidemiologic principles to more advanced designs of epidemiologic practice and research. Each chapter begins with a list of objectives to help focus readers, followed by 'an outline, clarification of concepts, appropriate tables and figures, a conclusion, and study questions. The study questions include definitions and pertiMARY QNEALE nent questions relative to the chapRN, MN, CNOR ter content. A comprehensive bibliPERIOPERATIVE NURSINGSPECIALIST ography is included at the end of CENTER FOR NURSINGPRACTICE, HEALTH each chapter. Examples that illusPOLICY,AND RESEARCH trate particular chapter concepts are
164 AORN JOlJRNAL
easy to understand. Many govemment epidemiologic statistics (eg, from the Centers for Disease Control and Prevention, National Institutes of Health) are used to illustrate concepts, and data is current within the last decade. The authors discuss the highlights of epidemiologic history of the social and health sciences. They describe the progression of research in the identification of infectious diseases and health care practices through the centuries to today's standards of practice. Contemporary topics also are discussed (eg, the pros and cons of early mammography screening for cancer) along with transcultural, gender, and international issues (eg, suicide, breast cancer rates; meningococcal disease distribution). As patient care moves rapidly back into the community setting, the section on community screening provides valuable information for health care providers who work with preoperative and postoperative patients. This book is useful and applicable to graduate-level classroom settings or to individuals who are interested in or who are working in community settings. This book is available from Aspen Publishers, Inc, 7201 McKinney Cir, Frederick, MD 21701-9782; (800) 638-8437. CYNTHIA C. ELLIS-STOLL RN, MSN, CNS, ARNP, TNCC (I) STAFFNURSE ST JOSEPH MEDICAL CENTER WICHITA,KAN
for developing allergies to natural rubber latex and if they also should be managed with latex avoidance protocols. The purpose of this study was to determine if the spina bifida congenital anomaly is itself a risk factor for latex sensitization or if exposures to latex during multiple surgical procedures are the actual risk factor. The researchers also evaluated the children in this study for other latex sensitization risk factors, such as atopy (ie, inherited predisposition to allergies) and ethylene oxide (EO) sensitization. Sample. The sample consisted of 80 French children between ages one year and 16 years who were divided into three groups. Group A consisted of 29 children who had spina bifida. Group B consisted of 31 children who did not have spina bifida but who had undergone multiple surgical procedures. Group C consisted of 20 children who had either no exposure to general anesthesia or who had undergone general anesthesia once, and these children served as the control group. The children in the three groups were similar in age, gender, and atopic status. The number of previous surgical procedures and perioperative anaphylactic episodes was comparable between the group of children with spina bifida (ie, group A) and those who had undergone multiple surgical procedures but did not have spina bifida (group B). Methods. The researchers interviewed the children and their parents to identify previous reactions to products made of natural rubber latex (eg, balloons, bottle nipples). To diagnose atopy in the children, the researchers applied prick tests with four common inhalant allergens. They defined
atopic status as one or more positive tests to these allergens. They evaluated latex sensitivity in all 80 children by applying skin prick tests with a commercial extract of natural latex and measuring specific immunoglobulin E to latex with the radioallergosorbent test (RAST). The RAST was considered positive if the response was greater than 0.35 Pharmacia RAST U/mL. Any child who had a positive skin prick test or a positive RAST was considered sensitized to latex. The researchers also evaluated each child’s EO sensitization using the RAST. They performed positive and negative control tests with codeine phosphate and coca solutions, respectively. Prick tests were considered positive if wheals measured greater than half the wheal induced by the positive control and greater than the wheal induced by the negative control. Results. Fifty-nine percent of the children in group A and 55% of the children in group B were hypersensitive to latex; however, none of the children in group C was hypersensitive to latex. Ethylene oxide sensitization followed a similar pattern, with 44%of the children in group A and 19% of the children in group B being sensitive to EO and none of the children in group C being sensitive to EO. Ethylene oxide sensitization was associated with latex sensitization status but not with the number of previous surgical procedures. The incidence of atopy in the latex-sensitized children was twice that of children who were not sensitized to latex, underscoring the relationship between atopy and latex sensitization.
Perioperative nursing implications. This study should heighten 162 AORN JOURNAL
perioperative nurses’ awareness of latex sensitization in pediatric surgical patients. It also emphasizes the possibility that all children (ie, not just children with spina bifida) who undergo multiple surgical procedures may be at high risk for latex sensitization. Perioperative nurses play key roles in preventing children’s sensitization to natural rubber latex by minimizing these children’s intraoperative exposures to latex products. One perioperative nursing intervention is to ensure that powderless, lowallergen, latex surgical gloves are used routinely. For surgical patients who are at high risk for latex sensitization, perioperative nurses can institute latex avoidance precautions. Perioperative nurse educators need to provide inservice education programs about screening surgical patients for latex-sensitization risk factors and about nursing care for these high-risk patients. This study provides an impetus for perioperative nurses to conduct further research about latex sensitization, including studies to identify risk factors. Further research also may identify the prevalence of and risk factors for EO sensitization. VICTORIA M. STEELMAN RN, PHD(c), CNOR CHAIR NURSINGRESEARCH COMMITTEE FILM REVIEW
OR FIRE SAFETY: A TRlAD OF PREVENTKIN
T
his film begins by identifying the three components necessary to start a fire: oxygen source, heat, and fuel. The OR, by its very nature, contains all three of these elements and is
JULY 1997. VOL 66, NO 1
extremely vulnerable to the threat of fire. It is crucial. therefore, that all surgical team members know how to respond quickly and efficiently should a fire occur in the OR. The film also introduces the OR fire prevention triad: awareness, diligence, and planning. Awareness is knowing that there is a high fire potential in the OR and understanding that under the right conditions, everything in the OR can bum. Diligence is having and following OR policies and procedures on fire safety. This includes knowing what skin prep solutions may be flammable, checking biomedical equipment, and adhering to safe electrosurgical practices. The third part of the fire prevention triad is planning. If a f i e in the OR should occur, perioperative nurse managers should have a plan of action for staff members to follow. This 14-minute videotape and study guide is an excellent training tool for new OR staff members and a good refresher for experienced OR personnel, including anesthesia care providers, surgeons, nurses, and surgical technologists. The videotape costs $99 and is available from Johnson & Johnson Medical, Inc, (800) 4868247.
BOOK REVIEWS
EPIDEMIOLOGY FOR PUBLIC HEALTH PRACTICE By Robert H . Friis, Thomas A. Sellers 1996,430 p p $39 paperback
T
his book is a comprehensive introduction to the principles and practices of epidemiology, beginning with the most basic of epidemiologic concepts and progressing to more advanced topics, such as research design. This is a valuable addition for graduate students of both the health sciences and liberal arts because social, psychological, and biologic epidemiology is reviewed and discussed. Readers should have some basic understanding of statistics because the authors use results and application of common statistical tests. The chapters and content progress from one stage to the next, building from basic epidemiologic principles to more advanced designs of epidemiologic practice and research. Each chapter begins with a list of objectives to help focus readers, followed by 'an outline, clarification of concepts, appropriate tables and figures, a conclusion, and study questions. The study questions include definitions and pertiMARY QNEALE nent questions relative to the chapRN, MN, CNOR ter content. A comprehensive bibliPERIOPERATIVE NURSINGSPECIALIST ography is included at the end of CENTER FOR NURSINGPRACTICE, HEALTH each chapter. Examples that illusPOLICY,AND RESEARCH trate particular chapter concepts are
164 AORN JOlJRNAL
easy to understand. Many govemment epidemiologic statistics (eg, from the Centers for Disease Control and Prevention, National Institutes of Health) are used to illustrate concepts, and data is current within the last decade. The authors discuss the highlights of epidemiologic history of the social and health sciences. They describe the progression of research in the identification of infectious diseases and health care practices through the centuries to today's standards of practice. Contemporary topics also are discussed (eg, the pros and cons of early mammography screening for cancer) along with transcultural, gender, and international issues (eg, suicide, breast cancer rates; meningococcal disease distribution). As patient care moves rapidly back into the community setting, the section on community screening provides valuable information for health care providers who work with preoperative and postoperative patients. This book is useful and applicable to graduate-level classroom settings or to individuals who are interested in or who are working in community settings. This book is available from Aspen Publishers, Inc, 7201 McKinney Cir, Frederick, MD 21701-9782; (800) 638-8437. CYNTHIA C. ELLIS-STOLL RN, MSN, CNS, ARNP, TNCC (I) STAFFNURSE ST JOSEPH MEDICAL CENTER WICHITA,KAN