Viral risk to dermatologists exposed to surgical smoke

SMOKE extractors should be made available in all settings where dermatology surgery takes place to mitigate the risk of viral transmission of infections such as Covid-19 and HPV.

This recommendation from The British Association of Dermatologists (BAD) comes amid growing concern that surgical smoke plumes can transmit viral infections such as HPV (human papillomavirus). The organisation is calling for further occupational health research into the risks of viruses being carried from patient to healthcare professionals through surgical smoke.

Surgical smoke is formed during procedures using lasers or cauterisation to destroy skin tissue, during which viral particles can be aerosolised and breathed in by healthcare professionals.

BAD points out that dermatologists are spending a larger proportion of their week in the operating theatre than ever before with an increased risk viral infection. Viral DNA has been observed on the face of surgeons following operations wherein surgical smoke was present.

The viruses thought to pose greatest concern include HPV, Merkel cell polyomavirus (MCPV) and COVID-19, although the risk is currently reduced with widespread use of PPE.

HPV infection has been shown to be a necessary component in the development of all cervical cancers, as well as a proportion of other genital cancers and is also a contributing element in head and neck squamous cell carcinomas (HNSCCs), especially oropharyngeal, tonsillar and laryngopharyngeal cancers.

BAD is calling for the use of appropriate PPE for all surgeries where surgical smoke is present, to prevent transmission of viral infections.

Professor Nick Levell of the British Association of Dermatologists commented: "In our hospitals, all kinds of precautions are taken to reduce the risks of cross infection. However, despite being aware of the potential risks for 30 years, surgeons are still breathing in smoke generated by human tissue, along with any viral particles present in the skin.

"Recent data reviews by the Centers of Disease Control and Prevention (CDC) and Health and Safety Executive (HSE) have found that the number of healthcare professionals known to have developed a HPV-associated disease is small, however, there are concerns that this is severely under-reported issue due to the fact that HPV can lie dormant in the body for decades. We are aware of reports of head and neck infections, including cancers, in specialists from ENT surgery, gynaecology, and dermatologists specialising in genital disease.

"More research must be done looking into this issue as an ever-increasing number of dermatologists find themselves in the operating theatre day-in-day-out. We are also urging hospitals to ensure that appropriate PPE and smoke extractors are available for use in all surgeries where surgical smoke may be generated."

Link: COVID-19: British Association of Dermatologists Position Statement on the Risk of Cancer from Viral Particles in Surgical Plume