Clearing the air: surgical smoke and workplace safety practices

Details

• Personal Author:
  Harkavy LM ; Novak DA
• Description:
  Unpleasant odors, particulates, gases, and vapors are emitted during most surgical procedures using cutting and cauterizing equipment. Surgical smoke, also known as surgical plume, is generated when procedures or treatments require the use of electrosurgical devices, tissue-ablating lasers, ultrasonic scalpels, high-speed drills, burrs, and saws. The literature is brimming with studies demonstrating that surgical smoke contains a variety of biological contaminants. Respiratory irritants known to have been present in surgical smoke have been linked to asthma and infectious agents, such as human papillomavirus (HPV). In addition, surgical smoke is similar to cigarette smoke in its potential toxicity to human tissue. Tomita et al. found the burning of 1g of tissue can release the same level of mutagenic contaminants as three to six cigarettes. As a route of disease transmission, intact virions (such as HIV, hepatitis B, HPV) have been found in the plume, and their infectivity has been demonstrated. Mihashi et al. vaporized animal tissue to determine the number, size, and mutagenicity of particles in the resultant smoke and the possible countermeasures to reduce the amount of emitted airborne smoke. An analysis demonstrated most of the particles were smaller than 1 micrometer in diameter, and the particles displayed mutagenic activity. Other studies indicate small particles less than 1.1 micrometer in diameter constitute 77% of the particulate matter generated in surgical smoke found in electrosurgery with a mean size of 0.07 micrometer. Brüske-Hohlfeld et al. examined the production of ultrafine particles generated in surgical smoke in different surgical suites, during various procedures, with the aim of measuring the concentration of ultrafine particles. Using a condensation particle counter, they measured the number of particles in the diameter sizes of 10 nm to 1 micrometer. The findings demonstrated "very high exposure to ultrafine particles for surgeons and close assisting personnel - alternating with longer periods of low exposure". The authors suggested that without adequate ventilation, the aerosolized particles would continue to accumulate, and therefore, increase the exposure of the OR staff with possibly long-term deleterious effects. In addition, Brandon and Young found it took approximately 20 minutes for particle concentrations to return to baseline levels following the use of electrosurgery during breast reduction surgery. This delay in aerosol reduction is typical of control approaches using dilution ventilation for contaminant reduction as opposed to local source control. "Dilution ventilation is not as satisfactory for health hazard control as is local exhaust ventilation (LEV)." Hallmo and Naess reported the case study of a 44-year-old surgeon's acquisition of laryngeal papillomatosis. The surgeon had treated several patients with anogenital condylomata acuminata using the Nd:YAG laser. There were no other exposure risks except for the laser treatments, during which the surgeon wore surgical masks, gloves, eye protection, and used ordinary smoke evacuators. The surgical masks may have provided an ineffective barrier to HPV because of a poor facial fit. A comparative study by Gloster et al. looked for possible differences in the incidence of HPV warts in surgeons exposed to CO2 laser plumes and two large groups of patients with warts. Surgeons who were exposed to surgical laser plumes were more likely to acquire nasopharyngeal warts than the control groups. This difference was statistically significant. The authors concluded the nasopharyngeal warts were as a result of inhalation of the laser plume. The four respondents who developed nasopharyngeal warts all used smoke evacuators, laser masks, and gloves, and yet it appeared they weren't adequately protected. [Description provided by NIOSH]
• Subjects:
  Aerosols Air Pollutants, Occupational Environmental Exposure Hazardous Substances Health Personnel Occupational Health Particulate Matter Respiratory Protective Devices Respiratory System Risk Assessment Risk Factors Safety Solvents Ventilation

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• Keywords:
  Aerosol Particles Airborne Particulates Biological Agents Biological Effects Equipment Design Equipment Operation Exposure Levels Gases Lasers Odors Particulates Respiratory Irritants Respiratory Protection Respiratory Protective Equipment Risk Factors Smoke Inhalation Surgeons Surgery Tissue Culture Toxins Ultrafine Particles Ultrafine Particulates Ultrasonics Vapors

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• ISSN:
  1933-3145
• Document Type:
  Text
• Genre:
  Journal Article
• Place as Subject:
  District of Columbia ; OSHA Region 3 ; Pennsylvania
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  NPPTL - National Personal Protective Technology Laboratory
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-7
• Volume:
  8
• Issue:
  6
• NIOSHTIC Number:
  nn:20048154
• Citation:
  OR Nurse 2014 Nov; 8(6):1-7
• Federal Fiscal Year:
  2015
• Peer Reviewed:
  True
• Source Full Name:
  OR Nurse
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:c3f3a4dd045477aeafa255e63372706c21c2edcd0d5c053c565bed5bb6736c3f71790de982a20f79273556bf5e23e0a115f1debf13166ae513291ae8922cd0c8
• Download URL:
  https://stacks.cdc.gov/view/cdc/202977/cdc_202977_DS1.pdf
• File Type:
  [PDF - 129.25 KB ]