Surgical smoke is a health hazard that can often be overlooked in surgical theatre. In Denmark, legislation has been in place since 2001 to ensure surgical smoke prompts removal at the point of surgery (not just from the operating room), so can legislation in the UK and elsewhere be far behind? And what can be done in terms of minimising potential harm to patients and healthcare staff?
To understand the extent of the problem, it is useful to define exactly what is meant by surgical smoke. The term normally encompasses all the gaseous byproducts produced during electrocautery, laser surgery or the use of ultrasonic scalpels. Surgical smoke can be called by a variety of names, including cautery smoke, diathermy plume, plume, smoke plume, aerosols, bioaerosols, vapour and air contaminants. It can be notable in that it can be seen and smelled.
To understand what is meant by surgical smoke is one thing; however, do we fully understand the concerns around substances contained within this smoke? How small are the particles and how far can the particles spread? What solutions provide adequate protection from inhaling the surgical smoke?
Surgical smoke is a comparatively recent problem, because the methods used to dissect tissue and stem blood flow during surgery have evolved as the associated technology has changed. As a result, perioperative professionals and patients are routinely exposed to surgical smoke, plumes and aerosols produced by instruments used to dissect tissue and provide haemostasis. Surgical devices that can produce surgical smoke as a byproduct include lasers, electrosurgical units, ultrasonic units, cautery units, and high-speed drills and burrs. In summary, anything that produces heat can produce smoke or aerosols, and smoke- and aerosol-generating procedures can in turn pose health risks.
Surgical smoke is now part of the patient-care environment wherever surgical and invasive procedures are undertaken. It has been described as part of the chemical soup that is present during the care of perioperative patients. Consequently, the air quality in operating rooms around the world has been a concern for over three decades. In one study examining surgical smoke generated during plastic surgery procedures, it was found that the smoke produced in one day was equivalent to 27 to 30 cigarettes.
So what is it about surgical smoke that causes such concern? For one thing, a surgical smoke plume may contain hair particles, viable cells, bacteria, viruses, prions and other deleterious matter. Numerous toxic and carcinogenic gases can also be given off. Inhalation of the smoke plume can therefore adversely affect patients, as well as medical staff in the immediate vicinity of the operation.
The smoke contains many potential risks, including infection of HIV (human immunodeficiency virus), hepatitis B and HPV (human papillomavirus). The smoke can also cause irritation to the lungs, leading to acute and chronic inflammatory changes. Cytotoxic, genotoxic and mutagenic effects have also been demonstrated.
A long list of chemicals present in surgical smoke have been identified. Two of the chemicals of concern were acrylonitrile and hydrogen cyanide. Acrylonitrile is a volatile, colourless chemical that can be absorbed through the skin and lungs. Acrylonitrile liberates hydrogen cyanide. Hydrogen cyanide is toxic, colourless and can be absorbed into the lungs, through the skin and via the gastrointestinal tract.
For healthcare professionals, chronic irritation caused by surgical smoke can lead to high rates of employee absence due to respiratory illness, regular headaches, nausea, mucous membrane irritations and skin irritations.
Given all this, and the risks posed to them as well as to the patients, healthcare staff involved in procedures resulting in smoke plumes should be educated on how the plumes are produced and how to reduce or eliminate exposure.
The use of standard surgical masks alone does not provide adequate protection from surgical smoke. While higher-quality filter masks and/or double masking may increase the filtration capability, a smoke evacuation device or filter placed near (2–5 cm) the electrocautery blade or on endoscope valves offers additional (and necessary) safety for operating personnel and patients. Pelican Feminine Healthcare can advise on as well as provide such devices.
Former AORN Journal Editor Brenda Gregory Dawes stated in 2000 that a stop smoke campaign begins with you: Use available tools and knowledge to minimize exposure to surgical smoke. Until there are regulations that reduce the occupational hazard of surgical smoke become an expert in what can be done.
Although the long-term effects for healthcare workers exposed to surgical smoke still remain unknown, it is evident that there needs to be proactive action taken to prevent any potential harm, regardless of the presence of external legislation. Engineering controls, revised procedures and personal protective equipment should be used to protect all staff and patients from exposure to smoke by-products. Understanding the environmental hazards related to surgical smoke and aerosols produced during all operative and invasive procedures is a critical first step in the implementation of adequate protective measures for both patients and perioperative personnel.
To find out more visit Single Use Surgical hall 16, stand 16F42.
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