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X2012: 7th International Conference
on the Science on Exposure Assessment, 2-5 July 2012, Edinburgh




              Surgical Smoke –
Hazards and Protective Measures

         Udo Eickmann, ISSA, Hamburg, Germany
           Inga Fokuhl, BGW, Hamburg, Germany
       Martine Bloch, Michel Falcy, INRS, Paris, France
  Brigitte Merz, Martin Rüegger, Suva, Lucerne, Switzerland
               Contact: Udo.Eickmann@bgw-online.de
www.bgw-online.de




 Problem:

Some surgical procedures emit      Critical multi-substance mixtures
smoke:                             constitute smoke:
o electro-surgical instruments
                                   -> gaseous, vaporous, particulate,
   (e.g. electrocautery)
                                   -> with cmr properties,
o surgical lasers
                                   -> possibly biologically active,
o special activities such as the
   removal of bone cement in       -> nauseating odour

   revision endoprosthetics        Recommended measures are the
                                   subject of controversy
www.bgw-online.de




Aim of the work
• To create an international consensus
 (CH, F, D) within the “Hazardous
 Substances” working group of the
 Healthcare ISSA Section.
• To describe the composition and
 effect of surgical smoke.
• To describe and analyse the
 exposure occurring.
• To determine the current knowledge
 status on the risks.
                                         www.issa.int/About-ISSA/Prevention-
• To describe the recommended safety     Sections/Section-on-Prevention-of-Occupational-
                                         Risks-in-Health-Services
 measures.
www.bgw-online.de




Surgical smoke: effects on health

• Irritation of the respiratory passages (animal tests)
• Mutagenic effect in the Ames test
• Effects on humans:
  o individual infections (papillomatosis), recognised as “occupational”,
  o increased frequency of warts in surgical dermatologists (USA, 1995)
  o non-specific symptoms (irritation of the respiratory tract and eyes,
      headaches)
   o highly unpleasant odours
   o no epidemiological evidence of (bronchial) carcinoma
www.bgw-online.de




 Safety measures
• Based on analysis of published recommendations (e.g. Ball (2001,
  2005); Barrett (2003); Frenette (2003); NIOSH (1999); TRGS 525 (1998))
• Local extraction of surgical smoke (Priority 1)
  o surgical extraction systems with disposable filter (small quantities)
  o mobile smoke evacuators: (HEPA filter system, active carbon filter
     only in special cases)
  o modified holder with integrated suction nozzle
• Technical room ventilation: air-con system in compliance with national
  requirements (in Germany: DIN 1946 Part 4)
• PPE: FFP2 masks during special surgical interventions
• No specific medical surveillance

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Udo Eickmann - Surgical Smoke - Hazards and Protective Measures

  • 1. X2012: 7th International Conference on the Science on Exposure Assessment, 2-5 July 2012, Edinburgh Surgical Smoke – Hazards and Protective Measures Udo Eickmann, ISSA, Hamburg, Germany Inga Fokuhl, BGW, Hamburg, Germany Martine Bloch, Michel Falcy, INRS, Paris, France Brigitte Merz, Martin Rüegger, Suva, Lucerne, Switzerland Contact: Udo.Eickmann@bgw-online.de
  • 2. www.bgw-online.de Problem: Some surgical procedures emit Critical multi-substance mixtures smoke: constitute smoke: o electro-surgical instruments -> gaseous, vaporous, particulate, (e.g. electrocautery) -> with cmr properties, o surgical lasers -> possibly biologically active, o special activities such as the removal of bone cement in -> nauseating odour revision endoprosthetics Recommended measures are the subject of controversy
  • 3. www.bgw-online.de Aim of the work • To create an international consensus (CH, F, D) within the “Hazardous Substances” working group of the Healthcare ISSA Section. • To describe the composition and effect of surgical smoke. • To describe and analyse the exposure occurring. • To determine the current knowledge status on the risks. www.issa.int/About-ISSA/Prevention- • To describe the recommended safety Sections/Section-on-Prevention-of-Occupational- Risks-in-Health-Services measures.
  • 4. www.bgw-online.de Surgical smoke: effects on health • Irritation of the respiratory passages (animal tests) • Mutagenic effect in the Ames test • Effects on humans: o individual infections (papillomatosis), recognised as “occupational”, o increased frequency of warts in surgical dermatologists (USA, 1995) o non-specific symptoms (irritation of the respiratory tract and eyes, headaches) o highly unpleasant odours o no epidemiological evidence of (bronchial) carcinoma
  • 5. www.bgw-online.de Safety measures • Based on analysis of published recommendations (e.g. Ball (2001, 2005); Barrett (2003); Frenette (2003); NIOSH (1999); TRGS 525 (1998)) • Local extraction of surgical smoke (Priority 1) o surgical extraction systems with disposable filter (small quantities) o mobile smoke evacuators: (HEPA filter system, active carbon filter only in special cases) o modified holder with integrated suction nozzle • Technical room ventilation: air-con system in compliance with national requirements (in Germany: DIN 1946 Part 4) • PPE: FFP2 masks during special surgical interventions • No specific medical surveillance