Hygiene measures for HP viruses in the operating room

Infection with human papilloma viruses (HPV) can lead to genital warts. They can be removed by a variety of methods, but electrocoagulation has been increasingly used in recent years. This method produces surgical smoke, which can be harmful to the health of exposed surgical staff [1]. But does surgical smoke pose an additional risk for the spread of HP viruses? This article reviews the potential impact of surgical smoke on infection prevention.

Surgical smoke and risk of infection

The generation of surgical smoke by electrocautery and laser systems is based on the same mechanism. During the procedure (cutting, coagulating, vaporising or ablation of tissue), the target cells are heated to boiling point, rupturing membranes and releasing fine particles into the environment [2].

Surgical smoke generated during the removal of HPV-related lesions, such as genital warts, may contain HPV DNA. However, it is not known whether the smoke also contains viable HPV that can infect surgical staff [3].

In a study of the effects of smoke in the operating room, viral DNA was detected on the nasal mucosa of the surgeon [4]. However, there was no evidence of tissue changes in the surgeon's mucosa over a longer period of observation. In fact, there is only one reported case of occupationally acquired laryngeal papillomas, i.e. benign tumours in the area of the larynx. Calero and Brusis describe the case of a surgical nurse who was exposed to surgical smoke during the treatment of papillomatosis [5]. However, such cases are very rare, and an increased prevalence of HPV-related disease in surgical staff following exposure to surgical smoke has not been convincingly demonstrated [3].

Measures to protect against smoke in the operating room

Although the risk of infection from surgical smoke is very unlikely, it cannot be ruled out 100%. Irrespective of the risk of infection, the health risk from surgical smoke should not be underestimated, as smoke is a mixture of gaseous, vapour and particulate pollutants [6]. Appropriate precautions should be taken.

- First, it is advisable to use higher quality filter masks (N95) [3].

- A smoke evacuation system placed close (2-5 cm) to the electrocautery blade provides additional and necessary safety for the operating surgical staff and patients [6].

- It is also recommended to reduce the distance between the suction device and the surgical site, as the incidence of HPV detection in smoke is significantly increased if the suction device is too far away [4].

Preventing infections by disinfecting surfaces and hands

In addition to smoke protection, disinfection measures play an important role in staff and patient safety. Although a single viable virus on a surface is not sufficient to infect an epithelial site by hand transmission [7], there is a risk with a higher number of HP viruses. A virucidal hand rub should therefore be used.

Contamination of surfaces can occur from the clinician's gloved hands after examining the patient or from the patients themselves, for example when using common areas or shared toilets [7]. Disinfection of the patient environment and equipment with a fully virucidal disinfectant effective against HPV reduces the potential for contamination of environmental surfaces with HPV.

The clinic should also develop and train a standard operating procedure (SOP) that includes all the necessary safeguards to ensure a consistent standard of quality.

Sources: