Occupational Hazards in Anaesthesiology: Causes, Controls and Recommendations

This article discusses the occupational hazards faced by healthcare workers in anaesthesiology, specifically chronic exposure to nitrous oxide. It covers the causes of the hazard, identification of controls, employee rights, recommendations, incident recurrence, and conclusion. The article also provides references for further reading.

Running head: OCCUPATIONAL HAZARDS
OCCUPATIONAL HAZARDS
Name of the University
Author Note

OCCUPATIONAL HAZARDS
Introduction
Human resource practitioners present in a hospital have to witness or deal with
several hazards that can potentially affect the health of the health care workers. The hazards
includes chemical and the biochemical hazards, hazardous drugs, ionising and the non-
ionising radiations, stresses, shift work and violence (Molina Aragonés et al., 2015). One of
the health hazards that I have witnessed during my career is the chronic exposure to the
nitrous oxide of the staffs working in the department of anaesthesiology. While working as
the human resource practitioner in a clinical setting, I was reported that the health care
workers are often becoming sick, having nausea and dizziness. One of the most serious case
that I have witnessed is when one day one of the healthcare workers in the anaesthetic unit
started vomiting and after diagnosis, it was found that the person was suffering from
tachycardia.
Hazards
The type of the hazard that has occurred in this case is nitrous oxide and several
halogenated anaesthetics like the halothane, isoflurane and enflurane that can cause various
harmful effects by the absorption through the alveolar capillary membrane (Allweiler &
Kogan, 2013). Once the lipid soluble agents are being metabolised in the body, the harmful
metabolites can lead to renal, hepatic and pulmonary cytotoxicity, decreasing the
psychomotor efficiency on the chronic exposure (Tankó et al., 2014). Normally, a face mask
is uses before the administration of the anaesthesia. It was reported that some of the health
care workers were not abiding by the work practice guidelines. Little focus was given on the

OCCUPATIONAL HAZARDS
cleaning of the liquid anaesthetic agent. It was also reported that the gloves and the chemical
protective clothing (CPC) used by the health care workers, were of quality below the
recommended guidelines. If the CPC and the gloves are not tested under he expected
conditions, then they might fail to give adequate protection to the health care workers.
Identification of the controls
Controlling of the occupational exposures can be done by the application of a number
of control including the engineering of the workplace, the administrative controls, the use of
the personal protective equipment and proper monitoring (Casale et al., 2015). After the
incident, I have scrutinised the anaesthetic room and found that the scavenging system of the
anaesthesia equipment was alright. In fact the active and the passive scavenging system of the
room was also good. All these indicated that gaps are left in the personal practices other than
the engineering control. With subsequent interrogation, I came to know that improper
techniques practiced by the health care workers are causing an increased waste gas levels in
the anaesthesia room. Furthermore, the use of the improperly fitted face mask, an
insufficiently treated tracheal tube often cause spillage of the liquid anaesthetic units (Casale
et al., 2015). Again, there might have been some anomalies in the ventilation system of the
room that has led to the increase of the gas levels in the room. Furthermore, it was also noted
that that the administrative control of the hospital was not suitable enough to serve the needs
of the health care workers. There was a lack of routined monitoring and regular repairment of
the equipment. Regular monitoring was not done to measure the airborne levels of the waste
gases in the breathing zone or the immediate working area of those who are heavily expose to
the gases. Again it was also found that most of the health professionals are not aware of the
OSHA's Hazard Communication Standard.

OCCUPATIONAL HAZARDS
Employee rights
The three main rights for the employees includes the –the right to refuse unsafe work,
the right to participate in the workplace safety activities, the right to be informed about the
potential dangers of the workplace. In this scenario, heath care providers were not evaluated
frequently or trained. In spite of some reported cases of the anaesthesia department, the health
care workers were compelled to work in that ambience. Regular monitoring of the
anaesthesia room or the equipment were not carried out, thus causing a breaching of the
employee rights.
Recommendations
The health of the anaesthesiologist is affected to a greater extend by the increasing
number of the professionals and the social burden both in the personal life and at the
workplace. Hence the occupational health and the safety should acquire primary importance
in the delivery of the professional duties. The controls administered at the hazard source, to
the general workplace, in the anaesthetic locations and the PACUs can be the most effective
method for controlling such workplace hazards (Ndejjo et al., 2015). Some of the general
recommendations about the work practices in an anaesthetic department is a complete
checkout procedure of the anaesthesia apparatus. An abbreviated version has to be considered
in the development of the inspections and the testing (Souza et al., 2016). All the vaporisers
should be filled in an area that has good ventilation. The spilling of ant anaesthetic agents has
to be cleaned up properly. Before the extubation of the mask of the patient or removal of the
mask, non-anaesthetic gases should be added. A periodic monitoring of the anaesthetic
equipment are necessary to ensure that they are working properly (Gorman et al., 2015). A
periodic monitoring of the waste gas concentration was required to ensure that the levels of
the anaesthetic gases in the breathing area are below the hazardous level.

OCCUPATIONAL HAZARDS
The health care workers should be trained properly about the appropriate usage of the
personal protective equipment in addition to the engineering, work practice and the
administrative control. They should be educated about the proper disposal of the liquid
agents.
Incident recurrence
In order to prevent the recurrence of such workplace hazards, it is necessary to
evaluate the interventions. The managers should assess the inputs, activities, outputs and the
immediate outcome after the interventions has been taken, with the help of a Performance
assessment tool. The external factors like the resource availability was measured. The current
occurrences of the mishaps were tallied with the base line data or was compared to the
previous reports. Feedbacks were taken from the health care workers to evaluate that the
interventions taken had been fruitful.
Conclusion
In conclusion it can be said that although, advancement in the anaesthesiology fields
have widened their functional scopes, but the occupational hazards occurring in this field are
not being controlled. In most of the cases, this chemical hazard takes place either due to the
defects in the engineering or the improper work practices or the faulty role of the
administration. In order to prevent such chemical hazards, it is necessary to train the health
care workers about the proper work practices like the usage of the PPE, prospering
monitoring of the ventilation and the anaesthesia apparatus. Finally to is necessary to evaluate
the interventions by feedback, by tallying the recent occurrence of the adverse events with the
baseline data.

OCCUPATIONAL HAZARDS
References
Allweiler, S. I., & Kogan, L. R. (2013). Inhalation anesthetics and the reproductive risk
associated with occupational exposure among women working in veterinary
anesthesia. Veterinary anaesthesia and analgesia, 40(3), 285-289.
Casale, T., Caciari, T., Rosati, M. V., Gioffrè, P. A., Schifano, M. P., Capozzella, A., ... &
Tomei, F. (2014). Anesthetic gases and occupationally exposed workers.
Environmental toxicology and pharmacology, 37(1), 267-274.
Gorman, T., Dropkin, J., Kamen, J., Nimbalkar, S., Zuckerman, N., Lowe, T., ... & Freund,
A. (2014). Controlling health hazards to hospital workers: A reference guide. NEW
SOLUTIONS: A Journal of Environmental and Occupational Health Policy,
23(1_suppl), 1-169.
Molina Aragonés, J. M., Ayora, A. A., Ribalta, A. B., Aparici, A. G., Lavela, J. M., Vidiella,
J. S., & López, M. H. (2015). Occupational exposure to volatile anaesthetics: a
systematic review. Occupational Medicine, 66(3), 202-207.
Ndejjo, R., Musinguzi, G., Yu, X., Buregyeya, E., Musoke, D., Wang, J. S., ... & Ssempebwa,
J. (2015). Occupational health hazards among healthcare workers in Kampala,
Uganda. Journal of environmental and public health, 2015.
Souza, K. M., Braz, L. G., Nogueira, F. R., Souza, M. B., Bincoleto, L. F., Aun, A. G., ... &
Braz, M. G. (2016). Occupational exposure to anesthetics leads to genomic instability,
cytotoxicity and proliferative changes. Mutation Research/Fundamental and
Molecular Mechanisms of Mutagenesis, 791, 42-48.

OCCUPATIONAL HAZARDS
Tankó, B., Molnár, L., Fülesdi, B., & Molnár, C. (2014). Occupational hazards of
halogenated volatile anesthetics and their prevention: review of the literature. J
Anesth Clin Res, 5(7), 1-7.