Secrets of Smoke Evacuation Success

Why don’t all healthcare facilities employ some sort of surgical smoke evacuation system? Not only does surgical smoke smell and obstruct the surgeon’s view of the surgical site, but it has also been shown to contain toxic gases, viruses and bacteria, causing eye, nose and throat irritation, headaches, congestion and asthma-like symptoms in more than a half-million healthcare workers who are exposed, often for hours at a time.

The problem is many providers aren’t aware of the devastating effects surgical smoke can have on their bodies. “I had been in the OR for a year before I heard about the risks of surgical smoke,” recalls Carolyn Maxam, RN, MSN, CNOR, a surgical nurse at Glen Falls (N.Y.) Hospital. “I knew it smelled awful, but I didn’t know the dangers associated with it.”

The hospital has an OR journal club, and each month the club selects a peer-reviewed article to study. When a member brought in an AORN article about the dangers of surgical smoke, the staff was baffled, remembers Britny McFadden, MSN, RN, also a surgical nurse at Glen Falls Hospital. “We all felt that our exposure to the smoke wasn’t right, especially when it’s our goal to have a safe work environment.”

Ms. Maxam and Ms. McFadden decided to do some research of their own, but back in early 2018, there wasn’t a plethora of information available on the topic. The two nurses decided to create a poster detailing the dangers of surgical smoke during National Nurses Week, which got the ball rolling. “Our chief nursing officer saw the poster and told us the hospital would address the issues surrounding surgical smoke,” says Ms. Maxam. That’s when the two nurses jumped head-on into making sure a surgical smoke evacuation program became a top priority at their facility. It wasn’t easy, but here are the steps they took to rid their ORs of dangerous plume.

You need to do your due diligence when it comes to selecting the right smoke evacuation system for your needs. After Ms. Maxam and Ms. McFadden created their poster in early 2018, their next step was finding a few smoke evacuation methods to trial. “We did a lot of research on different systems. We called all the vendors ourselves and asked them to send us information and flyers,” says Ms. Maxam. “We then went to our leadership team with the information we gathered, and together we chose three different evacuation systems to trial, based on their benefits as well as potential cost.”

Surgeons trialed each system in the OR for three to four weeks. “Some surgeons only operate one day a week, so we wanted to make sure they all had an opportunity to test them out,” says Ms. Maxam. The surgeons were given a survey to rate the systems and by the summer of 2019, one was selected to install in all 16 of the facility’s ORs.

Surgeon input and feedback is critical in getting a smoke evacuation system in place, but you also need to make sure those surgeons are willing to use the system consistently. While some surgeons at Glen Falls Hospital pushed back on the idea, many stated that as long as the system didn’t interfere with their procedures and wasn’t excessively noisy, they would have no problem adding it into their surgical routine. Many of the facility’s surgeons didn’t see the need for the smoke evacuation systems, as they are only in the OR one day a week, says Ms. Maxam. “But when we reminded them that the nurses and anesthesia providers are often in the OR for eight hours a day, they realized how important this issue was,” she adds.

The surgical team at Glen Falls performs a variety of cases, including revascularizations, mastectomies, orthopedic procedures and C-sections, all of which employ cautery devices that produce surgical smoke. This procedural diversity played a role in the decision-making process. After the extensive trial period and the recommendation of the surgeons, the hospital chose to implement a smoke evacuation system that is designed with a quiet, high-suction and high-flow rate vacuum motor. It also contains a telescoping feature that extends deeper into the surgical site, says Ms. Maxam. The system has three ways to activate smoke evacuation, and surgeons can choose from five different levels of flow rate for both laparoscopic and open procedures.

But even with a new system, you need to ensure it’s used consistently after the novelty of the equipment wears off. “The system was being used quite frequently when it was first rolled out, but then some surgeons started to get complacent,” says Ms. Maxam. “We decided to write a smoke evacuation policy, so that it becomes ingrained in our surgical process. Now that we have a smoke evacuation system in place, our next goal is to achieve an AORN Go Clear award.”