1. Management of Surgical Smoke Tool Kit Part III: An Overview of the Health Care Regulations, Standards, and Guidelines Related to Surgical Smoke

2. There are five slide decks related to the management of surgical smoke in the perioperative setting. We recommend that you review the slide decks in order. This is Part III. Part I: Introduction to Surgical Smoke Part II: The Hazards of Surgical Smoke Part III: An Overview of Health Care Regulations, Standards, and Guidelines Related to Surgical Smoke Part IV: Smoke Evacuation in the Perioperative Setting Part V: Additional Perioperative Nursing Care Instructions to the Learner

3. Part III An Overview of the Health Care Regulations, Standards and Guidelines Related to Surgical Smoke

4. AORN ANSI ECRI International Federation of Perioperative Nurses (IFPN) The Joint Commission National Institute of Occupational Safety and Health (NIOSH) Centers for Disease Control and Prevention (CDC) OSHA Health Care and Regulatory Standards and Guidelines

5. Airborne Contaminants: Shall be controlled by the use of ventilation (ie, smoke evacuator) and respiratory protection for any residual plume escaping capture. Note: ESU produces the same type of airborne contaminants as lasers. ANSI Standard 7.4 of Z136.3 - 2011 (Safe Use of Lasers in Healthcare)

6. Ventilation combination of general room and local exhaust ventilation (LEV) portable smoke evacuators room suction systems NIOSH/CDC: Ventilation

7. The smoke evacuator or room suction hose nozzle inlet must be kept within 2 inches of the surgical site. The smoke evacuator should be ON (activated) at all times when airborne particles are produced. Health care workers should follow standard precautions. NIOSH/CDC: Work Practices

8. All smoke evacuator tubing, filters, and absorbers -considered infectious waste -disposed of appropriately New tubing should be installed on the smoke evacuator for each procedure Change filters according to manufacturer’s directions Local exhaust ventilation equipment -regularly inspected and maintained Follow Standard Precautions at the Completion of the Procedure

9. General Duty Clause: Employer MUST provide a safe workplace environment! OSHA

10. Recognizes: Lasers and electrosurgical plume contains toxic, mutagenic, and carcinogenic elements Mandates and identifies: Removal of atmospheric contaminants with acceptable engineering controls and local ventilation, including smoke evacuation systems. OSHA Respiratory Protection Occupational Safety and Health Standards. 29 CFR 1910.134. Personal protective equipment: respiratory protection. June 8, 2011. Occupational Safety & Health Administration. https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=12716 Accessed April 14, 2016. https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=12716

11. Independent, nonprofit organization Researches the best approaches to improving the safety, quality, and cost-effectiveness of patient care Electrosurgical smoke is overlooked The spectral content of laser and ESU smoke is very similar ECRI

12. IFPN Guideline on Risks, Hazards, and Management of Surgical Plume 2015 Recognition that smoke particles may contain bloodborne pathogens and potential for viral transmission Identification of smoke as a workplace safety hazard Respiratory protection Use of standard precautions Use of local exhaust ventilation with ULPA filter Smoke evacuation methods International Federation of Perioperative Nurses (IFPN)

13. CSA Z305.13: Plume scavenging in surgical, diagnostic, therapeutic, and aesthetic settings, 2013 publication Supersedes the previous edition published in 2009 Provides detailed standards on surgical smoke evacuation Canadian Standards

14. Electrosurgery Laser Safety Minimally Invasive Surgery (MIS) AORN

15. “Recommendation X Potential hazards associated with surgical smoke generated in the practice setting should be identified and safe practices established.” 1, pg128-129 “Recommendation V Potential hazards associated with surgical smoke generated in the laser practice setting should be identified and safe practices established.” 2, pg141-142 “Recommendation IV Personnel should take additional precautions when using electrosurgery units (ESUs) during MIS and computed assisted procedures.” 3 pg597-600 AORN Guidelines

16. Evacuate smoke with a smoke evacuation system during open and laparoscopic procedures Used smoke evacuator filters, tubing, and wands should be disposed of as potentially infectious waste following standard precautions Personnel should wear respiratory protection during procedures that produce surgical smoke Guideline Interventions

17. Guidelines Wear appropriate PPE Remove smoke with an evacuation system for open procedures and MIS procedures Place the capture device close to the source of the smoke Use the evacuation system according to manufacturer’s written instructions for use Surgical Smoke is Hazardous

18. Several international and national organizations address standards affecting patients and health care workers on the topic of exposure to hazardous materials and surgical smoke. The AORN guidelines for ESU, laser safety, and minimally invasive surgery have recommendations that address surgical smoke evacuation. Both patients’ safety and health care workers’ safety concerns are addressed in health care regulations, standards, and guidelines related to surgical smoke. Summary Part III

19. Please continue to the next slide deck: Part IV Part I: Introduction to Surgical Smoke Part II: The Hazards of Surgical Smoke Part III: An Overview of Health Care Regulations, Standards, and Guidelines Related to Surgical Smoke Part IV: Smoke Evacuation in the Perioperative Setting Part V: Additional Perioperative Nursing Care End of Part III