OR Manager - March 2020 - 7

Safety/Quality
Surgical smoke and bioaerosol evacuation
for surgery and invasive procedural areas
Policy: When surgical smoke (ie,
plume) is generated during operative
and other invasive procedures by
heat-producing instruments (electrosurgical
units, lasers, and ultrasonic
devices), the smoke will be captured
and filtered through the use of smoke
evacuators or inline filters positioned
on suction lines.
Purpose: To create an environment that
reduces the exposure of patients, patient
care staff, and providers to surgical smoke
and bioaerosols.
Required action step
1. Select an appropriate smoke evacuation device based on the
size of the smoke plume that is generated. Use an electrosurgical
unit pencil with integrated evacuation tubing for open procedures,
unless contraindicated.
Scope: This policy applies to any area providing
care to patients undergoing operative
or other invasive procedures where surgical
smoke can occur.
Definitions:
Bioaerosol: Tiny, airborne particle (such
as a fungal spore, pollen grain, endotoxin,
or particle of animal dander) that is composed
of or derived from biological matter.
Note: Bioaerosols can produce significant
health effects by spreading infectious
disease or triggering allergic responses or
respiratory irritation.
Performed by
Patient care staff
Surgical smoke: The gaseous products of
burning organic material created as a result
of the destruction of tissue by lasers, electrosurgical
units, ultrasonic devices, and other
heat-producing surgical tools. Surgical smoke
may contain toxic gases and vapors such as
benzene, hydrogen cyanide, formaldehyde,
bioaerosols, and dead and live cellular material,
including blood fragments and viruses.
Adapted from: SCL Health system policy:
Surgical smoke and bioaerosol evacuation
for surgery and invasive procedural
areas. Used with permission.
Supplemental guidance
Use a fluid trap on the evacuation unit to protect the filter from fluid.
For contraindicated procedures (low surgical smoke producing cases)
use a suction tubing connected to a dedicated surgical smoke evacuator
and place no greater than two inches from the source of smoke.
The smoke evacuator unit will have an ultra-low particulate air or high
efficiency particulate air filter with a minimum of 0.1 micron filter.
2. Use a closed, inline laparoscopic smoke evacuation tubing for
laparoscopic and robotic procedures.
3. Activate the smoke evacuator unit at all times when airborne
particles are produced.
4. Follow manufacturer instructions for use of the smoke evacuator
and associated devices.
5. Use appropriate personal protective equipment when handling used
devices, including filters.
Patient care staff,
providers
Patient care staff,
providers
Patient care staff,
providers
Patient care staff,
providers
6. Document use of surgical plume evacuation in the intraoperative record. Patient care staff,
providers
Staff evaluations of the pencils and
machines during the trials identified
potential barriers to implementing a
smoke-free policy.
They included:
* cost of smoke evacuation equipment
and supplies
* concern about noise generated by
evacuation equipment
* inconsistent use and availability of
current evacuation equipment
* concern about the time and work
needed to set it up
* objections from surgeons to the feel
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of the electrosurgical pencil with the
evacuation device attached.
After review of the evaluations and
trials by each hospital's OR managers,
two vendors were selected to provide
smoke-evacuation devices and equipment
to all eight hospitals.
Non-smoke-evacuation electrosurgical
unit pencils were removed from
surgical packs, and smoke-evacuation
pencils were placed on case carts.
The new systemwide smoke-free
policy and procedure was presented
to each hospital's OR committee, and
after going through several other administrative
levels was approved and implemented
(sidebar above).
Outside the OR
Though the policy was initially implemented
in the OR, it now applies to any
procedural area that may produce surgical
smoke. " This includes the cath lab,
L&D, and anywhere surgical smoke is
produced, " says Hedrick.
Colorado has passed legislation that
" requires each hospital with surgical
Continued on page 24
OR Manager | March 2020
7
This should allow for maintaining pneumoperitoneum as well as
evacuating smoke plume. The inline filter will have a 0.1 micron filter.

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OR Manager - March 2020

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