Surgically generated aerosol and mitigation strategies: combined use of irrigation, respirators and suction massively reduces particulate matter aerosol.

BACKGROUND: Aerosol is a health risk to theatre staff. This laboratory study quantifies the reduction in particulate matter aerosol concentrations produced by electrocautery and drilling when using mitigation strategies such as irrigation, respirator filtration and suction in a lab environment to prepare for future work under live OR conditions. METHODS: We combined one aerosol-generating procedure (monopolar cutting or coagulating diathermy or high-speed diamond- or steel-tipped drilling of cadaveric porcine tissue) with one or multiple mitigation strategies (instrument irrigation, plume suction and filtration using an FFP3 respirator filter) and using an optical particle counter to measure particulate matter aerosol size and concentrations. RESULTS: Significant aerosol concentrations were observed during all aerosol-generating procedures with concentrations exceeding 3 × 106 particles per 100 ml. Considerable reductions in concentrations were observed with mitigation. In drilling, suction, FFP3 filtration and wash alone respectively reduced aerosol by 19.3-31.6%, 65.1-70.8% and 97.2 to > 99.9%. The greatest reduction (97.38 to > 99.9%) was observed when combining irrigation and filtration. Coagulating diathermy reduced concentrations by 88.0-96.6% relative to cutting, but produced larger particles. Suction alone, and suction with filtration reduced aerosol concentration by 41.0-49.6% and 88.9-97.4% respectively. No tested mitigation strategies returned aerosol concentrations to baseline. CONCLUSION: Aerosol concentrations are significantly reduced through the combined use of filtration, suction and irrigation. Further research is required to characterise aerosol concentrations in the live OR and to find acceptable exposure limits, and in their absence, to find methods to further reduce exposure to theatre staff.

Forensic examination of the mentally disabled sexual abuse complainant.

Individuals who have mental disabilities are more vulnerable to sexual abuse than the general population and even less likely to report the offence. Furthermore they face greater barriers if they wish to seek help, support or prosecution. Where abuse is alleged or suspected, a complainant with a mental disability will often have the capacity to decide whether they wish to undergo intimate forensic examination. However, in cases where the individual truly lacks capacity it must be decided on an case to case basis without assumption or preconception whether such an examination is truly in their best interests. This aim of this review is to discuss sexual offences against adults with mental disabilities and the identification and management of these individuals.