Precautionary Practices for Administering Anesthetic Gases: A Survey ofPhysician Anesthesiologists Nurse Anesthetists and AnesthesiologistAssistants

摘要

Scavenging systems and administrative and work practice controls for minimizing occupational exposure to waste anesthetic gases have been available and recommended for many years. Anesthetic gases and vapors that are released or leak out during medical procedures are considered waste anesthetic gases. To better understand the extent recommended practices are used, the NIOSH Health and Safety Practices Survey of Healthcare Workers was conducted in 2011 among members of professional practice organizations representing anesthesia care providers (ACPs) including physician anesthesiologists, nurse anesthetists and anesthesiologist assistants. This national survey is the first to examine self-reported use of controls to minimize exposure to waste anesthetic gases among ACPs. The survey was completed by 1,783 nurse anesthetists, 1,104 physician anesthesiologists and 100 anesthesiologist assistants who administered inhaled anesthetics in the seven days prior to the survey. Working in hospitals and outpatient surgical centers, respondents reported that they most often administered sevoflurane and, to a lesser extent desflurane and isoflurane, in combination with nitrous oxide. Use of scavenging systems was nearly universal, reported by 97% of respondents. However, adherence to recommended administrative and work practice controls were lacking to varying degrees and differed among those administering anesthetics to pediatric (P) or adult (A) patients. Examples ofpractices which increase exposure risk, expressed as percent of respondents, included:using high (fresh gas) flow anesthesia only (17% P, 6% A), starting anesthetic gas flowbefore delivery mask or airway mask was applied to patient (35% P; 14% A); not routinelychecking anesthesia equipment and components for leaks (4% P, 5% A), and using afunnel-fill system to fill vaporizers (16%). Respondents also reported that facilitieslacked safe handling procedures (19%) and hazard awareness training (18%). Adherence toprecautionary work practices was generally highest among nurse anesthetists compared tothe other ACPs. Successful management of waste anesthetic gases should include scavengingsystems, hazard awareness training, availability of standard procedures to minimizeexposure, regular inspection of anesthesia delivery equipment for leaks, prompt attentionto spills and leaks, and medical surveillance.