Surgical plume and its implications: A review of the risk and barriers to a safe work place

Tan, Eunice Hui Ying; Russell, Kylie

doi:10.26550/2209-1092.1019

Cited by 13 publications

(22 citation statements)

References 30 publications

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“…Studies of human papilloma virus (HPV), human immunodeficiency virus (HIV) and hepatitis B virus (HBV) have reported that the plume originating from diathermy contains viable infectious particles that can be transmitted to the upper respiratory tract through inhalation of surgical smoke [20,21]. In this context, some guidelines recommend avoiding or limiting the use of electrocautery to reduce exposure to the surgical plume [14][15][16].…”

Section: Discussionmentioning

confidence: 99%

Safe surgical tracheostomy during the COVID-19 pandemic: A protocol based on experiences with Middle East Respiratory Syndrome and COVID-19 outbreaks in South Korea

et al. 2020

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Background: A subset of patients with COVID-19 require intensive respiratory care and tracheostomy. Several guidelines on tracheostomy procedures and care of tracheostomized patients have been introduced. In addition to these guidelines, further details of the procedure and perioperative care would be helpful. The purpose of this study is to describe our experience and tracheostomy protocol for patients with MERS or COVID-19. Materials and Methods: Thirteen patients with MERS were admitted to the ICU, 9 (69.2%) of whom underwent surgical tracheostomy. During the COVID-19 outbreak, surgical tracheostomy was performed in one of seven patients with COVID-19. We reviewed related documents and collected information through interviews with healthcare workers who had participated in designing a tracheostomy protocol. Results: Compared with previous guidelines, our protocol consisted of enhanced PPE, simplified procedures (no limitation in the use of electrocautery and wound suction, no stay suture, and delayed cannula change) and a validated screening strategy for healthcare workers. Our protocol allowed for all associated healthcare workers to continue their routine clinical work and daily life. It guaranteed safe return to general patient care without any related complications or nosocomial transmission during the MERS and COVID-19 outbreaks. Conclusion: Our protocol and experience with tracheostomies for MERS and COVID-19 may be helpful to other healthcare workers in building an institutional protocol optimized for their own COVID-19 situation.

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Section: Discussionmentioning

confidence: 99%

Safe surgical tracheostomy during the COVID-19 pandemic: A protocol based on experiences with Middle East Respiratory Syndrome and COVID-19 outbreaks in South Korea

et al. 2020

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“…Surgeons and assistant staff should be better informed about the possible health risks of surgical smoke and its prevention. Awareness rising can take place through regularly updated instruction and other formalized training such as a facility-based initiative [42] and manufacturers of smoke evacuation devices should be invited to support regular onsite training [55].…”

Section: Discussionmentioning

confidence: 99%

“…A positive attitude on the part of the management is demonstrably an important supporting factor in achieving prevention goals [39,43,51,55,56]. Moreover, surgeons with positive attitudes should be identified as stakeholders and role models [13,38].…”

Section: Discussionmentioning

confidence: 99%

“…Outpatient facility: Owner (n = 53 of55) 96.2% (n = 51) -Exposure to surgical smoke (n = 354/141)(5) (6) Number of procedures with use of laser or electrosurgery during the last complete working week(2) 15.6 (34.3), MED = 10 19.2 (14.3), MED = 18 Total number of these surgery hours: 1-5 h 45.8% (n = 161) 58.2% (n = 82) 6-15 h 27.1% (n = 96) 12.1% (n = 17) ≥16 h 27.1% (n = 96) 29.8% (n = 42) Facility characteristics Percent (n) Hospital type (n = 446): Maximum care 44.4% (n = 198) Standard care 40.6% (n = 181) Basic care 12.6% (n = 56) Specialized hospital 2.5% (n = 11) Number of employees (n = 446) 1-99 12.8% (n = 57) 100-499 29.4% (n = 131) ≥500 57.8% (n = 258) Type of surgical methods in the current work area (n = 446) Electrosurgery 99.8% (n = 445) Laser surgery 24.7% (n = 110) Outpatient facility: Type (n = 55) Practice/Surg. center 87.3 (n = 48) Practice clinic 5.5 (n = 3) Med.…”

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confidence: 99%

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

Michaelis

Hofmann

Nienhaus

et al. 2020

IJERPH

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(1) Background: Hazardous substances in surgical smoke that is generated during laser or electrosurgery pose a potential health hazard. In Germany, the Technical Rules for Hazardous Substances (TRGS 525) have included recommendations for appropriate protective measures since 2014. Up to now, no empirical data has been available on the extent to which recommendations have been implemented in practice. (2) Methods: In 2018, 7089 surgeons in hospitals and outpatient practices were invited by email to participate in an online survey. In addition, 219 technical assistants were interviewed. The questionnaire dealt with knowledge of, and attitudes toward, the hazard potential of surgical smoke, as well as the availability and actual use of protective measures. Furthermore, manufacturers and distributors of smoke extraction devices were asked to give their assessment of the development of prevention in recent years. (3) Results: The survey response rate was 5% (surgeons) and 65% (technical assistant staff). Half of all surgeons assumed that there were high health hazards of surgical smoke without taking protective measures. Operating room nurses were more often concerned (88%). Only a few felt properly informed about the topic. The TRGS recommendations had been read by a minority of the respondents. In total, 52% of hospital respondents and 65% of the respondents in outpatient facilities reported any type of special suction system to capture surgical smoke. One-fifth of respondents from hospitals reported that technical measures had improved since the introduction of the TRGS 525. Fifty-one percent of the surgeons in hospitals and 70% of the surgeons in outpatient facilities “mostly” or “always” paid attention to avoiding surgical smoke. The most important reason for non-compliance with recommendations was a lack of problem awareness or thoughtlessness. Twelve industrial interviewees who assessed the situation and the development of prevention in practice largely confirmed the prevention gaps observed; only slight developments were observed in recent years. (4) Conclusions: The low response rate among surgeons and the survey results both indicate a major lack of interest and knowledge. Among other measures, team interventions with advanced training are needed in the future.

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“…Smoke and bio-aerosols are routinely produced by surgical instruments including lasers, electrosurgical units, radiofrequency devices, ultrasonic devices and power tools. Plume and bio-aerosols contain odour-causing and odourless toxic gases and vapors such as benzene, hydrogen cyanide and formaldehyde, as well as dead and live cellular debris (including blood fragments), bacteria and viruses [1][2][3][4][5][6][7][8][9] . The risk of inhaling surgical smoke and bio-aerosols has been linked to headaches, respiratory problems, eye and skin irritation, infection 1,2 and mutagenic and carcinogenic potential in patients, perioperative nurses, anesthesiologists and other operating room personnel 1,4,[10][11][12] .…”

Section: Introductionmentioning

confidence: 99%

Recommended practices for the management of surgical smoke and bio-aerosols for perioperative nurses in Thailand

Asdornwised¹,

Pipatkulchai²,

Damnin³

et al. 2018

JOB

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Surgical plume and its implications: A review of the risk and barriers to a safe work place

Cited by 13 publications

References 30 publications

Safe surgical tracheostomy during the COVID-19 pandemic: A protocol based on experiences with Middle East Respiratory Syndrome and COVID-19 outbreaks in South Korea

Safe surgical tracheostomy during the COVID-19 pandemic: A protocol based on experiences with Middle East Respiratory Syndrome and COVID-19 outbreaks in South Korea

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

Recommended practices for the management of surgical smoke and bio-aerosols for perioperative nurses in Thailand

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