麻醉气体给药的预防措施:对麻醉医师、麻醉护士和麻醉医师助理的一项调查。
Precautionary practices for administering anesthetic gases: A survey of physician anesthesiologists, nurse anesthetists and anesthesiologist assistants.
作者信息
Boiano James M, Steege Andrea L
机构信息
a Division of Surveillance, Hazard Evaluations and Field Studies , National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention , Cincinnati , Ohio.
出版信息
J Occup Environ Hyg. 2016 Oct 2;13(10):782-93. doi: 10.1080/15459624.2016.1177650.
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.
多年来,人们一直推荐使用清除系统以及管理和工作实践控制措施,以尽量减少职业接触废弃麻醉气体。在医疗程序中释放或泄漏的麻醉气体和蒸汽被视为废弃麻醉气体。为了更好地了解推荐做法的使用程度,美国国家职业安全与健康研究所(NIOSH)于2011年对代表麻醉护理提供者的专业实践组织成员进行了医护人员健康与安全实践调查,这些提供者包括麻醉医生、麻醉护士和麻醉医师助理。这项全国性调查首次考察了麻醉护理提供者自我报告的使用控制措施以尽量减少接触废弃麻醉气体的情况。该调查由1783名麻醉护士、1104名麻醉医生和100名麻醉医师助理完成,他们在调查前七天内实施了吸入麻醉。在医院和门诊手术中心工作的受访者最常使用七氟醚,其次是地氟醚和异氟醚,并与氧化亚氮联合使用。清除系统的使用率几乎达到普遍,97%的受访者报告使用了该系统。然而,对其他推荐做法的遵守程度各不相同,在为儿科(P)或成人(A)患者实施麻醉的人员中也存在差异。表示增加接触风险的做法示例(以受访者百分比表示)包括:仅使用高(新鲜气体)流量麻醉(儿科17%,成人6%)、在将输送面罩或气道面罩应用于患者之前启动麻醉气体流量(儿科35%;成人14%);不定期检查麻醉设备是否泄漏(儿科4%,成人5%),以及使用漏斗填充系统填充蒸发器(16%)。受访者还报告称,医疗机构缺乏安全处理程序(19%)和危害意识培训(18%)。与其他麻醉护理提供者相比,麻醉护士对预防性工作实践的遵守程度总体上最高。废弃麻醉气体的成功管理应包括清除系统、危害意识培训、提供尽量减少接触的标准程序、定期检查麻醉输送设备是否泄漏、及时处理泄漏和溢出物,以及医疗监测。