Anesthetic Gases: The Healthcare Worker Perspective

Results of a recently released survey of healthcare workers who provide anesthesia care show that many are not following recommended practices when administering anesthetics.

Yesterday we looked at the results of the survey and the possible health effects of exposure to anesthetic gases. Today we will review recommendations for both employers and healthcare workers to prevent exposure to these gases.

Recommendations for Employers

The National Institute for Occupational Safety and Health (NIOSH) recommends that healthcare employers step up their game and ensure that:

• Anesthesia care providers are initially and periodically trained;
• Safe-handling procedures reflecting recommended practices are in place and support for their implementation is understood;
• Anesthesia machines with scavenging systems are used;
• Anesthesia delivery equipment is regularly inspected for leaks;
• Air monitoring and exposure monitoring are periodically performed;
• Spills and leaks are promptly eliminated; and
• Medical surveillance, exposure monitoring, and other administrative controls are in place.

Recommendations for Workers

According to NIOSH, anesthetic gases cannot be detected by their odor until concentrations are very high. NIOSH recommends that operating-room workers reduce their exposure to anesthetic gases by:

• Inspecting the anesthetic delivery system before each use. Look for irregularities or breaks.
• Checking the patient’s breathing circuit for negative pressure and positive pressure relief as part of the daily machine checklist.
• Turning on the room or local ventilation system.
• Making sure the scavenging equipment is properly connected.
• Connecting the gas outlet to the hospital’s central scavenging system.
• Starting the gas flow after the laryngeal mask or endotracheal tube is installed.
• Filling vaporizers under a ceiling-mounted hood with an active evacuation system.
• Filling vaporizers before or after the anesthetic procedure.
• Making sure that uncuffed endotracheal tubes create a completely sealed airway.
• Using the lowest anesthetic gas flow rates possible for the proper functioning of the anesthesia delivery system and for patient safety.
• Avoiding very high anesthetic gas flow rates to prevent leaks. High flow rates generate more waste anesthetic gases than low flow rates.
• Avoiding delivering anesthesia by open drop (dripping liquid, volatile anesthetic onto gauze).
• Ensuring the proper fit of patient masks, if used.
• Eliminating residual gases through the scavenging system as much as possible before disconnecting a patient from a breathing system.
• Turning the gas off before turning off the breathing system.

Check out Safety.BLR.com’s Healthcare Safety Resource Center for easy access to training and compliance information for safety and health professionals working in the healthcare industry.