Clearing the air on surgical plume.

BACKGROUND: Surgical smoke or plume is produced by a variety of surgical coagulators and dissectors. A number of jurisdictions have recently introduced policies to reduce the associated occupational health risks including WorkSafe Victoria and New South Wales Health. METHOD: This paper is a narrative review of potential risks, including any associated with COVID-19, and options for mitigation. RESULTS: Surgical smoke or plume contains potentially toxic chemicals, some of which are carcinogens. Plume may also contain live virus, notably Human Papilloma and Hepatitis B, though any possible viral transmission is limited to a few case reports. Despite identifying COVID-19 ribonucleic acid fragments in various body tissues and fluids there are no current reports of COVID-19 transmission. Although plume is rapidly removed from the atmosphere in modern operating rooms, it is still inhaled by the operative team. Mitigation should include ensuring diathermy devices have evacuators while plume extraction should be standard for laparoscopic procedures. Consideration needs to be given to the potential to compromise the operating field of view, or the noise of the extractor impairing communication. There is an increasing range of suitable products on the market. The future includes pendant systems built into the operating room. CONCLUSION: The potential risks associated with surgical plume cannot be ignored. Health services should invest in plume extraction devices with a view to protecting their staff. The conduct of the operation should not be compromised by the devices chosen. Future operating theatres need to be designed to minimize exposure to plume.

Undergraduate surgical nursing preparation and guided operating room experience: A quantitative analysis.

The aim of this research was to determine if guided operating theatre experience in the undergraduate nursing curricula enhanced surgical knowledge and understanding of nursing care provided outside this specialist area in the pre- and post-operative surgical wards. Using quantitative analyses, undergraduate nurses were knowledge tested on areas of pre- and post-operative surgical nursing in their final semester of study. As much learning occurs in nurses' first year of practice, participants were re-tested again after their Graduate Nurse Program/Preceptorship year. Participants' results were compared to the model of operating room education they had participated in to determine if there was a relationship between the type of theatre education they experienced (if any) and their knowledge of surgical ward nursing. Findings revealed undergraduates nurses receiving guided operating theatre experience had a 76% pass rate compared to 56% with non-guided or no experience (p < 0.001). Graduates with guided operating theatre experience as undergraduates or graduate nurses achieved a 100% pass rate compared to 53% with non-guided or no experience (p < 0.001). The research informs us that undergraduate nurses achieve greater learning about surgical ward nursing via guided operating room experience as opposed to surgical ward nursing experience alone.

EDUCATION IN PRE AND POSTOPERATIVE SURGICAL NURSING: CAN GUIDED PERIOPERATIVE EXPERIENCE ASSIST?

It is reported that surgical adverse events occurred in 3.6% of patient admissions representing 64.5% of reported events (Zegers et al. 2011). These were severe and 41% were considered to be preventable (Zegers et al. 2011).

Effects of Guided Undergraduate Perioperative Education on Recruiting Novice RNs and Retaining Experienced RNs.

This qualitative research describes undergraduate nurses' perceptions of their perioperative placement experiences and how they may affect their future perioperative employment. It also describes experienced perioperative nurses' perceptions of the effect of student placement experiences on retention. The author asked undergraduate nurses about their experiences in the OR, if any, and whether they would consider perioperative nursing as a career; the author also asked experienced perioperative educators to comment on whether there are correlations between types of perioperative student experiences that affect stress levels for supervising staff members. The author used reporting of disconfirming data, and expert peers performed an external examination of data to guarantee the rigor of qualitative data analysis. The findings indicate that undergraduate nurses who are provided with guided practical experiences (as opposed to non-guided experiences or no OR experiences) are more likely to consider perioperative nursing as a career. In addition, the findings show that the arrival of students in the OR with no preparation for the experience is a major stressor for staff members.