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NSW OTA Position Statement on Surgical Plume 2021

 

Click on the link to download the NSW OTA Surgical Plume Position Statement 

 


NSW OTA

• supports the rights of perioperative nurses to work in an environment where the risks
posed by exposure to surgical plume are eliminated/reduced 1

• supports compliance with NSW Health, GL2015_002 Work health & safety – controlling
exposure to surgical plume, together with other Work Health & Safety legislation related to providing a safe workplace 1, 2, 3, 4

• supports a multidisciplinary approach to the management of surgical plume ie
surgeons, Perioperative Unit managers, local Work Health & Safety Officers

• supports the rights of nurses to refuse participation in procedures where a written
hospital policy on plume evacuation exists, but the equipment is not used

• encourages nurses to submit an incident report (or local equivalent) when plume
evacuation policies are not followed
 


Background:

  • surgical plume is produced by the use of energy generating equipment during surgery to cut, coagulate and vaporise tissue i.e. lasers and electrosurgical devices (diathermy) 5

  • the risks to the perioperative team from exposure to surgical plume have been well documented in literature published since the 1980s:

    • plume contains more than 80 toxic and noxious gases/chemicals similar to those found in cigarette smoke e.g. toluene, carbon monoxide and benzene

    • plume contains bacteria, tissue cells, DNA, carbon, aerosolised blood particles, viruses i.e. Hep B, human papillomavirus (HPV) and HIV 5, 6

  • though no conclusive evidence currently exists on the transmission of SARS CoV-2 (or variants) in plume, the virus is similar in size to the other viruses (Hep B, HIV, HPV) known to exist in plume and should be assumed to be present 5, 6, 7

  • if not effectively removed, all personnel working within the operating room are at risk from airborne exposure to surgical plume which may result in short and long term physical reactions and illnesses, including acute and chronic respiratory illness, irritation to the eyes, viral illness and cancer 8,9

  • whilst documented cases of healthcare personnel contracting diseases directly attributable to exposure to surgical plume are limited, 8,9 sufficient concerns exist due to the noxious contents of surgical plume to:

    • protect healthcare personnel from exposure to surgical plume

    • use specialised equipment to remove surgical plume from the operating room environment 3

  • patients may also be at risk from the potential harmful effects of plume if it is absorbed through the peritoneal membrane during laparoscopic surgery.
    Appropriate plume evacuation equipment (active or passive) should be used 10, 11, 12

 

Recommendations:

To ensure a safe environment for patients and healthy workplace for healthcare personnel
working in the perioperative environment the NSW OTA recommends that:

 

  • healthcare facilities comply with existing Work Health & Safety legislation and NSW Health Dept Guidelines

  • healthcare facilities establish a written policy for the management of surgical plume

  • healthcare facilities provide current, evidence based education to all healthcare personnel on the risks and hazards associated with surgical plume and strategies to reduce exposure

  • perioperative environments should provide and make use of plume evacuation equipment in every surgical procedure where energy generating equipment is used

  • NSW OTA will initiate dialogue with the Royal Australasian College of Surgeons to discuss ongoing safe practices when energy generating equipment is used
     

References

1. Australian College of Perioperative Nurses. (2020). Surgical plume. Standards for
perioperative nursing in Australia (16th ed., Vol 1). https://www.acorn.org.au/standards.
 

2. NSW Government (2011). Work Health & Safety Act & Regulations (NSW)
(Regulations amended in 2014). NSW Government.
https://www.legislation.nsw.gov.au/view/html/inforce/current/sl-2017-0404

3. NSW Health (2010). GL2015_002 Work health & safety – controlling exposure to surgical
plume. NSW Health.
https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/GL2015_002.pdf

4. NSWNMA (2013). Workplace health and safety for nurses and midwives. NSWNMA.
https://www.nswnma.asn.au/wp-content/uploads/2013/06/NSWNMA-Work-Health-and-
Safety-Essentials-for-Nurses-and-Midwives-2013.pdf

5. Zakka, K., Erridge, S., Chidambaram, S. et al. (2020). Electrocautery, diathermy, and
surgical energy devices: Are surgical teams at risk during the COVID-19 pandemic? Annals
of Surgery, 272(3): e257–e262.

6. International Standards Organisation (ISO) (2014). ISO 16571:2014.
Systems for evacuation of plume generated by medical devices. ISO.

7. Vourtzoumis, P.,Alkhamesi, N., Elnahas, N.,Hawel, J. & Schlachta, C. (2020). Operating
during COVID-19: Is there a risk of viral transmission from surgical smoke during surgery?
Can J Surg/J can chir, 63(3), E299 – E301. doi: 10.1097/SLA.0000000000004112

8. Ilce, A., Yuzden, G.E. & Yavuz van Giersbergen, M. (2017). The examination of problems
experienced by nurses and doctors associated with exposure to surgical smoke and the
necessary precautions. J Clin Nurs, 26(11-12):1555-1561. doi: 10.1111/jocn.13455.

9. Yi Liu, Yizuo Song, Xiaoli Hu, Linzhi Yan, Xueqiong Zhu (2019). Awareness of surgical smoke
hazards and enhancement of surgical smoke prevention among the gynaecologists.
Journal of Cancer, 10 (12): 2788-2799. doi: 10.7150/jca.31464.

10. Ott, D. (1997). Smoke and particulate hazards during laparoscopic procedures.
Surgical Services Management 3(3): 11-3.

11. Dobrogowski, M. et al (2015). Chemical composition of surgical smoke formed in the
abdominal cavity during laparoscopic cholecystectomy. International Journal of
Occupational Medicine And Environmental Health, 27(2):314–325. doi: 10.2478/s13382-014-
0250-3.

12. Australasian Gynaecological Endosopy & Surgery Society Limited (AGES) (2020). COVID-
19 update for AGES members. www.ages.com.au.

Approved 5th March 2021