Miners – Air Problems OR Team Serving as the Biological Indicator for Poor Air Quality
AORN RP Personnel working with an ESU or laser should avoid exposure to smoke plume generated during tissue cutting and coagulation. Surgical smoke causes headaches, watery eyes, respiratory problems in healthcare workers
NIOSHNIOSH ä 1988 ä “Smoke generated during laser surgery presents a potential health hazard.”
NIOSHNIOSH ä 1985 ä “There’s a potential hazard from smoke generated by electrosurgical knives.”
ResearchResearch Tomita et al, 1989 Laser: 1gm tissue 3 unfiltered cigarettes ESU: 1gm tissue 6 unfiltered cigarettes Laser and ESU smoke are very similar!
Toxic Fumes and Vapors Acrolein Benzene Formaldehyde Possible carcinogens!!!!
Particulate Matter American College of Surgeons: 5 microns = bacterial colonization Regular surgical mask: 5 micron filtration Research - 77% of surgical smoke is 1.1 microns in size and smaller (Mihashi et al., 1975) Particulate ends up in the alveoli of your lungs
ResearchResearch Baggish et al, 1988 Rats breathed unfiltered & filtered plume Unfiltered plume: Rats developed hypoxia, pulmonary problems Filtered plume: No changes
Viability Research Garden et al, 1988 Used CO2 laser on cow papillomavirus Used CO2 laser on cow papillomavirus Found intact viral DNA in plume Found intact viral DNA in plume Injected viral DNA from plume into cow Injected viral DNA from plume into cow Grew same viral lesion Grew same viral lesion Potential of transmission of viable viral contaminants Potential of transmission of viable viral contaminants
Transmission of virus to Dr. Hallmo et al, 1991 44yo laser Dr developed laryngeal papillomatosis 44yo laser Dr developed laryngeal papillomatosis Lesions show same DNA type as anogenital condyloma from patients Lesions show same DNA type as anogenital condyloma from patients
EndoscopyEndoscopy Ott et al, 1993 Laparoscopy & plume Laparoscopy & plume Increase methemoglobin & carboxyhemoglobin Increase methemoglobin & carboxyhemoglobin (methemoglobin- O 2 carrying (methemoglobin- O 2 carrying capacity of RBCs) capacity of RBCs) Delay in healing? Delay in healing?
RecommendationsRecommendations AORN ANSI NIOSH CDC OSHA Global recommendations All say to evacuate surgical smoke!
SolutionsSolutions Appropriate smoke evacuation system
In-line Filter For small amounts of plume use in-line filter Correct positioning needed Patient Wall Suction AORN Pilot Survey: Most popular method
Wall Suction Corrodes pipes Contaminates building Flow may not be high enough to capture surgical smoke Wall suction 2 cfm Evacuator 30-50 cfm
Smoke Evacuator Needed when larger amounts of smoke created
Critical Features Efficiency Filtering capability Charcoal filter – removes odor ULPA filter – removes small particulate (.1 microns, 99.999% efficiency) Suction power
Filter Changing Follow manufacturer’s recommendations when changing Occupational Hazard NOT Environmental Hazard
Solutions Position smoke tube close to the tissue impact site
Automatic On/Off System
Evacuation during endoscopy
SolutionsSolutions High Filtration Masks 0.1 micron filtration Not the first line of defense