Hazards of Surgical Smoke

  • Know the hazards of surgical smoke exposure for health care personnel. Smoke may contain:

    • - gaseous toxic compounds

    • - bio-aerosols

    • - viruses

    • - viable cancer cells

    • - lung-damaging dust

    • - carbonized tissue

    • - blood fragments

    • - bacteria

  • Know the hazards of surgical smoke exposure for patients:

    • - loss of visibility of the surgical field

    • - port site metastasis

    • - carbon monoxide exposure

    • - increased levels of carboxyhemoglobin

  • Report health symptoms and effects associated with surgical smoke exposure.

Surgical smoke, a by-product of the use of energy-generating devices in surgery, contains many components that are recognized health hazards. Repeated exposure to surgical smoke may increase the possibility of developing adverse effects.

Surgical Smoke Evacuation

  • Use a smoke evacuation system (smoke evacuator, in-line filter) to evacuate all surgical smoke.

  • Use a smoke evacuator with a 0.1 μm filter (eg, an ultra-low particulate air filter) when surgical smoke is anticipated.

  • Evacuate small amounts of surgical smoke with a medical-surgical vacuum system (ie, wall suction) with a 0.1 μm in-line filter between the suction wall connection and the suction canister.

  • Use smoke evacuation units and accessories according to manufacturers' written instructions.

  • Position the capture device (eg, wand, tubing) of a smoke evacuation system as close to the surgical site as necessary to effectively evacuate all traces of surgical smoke.

  • Activate the smoke evacuation system at all times when surgical smoke is being generated.

  • Use the smoke evacuation system during minimally invasive procedures.

  • Handle used smoke evacuator filters, tubing, and wands using standard precautions.

  • Dispose of used filters, tubing, and wands as biohazardous waste.

Consistent use of smoke control measures can help establish a safe environment for the surgical patient and team members.

Personal Protective Equipment

  • Wear respiratory protective equipment as secondary protection against residual surgical smoke.

  • Wear a fit-tested N95 filtering face piece respirator during higher-risk, aerosol-generating procedures and procedures on patients with known or suspected aerosol transmissible diseases (eg, tuberculosis, varicella, rubeola).

  • Wear personal protective equipment (eg, gloves) when disposing of contaminated filters and smoke supplies.

Room ventilation and smoke evacuation are the first lines of defense against the hazards of surgical smoke. Personal protective equipment provides a secondary defense against smoke exposure.

Education and Competency

  • Participate in education and maintain competency on surgical smoke safety. Be able to:

    • - define surgical smoke

    • - describe critical factors for managing surgical smoke for all procedures that generate smoke

    • - identify sources of surgical smoke (eg, lasers, electrosurgical units, ultrasonic devices, high-speed drills, burrs, saws)

    • - explain the effect of particle size on the speed and distance smoke travels

    • - describe the health effects of smoke exposure on patients and health care workers

    • - select smoke evacuation systems and supplies in accordance with the procedure being performed

    • - test smoke evacuation equipment before the procedure

    • - connect equipment correctly

    • - use smoke evacuation equipment correctly during the procedure

    • - use standard precautions to handle used smoke evacuation supplies

    • - discard used smoke evacuation supplies as biohazardous waste

  • Participate in education about new smoke evacuators and accessories prior to their use.

  • Review policies and procedures related to smoke evacuation.

  • Participate in performance improvement activities related to the management of surgical smoke.

Initial and ongoing education facilitates the development of knowledge, skills, and attitudes that affect safe patient care and workplace safety. Competency verification activities help verify that perioperative team members understand the hazards of surgical smoke, evacuation methods, and proper equipment usage.