247 - Implementing an Evidence Based Surgical Smoke Evacuation Bundle Enhancing Compliance

Description: Clinical Problem/Significance: Initial observations in the operating room revealed a need to improve compliance with smoke evacuation protocols. This project aims to promote a smoke-free environment within the operating room (OR), thereby protecting perioperative staff from exposure to surgical smoke. It seeks to enhance education and awareness regarding smoke evacuation devices. It introduced competencies for perioperative staff and aims to increase compliance with the use of these devices through a twelve-week evidence-based audit. This audit will identify practice deficiencies and provide constructive feedback to inform practice modifications, thereby supporting the sustainability of the smoke evacuation initiative and helping the facility achieve AORN Go Clear certification.

Background: In the United States, numerous healthcare professionals are exposed to surgical smoke annually. Electrosurgical devices heat tissue and generate smoke during surgery. Surgical smoke exposes patients and perioperative personnel to smoke byproducts made of chemicals, bacteria, blood, and viruses, which can cause long-term health problems or surgical site infections. Compliance with the Centers for Disease Control and Prevention (CDC), the National Institute for Occupational Safety and Health (NIOSH), The Joint Commission (TJC), the Association of Perioperative Registered Nurses (AORN), and state legislation addresses the growing concern about surgical smoke exposure. Smoke evacuation devices reduce exposure for both patients and healthcare personnel during procedures. However, ensuring compliance with smoke evacuation protocols has been challenging in many hospital environments due to resistance, a lack of understanding of the equipment operation, insufficient awareness of health hazards, and inadequate stakeholder support.

Clinical Question: For perioperative personnel, how does the implementation of an evidence-based smoke evacuation bundle, compared to baseline smoke evacuation knowledge, increase the compliance with smoke evacuator usage in the OR, occurring over one year beginning in the fall of 2024 and concluding in January 2026.

Evidence-Based Protocol: This project will utilize the AORN Go Clear audit tool over 12 weeks in the OR of a military medical center. These audits are focused on the OR utilization of smoke evacuation during surgical procedures that generate smoke by utilizing smoke evacuation devices with filters, the position of the device on the surgical field, staff wearing appropriate personal protective equipment, disposal of contaminated filters, and ensuring the filters are used per the manufacturer's instruction for use. This will facilitate problem identification, performance monitoring, and adherence to recommendations to enhance performance. By implementing adjustments, the project will optimize the OR's compliance. The Plan-Do-Study-Act (PDSA) methodology is chosen, as it will be crucial in guiding our change initiatives for quality improvement. The process will begin with an integrative literature review and an examination of current practice standards.

Results: Results are pending completion of the 12-week audit in August of 2025.

Conclusion: Evidence-based audit procedures can drastically enhance adherence to smoke evacuation guidelines in healthcare settings. Enhancing compliance is crucial for the safety of healthcare workers, patient welfare, and compliance with regulatory requirements.