Post Anaesthesia Care Unit Occupational Safety And Health Issuespost Anaesthesia Care Unit Occupational Safety And Health Issues

Post Anaesthesia Care Unit: Occupational Safety and Health Issues

Introduction

Post anaesthesia care unit is a very crucial aspect of hospitals and other health care providers. Usually attached to the operating room, this unit is meant to cater for the health needs of patients who are recovering from anaesthesia. The anaesthesia from which the patient is recovering from can be general, regional or local. The care that is given to the patients is not only post anaesthesia in nature, but also post operative. The nurses who man the unit monitor the vital signs of the patient together with treatment of post operative symptoms like post operative nausea and vomiting. Most operations are followed by pain on the part of the patient. Effective management of this pain is another duty that is performed by the post anaesthesia care unit staff.

Despite the fact that this unit plays a very central role in the running of the health care institution, its environment is full of risks, both to the patients and to the staff. These risks include infectious diseases and injuries among others. There is a convergence of risk factors in this unit that expose the patients and the staff to pathogens that are blood or air borne. The proximity of the caring staff to the recovering patients also puts them at risk of inhaling waste anaesthetic gases.

This paper is going to critically analyze occupational health and safety issues that are pertinent to the post anaesthesia unit environment. The writer will examine the occupational health and safety issues that are relevant for the safety of the patient and also for the safety of the staff. The ways that these issues are addressed or can be addressed by the hospital and other stakeholders will also be examined.

Objectives of the Study

Throughout the study, the writer will be guided by one major objective. This is the critical analysis of occupational health and safety issues in post anaesthesia units. To achieve this, the writer will be guided by several specific objectives. It is by way of addressing these specific objectives that the writer will effectively address the major objective. These specific objectives are as listed below:

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Post Anaesthesia Care Unit: Occupational Safety and Health Issues

1. Occupational health and safety issues for patient safety in post anaesthesia care unit (PACU)

2. Occupational health and safety issues for staff safety in PACU

1: Occupational Health and Safety Issues for Staff Safety in PACU

As they go about their duties within the PACU, the staff members are exposed to risks that are inherent to their line of work. This is as a result of the environment within which they are working.

Generally, the bed spaces in which the patients are tended are not partitioned from each other (McGregor 2006). What this means is that a nurse tending to a patient on an adjacent bed does not only inhale the air that is exhaled by this one patient, but the air exhaled by the patient in the adjacent bed, especially if the latter experiences coughing fits, which are not at all uncommon (McGregor 2006). The exhaled air is likely to be laden with pathogens and waste anaesthetic gas.

The scenario above is made worse by the fact that there is usually a high turnover of patients in the PACU. This is because the unit is a transitory stage for patients who are out of the operation room and on their way to the general ward or on their way home. Majority of the patients spend even less than a day in the unit (Iyer 2008). Given this fact, the history of the patient is sketchy, if anything, to the PACU nurses. It is not easy for them to delve into the medical history of each and every of their transient patients. This then points to the fact that the nurses have no idea of any communicable infections that the patient might be carrying.

In most cases, the unit is windowless, and ventilation is through the use of mechanised procedures. As such, the staff are at a greater risk of contracting communicable airborne diseases. The nature of the care that they are providing to the patients requires that a close proximity be maintained between the nurse and the patient (Berger 2008). Communicable diseases like hepatitis C, Human Immunodeficiency Virus among others are the most common communicable diseases that are passed from the patient to the nurse in the post anaesthesia care unit (Berger 2008).

In America, the Occupational Safety and Health Administration have realised the fact that the patients and staff of PACU are exposed to risks on a regular basis. The Centres for Disease Control have come to the same realisation (Panagiotis, Maria & Argiri 2005). The two have come up with procedures and standards for mitigating risks of occupational health to the staff and the patients in the unit (Panagiotis et al 2005).

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Post Anaesthesia Care Unit: Occupational Safety and Health Issues

Exposure of Staff to Waste Anaesthetic Gases

During operation procedure, anaesthetic gases are delivered to the patient through a face mask or through an endotracheal tube. The latter is secured to the patient through an inflatable cuff (Gaub & Rowland 2007). This seals the tube delivering the anaesthesia gas to the patient within the trachea. If a face mask is used, the same procedure is followed where the nurses ensures that the seal between the face and the mask is air tight. Leaking of anaesthetic gases under these conditions is maintained at the possible minimum levels.

This controlled leak means that it is very easy to scavenge effectively within the operation room. The patient is hooked to the breathing circuit by use of the tracheal tube or face mask. This is then connected to the scavenging unit in the room, ensuring that a large proportion of the gases that might leak from the patient is absorbed by the system, rather than been released to the operation room atmosphere (Panagiotis et al 2005).

However, this is not the case when the patient is transferred from the operating room to the post anaesthetic care unit for recovery. Scavenging systems like those employed in the operation room become ineffective (Farmingdale 2009). This is because the patient is not hooked to the breathing circuit in the PACU as he was in the operating room. The staff in this unit employs procedures for removing the waste gas from the environment. These procedures are rarely effective.

The patient is the chief source of waste anaesthetic gases within the PACU. This makes it really hard for effective control of staff exposure to these gases. These gases are composed of nitrous oxide and other halogenated agents or vapours within the PACU. They include, but not limited to, the following: Enflurane, Isoflurane, savoflurane, desflurane and halothane (Krenzischek & Bukowski 2009).

When the staff members are exposed to these gases, they experience adverse health effects that are far reaching. They include dizziness, headache, fatigue, miscarriages, birth defects, sterility and systems failure among others (Iyer 2008). This is very critical considering the fact that majority of the care givers within the unit are of child bearing age.

The exposure to these gases emanate from low standards of practices during the anesthetisation of the patient. This makes it possible for the patient to exhale large doses of the gas within PACU if the dose that was administered to him was equally high. Leaking or below standard connections of the gas lines within the operating room might be another source of leak to the PACU especially in situations where the two units are adjacent (Gaub & Rowland 2007). But these sources are negligible. The major source is the exhalation of the patient in PACU during recovery and off-gassing (Gaub & Rowland 2007).

Occupational Safety and Health Administration (OSHA) has given recommendations on how this exposure, which might lead to complications, might be maintained or avoided. They include the following:

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Post Anaesthesia Care Unit: Occupational Safety and Health Issues

i. Engineering Controls

Levels of atmospheric contamination within the operation room have been brought down by the adoption of appropriate scavenging procedures. However, these same measures cannot be employed to source-control the gas emissions from the patients within the PACU (Iyer 2008). Also, as earlier indicated, there are no partitions between the various beds that are to be found within the PACU. As such, convective currents especially emanating from the air circulation machinery disperse the waste anaesthetic gases from their source to the rest of the atmosphere within the unit (Huffman 2006).

Given this, it is obvious then that the only reliable way to minimise the level of waste anaesthetic gas in PACU is to rely on proper engineering mechanisms. This is where a dilution ventilation system is properly designed such that the amounts of these gases in the room are below the OSHA recommended standards (Krenzischek & Bukowski 2009).

OSHA, together with the American Institute of Architects provides for the minimum level of concentration of these gases in the room (Huffman 2006). The ventilation system should maintain a minimum total of six air changes per hour (Badgwell 2007). This is together with a minimum of “two air changes of outdoor air per hour” (Badgwell 2007). This way, there will be adequate dilution of the waste anaesthetic gases within the room. The ventilation system should be engineered in such a way that the exhaust whisked from the room which contains the gases is not recirculated to other rooms in the hospital.

ii. Work Practices

OSHA goes ahead to recommend that the PACU managers should carry out periodic exposure monitoring procedures. They should particularly pay attention to the peak gas levels. This is in the breathing zones of the staff working in the immediate vicinity of the recovering patient’s head (Payne, Smith, Newkirk & Hicks 2007). This is because it has been found that random sampling of the room ambient concentration of the same have been found to be ineffective in gauging the level of exposure that this staff members face (Payne et al 2007). Given the proximity of the care giver to the face of the patient who is exhaling the anaesthetic gases, such sampling techniques would not provide a clear picture of the concentration of the gases in the breathing zone of the care giver (Kerr 2004).

Also on the working practices, the OSHA and Centres for Disease Control provide that the managers of these units should ensure that regular maintenance procedures are carried out on the ventilation system (Kerr 2004). This is to ensure that the concentration of the gases in the room is kept at the recommended minimum levels.

The above are just some of the measures that are recommended for keeping the PACU staff safe from exposure to waste anaesthetic gases. Other measures include ensuring that the staff

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Post Anaesthesia Care Unit: Occupational Safety and Health Issues

members adorn protective gear such as face masks. This will ensure that the amount of waste anaesthetic gas that the bedside nurse inhales are reduced (McLeskey 2008). The staff members should also be kept abreast on the dangers that they face from the exposure through training programs (McLeskey 2008). This is through training programs that should be periodically conducted in the institution. This is provided for in OSHA’s Hazard Communication Standard for all staff members exposed to such gases (De Nicola 2009).

Exposure of Staff Members to Blood Borne Pathogens

The staff members in this unit are in contact with patients who have already undergone operation procedures. It is very likely that these patients have wounds and other skin breaks which are leaking blood that the bedside care giver might come into contact with. This puts the staff member at risk of contracting infections from pathogens that might be found in the patients blood (Kerr 2004). Such pathogens include hepatitis B and C virus, HIV and others.

To avert this, OSHA’s Blood Borne Pathogens Standard provides for various standards that should be met (De Nicola 2009). They provide for engineering and work practice controls to avert or mitigate exposure to the same.

One of the provisions is that injuries accrued from sharps should be eliminated or minimised as much as possible. This can be done by ensuring that the nurses and other members of staff in the unit use safe sharps devices that meet the required safety standards (Turnbull 2006). The suture needles that they use should have a blunt tip. The PACU patients sometimes require intravenous connections to supply them with fluids, nutrition, drugs or other necessities. The staff members should ensure that they use needleless intravenous connectors as much as possible (Farmingdale 2009).

OSHA also provides that the staff members should be adorned with protective clothing gear (Panagiotis et al 2005). This is especially so if there is a likelihood of coming into contact with blood matter when handling the patient. The protective clothing should be impermeable to blood under normal circumstances. They include gloves and gowns (Panagiotis et al 2005). Masks and eye protection gear such as goggles should also be worn. This is when the care giver expects splashes or sprays of blood to be emitted by the patient, for example when removing a dressing in a wound.

Contaminated sharps and needles should be exposed of appropriately. This ensures that there is no risk of coming into contact with them accidentally. Simple procedures such as hand washing using detergents have been known to go a long way in ensuring that the rate of occupational hazard as far as handling of blood material is concerned (Farmingdale 2009).

Mobility and Comfort

Staff members in PACU especially in busy institutions have been known to be on their feet the entire duration of their shift. This is because they have to assume a standing posture when

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Post Anaesthesia Care Unit: Occupational Safety and Health Issues

providing bedside care to their charges. They also keep on moving from one bed side to the other, as they try to cater for more than one patient at the same time (de Nicola 2009).

This posture puts the staff members at a risk of developing discomforts on his feet or back, especially if he has to bend over a patient when catering to him. Muscle fatigue is inevitable, as well as pooling of blood in the lower extremities of the nurse (Payne et al 2005). If the surface on which the nurse is trending on is hard and uncomfortable, trauma and pain to the feet is experienced (Badgwell 2007).

To avoid all this, OSHA provides that the surfaces of the post anaesthetic care unit be made of materials that are comfortable to stand and work on. The staff members are also encouraged to wear shoes that are fitted with insoles that are comfortable. This is to ensure that the feet do not have to undergo unnecessary fatigue. The beds in the unit should also be height adjustable (Berger 2008). This is to ensure that the nurse can adjust the height of the bed to a comfortable height, so that h does not have to bend or stretch his hands too much (Krenzischek & Bukowski 2009).

2: Occupational Health and Safety Issues for Patients in Post Anaesthesia Care Units

Like the staff members, the patients are also exposed to some risks in PACU as well. This is more significant given that in the hustle of providing care to these patients, some basics are overlooked both by the administration and the care givers who are in contact with the patient. On arrival, the patient requires constant monitoring and evaluation of his status, throughout the stay and to discharge. Most of the risks that the patient does face emanate from the likelihood of the staff members to deviate from the laid down procedures to care for the patient in this unit (Gaub & Rowland 2007).

Oxygen Deprivation

The patient faces risk of oxygen deprivation, restraints and cardiac arrest. General anaesthesia puts the patient at a risk of oxygen deprivation. This can occur when the instrument delivering the oxygen to the patient is blocked or malfunctions (Iyer 2008). Other causes are muscle relaxants that have been administered to the patient, together with other anaesthetic agents.

This been the case, the post anaesthetic care unit nurse is required to monitor the patient in his charge to ensure that the complications does not occur. The respiratory rate of the patient should be counted and recorded continuously. Failure to do this puts the patient at a risk of developing complications arising from deprivation of oxygen to the brain.

Injury

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Post Anaesthesia Care Unit: Occupational Safety and Health Issues

The patient is also exposed to injury risks as he recovers from the effects of the anaesthesia. Delirium may occur as the effects of the anaesthesia are wearing off. Probably at this time, the patient is at PACU. This emergence delirium involves the patient kicking about and been restless. In the process of thrashing about, the patient might fall off the bed and injure himself (Turnbull 2006).

To avert this, the nurses are expected to closely watch the patient as he emerges from the effects of the anaesthesia. The nurses should also use side rails in ensuring that the patient does not fall off the bed (McGregor 2006).

It has been found that in some instances, the nurses make use of restraints to make sure that the patient does not injure himself (de Nicola 2009). However, this practice has been found to be counterproductive and poses another risk to the patient. The anxiety of the patient is raised and this may lead to psychological injury. Other physical injuries can also arise. If the restraints are not checked periodically, they can injure the nerves of the patient’s affected body by cutting off blood supply to these areas.

Cardiac Arrest

Some anaesthetics administered to the patient during surgery can lead to irregular heart beats. This is through the lowering or rising of the heart rate. This is why the PACU staff members are expected to constantly monitor the cardiac patterns of the patient (Payne et al 2007). The risk to the patient in this critical moment is when the PACU staff members decide to turn off the monitoring machines (Turnbull 2006). When this is done, the alarm will not be raised if the patient does develop heart attack.

Another risk that the patients in PACU face is low blood pressure (Farmingdale 2009). This arises from the effects of the pain medication administered on the patient during operation. It can also accrue from anaesthesia or excessive bleeding during the procedure. If the patient is improperly positioned, this is another risk factor. Also, high blood pressure might also affect the patient who is recovering from the effects of anaesthesia (Iyer 2008). This is brought about by excessive fluid in his body among other risk factors. The patient may also have an underlying hypertension condition.

This is the reason why the staff members at the unit are expected to monitor the blood pressure of the patient who is recovering from anaesthesia. If the hypertension or hypotension is not detected early enough, there is a risk that the patient might develop cardiac arrest.

Conclusion

Post anaesthesia caring unit is a very important facet of any hospital or health care providing institution that is involved in carrying out surgical procedures on their patients. This is because

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Post Anaesthesia Care Unit: Occupational Safety and Health Issues

while undergoing the operation, the patient, most of the times, has to be put under general, local or regional anaesthesia. This anaesthesia, been foreign to the body system, tends to ravage the same. What this means is that specialised care has to be provided to wean the patient out of the effects of the anaesthesia after the operation. The weaning process is very critical and a lot of complications might arise in the process.

There are occupational health and safety issues that are inherent in PACU environment. These issues affect both the patient and the staff members. For the staff members, they involve exposure to waste anaesthetic gases, exposure to blood borne and airborne pathogens among others. For the patient, they range from cardiac arrest to physical and psychological injuries. These risks have to be managed effectively if the success of the PACU is to be maintained. OSHA and the Centres for Disease Control provide some recommendations on how these risks can be effectively managed.

Bibliography

Badgwell, IW 2007. Occupational Hazards in Hospitals. Long Beach: Wiley & Sons, 654-678.

Berger, NA 2008. Maintaining Hygiene in PACU. Lubbock: Heschet Books, 187-190.

De Nicola, UW 2009. Post Anaesthetic Care Units: A Safe or Disease Haven?

Cambridge:

Cambridge University Press, 189-190.

Farmingdale, TY 2009. Risk of Developing Complications in PACU for Cancer Patients.

Journal of Oncology America, 11(2), 16-18.

Gaub, BC & Rowland, JA 2007. Obstetric Post Anaesthesia Care Units.

Oxford: Oxford University Press, 189-190.

Huffman, DF 2006. Occupational Safety and Health Issues in Hospital Operations.

Journal of PeriAnesthesia Nursing, 11(3). 23-24.

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Post Anaesthesia Care Unit: Occupational Safety and Health Issues

Iyer, HW 2008. Evaluating Occupational Health Hazards in Critical Care Units.

Oxford: Oxford University Press, 489-493.

Kerr, IS 2004. Health Hazards in Post Anaesthetic Care Units. 2nd ed. London: Cengen Books, 234-256.

Krenzischek, HW & Bukowski, GB 2009. Standards for Post Anaesthesia Care Units in

American Hospitals.                                                                                                  New York: McGraw-Hill, 590-592.

McGregor, HG 2006. Improving Post Anaesthesia Care in Local Hospitals. Lubbock: Jersey Publishers, 278-279.

McLeskey, BA 2008. Occupational Safety and Health Administration: Provisions for Employees

Exposed to Waste Anaesthetic Gases. Journal of International Labour Relations, 12(3), 25.

Panagiotis, VA Maria, CP & Argiri, XL 2005. Health Hazards to Patients in PACU.

New Jersey:

Prentice-Hall, 567-578.

Payne, MN Smith, FA Newkirk, AW & Hicks, TE 2007. Postanesthetic Nursing. 4th ed. New York: McGraw-Hill, 432-445.

Turnbull, KS 2006. Becoming a Post Anaesthetic Care Nurse: Risks and Opportunities.

New

York: McGraw-Hill, 29-34.

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Post Anaesthesia Care Unit: Occupational Safety and Health Issues

Introduction

Post anaesthesia care unit is a very crucial aspect of hospitals and other health care providers. Usually attached to the operating room, this unit is meant to cater for the health needs of patients who are recovering from anaesthesia. The anaesthesia from which the patient is recovering from can be general, regional or local. The care that is given to the patients is not only post anaesthesia in nature, but also post operative. The nurses who man the unit monitor the vital signs of the patient together with treatment of post operative symptoms like post operative nausea and vomiting. Most operations are followed by pain on the part of the patient. Effective management of this pain is another duty that is performed by the post anaesthesia care unit staff.

Despite the fact that this unit plays a very central role in the running of the health care institution, its environment is full of risks, both to the patients and to the staff. These risks include infectious diseases and injuries among others. There is a convergence of risk factors in this unit that expose the patients and the staff to pathogens that are blood or air borne. The proximity of the caring staff to the recovering patients also puts them at risk of inhaling waste anaesthetic gases.

This paper is going to critically analyze occupational health and safety issues that are pertinent to the post anaesthesia unit environment. The writer will examine the occupational health and safety issues that are relevant for the safety of the patient and also for the safety of the staff.

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Post Anaesthesia Care Unit: Occupational Safety and Health Issues

The ways that these issues are addressed or can be addressed by the hospital and other stakeholders will also be examined.

Objectives of the Study

Throughout the study, the writer will be guided by one major objective. This is the critical analysis of occupational health and safety issues in post anaesthesia units. To achieve this, the writer will be guided by several specific objectives. It is by way of addressing these specific objectives that the writer will effectively address the major objective. These specific objectives are as listed below:

1. Occupational health and safety issues for patient safety in post anaesthesia care unit (PACU)

2. Occupational health and safety issues for staff safety in PACU

1: Occupational Health and Safety Issues for Staff Safety in PACU

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Post Anaesthesia Care Unit: Occupational Safety and Health Issues

As they go about their duties within the PACU, the staff members are exposed to risks that are inherent to their line of work. This is as a result of the environment within which they are working.

Generally, the bed spaces in which the patients are tended are not partitioned from each other (McGregor 2006). What this means is that a nurse tending to a patient on an adjacent bed does not only inhale the air that is exhaled by this one patient, but the air exhaled by the patient in the adjacent bed, especially if the latter experiences coughing fits, which are not at all uncommon (McGregor 2006). The exhaled air is likely to be laden with pathogens and waste anaesthetic gas.

The scenario above is made worse by the fact that there is usually a high turnover of patients in the PACU. This is because the unit is a transitory stage for patients who are out of the operation room and on their way to the general ward or on their way home. Majority of the patients spend even less than a day in the unit (Iyer 2008). Given this fact, the history of the patient is sketchy, if anything, to the PACU nurses. It is not easy for them to delve into the medical history of each and every of their transient patients. This then points to the fact that the nurses have no idea of any communicable infections that the patient might be carrying.

In most cases, the unit is windowless, and ventilation is through the use of mechanised procedures. As such, the staff are at a greater risk of contracting communicable airborne diseases. The nature of the care that they are providing to the patients requires that a close proximity be maintained between the nurse and the patient (Berger 2008). Communicable diseases like hepatitis C, Human Immunodeficiency Virus among others are the most common communicable diseases that are passed from the patient to the nurse in the post anaesthesia care unit (Berger 2008).

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Post Anaesthesia Care Unit: Occupational Safety and Health Issues

In America, the Occupational Safety and Health Administration have realised the fact that the patients and staff of PACU are exposed to risks on a regular basis. The Centres for Disease Control have come to the same realisation (Panagiotis, Maria & Argiri 2005). The two have come up with procedures and standards for mitigating risks of occupational health to the staff and the patients in the unit (Panagiotis et al 2005).

Exposure of Staff to Waste Anaesthetic Gases

During operation procedure, anaesthetic gases are delivered to the patient through a face mask or through an endotracheal tube. The latter is secured to the patient through an inflatable cuff (Gaub & Rowland 2007). This seals the tube delivering the anaesthesia gas to the patient within the trachea. If a face mask is used, the same procedure is followed where the nurses ensures that the seal between the face and the mask is air tight. Leaking of anaesthetic gases under these conditions is maintained at the possible minimum levels.

This controlled leak means that it is very easy to scavenge effectively within the operation room. The patient is hooked to the breathing circuit by use of the tracheal tube or face mask. This is then connected to the scavenging unit in the room, ensuring that a large proportion of the gases that might leak from the patient is absorbed by the system, rather than been released to the operation room atmosphere (Panagiotis et al 2005).

However, this is not the case when the patient is transferred from the operating room to the post

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Post Anaesthesia Care Unit: Occupational Safety and Health Issues

anaesthetic care unit for recovery. Scavenging systems like those employed in the operation room become ineffective (Farmingdale 2009). This is because the patient is not hooked to the breathing circuit in the PACU as he was in the operating room. The staff in this unit employs procedures for removing the waste gas from the environment. These procedures are rarely effective.

The patient is the chief source of waste anaesthetic gases within the PACU. This makes it really hard for effective control of staff exposure to these gases. These gases are composed of nitrous oxide and other halogenated agents or vapours within the PACU. They include, but not limited to, the following: Enflurane, Isoflurane, savoflurane, desflurane and halothane (Krenzischek & Bukowski 2009).

When the staff members are exposed to these gases, they experience adverse health effects that are far reaching. They include dizziness, headache, fatigue, miscarriages, birth defects, sterility and systems failure among others (Iyer 2008). This is very critical considering the fact that majority of the care givers within the unit are of child bearing age.

The exposure to these gases emanate from low standards of practices during the anesthetisation of the patient. This makes it possible for the patient to exhale large doses of the gas within PACU if the dose that was administered to him was equally high. Leaking or below standard connections of the gas lines within the operating room might be another source of leak to the PACU especially in situations where the two units are adjacent (Gaub & Rowland 2007). But these sources are negligible. The major source is the exhalation of the patient in PACU during recovery and off-gassing (Gaub & Rowland 2007).

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Post Anaesthesia Care Unit: Occupational Safety and Health Issues

Occupational Safety and Health Administration (OSHA) has given recommendations on how this exposure, which might lead to complications, might be maintained or avoided. They include the following:

i.                                                         Engineering Controls

Levels of atmospheric contamination within the operation room have been brought down by the adoption of appropriate scavenging procedures. However, these same measures cannot be employed to source-control the gas emissions from the patients within the PACU (Iyer 2008). Also, as earlier indicated, there are no partitions between the various beds that are to be found within the PACU. As such, convective currents especially emanating from the air circulation machinery disperse the waste anaesthetic gases from their source to the rest of the atmosphere within the unit (Huffman 2006).

Given this, it is obvious then that the only reliable way to minimise the level of waste anaesthetic gas in PACU is to rely on proper engineering mechanisms. This is where a dilution ventilation system is properly designed such that the amounts of these gases in the room are below the OSHA recommended standards (Krenzischek & Bukowski 2009).

OSHA, together with the American Institute of Architects provides for the minimum level of concentration of these gases in the room (Huffman 2006). The ventilation system should maintain a minimum total of six air changes per hour (Badgwell 2007). This is together with a minimum of “two air changes of outdoor air per hour” (Badgwell 2007). This way, there will be adequate dilution of the waste anaesthetic gases within the room. The ventilation system should

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Post Anaesthesia Care Unit: Occupational Safety and Health Issues

be engineered in such a way that the exhaust whisked from the room which contains the gases is not recirculated to other rooms in the hospital.

ii.                                                    Work Practices

OSHA goes ahead to recommend that the PACU managers should carry out periodic exposure monitoring procedures. They should particularly pay attention to the peak gas levels. This is in the breathing zones of the staff working in the immediate vicinity of the recovering patient’s head (Payne, Smith, Newkirk & Hicks 2007). This is because it has been found that random sampling of the room ambient concentration of the same have been found to be ineffective in gauging the level of exposure that this staff members face (Payne et al 2007). Given the proximity of the care giver to the face of the patient who is exhaling the anaesthetic gases, such sampling techniques would not provide a clear picture of the concentration of the gases in the breathing zone of the care giver (Kerr 2004).

Also on the working practices, the OSHA and Centres for Disease Control provide that the managers of these units should ensure that regular maintenance procedures are carried out on the ventilation system (Kerr 2004). This is to ensure that the concentration of the gases in the room is kept at the recommended minimum levels.

The above are just some of the measures that are recommended for keeping the PACU staff safe from exposure to waste anaesthetic gases. Other measures include ensuring that the staff members adorn protective gear such as face masks. This will ensure that the amount of waste anaesthetic gas that the bedside nurse inhales are reduced (McLeskey 2008). The staff members should also be kept abreast on the dangers that they face from the exposure through training programs (McLeskey 2008). This is through training programs that should be

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Post Anaesthesia Care Unit: Occupational Safety and Health Issues

periodically conducted in the institution. This is provided for in OSHA’s Hazard Communication Standard for all staff members exposed to such gases (De Nicola 2009).

Exposure of Staff Members to Blood Borne Pathogens

The staff members in this unit are in contact with patients who have already undergone operation procedures. It is very likely that these patients have wounds and other skin breaks which are leaking blood that the bedside care giver might come into contact with. This puts the staff member at risk of contracting infections from pathogens that might be found in the patients blood (Kerr 2004). Such pathogens include hepatitis B and C virus, HIV and others.

To avert this, OSHA’s Blood Borne Pathogens Standard provides for various standards that should be met (De Nicola 2009). They provide for engineering and work practice controls to avert or mitigate exposure to the same.

One of the provisions is that injuries accrued from sharps should be eliminated or minimised as much as possible. This can be done by ensuring that the nurses and other members of staff in the unit use safe sharps devices that meet the required safety standards (Turnbull 2006). The suture needles that they use should have a blunt tip. The PACU patients sometimes require intravenous connections to supply them with fluids, nutrition, drugs or other necessities. The staff members should ensure that they use needleless intravenous connectors as much as possible (Farmingdale 2009).

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Post Anaesthesia Care Unit: Occupational Safety and Health Issues

OSHA also provides that the staff members should be adorned with protective clothing gear (Panagiotis et al 2005). This is especially so if there is a likelihood of coming into contact with blood matter when handling the patient. The protective clothing should be impermeable to blood under normal circumstances. They include gloves and gowns (Panagiotis et al 2005). Masks and eye protection gear such as goggles should also be worn. This is when the care giver expects splashes or sprays of blood to be emitted by the patient, for example when removing a dressing in a wound.

Contaminated sharps and needles should be exposed of appropriately. This ensures that there is no risk of coming into contact with them accidentally. Simple procedures such as hand washing using detergents have been known to go a long way in ensuring that the rate of occupational hazard as far as handling of blood material is concerned (Farmingdale 2009).

Mobility and Comfort

Staff members in PACU especially in busy institutions have been known to be on their feet the entire duration of their shift. This is because they have to assume a standing posture when providing bedside care to their charges. They also keep on moving from one bed side to the other, as they try to cater for more than one patient at the same time (de Nicola 2009).

This posture puts the staff members at a risk of developing discomforts on his feet or back, especially if he has to bend over a patient when catering to him. Muscle fatigue is inevitable, as well as pooling of blood in the lower extremities of the nurse (Payne et al 2005). If the surface on which the nurse is trending on is hard and uncomfortable, trauma and pain to the feet is

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Post Anaesthesia Care Unit: Occupational Safety and Health Issues

experienced (Badgwell 2007).

To avoid all this, OSHA provides that the surfaces of the post anaesthetic care unit be made of materials that are comfortable to stand and work on. The staff members are also encouraged to wear shoes that are fitted with insoles that are comfortable. This is to ensure that the feet do not have to undergo unnecessary fatigue. The beds in the unit should also be height adjustable (Berger 2008). This is to ensure that the nurse can adjust the height of the bed to a comfortable height, so that h does not have to bend or stretch his hands too much (Krenzischek & Bukowski 2009).

2: Occupational Health and Safety Issues for Patients in Post Anaesthesia Care Units

Like the staff members, the patients are also exposed to some risks in PACU as well. This is more significant given that in the hustle of providing care to these patients, some basics are overlooked both by the administration and the care givers who are in contact with the patient. On arrival, the patient requires constant monitoring and evaluation of his status, throughout the stay and to discharge. Most of the risks that the patient does face emanate from the likelihood of the staff members to deviate from the laid down procedures to care for the patient in this unit (Gaub & Rowland 2007).

Oxygen Deprivation

The patient faces risk of oxygen deprivation, restraints and cardiac arrest. General anaesthesia puts the patient at a risk of oxygen deprivation. This can occur when the instrument delivering

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the oxygen to the patient is blocked or malfunctions (Iyer 2008). Other causes are muscle relaxants that have been administered to the patient, together with other anaesthetic agents.

This been the case, the post anaesthetic care unit nurse is required to monitor the patient in his charge to ensure that the complications does not occur. The respiratory rate of the patient should be counted and recorded continuously. Failure to do this puts the patient at a risk of developing complications arising from deprivation of oxygen to the brain.

Injury

The patient is also exposed to injury risks as he recovers from the effects of the anaesthesia. Delirium may occur as the effects of the anaesthesia are wearing off. Probably at this time, the patient is at PACU. This emergence delirium involves the patient kicking about and been restless. In the process of thrashing about, the patient might fall off the bed and injure himself (Turnbull 2006).

To avert this, the nurses are expected to closely watch the patient as he emerges from the effects of the anaesthesia. The nurses should also use side rails in ensuring that the patient does not fall off the bed (McGregor 2006).

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It has been found that in some instances, the nurses make use of restraints to make sure that the patient does not injure himself (de Nicola 2009). However, this practice has been found to be counterproductive and poses another risk to the patient. The anxiety of the patient is raised and this may lead to psychological injury. Other physical injuries can also arise. If the restraints are not checked periodically, they can injure the nerves of the patient’s affected body by cutting off blood supply to these areas.

Cardiac Arrest

Some anaesthetics administered to the patient during surgery can lead to irregular heart beats. This is through the lowering or rising of the heart rate. This is why the PACU staff members are expected to constantly monitor the cardiac patterns of the patient (Payne et al 2007). The risk to the patient in this critical moment is when the PACU staff members decide to turn off the monitoring machines (Turnbull 2006). When this is done, the alarm will not be raised if the patient does develop heart attack.

Another risk that the patients in PACU face is low blood pressure (Farmingdale 2009). This arises from the effects of the pain medication administered on the patient during operation. It can also accrue from anaesthesia or excessive bleeding during the procedure. If the patient is improperly positioned, this is another risk factor. Also, high blood pressure might also affect the patient who is recovering from the effects of anaesthesia (Iyer 2008). This is brought about by excessive fluid in his body among other risk factors. The patient may also have an underlying hypertension condition.

This is the reason why the staff members at the unit are expected to monitor the blood pressure of the patient who is recovering from anaesthesia. If the hypertension or hypotension is not

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detected early enough, there is a risk that the patient might develop cardiac arrest.

Conclusion

Post anaesthesia caring unit is a very important facet of any hospital or health care providing institution that is involved in carrying out surgical procedures on their patients. This is because while undergoing the operation, the patient, most of the times, has to be put under general, local or regional anaesthesia. This anaesthesia, been foreign to the body system, tends to ravage the same. What this means is that specialised care has to be provided to wean the patient out of the effects of the anaesthesia after the operation. The weaning process is very critical and a lot of complications might arise in the process.

There are occupational health and safety issues that are inherent in PACU environment. These issues affect both the patient and the staff members. For the staff members, they involve exposure to waste anaesthetic gases, exposure to blood borne and airborne pathogens among others. For the patient, they range from cardiac arrest to physical and psychological injuries. These risks have to be managed effectively if the success of the PACU is to be maintained. OSHA and the Centres for Disease Control provide some recommendations on how these risks can be effectively managed.

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Berger, NA 2008. Maintaining Hygiene in PACU. Lubbock: Heschet Books, 187-190.

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