Diathermy and bone sawing are high aerosol yield procedures

Author:

Hamilton Victoria1ORCID,Sheikh Sadiyah1ORCID,Szczepanska Alicja1ORCID,Maskell Nick2ORCID,Hamilton Fergus2ORCID,Reid Jonathan P.1ORCID,Bzdek Bryan R.1ORCID,Murray James R. D.23ORCID

Affiliation:

1. School of Chemistry, University of Bristol, Bristol, UK

2. Bristol Medical School, University of Bristol, Bristol, UK

3. Avon Orthopaedic Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK

Abstract

AimsOrthopaedic surgery uses many varied instruments with high-speed, high-impact, thermal energy and sometimes heavy instruments, all of which potentially result in aerosolization of contaminated blood, tissue, and bone, raising concerns for clinicians’ health. This study quantifies the aerosol exposure by measuring the number and size distribution of the particles reaching the lead surgeon during key orthopaedic operations.MethodsThe aerosol yield from 17 orthopaedic open surgeries (on the knee, hip, and shoulder) was recorded at the position of the lead surgeon using an Aerodynamic Particle Sizer (APS; 0.5 to 20 μm diameter particles) sampling at 1 s time resolution. Through timestamping, detected aerosol was attributed to specific procedures.ResultsDiathermy (electrocautery) and oscillating bone saw use had a high aerosol yield (> 100 particles detected per s) consistent with high exposure to aerosol in the respirable range (< 5 µm) for the lead surgeon. Pulsed lavage, reaming, osteotome use, and jig application/removal were medium aerosol yield (10 to 100 particles s-1). However, pulsed lavage aerosol was largely attributed to the saline jet, osteotome use was always brief, and jig application/removal had a large variability in the associated aerosol yield. Suctioning (with/without saline irrigation) had a low aerosol yield (< 10 particles s-1). Most surprisingly, other high-speed procedures, such as drilling and screwing, had low aerosol yields.ConclusionThis work suggests that additional precautions should be recommended for diathermy and bone sawing, such as enhanced personal protective equipment or the use of suction devices to reduce exposure.Cite this article: Bone Joint Res 2023;12(10):636–643.

Publisher

British Editorial Society of Bone & Joint Surgery

Subject

Orthopedics and Sports Medicine,Surgery

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4. No authors listed . Infection prevention and control of epidemic-and pandemic prone acute respiratory infections in health care: WHO Guidelines . World Health Organization (WHO) . 2014 . https://www.who.int/publications/i/item/infection-prevention-and-control-of-epidemic-and-pandemic-prone-acute-respiratory-infections-in-health-care ( date last accessed 20 July 2023 ).

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