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TJC makes it clear: get surgical smoke out of OR.
The air is clearing in the nation's operating rooms, as The Joint Commission (TJC) places a greater emphasis on evacuating smoke from electrocautery procedures.
In the accrediting process, hospitals have long been required to manage "risk related to hazardous material and waste." In the 2009 Environment of Care standard, The Joint Commission added a note for clarification: "Hazardous gases and vapors include, but are not limited to, glutaraldehyde, ethylene oxide, vapors generated while using cauterizing equipment and lasers, and gases such as nitrous oxide."
This is the first specific mention of surgical smoke in TJC standards, although the National Fire Protection Association (NFPA) code addresses smoke detectors and scavenging of waste anesthetic gases. TJC requires hospitals to comply with NFPA codes.
"We have always interpreted the smoke that's generated from these procedure [as a hazard]," says Jerry Gervais, CHFM, CHSP, BSME, associate director and engineer in the Standards Interpretation Group of TJC. "Organizations didn't make that connection so we wanted to be very, very clear about it. The hospital should have a written policy on how they're handling this issue," he says. "By having a written policy, they can require compliance by all employees. They can write in the required safety precautions and hold them accountable."
AORN says reduce exposure
The "clarification" by TJC comes on the heels of a 2008 position statement by the Association of periOperative Registered Nurses (AORN), urging hospitals and surgery centers to reduce exposure to surgical smoke and bioaerosols released in laser and electrosurgical procedures.
In March 2009, the Canada Standards Association issued a voluntary "Plume Scavenging Standard" that provides guidance on systems that evacuate surgical smoke from electrosurgery procedures. Hospitals frequently tout their "smoke-free" campus. Now, the "no-smoking" rule will include the pungent smoke produced when tissue is burned, say OR nurses who have advocated for greater attention to the issue.
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