The post anesthesia care unit: unique contribution, unique risk

The environment in the postanesthesia care unit (PACU) is unique in the modern hospital. It was born of necessity and continues of necessity. The modern PACU has evolved from a simple room designed to house a single patient and a nurse to a modern, bustling room of great proportions. Today's PACU is an open ward, probably the only one left in the modern hospital, and contains many immunocompromised patients, including pediatric patients; knowledge of the patient's medical history may be sketchy or brief. Patients undergo cough-inducing procedures and exhale waste anesthesia gases. The PACU has a high ratio of health care workers (HCWs) to patients. HCWs, often in their childbearing years, function in close proximity to the patient's face. These environmental conditions coupled with the epidemic proportions of tuberculosis in the United States, the increase in incidence of hepatitis C virus, the consequences of human immunodeficiency virus, and the possible adverse effects of waste anesthesia gases result in a milieu that is a risk to both patients and HCWs that cannot be managed with air exchange controls alone. This article reviews the historical contribution of the PACU and the factors in the PACU environment that increase the vulnerability of HCWs and patients to respiratory diseases, bloodborne pathogens, and adverse effects of waste anesthetic gases.