Taking a stand on surgical smoke
By Carina Stanton, MA
Senior News Editor/Writer
AORN recognizes the hazards surgical smoke and bio-aerosols pose to patients and perioperative professionals. That's why the association has taken its strongest stand yet to recognize these hazards and recommend risk reduction strategies in the new Position Statement on Surgical Smoke and Bio-aerosols, which was passed in April at AORN's 55th Congress in Anaheim, Calif.
"This position statement represents AORN's commitment to raise awareness about the need to evacuate all surgical smoke to provide a safe workplace environment," said Kay Ball, RN, BSN, MSA, CNOR, FAAN, a nurse educator/consultant with K&D Medical, Inc. in Lewis Center, Ohio and chair of AORN's Surgical Smoke Task Force.
Surgical smoke and bio-aerosols are routinely produced during operative and invasive procedures by surgical instruments, including lasers, electrosurgical units, radiofrequency devices, ultrasonic devices and power tools. The plume and bio-aerosols created by the use of these devices contain airborne contaminants that can cause respiratory, ocular, and dermatological and other health-related risks, including mutagenic and carcinogenic potential to patients and operating room personnel, as noted in the position statement.
"It is unthinkable for someone to smoke a cigarette in a healthcare facility, yet healthcare professionals are continually exposed to surgical smoke in operating rooms, endoscopy suites, clinics and other healthcare environments," Ball stressed. She is a strong advocate for awareness and action to prevent hazardous exposure to surgical smoke and bio-aerosols.
Watch a video interview with Kay Ball to learn more about the dangers of surgical smoke.
Understanding the hazards
More than 500,000 healthcare workers are exposed to surgical smoke each year, according to estimates from the Occupational Safety and Health Administration (OSHA).
With this high number of healthcare personnel exposed to surgical smoke, Ball stressed the critical areas of concern she has about related health risks, including the toxic gases, vapors and viruses found in surgical smoke plume and bio-aerosols.
"77% of what is in surgical smoke is 1.1 microns in size and smaller, so it can go right through a surgical mask and be deposited in your own alveoli of your own lungs," she noted.
She is also concerned about what happens to patients exposed to surgical smoke during laparoscopy. "When patients are exposed to surgical smoke during laparoscopy, they absorb the by-products of combustion and all of a sudden it increases their methemoglobin and carboxyhemoglobin, which decreases the oxygen-carrying capabilities of their red blood cells so they sometimes present with headaches and nausea in the PACU."
Transparent solutions
To protect patients and healthcare personnel from hazardous exposure to surgical smoke, AORN recommends a range of strategies for risk reduction, including local exhaust ventilation through central smoke evacuation systems, portable smoke evacuation units, wall suction with inline filter and laparoscopic evacuation/filtration systems.
Despite the widespread accessibility to these smoke evacuation tools, many healthcare facilities are not evacuating surgical smoke, according to findings from a study conducted last year by researchers at Duke University Medical Center who surveyed AORN members about the use of smoke evacuation.
The study findings indicate that many facilities are not implementing the well-established best practices for protecting patients and health care workers from surgical smoke hazards, especially during the use of electrosurgery devices. The survey also showed that, of the 623 people who participated in the survey, those who specified the obstacles to compliance with established surgical smoke control practices at their facility most commonly reported surgeons' resistance or refusal to allow use of smoke evacuation systems (Read the study findings in the April 2008 AORN Journal).
A lack of support from surgeons is a common reason that facilities are not evacuating smoke, explained Vangie Dennis, RN, CNOR, CMLSO, clinical manager procedural nursing at Gwinnett Medical Center-Duluth in Duluth, Ga. who works with Ball on AORN's Surgical Smoke Task Force.
Dennis says the key to overcoming this obstacle is doing your research on the hazards of surgical smoke and setting systems in place that make the evacuation of surgical smoke transparent to the physician.
"A common response from our surgeons is, 'I don't care if we evacuate smoke, just make sure it's quiet and doesn't interrupt my surgery'," she said. "Today there are smoke evacuation systems and disposables that, with proper hook-up, can assist in making the evacuation of surgical smoke so it doesn't interrupt the rhythm and culture of surgery. We owe it to ourselves, our colleagues and our patients to learn about these technologies, as well as the personal protective equipment that has been proven to protect against surgical smoke," Dennis stressed.
Dennis, Ball and other members of AORN's surgical smoke work group are currently developing a Surgical Smoke Tool Kit to help obtain 100% compliance with surgical smoke evacuation.
Find AORN's recommended strategies for reducing exposure to surgical smoke in AORN's Position Statement on Surgical Smoke and Bio-aerosols.Read the April 2008 issue of AORN Journal to learn more about surgical smoke and find a continuing education article on the subject.
Read more perioperative news from AORN Connections.