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Indoor air quality in hospital operating rooms (ORs) is of great concern for patients and medical personnel, thus mandating the use of efficient HVAC systems and active gas scavenging systems in ORs. A wide range of relevant medical and engineering literature is summarized in this paper, highlighting relevant challenges, problems and solutions, along with recommended good practices. Indoor conditions in Hellenic ORs were monitored and data were used to assess the exposure of medical personnel to anaesthetic gases and other indoor chemical 23573
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compounds. Accordingly, even when mechanical ventilation and scavenging systems were employed in some of the audited ORs, medical personnel are still exposed to poor indoor air quality. The average concentration of anaesthetic gases (isoflurane,sevoflurane) was 2362 mg/m3
, exceeding the exposure limit in 18% of the audited ORs. The average concentration of disinfecting agents was 288 mg/m3 for formaldehyde and 207 mg/m3 for glutaraldehyde. Additional compounds were identified in the OR indoor air that
represent 54% of the total volatile organic concentration.
r 2007 Elsevier Ltd. All rights reserved.1. Introduction
Hospital operating theaters (suites) that comprise
operating rooms (ORs) or surgical theatres are among
the most demanding health care work areas. Heating,
ventilating and air-conditioning (HVAC) installations
control indoor environmental quality (IEQ) and aseptic
conditions, and secure healthy, safe and suitable indoor air
quality (IAQ), for surgeons and medical staff, and of
course, the patients. An overview of relevant standards and
guidelines on the design, installation, commissioning,
operation, and maintenance of HVAC installations in
hospital ORs, is available in Ref. [1].
The indoor air of an OR contains different chemicals like
waste medical gases used for anaesthesia, disinfection and
sterilizing substances, and other particles such as skin
squames, lint, respiratory droplets, and aerosols. Adverse
health effects and discomfort have been detected to ORpersonnel by the occupational exposure to medical and
other chemical compounds, thus, personnel exposure
should be limited [2,3].
The use of anaesthetic gas scavenging systems (AGSS)
has become common practice in modern ORs to recover
waste anaesthetic gases (WAG). AGSS are complete
systems that are used to capture escaped and/or excess
anaesthetic gases from the patient’s respiratory track used
to administer anaesthesia. Gases are then exhausted to the
outdoors or to a place from where they can be safely
discharged, for example, by a non-recirculating exhaust
ventilation system.论文网
The unique requirements and characteristics of indoor
conditions in hospital ORs mandates that the design,
operation and maintenance of HVAC installations take
into account some knowledge and experiences from
medical sources, on top of good engineering. For this
purpose, a wide range of relevant medical and engineering
literature is summarized in this paper, highlighting relevant
challenges, problems and solutions, along with recom-
mended good practices. Measured data are then presentedcoordination and hearing among those exposed [13,31],
mutations in DNA [27], and an increased risk of genetic
damage [25,31], while even trace levels may be harmful to
OR personnel [2]. However, based on a questionnaire
survey in the UK, 49% of consultant anaesthetists had
reduced their use of nitrous oxide, due to medical
considerations rather than concerns over health and
pollution issues arising from the use of nitrous oxide [32].
In any event, even as a precaution, it is widely
recommended, to keep exposure to WAG as low as
possible, which is best achieved by combining sufficient
ventilation, waste gas scavengers, and even the considera-