Secondhand smoke in the operating room? Precautionary practices lacking for surgical smoke

Abstract

Background Consensus organizations, government bodies, and healthcare organization guidelines recommend that surgical smoke be evacuated at the source by local exhaust ventilation (LEV) (i.e., smoke evacuators or wall suctions with inline filters). Methods Data are from NIOSH’s Health and Safety Practices Survey of Healthcare Workers module on precautionary practices for surgical smoke. Results Four thousand five hundred thirty-three survey respondents reported exposure to surgical smoke: 4,500 during electrosurgery; 1,392 during laser surgery procedures. Respondents were mainly nurses (56%) and anesthesiologists (21%). Only 14% of those exposed during electrosurgery reported LEV was always used during these procedures, while 47% reported use during laser surgery. Those reporting LEV was always used were also more likely to report training and employer standard procedures addressing the hazards of surgical smoke. Few respondents reported use of respiratory protection. Conclusions Study findings can be used to raise awareness of the marginal use of exposure controls and impediments for their use.

A Systems Approach to Assess Transport and Diffusion of Hazardous Airborne Particles in a Large Surgical Suite: Potential Impacts on Viral Airborne Transmission

“…Surgical smoke is 95% water or steam and 5% particle material and therefore surgical smoke can act as a carrier for tissue particles, viruses, and bacteria [3]. Today, the risk of surgical smoke has clearly been established [4][5][6][7][8][9][10]. One of the main difficulties is that surgical smoke carries Ultra Fine Particles (UFP) as small as 0.01 microns, which are able to bypass pulmonary filtration, and small particles up to several microns [9].…”

Electrosurgical Smoke: Ultrafine Particle Measurements and Work Environment Quality in Different Operating Theatres

“…Thus, surgical smoke is widely recognized as an issue of concern, and all the available control options, i.e., personal protective equipment (PPE), local smoke evacuators and general ventilation, are used separately or in combination; however, there is no OSHA standard for a specific laser and electrosurgery plume hazard [28]. …”

“…The measurements carried out focused on the area close to the surgical table where the activities and the exposure of medical staff and surgeons are concentrated during surgeries, as stated also by Steege [28]. …”

Guideline Implementation: Surgical Smoke Safety

“…4,[15][16][17] Although the harmful effects of surgical smoke have been known for years, the evidence suggests that perioperative team members often lack knowledge of these effects and do not comply with smoke evacuation guidelines. 9,10,18,19 In addition, researchers have found there is greater compliance with evacuating surgical smoke during laser procedures compared with electrosurgical procedures, even though the smoke generated by electrosurgery is more hazardous than smoke generated by lasers. 5,[18][19][20] AORN published the new "Guideline for surgical smoke safety" 1 in December 2016.…”

“…9,10,18,19 In addition, researchers have found there is greater compliance with evacuating surgical smoke during laser procedures compared with electrosurgical procedures, even though the smoke generated by electrosurgery is more hazardous than smoke generated by lasers. 5,[18][19][20] AORN published the new "Guideline for surgical smoke safety" 1 in December 2016. AORN guideline documents provide guidance based on an evaluation of the strength and quality of the available evidence for a specific subject.…”