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.

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.

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.

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 Architect’s 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).

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).

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.

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

Solutions In addition, the Hospital Investigations: Health Hazards Chapter of the OSHA Technical Manual recommends that:Hospital Investigations: Health Hazards 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 ] for all employees exposed to waste anesthetic gases. See Healthcare-wide Hazards - Hazardous Chemicals.29 CFR Hazardous Chemicals

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