WHAT IS SURGICAL SMOKE PLUME?

Surgical smoke plume is a potentially dangerous byproduct generated from the use of energy-based
devices such as laser and electrosurgical units.These devices cause tissue to vaporise and expel
into the air, which is then inhaled by both the patient and clinicians. Approx. 95% of all surgical procedures produce some form of surgical plume. (Surgical Smoke Plume – Connecting The Dots, 2011).

WHAT ARE THE IMPLICATIONS OF SURGICAL SMOKE PLUME?

During electrosurgery, bacteria and viruses, along with a host of chemicals and toxins are released into the air through smoke plume. This plume contains particles of different natures and varying sizes. The smallest tend to be viruses and travel deepest into the human body.

If a surgical smoke evacuator is not used, these particles are inhaled by anyone nearby and will carry any bacterial and viral pathogens directly into the respiratory system. Toxins known to be in smoke plume are benzene, carbon monoxide, formaldehyde, hydrogen cyanide, methane, phenol, styrene and toluene.

Human papillomavirus (HPV) has often been linked to transmission through surgical smoke. Several case studies discuss perioperative professionals working with lasers and electrosurgery devices who have presented with cancerous masses along the airway that are positive for HPV (Surgical Smoke Transmits Infectious Diseases; Here’s How to Stop It, Martha Stratton, 2017).

WHO IS AT RISK?

Both the clinical staff and the patient within the operating room are at risk from surgical smoke plume. It can however reach far beyond the operating room, putting others at risk as well. Particle concentration in the operating room can rapidly increase within five minutes after the use of electrosurgical devices has begun. Measured 3 meters away from the surgical site, the level of ultrafine particles is between 15% and 30% of the level measured within the breathing area of the surgeon. The high concentration level remains, both during and after the procedure has taken place.

WHAT ARE THE GUIDELINES?

The Control of Substances Hazardous to Health Regulations (COSHH – 2002) require that exposure to substances hazardous to health, such as surgical smoke plume, are adequately controlled to prevent ill-health. The HSE (Health and Safety Executive) and NICE (National Institute for Health and Care Excellence) advise that in order to lower the risks caused by surgical smoke plume a smoke evacuation system, such as the Acu-Evac, should be used. The NATN (National Association of Theatre Nurses), state that dedicated smoke evacuators must be used and the filters checked and changed regularly. They also suggest high filtration face masks should be worn to minimise the inhalation of carbonaceous particles. There are a huge number of clinical papers to support the value of investing in a smoke evacuation unit, outlining the short term and long term implictions which have been linked directly to smoke plume inhilation. Many of these papers are suported by respected medical  associations who highly recommend the use of smoke evacuation systems.

HOW CAN IT BE CONTROLLED?

Smoke evacuation units, such as the Acu-Evac, form a very effective solution for evacuation of electrosurgical smoke. As well as eliminating unpleasant odours associated with laser and

electrosurgery, the Acu-Evac is designed to remove surgical smoke plume which may contain hazardous bio-aerosols and live and dead cellular matter including blood fragments and viruses. Using a smoke evacuation system will significantly reduce the concentration of surgical smoke in the operating room, posing less risk of contaminated air lingering in the operating room and spreading outside the theatre. The Acu-Evac filters are designed with charcoal/odour filter and ULPA (Ultra Low Penetration Air) filter technology – rated at 99.99997% efficiency in neutralizing particles between 0.01 and 0.12 μm (micron).