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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.
Introduction
Surgical plume, also known as surgical smoke, cautery smoke, smoke-plume, diathermy plume, aerosol, bio-aerosol, vapour and air-contaminants1,2, is a dangerous by-product produced by the electrosurgical instruments used to dissect tissue, provide haemostasis and perform laser ablation. These instruments include electrosurgery units, lasers, ultrasonic devices, high speed drills, burs and saws that produce heat and allow the surgeon to achieve the desired tissue effect3,4. Surgical plume is created by the thermal damage of tissue which releases cellular fluid as steam and spews cell contents into the air. Chemical analysis lists its constituents to be 95 per cent water vapour and 5 per cent other chemicals and cellular fragments5. Surgical plume can pose health risks to thousands of health care workers on an annual basis6. This article provides a review of the contemporary literature in relation to surgical plume, its composition, the risks it creates and management strategies.
Background
In this review, the authors aimed to identify, review and discuss the issues related to surgical plume and its implications for patients and perioperative staff. Health professionals in the perioperative environment are routinely exposed to surgical smoke, plume and aerosols produced by instruments used to dissect tissue and provide haemostasis. This can pose significant health risks, in particular for nurses and anaesthetists who spend more time in the operating room than ancillary workers, such as orderlies, and surgeons because of clinic or...