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The risk of secondary exposure in the operating room from a sulfur mustard-contaminated penetrating wound using a
Weniko Caré1, Anne-Cécile Ezanno2, Frédérik Bélot-de Saint Leger3
1Service de médecine interne, hôpital national d'instruction des armées Bégin, Saint-Mandé, France.
Introduction:
Wearing personal protective equipment that provides more protection than is necessary compromises the effectiveness of medical procedures. Using simulants, we aimed to assess the risk of secondary exposure in the operating room during surgery on patients with mustard-contaminated penetrating wounds.
Methods:
The evaluation was performed in an operating room equipped with a laminar flow ventilation system. The damage control procedure was simulated three times using a dummy with a contaminated abdominal wound, after prehospital decontamination. First, a fluorescent marker was used to assess cross-contamination by the liquid phase. Second, methyl salicylate was used twice at increasing doses (probable and worst-case scenarios) to evaluate vapor-phase atmospheric contamination. Finally, the atmospheric concentration of methyl salicylate in the operating room was modeled.
Results:
The transfer of the fluorescent marker to surfaces was minimal and strictly confined to the surgical area. Methyl salicylate vapor was only detected in the worst-case scenario, with the highest concentrations in the surgical area. The measured mean atmospheric concentration of methyl salicylate was close to the modeled concentration.
Discussion:
The measured ambient and individual methyl salicylate concentrations, as well as the modeled mean atmospheric concentration, were all below the Acute Exposure Limit Level 1 for sulfur mustard over a 1 h exposure period. Therefore, the risk of secondary exposure through the vapor phase is estimated to be very low. However, the results may vary slightly in the case of poor-quality sulfur mustard, due to its slight differences in physical and chemical properties compared to pure sulfur mustard.
Conclusion:
If a patient exposed to sulfur mustard with a contaminated penetrating wound is treated in the operating room of our facility for less than one hour, after prehospital decontamination, the personal protective equipment usually required for exposure to a chemical warfare agent could be reduced by removing the full-face air-purifying respirator.
