Operating room and PACU staff exposure to waste anesthetic gases is one of the least-understood OR hazards and one of the most difficult to prevent. The harm associated with these exposures may take years to develop, and when eventually seen, the underlying causes may go unrecognized. In addition, the concentrations of anesthetic waste gases that are of concern are so low as to seem almost immeasurable (see "How to Document Exposure").

We know exposure to waste anesthetic gases can cause many adverse effects. Short-term concentrated exposure can cause nausea and dizziness, as well as impaired judgment and coordination. Long-term effects may include sterility or miscarriages, as well as liver and kidney disease. The most common causes for exposure, according to OSHA, are poor or leaking connections from the gas lines and inadequate maintenance of anesthesia machines.

Reducing the risk
Even if your staff aren't being exposed to waste anesthetic gases, you should minimize the chance they will be. But maintaining a healthy atmosphere in a surgical facility is difficult, because anesthetic agents are intended to have a strong biological effect. Administrators and anesthesia providers must assume the responsibility of protecting staff as well as patients. OSHA offers the following recommendations to help you minimize OR and PACU staff exposure:

• Regulate your OR air-flow system. There should be a minimum total of 15 air changes per hour, with a minimum of three changes of fresh air per hour. Don't recirculate OR air containing waste anesthetic gases to other ORs or areas of the facility.
• Regularly inspect and maintain the anesthesia machine. Schedule this at least every four months. Gas leakage should be less than 100 ml/min under normal operation. Pay special attention to the scavenging system's performance in collecting and removing waste gas.
• Pre-flight the anesthesia machine daily. Before the day's first case, your anesthesia personnel should check all connectors and tubes on the machine, as well as the alarm system and breathing circuits.
• Safe housekeeping. Although staff are under pressure to keep cases moving, they should immediately clean up spilled liquid anesthesia gases to minimize exposure.

An invisible danger
Budgets are tight, and patient care is a more pressing concern than is controlling staff anesthetic gas exposure. Even so, you have a responsibility to your staff, not to mention staying in regulatory compliance and meeting accreditation standards.

The best source for details of sampling procedures is OSHA's Web site (www.osha-slc.gov/dts/sltc/methods/toc.html). You may also want to seek help from an industrial hygienist or a consulting company. A consultant may seem like a luxury if you're on a tight budget, but the most important thing you can do is provide a healthy environment for your staff.

Costs aside, you must implement effective safety protocols for protecting your staff from this invisible and dangerous byproduct of performing surgery.