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      Risk Management Status of Waste Anesthetic Gases Using ECRI Institute Standards

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          Abstract

          Background

          The aim of this study was assessment the risk management status of waste anesthetic gases in academicals hospitals in Iran to prevent from harmful effects of these gases on employees’ health.

          Methods:

          A descriptive-analytic study was designed in 2011. Standard structured checklist developed by ECRI institute (Emergency Care Research Institute) was applied. Checklists were filled onsite through direct observation and interviews with anesthesia personnel in 46 operating rooms at 4 hospitals from all of the hospitals under affiliation of Isfahan University of Medical Sciences. These hospitals were selected based on the number of surgical beds.

          Results:

          Total means score of WAGs risk management status was 1.72 from the scale of 3. In the studied operating rooms, only 28% complied with predetermined standards, 16% needed improvement and 56% had no compliance. Total mean scores of compliance in planning, training and evaluation and monitoring of waste anesthetic gases were weak and equipment and work activity was at medium level.

          Conclusion:

          The risk management status of waste anesthetic gases in the hospitals to be weak, therefore operating room personnel are exposed to medium to high level of these gases. The hospital mangers should prepare and apply scavenging equipment, development of control program, quality improvement, risk management and maintenance of anesthesia equipment. Finally, ongoing monitoring and evaluation, education to personnel and modification of policy and procedures and improvement of work activities should be considered.

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          Most cited references27

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          Special article: general anesthetic gases and the global environment.

          General anesthetics are administered to approximately 50 million patients each year in the United States. Anesthetic vapors and gases are also widely used in dentists' offices, veterinary clinics, and laboratories for animal research. All the volatile anesthetics that are currently used are halogenated compounds destructive to the ozone layer. These halogenated anesthetics could have potential significant impact on global warming. The widely used anesthetic gas nitrous oxide is a known greenhouse gas as well as an important ozone-depleting gas. These anesthetic gases and vapors are primarily eliminated through exhalation without being metabolized in the body, and most anesthesia systems transfer these gases as waste directly and unchanged into the atmosphere. Little consideration has been given to the ecotoxicological properties of gaseous general anesthetics. Our estimation using the most recent consumption data indicates that the anesthetic use of nitrous oxide contributes 3.0% of the total emissions in the United States. Studies suggest that the influence of halogenated anesthetics on global warming will be of increasing relative importance given the decreasing level of chlorofluorocarbons globally. Despite these nonnegligible pollutant effects of the anesthetics, no data on the production or emission of these gases and vapors are publicly available. The primary goal of this article is to critically review the current data on the potential effects of general anesthetics on the global environment and to describe possible alternatives and new technologies that may prevent these gases from being discharged into the atmosphere.
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            Comparing the costs of inhaled anesthetics.

            The immediate cost of an inhaled anesthetic results from an interplay between four factors: (1) the cost per milliliter of liquid anesthetic, (2) the volume of vapor that results from each milliliter of liquid, (3) the effective potency of the anesthetic (what concentration must be delivered from a vaporizer to provide a clinically appropriate level of anesthesia), and (4) the background flow of the gases that is chosen. A background flow that supplies only the gases/vapors required (taken up) by the patient (a "closed circuit") produces the least cost but also the least control of anesthetic level, whereas a high flow prevents rebreathing (a non-rebreathing system) but produces the greatest cost and control. We define greater "control" as a smaller ratio of delivered to alveolar concentrations. A lower solubility of an anesthetic accords the same level of control at a lower background flow rate than is achieved at a higher background flow rate with a more soluble anesthetic. Thus, a poorly soluble anesthetic may be used with a lower background flow rate than a more soluble anesthetic and may offer greater control and/or decreased cost. This report presents a method of determining the cost of inhaled anesthetic use. As an example, the cost of delivering a desflurane anesthetic is compared with that of delivering an isoflurane anesthetic, assuming both provide an alveolar concentration of 1 MAC. The comparison is based on the pharmacokinetic differences of the two anesthetics: taking into account that for a given therapeutic anesthetic concentration (MAC), for desflurane a lower flow rate of background gas is needed to produce similar control (relationship between delivered and alveolar gases) than is needed for isoflurane. The analysis demonstrates that the relative cost of administering the newer and less soluble anesthetic, desflurane, can be less than, greater than, or the same as the cost of administering isoflurane, depending on the background gas inflow rate selected. The manner in which inhaled anesthetics are used and their kinetic differences are important determinants of relative cost.
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              Chronic exposure to anesthetic gases in the operating room.

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                Author and article information

                Journal
                Iran J Public Health
                Iran. J. Public Health
                IJPH
                Iranian Journal of Public Health
                Tehran University of Medical Sciences
                2251-6085
                2251-6093
                2012
                1 November 2012
                : 41
                : 11
                : 85-91
                Affiliations
                [1 ]Research Center for Social Determinants of Health, Qazvin University of Medical Sciences, Qazvin, Iran
                [2 ]Educational Planning, Health Management, and Economic Research Center (HMERC), Isfahan University of Medical Sciences, Isfahan, Iran
                [3 ]Health Services Administration, Qazvin University of Medical Sciences, Qazvin, Iran
                Author notes
                [* ]Corresponding Author: Email: rose_mp7@ 123456yahoo.com
                Article
                ijph-41-85
                3521891
                23304681
                78477bff-05a7-4458-a9a8-fc0abf9b33a9
                Copyright © Iranian Public Health Association & Tehran University of Medical Sciences

                This is an open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License ((CC BY-NC 3.0), which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.

                History
                : 23 March 2012
                : 12 August 2012
                Categories
                Original Article

                Public health
                assessment,risk management,waste anesthetic gas
                Public health
                assessment, risk management, waste anesthetic gas

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