A recent survey of healthcare workers found that certain surgical procedures often lack ventilation that removes surgical smoke at its source, according to researchers at the National Institute for Occupational Safety and Health (NIOSH). As a result, some healthcare workers may face serious health problems from exposure to surgical smoke, as explained in an article in the American Journal of Industrial Medicine.

Thanks to medical advances in electrosurgery and laser surgery, we now have access to minimally or non-invasive procedures for everything from heart disease to glaucoma. For patients, these procedures provide clear benefits, including faster, less painful recoveries. However, the advances in technology can present new hazards to healthcare workers. As laser and electrosurgical tools heat body tissues, they generate surgical smoke that contains toxic gases, vapors, and cellular material. Exposure to these substances may cause short-term health problems, such as eye, nose, and throat irritation, and possible long-term illnesses, such as emphysema, asthma, and chronic bronchitis. OSHA estimates that 500,000 healthcare workers are exposed to surgical smoke each year.

To control emissions, professional, consensus, and government organizations recommend that local exhaust ventilation (LEV) be used to capture the smoke at its source. This local, as opposed to general, ventilation collects smoke at the surgical site so that it never reaches the breathing zone of healthcare workers or patients. NIOSH recommends LEV, in addition to general room ventilation, to control healthcare workers’ exposure to surgical smoke.

NIOSH researchers analyzed data from a targeted, anonymous, web-based survey to examine what precautions healthcare employers and workers take in relation to hazardous substances, including surgical smoke. The NIOSH Health and Safety Practices Survey of Healthcare Workers is the largest federally sponsored survey of healthcare workers in the United States. It addresses safety and health practices relative to the use of hazardous chemicals among more than 12,000 healthcare workers. Of the respondents, more than 4,500 reported exposure to surgical smoke during electrosurgery or laser surgery and answered specific questions about work practices that control surgical smoke. Most respondents were female, white, and between 41 and 55 years of age. In terms of occupation, over one-third were nurse anesthetists, and about one-fifth were anesthesiologists.

The results showed that only 47% of the respondents reported always using LEV during laser surgery, and even fewer, 14%, always used LEV during electrosurgery. Respondents who reported always using LEV also were more likely to report that they had received training on the hazards of surgical smoke and that their employer had procedures in place for preventing exposure. Few survey respondents reported that they wore respiratory protection; most wore surgical or laser masks, neither of which provide respiratory protection. Electrosurgery was the most common source of exposure to surgical smoke, with 4,500 respondents reporting they were present during this procedure. In contrast, 1,392 respondents reported exposure during laser surgery. These survey results can help raise awareness about the importance of local control of surgical smoke by underscoring impediments to LEV use.

More information is available:

• Secondhand Smoke in the Operating Room? Precautionary Practices Lacking for Surgical Smoke
• NIOSH Health and Safety Practices Survey of Healthcare Workers: Training and Awareness of Employer Safety Procedures
• NIOSH Division of Surveillance, Hazard Evaluations, and Field Studies

Disclaimer: Mention of company names or products does not constitute endorsement by the National Institute for Occupational Safety and Health.