401

| The Surgical Technologist | MAY 2017 214 concern due to the harmful chemicals they may contain. 2 Particle size in surgical smoke is dependent upon the meth- od of generation (see Table 1). M E T H O D S O F G E N E R A T I O N As much as 80% of smoke encountered in the operating room is produced by the use of traditional electrocautery devices. 3 As previously mentioned, this type of smoke often is considered to be less of a biological hazard than smoke generated by other means because the airborne particles are smaller. The average particle size found in electrocautery smoke ranges from 0.007-0.42µm (micrometers). 4 The small size, however, means they are capable of traveling farther in the air and reaching more OR staff. Additionally, the lower health risk may be offset by its sheer prevalence. Electro- cautery is used in approximately 80% of modern surgical procedures. 5 Another common source of surgical plume is lasers. Lasers produce extreme heat (100 to 1000 degrees Celsius), which boils and explodes cells, releasing steam and cellu- lar contents. 6 Most studies on laser plume have involved the CO2 or Nd:YAG laser. Laser plume is associated with a higher risk of disease transmission due to larger particulate matter, ranging in size from 0.1-0.8µm. 4 The growing popularity of ultrasonic scalpel devices in the last decade has added to the prevalence of surgical smoke. Ultrasonic scalpels have become a popular alterna- tive to traditional electrocautery for dissection because they produce less thermal damage to surrounding tissue. They utilize high frequency vibration – as much as 55,000 times per second – to cut and coagulate tissue. This low tempera- ture vaporization comes at a price as the vapors generated are more likely to carry infectious particles than vapor gen- erated by high temperature. 7 Finally, a very common but often ignored source of dan- gerous smoke and aerosol in the operating room are power instruments used in orthopedic surgery. The rapid move- ment of bone saws, drills, etc, generates heat and disrupts cells, sending potentially hazardous material into the air. R I S K S A N D H A Z A R D S T O O R P E R S O N N E L The hazards associated with surgical smoke can range from mild irritation to life threatening illnesses, affecting both scrubbed and non-scrubbed staff. The most common and least threatening symptoms associated with exposure include eye irritation, headaches, light-headedness and respiratory irritation. Surgical smoke contains a number of chemicals known to be respiratory irritants and carcinogens, such as ben- zene, formaldehyde, cyanide and ethanol, among others (see Table 3). Inhalation of these chemicals can lead to acute and chronic conditions including emphysema, asthma and bronchitis. 8 A study among perioperative nurses showed that they have an increased prevalence of respiratory ill- nesses (sometimes twofold) compared to the general popu- lation (see Table 2). 9 Studies have also shown that the smoke produced by the vaporization of 1g of tissue is equivalent to smoking three to six unfiltered cigarettes. 1 Multiple studies have shown surgical smoke to contain viable bacteria and viruses. One study cultured laser plume in 13 surgical procedures – of these, five specimens grew Staphylococcus. Among those five specimens, two of them also grew Corynebacterium (associated with diphtheria) and Neisseria. 4 One of the best known risks to OR staff is the potential transmission of human papillomavirus (HPV). This comes from a well-documented case of a surgeon who developed laryngeal papillomatosis after treating a patient for ano- genital papilloma with a Nd:YAG laser. Further study of the surgeon revealed HPV types 6 and 11 in his larynx, the same types found in anogential papilloma. This virus could have only been transmitted through inhalation. Viable human immunodeficiency virus (HIV) also has been found Table 1. Sizes of Particles produced by various surgical devices 4 Electrocautery 0.007-0.42µm Laser 0.1-0.8µm Ultrasonic scalpel 0.35-6.5µm The growing popularity of ultrasonic scal- pel devices in the last decade has added to theprevalenceof surgical smoke. Ultrasonic scalpels have become a popular alternative to traditional electrocautery for dissection because they produce less thermal damage to surrounding tissue.