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"Not all procedures need powerful suction, but all procedures that produce smoke need smoke capture"
AORN Going Clear Award Program!
A recognition program to ensure a surgical smoke free environment to protect the patient and healthcare providers. Components include:
Pretesting/Education- evaluates the current knowledge of surgical smoke, hazards of surgical smoke, and smoke evacuation equipment.
Gap Analysis/Compliance Monitoring- measures current percentages of surgical procedures where surgical smoke is evacuated, number of smoke evacuators, & current usage of smoke evacuation soft goods.
Particles 0.1 – 1.0 microns in diameter may enter lower lungs and alveolar ducts
Electrosurgical equipment generates particles approximately 0.07 mcm
Personal Protection
Health Effects
Best Practice
Long term effects of surgical plume include:
Health Effects
Chemically, surgical smoke contains over 80 toxic chemicals and by products. Here are a few.
1. Hydrogen cynanide- Pesticides
2. Toluene- Aerosol paint
3. Perchloroethylene-Insecticides
4. Benzene- Industrial solvents, and a trigger for leukemia.
5. Formaldehyde- Embalming fluid and preserver for specimens.
6. Ethylbenzene- Styrofoam
N95 Mask
Surgical Mask
"Just to clarify, does OSHA regard surgical smoke as a hazard and would the agency respond to a complaint by a healthcare worker on this?"
Answer: Yes, the agency does consider smoke from surgical procedures hazardous and would investigate if a worker filed a complaint.
"What are OSHA's regulations on worker exposure to surgical smoke, which NIOSH says can cause "both acute and chronic health effects ranging from eye, nose, and throat irritation to emphysema, asthma, or chronic bronchitis?"
Answer: OSHA does not have a specific standard that addresses hazards related to smoke from surgical procedures. However, there are other OSHA standards related to these hazards, including General Duty Clause, Personal Protective Equipment, Respiratory Protection, and Air Contaminants.
"Do you have any data on how often OSHA has inspected/cited healthcare employers on surgical smoke issues?"
Answer: We have not found any such inspections or citations.
Messages from Kay Ball, PhD, RN, CNOR, FAAN, an associate professor of nursing at Otterbein University in Westerville, OH.
"We need to get rid of this [smoke] so we are not breathing it in. We are in a confined area and we have ventilation and air currents in the room that are taking these small particles and delivering it to everybody in the room. I could be scrubbed in at the surgery table and you could be two yards away, but because of the ventilation in the room you are going to be exposed as much to the plume as I am."
"Surgical smoke has been shown to mutagenic, cytotoxic, and genotoxic."
"The surgeon may say, 'You don't have to evacuate surgical smoke during my procedure," Ball says. "Well, that's all well and good for one or two procedures those surgeons are exposed to this particulate smoke. But the surgical team members like the surgical nurses or the techs, anesthesia providers, are in there much more often and are exposed to a greater amount of surgical smoke than individual surgeons are. Surgeons should not have any say in making decisions that will affect the health of the staff who are working with them. It should come from the occupational health and safety committee at the hospital."
Case 2
28-year-old
gynecological operating room nurse, who assisted repeatedly in electrosurgical and laser surgical excisions of anogenital condolymas, and then developed recurrent laryngeal papillomatosis.
Case 1
44-year-old laser surgeon with laryngeal papillomatosis. DNA hybridization of tissue from the tumors revealed HPV DNA. History revealed that the surgeon had given laser therapy to patients with anogenital condylomas, which are known to harbor the same viral types."
Adverse Effects
Increase Awareness!
There is a need for regulation in the same way there is regulation for other potentially infectious material
On June 4, Rhode Island Governor Gina Raimondo signed into law legislation that will require hospitals and ambulatory surgery centers to adopt policies requiring elimination of surgical smoke by use of smoke evacuation systems in Rhode Island operating rooms.
It's Time to Evacuate. . .
the Smoke!!!
Electrosugical
Smoke Evacuation!
The ability to capture and remove plume away from the surgical team to an area in which it can be filtered.
Tube placed at varying distances from the tip of the electrode
Filters
Suction Wands
Suction Pumps
Captures: 51.4%
ESU Pencil
Using electrocautery on 1 gram of tissue = smoking 6 unfiltered cigarettes in 15 minutes!
Cell Foam
Flat suction device placed near incision site
Captures: 99.5%
No vision impairment potential
No risk for hand fatigue
A dismissive attitude toward the risks of smoke
inhalation is often the decisive factor in choosing
not to use smoke evacuation devices.
Concern that use will negatively affect the surgical result. . .
. . . smoke can influence wound contamination
Anxiety associated with any change to routines
Lack of knowledge about sources that recommend
the removal of surgical plume
Distraction caused by the noise generated by evacuators
Lack of enthusiasm for smoke removal on the
part of administrators or nursing personnel,
All of these factors can be overcome by education!
After educators and vendors
present educational material to surgeons and
other perioperative personnel, they often become
strong advocates of the use of smoke evacuation
Factors Influencing Smoke Capture
Dr. Ojo was recently witness trying out the smoke evacuator for the first time during one of her procedure. when asked about how she feels using this piece of equipment. " I love the fact that i don't percieve or have to breathe in the odor of something burning all through the entire procedure and most importantly i feel safer knowing that i am also protecting myself from preventable carcinogens over the years as a surgeon. we went ahead and asked her if she would most likely continue to use it in the future and if not what would the be reason. Dr Ojo stated that although the bovie was a little bulky than the regular one but she does believes that the benefits outweigh the inconvenience, she also mention cost as a deterrent as to why facilities may not be pushing for it. But in her conclusion she stated that she believes that more education is needed on the part of the surgeons as change is never an easy thing to implement, however with more education we may be in the right direction to having a smoke free Operating room. A.Seyi Ojo,MD________
distance of device from source
wand @ 1in = 99% capture
wand @ 3in= 53% capture
power of suction device, tube diameter, and amount of smoke produced
Other Indirect Influences. . .
personnel availability, incision length, and attitudes of the surgical team
Smoke Evacuation Suction Wand
Cuffed end covered by a latticed screen to prevent non-smoke items from entering.
Captures: 95%
There are multiple solutions to the problem!