There seems to be three stances on surgical smoke – it is a made-up issue created by suppliers to sell equipment; it is a real issue affecting the health of surgical team members and patients; and there is not enough data one way or the other to create a clear opinion on the issue.
In an effort to clear up some of the smoke surrounding the surgical plume issue, the International Council on Surgical Plume (ICSP) formed last year to compile educational resources. “One of the things that ICSP wants to do is to be a centralized location where people can go to find whatever they might be looking for on the topic of smoke evacuation,” Brenda Ulmer, RN, MN, CNOR, perioperative educator and ICSP member, said. “I think there is good information on the dangers of surgical smoke. One of the biggest challenges is to overcome practice standards grandfathered in from the early days of electrosurgery use. One of the misconceptions was that surgical smoke was sterile due to the high heat generated at the tip of the active electrosurgery electrode. Another challenge is, just like cigarette smoke, it can take years to see the cumulative effects of breathing surgical smoke.”
The ICSP is made up of veteran surgeons, nurses and industry experts, but it is not the only group talking about this issue. The Association of periOperative Registered Nurses (AORN) updated its stance against surgical smoke in 2013. “The data is available,” Mary J. Ogg, MSN, RN, CNOR, Perioperative Nursing Specialist at AORN and communications chair of the ICSP, said. “The challenge is that the data is in multiple literature sources in multiple disciplines, such as surgery, minimally invasive surgery, laser, dermatology, nursing, and industrial hygiene.” The updated guidelines state plume is a health risk and should be evacuated with the proper devices. It also says staff should wear respirators as a secondary precaution to protect against potential health effects, including: respiratory changes, hypoxia or dizziness, nose and throat irritation, carcinoma, leukemia, cardiovascular dysfunction and hepatitis.
Ogg added another issue was some of the studies were older, ranging from the 1980s to present. “(That said), there has been a lot of information published in the past five years, many in scientific journals that begin to quantify the hazards of surgical plume,” said Sherri Robinson Lloyd, product marketing manager at Buffalo Filter. “A quick search in the Cumulative Index of Nursing and Allied Health Literature (CINAHL) will yield many current studies and articles.”
In addition to referencing studies, team members can learn more through programs, like AORN’s Management of Surgical Smoke ToolKit, which discusses surgical smoke procedure templates and explores educational materials. This is available for CE credit.
Other government documentation and legislation can also offer insight. For instance, the Canadian Standards Association (CSA) published a set of standards on smoke evacuation, outlining the potential hazards of electrosurgical smoke.
As Robinson said, there have been many studies and articles published in the past five years on surgical plume. This list, compiled with help from AORN, Buffalo Filter and Nascent Surgical, includes some of those.
- Recommended practices for electrosurgery. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc;2013:125-141.
- Recommended practices for laser safety in the perioperative practice settings. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc;2013:143-156.
- Recommended practices for minimally invasive surgery. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc;2013::157-184.
- Recommended practices for prevention of transmissible infections in the perioperative practice setting. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc;2013::331-363.
- Edwards BE, Reiman RE. Comparison of current and past surgical smoke control practices. AORN J. 2012;95(3):337-350.
- Lester JD, Hsu S, Ahmad CS. Occupational hazards facing orthopedic surgeons. Am J Orthop (Belle Mead NJ). 2012;41(3):132-139.
- Hill DS, O’Neill JK, Powell RJ, Oliver DW. Surgical smoke—a health hazard in the operating theatre: a study to quantify exposure and a survey of the use of smoke extractor systems in UK plastic surgery units. J Plast Reconstr Aesthet Surg. 2012; 65(7):911-916.
- Marsh S. The smoke factor: things you should know. J Perioper Pract. 2012;22(3):91-94.
- Näslund Andréasson S, Mahteme H, Sahlberg B, Anundi H. Polycyclic aromatic hydrocarbons in electrocautery smoke during peritonectomy procedures. J Environ Public Health.2012;2012:929053. Epub May 22, 2012. doi:10.1155/2012/929053.
- American National Standards Institute. Standard 7.4. In: ANSI Z136.3—Safe Use of Lasers in Healthcare. Washington, DC: ANSI; 2011.
- ECRI Institute. Laser use and safety. Healthc Risk Control. 2011;4(Surgery and Anesthesia):17.
- Lewin JM, Brauer JA, Ostad A. Surgical smoke and the dermatologist. J Am Acad Dermatol. 2011;65(3):636-641.
- Occupational Safety and Health Standards. 29 CFR 1910.134. Personal protective equipment: respiratory protection. June 8, 2011. Occupational Safety & Health Administration.
- Pierce JS, Lacey SE, Lippert JF, Lopez R, Franke JE. Laser-generated air contaminants from medical laser applications: a state-of-the-science review of exposure characterization, health effects, and control. J Occup Environ Hyg. 2011;8(7):447-466.
- Ball K. Compliance with surgical smoke evacuation guidelines: implications for practice. AORN J. 2010;92(2):142-149.
- Ball K. Surgical smoke evacuation guidelines: compliance among perioperative nurses. AORN J. 2010;92 (2):e1-e23. doi: 10.1016/j.aorn.2009.10.026.
- Centers for Disease Control and Prevention. Bacterial meningitis after intrapartum spinal anesthesia—New York and Ohio, 2008-2009. MMWR Morb Mortal Wkly Rep. 2010;59(3):65-69.
- O’Riley M. Electrosurgery in perioperative practice. J Perioper Pract. 2010;20(9):329-333.
- Waddell AW. Cultivating quality: implementing surgical smoke evacuation in the operating room. Am J Nurs. 2010;110(1):54-58.
- Watson DS. Surgical smoke evacuation during laparoscopic surgery. AORN J. 2010;92(3):347-350.