When William T. Bovie introduced cauterization to surgery 90 years ago, he empowered surgeons to make precise cuts and to seal tissue and blood vessels to rapidly clear the surgical field. The ability to cauterize also spawned an insidious byproduct: surgical smoke.
Although it's easy to see and smell smoke, ridding the noxious, cancerous plumes from our ORs has proven difficult. For years, we accepted inhaling surgical smoke as simply "part of the job." But today, because we're aware of the many inherent risks, we understand the situation much differently. Awareness and understanding, however, are only part of the solution. Exposure to surgical smoke remains a daily occurrence for the men and women who make their living in the OR. To put the number into perspective, more than 500,000 healthcare workers are exposed to surgical smoke every year, according to an OSHA estimate. Depending on the source, a plume of surgical smoke could contain more than 150 toxic compounds (hydrogen cyanide, carbon monoxide, benzene and toluene, among many others), viruses (including HPV) and viable cancer cells, as well as other potentially harmful agents, such as bio-aerosols, bacteria and blood fragments.
Knowing is half the battle
Despite the risks and despite the fact that facilities have a legal responsibility to provide a safe environment for their employees not every OR is equipped with a smoke evacuator. According to a recent Outpatient Surgery Magazine reader poll, more than one-fourth (27%) of 229 surgical facility leaders don't use a smoke evacuation device in every case that's appropriate.
Some practitioners are either unaware of the hazards or simply discount the hazards. Other barriers to adoption include a practitioner's dislike for the noise smoke evacuators generate, the obtrusive nature of smoke-evacuation tubing and simply not having enough smoke evacuators to accommodate all ORs.
Once you understand the potential obstacles, you can then develop strategies to create smoke-free ORs. Likewise, education regarding the hazards of surgical smoke and adverse health effects of inhaling surgical smoke is key to building an action plan, because it's easier to make the case for smoke evacuation once the perioperative team knows the extent of the dangers.
Typically, healthcare providers place their patients' welfare above their own. This could be helpful in terms of adopting a policy for smoke evacuation. A suggestion: Focus on the benefits to the patient. These would include increased visibility during minimally invasive procedures, fewer delays during procedures to clear the air of surgical smoke, and less carbon monoxide absorption, resulting in less nausea and vomiting and shorter lengths of stay in the PACU.
You can then follow up with the benefits of a safer work environment the air being free of chemicals and particulates, thereby resulting in fewer health effects and fewer sick days for respiratory ailments. This, in turn, could reduce costs associated with having to make up for absent personnel.
How Surgical Smoke Sickens You
Surgical smoke is a gaseous byproduct of using energy-generating devices such as electrosurgical units (ESU) and lasers. Research from as far back as the 1980s has demonstrated the serious threat that surgical smoke poses.
The health effects of exposure include acute and chronic inflammatory respiratory changes (emphysema, asthma and chronic bronchitis, for example), anemia, anxiety, cardiovascular dysfunction, dermatitis, dizziness or lightheadedness brought on by hypoxia, eye irritation, headache, nasopharyngeal lesions, nausea or vomiting, sneezing, tearing, throat irritation and weakness. More serious effects include hepatitis, HIV and certain kinds of cancer, such as carcinoma and leukemia.
The size of the particles in surgical smoke directly influences the type of adverse effects to respiratory health that can be experienced by the perioperative team. For example, the smaller particles that penetrate to the deepest areas of the lung can obstruct gas exchange.
Vangie Dennis, BSN, RN, CNOR, CMLSO, has long understood the dangers of surgical smoke. It began early in her career, when she worked as a laser coordinator, and carried through her time as clinical manager of surgical services and certified laser safety officer for Gwinnett Hospital System in Duluth, Ga.
Today, as administrative director for The Emory Clinics in Atlanta, Ms. Dennis continues to keep the bull's-eye squarely on surgical smoke. In fact, under her direction, Emory was a beta site for AORN's Go Clear Award, launched in October to help ORs go "smoke free." The program's goals include:
- Increasing smoke-evacuation compliance on all procedures that generate surgical smoke.
- Ensuring the safety of all surgical patients by protecting them from the hazards of surgical smoke.
- Providing education for perioperative team members on the risks of surgical smoke and then teaching implementation methods for smoke evacuation.
- Helping facilities attract and retain the best clinicians due to a healthier, smoke-free environment.
"If administrative directors try to fly solo on smoke evacuation, they will face an uphill battle," says Ms. Dennis. "This needs to be approached from an interdisciplinary and administrative perspective. Go to the safety committee. They care about ergonomics. They care about sharps. Smoke evacuators are no different, because surgical smoke is an occupational hazard."
Ms. Dennis knows that creating a smoke-free environment begins with getting support from a facility's leadership circle. From there, you must create a formal action plan, educate (and re-educate) staff and continually monitor for compliance.
She uses the following story regarding the resistance you might encounter along the way: "We had one outlier, a surgeon who said, 'Prove [the harmful effects of surgical smoke] to me.' My response was, 'This is not an option; it's an administrative directive.' Everyone needs to understand that smoke evacuators are another form of protection, just like wearing a surgical mask, scrubbing your hands before surgery or properly disposing of sharps."
As Ms. Dennis can attest, making the decision to consistently evacuate surgical smoke will not only produce a healthier environment, but also act as a demonstrable commitment to the staff. Let me share this anecdote to explain: After a surgeon started evacuating smoke on his cases, the perioperative team began to ask to work with him over other surgeons. Why? Team members noticed they felt better at the end of the day, compared to when they worked in smoke-filled rooms.
Given the choice, an educated surgical team member will prefer to work in a smoke-free OR whether it's choosing one surgeon over another or one facility over another. A smoke-free mindset is not only the right thing to do, but it could also serve as a valuable recruitment and retention tool. OSM