According to data from 2018, of the 1.7 million doctors and 3.1 million nurses working in the EU, thousands work in operating rooms every day. This includes the 400,000 surgeons who work in operating rooms across the EU. Surgical smoke, that occurs in operating rooms (OR) when electrosurgical equipment, lasers and other energy equipment are used, may contain dependent on the tissues a variety and different quantities of harmful substances, including category 1A carcinogens such as benzene and formaldehyde. If exposed to surgical smoke, a day in the operating room can be as hazardous as smoking 27 cigarettes a day, posing a significant threat to the health of operating room staff across Europe.
Doctors, nurses and operating room technicians spend a significant amount of time in operating rooms and therefore are highly exposed to the risks of surgical smoke, breathing in air containing up to 150 harmful toxins, including well-known carcinogens.
Where risks occur
Surgical smoke, also known as diathermy plume, occurs during surgery and is produced by using surgical devices such as lasers, electrosurgical units, ultrasonic units, cautery units, and high-speed drills and burrs used to cut and dissect tissue. Surgical smoke contains a variety of toxic substances, including benzene and formaldehyde.
Nurses, surgeons, anaesthetists, technicians, veterinarians and everyone working in operating rooms are the most at risk for health complications posed by surgical smoke due to excessive exposure. It is also important to note that healthcare workers are not the only ones endangered by surgical smoke.
More about the hazard
Surgical smoke is composed of approximately 95% water and 5% organic vapours and cellular debris in a form of particulate matter. The particulate matter is composed of chemicals, blood and tissue particles, viruses, and bacteria. This variety of toxic and harmful substances are hazardous to people exposed to them.
Components of surgical smoke include acetonitrile, acrolein, benzene, toluene, formaldehyde and polycyclic aromatic hydrocarbons. Studies have shown that there are chemical and biological compounds found in surgical smoke which are irritant, mutagenic, carcinogenic, and neurotoxic.
Hazards that may occur
Surgical smoke can cause direct and indirect harms from the particles it contains. In the case of direct effects, it can lead to irritation of the eyes and skin (known as dermatitis), acute headaches or allergic rhinitis in hospital operating room staff. It can also increase the risk of chronic lung conditions, such as occupational asthma and chronic obstructive pulmonary disease (COPD). Research has shown that operating room nurses are at higher risk of severe persistent asthma than other nurses.
In the case of indirect effects, it has been reported as a hazard for pregnancy complications and infertility in female surgeons. There are also concerns that surgical smoke can transmit infections, such as live viruses or bacteria.
What you can do
A range of technologies exists to tackle surgical smoke, some of which are more effective than others. These include high ventilation systems, local smoke extraction devices and filtration surgical masks. A comprehensive approach requires different technologies to be used at once. By capturing smoke directly at the source and filtering out small particles, local evacuation devices ensure minimal to no exposure to the harmful effects of surgical smoke. Even if several mechanisms can be used to protect the health of those working in operating rooms, nothing is as efficient as capturing surgical smoke directly at the source and filtering out small particles. Local evacuation devices present the most protection to healthcare professionals and patients. It is therefore recommended to remove surgical smoke within a proximity of no more than 2 cm from the source to minimize the risk of exposure.
However, tissues can be divided into three distinct classes according to their surgical smoke production. High-PM tissues, such as the liver, medium-PM tissues, including the renal cortex, renal pelvis, and skeletal muscle and low-PM tissues, such as skin, gray matter, white matter, bronchus, and subcutaneous fat.
While source capture is highly effective in general, it may not be sufficient for high-PM tissues like the liver. Even with smoke evacuation systems, particulate matter concentrations can still reach unhealthy levels when operating on high-PM tissues. This suggests that additional protective measures, such as ULPA filters, organizational measures (e.g., reducing the number of staff and the duration of their presence in the operating room), and respirators (FFP3), in conjunction with smoke evacuators, are necessary to ensure adequate protection for operating room personnel.
Face masks and ventilation systems are widely used in operating rooms, however prove to be ineffective against surgical smoke. For instance, 77% of particles in surgical smoke are not adequately filtered out by standard surgical masks and high filtration masks are only effective down to 0.1 microns which doesn’t filter out all the viruses with subsequent potential health effects. However, an ULPA (Ultra-Low Particular Air) filter is efficient at removing submicron particles from the air.
References: Surgical Smoke Coalition
