This article appeared in the Jan./Feb. issue of  Surgical Products.

When it comes to limiting surgical smoke exposure, the risks are very real and the lack of action we're taking is quite disconcerting.

Are we giving our patients the best possible care in regards to surgical smoke exposure, or are we putting them and ourselves at risk by breathing hazardous toxins that could easily be avoided? A perioperative nurse working in a surgical suite 40-plus hours a week breathing in the toxic, mutagenic, and even carcinogenic compounds found to exist in surgical smoke has reason for concern.  The correlation between surgical smoke and the comparable hazards of cigarette smoke are well documented.

Studies show that the vaporization of just one gram of tissue using electrosurgery exposes a healthcare worker to mutagenic potential found in the equivalent of six cigarettes. This is DOUBLE the hazard of CO2 laser smoke plume. This data has been available since 1981, yet many surgeons and healthcare workers refuse to protect themselves and their patients from these hazards. Why then do healthcare providers seemingly ignore or minimize the hazards of surgical smoke?

Back in the 1980s, smoke evacuation equipment was noisy and the hand pieces were bulky. Thus, it would appear convenience won out over patient and staff health. Thankfully, things have changed. Not only have organizations such as the Association of Perioperative Registered Nurses taken a strong stance against surgical smoke (and provided excellent education materials for OR teams), but smoke evacuation equipment has dramatically improved, further removing the excuses for not using this equipment in the OR.

The biggest challenge facing the implementation of best practices for the removal of surgical smoke today and for our future is the education of its hazards and the education of the advancements made in the equipment and devices available to remove it.  Some manufacturers still sell loud equipment with bulky hand pieces, so you must do your homework.  Quiet systems are available and are well worth a nominal upcharge to keep the noise level down in the OR, keep the OR team safe, and keep their ears happy.  Typically, these systems require very little maintenance and are easy to operate and maintain. Don’t let materials management compromise on a cheap, loud system that the OR team will put in the closet the minute you turn your back.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) just might be looking for your smoke evacuators in your next audit. There’s a reason for this. Not only does the National Institute of Occupational Safety and Health recommend the use of smoke evacuation systems, but “a 2008 research study of perioperative nurses" compliance with surgical smoke evacuation guide revealed that perioperative nurses have a higher prevalence of pre-respiratory conditions (i.e., allergies, sinus infections, asthma, and bronchitis) than the general U.S. population. Smoke evacuation may reduce potential acute and chronic health risks to personnel and patients.” JCAHO may not only want to see the devices, but they may also want to make sure they are available for use.

The risks are real. The lack of action is concerning. Fingers usually point in one of two directions: Hospital administration (due to the perceived costs) or surgeons who don’t want to change.  Interestingly, surgeons who may not have wanted to use the bulky smoke evacuation hand pieces of years past may be the real winners with some of the new smoke removal technology. Not only are some of the better designed hand pieces sleeker and slimmer than ever before, but they include premium features that provide true benefits for surgeons like PTFE tips for less eschar buildup and telescopic features that offer both easier access to deep tissue without the need for blade changes. 

Manufacturers have even found ways to minimize the ergonomic impacts of the tubing and cords with strategically placed and well-designed swivel components that move with the surgeon and keep cords and tubing out of range. Smoke evacuation pencils are no longer a barrier to surgery but a valuable tool that adds value to procedures.  You could say the recent advancements in smoke evacuation systems are a lifesaver.

No matter how you look at it, excuses are excuses.  Yes, the hand pieces are a little bulkier and yes, smoke evacuation requires a little more work, but so does putting on a seatbelt. We may not like it, but our lives may depend on it. Do your part and keep your OR a safe place for your surgical team and your patients. Implement a smoke fee OR campaign and make a commitment to make 2013 the year you are fully committed to removing surgical smoke from the lungs of everyone in our OR for a safe and healthy year.

Jill Trasamar is the Marketing Manager for Megadyne Medical Products and resides in Sandy, UT. Megadyneis the recognized authority on non-stick electrosurgical electrodes and cost-effective surgical devices including the Mega Vac™ line of smoke evacuators, Ultra Vac™ line of smoke evacuation pencils, as well as the Mega Power® Electrosurgical Generator, the E-Z Clean® line of non-stick electrosurgical tips, the revolutionary reusable Mega Soft® Patient Return Electrode System, and many other electrosurgical accessories.

As Marketing and Product Manager, Jill is responsible for marketing Megadyne’s capital equipment lines as well as the company’s complete offering of smoke evacuation equipment and accessories. Jill has earned a M.A. from the University of Phoenix and a B.A. in Journalism from Arizona State University in Tempe, AZ and has enjoyed working at a variety of medical equipment companies including GE Healthcare and Bard Access Systems.