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Management of Surgical Smoke in the Perioperative Setting

Management of Surgical Smoke in the Perioperative Setting. Case Report. 44-year old surgeon developed laryngeal papillomatosis Biopsy identified the same virus type as anogenital condyloma Hallmo, et al (1991). Smoke Evacuation in July. Total Cases: 951. Smoke Evacuation in July.

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Management of Surgical Smoke in the Perioperative Setting

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  1. Management of Surgical Smoke in the Perioperative Setting

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

  3. Smoke Evacuation in July Total Cases: 951

  4. Smoke Evacuation in July

  5. Smoke Evacuation Compliance Study Key indicators of compliance: • Education • Leadership support • Easy to follow policies • Regular internal collaboration (Ball, K . 2010)

  6. I Want You… • 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.

  7. What is Surgical Smoke?

  8. 150 Ingredients • Gaseous toxic compounds • Bio-aerosols • Dead and live cellular material (including blood fragments) • Viruses • Carbonized tissue • Bacteria

  9. Toxic Gases • Acrolein • Benzene • Carbon Monoxide • Formaldehyde • Hydrogen cyanide • Methane • Toluene • Polycyclic aromatic hydrocarbons (PAH)

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

  11. Particle Sizes Human Immunodeficiency Virus = 0.15 micron Human Papilloma Virus = 0.055 micron Hepatitis B = 0.042 micron Surgical Smoke = 0.1-5.0 micron

  12. Particle Distribution • 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

  13. Your Safety “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)

  14. 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)

  15. Reported Health Effects • Eye, nose, throat irritation • Headaches • Nausea, dizziness • Runny nose • Coughing • Respiratory irritants • Fatigue • Skin irritation • Allergies

  16. Respiratory Problems Perioperative staff have twice the incidence of many respiratory problems as compared to the general population. (Ball, 2010)

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

  18. Patient Safety: • 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)

  19. Healthcare and Regulatory Standards and Recommendations • AORN • ANSI • ECRI • NIOSH/CDC • OSHA • Joint Commission

  20. Association of PeriOperative Registered Nurses (AORN) Recommended Practices “Potential hazards associated with surgical smoke generated in the practice setting should be identified, and safe practices established.”

  21. American National Standards Institute (ANSI) Standard 7.4 of Z136.3 - 2011 (Safe Use of Lasers in Healthcare) Airborne Contaminants: Shall be controlled by the use of ventilation (ie., smoke evacuator). Respiratory protection required for any residual plume escaping capture.

  22. Emergency Care Research Institute (ECRI) • Recommends the evacuation of surgical smoke • The content of laser and ESU smoke is very similar https://www.ecri.org/

  23. NIOSH/CDC: Work Practices • 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

  24. Occupational Safety and Health Administration (OSHA) General Duty Clause: Employer MUST provide a safe workplace environment!

  25. Joint Commission • 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, vapors generated while using cauterizing equipment and lasers, and gases such as nitrous oxide.

  26. Strategies for Success

  27. Team Briefing • Communication with Surgeon and Perioperative Team members • Plan for Smoke Evacuation • Equipment availability

  28. Documentation Relevant information about smoke evacuation and equipment used

  29. Quality Monitoring • Education • Chart Audits • Equipment Service Reports

  30. Smoke Evacuation Methods in the Perioperative Setting • In-line filters • Smoke evacuator systems • Laparoscopic filtering devices

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