Avoid the Risks of Surgical Smoke in Theatre

What is surgical smoke?
Laser and electrocautery devices used during surgery produce smoky emissions that may contain vapours and particulate aerosols, which can have a chemical and biological impact on those exposed.

Who is at risk?
Theatre staff, who inhale surgical smoke on a regular basis, and patients.

What is in smoke plume?
Acetontrile, Acetylene, Acrolein, Alkybenzene, Benzene, Bioaerosols, Blood fragments, Butene and Carbon Monoxide.

There is increasing evidence that smoke plume in theatres generated by the use of laser, sonic or ultrasonic devices can be hazardous for theatre staff. The evidence suggests that smoke plume created by using these devices can contain toxic chemicals, carbonised tissue, blood particles, viral DNA particles, bacteria and carbon dioxide.

Without adequate protection surgical teams are at risk of inhaling the small particles and gases created during surgical procedures. The unpleasant odour of surgical smoke plume is evidence of the harmful contents of the smoke. The smell is a combination of chemical by-products when using laser or electro-surgical instruments. Theatre staff often report smelling unpleasant odours during surgery.

Fact – If you can smell it, you are breathing it in. Serious risks associated with surgical smoke include: Hepatitis B, HIV, Carcinoma, Emphysema, Asthma, Pulmonary congestion and chronic bronchitis.

Experts have said:
• “Although some viruses do not aerosolise efficiently, others do, along with bacteria” (Sehulster LM 2004).
• “Blood contained in aerosols could expose surgeons to HIV & Hepatitis” (Bureau of National Affairs, Inc study).
• “Laryngeal papillomatosis with human papillomavirus DNAcontracted by laser surgeon” (Hallmo & O Naess).
• “Human papillomavirus that cause genital warts seem to have a predilection for infecting the upper airway mucosa and laser plume containing these viruses may represent more of a hazard to the surgeon” (Hugh M Gloster Jr MD, 1995).

How to help to combat the risks associated with Surgical Smoke?
Firstly, it’s important to note that surgical face masks are ineffective against surgical smoke plume. This is supported by the MHRA:
“Masks, including special laser surgical masks, are not recommended for use as a primary method of filtration: these protective Masks may not be sufficiently effective as the primary method of smoke plume filtration. They may not create an effective seal around the face” (MHRA-DB 2008 (03) April 2008.

Secondly, surgical smoke extractors are also not always effective at protecting you in theatre.

In order to combat surgical smoke plume effectively it is recommended to use an FFP3 Respirator for all clinical staff working with laser and electrocautery devices in theatres.

The respirator meets the requirements of EN149:2001 and protects against fine toxic dusts, fumes, oil-based mists/aerosols and airborne pathogens. Protection against non-toxic and low to average toxicity solid and liquid aerosols.

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