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included isoflurane, sevoflurane, halothane, formaldehyde,
glutaraldehyde, benzene, toluene, xylene, dimethylbenzene,
ethylbenzene. The concentration of total volatile organic
compounds (TVOC) was also quantified. Samples of the
organic compounds were collected in tenax-TA tubes using
low flow sampling pumps (SKC), which were located in
two sampling positions in each OR, at a height of about
1m from the floor. The sampling volume collected was
approximately 3000ml. The analysis of the target com-
pounds collected in the tenax tubes was performed using
thermal desorption (Tekmar 2000), gas chromatography
(Varian Star 3400 CX) equipped with capillary column and
mass spectrometry. The GC separation was performed
using He as the carrier gas with temperature programme
from 35 to 250 1C at a rate of 5 1C/min.
3.1. Results
At least half of the audited ORs were constructed or
renovated (partially or entirely) after 1980. In most cases,
the renovation included a replacement of the HVAC
system and an installation of an AGSS. More than half
of the audited ORs were equipped with an anaesthetic gas
scavenger (Table 2). However, in several cases where the
OR was equipped with an AGSS, it was evident that the
system did not operate properly. This kind of problems can
be encountered when the AGSS units are not properly
checked or maintained.
The anaesthetic gases used were the same in all audited
ORs, including sevoflurane, isoflurane, halothane and
mixture of N2O/O2. Sevoflurane was the most popular
anaesthetic gas and was used in most of the operations
during which volatile organic compound (VOC) sampling
was performed. Isoflurane was also used in some cases. In
addition to the use of anaesthetic gases, the anaesthesia
procedure quite often involved intravenous injections.
OR preparation includes cleaning and disinfection. For
the audited ORs, general disinfection is performed every
afternoon, following completion of all operations. The OR
floor is also cleaned between operations. Common
products used for disinfection include lisoformine, which
is the most popular cleaning product containing glutar-
aldehyde and formaldehyde, or some similar products
containing glutaraldehyde and glyoxal, chlorine, as well as
other products containing linear alkyl benzenes, ethanol,
butanol, isopropanol and inorganic salts. Sterilization of
surgery tools is performed using autoclaves and sterilizers
with steam or ethylene oxide (in about half of the audited
hospitals).
Occupational exposure to VOC must not be examined
only for each compound inpidually, since the health
effects from human exposure to combined high concentra-
tions of several compounds can be severe. Analysis of the
indoor air samples from the 17 ORs revealed that the
average TVOC concentration in the audited ORs was
8862 mg/m3
, ranging from 239 to 46,904 mg/m3
(Table 3).摘要
医院手术室（ORs）的室内空气品质是患者与医务人员高度关注的，从而高效的空调系统和活性气体清除系统在手术室内已被强制使用。在本文中总结了大量的相关医学和工程文献，着重介绍了所面临的相关挑战，问题和解决方法，同时具备良好的可操作性。研究者对希腊手术室的室内环境进行了监测以及对医务人员暴露于麻醉剂气体等室内化学物质的数据进行了评估。因此，即使机械通风和清除系统已在一些通过审核的手术室内使用，但医务人员仍旧处于恶劣的室内空气质量。麻醉气体（异氟醚，七氟醚）的平均浓度为2362µg/m3已超过经审计的手术室的18%的风险限额。消毒剂中甲醛的平均浓度为288µg/m3，戊二醛的平均浓度为207µg/m3。手术室室内空气可识别出额外的化合物代表了总挥发性有机物浓度的54%。