Surgical Suite Hazards
The anesthetic gases and vapors which leak into the surrounding room during medical procedures are considered waste anesthetic gases.
It is estimated more than 250,000 health care professionals who work in hospitals, operating rooms, dental offices and veterinary clinics, are potentially exposed to waste anesthetic gases and
are at risk of occupational illness.
This first module will take a closer look at waste anesthetic gases and how you can protect yourself from these hazards, as well as other potential hazards in a surgical suite.
Dangerous Waste Gases
The waste anesthetic gases and vapors of concern include the following:
- nitrous oxide
- halogenated agents (vapors)
Some potential effects of exposure to waste anesthetic gases are:
- birth defects
- liver and kidney disease among operating room staff
Employers and employees should be aware of the potential effects and be advised to take appropriate precautions.
Many health care workers are unaware of the potential health hazards associated with waste anesthetic gases in their work environment. This makes them more vulnerable to illness.
Workers could be exposed to waste anesthetic gases from:
- poor work practices during the anesthetization of patients
- leaking or poor gas-line connections
- improper or inadequate maintenance of the machine
- patient exhalation in the recovery room or Post Anesthesia Care Unit (PACU) during off-gassing of surgery patients
On the next tab, we will take a look at some possible solutions to protect yourself against exposure to dangerous anesthetic gases.
Employers should use an anesthetic gas finding system in operating rooms. An appropriate waste gas evacuation involves collecting and removing waste gases, detecting and correcting leaks, considering
work practices, and effectively ventilating the room.
There also needs to be enough ventilation in the surgical suite to keep the room concentration of waste anesthetic gases below the applicable occupational exposure levels. To minimize waste anesthetic
gas concentrations in the operating room, the recommended air exchange rate (room dilution ventilation) is a minimum total of 15 air changes per hour with a minimum of 3 air changes of outdoor air
(fresh air) per hour.
When using a properly designed and operating dilution ventilation system, it will minimize waste anesthetic gas concentrations in recovery room areas. The system should provide a recommended minimum
total of 6 air changes per hour with a minimum of 2 air changes of outdoor air per hour.
OSHA also recommends the following when dealing with anesthesia gases and machines:
- Vaporizers of anesthesia machines should be turned off when not in use. Proper face masks, sufficiently inflated endotracheal tubes, and the prevention of anesthetic spills will decrease the amount of
waste anesthetic gases in the operating room.
- Inspection and maintenance of anesthesia machines should be conducted by factory service representatives or other qualified personnel at least every four months.
- Prior to each day's use, a complete check of all anesthesia equipment (connectors, tubing, etc.) should be conducted.
- Spills of liquid anesthetic agents should be cleaned up promptly.
Occupational exposure to blood and other potential infectious material (OPIM) puts surgical room employees at risk of infection from bloodborne pathogens while performing surgery-related tasks.
- Hepatitis B Virus
- Hepatitis C Virus
- Human Immunodeficiency Virus (HIV)
Among other things, OSHA's Bloodborne Pathogens Standard, 1910.1030, requires that engineering and work practice controls be used to eliminate or minimize exposures to blood and OPIM.
- Engineering controls. These are devices that isolate or remove the bloodborne pathogens hazard from the workplace. They include sharps disposal containers, selfsheathing needles, and safer medical devices, such as sharps with engineered sharps-injury protection and needleless systems.
- Work practice controls. These are practices that reduce the possibility of exposure by changing the way a task is performed, such as appropriate practices for handling and disposing of contaminated sharps, handling specimens, handling laundry, and cleaning contaminated surfaces and items.
- Personal protective equipment (PPE). PPE includes gloves, gowns, eye protection, and masks. Employers must clean, repair, and replace this equipment as needed. Provision, maintenance, repair and replacement are at no cost to the worker.
Sharps injuries in the surgical area must be eliminated or minimized through use of measures such as:
- Using safer needle/other sharps devices.
- Using blunt-tip suture needles.
- Using needleless IV connectors.
- Providing proper containers for sharps.
- Perform a "No Pass Zone" for surgical instruments
- You should have a method for passing equipment safely between surgeon and assistants.
- The hands-free technique is a work practice whereby a tray or other means are used to eliminate simultaneous handling of sharp instruments during surgery.
- Appropriate personal protective equipment (PPE) must be worn if blood or OPIM exposure is anticipated. The type of PPE depends on the anticipated exposure. Appropriate PPE includes, but is not
limited to, gloves, gowns, face shields or masks, and shoe covers. For example:
- Gloves must be worn when hand contact with blood, mucous membranes, OPIM, or non-intact skin is anticipated, or when handling contaminated items or surfaces.
- Masks, in combination with eye protection devices, must be worn whenever splashes, spray, splatter or droplets of blood or OPIM may be generated.
Sharps Injuries (Continued)
- Contaminated needles and other contaminated sharps be discarded immediately or as soon as feasible into appropriate containers.
- Sharps containers must be located close to the area where sharps are used or could be found.
- Contaminated needles and other contaminated sharps must not be bent, recapped, or removed. Shearing or breaking contaminated needles is prohibited.
- Employers must make sure hand washing facilities be readily accessible and require employees to wash their hands immediately or as soon as feasible after removal of gloves or other personal protective equipment.
- Hands must be washed with an appropriate soap and water, whenever there has been occupational exposure to blood or OPIM. If a sink is not readily accessible (e.g., in the field) in instances where there has been occupational exposure, hands may be decontaminated with hand cleanser or towelette, but must be washed with soap and running water as soon as feasible.
- If there has been no occupational exposure to blood or OPIM, use of an appropriate antiseptic hand cleanser is acceptable.
For more information on bloodborne pathogens in the healthcare setting, please see OSHAcademy course 656 Bloodborne Pathogens in the Healthcare Setting.
Allergy to latex was first recognized in the late 1970s. Since then, it has become a major health concern as an increased number of people in the workplace are affected. Health care workers
exposed to latex gloves or medical products containing latex are especially at risk. It is estimated that 8-12% of health care workers are latex sensitive.
- Developing latex allergy from exposure to products that contain latex such as gloves, catheters, and tubing.
- Provide appropriate gloves, including powder-less, hypoallergenic, glove liners, or other similar alternatives to employees who are allergic to the gloves normally provided.
Note: Do not assume hypoallergenic gloves are non-latex or latex-free.
In addition, good work practices should be used. These may include:
- providing a latex-safe work environment
- using non-latex gloves and other latex-free products
- selecting a low protein, powder-free glove
Static and Awkward Postures
Medical staff in a surgical setting often assume prolonged awkward postures. Typically, employees vary in height which may require work surfaces at differing heights to minimize awkward postures.
- Standing in static postures continuously during lengthy surgical procedures causes muscle fatigue and pooling of blood in the lower extremities.
- Standing on hard work surfaces such as concrete creates trauma and pain to the feet.
- Awkward postures resulting from prolonged standing, trunk flexion, neck flexion, and arms held higher than the optimal working height.
- Provide stools, where possible.
- Use shoes with well-cushioned insteps and soles.
- Provide a footrest bar or a low stool, allowing employees to continually alter their posture by raising one foot.
- Use height-adjustable work tables and surfaces.
- Use anti-fatigue mats.
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