The Joint Commission releases safety advisory on alleviating dangers of surgical smoke

Dec. 18, 2020

The Joint Commission released a new Quick Safety advisory, “Alleviating the dangers of surgical smoke,” which reviews current regulations, recommendations and standards on surgical smoke or lasers from several governmental and professional organizations, including from the Occupational Safety and Health Administration (OSHA), National Institute of Occupational Safety and Health (NIOSH), American National Standards Institute (ANSI), Association of periOperative Registered Nurses (AORN) and ECRI.

Whenever and wherever lasers, electrosurgical systems, radio frequency devices, hyfrecators, ultrasonic scalpels, power tools and other heat destructive devices are used, everyone in the area – including the patient – may be exposed to surgical smoke. Surgical smoke plume can contain toxic gases and vapors such as benzene, hydrogen cyanide, formaldehyde, bioaerosols, dead and live cellular material (including blood fragments) and viruses.

The advisory also includes several safety actions for healthcare organizations that conduct surgery and other procedures using lasers and other devices that produce surgical smoke. Recommended safety actions to protect patients and healthcare workers include:

·        Implementing standard procedures for the removal of surgical smoke and plume through the use of engineering controls, such as smoke evacuators and high filtration masks.

·         During laser procedures, using standard precautions to prevent exposure to the aerosolized blood, blood by-products and pathogens contained in surgical smoke plumes.

·         Establishing and periodically reviewing policies and procedures for surgical smoke safety and control – making these policies and procedures available to staff in all areas where surgical smoke is generated.

·         Providing surgical team members with initial and ongoing education and competency verification on surgical smoke safety, including the organization’s policies and procedures.

·         Conducting periodic training exercises to assess surgical smoke precautions and consistent evacuation for the surgical suite and procedural area.

“While exposure of surgical smoke to patients is short-term and relatively low risk, surgeons, perioperative nurses and other operating room staff are exposed to surgical smoke daily,” says Ana Pujols McKee, MD, executive vice president, chief medical officer and chief diversity and inclusion officer, The Joint Commission. “At high concentrations, surgical smoke may cause ocular and upper respiratory tract irritation and potentially create visual problems for the surgeon. This is why it is so important for hospitals and ambulatory surgery centers to be aware of the risks of surgical smoke and how they can best mitigate those risks.”

Additional resources from The Joint Commission are provided in the advisory, along with resources from the Centers for Disease Control and Prevention (CDC), ANSI, AORN and several other academic journals. 

The Joint Commission has the release.