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Keeping Ambulatory Surgery Staff Safe From Smoke Plumes


Surgery in action.

By Herman McKenzie, Director, Physical Environment Department

Editor’s Note: Some of this information has been previously published in OR Today.

Surgeons, perioperative nurses and other staff in ambulatory surgery centers (ASCs) are exposed to surgical smoke on a daily basis that may cause ocular and upper respiratory tract irritation and potentially create visual problems.

Science has provided a lot more information about surgical smoke plumes in recent years and we now know these toxic gases and vapors contain: 

  • benzene
  • hydrogen cyanide
  • formaldehyde
  • bioaerosols
  • dead and live cellular material (including blood fragments) 
  • viruses

Exposure to smoke plumes happens rather easily and is linked with use of:

  • lasers
  • electrosurgical systems
  • radio frequency devices
  • hyfrecators
  • ultrasonic scalpels 
  • power tools
  • other heat destructive devices

With increased recognition of this problem, ASC leaders need to mitigate dangers for their staff. Part of this effort involves buying high-quality smoke evacuators to alleviate smoke plume inhalation.

Importance of Maintenance
Spending money on premium medical equipment won’t 100% alleviate the problem. Ambulatory care organizations need to consider the full risk for staff exposed to smoke though a physical environment lens because maintenance falls under Joint Commission medical equipment standards: EC 02.04.01 and EC 02.04.03.

Use of smoke evacuators is tied to The Joint Commission’s element of performance (EP) for managing hazardous materials and waste. Standard EC 02.02.01, EP 9 states that “the organization minimizes risks associated with selecting, handling, storing, transporting, using, and disposing of hazardous gases and vapors.” Hazardous gases and vapors include, but are not limited to:

  • ethylene oxide 
  • nitrous oxide gases
  • vapors generated by glutaraldehyde
  • cauterizing equipment, such as lasers
  • waste anesthetic gas disposal (WAGD)
  • laboratory rooftop exhaust

The Joint Commission outlined industry recommendations in our Quick Safety advisory, “Alleviating the Dangers of Surgical Smoke.” These recommendations were developed in accordance with guidelines from the Occupational Safety and Health Administration (OSHA), National Institute of Occupational Safety and Health (NIOSH), American National Standards Institute (ANSI), Association of periOperative Registered Nurses (AORN) and ECRI.

Safety actions for ASCs to consider include:

  • Implementing standard procedures for the removal of surgical smoke and plume through the use of engineering controls, such as smoke evacuators and high filtration masks
  • During laser procedures, using standard precautions to prevent exposure to the aerosolized blood, blood by-products and pathogens contained in surgical smoke plumes
  • Establishing and periodically reviewing policies and procedures for surgical smoke safety and control – making these policies and procedures available to staff in all areas where surgical smoke is generated
  • Providing surgical team members with initial and ongoing education and competency verification on surgical smoke safety, including the organization’s policies and procedures
  • Conducting periodic training exercises to assess surgical smoke precautions and consistent evacuation for the surgical suite and procedural area

When my career first started, exposure to surgical smoke plume wasn’t really considered a big deal. It’s a real advancement that the industry is getting serious about maintaining the health of the growing number of individuals working in ASCs.

Herman McKenzie is currently the director, Physical Environment Department in the Standards Interpretation Group at The Joint Commission. Mr. McKenzie has more than 25 years of health care experience having held managerial and director level roles in clinical engineering, plant operations and facilities services throughout the Chicagoland area. He was part of the team that opened the first new hospital in Illinois in over 25 years.