RR922 - Evidence for exposure and harmful effects of diathermy plumes (surgical smoke) - Evidence based literature review

The methods used to dissect tissue and stem blood flow during surgery have changed as technology has developed. Lasers and electro-surgery have become commonplace, so that medical staff in the operating theatre are (potentially) increasingly exposed to the thermal decomposition products of tissues. Variations in ventilation systems and the presence or absence of local exhaust ventilation are likely to influence the extent to which this occurs. A systematic review was carried out to identify existing evidence about surgical smoke (known as diathermy plume) and the potential harm to health care workers exposed in operating theatres. Limited published data were identified, but indicated that dedicated smoke evacuation/extraction devices are effective at reducing the levels of surgical smoke during various surgical procedures, and that correct (close) positioning of smoke evacuation devices to source emissions is likely to be important to the efficiency of surgical smoke removal. The data were insufficient to allow conclusions to be drawn on reported respiratory ill health symptoms linked with surgical smoke exposure. This report and the work it describes were funded by the Health and Safety Executive (HSE). Its contents, including any opinions and/or conclusions expressed, are those of the authors alone and do not necessarily reflect HSE policy. You may reuse this information (not including logos) free of charge in any format or medium, under the terms of the Open Government Licence. To view the licence visit Some images and illustrations may not be owned by the Crown so cannot be reproduced without permission of the copyright owner. Enquiries should be sent to ACKNOWLEDGEMENTS HSL would like to thank Diane Llewellyn, Philip Roberts (HSE) and David Fishwick and Anil Adisesh (HSL) for their contribution to the co-reviewing of scientific papers for this report process. • This systematic review has considered the evidence related to the use of surgical smoke evacuation devices, and their role in reducing the exposure of UK healthcare workers (HCWs) to smoke exposure in the surgical environment. Over recent years a small number of individual UK case reports have attributed such exposure to HCWs developing respiratory ill health due to exposure of this nature. Although there are existing legal requirements within the UK for all workers to be protected from unnecessary exposure to hazardous materials, a key issue related to surgical smoke is whether there is evidence that the unpleasant, cloying, odorous smoke actually equates to a hazard, and in turn whether this …