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首页> 外文期刊>Journal of occupational and environmental hygiene >Precautionary practices for administering anesthetic gases: A survey of physician anesthesiologists, nurse anesthetists and anesthesiologist assistants
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Precautionary practices for administering anesthetic gases: A survey of physician anesthesiologists, nurse anesthetists and anesthesiologist assistants

机译：麻醉气体的预防措施：医师麻醉师，护士麻醉师和麻醉师助理的调查

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Scavenging systems and administrative and work practice controls for minimizing occupational exposure to waste anesthetic gases have been 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 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 anesthesia care providers. 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 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 other recommended practices was lacking to varying degrees and differed among those administering anesthetics to pediatric (P) or adult (A) patients. Examples of practices which increase exposure risk, expressed as percent of respondents, included: using high (fresh gas) flow anesthesia only (17% P, 6% A), starting anesthetic gas flow before delivery mask or airway mask was applied to patient (35% P; 14% A); not routinely checking anesthesia equipment for leaks (4% P, 5% A), and using a funnel-fill system to fill vaporizers (16%). Respondents also reported that facilities lacked safe handling procedures (19%) and hazard awareness training (18%). Adherence to precautionary work practices was generally highest among nurse anesthetists compared to the other anesthesia care providers. Successful management of waste anesthetic gases should include scavenging systems, hazard awareness training, availability of standard procedures to minimize exposure, regular inspection of anesthesia delivery equipment for leaks, prompt attention to spills and leaks, and medical surveillance.
机译：多年来，人们一直建议采用清除系统以及行政管理和工作实践控制措施，以最大程度地减少对麻醉麻醉剂废气的职业性接触。在医疗程序中释放或泄漏的麻醉气体和蒸气被认为是废弃的麻醉气体。为了更好地了解使用推荐做法的程度，2011年，NIOSH对医护人员进行的健康和安全做法调查在代表麻醉护理提供者的专业行为组织成员中进行，这些成员包括医师麻醉师，护士麻醉师和麻醉师助理。这项全国性调查是首次检查自我报告的使用控制措施的情况，以最大程度地减少麻醉护理提供者对麻醉药废气的接触。该调查由1783名护士麻醉师，1104名医师麻醉师和100名麻醉师助手完成，他们在调查前的7天进行了吸入麻醉剂的使用。在医院和门诊手术中心工作时，受访者最常与七氧化二氮一起使用七氟醚，去氟醚和异氟烷（程度较小）。 97％的受访者表示，清除系统的使用几乎普及。然而，在其他方面，对儿科（P）或成人（A）患者使用麻醉药的依从性程度有所不同。以暴露者的百分比表示的增加暴露风险的实践示例包括：仅使用高（新鲜气体）流量麻醉（17％P，6％A），在向患者使用分娩面罩或气道面罩之前开始麻醉气体流动（ 35％P; 14％A）;而不是常规检查麻醉设备的泄漏（4％P，5％A），并使用漏斗填充系统填充蒸发器（16％）。受访者还报告说，设施缺乏安全处理程序（19％）和危害意识培训（18％）。与其他麻醉护理提供者相比，护士麻醉师对预防性工作惯例的遵守程度通常最高。麻醉药废气的成功管理应包括清除系统，危害意识培训，可减少接触的标准程序，定期检查麻醉输送设备是否泄漏，及时注意泄漏和渗漏以及医疗监督。

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