Chapter 28. Environmental Safety

1. Environmental risk factors for anesthesia include electrical, fire, radiation, and chemotherapeutic considerations.

2. Anesthesia providers must have a general understanding of these risks, preventive measures, and reactive procedures to serve as effective advocates for their patients.

3. Many regulatory bodies, professional societies, and standards organizations provide guidelines for environmental safety in anesthetizing locations.

Health care providers recognize patient safety as a primary area of concern. Anesthesia providers must take this responsibility especially seriously because they practice in an environment of increased patient risk, and do so with the intent of reducing the patient's ability to respond to stimulus on his or her own. The anesthesia team must act as the patient's steward in both risk avoidance and crisis management. In addition to the patient's safety, the anesthesia provider must also consider the safety of operating room colleagues and himself or herself. Many decisions as simple as draping technique, electrical outlet connection, supply selection, and equipment positioning can have serious implications for all persons in the vicinity of care.

As minimally invasive interventions increase in popularity, anesthesia care is more frequently pulled out of the relatively highly regulated operating room and into procedure rooms, intensive care unit (ICU) bed spaces, and physician offices. To provide safe and effective care in these areas, it is important that anesthesia providers understand the origins of operating room (OR) safety requirements so that they can apply them as needed during remote anesthetics.

Although much attention has been given to electrical safety in health care, environmental safety in anesthesia also includes consideration of fire, chemical, and radiation risks. A general knowledge of the potential environmental safety hazards associated with anesthesia and its related equipment will help providers protect themselves, their clinical colleagues, and act as effective advocates for their patients. This chapter reviews several common environmental risk factors associated with anesthesia care and discusses infrastructure, equipment, and procedures used to prevent and react to critical events. Safety and prevention of physical accidents such as needle sticks and cuts from broken medication vials are not discussed, although studies have shown that physical accidents may be more prevalent than critical fire and electrical events.1

Many regulatory bodies provide guidance on environmental safety. They serve as additional resources for the safe design, construction, and maintenance of anesthetizing locations and are also reviewed for reference and to familiarize providers with the bodies that encourage safety in their clinical space.

As electronic and, more recently, computerized equipment becomes more prevalent in anesthetizing locations, it has become increasingly important for providers to understand the specific risks posed by such equipment. This section focuses on the direct risks including temporary physiologic disruption and tissue damage. Ignition of fire or explosion is one of many indirect risks associated with electrical equipment and is discussed in the section on fire safety.

Electricity for Health Care Providers

Although it is not ...