April 1, 2021
Surgical smoke—a harmful byproduct created through the thermal destruction of tissue by medical devices such as lasers, electrosurgical systems, radio-frequency devices, hyfrecators, ultrasonic scalpels, power tools, and other heat-destructive devices—can be detrimental to the health of surgeons, nurses, health care professionals, and patients in an operating room (OR).
The smoke may contain small-particle toxins and proinflammatory agents, as well as carcinogens. Although the risk of patient exposure is low and short-lived, surgeons and other members of the OR team may be exposed to surgical smoke daily.1 At high concentrations, surgical smoke can cause ocular and upper respiratory tract irritation and create visual problems for the surgeon. Therefore, surgeons should be aware of the hazards surgical smoke can cause.
A recent issue of Quick Safety examines the dangers surgical smoke presents, citing studies that confirm that the surgical smoke plume may contain toxic gases and vapors, including the following:2
The Quick Safety article states that in some disciplines, such as orthopaedics, dentistry, and plastic surgery, it is possible to generate particulates and metal fumes.3
According to the article, research showed that nanoparticles comprise 80 percent of surgical smoke and “are the real danger of inhaled smoke.”4 Measuring at less than 100 nanometers, these tiny particulates can enter a person’s blood and lymphatic circulatory systems after inhalation and travel to vital organs.5
The “Environment of care” chapter of The Joint Commission’s accreditation manuals for hospitals, critical access hospitals, and ambulatory care and office-based surgery centers includes a standard that requires these facilities to minimize risks associated with selecting, handling, storing, transporting, using, and disposing of hazardous gases and vapors. The standard includes the following note: “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; and laboratory rooftop exhaust.”6
The Quick Safety article bolsters the standard by noting some government agencies and professional organizations that have issued recommendations or standards related to surgical smoke or the use of lasers. Examples include the Association of periOperative Registered Nurses, the Occupational Safety and Health Administration, the National Institute of Occupational Safety & Health, and the American National Standards Institute.
The Quick Safety article suggests some safety actions health care centers might consider implementing to address this issue, such as instituting a standard procedure for the removal of surgical smoke and plume using engineering controls, including smoke evacuators and high-filtration masks.6 Although N95s offer optimal protection, high-filtration masks with a smoke evacuator may provide staff with compatible protection.
Other safety recommendations are as follows:6
The Quick Safety article is available online.
The thoughts and opinions expressed in this column are solely those of Dr. Jacobs and do not necessarily reflect those of The Joint Commission or the American College of Surgeons.