Ninety-five percent water vapor, surgical smoke also contains a 5 percent mixture of particulate matter, chemical material and biological material. This material mix is villainous, threatening numerous health consequences.
OR staff and patients can contract a variety of diseases from surgical smoke, such as asthma, bronchiolitis, chronic obstructive pulmonary disease, atherosclerosis, and thrombogenesis.
Surgical smoke is the result of energy’s impact on tissue interacting with a variety of surgical instruments:
- Electrical surgical unit: A device using high radiofrequency to cut and coagulate tissues.
- Laser: A device using intense light to vaporize and destroy tissue.
- Ultrasonic scalpels: A device vibrating at ultrasonic frequency to cut and coagulate tissues and blood vessels.
- Plasma knife: A device using a different wavelength of energy. Plasma is the fourth state of matter, and possesses a more controlled energy and stable wavelength causing less collateral damage to tissue.
- Argon Beam: Similar to an electrical surgical unit, this device uses a stream of argon gas to deliver energy from the hand piece to the tissue, decreasing the depth of penetration to the tissue.
Physical hazard
Surgical smoke contains particulate matter ranging in size from 0.01 microns to more than 200 microns, with the average particle size checking in at 1.1 microns. The type of procedure determines the particle size.
A 0.3 micron-sized particle denotes a real hazard, explains Robert Scroggins, RN, Lancaster, N.Y.-based Buffalo Filter’s Clinical Programs Manager. At that size, “those [particles] can get down into the alveoli of the lungs and completely bypass the body’s natural defenses,” Mr. Scroggins adds. Since the alveoli represent the end of the road for the body’s defenses, the body uses a macrophage to engulf the material and digests it or squeezes it back into the blood stream.
“It’s called lung-damaging dust and is very similar in action to black lung disease,” says Mr. Scroggins. “It gets into your lungs and can’t come out.”
Chemical hazard
Of the 400 chemicals currently known to inhabit surgical smoke, 40 are considered hazardous. The chemicals can cause a variety of health issues, including carbon monoxide poisoning, methemoglobinemia, leukemia and other diseases.
The following are the seven worst offenders:
- Benzene is a solvent derived from petroleum. The chemical is known to cause blood cancers.
- Hydrogen cyanide is a chemical warfare agent, and not much can defeat it.
- Toluene is paint thinner, and should only be used in well-ventilated areas.
- Formaldehyde is a chemical that preserves tissues in mortuaries and labs
- Perchloroethylene is dry-cleaning fluid and toxic.
- Ethyl Benzene is a chemical used to manufacture Styrofoam.
- Carbon monoxide is a toxic gas that is a product of combustion
Surgical smokes’ biological hazards include human papillomavirus, Hepatitis B, human immunodeficiency virus, blood fragments, human and viral DNA fragments as well as other viruses and bacteria. Mr. Scroggins indicates all of these have been recovered in surgical smoke.
Supportive studies
Although a hefty amount of information outlining surgical smoke hazards is publicly available, Mr. Scroggins recommends relying on peer-reviewed journals as sources.
In 2012, the Journal of Plastic, Reconstructive, and Aesthetic Surgery published a study revealing a Great Britain plastic surgery center, daily surgical smoke intake in this facility was equivalent to smoking 27 to 30 cigarettes per day.
In 2013, the International Journal of Occupational Medicine and Environmental Health published a study supporting the assertion of toxic chemicals existing in surgical smoke. The study found various toxic chemicals during laparoscopic surgeries, such as benzene, toluene, xylene and dioxins.
Additionally, many surgical smoke evacuation companies, such as Buffalo Filter, offer educational programs about the dangers of surgical smoke on their websites.
Evacuate the smoke
Even though respirators and masks may combat inhalation of some surgical smoke, surgical masks often don’t fit tightly enough around one’s face, so the person is still inhaling smoke around the mask. And, a surgical N-95 respirator requires surveillance and upkeep and is classified as particulate filters not chemical filters.
There is a better solution out there. Surgical smoke evacuators include pre-filter, ULPA (Ultra Low Penetrating Air filter), carbon and post-filter components to get the job done. The carbon filtration captures and adsorbs gasses and chemicals, while the pre-filter captures larger particles and tissue. The evacuators flow at up to 839 liters per minute compared to 85 liters per minute in small suction tools. “That’s a big difference in air velocity and capture,” says Mr. Scroggins.
Surgical smoke evacuators can capture particles as small as 0.1 microns at a 99.999 percent efficiency rate. “It’s considered to be the best defense, given today’s technology,” says Mr. Scroggins.
Many facilities want a “one size fits all” surgical smoke accessory, but Joseph Lynch, Buffalo Filter’s Vice President of Sales and Marketing, emphasizes different clinical specialties will require different surgical smoke management tactics.
After implementing surgical smoke management policies, the first noticeable difference will probably be the absence of the “hospital smell.” Mr. Scroggins says staff members may also notice their eyes aren’t itchy or watery anymore.
Integrating the technology
Even though all signs point to the damaging health effects of surgical smoke, Mr. Lynch says providers have learned to acclimate to the smoke’s presence and thus, may not want to undergo change to eliminate it. But once an OR eliminates surgical smoke — as many restaurants have done with cigarette smoke due to state laws — the staff probably won’t welcome it back, he adds.
Mr. Lynch also notes technology won’t gain traction in the industry if it complicates surgeons’ tasks, no matter the potential benefits it presents. Therefore, safety technology developers must take into account ergonomics, clinical efficacy, ease of use and cost aspects of their products.
“The progression of technology has to be centered not only on the clinical effectiveness of the device but also on the surgical teams’ interaction with the device,” explains Mr. Lynch. “Human factor engineering is equally important as the technical factors that drive the performance of the product.”
Mr. Scroggins adds surgical smoke evacuation is just as crucial to OR safety as staff members wearing gloves, gowns and masks.
Immersed in the surgical smoke evacuation market, Buffalo Filter offers a full solution set of surgical smoke evacuation products, devoting a great deal of time to research and innovation in the space.
This article is sponsored by Buffalo Filter.
Pictured: Robert Scroggins and Joseph Lynch
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