Jennifer Johnson, BSN, RN Arizona State University
This study was intended to educate the perioperative staff (physicians, nurses, anesthesia, and surgical technologists) at Maple Grove Hospital in Maple Grove, MN to the dangers of inhaling surgical smoke. Surgical smoke (plume) contains an estimated 150 toxic and carcinogenic chemicals and is documented to be dangerous to those who inhale it (Brace et al., 2014). Both AORN (Association of periOperative Registered Nurses) and OSHA (Occupational Safety and Health Administration) have published regulations recommending the use of smoke evacuation devices, yet only one state in the union, Rhode Island, has mandated the use of the devices in cases where electrosurgical cautery or laser are used. Despite knowledge of the hazardous components of surgical smoke, and evidence based practices to control surgical smoke, health care workers continue to be exposed (Dobbie et al., 2017). According to OSHA, an estimated 500,000 healthcare workers including surgeons, nurses, anesthesiologists, and surgical technologist are exposed to laser or electrosurgical smoke (Hedley, 2018). In the past, perioperative personnel may have assumed that meeting the standards associated with OR ventilation or air exchanges were enough to protect healthcare workers from surgical smoke. Air exchanges of 20 per hour are not adequate to remove smoke from the operative site by ventilation alone (York & Autry, 2018).
Methods
Knowledge was disseminated through presentations and posters highlighting the results of peer reviewed research articles delineating the known toxic chemicals and bio hazards of surgical smoke. 5 PowerPoint presentations were shown to the OR staff and physicians at MGH during staff meetings and surgery committee meetings, and posters were left in both the physicians lounge and the staff lounge. A post presentation survey was given to confirm knowledge of the risks of smoke inhalation, and to demonstrate support for new policies requiring the use of smoke evacuation devices during surgical cases requiring electrosurgical cautery or laser.
Results
10 questions were given to the staff (65 staff consisting of nurses, surgical technologists and anesthesia providers, and 35 surgeons) for a total of 100 staff. The response rate was 95%. Of the 10 questions for 100 quizzes, only 3 were answered incorrectly requiring further discussion. Staff were questioned if Maple Grove Hospital should mandate the use of smoke evacuation equipment. 95% of staff said yes. 3% were undecided (surgeon) and 1% said no (surgeon).
Conclusion
Education to the staff regarding the toxic chemicals and biohazards of surgical smoke was necessary. The post survey results show the staff are now aware of the risks of breathing surgical plume, OSHA and AORN recommendations that healthcare organizations should provide a surgical smoke free environment, and peer reviewed evidence based guidelines for staff and patient safety.
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