44-year old surgeon developed laryngeal papillomatosis
Biopsy identified the same virus type as anogenital condyloma
Hallmo, et al (1991)

394
400
350
300
250
200
150
100
50
0
Yes
311
137
109
No N/A
Total Cases: 951
Not Charted

70%
60%
50%
40%
30%
20%
10%
0%
100%
90%
80%
35%
24%
34%
29%
52%
36%
42%
0%
20%
29%
20%

Key indicators of compliance:
 Education



Leadership support
Easy to follow policies
Regular internal collaboration
(Ball, K . 2010)

 To know the risks of surgical smoke
 To understand the rationale for smoke management
 To feel empowered to advocate for smoke evacuation in your OR.
6







Gaseous toxic compounds
Bio-aerosols
Dead and live cellular material (including blood fragments)
Viruses
Carbonized tissue
Bacteria

 Acrolein
 Benzene
 Carbon Monoxide
 Formaldehyde
 Hydrogen cyanide
 Methane
 Toluene
 Polycyclic aromatic hydrocarbons (PAH)

 Smoke plume and aerosols contain 95% water vapor
 Water vapor itself is not harmful, but acts as a carrier

Human Immunodeficiency Virus = 0.15 micron
Human Papilloma Virus = 0.055 micron
Hepatitis B = 0.042 micron

 Concentration: over 1 million particles/cubic feet
 It takes 20 min after the activation of the ESU for the concentration to return to the baseline level (Nicola, et al. 2002).
 Travel at 40 mph
 Evenly distributed throughout the operating room

“Each year, an estimated 500,000 workers, including surgeons, nurses, anesthesiologists, and surgical technologists, are exposed to laser or electrosurgical smoke.”
Laser/Electrosurgery Plume. Occupational Safety and Health Administration (OSHA) Quick Takes.
United States Department of Labor http://www.osha.gov/SLTC/laserelectrosurgeryplume/index.html
(accessed Dec 5, 2012)

 Using the CO2 laser on one gram of tissue is like inhaling the smoke from three cigarettes in 15 minutes.

 Using ESU on one gram of tissue is like inhaling smoke from six cigarettes in 15 minutes.
(Tomita et al., 1989)

 Eye, nose, throat irritation
 Headaches
 Nausea, dizziness
 Runny nose
 Coughing
 Respiratory irritants
 Fatigue
 Skin irritation
 Allergies

Perioperative staff have
of many respiratory problems as compared to the general population.
(Ball, 2010)

Soft contact lenses can absorb toxic gases produced by surgical smoke.

 Levels of carboxyhemoglobin of patients who underwent laparoscopic procedures using laser were significantly elevated. (Ott, 1998)
 Carbon monoxide levels increase in the peritoneal cavity and exceed recommended exposure limits.
(Beebe et al 1993)





AORN
ANSI
 ECRI
NIOSH/CDC
 OSHA
Joint Commission

“Potential hazards associated with surgical smoke generated in the practice setting should be identified, and safe practices established.”

Airborne Contaminants:
Shall be controlled by the use of ventilation (ie., smoke evacuator). Respiratory protection required for any residual plume escaping capture.

 Recommends the evacuation of surgical smoke
 The content of laser and ESU smoke is very similar https://www.ecri.org/

 The smoke evacuator or room suction hose nozzle inlet must be kept within 2 inches of the surgical site
 The smoke evacuator should be ON
(activated) at all times when airborne particles are produced

MUST

 The hospital must minimize risks associated with selecting, handling, storing, transporting, using, and disposing of hazardous gases and vapors.
 Hazardous gases and vapors include, but are not limited to, glutaraldehyde, ethylene oxide,
, and gases such as nitrous oxide.

 Communication with Surgeon and Perioperative Team members
 Plan for Smoke Evacuation
 Equipment availability

Relevant information about smoke evacuation and equipment used




Education
Chart Audits
Equipment Service Reports

30

 In-line filters
 Smoke evacuator systems
 Laparoscopic filtering devices