The hazard of surgical plume
What is surgical plume?
Surgical plume is the vaporous plume resulting from surgical intervention involving the use of an electrocautery device on tissue, using a heated surgical instrument to stop bleeding or remove a growth. The resulting plume, or surgical smoke, is a noxious and odorous by-product that contains both organic and inorganic matter. Surgical smoke in the operating room can also obscure visibility into the operative site, which could conceivably lead to greater risk to patient safety.
Surgical plume can be carcinogenic and can spread infection. To reduce the risk surgical plume poses, hospitals should introduce surgical smoke evacuation guidelines and introduce surgical safety technologies to safeguard the health of their surgical staff.
Types of surgical plume
The plume falls into two categories, those being chemical and those being bacteriological, of which both have their own health risks. Chemical matter is more likely to be smaller particles, whereas biological matter of larger size particles, however both are potential hazards to health. Surgical plume can contain carbons, hydrocarbons, viral particles, additionally toxic gases, cellular debris, blood borne products, carcinogens and numerous noxious substances like Benzene, Toluene and Formaldehyde.
How are healthcare professionals exposed? What is the risk?
When thermal energy devices are used, cellular disruption occurs. As a result, this produces a vaporous plume, which rises into the surrounding area and spreads throughout the entire room. The staff are exposed to significant risk levels, which have been likened to cigarette smoking.
Some suggest only 1 gram of surgical plume is equivalent in toxicity terms to smoking between 3 to 6 cigarettes1. In the OR, it would be reasonable to suggest that several grams of surgical plume are produced during the average surgical procedure. Based on the assumption during the average working day of 5 operative procedures involving thermal energy, healthcare professionals may be unwittingly exposed to the equivalent of smoking at least 20-30 cigarettes per day. Of course, smoking cigarettes is a lifestyle choice, whereas healthcare professionals would not necessarily choose to be exposed in this manner.
Why has there not been more widespread adoption of surgical plume evacuation devices to date?
Possibly, a lack of awareness of the dangers present in surgical plume has led to indifference to the need to remove surgical smoke. Also many of these exposure elements may not present until later in life, perhaps beyond the ability to collate data from individuals. Any suggestions therefore of morbidity or mortality due to surgical plume exposure remain subjective.
In addition, there have been some limitations in the solutions previously offered. Surgeons have complained that solutions have been ‘too noisy’, causing unnecessary distractions or that the ‘hand switch plume pencils are far too bulky and cumbersome’.
Finally, a new solution, that addresses these concerns, is in your hands.
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References
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Bree K, et al (2017). The Dangers of Electrosurgical Smoke to Operating Room Personnel. A Review. Workplace Health & Safety, Vol 65, No. 11
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