New Technology Addresses Surgical Staff Objections to Removal of Surgical Plume
By Alison Sanders
New technology is providing healthcare facilities with convenient and effective methods for the removal of plume produced by electrosurgical and surgical laser procedures. Everyone has read the studies describing the many hazardous contaminants that are found in surgical plume. Smoke generated through the use of lasers and electrocautery has been found to consist of benzene, carbon monoxide, formaldehyde, hydrogen cyanide, and other chemicals. Exposure to these chemicals is known to cause adverse health effects. In addition to these toxic chemicals, surgical plume also has been found to contain biologic hazards.
Two ophthalmologists are believed to have contracted idiopathic thrombocytopenic purpura (ITP) through exposure to surgical plume produced while performing photorefractive keratectomies with excimer lasers.1 ITP is a rare condition in non-HIV positive adults, in which the body's immune system produces antibodies that attack and destroy platelets. Since the incidence of ITP in the general public is rare, it seems unlikely that two laser surgeons should develop ITP after similar but separate exposures to excimer laser produced surgical plume. There has also been one documented case of a laser surgeon contracting laryngeal papillomatosis from a patient.2
Many agencies, including the Centers for Disease Control and Prevention (CDC), the American National Standards Institute, the Canadian Centre for Occupational Health and Safety, and the National Institute for Occupational Safety and Health (NIOSH), recommend the use of surgical smoke evacuation systems to decrease patient and staff exposure to surgical plume.3 The NIOSH guideline states, "During surgical procedures using a laser or electrosurgical unit, the thermal destruction of tissue creates a smoke byproduct. Research studies have confirmed that this smoke plume can contain toxic gases and vapors such as benzene, hydrogen cyanide, and formaldehyde, bioaerosols, dead and live cellular material (including blood fragments), and viruses. At high concentrations the smoke causes ocular and upper respiratory tract irritation in healthcare personnel and creates visual problems for the surgeon and surgical assistants. The smoke has pungent, unpleasant odors and has been shown to have mutagenic potential." The first study examining potential dangers from surgical smoke concluded that one gram of tissue generated the equivalent smoke condensate mutagenicity of three cigarettes for laser smoke and of six cigarettes for electrosurgical coagulation.4
Compounding the seriousness of these studies illustrating the hazardous contents of surgical plume, is the fact that researchers have concluded that a surgical mask is ineffective in filtering smoke particles (O'Grady & Easty, 1996).
Studies show surgical nurses may be exposed to surgical smoke for up to 90% of their assigned work hours. Although surgical staff are well aware of the potential hazards of breathing noxious surgical plume, their objections to utilizing smoke evacuation devices include disruptive noise, inconvenience, additional labor, and cost.
In the OR, technology is a way of life. Constant advances improve the efficiency and ease of performing life-saving and life-enhancing surgical procedures. Technological advances are now also available in smoke evacuation devices, eliminating the objections to providing a safer OR environment. These advances include:
- Quieter Operation--New technology has provided quieter motors delivering the suction necessary to evacuation surgical plume.
- Compact Efficiency--Through technological advances, smaller smoke evacuators can provide the same high suction levels that until recently were only available in large, floor standing smoke evacuation equipment.
- Laparoscopic Applications--Smoke evacuators are also being designed to function in conjunction with an insufflator during laparoscopic procedures. This ensures continuous inflation of the pneumoperitoneum while removing smoke produced during electrocautery or laser use within the pneumoperitoneum. Plume within the pneumoperitoneum not only obscures the surgeon's visibility and therefore ability to perform the procedure, studies have also shown that the harmful ingredients of the plume can be absorbed into the patient's bloodstream.
- Hands-Free Operation--While it had been originally thought that plume produced by laser procedures was more hazardous than that produced during electrosurgery, as studies shown, plume produced by an electrosurgical pen contains similar if not more toxic ingredients. The popularity of smoke evacuation tubing attached to an ESU pen holder which incorporates a channel for suctioning smoke, virtually at the sight of plume production, illustrates how technological advances enhance the ease and efficiency of tasks that were once considered arduous and awkward.
- Remote Control--Remote control devices further simplify the plume evacuation task. These devices activate the smoke evacuator every time the ESU pen is activated.
- Filter Life Sensors--Traditionally, timers on the smoke evacuator indicate to surgical staff when the filter should be changed. A timer is effective due to the fact charcoal odor control qualities is effective for a specific amount of time. However, recent technology has allowed manufacturers to computerize filter life sensing through applying sensors which read air flow through the filter and utilizing micro-chip technology, relays this information to the control panel LED indicators. This technology allows the filter life to increase when the smoke evacuator is only active during short, low flow procedures such as laparoscopy, and shortens filter life during heavy smoke producing procedures such as erbium laser and extensive ESU procedures.
- Unseen Evacuation--Smoke evacuators integrated into a surgical equipment arm, along with other surgical devices such as electrosurgical units, provide the option to house all required equipment in booms which hang from the ceiling, conserving valuable OR floor space. These power booms eliminate OR cart and cable clutter, and place surgical equipment conveniently for surgical staff use.
A noticeable increase in surgical smoke evacuation interest is currently being experienced even in the absence of enforceable regulations. Healthcare facility administrators and safety officers are taking the first step toward providing a safer work environment, rather than waiting for surgical staff to develop permanent adverse health affects from exposure to surgical smoke. Hospitals are budgeting for smoke evacuation equipment in the OR. It is important that surgical staff voice concern for their health as well as that of their associates and patients, and request smoke evacuation equipment for your OR.
Alison Sanders is the senior product marketing manager for STACKHOUSE, INC., a subsidiary of VIASYS Healthcare.