Academic journal article Iranian Journal of Public Health

Risk Management Status of Waste Anesthetic Gases Using ECRI Institute Standards

Academic journal article Iranian Journal of Public Health

Risk Management Status of Waste Anesthetic Gases Using ECRI Institute Standards

Article excerpt


Background: The aim of this study was assessment the risk management status of waste anesthetic gases in academicals hospitals in Iran to prevent from harmful effects of these gases on employees' health.

Methods: A descriptive-analytic study was designed in 2011. Standard structured checklist developed by ECRI institute (Emergency Care Research Institute) was applied. Checklists were filled onsite through direct observation and interviews with anesthesia personnel in 46 operating rooms at 4 hospitals from all of the hospitals under affiliation of Isfahan University of Medical Sciences. These hospitals were selected based on the number of surgical beds.

Results: Total means score of WAGs risk management status was 1.72 from the scale of 3. In the studied operating rooms, only 28% complied with predetermined standards, 16% needed improvement and 56% had no compliance. Total mean scores of compliance in planning, training and evaluation and monitoring of waste anesthetic gases were weak and equipment and work activity was at medium level.

Conclusion: The risk management status of waste anesthetic gases in the hospitals to be weak, therefore operating room personnel are exposed to medium to high level of these gases. The hospital mangers should prepare and apply scavenging equipment, development of control program, quality improvement, risk management and maintenance of anesthesia equipment. Finally, ongoing monitoring and evaluation, education to personnel and modification of policy and procedures and improvement of work activities should be considered.

Key words: Risk management, Waste anesthetic gas, Assessment


All operating-room personnel are continuously exposed to trace concentrations of anesthesia agents. Inhalation gases and vapors that leak into the workplace due to medical and research procedures are defined as waste anesthetic gases (WAGs) (1). These gases may leak from the patient's anesthesia breathing circuits because of malabsorption of gases ventilated into patient's lungs during anesthesia. In addition small amounts of volatile anesthetic gases leak from anesthesia machines because the anesthesia machines are not airtight (2). WAGs may be exhaled by patients recovering from anesthesia in the postanesthesia care unit. Anesthesia agents are lipid soluble so those agents eliminated through exhalation without being metabolized in the patient body and the anesthesia machines transfer these gases very slowly into the surrounding without any changes (3, 4).

Waste anesthetic gases including both nitrous oxide and halogenated anesthetics (halothane, enflurane, isoflurane, desflurane, sevoflurane, and methoxyflurane) that over-exposure of them, may produce health effects and hazards to operatingroom personnel. Anesthesiologists, surgeons, dentists, nurse anesthetists, operating-room nurses, operating-room technicians, recovery-room nurses and other operating-room personnel are exposed to these gases (5). Gas exposure and its effects is based on concentration of agent, measured in parts per million (ppm), and length of time the exposure (6). Despite a few number of studies that show no effects of anesthetic gases on the health (7) many studies demonstrated that there was a causes-and-effect relationship between health problems and being exposure to waste anesthetic gases. Based on these result, exposure to excess amounts of these gases, even for a short time, may create short-term and long-term effects on personnel health. Short-term symptoms are including drowsiness, headache, irritability, fatigue, nausea, drowsiness, poor judgment and loss of coordination. Tran. N and in 2000, Showed when personnel leave workplace, symptom of fatigue disappears (8). Chronic symptoms of overexposure can include reproductive effects, kidney and liver diseases. Rogers B. in 1986, showed that exposure to high levels of WAGs can cause cellular, mutagenic, carcinogenic, teratogenic effects and miscarriages in spouses of exposed workers or birth defects in their offspring. …

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