Waste Anesthetic Gases

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Waste Anesthetic Gases
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Waste Anesthetic Gases

• The anesthetic gas and vapors that leak out into
  the surrounding room during medical and surgical
  procedures are considered waste anesthetic gases.
  They include nitrous oxide and halogenated agents
  (vapors) such as
• Enflurane
• Isoflurane
• Sevoflurane
• Desflurane
• Halothane
• Potential adverse health effects of exposure to
  waste anesthetic gases include loss of
  consciousness, nausea, dizziness, headaches,
  fatigue, irritability, drowsiness, problems with
  coordination and judgment, as well as sterility,
  miscarriages, birth defects, cancer, and liver
  and kidney disease.

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Potential Hazards

• Exposure to waste anesthetic gases occurs from
• Poor work practices during the anesthetization of
  patients.
• Leaking or poor gas-line connections.
• Improper or inadequate maintenance of the
  machine.
• Patient exhalation in the recovery room or Post
  Anesthesia Care Unit (PACU) during off-gassing
  of surgery patients.

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Solutions

• OSHA provides the following recommendations
• The use of appropriate anesthetic gas scavenging
  systems in operating rooms.
• Appropriate waste gas evacuation involves
  collecting and removing waste gases, detecting
  and correcting leaks, considering work practices,
  and effectively ventilating the room.

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Solutions

• Provide enough ventilation in the surgical suite
  to keep the room concentration of waste
  anesthetic gases below the applicable
  occupational exposure levels. The ventilation
  design and specifications should meet the most
  current American Institute of Architects
  Guidelines for Design and Construction of Health
  Care Facilities.
• To minimize waste anesthetic gas concentrations
  in the operating room, the recommended air
  exchange rate (room dilution ventilation) is a
  minimum total of 15 air changes per hour with a
  minimum of 3 air changes of outdoor air (fresh
  air) per hour (American Institute of Architects
  2006).

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Solutions

• Use of a properly designed and operating dilution
  ventilation system to minimize waste anesthetic
  gas concentrations in recovery room areas.
• System should provide a recommended minimum total
  of 6 air changes per hour with a minimum of 2 air
  changes of outdoor air per hour (American
  Institute of Architects 2006).

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Solutions

• Conduct periodic exposure monitoring with
  particular emphasis on peak gas levels in the
  breathing zone of nursing personnel working in
  the immediate vicinity of the patient's head.
• Note Methods using random room sampling to
  assess ambient concentrations of waste anesthetic
  gases in the recovery room are not an accurate
  indicator of the level of exposure experienced by
  nurses providing bedside care. Due to the
  closeness of the recovery room nurse to the
  patient, such methods would consistently
  underestimate the level of waste anesthetic gases
  in the breathing zone of the bedside nurse.
  Therefore, personal sampling is required to
  determine the employee's overall workplace
  exposure to waste anesthetic gases.

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Solutions

• Implement a routine ventilation system
  maintenance program to keep waste anesthetic gas
  exposure levels to a minimum.

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Solutions

• In addition, the Hospital Investigations Health
  Hazards Chapter of the OSHA Technical Manual
  recommends that
• Vaporizers of anesthesia machines be turned off
  when not in use. Proper face masks, sufficiently
  inflated endotracheal tubes, and the prevention
  of anesthetic spills will decrease the amount of
  waste anesthetic gases in the operating room.
  Inspection and maintenance of anesthesia
  machines be conducted by factory service
  representatives or other qualified personnel at
  least every four months. Leakage of gas should be
  less than 100 ml/min during normal operation.
  During normal operation, employee exposure to
  anesthetic gases in use should not exceed the
  NIOSH recommended exposure limits.Prior to each
  day's use, a complete check of all anesthesia
  equipment (connectors, tubing, etc.) should be
  conducted.  
• Spills of liquid anesthetic agents be cleaned up
  promptly. Information be provided and a
  training program implemented in accordance with
  OSHA's Hazard Communication Standard 29 CFR
  1910.1200 for all employees exposed to waste
  anesthetic gases. See Healthcare-wide Hazards -
  Hazardous Chemicals.

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The End!

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