EXPOSING THE INVISIBLE RISK

WASTE ANESTHETIC GASES IN THE PACU

If you are a health care professional caring for patients in recovery rooms or post-anesthesia care units (PACUs), what you don't know about anesthetic gases could impact your health. Anyone in close proximity to a post-op patient's breathing zone multiple times a day is at risk for inhaling the waste anesthetic gases (WAG) that the patient exhales.

The above infrared video shows a routine check performed by a nurse. Waste anesthetic gas is breathed out by the patient and lingers directly in the nurse's breathing zone.

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KNOW THE FACTS

What is WAG?

WAG, or waste anesthetic gas, is the result of patients exhaling the anesthetic gas in their bodies following an operation. Depending on their body type, the solubility of the gas, and the amount of gas that is used for the procedure, the patient's body typically does not process all of the gas, so significant amounts are exhaled following their procedure. While this anesthetic gas is typically not harmful to a patient because it is only administered for one operation, the effects could be cumulative for nurses who spend every day working closely with post-op patients.

WAG Video Resources

Potential Effects of WAG

Through decades of studies, researchers have found possible correlations between exposure to waste anesthetic gases and some potential health effects. The OSHA website listing for waste anesthetic gases warns of potential effects such as nausea, dizziness, headaches, fatigue, and irritability, as well as sterility, miscarriages, birth defects, cancer, and liver and kidney disease. Additionally, NIOSH's Publication No. 2007-151 recommends: increasing awareness about the adverse health effects of WAG, describing how workers are exposed to Waste Anesthetic Gas, changing work practices to reduce these exposures, and identifying methods to minimize leakage of WAG into the work environment.

Although we are still learning about the potential health effects created by waste anesthetic gases, we do know that there is zero potential for positive effects of long-term exposure. We need to act now to inform our nurses.

"Why risk potential health and reproductive problems while waiting for definitive proof, when this is not likely to be forthcoming? Even without direct proof of cause, we should reduce levels of waste anesthetic gases to their lowest possible concentration by careful use of efficient control measures." - J Brodsky; Exposure to Anesthetic Gases: A Controversy. AORNJ, 1983.

Are PACU nurses at risk?

Because the patient is the main source of waste anesthetic gases in the PACU, it is more difficult to control clinician exposure. The extent of the exposure may also be difficult to quantify because measurements of anesthetic gases are often taken from different parts of recovery rooms. This poses a challenge as these systems and measurements may not account for the WAG levels in the patient's breathing zone.

PACU nurses are at risk because of the lack of close regulation on how much of these waste gases they are directly exposed to for significant periods of time each day. In August 2002, Krenzischek et al, identified in ASPAN, that there is a potential for staff exposure to WAG in the PACU setting. They noted that there were higher levels of WAG at the patient's breathing zone compared to the RN work environment and pointed out that NIOSH recommends that the risk be minimized by reducing exposures to the greatest extent possible.

It's the most critical area in the room.

The breathing zone, directly in front of the patient's mouth, is where waste gases tend to linger as they are exhaled from the patient's nose and mouth. This is also the primary source area for the nurses' exposure as they provide bedside care to their patients (as shown in the infrared video above).

Unfortunately, PACU nurses are often not even aware of the presence of these excess gases as some gases are only discernible to human detection at extremely high levels.

Learn the Facts

Knowledge is power. Many PACU and recovery room nurses are likely unaware that prolonged inhalation of these gases could potentially increase their risk for health complications and may even affect their cognitive functions. Find out what the government and medical organizations have to say about WAG exposure and the risks associated. Also, research the studies related to the issue. Even though multiple organizations have studied the issue and made recommendations, the technology used to monitor compliance is often not sufficient. Thus, nurses may have not received the level of attention and protection that they deserve.