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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.

Reference

  • Bovie Medical. (2018, February 19). Medical Resources. Retrieved from http://www.boviemedical.com/medical-resources/

References

  • Evans, G. (n.d.). NIOSH: Healthcare Workers Still Face Surgical Smoke Hazards. Retrieved from https://www.ahcmedia.com/articles/138062-niosh-healthcare-workers-still-face-surgical-smoke-hazards
  • OSHA: Surgical Smoke 'Hazardous,' but HCWs Must Report to Stir Action. (2016). Hospital Employee Health, 35(7), 77-78.
  • Schultz, L. (2014). An Analysis of Surgical Smoke Plume Components, Capture, and Evacuation. AORN Journal, 99(2), 289-298. doi:10.1016/j.aorn.2013.07.020
  • (2018) Buffalofilter.com
  • AORN (2018). RI Governor Signs Smoke Evacuation Legislation. Retrieved from https://www.aorn.org/Aorn-org/About-AORN/AORN-Newsroom/Health-Policy-News/2018-Health-Policy-News/RI-Governor-Signs-Smoke-Evacuation-Legislation
  • Conner, R., Spruce, L., & Burlingame, B. (2013). Perioperative standards and recommended practices (2013 ed.). Denver, CO: AORN.
  • Romano, F., Gustén, J., De Antonellis, S., & Joppolo, C. M. (2017). Electrosurgical Smoke: Ultrafine Particle Measurements and Work Environment Quality in Different Operating Theatres. International Journal of Environmental Research and Public Health, 14(2), 137. http://doi.org/10.3390/ijerph14020137
  • Eshleman, E. J., Leblanc, M., Rokoff, L. B., Xu, Y., Hu, R., Lee, K., . . . Hart, J. E. (2017). Occupational exposures and determinants of ultrafine particle concentrations during laser hair removal procedures. Environmental Health, 16(1), 22. doi:10.1186/s12940-017-0239-z
  • Benson, S. M., Novak, D. A., & Ogg, M. J. (2013). Proper use of surgical N95 respirators and surgical masks in the OR. Association of Operating Room Nurses. AORN Journal, 97(4), 457-67. doi:http://dx.doi.org.ezp.twu.edu/10.1016/j.aorn.2013.01.015

N95 Cons

Fit testing

  • effective seal required

Increased Cost

  • N95 vs surgical masks

Level of comfort

  • stiff, double bands

N95 Pros

Protection for the wearer

  • particulate filtration

Protection for the patient

  • petri dish study

Protection during emergent cases

  • high risk exposure

N95 Respirator

Offers protection from particles as small as 0.01 mcm

Properly fitted N95 respirators provide a tight seal to protect from smoke particles

Surgical Masks

Particle Size

Protect patient and environment from workers' saliva and mucous

Protect workers from sprays of body fluid and blood from patients

Surgical masks may offer no protection from particles less than 1 mcm in size and are loose fitting

Particles 0.1 – 1.0 microns in diameter may enter lower lungs and alveolar ducts

Electrosurgical equipment generates particles approximately 0.07 mcm

  • Tobacco smoke is 0.01 to 3 mcm

  • Viruses 0.02 to 0.3 mcm

  • Bacteria 0.5 to 10 mcm

Personal Protection

Health Effects

Best Practice

Long term effects of surgical plume include:

  • Cardiovascular Disease
  • Alzheimer's Disease
  • Parkinson's Disease
  • Collagen Disease; Autoimmune diseases, RA, lupus, scleroderma
  • Cancer
  • Choose wisely

  • Size matters

  • Keep it on till the fumes are gone

Health Effects

Risks:

  • Acute/ chronic pulmonary conditions; bronchitis, asthma
  • Acute headaches
  • Irritation and soreness of the eyes, nose and throat
  • Dermatitis
  • Colic
  • Bacterial/ viral contamination

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

Question Two

Question One

"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.

OSHA: Surgical Smoke 'Hazardous,' but HCWs Must Report to Stir Action. (2016). Hospital Employee Health, 35(7), 77-78.

What does OSHA have to say about surgical smoke?

OSHA: Surgical Smoke 'Hazardous,' but HCWs Must Report to Stir Action. (2016). Hospital Employee Health, 35(7), 77-78.

These are questions sent to OSHA by the Hospital Employee Health

Question Three

"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.

Lastly....

OSHA: Surgical Smoke 'Hazardous,' but HCWs Must Report to Stir Action. (2016). Hospital Employee Health, 35(7), 77-78.

"[Employee health professionals] need to raise awareness and provide education- they need to discuss this [hazard] at their safety committee meetings because this is not going to go away." says Kay Ball, PhD, RN, CNOR, FAAN.

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."

Evans G. NIOSH: Healthcare Workers Still Face Surgical Smoke Hazards. (2016). Hospital Employee Health, 35(7), 73-77.

NIOSH Warning Label:

"OSHA estimates that 500,000 healthcare workers are exposed to surgical smoke each year. Yet in the absence of routine inspections, the [duty] falls to healthcare workers to report facilities that have not adopted protection measures."

"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."

Evans G. NIOSH: Healthcare Workers Still Face Surgical Smoke Hazards. (2016). Hospital Employee Health, 35(7), 73-77.

Evans G. NIOSH: Healthcare Workers Still Face Surgical Smoke Hazards. (2016). Hospital Employee Health, 35(7), 73-77.

Cases of HPV Transmission

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."

Evans G. NIOSH: Healthcare Workers Still Face Surgical Smoke Hazards. (2016). Hospital Employee Health, 35(7), 73-77.

Evans G. NIOSH: Healthcare Workers Still Face Surgical Smoke Hazards. (2016). Hospital Employee Health, 35(7), 73-77.

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.

Testimony

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%

Pros of Surgical Smoke!?

There are multiple solutions to the problem!

What is Surgical Smoke?

  • Produced during procedures that utilize electrosurgical units (ESU), lasers, electrocautery and ultrasonic devices, bone saws and drills
  • Approximately 95% of all surgeries produce surgical smoke
  • Thermal destruction of tissue w/ temps reaching 100 degrees Celsius or higher
  • 95% water and 5% hazardous material
  • Contents include viruses, bacteria, cellular material,vapors
  • Exposure equal to 27-30 cigarettes

Surgical Smoke

Schinnell Haibon, Neha Haider, Ashley Jackson, Caroline Klingenberg, Sabina Mendoza,

Robbie Miller, Folu Olawepo, Kaley Thai

& Jesse Turner

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