Research has shown that there are again many variables: higher cautery temperatures produce greater chemical components in the smoke whereas lower temperatures produce more cell particles, (Barrett, 2003 as cited in Mellor & Hutchison, 2013). So the question asked here and from the scenario is which of these, if any, are hazardous to patient and staff? The feelings of concern were obvious to myself and others. The smoke evacuation unit would not have been used were there not some recommendation that showed it aided welfare of patient and staff. Health & Safety Executive (HSE) (2012) explains that there is no specific legal requirement for surgical departments to install smoke extraction systems for any type of surgical procedure yet British Occupational Hygiene Society (2006) offer COSHH Guidance for NHS mangers concluding that 'local exhaust ventilation should be considered a required control measure'. The surgeons' comment of 'no proven hazard' also emphasized the indeterminate nature of this issue.
From making the alterations it was felt that ultimately most of the smoke was being moved away from the patient but not filtered. It was a better solution than not using any form of smoke evacuation however only highlighted again the consistent lack of understanding on this topic. That there was no risk assessment was also another key indicator that with no real legislation and only guidelines where the system offered choice there was such ambiguity. The main need was to grasp a firmer understanding of the implications that this situation potentially hold and make an informed and clear protocol for the practice area to employ.
Winter (2008) states that cigarette smoke contains chemical carcinogens; and now theatre staff have rationally concluded that surgical smoke could be even more harmful, since it could potentially contain not only carcinogenic chemicals but also viruses and bacteria, which have not been killed by the electrosurgical equipment.
