Surgical smoke plume and laser plume are byproducts that are created when tissue and cells are vaporized during electrosurgical and laser procedures. While these methods provide immeasurable benefi t for the patients they treat, they and the healthcare workers (HCWs) who perform and facilitate the procedures in the operating room (OR) face possible risks to their own health from the smoke itself.
During the Surgical Application of energy based technologies, there is a well-recognized production of “smoke” that can impede surgical progress. The confined spaces associated with laparoscopic procedures have made smoke production a more significant problem. The aerosolized particles can impair visibility by settling on the lens of the laparoscope or by remaining in suspension between the laparoscopic and the surgical objective.
When analyzed, smoke from electrosurgical units, commonly known as Bovie smoke, is shown to be quite similar to that of other potentially pathogenic smoke, behaving as a carcinogen, a mutagen and an infectious vector. In addition, particulate matter in smoke is known to have health risks related to inducing inflammatory and allergic responses in susceptible people.
The observed occurrence of port site recurrence in laparoscopic surgery for malignant disease has stimulated interest in the dissemination of tumor cells during surgery. Study of electrocautery smoke has revealed the presence of large particles and viable viruses. The purpose of this study was to determine if viable malignant cells are present in suspension within the electrocautery plume.
If you saw a low-lying cloud that was labeled clearly with its contents, and the label contained the words benzene, carbon monoxide, formaldehyde, hydrogen cyanide, methane, phenol, styrene, and toluene, would you go out of your way to walk through that cloud and inhale those toxic chemicals? Of course not. But you expose yourself to these same toxic chemicals each time you participate in a surgical procedure in which smoke from tissue interaction with an electrosurgical device or laser is not evacuated.
With the performance of CO2 laser resurfacing in venues such as television studios, concerns have arisen in the plastic surgical community about appropriate safety precautions being taken. The literature supports the presence of viable tumor cells and intact viral DNA and proviral human immunodeficiency virus (HIV)-DNA within the laser plume during laser ablation procedures utilizing continuous-wave lasers. Furthermore, inspired laser vapor by-products have been demonstrated to cause anatomically identifiable lesions in animals.
Nasty. There’s no other way to describe the awful stench of surgical smoke. Eau de Seared Flesh. And they’re yet to invent the mask that can protect you from those noxious plumes. The harm to your lungs? One study likened the smoke from burning one gram of tissue to smoking three cigarettes. Uhh, no thanks. We’re trying to cut back.
The Occupational Safety and Health Administration (OSHA) has joined with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the Joint Commission Resources, Inc. (JCR) to educate the health care community on safety and health issues for healthcare workers.
Containment of airborne microorganisims to prevent transmission in a positively pressured operating room is challenging. Occupational transmission of Mycobacterium tuberculosis to perioperative personnel has occurred, but protection of the surgical site is of equal importance. HEPA filters can mitigate occupational exposure and improve air quality.
Although more and more states are adopting smoking restrictions in workplaces, restaurants, and bars to protect people from the dangers of second-hand cigarette smoke, health care workers continue to be exposed to similar dangers every day in the form of surgical smoke. During surgical procedures that use a laser or electrosurgical unit, the thermal destruction of tissue creates a smoke byproduct. According to the NIOSH 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.
Surgical masks have been in widespread use since the early 1900s to help prevent infection of surgical wounds from staff-generated nasal and oral bateria. Today, surgical masks vary widely in style and intended application and can be found in a broad range of hospital and health care sttings.
Electrocautery, laser tissue ablation and ultrasonic (harmonic) scalpel tissue dissection all create a gaseous by-product, commonly referred to as “smoke”, that can be seen and smelt easily. Concern about this smoke has led to numerous investigations in an effort to determine what, if any, risks this by-product poses to surgeons, OR personnel and / or patients.
Gaseous byproducts produced during electrocautery, laser surgery or the use of ultrasonic scalpels are usually referred to as ‘surgical smoke’. This smoke, produced with or without a heating process, contains bio-aerosols with viable and non-viable cellular material that subsequently poses a risk of infection (human immunodeficiency virus, hepatitis B virus, human papillomavirus) and causes irritation to the lungs leading to acute and chronic inflammatory changes. Furthermore, cytotoxic, genotoxic and mutagenic effects have been demonstrated.
The is substantial literature on the aspects of the hazards of smoke plume generated by electrosurgical instruments and lasers. Most studies address single issues. According to a recent survey of 4,500 Canadian physicians and surgeons (with 800 respondents), the more physicians are involved with electrosurgery, the more concerned they are about the hazards of surgical smoke.
OSHA enforces thousands of health and safety standards or rules. There are so many standards that sometimes workers get confused, get frustrated. Have you ever tried to look through the Code of Federal Regulations (CFR) containing these standards for occupational safety and health?