Surgical smoke simulation study: Physical characterization and respiratory protection

Exposure of operating room (OR) personnel to surgical smoke, a unique aerosol generated from the common use of electrocautery during surgical procedures, is an increasing health risk concern. The main objective of this simulation study was to characterize the surgical smoke exposure in terms of the particle number concentration and size distribution in a human breathing zone. Additionally, the performance of respiratory protective devices designed for ORs was examined using two commercially available N95 facepiece filtering respirators (FFRs) as well as the same FFRs modified with new faceseal technology. The tests were conducted in an OR-simulating exposure chamber with the surgical smoke generated by electrocautery equipment applied to animal tissue and measured in the breathing zone with four aerosol spectrometers. The simulated workplace protection factor of each tested respirator was determined for ten subjects by measuring the total aerosol concentrations inside and outside of a respirator. The peak of the particle size distribution was in a range of 60-150 nm. The concentration of particles generated during the simulated surgical procedure significantly exceeded the background concentration under all tested air exchange conditions. The data suggest that wearing N95 filtering facepiece respirators significantly decreased the human exposure to surgical smoke. The new faceseal technology provided significantly higher respiratory protection than the commercial N95 FFRs.