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A Quantitative Analysis of Surgical Smoke Exposure as an Occupational Hazard
Camille L Stewart1,2, Mustafa Raoof1, Robert Lingeman3
1Department of Surgery, City of Hope National Medical Center, Duarte, California.
Objective:
We hypothesized that OR airborne PM was different in quantity and mutagenic potential than office air and cigarette smoke.
Summary Of Background Data:
Exposure to surgical smoke has been equated to cigarette smoking and thought to be hazardous to health care workers despite limited data.
Methods:
PM was measured during 15 operations in ORs with 24.8 ± 2.0 air changes/h, and in controls (cigarettes, office air with 1.9-2.9 air changes/h). Mutagenic potential was assessed by gamma Histone 2A family member X staining of DNA damage in small airway epithelial cells co-cultured with PM.
Results:
Average PM concentration during surgery was 0.002 ± 0.002 mg/m3 with maximum values at 1.08 ± 1.30 mg/m3. Greater PM correlated with more diathermy (ρ = 0.69, P = 0.006). Values were most often near zero, resulting in OR average values similar to office air (0.002 ± 0.001 mg/m3) (P = 0.32). Cigarette smoke average PM concentration was significantly higher, 4.8 ± 5.6 mg/m3 (P < 0.001). PM collected from 14 days of OR air caused DNA damage to 1.6% ± 2.7% of cultured cells, significantly less than that from office air (27.7% ± 11.7%, P = 0.02), and cigarette smoke (61.3% ± 14.3%, P < 0.001).
Conclusions:
The air we breathe during surgery has negligible quantities of PM and mutagenic potential, likely due to low frequency of diathermy use coupled with high airflow. This suggests that exposure to surgical smoke is associated with minimal occupational risk.
Insights
Surgical smoke contains minimal airborne particulate matter (PM) and mutagenic potential, posing a low occupational risk to healthcare workers. This is due to high ventilation rates and limited use of diathermy during operations.
Area of Science:
- Environmental Health
- Occupational Safety
- Infectious Disease Control
Background:
- Surgical smoke exposure is a concern for healthcare workers, with limited data on its actual hazards.
- Previous assumptions equate surgical smoke to cigarette smoke, suggesting significant health risks.
Purpose of the Study:
- To quantify airborne particulate matter (PM) in operating rooms (ORs).
- To assess the mutagenic potential of OR airborne PM.
- To compare OR airborne PM with office air and cigarette smoke.
Main Methods:
- Particulate matter (PM) was measured during 15 surgical operations.
- Air changes per hour (ACH) were recorded in ORs and control environments (office air).
- Mutagenic potential was assessed by quantifying DNA damage in lung cells exposed to PM.
Main Results:
- Average OR PM concentration was significantly lower than cigarette smoke (0.002 vs. 4.8 mg/m³).
- OR PM levels were comparable to office air, with higher concentrations correlating with diathermy use.
- PM from OR air induced significantly less DNA damage in lung cells compared to office air and cigarette smoke.
Conclusions:
- Operating room air has negligible particulate matter and mutagenic potential, likely due to high airflow and limited diathermy use.
- Exposure to surgical smoke presents minimal occupational risk to healthcare personnel.
- Further research may be warranted to fully elucidate the long-term effects, if any.
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