by Don Sadler

There’s an old joke told among perioperative nurses that “the only place you can smoke in a hospital is in the OR.” But the joke isn’t funny when you consider the potential harmful effects of electrosurgical smoke plume on OR personnel.
Scientists are scrutinizing the content of surgical smoke more carefully and determining that it is potentially more hazardous than other types of smoke since it may contain not only carcinogenic chemicals, but also viruses and bacteria. In fact, studies have shown that inhaling the electrosurgical smoke plume created by burning just one gram of tissue is equivalent to smoking 6 unfiltered cigarettes. In addition, there is evidence that OR staff members suffer increased incidences of respiratory illnesses when compared to the general population.

Electrosurgical smoke evacuation systems are designed to remove the hazards of electrosurgical smoke plumes from the operating room so the OR personnel can breathe easier.

“These systems have come a long way in recent years,” says Jill Trasamar, marketing manager for Megadyne Medical Products, Inc.
Trasamar says that one of the biggest challenges many hospitals face with regard to using electrosurgical smoke evacuation systems is overcoming the objections of some surgeons.

“The overall perception that many surgeons have of smoke evacuation systems is that they’re loud and that hand pieces are cumbersome and not ergonomically friendly,” Trasamar says. “But today’s systems are much quieter than the old systems and can easily be turned off and on by the surgeon as they are needed. And today’s electrosurgical pencils are slim and ergonomically designed, allowing smoke evacuation directly at the surgical site, which is most effective.”

While electrosurgical smoke evacuation systems are not mandatory in the OR, they are highly recommended by industry organizations including the Association of periOperative Registered Nurses, the National Institute for Occupational Safety and Health Hazard Controls and ECRI.

AORN’s Recommended Practices state that “smoke plume should be removed by use of a smoke evacuation system.” In addition, experts have noted that there may be more than 600 chemical compounds that exist in surgical smoke, and that these contaminants have been shown to have mutagenic and carcinogenic potential, according to the AORN Recommended Practices.

“Surgical smoke produced by surgical instruments such as lasers and electrosurgical units in the OR environment poses a hazard to patients and perioperative team members,” says AORN Perioperative Nursing Specialist Mary J. Ogg, MSN, RN, CNOR.

“Perioperative team members suffer the cumulative effects of exposure to toxic gases, vapors, dead and live cellular debris (including blood fragments) and viruses. These airborne contaminants can pose respiratory, ocular, dermatological and other health-related risks.”

“Change takes time and education,” Trasamar says. “Staff education is beginning to change the assumption that nurses have to put up with smoke to work in the OR. Electrosurgical smoke evacuation is part of the larger concern to evacuate dust, fog, fume, mist, gas, spray and vapor of all kinds from the OR so everyone can breathe easier.”

One trend noted by Trasamar in electrosurgical smoke evacuation systems is their increasing use in robotic surgeries.

“Hospitals are spending millions of dollars to innovate their ORs with robotics,” she says. “However, many remain reluctant to utilize proven methods for the evacuation of surgical smoke (in both open and laparoscopic cases) for the health and safety of both patients and the surgical team.”