WORKPLACE HAZARD Breathing the smoke from 1 gram of cauterized tissue is comparable to smoking 6 unfiltered cigarettes in 15 minutes.

About 20 years ago I left full-time hospital nursing for a perioperative education position, but continued on as an OR per diem. One time I'd been away from the OR for a couple of months when I worked a day of cases that used a lot of electrosurgery. At the end of the day, walking to my car, I thought I was coming down with the flu. I had a sore throat, my nose was burning, my chest felt tight. This discomfort passed in a day or so, but a month later — ?after another day's work in the OR — I felt it again. That's when I connected surgical smoke with the symptoms I was suffering, and when I began to get involved in surgical smoke awareness programs.

It's not difficult to find healthcare workers who are surprised to learn about the hazards of surgical smoke. You see a lot of young people working in ORs, after all, and they may not have been exposed to the education, or the long-term effects, that long-term employees have. And if you've been breathing in surgical smoke for a long enough time, you might not realize the cumulative toll that the unpleasant scent you've learned to endure has taken on your respiratory health.

But it's unimaginable that any healthcare worker who's been told what we know about surgical smoke wouldn't be concerned about its hazards. Besides the charred-flesh odor, we're also facing toxic gases, some of them carcinogenic. Inhaling the smoke from 1 gram of burned tissue has been equated to smoking 6 unfiltered cigarettes in 15 minutes. The smoke has the potential to carry and transmit infectious bacteria and viral DNA. This particulate matter ends up in our throats and lungs, and can also impact our patients' outcomes when they absorb laparoscopic plume.

Surgical smoke is clearly a critical workplace safety issue. Protecting your employees and your patients from its risks depends on your facility's ability to correct the misunderstandings and overcome the barriers standing between hazardous clinical practices and better occupational health.

Clearing the air
First and foremost, it is utterly essential to equip every OR in which surgical energies are used and plume is generated with smoke evacuation technology. That's not all. You also have to make sure that your physicians and staff actually operate the devices in every case in which surgical energies are used and plume is generated, and do so correctly.

Surgical smoke evacuation technology is your first line of defense and, to a large extent, your only option for capturing and filtering the contaminants in plume. Standard-issue surgical masks, which are able to filter particles as small as 5 microns, won't stop the 77% of smoke that's less than 1.1 microns in size from reaching your alveoli. While N95 respirators and other high-filtration masks have been proven more effective, these more expensive, individually fit-tested barriers don't block all of smoke's hazardous matter, and won't protect the patient the way that evacuation and filtration does.

Don't make the mistake of thinking that regular room suction will evacuate surgical smoke. Without a high-powered filter, it's just moving it around and re-releasing it into the air. Keep in mind that if you can smell the smoke — even outside of the OR — you're getting the bad effects of it. All smoke evacuators are fitted with ultra-low penetration air (ULPA) filters, which capture 99.999% of airborne particles, and a charcoal filter to adsorb or bind toxic gases and odors.

Make sure that while you're evaluating and choosing an effective, easy to use, ergonomically accessible and quiet smoke evacuation solution, you're also rounding up a smoke safety team representing all surgical personnel, from physician champions in each specialty to the 'smoke police' among your nurses and techs, who are committed to clearing the air. The best machine on the market is useless if a lack of buy-in cripples compliance.

SUCTION ACTION Equip every OR in which smoke is generated with evacuation technology, and make sure it gets used.

Countering complacence
The successful implementation of smoke evacuation efforts in your ORs requires everyone on board, but sometimes surgeons resist changes in clinical practices or adaptations to their techniques. They might even downplay the hazards of plume. While it presents the same risks to them as it does to nurses and techs, the amount of time they spend in the OR in a day or a week may put them at shorter-term exposure to the byproducts of surgical energies in comparison to full-time OR personnel, and as a result it may limit their experience with its effects.

As everyone knows, physicians are data-driven. So be sure to search the medical literature for the latest findings on the contents and dangers of smoke before making a case to justify the purchase and use of evacuation technology to them. There's always new information out there, and the evidence base is continually growing.

An awareness of smoke's impact on occupational health is also instrumental in helping physicians understand the need for safer practices, but here we encounter a challenge. While there's no shortage of anecdotal evidence from nurses in the field — ?people who've left jobs, require asthma medications or other situations due to prolonged exposure to smoke — we don't have research confirming a cause-and-effect relationship. We inhale smoke, we suffer respiratory ailments, but spread out over time it's difficult to establish a connection, as we have with cigarette smoking. Without a randomized control study, there's no scientific certainty.

On the day-to-day level, perhaps the biggest obstacle to consistent compliance with a smoke evacuation protocol is the front line staff not speaking up when they should be. Even if they know the hazards that smoke poses, they may tolerate the unpleasantness because they feel powerless against the surgeon who is running the room. But they need to be able to say, 'I don't want to breathe the smoke. It may not bother you, but we're at risk here.' Give your employees the power to put protection into practice. OSM