By Debra A. Novak*, DSN, RN, and Stacey M. Benson, MS, National Institute for Occupational Safety and Health, National Personal Protective Technology, Laboratory, Pittsburgh, Pa.
More than 500,000 workers are exposed to surgical smoke every year; numerous studies have documented dangerous atmospheric agents in surgical smoke causing a range of adverse health symptoms and effects.[1,2,3] Hazardous air quality in the operating room has been an occupational concern since the mid 1970s.
Research and workplace studies conducted over long periods of time confirm that surgical smoke, also known as surgical plume, contains hazardous substances including respiratory irritants and carcinogens that have been linked to asthma and infectious agents such as human papilloma virus (HPV). This article will discuss why the proper use of local exhaust ventilation (LEV) augmented by the use of properly fitted filtering facepiece respirators are the recommended and effective controls to reduce surgical smoke exposures.
The composition and exposure hazards associated with surgical smoke depend on a variety of factors such as the type of surgical procedure and device (i.e. laser, electrosurgical, ultrasonic); type and infectious nature of the tissue; extent of tissue ablation; the duration of surgery; and the worker’s proximity to the surgical field. The hazards reported to be associated with exposure to surgical smoke are substantiated by the following research evidence.
Ninety-five percent of surgical smoke is made up of water, but the remaining 5% contains potentially hazardous particles including blood fragments, bacteria, viruses and lung-damaging dust.[3,5] Within 5 minutes of beginning an electrocautery procedure, during breast reduction surgery, the baseline measurement of particulate matter was found to increase from approximately 60,000 particles per cubic foot to more than 1 million particles per cubic foot. Additionally, it took approximately 20 minutes for particle concentrations to return to baseline levels once the surgical procedure was completed. However, most startling is a laboratory study finding that the burning of 1 gram of tissue can release the same level of mutagenic contaminants as three to six cigarettes.
In recent years, electrocautery has been commonly used for the treatment of genital warts caused by HPV and cervical neoplasia in patients infected with human immunodeficiency virus (HIV). Although electrocautery is potentially less hazardous than laser smoke as a route of disease transmission, intact virions (HIV, Hepatitis, HPV) have been shown to be present in electrocautery smoke, and their infectivity has been demonstrated.
[Note from SaneVax: One more example of how HPV can be transmitted by other than sexual means. One more reason to find out if you have been previously exposed to vaccine relevant HPV before you consent to vaccination. Both HPV vaccine package inserts clearly state these vaccines are not effective against already present vaccine-relevant genotypes of HPV.]