As the byproduct of life saving lasers, electrosurgical processes, radiofrequency devices, hyfrecators, ultrasonic scalpels and other power tools, wisps of surgical smoke hanging in the air represent hope and healing for patients.
For OR staff surgical smoke is an aerosol of bacteria, viruses, carcinogenic and mutagenic cells, ocular irritations, and respiratory hazards.
In this article, we will explore:
- Damaging Effects of Surgical Smoke
- Benefits of Surgical Smoke Evacuation
- Current Surgical Smoke Evacuation Laws
Damaging Effects of Surgical Smoke
It is ironic that the tools used to save lives produce toxic byproducts. In addition to the vaporized blood, tissue, and live or dead cellular material, plumes of surgical smoke contain biochemical hazards and contaminants on par with second-hand smoke. Like constantly being subjected to second-hand smoke, repeated exposure to surgical smoke can cause health issues for surgeons, surgical staff, and even the patient.
According to the Association of periOperative Registered Nurses (AORN) “the average daily impact of surgical smoke on an OR team is equivalent to inhaling the smoke of 27-30 unfiltered cigarettes”1. And that is just the beginning.
In addition to hazardous chemicals, studies have shown that surgical smoke may contain 1.1-micron particles of infectious agents like E. coli, MRSA, HPV, hepatitis viruses, HIV, and SARS-CoV-2 (and variants). These nanoparticles can comprise 80% of surgical smoke. At less than 100 nanometers, these particles can enter the alveoli when inhaled. From there they can move to the blood and lymphatic circulatory systems and on to organs.
Rounding out the damaging effects of surgical smoke, nurses and doctors attribute eye irritation that can hinder the surgeon’s vision, sore throat, nausea, drowsiness, dizziness, sneezing, rhinitis, and unpleasant odors absorbed into the hair to surgical plumes wafting in the air around the operating table.
N95 masks and exhaust ventilation in the OR offer the team some protection but it is not enough.
Benefits of Surgical Smoke Evacuation
The National Institute for Occupational Safety and Health (NIOSH) recommends using smoke evacuation devices in addition to ventilation and masks. Smoke evacuators filter and collect smoke at the surgical site, preventing it from reaching the airspace around the OR staff.
While protecting surgical teams constantly exposed to surgical smoke from the lengthy list of damaging effects is the primary benefit of surgical smoke evacuation, there are several other advantages associated with the evacuation devices.
Patient Safety
Smoke evacuators prevent potentially harmful particles from becoming airborne and inhaled by the patient.
Improved Visibility
Large plumes of surgical smoke can obstruct the surgeon’s field of view. Smoke evacuators capturing the smoke at the incision help maintain a clear field of view. An unobstructed view of the surgical site helps assure the precision required for positive outcomes.
Contamination Control
Within the surgical environment there are any number of objects and instruments that can be contaminated by particles in the air settling on the surfaces. Smoke evacuation helps extend the service life of surgical equipment by minimizing smoke residue buildup and corrosion from these particles.
Improved Air Quality in the OR
It is a fact surgical smoke can have an unpleasant odor. Preventing the smoke from mixing with the air in the OR can produce a more agreeable environment for the surgical team.
Compliance with Regulation
The first law governing surgical smoke evacuation was passed in 2018, twenty years after legislation was first introduced to allow OSHA to mandate smoke evacuation. Since then, states have, one-by-one, begun to enact legislation mandating the use of smoke evacuation systems in operating rooms during every smoke producing procedure.
Current Surgical Smoke Evacuation Laws
OSHA issued an alert about the health hazards of surgical smoke as far back as 1988. However, it was not until the early 2000s that regulatory bodies made formal statements.
On December 15, 2020, The Joint Commission (TJC) released “Quick Safety Issue 56: Alleviating the Dangers of Surgical Smoke”. In this statement TJC highlighted the dangers of surgical smoke and discussed current recommendations and regulations by OSHA, NIOSH, ANSI, AORN, and ECRI.
Quick Safety 56 emphasizes that the cost of correcting the hazard should never be an issue when the health and safety of healthcare professionals is in jeopardy.
Surgical smoke evacuation is also addressed in TJC’s Environment of Care chapter in the accreditation manual for hospitals, critical access hospitals, ambulatory care, and office-based procedures. This standard, EC 02.02.01 EP9 states that organizations
“Minimize risks associated with selecting, handling, storing, transporting, using, and disposing of hazardous gases and vapors”2.
Also included is National Fire Protection Association standard 99-2012:9.3.8;9.3.9 which says,
“hazardous gases and vapors include, but are not limited to, ethylene oxide and nitrous oxide gases; vapors generated by glutaraldehyde; cauterizing equipment, such as lasers; waste anesthetic gas disposal (WAGD); and laboratory rooftop exhaust.”2
In 2018 Rhode Island was the first state to enact legislation to prevent exposure to surgical smoke in hospitals and ambulatory surgery centers. As of 2022 fourteen states have enacted smoke evacuation laws with. Bills are pending in another seven states.3
Conclusion
It has taken time, but surgical smoke is a recognized hazard to surgical teams. Laws are being enacted across the country to mandate the use of smoke evacuation tools in ORs. Advances in surgical smoke removal technology are making it easier for hospitals and ASCs to move forward and implement these valuable devices either voluntarily or in response to regulation.
The medical equipment experts at CME Corp. have established relationships with leading smoke evacuator manufacturers. We can source quality devices, deliver them when it is convenient for you, and help keep you on budget.
We are the only medical equipment distributor to offer a comprehensive suite of services to make your job easier.
A single, dedicated point of contact will manage your order from the moment the purchase order is received. They will communicate with the manufacturer on your behalf, track the order through delivery to our warehouse, ensure clear lines of communication related to delivery between your staff and the CME Direct-to-Site team, and when needed, act as the liaison between CME DTS teams, CME Biomedical Equipment Technicians and your facility teams to assure the new equipment is ready for immediate use.
Click CHAT to talk with a CME expert about your smoke evacuation needs.
1. https://www.steris.com/healthcare/knowledge-center/surgical-equipment/surgical-smoke-evacuation-in-operating-room
2. https://www.ormanager.com/joint-commissions-safety-alert-supports-removal-surgical-smoke/
3. https://www.aorn.org/outpatient-surgery/article/september-27--2023
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