Operation Clean Air: Implementing a Surgical Smoke Evacuation Program

Abstract

Surgical smoke is a hazardous byproduct of any surgery involving a laser or an electrosurgical unit. Although research and professional organizations identified surgical smoke as harmful many years ago, this byproduct continues to be a safety hazard in the OR. An interdisciplinary team at a large academic medical center sought to address the exposure of patients and perioperative team members to surgical smoke. The team used the nursing process to resolve the lack of smoke-evacuator equipment and surgical smoke staff member knowledge. To increase awareness of the hazards of surgical smoke, we gave presentations to nursing staff members and surgeons, who then completed educational modules. We conducted audits in all ORs to monitor compliance. The use of smoke evacuation supplies has more than quadrupled since education began. Additional unit-based education continues every day and is a constant reminder that safety is the responsibility of all perioperative team members.

Surgical Smoke—Hazard Perceptions and Protective Measures in German Operating Rooms

“…In some places, this requires a rethinking of the interprofessional distribution of tasks. An American intervention study showed that if assistance staff is actively involved in risk assessment processes, personnel receive appropriate training and, in addition, an audit system for monitoring equipment usage is implemented and occupational health and safety can be protected [27,57]. A key component of the award-winning program was an interdisciplinary implementation team with facility coordinators who performed a gap analysis, coordinated between departments, identified champions, developed communication plans to address identified concerns, encouraged team involvement, and educated staff members about smoke-free working procedures.…”

Back to Basics: Protection From Surgical Smoke

“… smoke evacuation will be used for all smoke‐producing procedures, the RN circulator is to assess each procedure that could generate plume and provide an evacuation method to remove smoke from the OR, and surgical smoke will be removed using a smoke evacuation system during open and laparoscopic procedures . (p507) …”

“…Additionally, the team audited smoke evacuation practices during all procedures occurring in every OR during the eight‐hour workday, performed onsite education, and worked with perioperative team members to resolve problems. This team won the gold level Go Clear Award and will continue to maintain the program to uphold the safety and health of their patients and perioperative teams …”

“…14(p507) The team did encounter multiple barriers during the implementation process, including a lack of available disposable goods (eg, wands, tubing, products for laparoscopic procedures, electrosurgical pencils with evacuation tubing) and the high noise level of some smoke evacuator systems. 14 To overcome these barriers, the team added disposable smoke evacuator supplies to surgeon preference cards and invited supply chain management personnel to meetings to help them understand why there was a request for more supplies. To combat the noise issue, the team met with surgeons to brainstorm alternative solutions and ultimately found that moving the smoke evacuator farther away from the surgeon helped to reduce the distraction caused by the noise.…”

“…This team won the gold level Go Clear Award and will continue to maintain the program to uphold the safety and health of their patients and perioperative teams. 14 by Medtronic through the AORN Foundation and demonstrates the dedication of both nurses and industry partners alike to the health and safety of patients and health care workers. Perioperative RNs dedicate their lives to patient safety and advocacy and deserve a healthy work environment created by leaders who put the well-being of staff members and patients first and do all they can to decrease the harmful effects of surgical smoke.…”