Perioperative Nurses` competency level and adherence to guidelines related to surgical smoke safety : a descriptive literature review

Abstract

Nowadays, technological devices are widely used in surgeries (lasers, electrocauteries, ultrasonic scalpels, radiofrequency devices and power tools). These tools bring many advantages to the procedures, but on the other hand they produce surgical smoke leaving OR personnel exposed to its hazards. Surgical smoke (also known as plume, diathermy plume, cautery smoke, bioaerosols) is released into air, by using those devices, leading the tissue to reach its boiling point due to cutting and coagulating of target tissue. The plume is composed of 95% of water and 5% of cellular debris that contains toxic components such as benzene, bioaerosols, formaldehyde, cyanide, and biologic matter such as bacteria, viruses, blood, and tissue particles. There is evidence of the presence of some known carcinogens in the smoke, as well as potentially hazardous biological matter (such as HPV virus). Various symptoms including eye irritation, oral cavity irritation and headache, are suggested to be connected to the exposure of surgical smoke.

This thesis is a literature review with a purpose to describe nurses´ competency level related to surgical smoke and their adherence to the guidelines concerning surgical smoke safety. Nursing competency is viewed as a vital element of nursing care and its core abilities include knowledge, attitudes, skills, values, and abilities. Guidelines of safety related to surgical smoke advice for a total smoke evacuation, revision and development of policies and procedures, training for OR staff ad quality performance improvements.

The articles used in this literature review were selected from the databases CINAHL and Medline with different search terms and limitations. 9 studies were included based on the results (2 being from a performed manual search). According to the analysis of the studies selected to this thesis, the results indicate that there is generally demand for improved nurses’ knowledge level related to surgical smoke, especially when it comes to measures to improve safety. The guidelines need to be clear in order to improve adherence and there is an important need for training to improve the safety in the work environment.