Scavenging systems and administrative and work practice controls for minimizing occupational exposure to waste anesthetic gases have been available and 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 (ACPs) 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 ACPs. 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 reported that they 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 recommended administrative and work practice controls were 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 and components 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 ACPs. 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.
One of the principle goals of general anesthesia is to prevent patients from
feeling pain during surgery. Each year in the U.S., an estimated 20 million patients undergo
surgery where inhaled anesthetics are used.(
Acute exposure to halogenated anesthetics has been shown to cause headache,
irritability, fatigue, nausea, drowsiness and difficulties with judgement and
coordination.(
Acute exposure to nitrous oxide may cause lightheadedness, eye and upper airway
irritation, cough and shortness of breath.(
Methods of minimizing worker exposure to WAGs have been addressed by government
agencies and professional practice organizations.(
The primary objective of this study is to describe work practices including use of exposure controls and barriers to using scavenging systems by ACPs who administer general anesthesia to patients. This national survey is the first to examine adherence to precautionary practices and use of exposure controls including scavenging systems by type of ACP and patient (pediatric or adult).
The Health and Safety Practices Survey of Healthcare Workers is an anonymous,
modular, web-based survey conducted by the National Institute for Occupational Safety and
Health (NIOSH) in early 2011. The study population included members of professional
practice organizations representing healthcare occupations which routinely use or come in
contact with selected hazardous chemicals and drugs. Practices around administration of
AGs were addressed by one of seven hazard modules. Information on overall methods used in
the development and testing of the survey instrument, survey design and functionality,
survey population, survey implementation, respondent characteristics, and other
information including strengths and limitations of the survey have been described
elsewhere.(
The survey population for the module on administration of AGs was targeted to members of three major professional practice organizations representing physician anesthesiologists, nurse anesthetists and anesthesiologist assistants. These organizations invited members via email which included a link to the survey.
The web survey included a screening module, core module, and seven hazard modules. If the respondent indicated in the screening module that they had administered AGs in the past week, they were eligible for the module addressing AGs. The modular survey was programmed to sequentially present, based on screening questions, the most relevant hazard module, the core module, and a second hazard module, if indicated. Respondents were not presented with more than two hazard modules.
The hazard module addressing administration of AGs contained 39 questions, 34 of which were targeted to medical (i.e., non-dental) professionals. The format of the questions included multiple choice, Likert scale options, multi-part, yes/no and numeric. For a few questions where response options were not exhaustive, respondents could mark “other” and type in a response. These were reviewed and determined if they a) fit into one of the existing categories, b) were valid other responses, or c) were unrelated to the question i.e., general notes about the survey. Responses were recoded, or left as “other” in the case of b), to reflect this determination.
Most questions sought information for the seven days prior to the survey
(hereafter referred to as the past week). Topic areas and content of key practice
questions are presented in
Data were analyzed using SAS 9.3 (Cary, NC: SAS Institute, Inc.). Simple
frequencies and prevalences are presented. Because most (>97%) of the non-dental
respondents were physician anesthesiologists, nurse anesthetists and anesthesiologist
assistants, and worked in hospitals and ambulatory healthcare settings, analyses excluded
respondents in other occupations and work settings. Results include responses to selected
questions in the core module that describe demographic, employer and occupation
characteristics. This survey was developed to provide descriptive information on practices
around administration of AGs. No
The NIOSH Institutional Review Board determined that the activities in this
project were surveillance and did not meet the criteria of research according to 45 CFR
46.1101(b)(2) and CDC Guidelines for Defining Public Health Research and Public Health
Non-Research.(
A total of 2,987 ACPs including 1,783 nurse anesthetists, 1,104 physician
anesthesiologists and 100 anesthesiologist assistants completed the hazard module on AGs.
Respondent demographic and employer characteristics are presented for all respondents and
by type of ACP in
The mean age of nurse anesthetists was 50 years (range: 20–76 years); 56% were female, 95% were white, and 2% were Hispanic. The highest proportion of nurse anesthetists had master's degrees, and worked in their profession and for their current employer for 11–20 years and 1-5 years, respectively. Their employers were best characterized as hospitals, ≥250 employees, for profit, located in large cities, and mainly in the south. Four percent were members of labor unions.
The mean age of physician anesthesiologists was 51 years (range 23–76 years). They possessed many of the same characteristics as the nurse anesthetists with the exception that a higher proportion (74%) were male and non-White (13% Asian and 4% Hispanic). All possessed doctoral degrees or higher education, worked in their profession for 20–30 years, and 2% belonged to labor unions. Anesthesiologist assistants also possessed many of the same characteristics as the nurse anesthetists with the exception that they were the youngest of the three groups with a mean age of 41 years (range: 24–69 years); 54% were male, 90% were white, 94% had a master's degree, and the highest proportion worked in their profession for 1-5 years.
Eighteen percent of respondents reported that they had never received training on safe handling of AGs. The proportion of physician anesthesiologists (28%) who never received such training was over twice that of nurse anesthetists (13%) and three times that of anesthesiologist assistants (9%). Of the respondents who had received training, most (81%; range: 77–81%) reported it had been more than 12 months ago.
Only half (54%) of respondents reported that standard procedures to minimize exposure to AGs were available from their employer, and over a quarter (27%) reported that they did not know whether such procedures were available. Responses were comparable among the three groups. Approximately half (57%) of nurse anesthetists and even fewer physician anesthesiologists (49%) and anesthesiologist assistants (45%) reported that procedures were available, with about 30% reporting that they did not know if they were.
Anesthetic gas administration practices are presented in
On average, 97% of respondents reported that a waste anesthetic gas scavenging
system was used `every time' they administered AGs during the past week (
Respondents were asked how often (i.e., every time, most times, sometimes,
rarely, never) they utilized selected precautionary practices as part of their routine
for administering AGs to adult and pediatric patients. These practices included: 1)
checking delivery system for AG leaks (practice #1), 2) starting AG flow after delivery
mask or airway mask was applied to patient (practice #2), and 3) turning off AG flow
before carrier gas to the breathing system was turned off (
Respondents were also asked how often (same five response options as described
above) they implemented commonly used fresh gas flow techniques for delivering AGs to
adult and pediatric patients. In order of most to least effective in minimizing exposure
to waste AGs, these practices included: 1) closed-system anesthesia; 2) low flow
anesthesia only (on average <3 L/min of fresh gas); 3) high flow followed by low
flow anesthesia, and 4) high flow anesthesia only (on average 3–6 L/min of fresh
gas) (
Respondents were also asked how often (same response options as described
above) they used a face mask and/or airway device when administering AGs to adult and
pediatric patients. In order of most to least desirable in terms of minimizing waste gas
emissions and risk of exposure, these included: 1) airway device only, 2) face mask
followed by an airway device, and 3) face mask only (
Overall, 84% of respondents reported that they personally filled vaporizers with
liquid anesthetic agents during the past week. Filling of vaporizers was reported by most
anesthesiologist assistants (92%) and nurse anesthetists (91%) and, to a lesser extent, by
physician anesthesiologists (73%) (
One hundred thirteen respondents (5%) reported that a large spill (i.e., contents of a bottle of liquid anesthetic agent) had occurred during the past 12 months while filling or draining vaporizers. A higher proportion of physician anesthesiologists and nurse anesthetists reported spills compared to anesthesiologist assistants. Over half (56%) of respondents reported that the spills were cleaned-up by: 1) the person causing the spill whether trained (20%) or not (37%); 2) a designated spill response team (8%); or by others (4%) where `anesthesia technician' was the most common write-in response. One third (32%) reported that they did not know who cleaned up the spill. Several respondents used the `other' response category to type-in that most spills had evaporated before they could be cleaned-up.
Nearly all (97%) respondents reported that they spent time with patients in the
post-anesthesia patient recovery area. Of these respondents, 78% spent less than one hour
and 19% spent an hour or more in this area. Over half (54%) of respondents reported that
the recovery area was adequately ventilated, and 42% did not know. A very small proportion
of respondents reported that patients were intubated (i.e., on mechanical ventilation)
when transferred to the recovery area (
Air monitoring for detecting AG leaks was twice as common as personal exposure
monitoring. Thirty percent of respondents reported that air monitoring had been conducted
on a continuous or periodic basis in the operating room to detect AG leaks whereas only
15% of respondents reported that exposure monitoring had been conducted during the past
year to assess personal or co-worker exposure to AGs (
Exposure to waste anesthetic gases can result from a variety of causes:
ineffective or no waste gas scavenging system; improper or inadequate maintenance of
anesthesia machine; leaks from gas lines and other components; poor work practices or
facility guidelines (e.g., high flow anesthesia) and ineffective general ventilation in the
operating room and recovery areas. In our survey we found nearly universal use of waste gas
scavenging systems. This finding was not unexpected since all anesthesia machines sold in
the U.S. since the late 1990's have been equipped with these devices.(
We also found funnel-fill, `open-air' systems were being used by about one of
every six respondents. These systems, found in some older vaporizers(
Some respondents also reported that large spills of liquid anesthetic agents had occurred during the past year while filling or draining vaporizers. Over a third of respondents reported that spills were cleaned-up by untrained staff. Also of concern, some reported that it was not uncommon for spills to evaporate before they are cleaned up which represents another source of exposure to healthcare personnel in areas where spills occur.
Use of exposure control practices varied by type of patient (adult or pediatric) and ACP. For those respondents who administered AGs to pediatric patients, we found lower adherence to work practices which minimize exposure to waste anesthetic gases: starting AG flow after face mask or airway mask is applied to patient, use of closed-system anesthesia or low flow only anesthesia, and use of an airway device alone or immediately following face mask induction. Checking for leaks and judicious starting/stopping of AG flows are precautionary practices that should always be followed. The other surveyed practices (AG flow delivery technique and delivery devices) are usually utilized on a case-by-case basis depending on the patient's medical condition. Adherence to precautionary work practices and closed-system or low fresh gas flow techniques was generally highest among nurse anesthetists.
Nearly all respondents reported that anesthetized patients were extubated in the operating room or surgical suite before they were transferred to the recovery area. Because the extubated patients off-gas AGs in their breath, they represent a potential source of exposure to ACPs who reported that they spent time with patients in the post-anesthesia recovery area. Only a small proportion of respondents reported that the general ventilation in the recovery area was inadequate, although nearly half reported that they did not know. Room ventilation, proximity to the patient, and time spent in the recovery area are exposure risk factors. Another method to minimize waste anesthetic gases in the recovery room is to provide patients with face masks that simultaneously scavenge waste anesthetic gases and deliver oxygen. Information on whether these devices were used was not obtained during this survey and should be assessed in future studies.
Nearly one of every five respondents had not received training addressing safe
handling of anesthetic agents, including more than a quarter of physician anesthesiologists.
Of those who had received training, 6 to 7 of every ten respondents reported that the
training was more than a year ago. Training and education are fundamental administrative
controls, recommended upon initial job assignment or whenever a new chemical or process is
introduced.(
Air monitoring to assess leaks in the operating room anesthesia delivery equipment was reported by only 30% of respondents and was more common than personal exposure monitoring of ACPs, reported by 16% of respondents. Routine air monitoring for waste anesthetic gases is recommended by NIOSH, OSHA and AANA; however, the American Society of Anesthesiologists (ASA) considers proper maintenance and inspection of anesthesia machines to be a more effective strategy to minimize waste gas emissions.
Several limitations apply to this survey. Since the survey sample was targeted to members of professional practice organizations, findings reflect the experiences and practices of the respondents and are not generalizable to all healthcare workers or to all members of each of the participating professional organizations. Availability of the survey only to members with email addresses and internet access was another limitation. Survey participants who have resources to belong to a professional organization may be more likely to be further along in their career, better paid, more educated, and more aware of health and safety issues. A response rate cannot be calculated because the invitation email specified the chemical agents under study, including AGs, and that eligibility was based on whether or not invitees had used AGs on the job; it is unknown who decided not to participate because they did not use AGs versus those who used them but decided not to participate for other reasons. Finally, survey data are self-reported and not validated by observation or other means.
Information on the effectiveness of waste gas scavenging systems, types of PPE used during spill cleanup and filling/draining vaporizers, and availability of and participation in a medical surveillance program, was not collected in this study and should be evaluated in future studies. The nearly universal use of scavenging systems is noteworthy and may be associated with The Joint Commission's requirement that all waste anesthetic gases and vapors be scavenged using active scavenging methods.
This national survey is the first to examine use of engineering, administrative and work practice controls for AGs by physician anesthesiologists, nurse anesthetists and anesthesiologist assistants who primarily work in hospitals. 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, periodic air and exposure monitoring, prompt elimination of spills and leaks, and medical surveillance.
The authors thank Westat, Inc., for their collaboration in developing, testing and implementing the survey. The authors are grateful to the professional practice organizations and members who participated in the survey. We also thank Dr. Jonathan Katz and Jennifer Topmiller for their valuable comments and suggestions of an early draft of the manuscript. This project was supported by the National Institute for Occupational Safety and Health.
The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the National Institute for Occupational Safety and Health. Mention of company names or products does not constitute endorsement by the National Institute for Occupational Safety and Health. This article is not subject to U.S. copyright law.
Survey Instrument Topic Areas and Content of Questions
| Topic Area |
|---|
| Training |
| Frequency (within the past 12 months, more than 12 months ago, never) |
| Employer procedures |
| Availability of employer standard procedures to minimize exposure to AGs |
| Administration practices |
| Specific AGs administered |
| AGs simultaneously administered with nitrous oxide |
| Number of days administering AGs in the past 7 |
| Types of work settings where AGs were administered |
| Patient receiving AGs |
| non-pediatric |
| pediatric |
| Engineering controls |
| Frequency |
| Reasons for not always using scavenging
systems |
| Most important reason for not using scavenging
system |
| Work practice controls – frequency |
| face mask only |
| face mask followed by airway device |
| airway device only |
| Work practice controls – frequency |
| high flow anesthesia only |
| low flow anesthesia only |
| high followed by low flow anesthesia |
| closed system anesthesia |
| Precautionary work practices –
frequency |
| Check anesthesia machine and components for AG leaks |
| Start AG flow after face mask or airway device is applied |
| Stop AG flow before turning off carrier gas to breathing system |
| Post-administration practices |
| Frequency |
| Average time spent in patient recovery area (no time, <1 hour, ≥1 hour) |
| Filling AG vaporizers |
| Whether respondent filled vaporizer during past 7 calendar days |
| Frequency |
| Frequency |
| Frequency |
| Spills of liquid anesthetic agents |
| Did any large spills (i.e., contents of one bottle) occur during past 12 months? |
| Who is responsible for cleanup |
| Personal and environmental monitoring practices for AGs |
| Air monitoring in operating room to detect leaks |
| Personal exposure monitoring in past 12 months |
| Was patient recovery area adequately ventilated? |
Response options included: desflurane, enflurane, halothane, isoflurane, nitrous oxide and sevoflurane.
Asked separately for pediatric and non-pediatric patients.
Non-pediatric patient was defined as >13 years of age; pediatric patient was defined as ≤13 years of age.
Response options included: every time, most times, sometimes, rarely, never. Depending on the question, one final response option may have been be included: device not available, not available, not applicable, system not available.
Respondent Characteristics
| Characteristic | All Anesthesia Care Providers (n | Nurse Anesthetist (n | Physician Anesthesiologist (n | Anesthesiologist Assistant (n |
|---|---|---|---|---|
| Sex | (n=2933) | (n=1751) | (n=1083) | (n=99) |
| Male | 56 | 44 | 74 | 54 |
| Female | 44 | 56 | 26 | 46 |
| Race | (n=2894) | (n=1733) | (n=1063) | (n=98) |
| White | 91 | 95 | 85 | 90 |
| Black | 3 | 3 | 2 | 3 |
| Asian | 6 | 2 | 13 | 7 |
| Other | 1 | 1 | 1 | 1 |
| Ethnicity | (n=2921) | (n=1745) | (n=1078) | (n=98) |
| Hispanic | 2 | 2 | 4 | 2 |
| Age (years) | (n=2880) | (n=1728) | (n=1054) | (n=98) |
| 20–24 | <1 | <1 | <1 | 1 |
| 25–34 | 9 | 9 | 9 | 31 |
| 35–4 | 20 | 22 | 16 | 38 |
| 45–54 | 31 | 29 | 35 | 19 |
| 55–64 | 34 | 35 | 33 | 10 |
| >64 | 6 | 6 | 7 | 1 |
|
| ||||
| Education | (n=2928) | (n=1745) | (n=1084) | (n=99) |
| ≤Associate's degree | 4 | 6 | 0 | 0 |
| Bachelor's degree | 10 | 16 | 0 | 5 |
| Master's degree | 47 | 74 | <1 | 94 |
| Doctoral degree/Plus | 40 | 4 | 100 | 1 |
| Time in Current Occupation | (n=2972) | (n=1774) | (n=1098) | (n=100) |
| <1 year | 2 | 2 | 2 | 6 |
| 1–5 years | 16 | 18 | 10 | 27 |
| 6–10 years | 13 | 14 | 12 | 20 |
| 11–20 years | 25 | 26 | 25 | 25 |
| 20–30 years | 26 | 20 | 36 | 11 |
| >30 years | 17 | 19 | 15 | 11 |
| Time with Current Employer | (n=2982) | (n=1781) | (n=1101) | (n=100) |
| <1 year | 7 | 7 | 6 | 14 |
| 1–5 years | 32 | 35 | 28 | 41 |
| 6–10 years | 22 | 23 | 20 | 23 |
| 11–20 years | 21 | 20 | 23 | 13 |
| >20 years | 18 | 14 | 23 | 9 |
| Member of a Labor Union | (n=2940) | (n=1754) | (n=1087) | (n=99) |
| Yes | 3 | 4 | 2 | 0 |
| Employer Industry Category | (n=2987) | (n=1783) | (n=1104) | (n=100) |
| Ambulatory healthcare services | 17 | 16 | 20 | 9 |
| Hospital | 83 | 84 | 80 | 91 |
| Size of Employer (number of employees) | (n=2963) | (n=1768) | (n=1096) | (n=99) |
| 1 (i.e., only myself) | 1 | 2 | 1 | 0 |
| 2–9 | 5 | 7 | 3 | 3 |
| 10–99 | 23 | 24 | 22 | 26 |
| 100–249 | 12 | 14 | 9 | 10 |
| 250–1,000 | 26 | 26 | 28 | 15 |
| >1,000 | 32 | 28 | 37 | 45 |
| Employer Ownership Type | (n=2943) | (n=1755) | (n=1092) | (n=96) |
| For profit | 53 | 53 | 54 | 51 |
| Non-protit | 34 | 35 | 32 | 35 |
| City, county, district, state gov't | 10 | 8 | 12 | 14 |
| Federal gov't (e.g., VHA) | 3 | 4 | 2 | 0 |
| Employer Regional Location | (n=2938) | (n=1755) | (n=1084) | (n=99) |
| Northeast | 19 | 17 | 24 | 1 |
| Midwest | 25 | 28 | 20 | 34 |
| South | 38 | 42 | 29 | 61 |
| West | 17 | 13 | 26 | 4 |
| Employer Location by Population Density | (n=2971) | (n=1772) | (n=1099) | (n=100) |
| Large city (≥ 50,000 people) | 61 | 54 | 70 | 76 |
| Small city (< 50,000 people) | 20 | 22 | 16 | 14 |
| Suburbs | 11 | 11 | 10 | 8 |
| Rural areas (e.g. farms, ranches, small towns, and unpopulated regions) | 9 | 13 | 4 | 2 |
VHA=Veterans Health Administration
Number of respondents varied for individual items (i.e., number of eligible respondents less number who elected not to answer).
Percents may add to more than 100 percent because respondents could select more than one answer.
Percents may not add up to exactly 100 percent due to rounding.
Industry categories based on North American Industry Classification System (NAICS)
Northeast: Connecticut, Maine, Massachusetts, New Jersey, New Hampshire, New York, Pennsylvania, Rhode Island, and Vermont; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia; West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming
Anesthestic Gases Administration Practices of Respondents
| Administration Practices (in the past week unless otherwise noted) | All Anesthesia Care Providers (n | Nurse Anesthetist (n | Physician Anesthesiologist (n | Anesthesiologist Assistant (n |
|---|---|---|---|---|
| No. of years (in career) administering AGs | (n=2978) | (n=1777) | (n=1102) | (n=99) |
| < 1 year | <1 | <1 | 1 | 0 |
| 1–5 years | 14 | 16 | 8 | 30 |
| 6–10 years | 15 | 16 | 14 | 20 |
| 11–20 years | 25 | 26 | 24 | 27 |
| > 20 years | 45 | 42 | 53 | 22 |
| No. of days administering AGs | (n=2986) | (n=1782) | (n=1104) | (n=100) |
| 1 day | 6 | 3 | 10 | 3 |
| 2 days | 9 | 7 | 13 | 4 |
| 3 days | 16 | 16 | 15 | 15 |
| 4 days | 20 | 23 | 17 | 16 |
| 5 days | 40 | 42 | 34 | 52 |
| 6–7 days | 10 | 9 | 11 | 10 |
| AGs administered | (n=2987) | (n=1783) | (n=1104) | (n=100) |
| Sevoflurane | 96 | 96 | 96 | 98 |
| Desflurane | 69 | 72 | 66 | 65 |
| Nitrous oxide | 64 | 64 | 63 | 86 |
| Isoflurane | 36 | 34 | 39 | 45 |
| AGs administered most often | (n=2984) | (n=1782) | (n=1102) | (n=100) |
| Sevoflurane | 62 | 60 | 64 | 62 |
| Desflurane | 27 | 29 | 23 | 21 |
| Isoflurane | 8 | 7 | 9 | 7 |
| Nitrous oxide | 4 | 3 | 6 | 10 |
| Simultaneous administration of nitrous oxide with any of the halogenated AGs | (n=1927) | (n=1144) | (n=697) | (n=86) |
| Yes | 95 | 94 | 96 | 97 |
| AG most often administered with nitrous oxide | (n=1829) | (n=1075) | (n=671) | (n=83) |
| Sevoflurane | 73 | 71 | 76 | 72 |
| Desflurane | 16 | 18 | 12 | 17 |
| Isoflurane | 11 | 11 | 11 | 11 |
| AGs administered to patients 13 years or older (i.e., non-pediatric or adult patients) | (n=2987) | (n=1783) | (n=1103) | (n=100) |
| Yes | 99 | 100 | 98 | 97 |
| AGs administered to patients 12 years or younger (i.e., pediatric patients)? | (n=2986) | (n=1782) | (n=1104) | (n=100) |
| Yes | 47 | 46 | 49 | 47 |
| Location(s) where AGs were most often administered in the past week | (n=2986) | (n=1783) | (n=1104) | (n=100) |
| Hospital OR | 86 | 86 | 85 | 92 |
| Outpatient surgical center | 12 | 12 | 11 | 7 |
| Other | 2 | 2 | 4 | 1 |
Number of respondents varied for individual items (i.e., number of eligible respondents less number who elected not to answer).
Percents may not add up to exactly 100 percent due to rounding.
Percents may add to more than 100 percent because respondents could select more than one answer.
Scavenging Systems, Administrative Controls, and Work Practices for Administering Anesthetic Gases to Adult and Pediatric Patients
| Type of Exposure Control | All Anesthesia Care Providers | Nurse Anesthetists | Physician Anesthesiologists | Anesthesiologist Assistants | All Anesthesia Care Providers | Nurse Anesthetists | Physician Anesthesiologists | Anesthesiologist Assistants |
|---|---|---|---|---|---|---|---|---|
|
| ||||||||
| Engineering Control | Adult Patients | Pediatric Patients | ||||||
| How often was a waste gas scavenging system
used | 97 | 98 | 96 | 99 | 97 | 98 | 96 | 96 |
|
| ||||||||
| Administrative Controls | Adult Patients | Pediatric Patients | ||||||
| When administering anesthesia gas to patients
during | ||||||||
| (1) check anesthesia machine, breathing
circuit, | 95 | 97 | 92 | 96 | 96 | 98 | 95 | 96 |
| (2) start AG flow after delivery mask or airway
mask | 86 | 88 | 84 | 84 | 65 | 69 | 61 | 55 |
| (3) turn off AG flow before carrier gas to
the | 94 | 95 | 93 | 95 | 91 | 94 | 88 | 91 |
|
| ||||||||
| Work Practice – Use of Closed System and Fresh
Gas | Adult Patients | Pediatric Patients | ||||||
| When administering anesthesia gas to patients
during | ||||||||
| (1) closed-system anesthesia? | 33 | 42 | 22 | 11 | 29 | 37 | 18 | 9 |
| (2) low flow anesthesia only (on average less
than | 51 | 56 | 42 | 51 | 21 | 23 | 18 | 21 |
| (3) high flow followed by low flow anesthesia? | 58 | 53 | 66 | 59 | 72 | 68 | 77 | 77 |
| (4) high flow anesthesia only (on average
3–6 L/min | 6 | 7 | 6 | 2 | 17 | 20 | 12 | 11 |
|
| ||||||||
| Work Practice – Use of Patient Face Mask and
Airway | Adult Patients | Pediatric Patients | ||||||
| When administering anesthesia gas to patients
during | ||||||||
| (1) an airway device only? | 28 | 30 | 26 | 24 | 6 | 7 | 5 | 2 |
| (2) a face mask followed by airway
device? | 74 | 73 | 75 | 75 | 70 | 67 | 74 | 70 |
| (3) a face mask only? | 5 | 5 | 4 | 2 | 11 | 12 | 8 | 4 |
Respondents were asked to select from the following response options: every time, most times, sometimes, rarely or never. Some of the questions included `not available' or `not applicable' as additional response options.
Total number of respondents varies for individual items (i.e., number of eligible respondents less number who elected not to answer and excluded respondents where the activity was not applicable to them).
Excludes respondents who reported “not applicable” (i.e., others were responsible for this work practice).
Excludes respondents who reported that this technique or device was not available.
Examples of airway devices include endotracheal tube, tracheostomy tube and laryngeal mask airway (LMA).
Anesthesia Vaporizer Filling Practices and Spills Associated With Filling and Draining Vaporizers
| Filling Practices/Spills | All Anesthesia Care Providers | Nurse Anesthetists | Physician Anesthesiologists | Anesthesiologist Assistants | ||||
|---|---|---|---|---|---|---|---|---|
| Did you personally fill anesthesia vaporizers during the past week? | n | % | n | % | n | % | n | % |
| 2968 | 84 | 1767 | 91 | 1101 | 73 | 100 | 92 | |
| When filling anesthesia vaporizers, how often did you use… | n | % | n | % | n | % | n | % |
| a “key-filler” or other closed
system | 2434 | 86 | 1559 | 86 | 784 | 87 | 91 | 79 |
| a “funnel-fill” system (also called
“pour-fill” or “screw cap fill” systems) | 2034 | 17 | 1280 | 19 | 677 | 11 | 77 | 18 |
| How often did you fill the vaporizer (using the funnel-fill system) in a location where fugitive vapors are controlled (e.g., ventilated enclosure)? | n | % | n | % | n | % | n | % |
| 759 | 7 | 495 | 7 | 230 | 9 | 34 | 0 | |
| In the past 12 months, did any large
spills | n | % | n | % | n | % | n | % |
| 2500 | 5 | 1606 | 4 | 802 | 5 | 92 | 2 | |
Total number of respondents; varies for individual items (i.e., number of eligible respondents less number who elected not to answer).
Percent reporting Yes
Percent reporting Everytime/Most times. Respondents were asked to select from the following response options: every time, most times, sometimes, rarely or never. Some of the questions included `not available' or `not applicable' as additional response options.
Excludes respondents who reported that system was not available.
Defined in the survey as the contents of one bottle of liquid anesthetic agent.
Work Practices and Self-Assessment of General Ventilation in the Post Anesthesia Patient Recovery Area
| Practice/Self-Assessment | All Anesthesia Care Providers | Nurse Anesthetists | Physician Anesthesiologists | Anesthesiologist Assistants | ||||
|---|---|---|---|---|---|---|---|---|
| What was the average amount of time you spent each work day with patients in recovery area(s)? | n | % | n | % | n | % | n | % |
| 2986 | 1782 | 1104 | 100 | |||||
| No time spent in recovery area | 3 | 4 | 1 | 0 | ||||
| < 1 hour | 78 | 83 | 68 | 92 | ||||
| ≥ 1 hour | 19 | 13 | 30 | 8 | ||||
| Was the patient recovery area where you spent the most time during the past week adequately ventilated? | n | % | n | % | n | % | n | % |
| 2889 | 1701 | 1088 | 100 | |||||
| Yes | 54 | 53 | 55 | 48 | ||||
| No | 4 | 5 | 4 | 2 | ||||
| I don't know | 42 | 42 | 50 | 50 | ||||
| How often was the patient transferred to recovery area while intubated? | n | % | n | % | n | % | n | % |
| 2812 | 1 | 1675 | 1 | 1044 | 2 | 93 | 0 | |
Total number of respondents; varies for individual items (i.e., number of eligible respondents less number who elected not to answer).
Percents may not add up to exactly 100 percent due to rounding.
Percent of respondents reporting Everytime/Most times. Respondents were asked to select from the following response options: every time, most times, sometimes, rarely or never. Some of the questions included 'not available' or 'not applicable' as additional response options.
Ambient Air and Worker Exposure Monitoring Practices for Anesthetic Gases
| Air Monitoring Practices | All Anesthesia Care Providers | Nurse Anesthetists | Physician Anesthesiologists | Anesthesiologist Assistants | ||||
|---|---|---|---|---|---|---|---|---|
| Has air monitoring for anesthetic gases been conducted on a continuous or periodic basis in the operating room to detect anesthetic gas leaks? | n | % Yes | n | % Yes | n | % Yes | n | % Yes |
| 2967 | 30 | 1766 | 29 | 1101 | 32 | 100 | 17 | |
| Has exposure monitoring (using badges or other air sampling devices) been conducted in the past 12 months to assess your exposure or your co-workers' exposure to anesthetic gases? | n | % Yes | n | % Yes | n | % Yes | n | % Yes |
| 2984 | 15 | 1780 | 16 | 1104 | 13 | 100 | 16 | |
Total number of respondents may vary for individual items (i.e., number of eligible respondents less number who elected not to answer).