The Compliance Conundrum

It is well known that surgical smoke can contain toxic gases and vapors such as hydrogen cyanide, benzene, and formaldehyde, as well as living and dead cellular material (including blood particles), and viruses. At high concentrations, surgical plume causes upper respiratory tract irritation in OR staff and creates visual difficulty for surgeons. Smoke from cauterized tissue has an unpleasant odor and has even been shown to have mutagenic potential.

While there’s no question that surgical smoke jeopardizes the health, safety and comfort of OR personnel, compliance with current standards and guidelines designed to protect surgeons, techs and nurses fluctuates widely.

Reasons for non-compliance and non-adherence to industry best practices vary. In some cases, smoke evacuation equipment is obsolete or unavailable due to cost. Some surgeons feel that smoke evacuators are noisy and distracting in the OR and they prefer to work without them. In some instances, nurses, techs and scrub staff are complacent about the status quo or do not feel empowered to lobby for a safer working environment.

Federal regulations require all employers, including hospitals and clinics, to provide a safe working environment for their employees, and this includes non‐contaminated air to breathe. Clearly, a smoke‐filled operating room which harbors irritants and potential pathogens is not a safe working environment.

Although there are currently no specific OSHA standards for laser/electrosurgery plume hazards, ORs in the U.S. must comply with other workplace safety mandates imposed by OSHA through the Blood Bourne Pathogen Rule.  Moreover, it is strongly recommended that facilities adhere to guidelines and recommendations of reputable industry organizations, such as AORN, which advocate for evacuation of surgical plume from the operating room because of the potentially infectious elements and mutagenic/carcinogenic chemicals present in plume.

Each year, an estimated 500,000 workers, including surgeons, nurses, anesthesiologists, and surgical technologists, are exposed to laser or electrosurgical smoke. Studies indicate that poor air quality results in increased absenteeism and decreased productivity. (Consider that the incidence of respiratory illnesses in perioperative nurses is twice that found in the general U.S. population.) Clean air is fundamental to a safe, healthy working environment – and has the added benefit of lowering absenteeism and saving manpower costs for the surgical facility.

Workers have a right to a safe workplace. The law requires employers to provide their employees with safe and healthful workplaces. And safe, effective evacuation of surgical smoke from ORs is a no-brainer in this regard.

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