 Below is the position statement adopted at the 2008 Congress of members of the Association periOperative Registered Nurses (AORN) regarding surgical smoke and bio-aerosols. Cresent Laser strongly recommends that smoke evacuation equipment be used with all medical lasers.
PREAMBLE
AORN recognizes that exposure to surgical smoke and bio-aerosols poses a hazard to patients and perioperative professionals. Smoke and bio-aerosols are routinely produced by surgical instruments; eg, lasers, electrosurgical units, radiofrequency devices, ultrasonic devices, power tools. Research studies have confirmed that plume and bio-aerosols contain odor-causing and odorless toxic gases, vapors, dead and live cellular debris (including blood fragments), and viruses.1-7 These airborne contaminants can pose respiratory, ocular, dermatological and other health-related risks, including mutagenic and carcinogenic potential, to patients and operating room personnel.1-7
OSHA estimates that 500,000 health care workers are exposed to surgical smoke each year.8 Although the long-term deleterious effects from exposure to surgical smoke and bio-aerosols have not been clearly established, AORN supports the need to be proactive to prevent harm. Understanding the environmental hazards of surgical smoke and bio-aerosols produced during operative and invasive procedures is paramount to the implementation of adequate protective measures for both patients and personnel involved in their care. AORN also recognizes that this hazard exists in practice areas that extend beyond the perioperative environment, such as obstetrical surgical services, cardiac cath labs, emergency rooms, interventional radiology, endoscopy suites, clinics, and physician offices.
POSITION STATEMENT
AORN believes that exposure to surgical smoke and bio-aerosols can and should be controlled. Health care professionals are responsible for learning about surgical smoke and bio-aerosols and taking steps to minimize the risks associated with these hazards.
AORN recommends the following risk reduction strategies:
- Use local exhaust ventilation (.1 micron filtration
at 99.999% efficiency)
o Central smoke evacuation systems
o Portable smoke evacuation units
o Wall suction with inline filter
o Laparoscopic evacuation/filtration systems
- Use personal protective equipment
o High filtration surgical masks worn properly
o Protective eye wear
o Skin protection (eg, gloves)
- Educate perioperative staff
o Develop and implement training programs
o Demonstrate competencies on equipment and supplies
o Comply with federal, state, and local regulations and standards
o Document and maintain educational activities
REFERENCES
1. Barrett WL, Garber SM. Surgical smoke-a review of the literature. Business Briefing: Global Surgery. 2004;1-7.
2. Pillinger SH, Delbridge L,Lewis DR. Randomized clinical trial of suction vs standard clearance of diathermy plume. Br J Surg. 2003;90(9):1068-1071.
3. Taravella MJ, Viego J, Luiszer F, et al. Respirable particles in the excimer laser plume. J Cataract Refract Surg. 2001;27(4):604-607.
4. Karoo ROS, Whitaker IS, Sharpe DT. Surgical smoke without fire: the risks to the plastic surgeon. Plast Reconstr Surg. 2004;114(6):1658-1660.
5. Garden JM, O'Banion K, Bakus AD, Olson C. Viral disease transmitted by laser-generated plume (aerosol). Arch Dermatol. 2002;38:1303-1307.
6. Hollmann R, Hort CE, Kammer E, Naegele M, Sigrist MW, Meuli-Simmen C. Smoke in the operating theater: an unregarded source of danger. Plast Reconstr Surg. 2004;114(2):458-463.
7. Alp E, Biji D, Bleichrodt RP, Hansson A, Voss A. Surgical smoke and infection control. J Hosp Infect. 2006;62:1-5.
8. OSHA (n.d.). Lasers and Electrosurgery Plume. |
|
It has long been a standard requirement for smoke evacuation to be used during laser procedures. The following PDF articles provide much of the background information needed to understand surgical smoke plume/ aerosols and how they affect staff and patient safety.
 No Smoking in the OR, Outpatient Surgery, Nov 2004
Clearing the Air in the OR, Infection Control Today, Oct 2004
Don’t be a Victim of Surgical Smoke, AORN Journal, Jun 1998
Surgical Smoke - A Review of the Literature
Surgical Smoke - What We Know Today
Microbiologic Activity in Laser Resurfacing Plume and Debris
Principles and Function of Smoke, Aerosols, Gases, and Smoke Evacuation |
|
 The following is excerpted from the OSHA website regarding surgical plume from use of lasers:
During surgical procedures that use a laser or electrosurgical unit, the thermal destruction of tissue creates a smoke byproduct. Each year, an estimated 500,000 workers, including surgeons, nurses, anesthesiologist, and surgical technologists, are exposed to laser or electrosurgical smoke. Surgical plumes have contents similar to other smoke plumes, including carbon monoxide, polyaromatic hydrocarbons, and a variety of trace toxic gases. As such, they can produce upper respiratory irritation, and have in-vitro mutagenic potential. Although there has been no documented transmission of infectious disease through surgical smoke, the potential for generating infectious viral fragments, particularly following treatment of venereal warts, may exist. Local smoke evacuation systems have been recommended by consensus organizations, and may improve the quality of the operating field. Employers should be aware of this emerging problem and advise employees of the hazards of laser smoke.
|
|
|
Cresent Laser distributes the QuantaVac Harmony line of Surgical Smoke Evacuation Systems. The QuantaVac solution is completely portable and one system can be moved from room to room or laser to laser, and it costs just a fraction of a built-in central smoke evacaution system. We strongly recommend smoke evacuation for ALL aesthetic laser environments.