Study on Influencing Factors and Control Strategies of Surgical Smoke Concentration Distribution

Paroxysmal fumes during surgical operations endanger the health of medical staff. Special measures for removing surgical smoke are lacking. Article Real-time monitoring of particulate matter concentrations in surgical smoke at different locations under different surgical conditions were explored, and a particulate matter purification control strategy was proposed. The PM2.5 and PM10 concentrations in the operating and respiratory zones near the operating table were about 3.0 times more than the specified value, but both surgical procedures met the requirements of PM concentration in the public zone. Therefore, a clean operating room is not clean for medical staff. The smoke produced by the three scalpels resulted in particle sizes of 0.30–2.50 μm in the respiratory zone, and calculate apparent density of powders to be 1.21g cm–3. The surgical smoke produced by the ultrasound scalpel resulted in the highest median PM10 concentration in the operating area. The results show that the smoke produced by different surgical conditions is mainly ultra-fine particles, which are more likely to harm the health of medical staff. A small surgical smoke circulation purification and dust removal system was designed, which could effectively suppress the spread of surgical smoke and reduce the occupational hazards of medical staff. The optimized control plan could significantly reduce the PM2.5 concentration value at measurement point a when the electric knife was turned on by approximately 200.0%. The PM2.5 concentration of breathing zone was close to 75.0 μg m–3, which basically met the occupational health requirements. The decrease in the PM2.5 concentration of operating zone was about 50.0%, but it still exceeded the limit. It had a reference value for the occupational health protection of the first-line medical staff of existing epidemics.

were explored, and a particulate matter purification control strategy was proposed. The PM2.5 and 16 PM10 concentrations in the operating and respiratory zones near the operating table were about 3.0 17 times more than the specified value, but both surgical procedures met the requirements of PM 18 concentration in the public zone. Therefore, a clean operating room is not clean for medical staff. 19 The smoke produced by the three scalpels resulted in particle sizes of 0.30 -2.50 μm in the 20 respiratory zone, and calculate apparent density of powders to be 1.21g cm -3 . The surgical smoke 21 produced by the ultrasound scalpel resulted in the highest median PM10 concentration in the 22 operating area. The results show that the smoke produced by different surgical conditions is mainly 23 ultra-fine particles, which are more likely to harm the health of medical staff. A small surgical 24 smoke circulation purification and dust removal system was designed, which could effectively 25 suppress the spread of surgical smoke and reduce the occupational hazards of medical staff. The 26 optimized control plan could significantly reduce the PM2.5 concentration value at measurement 27 point a when the electric knife was turned on by approximately 200.0 %. The PM2.5 concentration 28 of breathing zone was close to 75.0 μg m -3 , which basically met the occupational health 29 requirements. The decrease in the PM2.5 concentration of operating zone was about 50.0 %, but it 30 still exceeded the limit. It had a reference value for the occupational health protection of the first-31 line medical staff of existing epidemics. Air quality and environmental issues that affect human health have created widespread concern, 37 resulting in research on environmental particulate pollution control by the government and scholars. 38 As a typical highly clean indoor space in Fig. 1

Surgical Smoke As Primary Pollution Source 45
Surgical smoke contains fine particles caused by the destruction, ablation, and decomposition of 46 tissue when a high-frequency electrosurgical knife, laser knife, or ultrasonic scalpel is used, as 47 aerosol optical particle size spectrometer probes from the Grimm Company of Germany were set 145 up at measurement points a and b, and the instrument model was a Grimm 1.108, which recorded 146 data every 0.6 s on average. The range of particulate matter tested was 0.30 -20 μm. A portable 147 atmospheric dust monitor from TSI Incorporated (model TSI8530, United States) was set up at 148 point c, and the range of particulate matter tested was 0.10 -10 μm. Table 1 shows the specific 149 parameters of the test instruments. To avoid interference with the operating procedures of the 150 medical staff, all probes were fixed on medical equipment at a certain height near the operating 151 table. There was not a significant difference in the risk of exposure in the same surgical 152 environment between members of the same medical team (Ragde et al., 2016). According to the 153 GB3095-2012 "Ambient Air Quality Standard," an average PM2.5 concentration of < 35.00 μg m -3 154 meets the requirements for air cleanliness, and an average PM2.5 concentration of < 75.00 μg m -3 155 meets the health requirements for personnel. 156

Experiment Content And Control Strategy 157
The operating room of a hospital in Shanghai was used as the test object to monitor the 158 concentration of particulate matter in the concentration area of the medical staff and the public 159 environment area under different operating conditions. The main features were as follows. (1) 160 Measurement points were set in the public environment areas in the operation zone, respiratory 161 zone, and public environment zone. The concentrations of fine particulate matter in different 162 locations of the operating room during two different operations (prostate and thyroid cancer 163 resection) and three different scalpels (electric scalpel, laser scalpel, and ultrasound scalpel) were 164 obtained by synchronized measurements. A double sample t-test (significance level P < 0.05) was 165

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8 used to test the results, which provided a reliable basis for future research on the monitoring and 166 control technology of clean surgical environments. (2) A small surgical smoke circulation 167 purification system was designed. The operating principle is shown in Fig. 3(A). A group of 168 combined ultra-quiet purification units was arranged at the bottom of the operation bed, a long strip 169 air supply port was arranged above the head of the patient, and a smoke exhaust port was arranged 170 at the foot area. When the doctor performed the operation, the air supply section blew clean fresh 171 air from the air supply port and blew the surgical smoke to the smoke exhaust port. The air exhaust 172 port drew in the surgical smoke and sent it to the purification and disinfection sections to process 173 the polluted air stream to satisfy the GB50333-2013 "Building Technical Specification for Clean 174 Surgery Department of the Hospital" standard for recycling, forming an air curtain layer above the 175 operating table. This provided the fastest isolation and suction of surgical smoke, preventing the 176 smoke from escaping to the environment, as shown in Fig. 3

Different Surgical Scalpels 225
To explore the effect of scalpel type on the characteristics of paroxysmal particulate matter 226 during an operation, the surgical test environment was kept the same. The measurement time was 227 13:00 -15:30. Fig. 6 shows the statistical analyses of the PM2.5 and PM10 concentrations of surgical 228 paroxysmal particulate matter for three kinds of scalpels (electric, laser, and ultrasound). There 229 were significant differences in the particle concentrations and sizes of the surgical smoke generated

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12 corresponding values of PM10 and PM2.5 were almost equal. These results revealed that the total 251 weight concentration of fine particulate matter in the operating area was close to that of the smoke 252 generated by the three scalpels.  Fig. 7(B) shows that the surgical smoke produced by the three scalpels mainly contained fine 277 particles in the range of 0.3 -2.5 μm. The particle size was lower than that of the lung-damaging 278 dust. The concentration of fine particles produced by the electrosurgical knife was also significantly 279 higher than that of the other two types of scalpels, endangering the health of the medical personnel. 280

Control Strategies to Prevent Doctors' Exposure to Surgical Smoke 281
High-efficiency purification of clean room particles could effectively prevent post-operative 282 infections and protect the health of the medical staff. From the analysis of the test data in this paper, 283  The small-scale circulating purification and dust removal system was designed to form an air       , respectively. Measurement data higher than 578 the"upper whisker" or lower than the "lower whisker" were considered to be outliers and are not 579

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shown here.