IFPN 2015Guideline

IFPN Guideline on Risks, Hazards, and Management of Surgical Plume
Introduction
Healthcare workers are exposed to surgical plume when energy based devices suchas: diathermy, plasma, ultrasonic equipment, and lasers, are used during surgicalinterventions. The plume that is released into the atmosphere contains many harmful
substances such as carbonised tissue, blood borne pathogens, viral particulates,bacteria, toxic and/or carcinogenic chemicals and noxious gases such as carbon
monoxide, benzene, and formaldehyde.
Surgical plume becomes a patient safety hazard when it accumulates in the intraabdominal cavity during laparoscopic procedures that include vapourisation of tissue
with an energy based device. Gases, toxins, and chemicals from plume can absorb
into the patient’s bloodstream and cause decreased oxygenation of tissues withresulting symptoms, leading to prolonged recovery times and potential complications.
Plume may interfere with visibility of the surgical site, resulting in unsafe operating
conditions, or it may be invisible, but noticeable due to the presence of an unpleasantodour. When plume is inhaled, it can cause ocular, respiratory and skin irritation,
asthma and allergic reactions, headaches, sinus congestion, and other aerodigestive symptoms.
It is important that Employers and Employees are aware of the risks and hazards
associated with exposure to surgical plume and ensure that there are policies inplace to reduce that exposure. Surgical policies must comply with Workplace and/or
Occupational health and safety laws, International Electro-technical Commission(IEC) and ISO (International Standards Organisation) standards, professional bestpractices, and other local rules and guidance pertinent to the particular healthcare
setting.
Definitions
Surgical Plume
This is a vaporous product that is generated when electro-cautery, electro-diathermy,laser equipment, or other energy based devices are utilised in perioperativeinterventions It is created by the rapid heating action of this equipment that causes
tissue membranes to rupture thus releasing a plume in the form of a bio aerosol that
contains noxious and toxic materials.
Guidelines to reduce the risks of surgical plume
Face Masks
Plume evacuation systems should always be selected as the first line of defence
against exposure to the occupational health hazards of surgical plume. Face masks,including N-95 respirators, and 0.1micron high filtration masks (often referred to as
laser masks, point 1 masks, or high efficiency masks) should never be used as thefirst line of protection in the operating theatre, or anywhere energy based devices areused to treat or vapourise tissue. (IEC 60825-TR8)
If face masks are used as a secondary form of personal protection against plume, it
is important to adhere to good practices in wearing and handling them.

1IFPN 2015•••GuidelineMasks must be properly fitted and worn, leaving no loose or gaping edges,
which allow for peripheral leakage.
As far as possible such masks should be single use and disposable to ensurethat they are free from contamination
Masks should be disposed of according to appropriate infection control
guidelines for contaminated items

Surgical Plume Evacuation systems
In order to minimise the risks of surgical plume hazards to all individuals in theperioperative environment, the use of specific plume evacuation systems isadvocated.
•••••

Surgical plume evacuation systems require ULPA filters (ultra low penetrating
air filters) that filter out particulates to 0.12 microns in size, at 99.999%
efficiency. This provides filtration of viral particulates. HEPA (high efficiency
particulate air filters) provide 0.3 micron filtration, and provide only bacterialfiltration, which does not capture viral particles, and should not be used for
surgical plume. Filters and other accessories should be changed/maintained
and used, in accordance with the manufacturer’s instructions. Consumableitems require regular replacement in order to ensure that the plumeevacuation unit operates at maximum efficiency.
Filters, tubing, and all consumable accessories used with a surgical plumeevacuator should be disposed of according to infection control procedures forblood borne pathogen contamination.
The plume capture device attached to the evacuation system, should bepositioned as close as possible to where the plume is generated without
interfering in the operative site. This will ensure maximum reduction ofsurgical plume hazards and provide optimal visibility of the operative field.
Existing suction units, including HVAC systems, in use in the perioperativeenvironment should not be used for plume evacuation, as they are notdesigned for this purpose. If wall suction is the only option, a 0.1micron inline filter must be placed between the wall outlet and the floor canister. Thesefilters are consumable devices, and must be changed according to
manufacturer’s instructions, and disposed of as biohazard.
Plume evacuation devices designed for use during laparoscopy can be either
active or passive, and must be used to remove plume with limited reduction of
the pneumoperitoneum, or without allowing unfiltered venting into the roomair.

References
American National Standards: ANSI Z136.3: 2011section 7: Non-Beam Hazards
Association of peri-Operative Registered Nurses (AORN), Recommended Practices
and Guidelines. Denver, CO, USA. January 2010
Australian / New Zealand Standards: AS/NZ 4173:2004, sections 5.5 and 9.4
Australian College of Operating Room Nurses, ACORN Standards for PerioperativeNursing. Standard 20, 2013
Canadian Standards Association: CSA Z305.13-13,
Plume scavenging in surgical, diagnostic, therapeutic, and aesthetic settings

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Guideline

International Electrotechnical Commission (IEC) Standards: 60825, 60825-TR8, 2005
National Association of Theatre Nurses, 2004 Standards and Recommendations forsafe perioperative practice. Harrogate, UK, NATN, 2004.
International Standards Organization (ISO) ISO:16571 - 2014
Operating Room Nurses Association of Canada (ORNAC). 2013
The ORNAC Standards for Perioperative Registered Nursing Practice.

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(2014). Chemical Composition of Surgical Smoke Formed in the Abdominal CavityDuring Laparoscopic Cholestectomy – Assessment of the Risk to the Patient.
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