Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Quality of Air in the Operating Room: Surgical Smoke-A Descriptive Study
Ameliyathanenin Hava Kalitesi: Cerrahi Duman-Tanımlayıcı Bir Çalışma
Burçak ŞAHİN KÖZEa, Meryem YAVUZ van GIERSBERGENa, Levent YENİAYb
aDepartment of Surgical Diseases Nursing, Ege University Faculty of Nursing, İzmir, Türkiye
bDepartment of General Surgery, Ege University Hospital Health Practice and Research Center, İzmir, Türkiye
Turkiye Klinikleri J Med Sci. 2022;42(4):282-8
doi: 10.5336/medsci.2022-90290
Article Language: EN
Full Text
ABSTRACT
 Objective: Electrosurgery is used in almost all surgeries. The entire surgical team working in these operating rooms is exposed to surgical smoke. In the literature, there is no study examining the direct effect of surgical smoke on operating room staff and involving the entire surgical team in sampling. This study aimed to examine the operating room air quality due to surgical smoke. Material and Methods: This descriptive study was conducted in August 2018 in the operating room of the department of general surgery of a university hospital. Air samples were taken from different parts of the operating room during surgery, and levels of volatile organic compounds in the breathing zone of the surgical team were measured. Results: Volatile organic compounds were not detected in the air samples taken during the surgery. The measured levels were well below the limits that could affect human health. Levels of some volatile organic compounds in the breathing zone of the surgical team were above the limit. Benzene levels in the breathing zone of the surgical resident, scrub nurse, circulating nurse and support staff were above the normal limit, and the chloroform level of the support staff was above the normal limit. Conclusion: Levels of some volatile organic compounds in the surgical smoke from the breathing zone of operating room health care professionals were above the normal limit. It is recommended to establish a protocol for protection from surgical smoke in operating rooms and to take the necessary measures.

Keywords: Volatile organic compounds; operating rooms; air pollution (indoor); occupational health
ÖZET
 Amaç: Elektrocerrahi neredeyse tüm ameliyatlarda kullanılmaktadır. Bu ameliyathanelerde çalışan ekibin tamamı cerrahi dumana maruz kalmaktadır. Literatürde cerrahi dumanın ameliyathane personeli üzerine doğrudan etkisini inceleyen ve tüm cerrahi ekibi örneklemeye dâhil eden bir çalışmaya rastlanmamıştır. Bu çalışmada, cerrahi dumana bağlı ameliyathane hava kalitesinin incelenmesi amaçlanmıştır. Gereç ve Yöntemler: Tanımlayıcı tipteki bu çalışma, 2018 yılı Ağustos ayında bir üniversite hastanesinin genel cerrahi ana bilim dalı ameliyathanesinde yapılmıştır. Ameliyat sırasında ameliyathanenin farklı yerlerinden hava örnekleri alındı ve ameliyathane ekibinin solunum alanı içinden alınan örneklerde uçucu organik bileşiklerin seviyeleri ölçülmüştür. Bulgular: Ameliyat sırasında ameliyathanenin farklı yerlerinden alınan hava örneklerinde uçucu organik bileşiklere rastlanmamıştır. Ölçülen seviyeler, insan sağlığını etkileyebilecek sınırların oldukça altındaydı. Cerrahi ekibin solunum bölgesindeki hava örneklerinde bazı uçucu organik bileşiklerin seviyeleri sınır değerin üzerindeydi. Cerrahi asistanı, steril giyinen hemşire, dolaşıcı hemşire ve yardımcı personelin solunum bölgesindeki benzen seviyeleri normal değerlerin üzerindeydi ve yine yardımcı personelin kloroform seviyesi normal değerin üzerindeydi. Sonuç: Ameliyathane çalışanlarının solunum alanındaki cerrahi duman içerisinde bulunan bazı uçucu organik bileşiklerin seviyeleri normal değerin üzerindedir. Ameliyathanelerde cerrahi dumandan korunmaya yönelik protokol oluşturulması ve gerekli önlemlerin alınması önerilmektedir.

Anahtar Kelimeler: Uçucu organik bileşikler; ameliyathaneler; hava kirliliği, ev içi; iş sağlığı
REFERENCES:
  1. AORN. Guideline summary: surgical smoke safety. Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2018. p.469-97.
  2. Romano F, Gustén J, De Antonellis S, Joppolo CM. Electrosurgical smoke: ultrafine particle measurements and work environment quality in different operating theatres. Int J Environ Res Public Health. 2017;14(2):137. [Crossref]  [PubMed]  [PMC] 
  3. Ulmer BC. The hazards of surgical smoke. AORN J. 2008;87(4):721-34; quiz 735-8. [Crossref]  [PubMed] 
  4. Ball K. Compliance with surgical smoke evacuation guidelines: implications for practice. AORN J. 2010;92(2):142-9. [Crossref]  [PubMed] 
  5. Alp E, Bijl D, Bleichrodt RP, Hansson B, Voss A. Surgical smoke and infection control. J Hosp Infect. 2006;62(1):1-5. [Crossref]  [PubMed] 
  6. Garden JM, O'Banion MK, Bakus AD, Olson C. Viral disease transmitted by laser-generated plume (aerosol). Arch Dermatol. 2002;138(10):1303-7. [Crossref]  [PubMed] 
  7. Occupational Safety and Health Administration [Internet]. [Cited: August 2, 2017]. Laser/electrosurgery plume. Available from: [Link] 
  8. Pierce JS, Lacey SE, Lippert JF, Lopez R, Franke JE. Laser-generated air contaminants from medical laser applications: a state-of-the-science review of exposure characterization, health effects, and control. J Occup Environ Hyg. 2011;8(7):447-66. [Crossref]  [PubMed] 
  9. Benson SM, Novak DA, Ogg MJ. Proper use of surgical n95 respirators and surgical masks in the OR. AORN J. 2013;97(4):457-67; quiz 468-70. [Crossref]  [PubMed]  [PMC] 
  10. Fan JK, Chan FS, Chu KM. Surgical smoke. Asian J Surg. 2009;32(4):253-7. [Crossref]  [PubMed] 
  11. Okoshi K, Kobayashi K, Kinoshita K, Tomizawa Y, Hasegawa S, Sakai Y. Health risks associated with exposure to surgical smoke for surgeons and operation room personnel. Surg Today. 2015;45(8):957-65. [Crossref]  [PubMed] 
  12. Wang HK, Mo F, Ma CG, Dai B, Shi GH, Zhu Y, et al. Evaluation of fine particles in surgical smoke from an urologist's operating room by time and by distance. Int Urol Nephrol. 2015;47(10):1671-8. [Crossref]  [PubMed] 
  13. In SM, Park DY, Sohn IK, Kim CH, Lim HL, Hong SA, et al. Experimental study of the potential hazards of surgical smoke from powered instruments. Br J Surg. 2015;102(12):1581-6. [Crossref]  [PubMed] 
  14. Mowbray N, Ansell J, Warren N, Wall P, Torkington J. Is surgical smoke harmful to theater staff? a systematic review. Surg Endosc. 2013;27(9):3100-7. [Crossref]  [PubMed] 
  15. Tseng HS, Liu SP, Uang SN, Yang LR, Lee SC, Liu YJ, et al. Cancer risk of incremental exposure to polycyclic aromatic hydrocarbons in electrocautery smoke for mastectomy personnel. World J Surg Oncol. 2014;12:31. [Crossref]  [PubMed]  [PMC] 
  16. Al Sahaf OS, Vega-Carrascal I, Cunningham FO, McGrath JP, Bloomfield FJ. Chemical composition of smoke produced by high-frequency electrosurgery. Ir J Med Sci. 2007;176(3):229-32. [Crossref]  [PubMed] 
  17. Näslund Andréasson S, Mahteme H, Sahlberg B, Anundi H. Polycyclic aromatic hydrocarbons in electrocautery smoke during peritonectomy procedures. J Environ Public Health. 2012;2012:929053. [Crossref]  [PubMed]  [PMC] 
  18. Choi SH, Kwon TG, Chung SK, Kim TH. Surgical smoke may be a biohazard to surgeons performing laparoscopic surgery. Surg Endosc. 2014;28(8):2374-80. [Crossref]  [PubMed] 
  19. Fitzgerald JE, Malik M, Ahmed I. A single-blind controlled study of electrocautery and ultrasonic scalpel smoke plumes in laparoscopic surgery. Surg Endosc. 2012;26(2):337-42. [Crossref]  [PubMed] 
  20. Gianella M, Hahnloser D, Rey JM, Sigrist MW. Quantitative chemical analysis of surgical smoke generated during laparoscopic surgery with a vessel-sealing device. Surg Innov. 2014;21(2):170-9. [Crossref]  [PubMed] 
  21. Hollmann R, Hort CE, Kammer E, Naegele M, Sigrist MW, Meuli-Simmen C. Smoke in the operating theater: an unregarded source of danger. Plast Reconstr Surg. 2004;114(2):458-63. [Crossref]  [PubMed] 
  22. Lin YW, Fan SZ, Chang KH, Huang CS, Tang CS. A novel inspection protocol to detect volatile compounds in breast surgery electrocautery smoke. J Formos Med Assoc. 2010;109(7):511-6. [Crossref]  [PubMed] 
  23. Moot AR, Ledingham KM, Wilson PF, Senthilmohan ST, Lewis DR, Roake J, et al. Composition of volatile organic compounds in diathermy plume as detected by selected ion flow tube mass spectrometry. ANZ J Surg. 2007;77(1-2):20-3. [Crossref]  [PubMed] 
  24. Weston R, Stephenson RN, Kutarski PW, Parr NJ. Chemical composition of gases surgeons are exposed to during endoscopic urological resections. Urology. 2009;74(5):1152-4. [Crossref]  [PubMed] 
  25. Zhao C, Kim MK, Kim HJ, Lee SK, Chung YJ, Park JK. Comparative safety analysis of surgical smoke from transurethral resection of the bladder tumors and transurethral resection of the prostate. Urology. 2013;82(3):744.e9-14. [Crossref]  [PubMed] 
  26. ISO [Internet]. Erişim tarihi; Temmuz 2019. (Cited; July 2019). Available from: [Link] 
  27. Ragde SF, Jørgensen RB, Føreland S. Characterisation of exposure to ultrafine particles from surgical smoke by use of a fast mobility particle sizer. Ann Occup Hyg. 2016;60(7):860-74. [Crossref]  [PubMed] 
  28. Sezdi M, Üzcan Y. Ameliyathanelerde temiz oda sınıflandırması. Paper presented at: Medical Technologies Conference; October 27-29, 2016; Antalya, Turkey. 2016. p.276-9. [Link] 
  29. Süngü A. Ameliyathanede havalandırma Sistemleri IVF ve genetik laboratuvar havalandırma sistemleri. Günaydın M, Öztürk R, Ulusoy S, Güntekin M, editörler. 5. Ulusal Sterilizasyon Dezenfeksiyon Kongre Kitabı. Antalya: Bilimsel Tip Yayinlari; 2007. p.466-85. [Link] 
  30. World Health Organization(WHO). Air Quality Guidelines for Europe. 2nd ed. World Health Organizatio; Copenhagen: 2000. Cited: August 4, 2017. Available from: [Link] 

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