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diarrhea, while chronic health effects include altered
behaviour, anaemia, secondary respiratory infections, skin
sensitization, miscarriages, and reproductive problems, and
it is characterized as carcinogenic and mutagenic agent.
According to OSHA [19], exposure usually occurs from
improper aeration of the ethylene oxide chamber after the
sterilizing process.
The occupational exposure limits for the above men-
tioned compounds, including the threshold limit value
(TLV) for an 8-h exposure, time weighted average (TWA),
and short-term exposure limit (STEL) are given in Table 1.
There are varying exposure limits depending on national
and international standards and recommended practices.For example, nitrous oxide has an occupational exposure
limit of 100 ppm over an 8-h TWA in the UK, based on
personal exposure, while in the USA the limit for nitrous
oxide is as low as 25 ppm; internationally, there is no
agreed standard [32]. NIOSH recommends a personal
exposure limit to anaesthetic agents of 2 ppm for an 8-h
TWA [13]. In the UK, the Control of Substances
Hazardous to Health (COSHH) Regulations 1999 state
that exposure to anaesthetic agents must be reduced to as
low as is reasonably practicable [32].
3. Audit campaign in Hellenic hospitals
The total number of available ORs in Hellenic hospitals
is rather small and space availability is problematic in most
cases. At the same time, the number of patients that
undergo surgery is high in comparison to the capacity of
the hospitals, imposing an additional burden to the
hospital and OR operating conditions. The stock of
Hellenic hospitals and clinics exceeds 360 facilities (not
including military hospitals) with a total capacity of 51,788
beds, employing 18,764 doctors and 37,476 staff. In most
cases, new hospital installations and recently retrofitted
facilities meet the desirable indoor conditions for physical
health and safety according to standards.
The audit campaign of Hellenic hospitals performed
during this work included a walk-through audit, along with
spot and long-term measurements in 20 ORs at 10 hospitals
with an emphasis on the assessment of the indoor
environmental quality and the HVAC installations [1].
An overview of the audited ORs is presented in Table 2.
Two ORs were audited in each hospital. However, a total
of nine hospitals granted permission to perform measure-
ments of the indoor chemical compounds. Relevant
information were collected using a standardized audit
form that included questions concerning the general
characteristics of each hospital and the specific character-
istics of the ORs (construction materials, ventilation
system, anaesthesia procedure, sterilization/disinfection
products used, etc.). Finally, data were collected from 17
ORs and are reported herein.
For the audited ORs (Table 2), only 10% had a
dedicated air handling unit (AHU) for the OR, 10% had
a stand-by (backup) AHU, 20% had an indoor thermostat
control, 60% had scavenging equipment to recover
anaesthetic gases, 10% operate the AHU continuously,
70% turn off the AHUs at night and 20% periodically
suspend operation when the ORs are not in use although
22% of these units were equipped with a fan inverter that
could be used to lower the airflow for energy conservation
while maintaining continuous operation to secure optimum
indoor conditions and stand-by operation. Only 35% of
the AHUs had an economizer for heat recovery although
practically all of them operate with 100% outdoor air.
Consequently, there are direct complications in terms of
overall performance and dependability, indoor environ-
mental quality, and energy performance.The chemical parameters measured in the audited ORs