『21: What Is Surgical Smoke, and Why Is it So Dangerous? An Expert Explains』のカバーアート

21: What Is Surgical Smoke, and Why Is it So Dangerous? An Expert Explains

21: What Is Surgical Smoke, and Why Is it So Dangerous? An Expert Explains

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概要

 Surgical smoke has been part of operating room culture for decades, generated routinely by lasers, electrosurgical devices, and ultrasonic tools. Yet despite its constant presence, it remains one of the least understood and least consistently addressed risks in perioperative care.In a recent interview with Infection Control Today® (ICT®), Vangie Dennis, MSN, RN, CNOR, CMLSO, FAORN, FAAN, a former president of AORN and current member of the ICT’s Editorial Advisory Board, made it clear that this normalization has contributed to a dangerous blind spot in health care.“It is a hazard that sometimes we’ve been doing it for so many years… it is just part of the culture,” Dennis, who is also a health care consultant with Perioperative Consulting, LLC, said, describing how familiarity has dulled concern across the field. A Risk That Extends Beyond the Surgical FieldDennis, who is also a perioperative nurse executive and speaker, stressed that one of the biggest misconceptions about surgical smoke is who it affects. While many clinicians associate exposure primarily with surgeons, the reality is far broader.She pointed to overlooked patient risks, particularly in vulnerable scenarios such as cesarean deliveries or procedures under monitored anesthesia.“The patients are affected by the surgical smoke,” she said. “What about the baby’s first breath on a C-section… the nurse who’s pregnant… that unborn baby is exposed to surgical smoke.” This framing expands the conversation from occupational safety alone to a shared exposure risk across the entire perioperative team and patient population.“It really affects everybody in that perioperative platform when we generate smoke,” Dennis added, emphasizing that no one in the room is truly isolated from exposure. Understanding the Science Behind the SmokeDennis explained that the source of the smoke matters less than many clinicians believe. Whether generated by lasers, electrosurgery, or other heat-producing devices, the resulting plume contains harmful components.“Any heat-generating device will create a surgical plume or smoke… it’s all bad for you,” she said, underscoring that differentiation between technologies does not equate to differences in safety. She reinforced this point with a lesson from early in her career, recalling a physician who distilled the issue bluntly.“He said, there’s no such thing as safe smoke,” Dennis noted. To make the risk more tangible, she cited common comparisons used in education and research.“One gram of tissue vaporized by a laser is equivalent to 3 unfiltered cigarettes… by an electrosurgical device, 6 unfiltered cigarettes,” she said. However, Dennis emphasized that even this comparison may underestimate the danger, given the biological and chemical complexity of surgical smoke, which includes human tissue, blood particles, and toxic gases such as benzene and formaldehyde.Health Effects That Accumulate Over TimeDennis described both the immediate and long-term health consequences associated with repeated exposure. Early in her career, she experienced symptoms that many perioperative staff still report today.“You had headaches… your eyes are burning… nausea, fatigue,” she said, recalling the physical effects of prolonged exposure during smoke-heavy procedures. While these symptoms may seem transient, Dennis emphasized that chronic exposure could lead to more serious outcomes.“I know several of my friends… one has adult-onset asthma, and the other has stage 2 [chronic obstructive pulmonary disease],” she said, highlighting the potential progression from irritation to long-term respiratory disease. She also pointed to the presence of mutagenic and carcinogenic compounds in surgical smoke.“We’re being exposed to toxic gases and volatile organic compounds… these are all mutagenic and carcinogenic chemicals,” she explained, reinforcing that the risks are not hypothetical. In addition to respiratory concerns, Dennis discussed infection risks, noting that viable viral particles have been identified in surgical smoke.“There has been documented, proven risk,” she said, referencing studies involving pathogens such as [human papillomavirus (HPV)]. The Persistent Awareness GapDespite decades of research and guidance, Dennis believes the greatest barrier to progress remains a lack of awareness.“It is the unknown,” she said. “If you don’t see it, smell it, touch it, it’s not real, but it is real.” This gap extends beyond clinicians. Dennis highlighted that many ancillary staff, including environmental services personnel, are rarely educated about surgical smoke exposure.“If I walked up to anybody with [environmental services], I bet they would have no idea,” she said, pointing to missed opportunities for broader organizational engagement. For infection prevention professionals, this underscores the need to expand education beyond traditional ...
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