This experimental study aimed to evaluate airborne particulates and volatile organic compounds (VOCs) from surgical smoke when a local exhaust ventilation (LEV) system is in place. Surgical smoke was generated from human tissue in an unoccupied operating room using an electrocautery surgical device for 15 min with 3 different test settings: (1) without LEV control; (2) control with a wall irrigation suction unit with an in-line ultra-low penetration air filter; and (3) control with a smoke evacuation system. Flow rate of LEVs was approximately 35 L/min and suction was maintained within 5 cm of electrocautery interaction site. A total of 6 experiments were conducted. Particle number and mass concentrations were measured using direct reading instruments including a condensation particle counter (CPC), a light-scattering laser photometer (DustTrak DRX), a scanning mobility particle sizer (SMPS), an aerodynamic particle sizer (APS), and a viable particle counter. Selected VOCs were collected using evacuated canisters using grab, personal and area sampling techniques. The largest average particle and VOCs concentrations were found in the absence of LEV control followed by LEV controls. Average ratios of LEV controls to without LEV control ranged 0.24-0.33 (CPC), 0.28-0.39 (SMPS), 0.14-0.31 (DustTrak DRX), and 0.26-0.55 (APS). Ethanol and isopropyl alcohol were dominant in the canister samples. Acetaldehyde, acetone, acetonitrile, benzene, hexane, styrene, and toluene were detected but at lower concentrations (<500 μg/m) and concentrations of the VOCs were much less than the National Institute for Occupational Safety and Health recommended exposure limit values. Utilization of the LEVs for surgical smoke control can significantly reduce but not completely eliminate airborne particles and VOCs.

The collection efficiencies of commonly used membrane air sampling filters in the ultrafine particle size range were investigated. Mixed cellulose ester (MCE; 0.45, 0.8, 1.2, and 5 μm pore sizes), polycarbonate (0.4, 0.8, 2, and 5 μm pore sizes), polytetrafluoroethylene (PTFE; 0.45, 1, 2, and 5 μm pore sizes), polyvinyl chloride (PVC; 0.8 and 5 μm pore sizes), and silver membrane (0.45, 0.8, 1.2, and 5 μm pore sizes) filters were exposed to polydisperse sodium chloride (NaCl) particles in the size range of 10–400 nm. Test aerosols were nebulized and introduced into a calm air chamber through a diffusion dryer and aerosol neutralizer. The testing filters (37 mm diameter) were mounted in a conductive polypropylene filter-holder (cassette) within a metal testing tube. The experiments were conducted at flow rates between 1.7 and 11.2 l min−1. The particle size distributions of NaCl challenge aerosol were measured upstream and downstream of the test filters by a scanning mobility particle sizer (SMPS). Three different filters of each type with at least three repetitions for each pore size were tested. In general, the collection efficiency varied with airflow, pore size, and sampling duration. In addition, both collection efficiency and pressure drop increased with decreased pore size and increased sampling flow rate, but they differed among filter types and manufacturer. The present study confirmed that the MCE, PTFE, and PVC filters have a relatively high collection efficiency for challenge particles much smaller than their nominal pore size and are considerably more efficient than polycarbonate and silver membrane filters, especially at larger nominal pore sizes.

BackgroundOperating room personnel have the potential to be exposed to surgical smoke, the by-product of using electrocautery or laser surgical device, on a daily basis. Surgical smoke is made up of both biological by-products and chemical pollutants that have been shown to cause eye, skin and pulmonary irritation.MethodsIn this study, surgical smoke was collected in real time in cell culture media by using an electrocautery surgical device to cut and coagulate human breast tissues. Airborne particle number concentration and particle distribution were determined by direct reading instruments. Airborne concentration of selected volatile organic compounds (VOCs) were determined by evacuated canisters. Head space analysis was conducted to quantify dissolved VOCs in cell culture medium. Human small airway epithelial cells (SAEC) and RAW 264.7 mouse macrophages (RAW) were exposed to surgical smoke in culture media for 24 h and then assayed for cell viability, lactate dehydrogenase (LDH) and superoxide production.ResultsOur results demonstrated that surgical smoke-generated from human breast tissues induced cytotoxicity and LDH increases in both the SAEC and RAW. However, surgical smoke did not induce superoxide production in the SAEC or RAW.Conclusion These data suggest that the surgical smoke is cytotoxic in vitro and support the previously published data that the surgical smoke may be an occupational hazard to healthcare workers.