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Background. Inhalational exposures in the operating theatre, such as waste anaesthetic gases, surgical smoke, airborne particles,
microbiological contaminants and cleaning agents, may compromise lung function.
Objectives. To evaluate pulmonary function test (PFT) values of operating theatre sta who work in resource-constrained settings.
Methods. is comparative cross-sectional study included 184 participants (exposed and matched unexposed cohorts). Data were acquired
via a structured questionnaire, and the standard procedure was used to calculate each participant’s forced vital capacity (FVC), forced
expiratory volume in 1 second (FEV1), FEV1/FVC ratio and peak expiratory ow rate (PEFR). Mann-Whitney U-tests, Kruskal-Wallis tests,
Spearman analysis and multiple linear regression analysis were used to investigate the statistical relationships between variables. Ap-value
<0.05 was considered signicant.
Results. e study cohort comprised 38 surgeons, 28 anaesthetists, 14 scrub nurses and 12 assistants, with a median age of 34years.
emedian age for the matched unexposed cohort was 33years. e healthcare sta had signicantly lower FEV1, FVC and PEFR
values and FEV1/FVC ratios (p<0.05) than the unexposed cohort. ese values decreased signicantly as sta experience/exposure time
increased (p=0.001). Furthermore, the scrub nurses and assistants had signicantly lower PFT values than the other healthcare groups
(p=0.001).
Conclusion. e study showed that PFT values were considerably lower among operating theatre healthcare sta than in a matched
unexposed group, with measures decreasing as sta experience/duration of exposure rose.
Keywords. Pulmonary function tests, spirometry, values, occupational lung disease, waste anaesthetic gases.
Afr J Thoracic Crit Care Med 2025;31(2):e2639. https://doi.org/10.7196/AJTCCM.2025.v31i2.2639
e frequency of occupational diseases reects the quality of work
conditions and the general healthiness of the workplace environment.
Occupational lung diseases can cause signicant damage to the lungs,
leading to substantial respiratory insuciency and even mortality.[1,2]
Several factors inuence the development of occupational lung diseases,
such as the chemical nature and physical state of the substance inhaled,
the size and concentration of dust particles, the duration of exposure,
and individual vulnerability.[3] Although hypersensitivity pneumonitis,
occupational asthma and chronic obstructive pulmonary disease
are increasingly recognised as occupational lung diseases, historical
diseases such as silicosis and coal workers’ pneumoconiosis have also
been described.[3-5]
Waste management, noise, infection control, radiation safety,
general building safety, water quality, heating, ventilation and air
conditioning systems, and sewage treatment all have signicant
eects on complex hospital environments (which include patients,
staff, equipment, services and information).[6] Microbiological
contamination of hospital units and wards with amoebae cysts and
fungal species that can be inhaled increases the risk of patients
and healthcare personnel acquiring illnesses, particularly if they
Evaluation of spirometric lung function among healthcare
professionals working in operating theatres: A comparative
cross‑sectional study
J B Ibrahim,1 MBBS, MSc ; I A Ali,2 MBBS, MSc, MHPE, PhD ; M A Mohammed,2 MBBS, MSc, MHPE ;
I A Ahmed,2 MBBS, MSc ; O A Musa,2 MBBS, MSc, PhD
1 Department of Physiology, Faculty of Medicine, Karary University, Omdurman, Sudan
2 Department of Physiology, Faculty of Medicine, e National Ribat University, Khartoum, Sudan
Corresponding author: M A Mohammed (mwawssi0@gmail.com)
Study synopsis
What the study adds. Since occupational lung disease places signicant pressure on the healthcare system, this study evaluated the
spirometric lung function of healthcare sta who worked in an environment without proper respiratory safeguards.
Implications of the ndings. e hospital environment may trigger respiratory problems, particularly for healthcare sta who work in
operating theatres, restricting their economic productivity. It is therefore vital to establish, execute and maintain high-quality procedures
that guarantee workplace health and safety, especially in settings with limited resources.
AJTCCM VOL. 31 NO. 2 2025 61
ORIGINAL RESEARCH: ARTICLES
are immunocompromised.[7,8] Waste anaesthetic gases, including
nitrous oxide and halogenated anaesthetics (such as halothane,
enurane, isourane, desurane, sevourane and methoxyurane),
released from or leaked during medical procedures, may endanger
individuals who work in high-risk areas such as operating theatres,
delivery and labour rooms, recovery rooms, and remote anaesthetic
areas such as radiology or post-anaesthesia care units, as well as
those who work in dental practices, veterinary clinics and animal
research facilities.[9,10] Health concerns caused by exposure to such
waste anaesthetic gases include headache, irritability, exhaustion,
nausea, drowsiness, diculties with judgement and co-ordination,
liver and kidney diseases, miscarriages, genetic damage and cancer.
[11] Additionally, the air in the operating theatre environment may
contain airborne particles such as skin cells, dust, lint carried on
clothing, or respiratory droplets (mostly produced by the presence
of medical sta) that may carry germs that are harmful to both
patients and working personnel.[11] Furthermore, surgical smoke,
which is dened as a by-product of electrosurgical devices as a result
of thermal interactions with so tissues that disrupt intracellular
and extracellular components at 100°C through direct or indirect
heat or shock wave exposure, poses a potential danger to respiratory
health.[12] Finally, cleaning agents for disinfecting medical equipment
(e.g. ortho-phthalaldehyde and enzymatic cleansers) and patient
care procedures (e.g. disinfection before operations and of open
wounds), and sprays used for xed-surface cleaning, are substantial
occupational risk factors for airway illness among healthcare sta.[13]
Similarly, an increased risk of asthma has been documented among
healthcare personnel who frequently use cleaning and disinfection
agents for their work compared with those who do not.[14] All
these health implications are potentially more widespread among
personnel in operating theatres and recovery facilities with no or
inadequate ventilation or scavenging systems than among those
whose workplaces are better equipped.
Pulmonary function tests (PFTs) enable doctors to assess respiratory
system function in a variety of clinical settings, including those
involving risk factors for pulmonary illness, occupational exposure
and pulmonary toxicity.[15] PFTs do not provide a specic diagnosis; to
aid in diagnosis, the results should be paired with a pertinent history,
findings on physical examination, and laboratory data. PFTs also
enable clinicians to dene the severity of pulmonary disease, track its
progression over time, and evaluate its response to treatment.[16] Readers
interested in knowing more about PFT indications, contraindications,
precautions and procedures are referred to Stanojevic etal.[17] and Ranu
etal.[18]
Many studies have been undertaken at national and international
levels to investigate the eects of various occupational exposures on
lung function.[19-21] However, research on the eects of work in the
operating theatre setting on respiratory system health is limited.
is study therefore aimed to evaluate spirometric measurements of
operating theatre sta working in resource-constrained settings.
Methods
Study design, duration and setting
is cross-sectional hospital-based studywas carried out from October
to December 2022 at Ibn-Sina Teaching Hospital and National Ribat
University Hospital in Khartoum, Sudan. Ibn Sina Teaching Hospital
is a government tertiary referral hospital with specialist medical
and surgical services such as gastroenterology and gastrointestinal
haemorrhage centres, urology, otolaryngology, nephrology, and
a kidney transplant facility. e hospital has twooperating theatre
complexes, each with three operating theatres. National Ribat
University Hospital is a government hospital that provides medical
and surgical care. It has four operating theatre complexes, each with
six operating theatres.
Study population and eligibility criteria
e operating theatre personnel studied were surgeons, anaesthetists,
scrub nurses and assistants (porters and cleaners). All were Sudanese
adults aged ≥18years who had worked in an operating theatre for
≥3 hours per day, ≥3 days perweek, for at least 1year. Smokers (past
or present), pregnant women, individuals on chronic therapy for
any disease, those with known cardiopulmonary disease or other
chronic diseases (diabetes, hypertension, renal diseases, etc.), and
those with any contraindication to lung function tests (e.g. a history
of eye, chest or abdominal surgery, haemoptysis, or pneumothorax,
emboli or aneurysms; or current respiratory infection) were excluded.
Additionally, a comparison group of Sudanese adults matched for age,
sex and height comprised postgraduate university students and arts
faculty sta who had no prior exposure to respiratory risks.
Survey size determination
e operating theatres at the two hospitals employed ~300 healthcare
personnel, of whom about half were excluded because of a history of
smoking (n=110), being a new employee (n=31) or having a history
of chronic illness (n=11). e remaining 148 healthcare workers were
eligible to participate in the study.
Data collection tool and procedure
A structured questionnaire was used to collect sociodemographic,
anthropometric and respiratory health data. All the participants
underwent a general physical examination. Height (m) and weight
(kg) were measured, and the body mass index (BMI) was calculated
(weight (kg) divided by height (m²)). PFTs were done using an
electronic digital spirometer (pocket microspirometer D-97204
(VIASYS Healthcare GmbH, Germany)), followinga standardised
and updated American Thoracic Society/European Respiratory
Society (ATS/ERS) recommendation.[17] e study participants were
rst informed about the principles and processes of the tests. e
spirometerwas calibrated and tested before the real test, and all the
measurements were recorded in the operating theatre during early-
morning working hours (08h00-10h00). e subjects were told to
inhale maximally and rapidly to total lung capacity with a pause of ≤2
seconds and then exhale forcibly into the spirometer mouthpiece with
maximal eort until no more air could be exhaled while remaining
upright. e forced expiratory volume in 1 second (FEV1), forced vital
capacity (FVC), FEV1/FVC ratio and peak expiratory ow rate (PEFR)
were measured. ree readings were taken from each individual,
with an appropriate rest in between, to conrm the accuracy and
reproducibility of the results, and the best of the three readings was
chosen. To reduce inter-investigator variability, only one investigator
(JBI) did the PFTs. According to the ATS/ERS grading of quality of
the PFT session, 140 participants achieved grade A, representing the
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highest quality (≥3 acceptable manoeuvres with 0.150 L dierences
between the two highest FVC and FEV1 values), 30 achieved grade B
(2 acceptable manoeuvres with 0.150 L dierences between the two
highest FVC and FEV1 values), and 14 achieved grade C (≥2 acceptable
manoeuvres with 0.200 L dierences between the two highest FVC
and FEV1 values). e PFT data for the exposed participants were
compared with those of the matched unexposed cohort on the basis
of age, sex and height.
Statistical analysis
The data were analysed with SPSS version 25 (IBM, USA). The
distribution of the data was assessed with Kolmogorov-Smirnov and
Shapiro-Wilk tests. Continuous variables were reported as medians
and ranges, whereas categorical data were presented as frequencies
and percentages. When comparing the results between the healthcare
workers and the matched unexposed cohort, the Mann-Whitney U-test
and the Kruskal-Wallis test were employed. Furthermore, correlation
(Spearman) analysis and multiple linear regression analysis were used
to investigate the relationships between independent factors and PFT
results. A p-value <0.05 was considered signicant.
Ethical considerations
All procedures involving human participants in this study followed
ethical standards established and approved by the research committee
of the Faculty of Medicine at The National Ribat University in
Khartoum, as well as the 1964 Declaration of Helsinki and subsequent
amendments or comparable ethical standards. Aer a clear and basic
description of the research technique and study objectives, each
participant provided signed informed consent. e participants were
assured that the information obtained would be keptcondential and
used only for research purposes.
Results
e study included 184 participants (92 of the eligible 148 healthcare
workers, giving a response rate of 62%, and 92 in the matched
unexposed cohort). The median age of the healthcare staff was
34years, with a range of 26-74years, and that of the unexposed
group 33years, with a range of 26-74years. e healthcare workers
had a median BMI of 25.7 kg/m² (range 20.1-31.6 kg/m²), whereas
the unexposed group had a median BMI of 26.8 kg/m² (range
20.34-32.2 kg/m²). e healthcare workers comprised 38 surgeons,
28 anaesthetists, 14scrub nurses and 12 assistants (Table1). All
healthcare sta reported that they could smell anaesthetic gases
in the operating theatres. e healthcare workers had signicantly
lower FEV1, FVC and PEFR values and FEV1/FVC ratios than the
unexposed group (Table2).
Assistants and scrub nurses had lower PFT values than the other
healthcare categories, and lower values than their matched groups
(Table3). is signicant relationship was demonstrated in simple
regression analysis (Table4).
Compared with those of the matched unexposed groups, the PFT
values of healthcare workers signicantly decreased as their duration
of experience/exposure increased (Table5).
e duration of experience/exposure of healthcare personnel was
strongly correlated with and can be a predictor of decreasedPFT
values (Table6).
Discussion
Our study assessed spirometry measurements among healthcare
personnel working in operating theatres and compared the results
with those of a matched unexposed cohort. Spirometry results were
signicantly lower among healthcare sta than in the matched cohort.
Furthermore, values decreased significantly as staff experience/
exposure time increased.
Occupational lung illnesses continue to contribute signicantly
to the respiratory disease burden worldwide, as they can cause
respiratory problems and limit economic productivity in young and
healthy populations.[22] In Sudan, occupational lung diseases place
signicant stress on the healthcare system, as many industries, such
as lumber, oil, cotton and sugar, have been linked to disturbances in
lung function.[19,23]
Our ndings demonstrated decreased spirometric values among
operating theatre sta. As we practise in a resource-limited setting,
potential inhalational exposures such as waste anaesthetic gases,
surgical smoke, airborne particles, microbiological contamination
and cleaning agents that aect lung function and result in such
ndings are not unexpected. e waste anaesthetic concentrations
of isourane and sevourane in unscavenged operating theatres have
been reported to exceed permissible limits and have been linked to
negative health outcomes.[24] Additionally, young doctors exposed
to high quantities of waste anaesthetic gases in operating theatres
with poor scavenging systems have been found to have genetic and
inammatory problems.[25] Early screening for and diagnosis of
occupational lung illness are therefore critical in safeguarding health
status and tness forwork of operating theatre personnel.
Compared with other exposed sta, scrub nurses and assistants
in the present study had lower PFT values. A study at a Brazilian
university hospital that used an infrared gas analyser to detect
isoflurane contamination in the operating theatre revealed that
the areas of the operating theatre where specic healthcare sta
are postioned are critical because the degree of gas accumulation
varies, with the majority of accumulation occurring in the breathing
corners of anaesthetists and surgeons.[26] Although such an analyser
is not available in our country, our study participants indicated that
they could smell the escaped anaesthetic gases. However, it is worth
mentioning that the odour threshold of a substance is not always
indicative of its hazardous potential. Moreover, the low PFT values
in our study participants (especially scrub nurses and assistants) may
be due to the eects of cleaning agents (such as sodium hypochlorite,
ethanol, hydrogen peroxide, chloroxylenol, chlorhexidine gluconate
and formaldehyde) used for disinfection and sterilisation in
our study setting. Mwanga etal.,[13] whose study included both
Tanzanian and South African healthcare professionals, reported
such eects, nding that cleaning agents for disinfecting medical
equipment (such as ortho-phthalaldehyde and enzymatic cleansers),
patient care procedures (disinfection before operations and of open
wounds), and sprays used for xed-surface cleaning were potential
risk factors for airway illness among participants. Similarly, the
relationship between cleaning agents in healthcare settings and the
development of occupational asthma is widely recognised.[14] e
response to the question ‘Does the operating theatre environment
pose a potential riskto the spirometric lung function of staff
members?’ is therefore highly dependent on the individual theatre
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setting and the roles of the healthcare sta working there. Finally,
biological exposures (such as bio-aerosols or airborne particles and
dust or surgical smoke, passive tobacco smoke, and vapours) may
also be responsible for the low PFT values in the healthcare sta in
our study, as they pose a potential risk to the respiratory system,
are considered important vehicles of microbiological contamination
at workplaces, and are assumed to interact with other occupational
agents.[27] They can potentially cause occupational respiratory
disorders such as airway inammation, rhinitis, toxic pneumonitis,
hypersensitivity pneumonitis and asthma in exposed workers and
are considered job hazards for healthcare providers, especially
when combined with other occupational agents.[28] While our study
Table1. Characteristics of the exposed and unexposed study participants
Variable Healthcare sta (n=92), n (%)* Matched unexposed group (n=92), n (%)*
Age (years), median (range) 34 (26-74) 33 (26-74)
Sex
Male 64 (69.6) 60 (65.2)
Female 28 (30.4) 32 (34.8)
BMI (kg/m²), median (range) 25.7 (20.1-31.6) 26.8 (20.3-32.2)
Job title
Surgeon 38 (41.3) Postgraduate students and arts faculty sta
Anaesthetist 28 (30.4)
Scrub nurse 14 (15.3)
Assistant 12 (13.0)
BMI = body mass index.
*Except where otherwise indicated.
Table2. Dierences in pulmonary function values between the exposed and unexposed study participants
Parameter Healthcare sta (n=92), median (range) Matched unexposed group (n=92), median (range) p‑value
FEV1 (L) 2.78 (0.43-3.97) 3.14 (2.17-3.88) 0.001*
FVC (L) 3.02 (0.52-6.18) 3.45 (2.21-4.0) 0.001*
FEV1/FVC (%) 91.91 (50-100) 91.01 (76-100) 0.012*
PEFR (L/min) 327.5 (115-506) 483.5 (137-570) 0.001*
FEV1 = forced expiratory volume in 1 second; FVC = forced vital capacity; PEFR = peak expiratory ow rate.
*Signicant (p<0.05) according to the Mann-Whitney U-test.
Table3. Dierences in pulmonary function test values across dierent healthcare professions and compared with matched
unexposed groups
Parameter
Surgeons (n=38),
median (range)
Anaesthetists (n=28),
median (range)
Nurses (n=14),
median (range)
Assistants (n=12),
median (range) p‑value
FEV1 (L) 3.21 (2.04-3.74) 3.05 (2.05-3 .97) 2.26 (0.79-3.51) 2.22 (0.43-2.94) 0.001*
FVC (L) 3.43 (2.32-4.02) 3.28 (2.32-6.18) 2.6 (0.94-3.12) 2.63 (0.52-3.84) 0.001*
FEV1/FVC (%) 93 (68-100) 92 (50-100) 86 (81-93) 84.5 (61-100) 0.001*
PEFR (L/min) 410 (163-500) 348 (192-507) 309 (115-360) 277 (153-325) 0.001*
Surgeons (n=38),
mean (SD)
Matched group,
mean (SD) p‑value
Anaesthetists
(n=28), mean (SD)
Matched group,
mean (SD) p‑value
FEV1 (L) 3.0 (0.51) 3.22 (0.37) <0.001†2.94 (0.49) 3.11 (0.32) <0.001†
FVC (L) 3.26 (0.48) 3.48 (0.44) <0.001†3.29 (0.73) 3.37 (0.33) 0.018†
FEV1/FVC (%) 92.02 (8.48) 91.34 (1.61) 0.559 89.36 (9.83) 91.82 (1.46) 0.388
PEFR (L/min) 388.42 (81.06) 488.87 (55.94) <0.001†368 (82.57) 454.89 (64.98) <0.001†
Nurses (n=14),
mean (SD)
Matched group,
mean (SD) p‑value
Assistants (n=12),
mean (SD)
Matched group,
mean (SD) p‑value
FEV1 (L) 2.2 (0.6) 2.53 (0.12) 0.017†2.03 (0.76) 2.91 (0.51) 0.002†
FVC (L) 2.45 (0.52) 2.84 (0.34) 0.001†2.46 (0.91) 3.07 (0.44) 0.042†
FEV1/FVC (%) 89.79 (3.83) 91.43 (3.03) 0.002†82.52 (10.65) 89.92 (4.75) 0.024†
PEFR (L/min) 277.43 (81.9) 380.14 (57.04) <0.001†257.25 (67.02) 372.75 (98.26) 0.004†
FEV1 = forced expiratory volume in 1 second; FVC = forced vital capacity; PEFR = peak expiratory ow rate; SD = standard deviation.
*Signicant (p<0.05) according to the Kruskal-Wallis test.
†Signicant (p<0.05) according to the Mann-Whitney U-test.
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settings have explicit theatre and infection control policies and
we maintained a low threshold for exclusion criteria, it may not
be possible to control for such biological hazards and identify the
magnitude of all potential risks.
Although the duration of experience/exposure was a signicant
predictor of poor PFT results among participants, such exposures
cannot be prevented; rather, they should be managed and reduced
to the lowest practicable level. Healthcare facilities must establish,
implement, monitor, advocate and oversee practices aimed at
eliminating hazardous work environments.[29] is is the rst study
in Sudan to explore how the operating theatre environment aects
Table4. Simple regression between pulmonary function test
parameters and job title
Parameter Coecient p‑value 95% CI
FEV1 (L) –0.495 <0.001* –0.247
FVC (L) –0.445 <0.001* –0.466 -–0.19
FEV1/FVC (%) –0.235 0.024* –0.037
PEFR (L/min) –0.441 <0.001* –35.78
CI = condence interval; FEV1 = forced expiratory volume in 1 second;
FVC = forced vital capacity; PEFR = peak expiratory ow rate.
*Signicant (p<0.05).
Table5. Eects of duration of experience/exposure on participants’ pulmonary function test values
Exposure duration (years)
(participants, n)
FEV1 (L),
median (range)
FVC (L),
median (range)
FEV1/FVC (%),
median (range)
PEFR (L/min),
median (range)
1-5 (50) 3.2 (2.05-3.97) 3.43 (2.32-6.18) 93 (50-100) 379 (192-506)
6-10 (10) 3.06 (2.32-3.59) 3.35 (2.6-3.96) 91.5 (76-93) 337.5 (163-500)
11-15 (7) 2.36 (2.12-2.86) 2.61 (2.41-3.12) 90 (80-82) 285 (170-310)
>15 (25) 2.19 (0.43-3.3) 2.6 (0.52-3.58) 84 (61-100) 310 (115-410)
p-value 0.001* 0.001* 0.001* 0.001*
Exposure duration (years)
(participants, n)†Parameter
Exposed (n=92),
mean (SD)
Matched group
(n=92), mean (SD) p‑value
1-5 (50) FEV1 (L) 3.04 (0.49) 3.19 (0.33) <0.001‡
FVC (L) 3.32 (0.65) 3.47 (0.38) <0.001‡
FEV1/FVC (%) 91.56 (7.9) 91.93 (0.15) 0.574
PEFR (L/min) 384.18 (74.66) 477.2 (57.47) <0.001‡
6-10 (10) FEV1 (L) 3.0 (0.46) 3.18 (0.41) 0.36
FVC (L) 3.29 (0.47) 3.47 (0.44) 0.005‡
FEV1/FVC (%) 91.18 (5.28) 91.64 (1.94) 0.311
PEFR (L/min) 371.9 (109.77) 462.4 (78.51) 0.007‡
11-15 (7) FEV1 (L) 2.38 (0.24) 2.63 (0.37) 0.075
FVC (L) 2.69 (0.24) 2.87 (3.8) 0.063
FEV1/FVC (%) 88.4 (4.1) 91.63 (2.08) 0.072
PEFR (L/min) 269.29 (49.15) 358.23 (48.11) 0.018‡
>15 (25) FEV1 (L) 2.12 (0.69) 2.8 (0.41) <0.001‡
FVC (L) 2.56 (0.76) 3.09 (0.41) 0.002‡
FEV1/FVC (%) 82.81 (10.47) 90.61 (3.78) <0.001‡
PEFR (L/min) 289.04 (93.17) 404.96 (90.74) <0.001‡
FEV1 = forced expiratory volume in 1 second; FVC = forced vital capacity; PEFR = peak expiratory ow rate; SD = standard deviation.
*Signicant (p<0.05) according to the Kruskal-Wallis test.
†Years of education and employment in the matched unexposed group were adjusted to match theyears of experience/exposurein the exposed group.
‡Signicant (p<0.05) according to the Mann-Whitney U-test.
Table6. Correlations and regressions between duration of experience/exposure and pulmonary function test results
Parameter
Correlation Regression
ρ coecient p‑value Coecient p‑value 95% CI Adjusted R2
FEV1 (L) –0.560 <0.001* –0.248 <0.000†–0.355-–140 0.371
FVC (L) –0.437 <0.001* –0.235 0.001†–0.027-0.005 0.211
FEV1/FVC (%) –0.498 <0.001* –0.001 0.160 –0.027-0.005 0.226
PEFR (L/min) –0.438 <0.001* –29.768 0.001†–46.685-–12.851 0.204
CI = condence interval; FEV1 = forced expiratory volume in 1 second; FVC = forced vital capacity; PEFR = peak expiratory ow rate.
*Signicant (p<0.05) according to Spearman’s correlation.
†Signicant (p<0.05). e regression models were also adjusted for age and body mass index; however, duration of experience/exposure was the only signicant variable.
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the PFT values of healthcare workers. Furthermore, the inclusion
of a matched unexposed group helped to control for confounding
factors and improved the conclusions reached through this study
design. However, our study has several limitations. First, we did not
measure anaesthetic gas concentrations. Second, because the study
was conducted at only two hospitals, a larger study is needed. ird,
the recall and response biases inherent in such surveys restrict causal
inferences. Fourth, we followed restricted exclusion criteria, which
could result in selection bias. Fih, owing to the cross-sectional design,
participants were not followed up. Sixth, while we made every eort
to ensure good consistency across the exposed and matched cohorts,
full control for ethnicity may not have been be feasible. Seventh, PFT
manoeuvres for 44 participants were acceptable at grading levels B and
C, but their results were useful based on the clinical judgement of the
primary data collector, who had an overarching goal to achieve the
maximum possible testing quality for all study participants.
Conclusion
Compared with the matched unexposed group, healthcare workers
had signicantly poorer FEV1, FVC and PEFR values and FEV1/FVC
ratios. Quality practices to maintain workplace safety in operating
theatres must be developed, implemented and sustained.
Data availability. e datasets generated and analysed during the present
study are available from the corresponding author (MAM) on reasonable
request. Any restrictions or additional information regarding data access
can be discussed with the corresponding author.
Declaration. e research for this study was done in partial fullment of
the requirements for JBI’s MSc degree at e National Ribat University.
Acknowledgements. Special thanks to all the personnel who agreed to
participate in the study. Additionally, the authors would like to thank the
AJTCCM team for giving a full publication cost waiver for this article.
Author contributions. JBI: obtained study approval, contributed to
the study design, data collection and analysis, and wrote the rst dra.
IAAl: contributed to the study design, data collection, analysis and
interpretation, draed and edited the manuscript, and supervised the
research. MAM: contributed to the study design, data collection, analysis
and interpretation, and wrote the nal dra. IAAI: contributed to the
study design, data collection, analysis and interpretation, and wrote the
final draft. OAM: reviewed the scientific content, drafted and edited
the manuscript, and co-supervised the research. All authors read and
approved the nal manuscript.
Funding.None.
Conicts of interest.None.
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Submitted 14 September 2024. Accepted 14 March 2025. Published 2 June 2025.
