Surgical Smoke and Discovery of Electrosurgery

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Introduction
Since the discovery of electrosurgery in the 1900s, it has been widely used to cut tissues and produce the minimum amount of blood through coagulation secondary to the heat and vaporization which diffuses the small particles and cellular fluid into thin air. Thus, generating a plume (Lindsey, Hutchinson, & Mellor, 2015).
Occupational hazards are often present during electrosurgeries secondary to the dangerous organic and inorganic compounds that are released by surgical smoke. Studies have shown that the surgical smoke released during a plastic surgery is comparable to approximately 27 to 30 cigarettes per day. Laparoscopic surgeries also create a closed gaseous environment that results in the systemic absorption of lethal compounds (Bree, Barnhill, & Rundell, 2017).
Animal studies demonstrated congestive pneumonia, bronchiolitis, and emphysema. On the other hand, studies from the bronchial tissues of sheep experimental subjects revealed a reduced arterial PO2, reduced tracheal mucus velocity, and serious inflammation accompanied by a drastic increase in the inflammatory cells. All of these events lead to a decrease in the oxygenation secondary to reduced blood flow to the other organ systems (Lee, Soo, LeBouf, et al., 2018).
The Occupational Safety and Health Administration (OSHA) identifies around 500, 00 at risk operating room (OR) personnel in the United States. These include surgeons, anesthesiologists, surgical and anesthesiology residents, and nurses (Lee, Soo, LeBouf, et al., 2018). Due to the factors stated, scientists have demonstrated interest in ascertaining and analyzing the components of surgical plumes and the protective measures provided to the OR staff (Bree, Barnhill, & Rundell, 2017).
Similarly, the Centers for Disease Control and Prevention (n.d.) has surveyed the health practices of health workers, especially in the OR. This study has revealed that surgical smoke also contributes to the spread of communicable diseases caused by bacteria and viruses. It has been found that there is an increased human papillomavirus (HPV) transmission from the smoke generated by the lasers and more than 5 million healthcare workers are exposed to this hazard annually.
The primary cause of the spread of the diseases may be due to poor ventilation. Only 47% of the respondents informed the lack of local exhaust ventilation (LEV) in their OR or if present, LEV is usually used during laser surgery and not during an electrosurgery. 44-49% of the participants stated that the employers do not provide training addressing the occupational hazards of surgical smoke and the majority of employers do not have protocols concerning this. Furthermore, 90% of laser surgery respondents and 98% of the electrosurgery respondents have revealed that their employers only provide laser masks or surgical masks that do not offer optimal respiratory protection (Centers for Disease Control and Prevention, n.d.).
Many nurses, especially the advanced practice nurses (APN), are also being exposed to this hazard yearly. These hazards may lead to several mortalities and morbidities of healthcare workers annually. However, these hazards are preventable factors that when addressed, may enhance the performance of the healthcare workers, prevent their increasing annual mortalities and morbidities, and reduce the number of lawsuits.
In line with this, this paper discusses the review of literature concerning the causes and impact of surgical smoke to the healthcare workers, particularly the OR nurses. The objectives of this paper are to summarize the existing evidence on the effects of surgical smoke among medical personnel and the benefits of its limited exposure; to identify the known risk factors associated with the surgical smoke generated from the different techniques of electrosurgery; to analyze the implications to the APNs.
Methodology
Design
To present a detailed summary of the searched evidence, the researchers included articles between January 2015 to January 2018. This time frame has been decided to analyze the emerging modern technologies in the literature. An in-depth understanding is authenticated through the review of qualitative, quantitative, and qualitative-quantitative research papers.
Search Strategy
The researchers accessed PubMed, Science Direct, EBSCO Host, and Proquest electronic databases to perform the investigation. To narrow down and to find the pertinent manuscripts titles, subject indicators, and abstracts, the researchers utilized the terms electrosurgery, diathermy, surgical smoke, surgical plumes.
Articles selected were those that elaborated the notions on electrosurgery, the components of the surgical smoke, the positive and negative health effects of surgical smoke, the overall impact to the healthcare workers, and the techniques utilized to minimize its poor effects to the medical personnel’s well-being. Articles must be peer-reviewed and non-opinionated full-text papers. Considering these factors, 7 articles have been selected for the literature review.
Review of Related Literature
Lindsey, Hutchinson, & Mellor (2015) studied the links between the exposure to the smoke generated by diathermy and its health risks and describes the significance of protective techniques in the nursing practice. The study is a level 4 evidence that presents a comprehensive analysis of the research papers published between January 1990 and July 2011. All of the studies included are peer-reviewed English research papers with all the necessary information on diathermy plume. After the methodical approach, the search yielded a total number of 26 papers which are a combination of quasi-experimental human and animal studies, cross-sectional and prospective cohort designs, literature reviews, and control group and single-blind studies. The results of the review are focused on the chemical and biological properties of diathermy plumes, potential health effects, and the current standard protocols. The chemicals identified in diathermy plumes include aldehydes, ketones, benzenes, xylene, toluene, styrene, furfural, hydrogen cyanide, 1,3-butadiene, methylpropene, ethylene, and propane nitrile. Aldehydes and ketones are mainly generated by executing muscular cuts while hydrocyanic acid and carbon monoxide are generated through the coagulation of fatty and liver tissues. The biological properties proved the induction of mutagens and oncogenes in the rat studies. Most of these factors are related to Salmonella and HPV. Consequences of the exposure include histological lung changes experimental studies in humans and animals, specifically, the rats and an increased incidence of respiratory symptoms in OR nurses such as sinus infections in the cross-sectional studies. However, the literature in this study is mainly directed to the presence of harmful substances in the plumes without substantial evidence linking it to the harmful effects.
Protocols are focused on control measures, evacuation techniques, and protective standards. The researchers revealed in the literature review that diathermy liberates ultrafine particles around 0.02 mm to 1mm which makes the use of surgical masks inappropriate. However, this is the standard practice in ORs. One experimental study revealed that the particles in close contact with the surgeon’s surgical mask after the operation in a randomized controlled trial (RCT) are significantly reduced when an effective ventilation system, such as LEV, is utilized. The differences attitudes of the medical personnel toward the occupational hazard revealed that the registrars mainly utilized evacuation equipment while consultants use wall-mounted suctions to clear the surgical plumes. This study is limited by the use of summarized literature reviews and experimental studies with a small sample size (Lindsey, Hutchinson, & Mellor, 2015).
Bree, Barnhill, & Rundell (2017) supported the consistent use of smoke evacuation methods in ORs to prevent the utilization of electrosurgery when possible. This is done to safeguard the health of the OR staff from the negative long-term impact of the surgical smoke. The researchers used the PubMed database to search for evidence-based papers. The indicating words include electrosurgical, diathermal, and electrocautery smoke, and William Bovie. National organizational websites were also explored for guidelines related to the surgical smoke. Articles were limited to peer-reviewed English studies published from 1981 to 2017. A total of 43 articles fulfilled the criteria.
It has been revealed that below standard steps are practiced in safeguarding the health of the medical staff from the morbidities resulting from surgical smoke, which is mainly composed of fine particulate matter, many chemicals, and several infectious microorganisms. Some of the adverse effects of the plumes include pounding of head, irritation of the senses, acute dermatitis, and colic. Some healthcare workers also experience chronic pulmonary diseases. The mode of transmission is through aerosols and...