Research Centre for Occupational and Social Medicine (FFAS), 79098 Freiburg, Germany.
Department of Occupational Medicine, Hazardous Substances and Health Sciences, German Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), 20357 Hamburg, Germany.
Int J Environ Res Public Health. 2020 Jan 14;17(2):515. doi: 10.3390/ijerph17020515.
(1) Background: Hazardous substances in surgical smoke that is generated during laser or electrosurgery pose a potential health hazard. In Germany, the Technical Rules for Hazardous Substances (TRGS 525) have included recommendations for appropriate protective measures since 2014. Up to now, no empirical data has been available on the extent to which recommendations have been implemented in practice. (2) Methods: In 2018, 7089 surgeons in hospitals and outpatient practices were invited by email to participate in an online survey. In addition, 219 technical assistants were interviewed. The questionnaire dealt with knowledge of, and attitudes toward, the hazard potential of surgical smoke, as well as the availability and actual use of protective measures. Furthermore, manufacturers and distributors of smoke extraction devices were asked to give their assessment of the development of prevention in recent years. (3) Results: The survey response rate was 5% (surgeons) and 65% (technical assistant staff). Half of all surgeons assumed that there were high health hazards of surgical smoke without taking protective measures. Operating room nurses were more often concerned (88%). Only a few felt properly informed about the topic. The TRGS recommendations had been read by a minority of the respondents. In total, 52% of hospital respondents and 65% of the respondents in outpatient facilities reported any type of special suction system to capture surgical smoke. One-fifth of respondents from hospitals reported that technical measures had improved since the introduction of the TRGS 525. Fifty-one percent of the surgeons in hospitals and 70% of the surgeons in outpatient facilities "mostly" or "always" paid attention to avoiding surgical smoke. The most important reason for non-compliance with recommendations was a lack of problem awareness or thoughtlessness. Twelve industrial interviewees who assessed the situation and the development of prevention in practice largely confirmed the prevention gaps observed; only slight developments were observed in recent years. (4) Conclusions: The low response rate among surgeons and the survey results both indicate a major lack of interest and knowledge. Among other measures, team interventions with advanced training are needed in the future.
(1) 背景：激光或电外科手术中产生的手术烟雾中的有害物质构成了潜在的健康危害。自 2014 年以来，德国有害物质技术规则（TRGS 525）包含了关于适当防护措施的建议。到目前为止，尚无关于建议在实践中实施程度的经验数据。(2) 方法：2018 年，通过电子邮件邀请医院和门诊的 7089 名外科医生参与在线调查。此外，还对 219 名技术助理进行了采访。问卷涉及对手术烟雾危害潜力的认识和态度，以及防护措施的可用性和实际使用情况。此外，还要求烟雾提取设备的制造商和分销商评估近年来预防措施的发展情况。(3) 结果：调查回复率为 5%（外科医生）和 65%（技术助理）。一半的外科医生认为在没有采取防护措施的情况下，手术烟雾存在高度健康危害。手术室护士更为关注（88%）。只有少数人认为自己对该主题有足够的了解。很少有受访者阅读过 TRGS 建议。总的来说，52%的住院医生和 65%的门诊医生报告说他们使用了特殊的抽吸系统来捕获手术烟雾。五分之一的住院医生报告说，自 TRGS 525 实施以来，技术措施有所改善。51%的住院医生和 70%的门诊医生“主要”或“总是”注意避免手术烟雾。不遵守建议的最重要原因是缺乏问题意识或轻率。12 名对实践中的情况和预防措施进行评估的工业受访者在很大程度上证实了观察到的预防差距；近年来仅观察到轻微的发展。(4) 结论：外科医生的低回复率和调查结果都表明他们的兴趣和知识严重不足。未来需要采取团队干预措施并进行高级培训。
