Getting Buy-in for Smoke Evacuation

Placing products at eye level in grocery stores and retail chains is a strategy used to increase sales. Tabitha Turner, RN, MSN, CNOR, CGRN, the driving force behind the implementation of a surgical smoke evacuation program at Cone Health MedCenter Mebane (N.C.) Surgery Center, cunningly employed this "what you see is what you buy" technique to clear the air in the facility's ORs. Ms. Turner, the facility's assistant director, put packets of research everywhere the eyes of surgeons and staff would fall, including in locker rooms and lounges. She even enticed the surgical team with candy cigarettes to get her point across: Surgical smoke, like cigarette smoke, is dangerous to your health.

In just over a year, Ms. Turner established a smoke evacuation program, an astonishing achievement in so little time. She managed to educate staff and implement the system so quickly because of her determination to find credible research, as well as the guidance offered by AORN's Go Clear Award Program (see "Need Help Going Smoke-free?" below). She systematically followed the steps outlined by the program to institute a strong smoke evacuation protocol, which eventually earned Go Clear's Gold Status.

Ms. Turner's clinical passion drove her to campaign for smoke evacuation, according to Dana Hatchett, RN, BSN, MBA, RNFA, CNOR, director of MedCenter Mebane Surgery Center. After attending a medical conference where she learned about the Go Clear program, Ms. Turner began to dive more deeply into the issue. She spent two months researching the dangers of surgical smoke and presented the information to her leadership to gain support for implementing the Go Clear program. After getting the go ahead, Ms. Turner collected every study and article she could find about surgical smoke and bound the stack of research into a book, which she passed out to staff and surgeons.

Each week, Ms. Turner also posted new information on bulletin boards throughout the center, including a story about an Arizona orthopedic surgeon whose lung cancer was attributed to surgical smoke. It didn't take long to convince staff and surgeons to join the smoke-free movement.

"I spent many months gathering data to support what I was talking about," says Ms. Turner. "It's really important to present surgeons with clinical evidence when asking them to change how they operate."

The research detailing the dangers of surgical plume is irrefutable. Lasers and other electrosurgical devices are used in 90% of surgeries, and about 150 different chemicals are released in the smoke they generate. Surgical masks don't filter out the majority of smoke particles, resulting in hundreds of thousands of healthcare workers being exposed to surgical plume each year. Ms. Turner, who has been working on breast reduction surgeries for about 15 years, says just a gram of tissue — about the size of a jellybean — is equal to six smoked cigarettes, an example she used to hammer home the importance of smoke evacuation.

While getting her surgery center to go smoke-free, Ms. Turner walked away with several valuable lessons, including:

• Sell the latest options. After gaining widespread support as a result of her research, Ms. Turner brought in sales reps to introduce the latest smoke evacuators and set up trials. She had to work closely with the health system's ENT surgeons, who were concerned that the way they perform their complex procedures would be negatively impacted by the presence of a smoke evacuation pencil close to the surgical site. Ms. Turner moved systematically, though, and gained the support of the ENT surgeons and staff before moving on to convince orthopedic and general surgeons to work with evacuators.

Recent improvements in the design and function of the devices helped Ms. Turner make her case. Newer evacuators have slimmer profiles and can be incorporated into electrosurgery devices, factors that let surgeons perform procedures using their preferred technique. Evacuation units that used to sound like a loud vacuum cleaner are much quieter, which eliminates a common complaint from surgeons and surgical team members. "Now we hear just a soft hum in the room — like white noise," says Ms. Turner.

• Choose the correct filters. After staff and surgeons trialed smoke evacuators and began to use them during procedures, Ms. Turner continued her educational efforts to ensure the devices were being used properly. During the process, she discovered many facilities that have implemented smoke evacuation programs don't use the correct filters, a specification that was absent from the articles Ms. Turner had read. She now refers to the evacuators' instructions for use and makes sure surgical teams are aware of the importance of using the correct filters.
• Wear proper PPE. Another level of smoke protection, which Ms. Turner wasn't fully aware about before COVID-19, involves the proper level of mask protection that should be used during smoke-producing cases. "I never made sure I wore the correct mask — I just made sure it fit well," she says. "But now I realize you always need to wear an ASTM level 3 mask."

This level of protection is ideal for most smoke-producing cases, though Ms. Turner points out higher-grade surgical laser masks should be used for procedures that are expected to generate heavy amounts of plume.

Momentum for change

After training staff at her center on smoke evacuation, Ms. Turner traveled throughout eight facilities within the Cone Health system to educate other surgical teams about the hazards of surgical smoke, and the importance of evacuating it. While many facilities working to implement smoke evacuation have received some pushback from surgeons, this has largely not been the case at Cone Health. "That's because of the culture we have with the physicians," says Ms. Hatchett. "We're comfortable talking to them and having those crucial conversations."

FILLED WITH FACTS A binder packed with irrefutable data helped convince staff and surgeons to use smoke evacuators during plume-producing procedures.  |  MedCenter Mebane Surgery Center

In fact, one of the program's biggest critics turned out to become one of its biggest supporters. An ENT surgeon who was tired of trialing new products was hesitant about the program at first. Ms. Turner had to essentially force him to read the data she had collected that backed the benefits of smoke evacuation. Now that ENT surgeon uses smoke evacuators every time he operates.

Before getting started on implementing a smoke evacuation program, Ms. Turner heard about efforts to pass legislation in North Carolina that would ensure smoke evacuators are used during plume-producing cases. Though her state does not yet have official regulations for smoke evacuation in place, Mebane Surgery Center established a program on its own terms — and Ms. Turner advises other facilities to do the same. Referencing smoke evacuation legislation passed in Rhode Island and Colorado, she points out facilities probably don't have a lot of time to put a program in place before they're required to do so. "It's going to be managed for you at some point, so get ahead of it," says Ms. Turner. "Pick out the products you want. Make your own path — don't wait for somebody to tell you what to do."

Ms. Turner has expanded her smoke evacuation program to facilities throughout the Cone Health system, and her goal is to make smoke evacuation the norm in every one of them. Her efforts prove that change really can start with one person. Now's the time to get started on setting your facility up for a smoke-free future. OSM

After training staff at her center on smoke evacuation, Ms. Turner traveled throughout eight facilities within the Cone Health system to educate other surgical teams about the hazards of surgical smoke, and the importance of evacuating it. While many facilities working to implement smoke evacuation have received some pushback from surgeons, this has largely not been the case at Cone Health. "That's because of the culture we have with the physicians," says Ms. Hatchett. "We're comfortable talking to them and having those crucial conversations."