Mitigating the risks of surgical smoke: positive pressure rooms and particulate air filters

Abstract

We thank Dr Brady for his response 1 to our article on surgical plume in dermatology, 2 and note his interest in investigating the difference between positive room air pressure compared with a normal pressure room. 1 In a positive air pressure room, the room is sealed and the air pressure in the room is greater than that outside, potentially pushing infectious particles such as those found in the surgical plume away from the patient and operator. 3 In our paper, we discussed the use of high-efficiency particulate air (HEPA) and ultra-low particulate air (ULPA) filters. 2 A HEPA filter can filter particles ≥ 0.3 lm in size, and ULPA filters can filter 99.99% of particles ≥ 0.12 lm. 4 In our research, we found that particles < 5 lm have the capacity to reach the terminal bronchioles. 2 The combination of a positive pressure room with HEPA and ULPA filters could have the potential to reduce the infectious and malignant capabilities of the surgical plume by facilitating both mechanical filtering as well as suction. 2 This warrants further investigation to improve safety outcomes for both patients and clinicians. In the absence of positive pressure rooms (as is the case for many dermatologists), such particulate air filters, measures to reduce the generation of surgical smoke, and provision of appropriate personal protective equipment for patients and staff should mitigate the risk posed by surgical smoke.