Diathermy and bone sawing are high aerosol yield procedures

Victoria A Hamilton; Sadiyah Sheikh; Alicja K Szczepanska; Nick A Maskell; Fergus W Hamilton; Jonathan P Reid; Bryan R Bzdek; James R D Murray

doi:10.1302/2046-3758.1210.BJR-2023-0028.R1

Diathermy and bone sawing are high aerosol yield procedures

Victoria A Hamilton, Sadiyah Sheikh, Alicja K Szczepanska, Nick A Maskell, Fergus W Hamilton, Jonathan P Reid, Bryan R Bzdek^*, James R D Murray^*

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

3 Citations (Scopus)

Abstract

Aims
Orthopaedic surgery uses many varied instruments with high-speed, high-impact, thermal energy and sometimes heavy instruments, all of which potentially result in aerosolization of contaminated blood, tissue, and bone, raising concerns for clinicians’ health. This study quantifies the aerosol exposure by measuring the number and size distribution of the particles reaching the lead surgeon during key orthopaedic operations.

Methods
The aerosol yield from 17 orthopaedic open surgeries (on the knee, hip, and shoulder) was recorded at the position of the lead surgeon using an Aerodynamic Particle Sizer (APS; 0.5 to 20 μm diameter particles) sampling at 1 s time resolution. Through timestamping, detected aerosol was attributed to specific procedures.

Results
Diathermy (electrocautery) and oscillating bone saw use had a high aerosol yield (> 100 particles detected per s) consistent with high exposure to aerosol in the respirable range (< 5 µm) for the lead surgeon. Pulsed lavage, reaming, osteotome use, and jig application/removal were medium aerosol yield (10 to 100 particles s-1). However, pulsed lavage aerosol was largely attributed to the saline jet, osteotome use was always brief, and jig application/removal had a large variability in the associated aerosol yield. Suctioning (with/without saline irrigation) had a low aerosol yield (< 10 particles s-1). Most surprisingly, other high-speed procedures, such as drilling and screwing, had low aerosol yields.

Conclusion
This work suggests that additional precautions should be recommended for diathermy and bone sawing, such as enhanced personal protective equipment or the use of suction devices to reduce exposure.

Cite this article: Bone Joint Res 2023;12(10):636–643.

Original language	English
Pages (from-to)	636-643
Number of pages	8
Journal	Bone and Joint Research
Volume	12
Issue number	10
DOIs	https://doi.org/10.1302/2046-3758.1210.BJR-2023-0028.R1
Publication status	Published - 10 Oct 2023

Bibliographical note

Funding Information:
The authors disclose receipt of the following financial or material support for the research, authorship, and/or publication of this article: funding from the National Institute for Health and Care Research (NIHR) for the AERosolisation And Transmission Of SARS-CoV-2 in Healthcare Settings (AERATOR) study (COV003, MC_PC_20017), and a grant to B. R. Bzdek from the Natural Environment Research Council (NE/P018459/1). We acknowledge the AERATOR group, which consists of (in alphabetical order): D. Arnold, J. Brown, B. R. Bzdek, T. Cook, A. Davidson, J. W. Dodd, M. Gormley, F. Gregson, F. Hamilton, V. Hamilton, N. Maskell, A. Morley, J. R. D. Murray, J. Keller, A. E. Pickering, J. P. Reid, S. Sheikh, A. Shrimpton, A. Szczepanska, and C. White. We also thank all the participants and the clinical staff at Southmead Hospital for their support with the AERATOR study.

Publisher Copyright:
© 2023 Author(s) et al. Open Access.

Research Groups and Themes

Academic Respiratory Unit
Physical & Theoretical

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Cite this

@article{79532ed958fe45ab8365d89a1423b680,

title = "Diathermy and bone sawing are high aerosol yield procedures",

abstract = "Aims Orthopaedic surgery uses many varied instruments with high-speed, high-impact, thermal energy and sometimes heavy instruments, all of which potentially result in aerosolization of contaminated blood, tissue, and bone, raising concerns for clinicians{\textquoteright} health. This study quantifies the aerosol exposure by measuring the number and size distribution of the particles reaching the lead surgeon during key orthopaedic operations. Methods The aerosol yield from 17 orthopaedic open surgeries (on the knee, hip, and shoulder) was recorded at the position of the lead surgeon using an Aerodynamic Particle Sizer (APS; 0.5 to 20 μm diameter particles) sampling at 1 s time resolution. Through timestamping, detected aerosol was attributed to specific procedures. Results Diathermy (electrocautery) and oscillating bone saw use had a high aerosol yield (> 100 particles detected per s) consistent with high exposure to aerosol in the respirable range (< 5 µm) for the lead surgeon. Pulsed lavage, reaming, osteotome use, and jig application/removal were medium aerosol yield (10 to 100 particles s-1). However, pulsed lavage aerosol was largely attributed to the saline jet, osteotome use was always brief, and jig application/removal had a large variability in the associated aerosol yield. Suctioning (with/without saline irrigation) had a low aerosol yield (< 10 particles s-1). Most surprisingly, other high-speed procedures, such as drilling and screwing, had low aerosol yields. Conclusion This work suggests that additional precautions should be recommended for diathermy and bone sawing, such as enhanced personal protective equipment or the use of suction devices to reduce exposure. Cite this article: Bone Joint Res 2023;12(10):636–643.",

author = "Hamilton, \{Victoria A\} and Sadiyah Sheikh and Szczepanska, \{Alicja K\} and Maskell, \{Nick A\} and Hamilton, \{Fergus W\} and Reid, \{Jonathan P\} and Bzdek, \{Bryan R\} and Murray, \{James R D\}",

note = "Funding Information: The authors disclose receipt of the following financial or material support for the research, authorship, and/or publication of this article: funding from the National Institute for Health and Care Research (NIHR) for the AERosolisation And Transmission Of SARS-CoV-2 in Healthcare Settings (AERATOR) study (COV003, MC\_PC\_20017), and a grant to B. R. Bzdek from the Natural Environment Research Council (NE/P018459/1). We acknowledge the AERATOR group, which consists of (in alphabetical order): D. Arnold, J. Brown, B. R. Bzdek, T. Cook, A. Davidson, J. W. Dodd, M. Gormley, F. Gregson, F. Hamilton, V. Hamilton, N. Maskell, A. Morley, J. R. D. Murray, J. Keller, A. E. Pickering, J. P. Reid, S. Sheikh, A. Shrimpton, A. Szczepanska, and C. White. We also thank all the participants and the clinical staff at Southmead Hospital for their support with the AERATOR study. Publisher Copyright: {\textcopyright} 2023 Author(s) et al. Open Access.",

year = "2023",

month = oct,

day = "10",

doi = "10.1302/2046-3758.1210.BJR-2023-0028.R1",

language = "English",

volume = "12",

pages = "636--643",

journal = "Bone and Joint Research",

issn = "2046-3758",

publisher = "British Editorial Society of Bone and Joint Surgery",

number = "10",

}

TY - JOUR

T1 - Diathermy and bone sawing are high aerosol yield procedures

AU - Hamilton, Victoria A

AU - Sheikh, Sadiyah

AU - Szczepanska, Alicja K

AU - Maskell, Nick A

AU - Hamilton, Fergus W

AU - Reid, Jonathan P

AU - Bzdek, Bryan R

AU - Murray, James R D

N1 - Funding Information: The authors disclose receipt of the following financial or material support for the research, authorship, and/or publication of this article: funding from the National Institute for Health and Care Research (NIHR) for the AERosolisation And Transmission Of SARS-CoV-2 in Healthcare Settings (AERATOR) study (COV003, MC_PC_20017), and a grant to B. R. Bzdek from the Natural Environment Research Council (NE/P018459/1). We acknowledge the AERATOR group, which consists of (in alphabetical order): D. Arnold, J. Brown, B. R. Bzdek, T. Cook, A. Davidson, J. W. Dodd, M. Gormley, F. Gregson, F. Hamilton, V. Hamilton, N. Maskell, A. Morley, J. R. D. Murray, J. Keller, A. E. Pickering, J. P. Reid, S. Sheikh, A. Shrimpton, A. Szczepanska, and C. White. We also thank all the participants and the clinical staff at Southmead Hospital for their support with the AERATOR study. Publisher Copyright: © 2023 Author(s) et al. Open Access.

PY - 2023/10/10

Y1 - 2023/10/10

N2 - Aims Orthopaedic surgery uses many varied instruments with high-speed, high-impact, thermal energy and sometimes heavy instruments, all of which potentially result in aerosolization of contaminated blood, tissue, and bone, raising concerns for clinicians’ health. This study quantifies the aerosol exposure by measuring the number and size distribution of the particles reaching the lead surgeon during key orthopaedic operations. Methods The aerosol yield from 17 orthopaedic open surgeries (on the knee, hip, and shoulder) was recorded at the position of the lead surgeon using an Aerodynamic Particle Sizer (APS; 0.5 to 20 μm diameter particles) sampling at 1 s time resolution. Through timestamping, detected aerosol was attributed to specific procedures. Results Diathermy (electrocautery) and oscillating bone saw use had a high aerosol yield (> 100 particles detected per s) consistent with high exposure to aerosol in the respirable range (< 5 µm) for the lead surgeon. Pulsed lavage, reaming, osteotome use, and jig application/removal were medium aerosol yield (10 to 100 particles s-1). However, pulsed lavage aerosol was largely attributed to the saline jet, osteotome use was always brief, and jig application/removal had a large variability in the associated aerosol yield. Suctioning (with/without saline irrigation) had a low aerosol yield (< 10 particles s-1). Most surprisingly, other high-speed procedures, such as drilling and screwing, had low aerosol yields. Conclusion This work suggests that additional precautions should be recommended for diathermy and bone sawing, such as enhanced personal protective equipment or the use of suction devices to reduce exposure. Cite this article: Bone Joint Res 2023;12(10):636–643.

AB - Aims Orthopaedic surgery uses many varied instruments with high-speed, high-impact, thermal energy and sometimes heavy instruments, all of which potentially result in aerosolization of contaminated blood, tissue, and bone, raising concerns for clinicians’ health. This study quantifies the aerosol exposure by measuring the number and size distribution of the particles reaching the lead surgeon during key orthopaedic operations. Methods The aerosol yield from 17 orthopaedic open surgeries (on the knee, hip, and shoulder) was recorded at the position of the lead surgeon using an Aerodynamic Particle Sizer (APS; 0.5 to 20 μm diameter particles) sampling at 1 s time resolution. Through timestamping, detected aerosol was attributed to specific procedures. Results Diathermy (electrocautery) and oscillating bone saw use had a high aerosol yield (> 100 particles detected per s) consistent with high exposure to aerosol in the respirable range (< 5 µm) for the lead surgeon. Pulsed lavage, reaming, osteotome use, and jig application/removal were medium aerosol yield (10 to 100 particles s-1). However, pulsed lavage aerosol was largely attributed to the saline jet, osteotome use was always brief, and jig application/removal had a large variability in the associated aerosol yield. Suctioning (with/without saline irrigation) had a low aerosol yield (< 10 particles s-1). Most surprisingly, other high-speed procedures, such as drilling and screwing, had low aerosol yields. Conclusion This work suggests that additional precautions should be recommended for diathermy and bone sawing, such as enhanced personal protective equipment or the use of suction devices to reduce exposure. Cite this article: Bone Joint Res 2023;12(10):636–643.

U2 - 10.1302/2046-3758.1210.BJR-2023-0028.R1

DO - 10.1302/2046-3758.1210.BJR-2023-0028.R1

M3 - Article (Academic Journal)

C2 - 37813391

SN - 2046-3758

VL - 12

SP - 636

EP - 643

JO - Bone and Joint Research

JF - Bone and Joint Research

IS - 10

ER -

Diathermy and bone sawing are high aerosol yield procedures

Abstract

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