面罩式呼吸器和外科口罩对手术烟雾的防护性能：模拟工作场所防护因数研究
Performance of Facepiece Respirators and Surgical Masks Against Surgical Smoke: Simulated Workplace Protection Factor Study.
作者信息
Gao Shuang, Koehler Richard H, Yermakov Michael, Grinshpun Sergey A
机构信息
1.Department of Environmental Health, Center for Health-Related Aerosol Studies, University of Cincinnati, PO Box 670056, Cincinnati, OH, USA;
2.Department of Surgery, Martha's Vineyard Hospital, 1 Hospital Rd, Oak Bluffs, MA 02557, USA.
出版信息
Ann Occup Hyg. 2016 Jun;60(5):608-18. doi: 10.1093/annhyg/mew006. Epub 2016 Feb 28.
OBJECTIVE
Surgical smoke generated during electrocautery contains toxins which may cause adverse health effects to operating room (OR) personnel. The objective of this study was to investigate the performance of surgical masks (SMs), which are routinely used in ORs, more efficient N95 surgical mask respirator (SMRs) and N100 filtering facepiece respirator (FFRs), against surgical smoke.
METHODS
Ten subjects were recruited to perform surgical dissections on animal tissue in a simulated OR chamber, using a standard electrocautery device, generating surgical smoke. Six respiratory protective devices (RPDs) were tested: two SMs, two SMRs, and two N100 FFRs [including a newly developed faceseal (FS) prototype]. Fit testing was conducted before the experiment. Each subject was then exposed to the surgical smoke while wearing an RPD under the tests. Concentrations inside (C in) and outside (C out) of the RPD were measured by a particle size spectrometer. The simulated workplace protection factor (SWPF) was determined by the ratio of C out and C in for each RPD-wearing subject.
RESULTS
For the SMs, the geometric means of SWPFtotal (based on the total aerosol concentration) were 1.49 and 1.76, indicating minimal protection. The SWPFtotal values of the SMRs and N100 FFRs were significantly higher than those of the SMs: for the two SMRs, the SWPFtotal were 208 and 263; for the two N100s, the SWPFtotal values were 1,089 and 2,199. No significant difference was observed between either the two SMs or the two SMRs. The SWPFtotal for the novel FS prototype N100 FFR was significantly higher than the conventional N100 FFR. The correlation between SWPFtotal and fit factor (FF) determined for two N95 SMRs was not significant.
CONCLUSIONS
SMs do not provide measurable protection against surgical smoke. SMRs offer considerably improved protection versus SMs, while the N100 FFRs showed significant improvement over the SMRs. The FS prototype offered a higher level of protection than the standard N100 FFR, due to a tighter seal. While we acknowledge that conventional N100 FFRs (equipped with exhalation valves) are not practical for human OR use, the results obtained with the FS prototype demonstrate the potential of the new FS technology for implementation on various types of respirators.
目的
电灼过程中产生的手术烟雾含有毒素，可能会对手术室（OR）工作人员的健康产生不利影响。本研究的目的是调查手术室常规使用的外科口罩（SM）、防护效果更好的N95型医用防护口罩（SMR）和N100型过滤式面罩呼吸器（FFR）对手术烟雾的防护性能。
方法
招募10名受试者，在模拟手术室环境中使用标准电灼设备对动物组织进行手术解剖，以产生手术烟雾。测试了六种呼吸防护装置（RPD）：两种SM、两种SMR和两种N100 FFR[包括一种新开发的面部密封（FS）原型]。实验前进行了适合性测试。然后让每位受试者在测试中佩戴RPD暴露于手术烟雾中。通过粒径光谱仪测量RPD内部（C in）和外部（C out）的浓度。通过每位佩戴RPD受试者的C out与C in之比确定模拟工作场所防护因数（SWPF）。
结果
对于SM，SWPFtotal（基于总气溶胶浓度）的几何平均值分别为1.49和1.76，表明防护作用极小。SMR和N100 FFR的SWPFtotal值显著高于SM：两种SMR的SWPFtotal分别为208和263；两种N100的SWPFtotal值分别为1089和2199。两种SM之间以及两种SMR之间均未观察到显著差异。新型FS原型N100 FFR的SWPFtotal显著高于传统N100 FFR。两种N95 SMR的SWPFtotal与适合因数（FF）之间的相关性不显著。
结论
SM对手术烟雾没有可测量的防护作用。SMR比SM提供了显著更好的防护，而N100 FFR比SMR有显著改进。由于密封更紧密，FS原型提供了比标准N100 FFR更高水平的防护。虽然我们承认传统的N100 FFR（配备呼气阀）在人类手术室使用中不实用，但FS原型获得的结果证明了新的FS技术在各种类型呼吸器上应用的潜力。
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