Clearing the Air around Surgical Smoke: Know the Risks

Surgical smoke can visually obstruct the surgical field and present a safety hazard to OR staff. Recent research shows that surgical smoke contains some potentially harmful components. However, whether they are present in concentrations high enough to cause chronic issues for clinicians who are regularly subjected to them is not known. Contributing to the uncertainty is the fact that some clinicians with regular exposure develop chronic issues while others may not. Even so, surgical smoke is an acute irritant and presents enough of a risk that some states are beginning to require the use of some form of evacuation in relevant procedures, as a means of limiting human exposure to surgical smoke. As such, ECRI recommends that knowledge of the risks of surgical smoke and smoke hazard evacuation strategies be made available to clinicians and management.

The thermal destruction of tissue or bone during surgical procedures generates surgical smoke. This smoke contains mostly water vapor, at approximately 95%, but the remaining 5% can also contain high-risk chemical and biological components such as cellular debris, blood fragments, viruses (including human papilloma virus HPV and hepatitis), and bacteria (Ulmer 2008, Addley and Quinn 2018). The energy-generating device used in the surgical procedure can determine smoke particle size, based on the temperature required to achieve the desired surgical effect, with higher temperatures yielding smaller particles (Ilce et al. 2017, Fan et al. 2009).

1. Electrosurgery yields smoke particles in the range of 0.07 to 0.42 µm.

2. Laser surgery yields smoke particles in...