Surgical Plume and Its Implications: A Review of the Risk and Barriers to a Safe Workplace
Abstract
Every year thousands of health care professionals worldwide are exposed to surgical smoke. There is evidence that this smoke consists of toxic gases, pathogens and particulate matter that is a hazard for patients and the perioperative team. Past research indicates that perioperative staff inconsistently comply with smoke evacuation recommendations. The aim of this study was to identify, review and discuss the issues related to surgical plume and its implications for patients and perioperative staff. The findings of this review relate to surgical smoke content, its risks to the health of the perioperative staff, preventative measures, infection control measures, compliance with smoke evacuation systems, staff knowledge and barriers to implementing smoke evacuation practices. Of particular importance, the literature indicated that strong support from management and the implementation of regular staff education could improve practice for the management of surgical plume in the operating theatre.
References
Discover the reasons for a surgical
smoke free zone [Internet].
Lancaster: Buffalo Filter [cited
July 30]. Available from
www.buffalofilter.com/educationarticles/.
Ulmer BC. The hazards of surgical
smoke. AORN J 2008;87(4):721–
Ball, K. Update for anesthetic
nurses. Part 1. The hazards of
surgical smoke. AANA J
;69(2):125–132.
Buffalo Filter. Why is surgical
smoke plume so hazardous?
[Internet]. Lancaster: Buffalo Filter
[cited 2015 July 30]. Available
from: www.buffalofilter.com/
files/7914/1443/3525/Website
_Training__Education_Section
_10_27_2014.pdf
Spearman J, Tsavellas G, Nichols P.
Current attitudes and practices
towards diathermy smoke. Ann R
Coll Surg Eng 2007;89(2):162–
Lynch J. The ABCs of surgical
smoke plume [Internet]. Surgical
products; 2009 [cited 2015 July
. Available from
www.surgicalproductsmag.com/
news/2009/abcssurgical-smokeplume.
Mowbray N, Ansell J, Warren N,
Wall P, Torkington J. Is surgical
smoke harmful to theater staff? A
systematic review. Surg Endosc
;27(9):3100–3107.
Association of Perioperative
Practice (AfPP). Surgical smoke:
What we know [Internet].
Harrogate: AfPP); 2009 [cited
July 30]. Available from
http://www.afpp.org.uk/filegrab/
smokeplume-Final1.pdf?ref=1112.
Benson SM, Novak DA, Ogg MJ.
Proper use of surgical N95
respirators and surgical masks in
the OR. AORN J 2013;97(4):457–
Lewin JM, Brauer JA, Ostad A.
Surgical smoke and the
dermatologist. J Am Acad
Dermatol 2011;
(3)636–641.
Romig CL, Smalley PJ. Regulation
of surgical smoke plume. AORN J
;65(4):824–828.
Alp E, Bijl D, Bleichrodt RP,
Hansson B, Voss, A. Surgical
smoke and infection control. J
Hosp Infect 2006;62(1):1–5.
Carbajo-Rodriguez H, Aguayo-
Albasini JL, Soria-Aledo V, Garcia-
Lopez C. Surgical smoke: Risks
and preventive measures. Cir Esp
;85(5):274–279.
Fan JKM, Chan FSY, Chu KM.
Surgical smoke. Asian J Surg
;39(4):253–7.
Ball, K. Controlling surgical
smoke: A team approach. IC
Medical Inc Informational Booklet
n.d.
Polit DF, Beck CT. Essentials of
Nursing Research: Methods,
Appraisal, and Utilization. 6th ed.
Philadelphia: Lippincott Williams
& Wilkins; 2006.
Campbell Collaboration. What is a
systematic review? [Internet]. Oslo:
Campbell Collaboration; 2017
[cited 2017 March 29]. Available
from www.campbellcollaboration.
org/researchresources/writing-acampbell-
systematicreview/
systemic-review.html.
Cochrane Consumer Network.
What is a systematic review? [
Internet]. London: Cochrane
Consumer Network; 2017 [cited
March 29]. Available from
http://consumers.cochrane.org/
whatsystematic-review.
Hill DS, O’Neill JK, Powell RJ,
Oliver, DW. Surgical smoke – A
health hazard in the operating
theatre: A study to quantify
exposure and a survey of the use of
smoke extractor systems in UK
plastic surgery units. J Plast
Reconstr Aesthet Surg
;65(7):911–916.
Nascent Surgical. Prioritizing
Surgical Plume [Internet]. Eden
Prairie; Nascent Surgical; 2017
[cited 2017 Feb 16]. Available
from http://nascentsurgical.com/
surgicalsmoke/prioritizing-surgicalplume/.
Baggish MS, Baltoyannis P, Sze E.
Protection of the rat lung from the
harmful effects of laser smoke.
Lasers Surg Med 1988;8(3):248–
Bigony L. Risks associated with
exposure to surgical smoke plume:
A review of the literature. AORN J
;86(6):1013–1020.
Rimmer, V. Diathermy smoke
plume: why do we put up with it? J
Perioper Pract 2009;19(12):424–
Weld KJ, Dryer S, Ames CD, Cho
K, Hogan C, Lee M et al. Analysis
of surgical smoke produced by
various energy-based instruments
and effect on laparoscopic
visibility. J Endourol
;21(3):347–351.
Matthews S. Preventing harm from
surgical plume. Kai Tiaki: Nursing
New Zealand 2016;22(6):26–27.
Management of surgical smoke tool
kit: Surgical smoke evacuation
(part IV) [Internet]. Denver:
Association of Perioperative
Registered Nurses (AORN); [cited
April 20]. Available from
www.aorn.org/guidelines/clinicalresources/
tool-kits/management-ofsurgical-
smoketool-kit.
Karsai S, Daschlein G. ‘Smoking
guns’: Hazards generated by laser
and electrocautery smoke. J Dtsch
Dermatol Ges. 2012;10(9):633–636.
Scott E, Beswick A, Wakefield, K.
The hazards of diathermy plume.
Br J Perioper Nurs
;14(9):409–414.
Walczak DA, Grobelski B, Pasieka
Z. ‘There is no smoke without a
fire’ - Surgical smoke and the risk
connected with it. Pol Przegl Chir
;83(11):634–639.
SURGICAL PLUME (cont.)
Kwak HD, Kim SH, Seo YS, Song
KJ. Detecting hepatitis B virus in
surgical smoke emitted during
laparoscopic surgery. Occup
Environ Med 2016;73(12):857–
Management of surgical smoke tool
kit: Additional perioperative
nursing care (part V) [Internet].
Denver: Association of
Perioperative Registered Nurses
(AORN); [cited 2017 April 20].
Available from
www.aorn.org/guidelines/clinicalresources/
tool-kits/management-ofsurgical-
smoketool-kit.
King CA. Health care worker safety
in surgery. AORN J
;94(5):457–468.
Lindsey C, Hutchinson M, Mellor
G. The nature and hazards of
diathermy plumes: A review.
AORN J 2015;101(4):
–442.
Edwards BE, Reiman RE.
Comparison of current and past
surgical smoke control practices.
AORN J 2012;95(3):337–350.
Case study: protection of
healthcare staff from surgical
smoke in operating theatres.
Sutton: Tregoning C; 2015 [cited
March 21]. Available from
www.personneltoday.com/hr/casestudy-
protection-ofhealthcare-staff
-from-surgical-smoke-inoperatingtheatres/.
Khoshdel H, Amouzeshi A,
Amouzeshi Z, Unesi Z. Surgical
team knowledge about
electrocautery smoke
complications in the educational
hospitals in Birjand, 2011 Journal
of Surgery and Trauma,
;2(1):17–20.
Kang E, Gillespie BM, Massey D.
What are the non-technical skills
used by scrub nurses?: An
integrated review. ACORN
;27(4):16–25.
Criscitelli, T. Human factors
engineering: Its place and potential
in OR safety. AORN J
;101:571–573.
Smalley P, Cubitt J. Clear air in
surgery – a new ACORN initiative.
ACORN 2015;28(3):38–39.
Marsh S. The smoke factor: things
you should know. J Perioper Pract
;22(3):91–94.
Battie R, Steelman VM.
Accountability in nursing practice:
Why it is important for patient
safety. AORN J 2014;100(5):537–
Davies M, Shaw E. Safer
Australian surgical teamwork – a
multidisciplinary human factors
project. ACORN 201;
(4):42–44.
Sinnott MJ, Eley RM. Staff safety
first – a priority in the operating
room. ACORN 2015;
(2):8–11.
Ball, K. Compliance with surgical
smoke evacuation guidelines:
implications for practice. AORN J
;92(2):142–149.
Chavis S, Becker M, Jamias MS.
Clearing the air about surgical
smoke: An education program.
AORN J 2016;103(3):289–296.
Dawes BSG. Stop smoke campaign
begins with you. AORN J
;72(5):768–770.
Giordano BP. Don’t be a victim of
surgical smoke. AORN J
;63(3)520–522.
Steege AL, Boiano JM, Sweeney
MH. Secondhand smoke in the
operating room? Precautionary
practices lacking for surgical
smoke. Am J Ind Med
;59(11):1020–1031.
Holmes S. Factors affecting
surgical plume evacuation
compliance. ACORN
;29(4):39–42.
Ball, K. Surgical smoke evacuation
guidelines: compliance among
perioperative nurse. AORN J
;92(2):e1-e23.
Duff J, Butler M, Davies M,
Williams R, Carlile J. Perioperative
nurses’ knowledge, practice,
attitude, and perceived barriers to
evidence use: A multisite, crosssectional
survey. ACORN J
;27(4):28–35.
Duff J, Butler M, Davies M,
Williams R, Carlile J. Factors that
predict evidence use by Australian
perioperative nurses. ACORN
;29(2):24–29.
Gillespie, BM. ACORN: Promoting
an evidence-based culture through
recognition of the contribution
of research to perioperative
practice. ACORN 2014;
(3):4–5.
Waddell AW. Cultivating quality:
implementing surgical smoke
evacuation in the operating room.
Am J Nurs 2010;110(1)54–58.
Association of Perioperative
Registered Nurses (AORN).
‘Recommended practices for
electrosurgery’ in Perioperative
standards and recommended
practices, pp. 134–135. AORN
Association of Perioperative
Registered Nurses (AORN).
‘Recommended practices for laser
safety in perioperative settings’ in
Perioperative standards and
recommended practices, pp. 147–
AORN 2013.
Association of Perioperative
Registered Nurses (AORN).
‘Recommended practices for
minimally invasive surgery’ in
Perioperative standards and
recommended practices, p. 168.
AORN 2013.
