1408 Surgical smoke – what is it and what are the risks? a review

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IntroductionOperating room (OR) staff are exposed to surgical smoke on a daily basis. With the increased use of intraoperative smoke-generating devices, this is a significant occupational health hazard.MethodsA database search was performed for literature on surgical smoke from 1980–2017.ResultsElectro-, laser and ultrasonic surgical techniques produce surgical smoke. 95% of surgical smoke is water and 5% is a combination of chemicals and cellular debris. Up to eighty chemicals, including the carcinogen Benzene, have been identified. The chemical load from cautery of one gram of tissue is comparable to that derived from six cigarettes. HIV and HPV viral DNA have been isolated, and both Staphylococcus and Neisseria cultured from surgical smoke. At less than ten micrometres in diameter, surgical smoke particles can remain airborne and are inhalable; the smallest fractions entering the alveoli. Smoke particles diffuse along concentration gradients within the OR atmosphere exposing all staff, and not just the operator or those scrubbed. Animal studies have demonstrated pulmonary congestion, interstitial pneumonia and emphysema secondary to surgical smoke exposure. Associated symptoms reported by staff include headache, problematic lacrimation and cough – affecting 58%, 42% and 20% of doctors respectively in one survey. An association with cancer has been made through case series. Standard surgical facemasks offer no protection; whilst portable evacuation devices are the best risk reduction measure. No legislation currently exists in the United Kingdom, but many international organisations offer guidance on minimising surgical smoke exposure in the workplace.ConclusionOR staff training ad policies should align with the latest guidance so that appropriate risk reduction measures can be put in place to protect health.

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