Anaesthesia, 2001, 56, pages 372±402
Correspondence
.
...............................................................................................................................................................................................................................................
Table 1 The location of gloves, aprons and
visors in 39 clinical areas.
transmission of human
immunodeficiency virus, hepatitis B
model was used to determine an `ideal'
sequence of fresh gas flow and vaporiser
virus, and other bloodborne pathogens concentration which, for each anaes-
in health-care settings. Morbidity and
Mortality Weekly Report 1988; 37:
thetic, would raise the end-expired
concentration to 1 MAC as quickly as
practicable and then keep it within
^ 5% of that level for 20 min. We
present a brief report of our experience
in applying these ideal sequences in
clinical practice.
Gloves Aprons Visors
377±88.
On arrest trolley 30
1
5
6
27
0
0
3
5
7
24
2
Nelsing S, Neilson TL, Neilson JO.
Noncompliance with universal
At bedside
In patient bay
In sluice
5
3
1
0
precautions and the associated risk of
mucocutaneous blood exposure among
Danish physicians. Infection Control and
Hospital Epidemiology 1997; 18: 692±8.
Not available
The study was approved by the
hospital ethics committee. Twenty-
eight patients, aged 18±55 years, ASA
grade 1 or 2, scheduled to undergo
orthopaedic surgery, gave their infor-
med consent. They were allocated to
four groups for general anaesthesia with
halothane, isoflurane, sevoflurane or
desflurane, seven in each group. All
patients received midazolam, 15 mg
orally, as premedication 1 h before
anaesthesia. Induction of anaesthesia
provisions for cardiac arrests in 39 clini- 3 Akduman D, Kim LE, Parks RL, et al.
cal areas, namely: casualty, all general
and specialist wards, all outpatient areas,
and physiotherapy. Where equipment
was not found on the cardiac arrest
trolley, a member of the ward's nursing
staff was asked to show its location.
Gloves were immediately accessible
in all clinical areas; in the vast majority
Use of personal protective equipment
and operating room behaviors in four
surgical subspecialties: personal
protective equipment and behaviors in
surgery. Infection Control and Hospital
Epidemiology 1999; 20: 110±14.
4
5
Evanoff B, Kim L, Mutha S, et al.
Compliance with universal precautions
among emergency department
(
30 sites), they were located on the
cardiac arrest trolley. (Table 1). In
frontline' clinical areas (i.e. Casualty,
personnel caring for trauma patients.
Annals of Emergency Medicine 1999; 33:
21
was with propofol 2.5 mg.kg , and
21
`
fentanyl or remifentanil 1 mg.kg
21
with vecuronium 0.1 mg.kg
,
for
160±5.
CCU, ITU/HDU), aprons were avail-
able in close proximity to the patient.
However, in the `non-frontline' areas,
gowns were located remote from the
patient. Facial protection could not be
provided to a rescuer in 24 clinical areas.
The current distribution of facilities
reflects a selective approach to the pro-
vision of equipment to rescuers, rather
than accepting that universal precau-
tions imply a universal standard of
provision of equipment.
Kim LE, Evanoff BA, Parks RL, et al.
Compliance with Universal Precautions
among emergency department
muscle relaxation. After oral intubation
of the trachea, the lungs were ventilated
21
with a tidal volume of 10 ml.kg at
personnel: implications for prevention
programs. American Journal of Infection
Control 1999; 27: 453±5.
21
0 breath.min . A circle breathing
1
system was used with an internal
volume of 4 l, including the ventilator
bellows. The administration of the
assigned inhalation anaesthetic com-
menced immediately and followed the
corresponding Mapleson [1] sequence
6
7
Handley AJ, Swain A, eds. Advanced Life
Support Manual, 2nd edn (with
Revisions). Resuscitation Council
(
UK), 1996: 7±9.
Gehanno JF, Kohen-Couderc L,
Lemeland JF, Leroy J. Nosocomial
meningococcemia in a physician.
Infection Control and Hospital
(Table 2), except that the maximum
This survey identifies a potential
hazard to medical staff. We recognise
that this study presents data from only
one hospital, but feel it is representative
of many institutions, and that it high-
lights an area of clinical risk. Hospitals
owe a duty of care to staff for the
provision of necessary equipment for
the isolation of potential hazard [8].
concentration for a desflurane vaporiser
is 18% or 2.3 times the mean MAC of
our desflurane patients.
Epidemiology 1999; 20: 564±5.
Health and Safety Executive. Essentials
of Health and Safety at Work, 4, 8±9.
HMSO, 1992.
In addition to routine monitoring of
cardiovascular and respiratory variables,
we measured the inspired and end-
expired fractional concentrations of the
inhaled anaesthetics with the gas moni-
tor of the Ohmeda anaesthetic machine.
Conversion to MAC units allowed for
the age of each patient [2] and the mean
ambient barometric pressure of 93 kPa.
The four groups of patients were
similar in respect of age and body
8
The fresh-gas flow sequence at
the start of low-flow
anaesthesia
S. M. Edwards
J. C. Williams
R. A. McCahon
Morriston Hospital,
Swansea SA6 6NL, UK
In a theoretical study, Mapleson [1] used
a
multicompartmental physiological
model of a patient and breathing weight (Table 3). With all four anaes-
system, to simulate the first 20 min of thetics, the mean end-expired concen-
low-flow anaesthesia, using halothane, tration (Fig. 3) reached 1 MAC earlier
enflurane, isoflurane, sevoflurane and than predicted by Mapleson (with a
desflurane, in a
standard man of minor exception for desflurane) and
40 years and 70 kg body weight. The remained above 1 MAC throughout
References
1
Centres for Disease Control and
Prevention. Update. Universal
precautions for prevention of
q 2001 Blackwell Science Ltd
379