Abstract
ABSTRACTThe objective of this study is to analyze the volatile organic compounds (VOCs) in the surgical smoke generated during laparoscopic surgery, and determine their influence on the indoor air quality in hospital operating rooms (ORs). Field measurements were carried out during eight surgeries in conventional and robotic ORs in which an electrosurgery system was being used, thus continuously generating surgical smoke. The VOCs were measured at three different locations, in the patients’ abdominal cavities, beside the surgical table, and at the exhaust vent. Other indoor pollutants including carbon monoxide (CO), carbon dioxide (CO2), and total airborne bacteria (TAB) in the indoor air were measured at the exhaust to assess the general indoor air quality in the ORs. The results from the patients’ abdominal cavities confirmed that the surgical smoke contained abundant VOCs, with the levels of benzene and toluene exceeding the health guidelines. Compared to the results obtained in the abdominal cavity, the measurements obtained at the surgical table and exhaust vent exhibited low levels of VOCs, indicating that the actual exposure to these compounds was minimized in a highly-ventilated operating room. However, the benzene concentration in the operating room approached a level that threatens the health of the occupants. Therefore, the results of this study suggest that there is a potential health risk to the surgeon who is closest to the point of origin of the surgical gas, as well as a need for further attention to identify the local pollutant dispersion near the surgical table while the ventilation system is operating.
Highlights
The maintenance of a high indoor air quality (IAQ) in a hospital is important to ensuring successful patient care and health outcomes (Choosong and Phakthongsuk, 2006; Chuaybamroong et al, 2008; Huang et al, 2013)
Compared to the results obtained in the abdominal cavity, the measurements obtained at the surgical table and exhaust vent exhibited low levels of volatile organic compounds (VOCs), indicating that the actual exposure to these compounds was minimized in a highlyventilated operating room
Among VOCs, aromatic hydrocarbons such as benzene, toluene, ethylbenzene, xylene, and styrene (BTEXS), which are reported to be generated by combustion processes and abundant in the surgical smoke were chosen for the analysis (Weston et al, 2009; Choi et al, 2014)
Summary
The maintenance of a high indoor air quality (IAQ) in a hospital is important to ensuring successful patient care and health outcomes (Choosong and Phakthongsuk, 2006; Chuaybamroong et al, 2008; Huang et al, 2013). In operating rooms (ORs), the challenge is to achieve infection control and safety for the benefit of the patients and surgical staff. The air quality is essential to infection control and reducing the number of surgical site infections (SSIs). SSIs are regarded as being one of the most common causes of serious surgical complications (World Alliance for Patient Safety, 2008) and account for 14% to 17% of all hospitalacquired infections (Centers for Disease Control and Prevention, 2004; Weigelt et al, 2010). Considered part of the patient care environment, the burning process leads to the generation of combustion gases, producing carbon monoxide (CO), particulates, and other harmful pollutants (King and McCullough, 2006; Watson, 2010) according to surgical types and instrument used (Mowbray et al, 2013).
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