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2017 Conference Poster Collection
2017 CONFERENCE POSTER COLLECTION SURGICAL SMOKE EVACUATION The AORN Journal is pleased to include this special collection of surgical smoke evacuation posters that were presented at the 2017 AORN Global Surgical Conference & Expo. The decision to reprint this particular collection in the Journal was based on advertiser support.
Implementing Change: An EvidenceBased Practice Project to Educate Operating Room Staff on the Hazards of Surgical Smoke Rebecca J. Hadley, BSN, RN, CNOR; Tommie Jo Tipton, BSN, RN, CNOR; June Vanhoose, RN Practice problem: Surgical smoke causes multiple health hazards to employees. However, the usage of smoke evacuation devices in the typical hospital OR setting remains less than 50%.
Conclusion: Formal policy changes, based on EBP guidelines regarding the use of surgical smoke evacuation in the OR setting, are recommended to ensure utilization within our institution.
Staff Compliance With Smoke Evacuation in the Operating Room Richard Anderson, RN, CNOR; David Bradley, RN; Jeremy Etzkin, RN; Nyesha N. Turner Pye, RN; Deborah L. Lane, RN; Breana C. Brooks; LaToya G. Blade, RN; Jennifer S. Mellanson, RN Clinical problem/significance: Perioperative staff are subjected to routine inhalation of toxic surgical smoke that has been proven in several peer-reviewed studies to cause respiratory issues. Smoke evacuation policy and methods are available, yet staff compliance with smoke evacuation continues to remain low.
Evidence: A comprehensive literature search was completed using online databases such as EBSCO, CINAHL, and PubMed. Using the IOWA evidence-based practice (EBP) model, 10 articles met our search limits and were reviewed for inclusion.
Background: Brooke Army Medical Center, San Antonio, Texas, conducts 1,400 surgeries a month, with daily use of electrosurgical units and lasers. Of total cases per month, 80% possibly put staff at risk from toxic smoke.
Key evidence-based practice: Implementation of surgical smoke evacuation devices is recommended by the AORN guidelines.
Clinical question/purpose: Would education through an evidence-based approach versus the current operating procedures increase staff knowledge and compliance toward protecting OR staff against toxic smoke plume?
Implementation: An inservice was provided that included a presentation regarding the hazards of surgical smoke, hands-on demonstration of the EBP, and recommended surgical smoke evacuation devices. Prior to this educational inservice, a 10-question survey was created, consisting of multiple choice questions regarding knowledge of surgical smoke hazards and evacuation recommendations; it was then completed by the surgical staff. Six weeks after the inservice, the staff was resurveyed to evaluate for improved knowledge and implementation. Outcomes: There was an increased awareness of surgical smoke hazards among the staff. Smoke hazards and recommendations to use evacuation devices to reduce risk were discussed with surgeons. A clinical trial was conducted to evaluate various smoke evacuation devices; however, their use did not improve after the inservice.
Description of evidence-based protocol: A prodigious amount of evidence supported applying an evidence-based smoke evacuation program. Team conferences led to policies based on national standards, and multidisciplinary members ensured equipment and resource availability. Staff training would be conducted and competencies evaluated routinely. Implementation of evidence-based protocol: A select multidisciplinary team initiated the evidenced-based surgical smoke program. An initial survey was conducted to measure staff compliance based on an AORN competency assessment tool. The survey created baseline data and resulted in identifying areas of knowledge deficit and ways to improve resource allocations. Next, current literature and the AORN smoke evacuation program were presented to staff members with
http://dx.doi.org/10.1016/j.aorn.2017.04.012 ª AORN, Inc, 2017
www.aornjournal.org
AORN Journal j 561
Conference Poster Collection
hands-on demonstrations. A 30-day postsurvey was conducted using the initial AORN competency assessment tool. Results: Of 41 randomized surveys, an initial baseline survey averaged 21% comprehension, compared with the 30-day posteducational survey of 64%. Staff indicated increased knowledge of supply location by 41%, improved equipment troubleshooting skills, and increased understanding of smoke evacuation system use during surgery to 80% overall. Areas for improvement revealed installing and calibrating ultralow particulate air filters and the cleaning, decontamination, and disposal of smoke evacuation supplies after use. Conclusions: Identifiable hazards of smoke plume (eg, carbon monoxide, bacteria, viruses, carcinogens) expose all intraoperative staff and patients to potential long-term health problems. Staff should protect their health and advocate for their patients’ well-being when generating toxic smoke plume. Perioperative nursing implications: Decrease in smoke plume leads to decreased exacerbations of allergies, asthma, sinus infections, and bronchitis in staff and fewer lost work days due to illnesses and associated health care costs. The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the US Army Medical Department, the US Army Office of the Surgeon General, the Department of the Air Force, the Department of the Army, the Department of Defense, or the US Government.
Smoking in the OR Joann Ruff, BSN, RN; Evelyn McCormack; Mary Beth Houlahan, BSN, RN, CNOR Clinical issue: Surgical plume or smoke aerosol is the vaporization of substances (eg, tissue, fluid, blood) into a gaseous form and is the byproduct of surgical instruments used to destroy tissue. Perioperative nurses in the OR are exposed to surgical plume created by the use of electrosurgical units or laser beams that cut, coagulate, or vaporize tissue. Research has proven that surgical plume creates a serious safety issue and workplace hazard for perioperative nurses. Operating room nurses are at high risk for extensive and sustained exposure to surgical plume due to the nature of their work. This exposure can cause health-related symptoms including eye irritation, headache, nausea, acute or chronic inflammatory respiratory changes, asthma, chronic bronchitis, light-headedness, nasopharyngeal lesions, throat irritation, and weakness and fatigue. The Cleveland Clinic Marymount Hospital Surgery 562 j AORN Journal
June 2017, Vol. 105, No. 6
Department, Garfield Heights, Ohio, provided traditional surgical masks. Traditional surgical masks provide inadequate protection. Description of team: The team consisted of the OR leadership team, including the director of Perioperative Services, surgery nurse manager, assistant nurse managers, and a surgical technologist. Preparation and planning: Discussed concerns regarding workplace hazards of surgical plume. Researched surgical plume. Reviewed the AORN position statement regarding the hazards of exposure to surgical plume. Contacted several surgical product vendors. Coordinated the trial of products that control the presence of surgical plume in the OR. Assessment: Evaluated staff’s knowledge of the production of surgical plume and knowledge of the hazards of surgical plume. Surveyed our equipment capabilities to decrease the amount of surgical plume. Met with three vendors to evaluate their products. Implementation: Educated the perioperative staff regarding safety issues caused by surgical plume at department meetings and posted communications on the unit. Arranged for vendor to attend the department meeting to provide an inservice for the staff regarding surgical plume and to present products for review. Educated the staff regarding appropriate use of the products. Provided information and clinical data for staff to use as resources. Outcome: As a result of concerns regarding the safety of perioperative nurses’ exposure to surgical plume, several safety devices were evaluated to eliminate this workplace hazard. The safety issue of exposure to surgical plume and associated workplace hazards has been effectively resolved. Implication for perioperative nursing: The benefits of plume evacuation affect not only the entire perioperative team but the patients they care for intraoperatively. We routinely advocate for the welfare and safety of our patients. Using devices that reduce the surgical plume advocates for our own health and safety as well.
Surgical Smoke: Putting the Pieces Together to Become Smoke-free Kim B. York, MS, BSN, RN, CNOR Problem: AORN states that exposure to surgical smoke is hazardous to patients and perioperative team members. During surgical procedures using lasers or electrosurgical units,
www.aornjournal.org
June 2017, Vol. 105, No. 6
the thermal destruction of tissue creates smoke byproducts. Research studies have confirmed that this 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. At high concentrations, the smoke causes ocular and upper respiratory tract irritation in health care personnel. The smoke has an unpleasant odor and has been shown to have mutagenic potential. Ablation of 1 g of tissue produces a smoke plume with a mutagenicity equivalent to six unfiltered cigarettes. This measure easily equates to the mutagenicity of dozens of unfiltered cigarettes in each OR every day, a potential health risk that can and should be avoided. Evidence: Each year, an estimated 500,000 workersdincluding surgeons, nurses, anesthesiologists, and surgical technologistsd are exposed to laser or electrosurgical smoke. The best protection afforded to these workers is the use of smoke evacuation devices placed near the source of production.
Conference Poster Collection
systems. The surgical technologists were instrumental in getting the devices to the surgical field and presenting them in a positive way. Each cauterizing tool was evaluated for comfort, ease of use, and overall effectiveness. Pricing for each comparable tool was similar. Outcome: Using visual observation, all three cautery pencil devices performed equally well to remove electrosurgical smoke plume. There was no offensive smoke odor in the OR with any of the devices. All three cautery pencils were compatible with the existing high-efficiency particulate air filters on the fluid-management systems. The only significant difference was related to comfort in the surgeon’s hand. Comfort was described as undemanding and relaxing in the hand. The surgeons, based on functionality and comfort, chose one surgical pencil unanimously.
Our hospital uses electrocautery in approximately 80 cases per month. Concerned about the dangers of surgical smoke, the staff developed a plan to become smoke-free.
Recommendation: The use of surgical smoke evacuation tools in the operating room is a win-win for hospitals and health care professionals alike. Using smoke evacuation pencils and the existing fluid-management smoke-filtering system will minimize potential health risks in this environment.
First, we trialed samples of smoke-evacuating electrosurgical or cautery pencils in cases that normally require usage of electrosurgical pencils that produce surgical smoke. In addition, we installed evacuation filters on two fluid-management
Editor’s notes: EBSCO and CINAHL, Cumulative Index to Nursing and Allied Health Literature, are registered trademarks of EBSCO Industries, Inc, Birmingham, AL. PubMed is a registered trademark of the US National Library of Medicine, Bethesda, MD.
www.aornjournal.org
AORN Journal j 563
Implementing Change: An EvidenceBased Practice Project to Educate Operating Room Staff on the Hazards of Surgical Smoke Rebecca J. Hadley, BSN, RN, CNOR; Tommie Jo Tipton, BSN, RN, CNOR; June Vanhoose, RN Practice problem: Surgical smoke causes multiple health hazards to employees. However, the usage of smoke evacuation devices in the typical hospital OR setting remains less than 50%.
Conclusion: Formal policy changes, based on EBP guidelines regarding the use of surgical smoke evacuation in the OR setting, are recommended to ensure utilization within our institution.
Staff Compliance With Smoke Evacuation in the Operating Room Richard Anderson, RN, CNOR; David Bradley, RN; Jeremy Etzkin, RN; Nyesha N. Turner Pye, RN; Deborah L. Lane, RN; Breana C. Brooks; LaToya G. Blade, RN; Jennifer S. Mellanson, RN Clinical problem/significance: Perioperative staff are subjected to routine inhalation of toxic surgical smoke that has been proven in several peer-reviewed studies to cause respiratory issues. Smoke evacuation policy and methods are available, yet staff compliance with smoke evacuation continues to remain low.
Evidence: A comprehensive literature search was completed using online databases such as EBSCO, CINAHL, and PubMed. Using the IOWA evidence-based practice (EBP) model, 10 articles met our search limits and were reviewed for inclusion.
Background: Brooke Army Medical Center, San Antonio, Texas, conducts 1,400 surgeries a month, with daily use of electrosurgical units and lasers. Of total cases per month, 80% possibly put staff at risk from toxic smoke.
Key evidence-based practice: Implementation of surgical smoke evacuation devices is recommended by the AORN guidelines.
Clinical question/purpose: Would education through an evidence-based approach versus the current operating procedures increase staff knowledge and compliance toward protecting OR staff against toxic smoke plume?
Implementation: An inservice was provided that included a presentation regarding the hazards of surgical smoke, hands-on demonstration of the EBP, and recommended surgical smoke evacuation devices. Prior to this educational inservice, a 10-question survey was created, consisting of multiple choice questions regarding knowledge of surgical smoke hazards and evacuation recommendations; it was then completed by the surgical staff. Six weeks after the inservice, the staff was resurveyed to evaluate for improved knowledge and implementation. Outcomes: There was an increased awareness of surgical smoke hazards among the staff. Smoke hazards and recommendations to use evacuation devices to reduce risk were discussed with surgeons. A clinical trial was conducted to evaluate various smoke evacuation devices; however, their use did not improve after the inservice.
Description of evidence-based protocol: A prodigious amount of evidence supported applying an evidence-based smoke evacuation program. Team conferences led to policies based on national standards, and multidisciplinary members ensured equipment and resource availability. Staff training would be conducted and competencies evaluated routinely. Implementation of evidence-based protocol: A select multidisciplinary team initiated the evidenced-based surgical smoke program. An initial survey was conducted to measure staff compliance based on an AORN competency assessment tool. The survey created baseline data and resulted in identifying areas of knowledge deficit and ways to improve resource allocations. Next, current literature and the AORN smoke evacuation program were presented to staff members with
http://dx.doi.org/10.1016/j.aorn.2017.04.012 ª AORN, Inc, 2017
www.aornjournal.org
AORN Journal j 561
Conference Poster Collection
hands-on demonstrations. A 30-day postsurvey was conducted using the initial AORN competency assessment tool. Results: Of 41 randomized surveys, an initial baseline survey averaged 21% comprehension, compared with the 30-day posteducational survey of 64%. Staff indicated increased knowledge of supply location by 41%, improved equipment troubleshooting skills, and increased understanding of smoke evacuation system use during surgery to 80% overall. Areas for improvement revealed installing and calibrating ultralow particulate air filters and the cleaning, decontamination, and disposal of smoke evacuation supplies after use. Conclusions: Identifiable hazards of smoke plume (eg, carbon monoxide, bacteria, viruses, carcinogens) expose all intraoperative staff and patients to potential long-term health problems. Staff should protect their health and advocate for their patients’ well-being when generating toxic smoke plume. Perioperative nursing implications: Decrease in smoke plume leads to decreased exacerbations of allergies, asthma, sinus infections, and bronchitis in staff and fewer lost work days due to illnesses and associated health care costs. The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the US Army Medical Department, the US Army Office of the Surgeon General, the Department of the Air Force, the Department of the Army, the Department of Defense, or the US Government.
Smoking in the OR Joann Ruff, BSN, RN; Evelyn McCormack; Mary Beth Houlahan, BSN, RN, CNOR Clinical issue: Surgical plume or smoke aerosol is the vaporization of substances (eg, tissue, fluid, blood) into a gaseous form and is the byproduct of surgical instruments used to destroy tissue. Perioperative nurses in the OR are exposed to surgical plume created by the use of electrosurgical units or laser beams that cut, coagulate, or vaporize tissue. Research has proven that surgical plume creates a serious safety issue and workplace hazard for perioperative nurses. Operating room nurses are at high risk for extensive and sustained exposure to surgical plume due to the nature of their work. This exposure can cause health-related symptoms including eye irritation, headache, nausea, acute or chronic inflammatory respiratory changes, asthma, chronic bronchitis, light-headedness, nasopharyngeal lesions, throat irritation, and weakness and fatigue. The Cleveland Clinic Marymount Hospital Surgery 562 j AORN Journal
June 2017, Vol. 105, No. 6
Department, Garfield Heights, Ohio, provided traditional surgical masks. Traditional surgical masks provide inadequate protection. Description of team: The team consisted of the OR leadership team, including the director of Perioperative Services, surgery nurse manager, assistant nurse managers, and a surgical technologist. Preparation and planning: Discussed concerns regarding workplace hazards of surgical plume. Researched surgical plume. Reviewed the AORN position statement regarding the hazards of exposure to surgical plume. Contacted several surgical product vendors. Coordinated the trial of products that control the presence of surgical plume in the OR. Assessment: Evaluated staff’s knowledge of the production of surgical plume and knowledge of the hazards of surgical plume. Surveyed our equipment capabilities to decrease the amount of surgical plume. Met with three vendors to evaluate their products. Implementation: Educated the perioperative staff regarding safety issues caused by surgical plume at department meetings and posted communications on the unit. Arranged for vendor to attend the department meeting to provide an inservice for the staff regarding surgical plume and to present products for review. Educated the staff regarding appropriate use of the products. Provided information and clinical data for staff to use as resources. Outcome: As a result of concerns regarding the safety of perioperative nurses’ exposure to surgical plume, several safety devices were evaluated to eliminate this workplace hazard. The safety issue of exposure to surgical plume and associated workplace hazards has been effectively resolved. Implication for perioperative nursing: The benefits of plume evacuation affect not only the entire perioperative team but the patients they care for intraoperatively. We routinely advocate for the welfare and safety of our patients. Using devices that reduce the surgical plume advocates for our own health and safety as well.
Surgical Smoke: Putting the Pieces Together to Become Smoke-free Kim B. York, MS, BSN, RN, CNOR Problem: AORN states that exposure to surgical smoke is hazardous to patients and perioperative team members. During surgical procedures using lasers or electrosurgical units,
www.aornjournal.org
June 2017, Vol. 105, No. 6
the thermal destruction of tissue creates smoke byproducts. Research studies have confirmed that this 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. At high concentrations, the smoke causes ocular and upper respiratory tract irritation in health care personnel. The smoke has an unpleasant odor and has been shown to have mutagenic potential. Ablation of 1 g of tissue produces a smoke plume with a mutagenicity equivalent to six unfiltered cigarettes. This measure easily equates to the mutagenicity of dozens of unfiltered cigarettes in each OR every day, a potential health risk that can and should be avoided. Evidence: Each year, an estimated 500,000 workersdincluding surgeons, nurses, anesthesiologists, and surgical technologistsd are exposed to laser or electrosurgical smoke. The best protection afforded to these workers is the use of smoke evacuation devices placed near the source of production.
Conference Poster Collection
systems. The surgical technologists were instrumental in getting the devices to the surgical field and presenting them in a positive way. Each cauterizing tool was evaluated for comfort, ease of use, and overall effectiveness. Pricing for each comparable tool was similar. Outcome: Using visual observation, all three cautery pencil devices performed equally well to remove electrosurgical smoke plume. There was no offensive smoke odor in the OR with any of the devices. All three cautery pencils were compatible with the existing high-efficiency particulate air filters on the fluid-management systems. The only significant difference was related to comfort in the surgeon’s hand. Comfort was described as undemanding and relaxing in the hand. The surgeons, based on functionality and comfort, chose one surgical pencil unanimously.
Our hospital uses electrocautery in approximately 80 cases per month. Concerned about the dangers of surgical smoke, the staff developed a plan to become smoke-free.
Recommendation: The use of surgical smoke evacuation tools in the operating room is a win-win for hospitals and health care professionals alike. Using smoke evacuation pencils and the existing fluid-management smoke-filtering system will minimize potential health risks in this environment.
First, we trialed samples of smoke-evacuating electrosurgical or cautery pencils in cases that normally require usage of electrosurgical pencils that produce surgical smoke. In addition, we installed evacuation filters on two fluid-management
Editor’s notes: EBSCO and CINAHL, Cumulative Index to Nursing and Allied Health Literature, are registered trademarks of EBSCO Industries, Inc, Birmingham, AL. PubMed is a registered trademark of the US National Library of Medicine, Bethesda, MD.
www.aornjournal.org
AORN Journal j 563