Access Now: AORN COVID-19 Clinical Support

Smoke and COVID-19 FAQs

  • Is the COVID-19 virus in surgical smoke?

    Answer: At this time with a lack of research studies, AORN does not know if the virus that causes COVID-19 (SARS-CoV-2) can be transmitted through surgical smoke. Research studies have demonstrated the presence of viruses (eg, human papilloma virus) in surgical smoke with transmission to health care providers. According to limited data from the CDC, SARS-CoV-2 RNA has been detected in blood specimens, but it is unknown whether the virus is viable or infectious in extrapulmonary specimens. For similar coronaviruses, viable and infectious SARS-CoV was isolated from blood specimens, although infectious MERS-CoV was only isolated from the respiratory tract.

    AORN recommends the evacuation of all surgical smoke as it contains hazardous chemicals, ultra-fine particle, viruses, bacteria, and cancer cells. During higher-risk, aerosol generating procedures or procedures with known or suspected aerosol transmissible diseases (eg, tuberculosis), the perioperative team should wear a fit-tested surgical N95 filtering face piece respirator in addition to using a smoke evacuator. Wearing respiratory protection (ie, fit-tested surgical N95 filtering face piece respirator) is secondary protection against residual surgical smoke.

    Consult with your infection preventionist on measures (eg, smoke evacuation, fit-tested surgical N95) to take when performing surgery on a patient with known or suspected COVID-19.

    Resources:

  • How do I dispose of a used smoke evacuator filter after use on a COVID-19 patient?

    Answer: As surgical smoke contains potentially infectious material such viruses, bacteria, blood, and cancer cells, OSHA and the AORN Guideline for Surgical Smoke Safety requires that the used filters, tubing, electrosurgical pencils with evacuation tubing, be handled using standard precautions and disposed of as biohazardous waste.

  • Are there any additional measures that should be taken during laparoscopic cases?

    Answer: Society of American Gastroenterologists and Endoscopic Surgeons (SAGES) has detailed recommendations for reducing the risk of aerosolization during laparoscopy. See SAGES resource document. https://www.sages.org/resources-smoke-gas-evacuation-during-open-laparoscopic-endoscopic-procedures/

  • Do the filters in the smoke evacuator need to be changed after use on a diagnosed COVID-19 patient?

    Answer:  Check with your local product representative and/or the manufacturer of your smoke evacuation devices for their specific instructions for use. Your manufacturers are your best resource for this information. Several manufacturers are sending letters to their customers and providing guidance and resources on their websites regarding COVID-19. If you have not received the information, contact your local product representative and the manufacturer.

    Resource:  

    • AORN Guideline for Surgical Smoke Safety. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.
  • Can you provide a list of aerosol-generating procedures (AGPs)?

    Answer:  The CDC has identified specific aerosol-generating procedures that are linked to the potential for transmission from respiratory droplets. (Table 1) There is a known risk for potential transmission from smaller aerosolized respiratory droplets that may occur during aerosol-generating procedures. When performing these procedures CDC recommends that health care providers in the room wear respiratory protection such as N95s.

    AORN has identified procedures that may occur during surgery that can aerosolize blood and body fluids. According to limited data from the CDC, COVID-19 has been detected in blood specimens, and it is unknown whether the virus is viable or infectious in extrapulmonary specimens, meaning specimens that come from outside the lungs. The risk for transmission from aerosolized blood and body fluid remains unknown currently. Out of an abundance of caution, AORN recommends taking precautions including respiratory protection, to prevent transmission when aerosolized blood and body fluids that may be present. Bronchoscopy, tracheostomy, and thoracic cases may have a higher risk for airborne transmission of COVID-19 because the nature of the procedures involve the respiratory tract, which could lead to aerosolization of the virus. There have been some reports that COVID-19 is present in stool and may be transmissible through the fecal-oral route.

    Table 1. Aerosols

    Organization

    CDC

    AORN

    Procedures

    Aerosol-Generating Procedures (AGPs)

    Surgical Procedures that may Generate Aerosols

    Types of Particulates

    Respiratory Droplet Aerosolization

    Blood and Body Fluid Aerosolization

    Risk for Transmission

    Potential Risk for Transmission

    Unknown Risk for Transmission

    Recommended PPE

    Respiratory Protection (eg, N95, PAPR)

    Respiratory Protection (eg, N95, PAPR)

    Identified Procedures

    Intubation

    Extubation

    Suctioning of airways

    Bronchoscopy

    Endoscopy procedures

    Laparoscopy procedures

    Tracheostomy procedures

    Thoracic procedures

    Electrocautery of blood or Gastrointestinal tissue

    Use of high-speed powered equipment (eg, saws, drills)

    Use of intraoperative debridement devices with irrigation (eg, hydrosurgery, pulsatile lavage, low-frequency ultrasonic debridement)


    Resources:

  • Does AORN have educational resources regarding the hazards of surgical smoke?

    Answer: AORN has several existing educational programs on surgical smoke available to our members.


    Resource:

    • AORN Guideline for Surgical Smoke. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.
  • What is the difference between an N95 and a Surgical N95?

    Answer:  An N95 respirator is a particulate filtering facepiece respirator that has been approved by the National Institute for Occupational Safety and Health (NIOSH), a US Federal agency responsible for conducting research and making recommendations for the prevention of work-related disease and injury, and cleared for use by the FDA in a medical setting.  A surgical N95 respirator is a NIOSH-approved N95 respirator that has also been cleared by the FDA as a surgical mask (surgical masks provide barrier protection against droplets including large respiratory particles).   

    Resources:  

     

  • If a smoke evacuator is recommended to contain surgical smoke, should a smoke evacuator be used during intubation and extubation holding the tubing close to the patient’s mouth?

    Answer: There is no literature or research to support using smoke evacuators in this manner. Also, the smoke evacuators have not be tested and approved by the FDA for this type of application. Please check with your manufacturer of your smoke evacuator for further direction.

    Resource:

    • AORN Guideline for Surgical Smoke Safety. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.