{"id":9835,"date":"2017-03-08T13:25:42","date_gmt":"2017-03-08T20:25:42","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=9835"},"modified":"2020-07-21T10:48:13","modified_gmt":"2020-07-21T16:48:13","slug":"initiative-aims-clear-air","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/initiative-aims-clear-air\/","title":{"rendered":"Initiative aims to clear the air in the OR"},"content":{"rendered":"
<\/div>

Chris Lolley stands in an inpatient operating room at UCHealth University of Colorado Hospital. He attaches a series of plastic tubes to a small device with a tip resembling a pencil lead and points to a spot on the ceiling above the surgical boom. It\u2019s a duct designed to whisk away the risky remnants of surgery.<\/p>\n

\"In
Chris Lolley, OR charge nurse at UCH, points to the plastic tube that fits over the tip of an electrosurgery device, evacuating surgical smoke.<\/figcaption><\/figure>\n

Lolley, an inpatient OR charge nurse, is demonstrating a system for evacuating the smoke created by the laser and electrical devices surgeons use to cut tissue and cauterize it to minimize bleeding. These tools are vital, but they generate smoke that contains toxic gases as well as microscopic particles that can elude surgical masks. These emissions have been shown to cause respiratory problems for those who inhale them. The smoke also increases the risk of pulmonary fibrosis and the transmission of viruses.<\/p>\n

The risks decline dramatically if surgeons use smoke-evacuation systems. At UCH, they can be fitted to the laser or electrosurgical unit at the surgical table in some of the ORs. While the surgeon works, the device pulls the smoke through tubing and vents it through the ceiling ductwork. The hospital also has portable evacuators that suck the smoke through charcoal filters, cleansing it of the toxic particulates.<\/p>\n

Clear the air<\/strong><\/p>\n

The organization\u2019s policy on surgical smoke plume evacuation, written in 2013, is unambiguous. \u201cThe wearing of a mask is not adequate to prevent the inhalation of smoke produced from the cautery or laser during a patient procedure,\u201d it states. \u201cTo eliminate the hazards of breathing in the smoke, a smoke evacuator unit or in-line filter should be used for any procedure in which an electrocautery or laser is used.\u201d<\/p>\n

To keep OR providers as safe as possible, Lolley and others want to ensure the greatest possible compliance with the policy and are taking specific steps to reach that goal. He\u2019s leading an effort to secure a \u201cGo Clear Award<\/a>\u201d from the AORN<\/a> (Association of periOperative Registered Nurses). The hospital is seeking a Gold designation, which requires at least 90 percent compliance with standards for education, availability of evacuation equipment and use of it during surgical procedures.<\/p>\n

To earn the award, all OR nurses and certified surgical techs will take a pretest about surgical smoke, and then will complete two online education modules and a post-test. Lolley said the results will help to identify barriers to using smoke evacuation equipment during surgery. To demonstrate compliance, the hospital also will submit three months of data gleaned from the Epic electronic health record and from observation. He\u2019s hoping the hospital can complete the entire process in July.<\/p>\n

Not blowing smoke<\/strong><\/p>\n

The risk that surgical smoke poses to health care workers is well established. As far back as 1989, a study<\/a> concluded that the inhaled smoke produced from electrosurgery devices was equivalent to smoking six unfiltered cigarettes. The Centers for Disease Control and Prevention, the Occupational Safety and Health Administration and the National Institute for Occupational Safety and Health have all weighed in on the need to protect providers from the smoke.<\/p>\n

\"This
Melanie Sandoval, PhD, MSN, RN, perioperative research nurse scientist at UCH, is helping to lead the Go Clear initiative.<\/figcaption><\/figure>\n

\u201cWe\u2019ve had staff report tightness in the chest and complaints of headaches,\u201d Lolley said. \u201cWe know now that there is a reason for that.\u201d<\/p>\n

Technology also contributes to the problem, said Melanie Sandoval, PhD, MSN, RN, perioperative research nurse scientist at UCH, who is helping to lead the Go Clear initiative. Newer, faster laser devices increase the amount of fine particulates that \u201cmasks can\u2019t stop,\u201d she said.<\/p>\n

The smoke can also be harmful to patients, Lolley noted. For example, during some laparoscopic procedures, smoke can build up in the patient\u2019s belly. That makes it harder for the surgeon to see, but unvented smoke can also increase levels of carboxyhemoglobin \u2013 carbon monoxide molecules that bind to red blood cells \u2013 thus decreasing the patient\u2019s oxygen absorption. That, in turn, slows healing.<\/p>\n

Rising awareness<\/strong><\/p>\n

The variety of threats illustrates the need to use smoke evacuation equipment consistently, Sandoval said. \u201cWe want to put a spotlight on it.\u201d<\/p>\n

The illumination is needed. The AORN estimates that a half-million health care workers are exposed to surgical smoke each year, Sandoval said. Yet roughly half of respondents to a NIOSH survey on laser procedures said they\u2019d never received training that educated them about the dangers of the smoke.<\/p>\n

That\u2019s changing. It\u2019s now mandatory in California to use smoke evacuators during surgery. So far it\u2019s the only state to take that step, but it won\u2019t be the last, predicted Richard Schulick, MD<\/a>, chair of the Department of Surgery at UCH, who is serving as physician champion for the Go Clear initiative.<\/p>\n

\u201cWherever California leads, the rest of the nation follows,\u201d he said.<\/p>\n

\"This
One of a dozen portable smoke evacuators used in the ORs at UCH.<\/figcaption><\/figure>\n

Schulick acknowledged that the evacuation devices can at first feel \u201cclunky.\u201d Surgeons may feel they have less precision and that they can\u2019t see the surgical area as well because the evacuation device fits over the top of the cauterizing tip, he said.<\/p>\n

He is sympathetic to those concerns, but added, \u201cThis is a safety issue. If it\u2019s safer for me and for everyone else in the OR, then we need to take a little bit of time to learn to use the devices. We can adapt.\u201d<\/p>\n

Protecting providers and patients is the paramount purpose of smoke evacuators, but they may yield other benefits, Lolley added.<\/p>\n

\u201cWe\u2019re hoping the Go Clear Award will help us with staff retention and acquisition,\u201d Lolley said. \u201cWe think that our use of extra safety equipment will encourage people to come work with us.\u201d<\/p>\n

Schulick agreed. \u201cIf a nurse has an opportunity to work at two places and one of them uses smoke evacuation equipment consistently and the other doesn\u2019t, why would you not go to the place where they use it?\u201d he said. \u201cIt speaks to culture: do you care about your providers and employees?\u201d<\/p>\n

Lolley said UCH wants to be an institutional leader in clearing the OR air, and he believes the time is right. A decade ago, skepticism, unawareness of the risks, and a lack of readily available equipment combined to hold compliance rates down. A new generation of providers is more aware of the dangers of surgical smoke and willing to speak up on their own behalf.<\/p>\n

\u201cIt\u2019s hard to change culture,\u201d Lolley said, \u201cbut now we have younger nurses and other providers, and it\u2019s easier.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

Chris Lolley stands in an inpatient operating room at UCHealth University of Colorado Hospital. He attaches a series of plastic tubes to a small device with a tip resembling a pencil lead and points to a spot on the ceiling above the surgical boom. 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