New guidance for gas and air in hospitals

The Health and Safety Executive (HSE) has published new guidance to help safeguard UK midwives from excessive exposure to nitrous oxide in a hospital environment.

This new guidance is targeted towards those who are responsible for the safety of both staff and new mothers within maternity wards.

Nitrous oxide, commonly referred to as ‘gas and air’  is often used during childbirth, for pain relief. Depending on the level of control placed upon the exhaled gas, midwives are placed under a much greater risk of exposure to higher levels of nitrous oxide due to the length of time spent within labour rooms.

If left uncontrolled, exposure to gas and air over a prolonged period of time can lead to serious health issues, including neurological problems and anaemia. it is therefore essential that proper controls are established and maintained.

Therefore, the HSE has published some guidance, which was developed in conjunction with NHS maternity specialists. It has also been ensured that it is relevant to healthcare professionals working outside of maternity.

Nitrous oxide falls under the COSHH regulations (Control of Substances Hazardous to Health), with a long-term workplace exposure limit of 100 ppm or 183 mg.m3 8-hour time weighted average.

HSE’s head of health and public services, Helen Jones, said:

“This is an essential piece of guidance.

“It should be taken on board by those responsible for managing health and safety in maternity units and for controlling the risks faced by staff who work with nitrous oxide. This should include consideration of workers who may be more vulnerable to the effects of exposure, such as those who are pregnant.

“Workers must also be fully consulted when it comes to monitoring how effective the control measures are, including how results are to be used.

“This will include how workers will be managed if results suggest their exposure should be reduced.”

Control systems used in maternity wards

• Demand valves and mouthpieces or facemasks used by patients. These capture the exhaled breath and prevent it from being released into the room
• Association extractions or scavenging systems placed near the patient’s breathing zone
• General ventilation

The first option is deemed to be the most effective, as it prevents the breathed air from circulating into the room. Provided of course that the patient keeps it on until they have exhaled.

General ventilation has the least effect, as it may be some distance away from the patient, and the room itself may not be structured in a way that allows for effective ventilation.

Exposure monitoring is also important, including such methods as:

• The length of time midwives and student midwives attend to a delivery
• Estimates of the level of demand the mother has for gas and air
• Monitoring of which controls are present, as listed above
• Other data which may affect the level of exposure, such as movement of people in the room and other activities taking place in the same area

Further reading

Respiratory disease claims – Oakwood Solicitors

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