Research Progress on the Hazards of Surgical Smoke and Its Protective Measures

 中西医结合心血管病电子杂志   2020年6期 

【Abstract】Surgical smoke poses serious health risks to medical personnel, yet awareness of its hazards and protective measures remains insufficient among healthcare workers in China. This paper reviews the composition, hazards, and protective strategies of surgical smoke through literature analysis, aiming to provide clinical guidance for mitigating its adverse effects.

【Keywords】Surgical smoke; Hazards; Awareness; Protection

【Chinese Library Classification】R472.3 【Document Code】A 【Article Number】ISSN.2095.6681.2020.6..02

With the continuous advancement of surgical techniques, the clinical application of electrosurgical equipment and ultrasonic scalpels has significantly increased. Due to their safety, efficiency, and reliability, these devices have become indispensable tools in modern surgical procedures. However, beyond facilitating patient care, the use of these instruments introduces new health hazards for medical personnel. During surgery, the interaction between patient tissues—including proteins and fats—and these electrosurgical tools generates surgical smoke through processes like ablation, decomposition, and vaporization [1]. This smoke, suspended in the air, not only obscures the surgical field, hindering the surgeon's vision and affecting precise intraoperative maneuvers, but also contains toxic and harmful gases that pose significant potential hazards to human health [2]. Therefore, enhancing protection against surgical smoke is critically important for surgical personnel. To gain a deeper understanding of the hazards of surgical smoke and the latest research on protective measures, this review summarizes and analyzes relevant literature for clinical reference.

1 Concept and Composition of Surgical Smoke

Surgical smoke refers to gaseous substances generated during surgical procedures, also known as aerosols or fumes. The most common sources encountered clinically include electrosurgical equipment, high-frequency electrosurgical units, laser scalpels, high-speed electrical devices, and ultrasonic scalpels. Surgical smoke produced by these devices is the most prevalent in clinical settings [3]. The smoke contains numerous harmful components, including carbon monoxide (CO), phenols, hydrocarbons, and acrylonitrile [4]. Among these harmful chemical constituents, CO and acrylonitrile are particularly severe [5].

2. Hazards of Surgical Smoke

Research indicates that the smoke generated by the heat from an electrosurgical knife when destroying 1 gram of tissue is equivalent to the harm caused by burning 3 to 6 cigarettes over 15 minutes [6]. When medical personnel and patients inhale surgical smoke, symptoms such as inflammation and pain may occur in the head, eyes, and nose. Research indicates that surgical smoke contains benzene, a high-risk carcinogen. Even at low concentrations in the air, short-term exposure can cause inflammation of the respiratory mucosa and ocular conjunctiva in patients and medical staff. Long-term, repeated exposure may lead to conditions such as leukemia [7]. Beyond various harmful chemical components, surgical smoke also contains active viruses, active cancer cells, inactive particles, and pathogens. The presence of these elements can cause acute or chronic irritation to operating room staff and patients, easily inducing respiratory infections and other diseases. In severe cases, it may lead to carcinogenic and mutagenic effects. Beyond physical harm, the presence of surgical smoke also impacts the psychological state of surgical personnel. It can cause discomfort such as stuffiness, leading to irritability and distractions among staff. This, in turn, may disrupt the surgical process and negatively affect patient outcomes [8].

3 Protection Against Surgical Smoke

3.1 Enhancing Awareness of Surgical Smoke

Authoritative institutions such as the National Institute for Occupational Safety and Health (NIOSH) and the American Association of Operating Room Nurses (AAORN) have confirmed the potential hazards of surgical smoke and proposed comprehensive protective recommendations. Corresponding management policies and operational standards have been progressively established. However, awareness of surgical smoke among operating room personnel in China remains inadequate. Zhang Haiwei et al. [9] conducted a cross-sectional survey of 141 healthcare workers in hospital operating rooms and found that their knowledge and protection scores regarding surgical smoke were low, averaging only 56.79 points (out of 100). Zhi Hui et al. [10] surveyed 260 healthcare workers exposed to surgical smoke and found that 48 individuals (19.05%) had no knowledge of surgical smoke, while 201 (79.76%) possessed only superficial understanding. Regarding protective measures, 72 respondents (28.57%) reported no protective measures at all, Additionally, 162 individuals lacked effective protective measures, accounting for 64.29%. This indicates that operating room personnel in China possess limited understanding of surgical smoke and fail to implement effective preventive measures. Therefore, it is imperative to enhance the awareness of surgical smoke among operating room medical staff, enabling them to recognize its hazards and prioritize protective measures against it.

3.2 Reducing Surgical Smoke Generation

Chinese researchers Wang Lixia et al. [11] analyzed 100 electrosurgical procedures in hospital operating rooms and found that hybrid cutting techniques combined with electrocoagulation and spray coagulation constitute risk factors for exposure to electrosurgical smoke particles in enclosed operating rooms. Therefore, as a surgeon, one should conduct thorough patient assessment before surgery. Based on the patient's physical condition and the surgical technique employed, electrosurgical equipment should be used correctly, selecting the most appropriate cutting mode. By utilizing lower output power to achieve greater efficacy, the generation of surgical smoke can ultimately be reduced.

3.3 Personal Protective Measures

Personal protective measures include correctly wearing high-filtration surgical masks, eye protection, gloves, and isolation gowns. Proper mask usage during surgery is one of the most effective methods to prevent inhalation of surgical smoke. Many surgical nurses believe wearing surgical masks alone can prevent inhalation of surgical fumes. However, in practice, surgical masks only protect against particles larger than 5.0 μm, while 77% of fumes generated during surgery have particle diameters below 1.1 μm. Additionally, gaps between the mask and the face/nose allow fumes to penetrate, rendering standard surgical masks ineffective at preventing inhalation. Some healthcare workers wear masks too loosely or reuse them, further diminishing their effectiveness against surgical smoke. Wang Ling et al. [12] suggest using respirators for protection, with surgical masks worn over them as an additional precaution. Ge Jingwu et al. [13] propose that the most effective protective measure during smoke generation is turning one's head away. Zhou Qing [14] also concluded that moving the body or head away from large plume-like smoke effectively reduces surgical smoke inhalation.

3.4  Ensuring Effective Surgical Smoke Evacuation

Most operating rooms in China utilize laminar flow systems, where clean air is vertically blown from above the surgical bed through high-efficiency filters. This vertical airflow pattern effectively expels smoke and bacteria from the surgical field, thereby reducing the amount of surgical smoke that disperses. However, proper maintenance of laminar flow equipment is essential. Regular inspection and cleaning of filter screens and return air vents must be conducted to ensure effective air purification and replacement. Additionally, proper use of smoke evacuation devices can further reduce surgical smoke. The National Institute for Occupational Safety and Health recommends maintaining suction power at 100–150 m/min and positioning the suction tip 5.08 cm from the electrosurgical knife tip. Placing it too far away reduces suction efficiency. Chinese researchers Mo Liping et al. [15] applied a custom-made controllable suction tube for smoke evacuation during laparoscopic surgery. Results demonstrated that this laparoscopic trocar filtration system effectively reduced interference rates caused by smoke during surgical procedures. Currently, disposable chemical smoke evacuation devices for laparoscopic surgery are widely adopted in clinical settings.

4 Conclusion

In summary, the harm caused by surgical smoke to operating room personnel does not occur overnight but results from long-term accumulation. However, most medical staff in China's operating rooms lack sufficient awareness and concern regarding surgical smoke, leading to persistent deficiencies in protective measures against it. Therefore, future efforts should focus on intensifying awareness campaigns and training programs to enhance healthcare workers' understanding of surgical smoke hazards and the importance of protective measures. This includes educating them on the potential risks and safety concerns associated with surgical smoke. Concurrently, measures to reduce surgical smoke generation, ensure proper mask usage, and improve smoke evacuation systems must be implemented. With the continuous advancement of medical technology, the widespread clinical application of electrosurgical equipment, and the ongoing development of new protective gear, we believe that in the near future, we will achieve a smoke-free operating room environment. This will better safeguard the physical and mental health of healthcare workers.

References

[1] Hu Caihong, Lai Ping, Ji Chulei, et al. Research on Surgical Smoke Hazards and Protective Measures in Operating Rooms [J]. World Latest Medical Information Digest (Electronic Edition), 2017.

[2] Li Hui. A Qualitative Study on Operating Room Nurses' Experiences and Coping Strategies Regarding Surgical Smoke [J]. Journal of Nursing, 2016(22).

[3] Alp E, Bij D, Bleichrodt RP, et al. Surgical Smoke and Infection Control [J]. J Hosp Infect, 2006, 62(1): 1-5.

[4] Qi YH. Composition, Hazards, and Protection Against Surgical Smoke [J]. Gansu Medicine, 2016, 35(4): 269-271.

[5] Wu YC, Tang CS, Huang HY, et al. Chemical production in electro-cautery smoke by a novel predictive model[J]. Eur Surg Res, 2011, 46(2): 102-107.

[6] Barrett WL, Garber SM. Surgical smoke: a review of the literature. Business Briefing: Global Surgery. 2004: 1-7.

[7] Torres-Ramos Y D, Guzman-Grenfell A M, Montoya-Estrada A, et al. RBC membrane damage and decreased band 3 phospho-tyrosine phosphatase activity are markers of COPD progression[J]. Front Biosci, 2010, 2(4): 1385-1393.

[8] Xu J, Ye F, Lü XF, et al. Study on the Health Impact of Surgical Fumes on Medical Staff in Oncology Hospitals [J]. Modern Oncology Medicine, 2016, 24(16): 2618-2620.

[9] Zhang H, Ji P. Survey on Surgical Fume Awareness and Protection Among Operating Room Medical Staff [J]. Comprehensive Nursing, 2016, 14(8): 851-853.

[10] Zhi Hui, Xu Li. Medical Personnel Should Enhance Awareness of Surgical Smoke Hazards and Strengthen Protection [J]. Chinese Medical Journal, 2015, 95(25): 2045-2046.

[11] Wang Lixia, Wang Chenguang. Analysis of Risk Factors Associated with Exposure to Electrosurgical Smoke in Domestic Closed Operating Rooms [J]. Nursing Practice and Research, 2017, 14(11): 4-6.

[12] Wang Ling, Zhou Suling, Lu Guilan, et al. Research Progress on the Hazards and Protective Measures of Surgical Smoke [J]. Journal of Nursing, 2013, 20(4A): 17-21.

[13] Ge Jingwu, Yang Meiling, Mao Wenge. Research Progress on Hazards and Protection of Surgical Smoke [J]. Nursing Research, 2012, 26(11B): 2977-2978.

[14] Zhou Qing. Management and Prevention of Operating Room Smoke in the United States [J]. Chinese Journal of Nursing, 2013, 48(12): 1080-1082.

[15] Mo Liping, Tan Yunyan, Yang Xiuyuan. Application of a Self-made Controllable Suction Tube in Aspiration of Laparoscopic Surgical Smoke [J]. Minimally Invasive Medicine, 2016, 11(2): 200-202.