Exposure of paediatric healthcare personnel to nitrous oxide in paediatric care units

During hospital visits, children often undergo examinations and treatments that may involve an experience of pain and distress that is also connected to the staff’s treatment. The United Nation’s Convention on the Rights of Persons with Disability advocates the use of Universal Design. One way of implementing this idea within paediatric nursing is to increase the use of pictorial supports, and the few studies that have been published show promising results. The aim of this study was to do a comparison between two groups of children in regard to the pre- and postconditions of implementing an intervention including staff instruction and the use of pictorial support. The support consisted of a visual schedule with pictures and text, used both preparatory to and during the hospital visit. One hundred children aged 5–15 (50 children during the preinterventional data collection and 50 children postinterventionally) reported pain intensity and distress during needle-related procedures in nitrous oxide sedation. The results showed that the intervention had a positive effect in significantly lowering the level of preprocedural distress. The results showed that the pain intensity was also lowered however not reaching statistical significance. This confirms other positive research results on the use of visual supports within paediatric care, a topic that has to be further studied.

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O5D.2 Occupational exposure of healthcare personnel to nitrous oxide in various pediatric specialty care units: an observational study

Occupational and Environmental Medicine ◽

10.1136/oem-2019-epi.128 ◽

2019 ◽

Vol 76 (Suppl 1) ◽

pp. A47.2-A47

Author(s):

Marie-Agnès Denis ◽

Charlotte Pete-Bonneton ◽

Benjamin Riche ◽

Robert Cadot ◽

Amélie Massardier-Pilonchery ◽

...

Keyword(s):

Nitrous Oxide ◽

Occupational Exposure ◽

Observational Study ◽

Healthcare Providers ◽

Weighted Average ◽

Pediatric Care ◽

Healthcare Personnel ◽

Infrared Spectrometry ◽

Childbearing Age ◽

Exposure Limit

ObjectivesNitrous oxide (N2O) present in anesthetic mixtures (e.g., equimolar mix of oxygen and N2O, EMONO) has been found responsible for various toxicities, including genetic and reproductive toxicities. N2O-containing mixtures are widely used in pediatric care units where most healthcare providers (HCPs) are women of childbearing age. This motivated an investigation of occupational exposure to N2O in search for overexposure and overexposure factors in a pediatric hospital.MethodsThis observational study concerned seven different units. On each of 34 HCPs, air samples were extracted by portable pumps and collected in Tedlar® bags. N2O was quantified by gas chromatography coupled to pulsed discharge ionization detection and infrared spectrometry. The data allowed calculating mainly the instantaneous exposure and the 8 hour time-weighted average (8h-TWA).ResultsThe exposure was four times higher in closed than in open treatment rooms and two times higher in case of use vs. non-use of EMONO. The exposure was significantly higher in junior vs. senior HCPs (by 12%) and higher during presumably short vs. presumably long procedures (by 20%). The mean 8h-TWAs were rather higher than the recommended exposure limit (25 ppm/8 hour) in emergency unit and in day hospital for thoracic and abdominal diseases. Overexposures represented 11% of all measurements but reached substantial levels (up to 3.5 times the recommended threshold).ConclusionsOverexposures to N2O were frequent during short-duration procedures. The causes of overexposure were insufficient air renewal and inappropriate equipment use. This calls for dedicated rooms, more efficient medical/nursing practices, proper training, and regular checks of gas levels.

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