Koda S, Kumagaj S, Toyoto M, Yasuda N, Ohara H
Department of Public Health, Kochi Medical School, Japan.
Sangyo Eiseigaku Zasshi. 1997 Jan;39(1):38-45.
There are hazardous factors threatening health care workers, and many hazardous chemical substances have been reported in operating rooms, central supply facilities, laboratories and so on. In Japan, little attention has been paid to exposure to these chemicals and to working environmental controls. Waste anesthetic gases are chemicals concerned, and we conducted environmental monitoring continuously and measured exposure to nitrous oxide, isoflurane and sevoflurane in operating rooms, and examined working environmental controls. The average environmental concentrations of nitrous oxide were about 400 ppm in anesthetists' working areas, and about 180 ppm in surgeons' and instrument nurses' working areas under unscavenged conditions. Under scavenged conditions, environmental concentrations were 70-190 ppm in anesthetists' zones, and 70-90 ppm in surgeons' and instrument nurses' zones. Even under scavenged conditions, operating room personnel are presumed to be exposed to high concentrations of nitrous oxide above ACGIH's TLV and NIOSH's REL. The level of exposure of isoflurane and sevoflurane was 2-4 ppm. Managing general ventilation system and airflow direction, working area under scavenged system, environmental concentration levels of nitrous oxide could be reduced to 20-30 ppm. In order to control occupational exposure to anesthetic gases, it is not sufficient to merely adapt scavenging systems in operating rooms. Working environmental control and occupational hygiene management should be required.
存在威胁医护人员健康的危险因素,手术室、中央供应设施、实验室等场所已报告了许多有害化学物质。在日本,人们对这些化学物质的暴露及工作环境控制关注甚少。废弃麻醉气体就是相关化学物质,我们持续进行环境监测,测量手术室中氧化亚氮、异氟烷和七氟烷的暴露情况,并检查工作环境控制措施。在未使用废气清除装置的情况下,麻醉师工作区域氧化亚氮的平均环境浓度约为400 ppm,外科医生和器械护士工作区域约为180 ppm。在使用废气清除装置的情况下,麻醉师区域的环境浓度为70 - 190 ppm,外科医生和器械护士区域为70 - 90 ppm。即使在使用废气清除装置的情况下,手术室人员仍被认为暴露于高于美国政府工业卫生学家会议(ACGIH)阈限值(TLV)和美国国家职业安全与健康研究所(NIOSH)推荐接触限值(REL)的高浓度氧化亚氮中。异氟烷和七氟烷的暴露水平为2 - 4 ppm。通过管理一般通风系统和气流方向,在使用废气清除系统的工作区域,氧化亚氮的环境浓度水平可降至20 - 30 ppm。为了控制麻醉气体的职业暴露,仅在手术室采用废气清除系统是不够的。还需要进行工作环境控制和职业卫生管理。