Roy H. Constantine PA-C, MPH, PhD, FCCM, DFAAPA
Former CSPS Representative and Chair
Article originally printed in Sutureline: Jan/Feb 2017 p. 8
One of the latest topics brought to the table at the Council on Surgical and Perioperative Safety (CSPS) concerns further research on exposure to waste anesthetic gases (WAGs) and any adverse effects identified on healthcare workers.
A position statement from the American Society of PeriAnesthesia Nurses (ASPAN) focuses on “Air Quality and Occupational Hazard Exposure Prevention.” ASPAN is currently working with the National Institute for Occupational Safety and Health (NIOSH) to investigate and evaluate nurse exposure to waste anesthetic gases in healthcare settings, particularly in the Post Anesthesia Care Unit (PACU).
From Position Statement 15 on Air Quality and Occupational Hazard Exposure Prevention, “NIOSH recommends that exposure to waste anesthetic gases (WAGs) are minimized to the lowest levels possible.” The recommendation by professional and governmental organizations is to “scavage WAGs.”
Awareness regarding exposure and risks is important. Note that standards do exist regarding the design of a PACU and the minimal number of air exchanges that need to occur. “The standard for air exchanges in the PACUS is to provide, as a proposed minimum, a total of six air exchanges per hour with a minimum of two air changes of outdoor air per hour. Theses exchanges are recommended to adequately dilute waste anesthetic gases.”
Many facilities already follow the international technical society regulations organized to Advance the Arts and Science of Heating, Ventilation, Air-conditioning and Refrigeration (ASHRAE) as specified by Facility Guidelines Institute (FGI). Specific testing of these areas ventilation units are performed in order to comply with CMS regulations.
The following is ASPAN’s Position:
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It is, therefore, ASPAN’s position that necessary, appropriate and evidence-based protective engineering controls, technologies, work practices, and personal protective equipment be utilized in the perianesthesia environment.
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ASPAN advocates for a perianesthesia environment that promotes patient health and safety.
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ASPAN recommends that occupational exposure to waste anesthetic gases, as well as respiratory pathogens, be controlled by adherence to regulations and guidelines set forth by nationally recognized agencies (e.g., National Institute for Occupational Safety and Health [NIOSH], Centers for Disease Control and Prevention [CDC], Occupational Safety and Health Administration [OSHA]) to establish a hierarchy of controls based on principles of good industrial hygiene.
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ASPAN further recommends adherence to identified regulations and guidelines that protect HCWs and patients at risk in the perianesthesia environment.
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ASPAN supports the development of health care policies addressing improved air quality and reduction of occupational exposure hazards. ASPAN supports additional research studies and encourages collaboration with other professionals to improve air quality and safety related to occupational hazards exposure to patients and HCWs.
Physician assistants are important “patient-safety stakeholders.” Recommendation awareness is extremely important. With you effort the goal of reaching high reliability is that much closer. Please take the time to review ASPANs position statement - the link is included below.
Position Statement 15- American Society of PeriAnesthesia Nurses – A Position Statement on Air quality and Occupational Hazard Exposure Prevention Available at:http://www.aspan.org/Portals/6/docs/ClinicalPractice/PositionStatement/Current/PS15_2016.pdf?ver=2016-08-08-084634-130