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Exposure to surgical smoke is an anticipated risk for perioperative team members in all operating room. OR practice settings The hazards of surgical smoke in the OR have received increased attention due to. the escalating use of various energy modalities such as electrosurgery lasers and ultrasonic devices. all of which generate smoke plume Moreover the smoke generated from these devices has been. found to contain toxic gases and vapors bioaerosols and viruses which in high concentrations can. lead to adverse health conditions Therefore all members of the perioperative team should be aware. of the concerns related to surgical smoke in the OR and the need to implement effective strategies to. minimize the associated hazards respiratory protection is one measure to protect OR personnel This. continuing education activity will present a review of the risks associated with exposure to surgical. smoke The contents of surgical smoke as well as the potential respiratory hazards will be discussed. Surgical masks and surgical N95 respirators will be differentiated in terms of respiratory protection. The recommendations for appropriate use of a surgical N95 respirator for respiratory protection. will be outlined,LEARNER OBJECTIVES, Upon completion of this continuing education activity the participant should be able to. 1 Discuss the risks associated with surgical smoke. 2 Discuss the airborne contaminates and respiratory hazards of surgical smoke. 3 Explain the differences between surgical masks and surgical N95 respirators. 4 Identify when the use of a surgical N95 respirator is recommended. INTENDED AUDIENCE, The information contained in this self study guidebook is intended for use by healthcare professionals. who are responsible for or involved in the following activities related to this topic. Educating healthcare personnel, Establishing institutional or departmental policies and procedures. Decision making responsibilities for safety and infection prevention products. Maintaining regulatory compliance, Managing employee health and infection prevention services. INSTRUCTIONS, Ansell Healthcare is a provider approved by the California Board of Registered Nursing Provider CEP.
15538 for 2 two contact hours Obtaining full credit for this offering depends on completion of the self. study materials on line as directed below, Approval refers to recognition of educational activities only and does not imply endorsement of any product. or company displayed in any form during the educational activity. To receive contact hours for this program please go to the Program Tests area and complete the post. test You will receive your certificate via email, AN 85 PASSING SCORE IS REQUIRED FOR SUCCESSFUL COMPLETION. Any learner who does not successfully complete the post test will be notified and given an opportunity to. resubmit for certification, RESPIRATORY For more information about our educational programs or perioperative safety solution topics please contact. Ansell Healthcare Educational Services at 1 732 345 2162 or e mail us at edu ansellhealthcare com. Planning Committee Members,PROTECTION Roger Huckfeldt MD. Luce Ouellet BSN RN,Latisha Richardson MSN BSN RN,Patty Taylor BA RN.
IN SURGERY Pamela Werner MBA BSN RN CNOR, As employees of Ansell Mrs Ouellet Mrs Richardson Mrs Taylor and Ms Werner have declared an affiliation that could be perceived. as posing a potential conflict of interest with development of this self study module As a consultant for Ansell Dr Huckfeldt has. declared an affiliation that could be perceived as posing a potential conflict of interest with development of this study guide. TABLE OF CONTENTS,OVERVIEW 2,INTRODUCTION 4,RISKS ASSOCIATED. WITH SURGICAL SMOKE 6,DIFFERENCES BETWEEN SURGICAL MASKS. AND SURGICAL N95 RESPIRATORS 11,HYBRID HIGH FILTRATION N95. RESPIRATOR AND SURGICAL MASK 13,GLOSSARY 18,REFERENCES 20.
INTRODUCTION, The inherent nature of the surgical practice setting places staff. members at greater risk for occupational exposure to infectious. agents The number of surgical procedures performed continues. to rise as invasive procedures are being performed in clinics and. physician offices in addition to hospitals and ambulatory surgery. centers 1 Smoke is present in any operating room OR environment. where procedures are performed with the use of heat producing. devices eg electrosurgery units lasers ultrasonic devices and. high speed drills burrs and saws to achieve a desired tissue. effect ie hemostasis or tissue dissection 2 As the use of these. devices continues to increase to support contemporary surgical. techniques there is a corresponding increase in exposure to the. smoke generated during these procedures which poses certain. health risks Approximately 90 of both open and endoscopic. procedures generate some level of surgical smoke 3. Surgical smoke use has been found to contain toxic gases. and vapors bioaerosols and viruses all of which in high. concentrations can cause adverse health conditions In. today s dynamic healthcare environment reducing the risk for. transmission of infectious agents and other adverse events. remains a primary focus for the perioperative team especially. in the face of newly recognized pathogens and microorganisms. that have become resistant to current treatment modalities 4. RESPIRATORY,PROTECTION,IN SURGERY, The term surgical smoke is used to describe any gaseous by. product that contains bioaerosols including viable and non. viable cellular material however in the medical literature the. terms plume and aerosol are also used to describe this gaseous. by product 5 6 The qualities of surgical smoke produced by. electrosurgery and laser energy modalities are very similar. Furthermore both electrosurgery and laser systems generate. smoke by the same mechanism during the procedure ie. cutting coagulating vaporizing or ablating tissue the targeted. cells are heated to the point of boiling which causes the. membranes to rupture and disperse fine particles into the air or. pneumoperitoneum during laparoscopic procedures The by. product that results from the use of ultrasonic scalpels is often. referred to as plume aerosol or vapor The use of ultrasonic. energy produces aerosols without a heating ie burning process. which is generally referred to as low temperature vaporization. however this low temperature vapor generally has a greater. chance of carrying viable and infectious particles than higher. temperature aerosols, It is estimated that every year 500 000 healthcare workers. HCWs in the OR including surgeons anesthesia providers. nurses and surgical technologists are exposed to electrosurgical. or laser smoke 7 Effective respiratory protection is one measure. to reduce the risk of occupational exposure to surgical smoke. and its associated hazards,RISKS ASSOCIATED WITH,SURGICAL SMOKE. Research conducted over the past several decades demonstrates. that surgical smoke can transmit disease A study that quantified. the toxic compounds present in surgical smoke found the. presence of irritant carcinogenic and neurotoxic compounds in. electrosurgical smoke which may have significant implications. for the health and safety of personnel involved in surgical. procedures 8, In a research study designed to evaluate the potential for.
disease transmission through plume released from virally. infected tissue exposed to a carbon dioxide laser the collected. laser plume was shown to contain papillomavirus DNA is all. tested laser settings 9 The results of an earlier study conducted. to determine if viable malignant cells are present in suspension. within the electrocautery plume confirmed that the application. of electrocautery to a pellet of melanoma cells releases these. cells into the plume furthermore these cells are viable and may. be grown in culture 10 This release of malignant cells may explain. the appearance of port metastases at sites that are remote from. the surgical dissection or that were never in direct contact with. Generally within five minutes of using electrosurgery during a. procedure particulate matter in the immediate area increases. from a baseline measurement of approximately 60 000. particles per cubic foot to over one million particles per cubic. foot 11 In addition it takes the typical OR air handling system. approximately 20 minutes to return particle concentrations to. normal after the procedure has been completed,RESPIRATORY. PROTECTION,IN SURGERY, An early study comparing smoke condensates induced by the Surgical smoke can be seen and also smelled both the visible. use of CO2 laser and electrosurgery demonstrated that the and the odorous components of surgical smoke are the gaseous. total mutagenic potency observed was comparable to that of by products of the disruption and vaporization of tissue protein. cigarette smoke and fat 13 Surgical smoke is comprised of 95 water or steam. and 5 cellular debris in the form of particulate matter which. Using the CO2 laser on one gram of tissue is like inhaling contains chemicals blood and tissue particles intact viruses. the smoke from three unfiltered cigarettes in 15 minutes 12 and intact bacteria The water itself is not harmful however. it acts as a carrier for particulate matter contained in surgical. Using electrosurgery on one gram of tissue is like inhaling smoke The concentration of these by products produced during. smoke from six unfiltered cigarettes in 15 minutes pyrolysis depends on the type of tissue power density and. length of time the energy is used on the tissue,AIRBORNE CONTAMINATES OF. SURGICAL SMOKE Since the mid 1970s as the body of evidence documenting the. hazardous components of surgical smoke has continued to grow. the chemical composition of surgical smoke has also been well. documented see Table 1 14 As noted above surgical smoke. contains chemicals and chemical by products similar to other. smoke plumes eg cigarette smoke including benzene carbon. monoxide CO formaldehyde hydrogen cyanide methane, phenol styrene and toluene these by products also are known. to be carcinogenic,Table 1 Chemical Contents of Surgical Smoke15.
Acetonitrile 1 Decene 4 Methly phenol,Acetylene 2 3 Dihydro indene 2 Methyl propanol. Acroloin Ethane Methyl pyrazine,Acrylonitrile Ethyl benzene Phenol. Alkyl benzene Ethylene Propene,Benzaldehyde Formaldehyde 2 Propylene nitrile. Benzene Furfural Pyridine,Benzonitrile Hexadecanoic acid Pyrrole. Butadiene Styrene Hydrogen cyanide Styrene,Butene Indole Toluene.
3 Butenenitrile Methane 1 Undecene,Carbon dioxide 2 Methyl butenal Xylene. Creosol 6 Methyl indole, The most prominent chemicals found in electrosurgery smoke. are hydrocarbons phenols nitriles and fatty acids 16 Of these. chemicals acrylonitrile hydrogen cyanide and benzene are of. great concern as follows 17 18, Acrylonitrile is a volatile colorless chemical which can. be absorbed through the skin and lungs it also releases. hydrogencyanide, Hydrogen cyanide is toxic and colorless and can also. be absorbed into the lungs and through the skin and. gastrointestinal tract, Benzene is documented as being a trigger for leukemia.
therefore the Occupational Safety and Health,Administration OSHA mandates permissible exposure. limits PELs to protect workers from the hazards,associated with inhaling benzene. RESPIRATORY,PROTECTION,IN SURGERY, RESPIRATORY AND HEALTH HAZARDS In addition to respiratory problems after repeated exposures. ASSOCIATED WITH SURGICAL SMOKE to surgical smoke perioperative staff members have reported. signs and symptoms that include burning and watery eyes. In the past perioperative personnel may have believed that nausea and headaches 22. surgical smoke is not dangerous however over the years. there has been greater interest in defining the specific hazards Table 2 lists the potential health hazards associated with. associate with surgical smoke 19 While there are no mandatory exposure to surgical smoke. regulations in the United States for evacuation of surgical. smoke the voluntary standards from professional organizations. and other studies clearly indicate that a potential danger exists Table 2 Potential Health Hazards of Surgical Smoke 23. if personnel continuously inhale the substances contained in Acute and chronic inflammatory respiratory changes ie. surgical smoke asthma chronic bronchitis emphysema. As early as 1996 the National Institute for Occupational Safety. and Health NIOSH recognized the hazards of surgical smoke Anxiety. when it released a hazard control report outlining that at high Carcinoma. concentrations smoke generated by electrosurgical or laser. Cardiovascular dysfunction, systems causes ocular and upper respiratory tract irritation in. healthcare personnel and also creates visual problems for the Colic. surgeon furthermore the smoke has unpleasant odors and has Dermatitis. been shown to have mutagenic potential 20,Eye irritation.
Surgical smoke and aerosols are potentially dangerous to OR Headache. personnel the potential risks include pulmonary irritation and. inflammation transmission of infection and genotoxicity. Many of the by products that result from pyrolysis of tissue are Human Immunodeficiency Virus HIV. respiratory irritants It has been shown that when laboratory rats Hypoxia o. A SELF STUDY GUIDE OVERVIEW Exposure to surgical smoke is an anticipated risk for perioperative team members in all operating room OR practice settings The hazards of surgical smoke in the OR have received increased attention due to the escalating use of various energy modalities such as electrosurgery lasers and ultrasonic devices all of which generate smoke plume Moreover the smoke

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