Factors contributing to airborne particle dispersal in the operating room

Operating rooms are stringent controlled environments. All influential factors, in particular, airborne particles, must be within the limits established by regulations. Therefore, energy efficiency stays in the background, prioritizing safety and comfort in surgical areas. However, the potential of improvement in energy savings without compromising this safety is broad. This work presents a new procedure, based on calibrated simulations, that allows the identification of potential energy savings in an operating room, complying with current airborne particle standards. Dynamic energy and airborne particle models are developed and then simulated in TRNSYS and calibrated with GenOpt. The methodology is validated through experimental contrast with a real operating room of a hospital in Spain. A calibrated model with around 2% of error is achieved. The procedure determines the variation in particle concentration according to the flow rate of ventilation supplied and the occupancy of the operating room. In conclusion, energy savings up to 51% are possible, reducing ventilation by 50% while complying with airborne particles standards.

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Quantification of Aerosol Particle Concentrations During Endoscopic Sinonasal Surgery in the Operating Room

American Journal of Rhinology and Allergy ◽

10.1177/1945892420962335 ◽

2020 ◽

pp. 194589242096233

Author(s):

Alex Murr ◽

Nicholas R. Lenze ◽

William Colby Brown ◽

Mark W. Gelpi ◽

Charles S. Ebert ◽

...

Keyword(s):

Operating Room ◽

Particle Concentration ◽

Surgical Techniques ◽

Indirect Evidence ◽

Airborne Particle ◽

Endoscopic Endonasal ◽

Aerosol Generation ◽

Particle Sizer ◽

Endoscopic Sinonasal Surgery ◽

Live Patient

Background Recent indirect evidence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) transmission during endoscopic endonasal procedures has highlighted the dearth of knowledge surrounding aerosol generation with these procedures. As we adapt to function in the era of Coronavirus Disease 2019 (COVID-19) a better understanding of how surgical techniques generate potentially infectious aerosolized particles will enhance the safety of operating room (OR) staff and learners. Objective To provide greater understanding of possible SARS-CoV-2 exposure risk during endonasal surgeries by quantifying increases in airborne particle concentrations during endoscopic sinonasal surgery. Methods Aerosol concentrations were measured during live-patient endoscopic endonasal surgeries in ORs with an optical particle sizer. Measurements were taken throughout the procedure at six time points: 1) before patient entered the OR, 2) before pre-incision timeout during OR setup, 3) during cold instrumentation with suction, 4) during microdebrider use, 5) during drill use and, 6) at the end of the case prior to extubation. Measurements were taken at three different OR position: surgeon, circulating nurse, and anesthesia provider. Results Significant increases in airborne particle concentration were measured at the surgeon position with both the microdebrider (p = 0.001) and drill (p = 0.001), but not for cold instrumentation with suction (p = 0.340). Particle concentration did not significantly increase at the anesthesia position or the circulator position with any form of instrumentation. Overall, the surgeon position had a mean increase in particle concentration of 2445 particles/ft3 (95% CI 881 to 3955; p = 0.001) during drill use and 1825 particles/ft3 (95% CI 641 to 3009; p = 0.001) during microdebrider use. Conclusion Drilling and microdebrider use during endonasal surgery in a standard operating room is associated with a significant increase in airborne particle concentrations. Fortunately, this increase in aerosol concentration is localized to the area of the operating surgeon, with no detectable increase in aerosol particles at other OR positions.

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Biomedical applications: Pitfalls in the practice

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100169626 ◽

1994 ◽

Vol 52 ◽

pp. 378-379

Author(s):

J. D. Shelburne ◽

Peter Ingram ◽

Victor L. Roggli ◽

Ann LeFurgey

Keyword(s):

Operating Room ◽

Liquid Nitrogen ◽

Lung Tissue ◽

Biomedical Applications ◽

Microprobe Analysis ◽

Tissue Sample ◽

Cellular Level ◽

Tissue Samples ◽

Asbestos Fibers

At present most medical microprobe analysis is conducted on insoluble particulates such as asbestos fibers in lung tissue. Cryotechniques are not necessary for this type of specimen. Insoluble particulates can be processed conventionally. Nevertheless, it is important to emphasize that conventional processing is unacceptable for specimens in which electrolyte distributions in tissues are sought. It is necessary to flash-freeze in order to preserve the integrity of electrolyte distributions at the subcellular and cellular level. Ideally, biopsies should be flash-frozen in the operating room rather than being frozen several minutes later in a histology laboratory. Electrolytes will move during such a long delay. While flammable cryogens such as propane obviously cannot be used in an operating room, liquid nitrogen-cooled slam-freezing devices or guns may be permitted, and are the best way to achieve an artifact-free, accurate tissue sample which truly reflects the in vivo state. Unfortunately, the importance of cryofixation is often not understood. Investigators bring tissue samples fixed in glutaraldehyde to a microprobe laboratory with a request for microprobe analysis for electrolytes.

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