Health hazard evaluation report: HETA-2000-0402-3021, Inova Fairfax Hospital, Falls Church, Virginia.
On August 21, 2000, the National Institute for Occupational Safety and Health (NIOSH) received a confidential employee request for a health hazard evaluation at Inova Fairfax Hospital in Falls Church, Virginia. The request noted concerns from surgery department employees in regard to exposure to compounds found in surgical smoke and respiratory symptoms and headaches thought to be associated with such exposure. In March 2001, NIOSH investigators conducted a site visit to the facility and met with management and employee representatives. A return site visit was made in May 2001. A questionnaire regarding symptoms potentially associated with exposure to surgical smoke byproducts was distributed to employees of the surgery department. Personal breathing zone and area air samples were collected during 15 procedures over 3 days for compounds commonly found in surgical smoke plume. These substances included volatile organic compounds (including benzene, toluene, and xylene), acrolein, phenol, cresols, hydrogen cyanide, formaldehyde, acetaldehyde, polycyclic aromatic compounds, and carbon monoxide. Although exposures to chemical compounds above the permitted or recommended limits were not identified, low concentrations of compounds found in surgical smoke may be sufficient to cause irritative effects on the eyes and mucous membranes, especially in sensitive individuals. In fact, greater than half of employees surveyed associated at least one symptom with exposure to surgical smoke and most employees surveyed found the odor associated with surgical smoke annoying and/or objectionable. Although not studied in this evaluation, past NIOSH research has also shown the possibility of mutagenic airborne particulates being present in surgical smoke. The use of engineering controls such as a smoke evacuator is recommended to reduce the levels of surgical smoke in the operating rooms.