As far back as 1996, the National Institute for Occupational Safety and Health (NIOSH) identified surgical smoke as a hazard. In a survey fielded in 2011, NIOSH found that best practices to minimize exposure to surgical smoke had not been universally implemented and that local exhaust ventilation (LEV), a widely recommended engineering control, was not commonly used in surgical settings.
A number of countries around the world have enacted laws or regulations to eliminate or contain surgical smoke.
In Denmark, the Working Environment Act of 2010 makes it mandatory to implement a measurable setup for local evacuation of harmful substances such as surgical smoke. The setup must have a monitoring feature to indicate if the evacuation system’s suction is inadequate. The act specifies that surgical smoke should be removed with local evacuation and as close to the source as possible.
The Canadian Standards Association (CSA) developed and released a strongly worded standard that is being adopted provincially as regulation regarding the management of surgical plume. CSA Z305.13-13 relating to “plume scavenging in surgical, diagnostic, therapeutic, and aesthetic settings” details a comprehensive approach to managing plume that extends to all surgical settings based on risk assessment.
Other countries, including Australia, New Zealand and the UK, have also enacted regulations that carry the force of law to protect surgical workers from surgical smoke. But the U.S. Department of Labor, Occupational Safety and Health Administration (OSHA) has yet to mandate the removal of surgical smoke from ORs.
It’s not as though U.S. regulatory authorities are unaware of the hazard surgical smoke presents or ways to minimize/eliminate it. The Centers for Disease Control (CDC) has recommended a number of best practices,* including:
- Employers should use LEV for all procedures where surgical smoke is generated. Smoke evacuators should be used in situations where considerable plume is generated.
- Surgical staff should be educated about the hazards of surgical smoke and trained on methods to minimize exposure prior to working in areas where surgical smoke is generated.
And the Association of periOperative Registered Nurses (AORN) in its 2017 AORN Guideline for Surgical Smoke Safety recommended the following:
- “The health care organization should provide a surgical smoke free environment.”
- “The perioperative team should evacuate all surgical smoke.”
- “The collective evidence, standards, and guidelines from NIOSH, the Healthcare Infection Control Practices Advisory Committee, and professional organizations indicates that evacuating surgical smoke protects patients and health care workers from the hazards of surgical smoke.”
On a number of occasions OSHA has reiterated that the management of surgical smoke is a healthcare worker safety issue. OSHA has indicated that plume hazards fall under the scope of the General Duty clause and the Personal Protective Equipment (PPE) statement, which states that controlling a hazard at its source is the best way to protect employees
But so far, OSHA has not set standards or adopted regulations to protect healthcare personnel and patients from surgical plume or mandated the use of surgical smoke evacuation equipment in health care facilities throughout the country.
Is the U.S. lagging behind other countries in addressing this known peril? If so, maybe it’s time to take a hard look at U.S. policy and regulations.
# # #
*These CDC recommendations are based on the above-cited NIOSH survey and were last reviewed and updated on March 30, 2017.