Description: Surgical Smoke Evacuation Clinical Problem/Significance: OSHA estimates 500,000 surgical health workers are exposed to surgical smoke (SS) each day. SS contains gaseous cytotoxic compounds, bio-aerosols, and live and dead cellular material. While the hazards are known, smoke evacuation remained a challenge at our facility. Lack of administrative protocols, education, and equipment are contributing factors.
Background: Nurses at Providence St Vincent became aware that best practices for surgical smoke evacuation were not being followed in their facility. SS is the by-product of surgical energy generating equipment used to desiccate tissue, including electrosurgical units, lasers, and ultrasonic devices. The hazards of SS include increased chronic respiratory illnesses, headaches, watery eyes, nausea, and fatigue. SS containing chemicals, cellular material, viruses, and ultrafine particles are distributed throughout the OR adversely affecting everyone in the room. Clinical Question: How will we implement culture change for perioperative team members and increase available smoke evacuation supplies to decrease surgical smoke in the OR? Description of Evidence based protocol: Local elimination of SS is proven to reduce the number of chemicals, cellular material, viruses, and ultrafine particles in the surgical environment. Creating policy that clearly states this to be our evidence-based practice; using the appropriate SS elimination devices, and local evacuation of SS where it is generated, every time, in addition to room air exchange. Implementation of Evidence Based Protocol: We enrolled in the Go Clear program through AORN. We did a gap analysis to get a baseline understanding of equipment deficits. Stake holders identified and engaged for support included administration, physicians and staff nurses. Policy was updated. Staff were given a pretest to determine baseline knowledge, in-service time for completion of learning modules, and post-test administration measured improvement. Equipment was trialed to determine surgeon preferences and preference cards were updated. Staff were trained on all smoke evacuation equipment.
Results: Post- tests revealed that 100% of participants received a grade 80% or higher. Smoke evacuators increased from 2 to 28 for a ratio > 1 machine for every 2 OR suites. In-line filters increased by 100% as not previously used. Our facility was awarded a silver recognition award from the Go Clear Program through AORN.
Conclusions: By educating perioperative staff on hazards of surgical smoke and providing smoke evacuation products, staff were able to increase compliance of smoke evacuation. Surgical smoke in the OR. is reduced and health and safety for perioperative team and patients increased. Ongoing education and advocacy ensure that we create a culture change to eliminate SS where it is generated. The healthier work environment positively affects patient and staff.