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    Indoor air quality in hospital operating rooms (ORs) is of great concern for patients and medical personnel, thus mandating the use of efficient HVAC systems and active gas scavenging systems in ORs. A wide range of relevant medical and engineering literature is summarized in this paper, highlighting relevant challenges, problems and solutions, along with recommended good practices. Indoor conditions in Hellenic ORs were monitored and data were used to assess the exposure of medical personnel to anaesthetic gases and other indoor chemical 23573
    compounds. Accordingly, even when mechanical ventilation and scavenging systems were employed in some of the audited ORs, medical personnel are still exposed to poor indoor air quality. The average concentration of anaesthetic gases (isoflurane,sevoflurane) was 2362 mg/m3
    , exceeding the exposure limit in 18% of the audited ORs. The average concentration of disinfecting agents was 288 mg/m3 for formaldehyde and 207 mg/m3 for glutaraldehyde. Additional compounds were identified in the OR indoor air that
    represent 54% of the total volatile organic concentration.
    r 2007 Elsevier Ltd. All rights reserved.1. Introduction
    Hospital operating theaters (suites) that comprise
    operating rooms (ORs) or surgical theatres are among
    the most demanding health care work areas. Heating,
    ventilating and air-conditioning (HVAC) installations
    control indoor environmental quality (IEQ) and aseptic
    conditions, and secure healthy, safe and suitable indoor air
    quality (IAQ), for surgeons and medical staff, and of
    course, the patients. An overview of relevant standards and
    guidelines on the design, installation, commissioning,
    operation, and maintenance of HVAC installations in
    hospital ORs, is available in Ref. [1].
    The indoor air of an OR contains different chemicals like
    waste medical gases used for anaesthesia, disinfection and
    sterilizing substances, and other particles such as skin
    squames, lint, respiratory droplets, and aerosols. Adverse
    health effects and discomfort have been detected to ORpersonnel by the occupational exposure to medical and
    other chemical compounds, thus, personnel exposure
    should be limited [2,3].
    The use of anaesthetic gas scavenging systems (AGSS)
    has become common practice in modern ORs to recover
    waste anaesthetic gases (WAG). AGSS are complete
    systems that are used to capture escaped and/or excess
    anaesthetic gases from the patient’s respiratory track used
    to administer anaesthesia. Gases are then exhausted to the
    outdoors or to a place from where they can be safely
    discharged, for example, by a non-recirculating exhaust
    ventilation system.论文网
    The unique requirements and characteristics of indoor
    conditions in hospital ORs mandates that the design,
    operation and maintenance of HVAC installations take
    into account some knowledge and experiences from
    medical sources, on top of good engineering. For this
    purpose, a wide range of relevant medical and engineering
    literature is summarized in this paper, highlighting relevant
    challenges, problems and solutions, along with recom-
    mended good practices. Measured data are then presentedcoordination and hearing among those exposed [13,31],
    mutations in DNA [27], and an increased risk of genetic
    damage [25,31], while even trace levels may be harmful to
    OR personnel [2]. However, based on a questionnaire
    survey in the UK, 49% of consultant anaesthetists had
    reduced their use of nitrous oxide, due to medical
    considerations rather than concerns over health and
    pollution issues arising from the use of nitrous oxide [32].
    In any event, even as a precaution, it is widely
    recommended, to keep exposure to WAG as low as
    possible, which is best achieved by combining sufficient
    ventilation, waste gas scavengers, and even the considera-
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