DS05 Intraoperative exposure to fine particulate matter during dermatological diathermy: a prospective comparison of smoke evacuation practices

Abstract

Surgical smoke produced by electrosurgical diathermy contains fine particulate matter (PM2.5). This is capable of penetrating deep into the respiratory tract, posing potential occupational health risks to operating theatre staff. Standard surgical masks offer limited protection against PM2.5, and many dermatological procedures rely on passive ventilation without dedicated smoke evacuation systems, resulting in uncontrolled airborne exposure at the operator’s breathing zone. We compared practices at two NHS hospitals – one using smoke evacuators and one without smoke evacuators – and measured the peak PM2.5 particle value for comparison. A prospective study was undertaken between two NHS hospital sites: one routinely using smoke evacuation and one relying on passive room ventilation during skin surgery involving bipolar and monopolar diathermy. Real-time monitoring recorded peak PM2.5 concentrations in the operator’s breathing zone across cases at each site. Mean and maximum peak values were compared to assess exposure differences attributable to theatre practice. In total, 18 procedures were analysed. Four procedures were performed at a site without smoke evacuation and 14 at a site with smoke evacuation. The mean peak PM2.5 concentration at the former site was 75.0 μg m−3 (range 10.1–144), compared with 4.9 μg m−3 (range 1.0–11.9) at the site with smoke evacuation. Peak PM2.5 levels were therefore approximately 15 times higher in procedures performed without smoke evacuation. Our findings demonstrate that intraoperative PM2.5 exposure during diathermy in skin surgery is significantly reduced by the use of routine smoke evacuation. The site without smoke evacuation exhibited highly variable PM2.5 peaks, exceeding the 24-h WHO 2021 guideline values, whereas smoke evacuation maintained consistently low levels. The findings are in line with the BAD recommendation for the implementation of appropriate smoke extraction and personal protective equipment for all procedures generating surgical smoke.