S.A.F.E.T.Y First - Eliminating Surgical Smoke

Healthcare and surgical innovation have radically changed the face of medicine in relatively short historical terms. Consider this: Until around 1885, a person with appendicitis was expected to die of the infection that occurred once the appendix ruptured. Now, not only is appendectomy a common surgery with very positive patient outcomes, other successes we may now take for granted include the discovery of antibiotics, organ transplants, and many thousands of robotic-assisted surgeries since the first one took place in 1985. Clearly, a lot can change in 100 years.

Alongside scientific advancement and progress though, unsought consequences can occur. Laser surgery, laparoscopic surgery and electrosurgical techniques—now routine—are still somewhat new in the context of the history of surgery. These are also the techniques that are the cause of what is called surgical smoke.

For people who work in the operating room—an estimated half million annually—the exposure to surgical smoke has several deleterious effects. Acute health effects of surgical smoke include eye, nose and throat irritation, headache, cough, congestion, bronchitis, asthma and other respiratory issues.

Marianne Stallings – BSN, RN, CNOR, is not only very aware of surgical smoke and its impacts, she is actively implementing solutions in her role as the professional development educator for perioperative services at Valley View Hospital. (Perioperative is a term used to describe three distinct phases of any surgical procedure, which includes the preoperative phase, the intraoperative phase, and the postoperative phase.)

Marianne explains that surgical smoke is produced by the thermal destruction of tissue by cauterization. Its effects are undesirable because it can obstruct the surgeon’s view of the surgical site, and it’s been shown to contain toxic gases, vapors, particulates, viruses, bacteria and 40+ carcinogenic compounds.

“The hospital is a tobacco-smoke-free facility, of course,” says Marianne. “So, it was natural for our team to want to eliminate surgical smoke, too.”

In her position, Marianne stays up to date with best practices in all aspects of surgery and then works to remedy any gaps. And that includes the operating room (OR), recovery room, procedures department and day surgery.

In 2017, Marianne led smoke evacuation trials in the Valley View OR. Surgeons in several disciplines tested devices to eliminate surgical smoke through suction and mitigation and ultimately two devices were selected.

Marianne stewarded the process of staff education, literature review, and ultimately the adoption of a new policy consistent with the recommendation of the Association of periOperative Registered Nurses (AORN), a governing body based in Denver.

As a nod to her work and study in this realm, Marianne and her team were invited to present to the Valley View Evidence-Based Practice Symposium, and then were voted by peers to present further. They gave a podium presentation at the 31st annual Rocky Mountain Inter-Professional Research and Practice-Based Symposium in April 2019, and later that month, were invited to make an AORN chapter poster presentation.

Marianne explains that the effects of surgical smoke have been studied since the 1980s, but it was just recently in March 2019 that Colorado passed a law, HB 18-1399, to create policy around surgical smoke. The law has specific regulations for surgical smoke that must be in place in all Colorado operating rooms by May 1, 2021. Colorado was second in the nation, behind Rhode Island, to pursue this type of legislation.

Well ahead of the state mandate, the process to eliminate the risks of surgical smoke at Valley View was a multi-discipline undertaking that included administration, surgeons, medical staff, and other departments. Tasks ranged from ordering supplies to changing documentation; auditing activity to compliance review.

“We had some surgeons and anesthesiologists who took a leadership role in making the necessary changes,” says Marianne. “The major thing was education for all and communication with everyone. Making changes isn’t always easy, and our staff was very open. In the end it was a large team effort with many people involved and working behind the scenes to make it successful.”