26 Feb Sweating the Small Stuff – The Problem of Nanoparticles

To date, I have detailed my personal evolution from a surgeon who could not endure inhaling the smoke that resulted from my practice to one dedicated to resolving the problem for myself and others. I hope that as you have read these blogs, you have become energized to pursue your own solutions to surgical problems.

Now we need to focus on the why, not the how of surgical plume. Most of you already know that surgical plume is really cigarette smoke without the nicotine since the burning (pyrolysis) of organic, carbon- based matter results in multiple carbon fragments such as benzene, carbon monoxide, formaldehyde, etc. You also know that it contains live transmissible viral DNA, viable bacteria, red blood cells and mostly vaporized body fluids; the same fluid present as blood from the same patient who may be infected with Hepatitis B or C or AIDS. OSHA mandates protection from blood spatter but ignores your inhalation of that same fluid with every breath you take through your surgical mask. The problem is compounded by surgeons who, for reasons that need to be detailed by them, refuse to use smoke evacuation tools. Even worse is the vexing question, “Do surgeons have the right to prevent me, the perioperative nurse, from protecting by health?”

Thus, OSHA not only ignores your protection from inhaled potentially infected material but also your inhalation of nanoparticles which accounts for 80% of the surgical plume and which have been shown, in hundreds of research papers, to cause or be associated with multiple serious systemic diseases. Unfortunately, these studies have not been published in the surgical literature but rather have appeared in environmental and occupational health journals. A previous attempt by this author to point out this folly to OSHA was met with a twelve year old argument against protection from chronic inhalation of smoke.

Personally, I was never aware of what the medical field calls, “ultra fine particles,” until I studied smoke capture efficiencies of the “wand,” the ESU “pencil” and the miniSquair. The laboratory manager where these devices were tested informed me that he had studied both the percent efficiency of each but also the size of the smoke particles and found that 80% of them were nanoparticles. In my thirty years as a general surgeon with an interest in smoke removal, I had never heard of a nanoparticle except in industry. Since that time in 2011, I have educated myself in the relationship between chronic inhalation of organic smoke and the development of systemic disease. The primary source of my knowledge has been Buzea’a monograph on the topic (Buzea C, Blandino IIP and Robbie K. Nanomaterials and nanoparticles: Sources and toxicity. Biointerphases. 2007; 2:4: MR 17-MR 172.). The paper contains hundreds of references on this topic.

For those who are skeptical, you may ask, “Why bother?” After 10-15 years as a surgical team member, your health appears good and you feel fine. Well, coal miners said the same thing until 15-20 years after working underground resulted in hopelessly fibrosed lungs unable to get oxygen to their blood. John Grisham detailed this sequence in his latest novel, “Gray Mountain.”

More to the point, the short-term benefits of clean air include reduced absenteeism, increased productivity and reduced acute respiratory illnesses. The long-term sequelae of chronic inhalation have already been detailed. For the hospital administrators, the benefits of employee protection can be protean since such efforts can significantly lessen the financial liability of future health-related disability and even civil liability claims.

Is the relationship between chronic inhalation of nanoparticles and the later development of systemic diseases that different from chronic inhalation of asbestos and development of mesothelioma?