Effect of Smoke Evacuator on Reduction of Volatile Organic Compounds and Particles in Surgical Smoke: A Randomized Controlled Trial.

BACKGROUND: Surgical smoke is an occupational health problem and is increasingly recognized as a potential source of virus transmission. Dedicated smoke evacuators are used to protect against surgical smoke exposure. We tested the hypothesis that using smoke evacuators would reduce volatile organic compounds and the number of particles in surgical smoke during the laparotomy procedure. STUDY DESIGN: A randomized, double-blind clinical trial was conducted in patients undergoing laparotomy from June 11, 2021, to March 30, 2022, to compare the effectiveness of smoke evacuators with a control (registration, UMIN000044250). The primary outcome was a change in the acetaldehyde level. Secondary outcomes were changes in the formaldehyde level and particle count assessed by the particle size of 0.3, 0.5, 1.0, and 5.0 nm. RESULTS: A total of 42 patients were randomized and assessed (smoke evacuator group, n = 22 vs control group, n = 20). The acetaldehyde level was significantly lower in the smoke evacuator group than in the control group: mean (95% CI), 10.6 (3.7 to 17.5) vs 47.2 (19.9 to 74.5) µg/m 3 , p < 0.001. Similarly, the formaldehyde level was 72.2% lower in the smoke evacuator group than in the control group. Particle counts by each particle size category were 80% to 95% lower in the smoke evacuator group than in the control group (all, p < 0.001). CONCLUSIONS: Dedicated smoke evacuators reduced the level of acetaldehyde and formaldehyde, and the number of particles in surgical smoke, minimizing the potential exposure to volatile organic compounds and particle matters during surgery.

HeLP: Development of occupational protection mask against surgical smoke.

OBJECTIVES: to describe a technological innovation in the development of an individual, ergonomic, sustainable and effective occupational respiratory protection mask for workers exposed to surgical smoke. METHODS: applied, exploratory, quantitative research, using design methods and tools: Sense Intent, Know Context, Know People, Frame Insights, Explore Concepts, Frame Solutions, Realize Offerings, in addition to the Product Development Process tools. It was developed from March 2019 to December 2021. RESULTS: from the prototyping mold, it became possible to represent the abstract to the physical, where all the concepts created in the methodological steps were implemented and the necessary adjustments were made to create the model as a technological innovation, which will have the concept for product commercialization. CONCLUSIONS: a mask for protection against surgical smoke (HeLP) was developed, from the design step to the prototype development, being a technological innovation.

Surgical smoke and the orthopedic surgeon: a non-systematic review of the hazards and strategies for mitigating risk.

INTRODUCTION: Surgical smoke generated through the use of electrical surgical devices poses a risk to the surgeon, medical personnel in the operating room, and the patient by exposing them to environmentally hazardous particulate matter. Previous investigation has shown that surgical smoke leads to an increased risk of pulmonary conditions, circulatory disorders, and irritation of the eyes, nose, and throat. Transmission of infectious disease can occur through inhalation of viral particles, and the presence of carcinogens are also of major concern. The deleterious effects of surgical smoke are well documented in several subspecialties, namely dermatology and general surgery, but there has been little discussion on the topic amongst orthopedic surgeons. METHODS: A non-systematic review of the literature was completed with the aim of identifying the major categories of adverse health effects associated with surgical smoke inhalation and offering recommendations to reduce these hazards in the orthopedic surgical community. RESULTS: Three primary categories of risk associated with surgical smoke inhalation were identified: inflammation, viral/bacterial transmission, and carcinogenicity. In addition, strategies for mitigating risk and best practice recommendations were explored. CONCLUSION: Surgical smoke is an under-recognized occupational hazard within the orthopedic surgery literature. There are several strategies which can be employed to reduce risk. Further investigation is needed to understand the long-term impact of these risks, as well as what can be done to improve the practicality and compliance with protective measures.

Máscara n95: percepções dos trabalhadores do centro cirúrgico / Máscara n95: percepciones de los trabajadores del centro quirúrgico / N95 mask: perceptions of surgical center workers

Objetivo: identificar as percepções dos trabalhadores do centro cirúrgico quanto ao uso da máscara N95 como Equipamento de Proteção Individual em relação à fumaça cirúrgica. Método: pesquisa qualitativa mediante entrevistas áudio-gravadas, com nove trabalhadores do Centro Cirúrgico de um hospital no norte do Paraná, Brasil. Questionou-se: qual a percepção dos trabalhadores expostos à fumaça cirúrgica em relação ao uso das máscaras N95? Foi utilizada a técnica de análise de conteúdo. Resultados: o estudo revela a fragilidade do conhecimento dos profissionais sobre a utilização da máscara N95 e sobre os riscos que estão expostos durante sua jornada de trabalho, quando expostos à fumaça cirúrgica. Assim como o desconforto pelo uso da máscara. Conclusão: sugere-se capacitação aos profissionais da saúde expostos à fumaça cirúrgica, onde possa ser esclarecido sobre o uso de Equipamento de Proteção Individual de forma correta e sua importância na prevenção para o desenvolvimento de doenças ocupacionais.

Objetivo: identificar las percepciones de los trabajadores del centro quirúrgico en cuanto al uso de la máscara N95 como Equipo de Protección Individual en relación al humo quirúrgico. Método: investigación cualitativa mediante entrevistas audio-grabadas, con nueve trabajadores del Centro Quirúrgico de un hospital en el norte de Paraná, Brasil. Se preguntó: ¿cuál es la percepción de los trabajadores expuestos al humo quirúrgico con respecto al uso de las máscaras N95? Se utilizó la técnica de análisis de contenido. Resultados: el estudio revela la fragilidad del conocimiento de los profesionales sobre la utilización de la máscara N95 y sobre los riesgos que están expuestos durante su jornada de trabajo, cuando están expuestos al humo quirúrgico. Así como la incomodidad por el uso de la máscara. Conclusión: se sugiere capacitación a los profesionales de la salud expuestos a humo quirúrgico, donde pueda ser esclarecido sobre el uso de Equipo de Protección Individual de forma correcta y su importancia en la prevención para el desarrollo de enfermedades ocupacionales.

Objective: to identify the perceptions of surgical center workers regarding the use of the N95 mask as Personal Protection Equipment in relation to surgical smoke. Method: qualitative research through audio-recorded interviews with nine workers from the Surgical Center of a hospital in northern Paraná, Brazil. It was questioned: what is the perception of workers exposed to surgical smoke in relation to the use of N95 masks? The technique of content analysis was used. Results: the study reveals the fragility of professionals' knowledge about the use of the N95 mask and the risks they are exposed during their working day, when exposed to surgical smoke. As well as discomfort from wearing the mask. Conclusion: training for health professionals exposed to surgical smoke is suggested, where it can be clarified about the use of Personal Protective Equipment correctly and its importance in preventing the development of occupational diseases.

Uncovering eco-friendly design in the ancient bronze goose-and-fish lamp: an unnoticeable gap boosts ventilation.

The bronze goose-and-fish lamp exhibited in the national museum of China is a 2,000-y-old artifact once used for indoor lighting by nobility in the Western Han dynasty (206 BCE TO 25 CE). The beauty of this national treasure arises from its elegant shape vividly showing a goose catching fish with beautiful colors painted over the whole body. Beyond the artistic and historical value, what enchants people most is the eco-design concept of this oil-burning lamp. It is widely believed that the smoke generated by burning animal oil can flow into the goose belly through its long neck, then be absorbed by prefilled water in the belly, hence mitigating indoor air pollution. Although different mechanistic hypotheses such as natural convection and even the siphon effect have been proposed to qualitatively rationalize the above-claimed pollution mitigation function, due to the absence of a true scientific analysis, the definitive mechanism remains a mystery. By rigorous modeling of the nonisothermal fluid flow coupled with convection-diffusion of pollutant within and out of the lamp, we discover that it is the unnoticeable gap between goose body and lamp tray (i.e., an intrinsic feature of the multicompartmental design) that can offer definitive ventilation in the lamp. The ventilation is facilitated by natural convection due to oil burning. Adequate ventilation plays a key role in enabling pollution mitigation, as it allows pollutant to reach the goose belly, travel over and be absorbed by the water.

Measurements, emission characteristics, and control methods of fire effluents generated from tunnel asphalt pavement during fire: a review.

Tunnels are widely used in high-grade roads, particularly in mountainous areas; however, tunnel fires often result in severe economic losses and casualties. The fire effluents produced from asphalt pavement have attracted significant research attention. The main objective of this study is to assimilate information on various aspects of bituminous mixture emissions during fires. In this study, the fume emissions of bitumen and bituminous mixtures during combustion are comprehensively reviewed and summarized. First, the test methods for fire effluents produced by bitumen and bituminous mixtures after combustion are summarized. Second, the factors influencing the fume concentration and composition are determined. In addition, different methods to reduce the emission of fire effluents are compared, particularly for the suppression of toxic gas emissions. Then, reasonable suggestions are proposed to reduce the damage caused by hazardous gases to humans and the environment. This review is beneficial for comprehensively understanding the fume emission behaviour and future research on the smoke suppression of highway tunnel asphalt pavements during fires.

Perceptions of long-term impact and change following a midwife-led biomass smoke education program for mothers in rural Uganda: a qualitative study.

INTRODUCTION: Women and children in Uganda and other low- and middle-income countries are exposed to disproportionately high levels of household air pollution from biomass smoke generated by smoke-producing cookstoves, especially in rural areas. This population is therefore particularly vulnerable to the negative health effects caused by household air pollution, including negative pregnancy outcomes and other health issues throughout life. The Midwife Project, a collaboration between research and health teams in the UK and Uganda, began in 2016 to implement an education program on lung health for mothers in Uganda, to reduce the health risks to women and children. Education materials were produced to guide midwives in the delivery of health messages across four rural health centres, and mixed-methods results of knowledge questionnaires and interviews demonstrated knowledge acquisition, acceptability and feasibility. This qualitative follow-up study aimed to improve understanding of the longer term impact of this education program from the perspective of midwives, village health team members and mothers, in consideration of rolling the program out more widely in rural Uganda. METHODS: Purposive sampling was carried out to recruit consenting antenatal or postnatal women, midwives and village health team members who had been involved in an education session. Individual interviews were conducted with 12 mothers and four village health team members, and four focus groups were conducted with 10 midwives in total. Interviews and focus groups were conducted across all four health centres by two researchers and six translators as appropriate depending on language spoken (English or Lusoga). These were semi-structured and directed by topic guides. Reflective and observational notes were also made. A thematic analysis was carried out by two researchers, along with production of a narrative for each mother, to enrich understanding of each individual story. RESULTS: Midwives and village health teams had continued with the program well past the project end date and all mothers expressed making, or intending to make, changes, suggesting long-term feasibility and acceptability. Main themes generated were ability to change and changes made, ability to change dictated by money, importance of practical education, perceived health improvements, and passing on knowledge. Additional findings were that some education topics seemed to be overlooked, and there was a lack of clarity about the village health team role for the purposes of this program. Some mothers had been motivated to overcome financial barriers, for example by reconstructing cooking areas cheaply themselves. However, information given in the program about building advice and potential financial gains was inconsistent. CONCLUSION: Recommendations for future biomass smoke education should include explicit building advice, emphasis on financial gains, encouragement to share the knowledge acquired and clarification of the village health team role. These program changes will improve focus and relevancy, optimise impact and, with behaviour change and implementation strategy in mind, could be used for widespread rollout in rural Uganda. Future research should include quantitative data collection to objectively examine surprising perceived health benefits, including reduction in malaria and burns, and further qualitative work on why some education content appears neglected.

Surgical smoke: modern mobile smoke evacuation systems improve occupational safety in the operating theatre.

OBJECTIVES: Evaluation of smoke capture efficiency of different mobile smoke evacuation devices with respect to volatile organic compounds and their noise emission. METHODS: Electrosurgical incisions were performed on fresh porcine liver in an operating room with vertical laminar flow. The generated surgical smoke was analysed with proton-transfer-reaction mass spectrometry with and without the use of a mobile smoke evacuation system consisting of a smoke evacuator machine, a suction hose and a handpiece. The inlet of the mass spectrometer was positioned 40 cm above the specimen. Various devices were compared: a hard plastic funnel, a flexible foam funnel, an on-tip integrated aspirator of an electrosurgical knife and a standard secretion suction (Yankauer). Also, sound levels were measured at a distance of 40 cm from the handpieces' inlet. RESULTS: The smoke capture efficiency of the secretion suction was only 53%, while foam funnel, plastic funnel and integrated aspirator were all significantly more effective with a clearance of 95%, 91% and 91%, respectively. The mean sound levels were 68 and 59 A-weighted decibels with the plastic and foam funnel, respectively, 66 A-weighted decibels with the integrated aspirator and 63 A-weighted decibels with the secretion suction. CONCLUSIONS: Carcinogenic, mutagenic and reprotoxic volatile organic compounds in surgical smoke can be efficiently reduced by mobile smoke evacuation system, providing improved protection for medical personnel. Devices specifically designed for smoke evacuation are more efficient than standard suction tools. Noise exposure for the surgeon was lowest with the flexible foam funnel and higher with the other handpieces tested.

Implementing a Surgical Smoke Evacuation Policy and Procedure: A Quality Improvement Project.

Energy-generating surgical devices (eg, electrosurgical units, lasers) produce surgical smoke that can cause negative health effects in exposed individuals. In 2019, a review of nursing documentation at an urban teaching hospital revealed that personnel were properly evacuating surgical smoke during less than 0.5% of applicable procedures. To address the noncompliance and reduce exposure to surgical smoke, an interdisciplinary team initiated a quality improvement project to implement a surgical smoke evacuation policy for all smoke-generating procedures. The project included creation and implementation of a smoke evacuation policy, staff member education on the hazards of surgical smoke and proper evacuation device use, and acquisition of the proper smoke evacuation equipment. After instituting the policy in June 2020, results of a three-month chart audit showed that there was nursing documentation confirming personnel used energy-generating devices and the corresponding surgical smoke evacuation devices during 664 of 2,224 procedures, for a compliance rate of 30%.

Optimizing Parameters for Smoke Evacuation.

BACKGROUND: Current literature lacks recommendations regarding the ideal organization of the smoke evacuation system to minimize inhalation of surgical smoke. OBJECTIVE: This study determines optimal parameters of the smoke evacuation system with respect to the surgical field. MATERIALS AND METHODS: This study was conducted in an outpatient surgical facility at a tertiary care center. After 30 seconds of continuous electrocautery of tissue, particulate measurements were recorded using the TSI DustTrak Aerosol Monitor 8520 (>2.5 µm particles) and the TSI P-Trak Ultrafine Particle Counter 8525 (<1 µm particles) while changing the angle and distance of the smoke evacuation system. RESULTS: Particulate matter measurements were lower when suction angle was at 45° than at 90°. For both small-sized and large-sized particles, the lowest particulate matter was recorded when the evacuator was maintained at a 45° angle, 2 to 4 inches away from the cauterizing procedure. Particulate matters dramatically increased after increasing the distance of the smoke evacuator beyond 8 inches from the procedural site. CONCLUSION: In an effort to reduce smoke inhalation, the authors recommend that smoke evacuation should be placed at a 45° suction angle, no further than 8 inches away from the surgical site, while preserving the surgeon's field of vision.

The effects on mortality and the associated financial costs of wood heater pollution in a regional Australian city.

OBJECTIVES: To estimate the annual burden of mortality and the associated health costs attributable to air pollution from wood heaters in Armidale. DESIGN: Health impact assessment (excess annual mortality and financial costs) based upon atmospheric PM2.5 measurements. SETTING: Armidale, a regional Australian city (population, 24 504) with high levels of air pollution in winter caused by domestic wood heaters, 1 May 2018 - 30 April 2019. MAIN OUTCOME MEASURES: Estimated population exposure to PM2.5 from wood heaters; estimated numbers of premature deaths and years of life lost. RESULTS: Fourteen premature deaths (95% CI, 12-17 deaths) per year, corresponding to 210 (95% CI, 172-249) years of life lost, are attributable to long term exposure to wood heater PM2.5 pollution in Armidale. The estimated financial cost is $32.8 million (95% CI, $27.0-38.5 million), or $10 930 (95% CI, $9004-12 822) per wood heater per year. CONCLUSIONS: The substantial mortality and financial cost attributable to wood heating in Armidale indicates that effective policies are needed to reduce wood heater pollution, including public education about the effects of wood smoke on health, subsidies that encourage residents to switch to less polluting home heating (perhaps as part of an economic recovery package), assistance for those affected by wood smoke from other people, and regulations that reduce wood heater use (eg, by not permitting new wood heaters and requiring existing units to be removed when houses are sold).

Urgent safety considerations for dermatologic surgeons in the COVID-19 pandemic.

Dermatologic surgeons are at increased risk of contracting SARS-COV-2. At time of writing, there is no published standard for the role of pre-operative testing or the use of smoke evacuators, and personal protective equipment (PPE) in dermatologic surgery. Risks and safety measures in otolaryngology, plastic surgery, and ophthalmology are discussed. In Mohs surgery, cases involving nasal or oral mucosa are highest risk for SARS-COV-2 transmission; pre-operative testing and N95 masks should be urgently prioritized for these cases. Other key safety recommendations include strict control of patient droplets and expanded pre-clinic screening. Dermatologic surgeons are encouraged to advocate for appropriate pre-operative tests, smoke evacuators, and PPE. Future directions would include national consensus guidelines with continued refinement of safety protocols.