Work Environment in the Operating Room during Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy : Factors Influencing Choice of Protective Equipment

Sammanfattning: Peritoneal carcinomatosis (PC) is a common metastatic manifestation of both gastrointestinal and gynecological malignancies. Curative modes of treatment are cytoreductive surgery (CRS) combined with intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC). Surgeons and operating room (OR) staff attending these procedures are exposed to chemotherapy and electrocautery smoke. Heated chemotherapy (HIPEC) may vaporize and become inhaled by those administering it and, moreover, large quantities of electrocautery smoke may also be inhaled by surgeons and OR staff, with unknown adverse health effects. The general aim of this thesis was to investigate the work environment during major abdominal surgery and HIPEC, and to map the factors influencing the behavior of OR nurses and surgeons when choosing protective equipment against electrocautery smoke. To determine the presence of platinum, a total of 36 blood and 36 urine samples were collected from one surgeon and one perfusionist during six oxaliplatin-based HIPEC treatments (Paper I). Regarding electrocautery smoke, amounts of ultrafine particles (UFPs) in the smoke from 14 CRS procedures and 11 colorectal cancer (CRC) procedures were collected and compared (Paper II). Additionally, polycyclic aromatic hydrocarbons (PAHs) were identified and quantified in electrocautery smoke during 40 CRS procedures (Paper III). Lastly, seven OR nurses and seven surgeons were interviewed individually to explore what factors influenced their behavior when choosing protective equipment against electrocautery smoke. The transcribed texts were analyzed with qualitative content analysis (Paper IV). All blood and urine samples were below the detection limit (Paper I). The amount of UFPs produced during CRS procedures was significantly higher than from CRC procedures (Paper II), and PAHs never exceeded Swedish occupational exposure limits (OELs) (Paper III). OR nurses and surgeons had a knowledge of electrocautery smoke and were aware of risks. However, external factors governed the use of protective equipment against electrocautery smoke (Paper IV). HIPEC with oxaliplatin seems to present no risk for treatment givers. However, the possible risks from exposure of cumulative amounts of UFPs and PAHs are still unknown. OR nurses’ and surgeons’ knowledge about the possible risks of electrocautery smoke, and the use of protective equipment, are therefore important.