Exploring Electrosurgical Smoke Control Practices among New Zealand Operating Theatre Personnel: A Qualitative Study
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Background: Inconsistent electrosurgical smoke evacuation is a concern among operating theatre personnel at a large District Health Board in New Zealand. Despite a growing body of evidence on the hazardous nature of electrosurgical smoke and its harmful effects on operating theatre patients and personnel, there is a paucity of research on electrosurgical smoke control practices among diverse operating theatre personnel. Currently, there are no government regulations that mandate electrosurgical smoke evacuation in New Zealand. Objectives: This study explores and describes electrosurgical smoke control practices at a large District Health Board in New Zealand. It aims to gain a better understanding of diverse operating theatre personnel’s attitudes towards electrosurgical smoke, and how it influences their compliance with electrosurgical smoke evacuation. The goal is to apply the knowledge gained to develop key recommendations to mitigate operating theatre patients’ and personnel’s risk of exposure to hazardous electrosurgical smoke, promoting a healthy surgical smoke-free operating theatre environment for patients and personnel. Methods: An exploratory-descriptive qualitative methodological framework guides this study with individual semi-structured virtual interviews for data collection. A purposeful sample of six diverse operating theatre personnel, comprising of two surgeons, two nurses, an anaesthetist and an anaesthetic technician were voluntarily recruited from a large District Health Board in New Zealand. The researcher conducted the interviews which were audio-recorded. Notes were taken during the interviews. Furthermore, interviews were transcribed verbatim and analysed utilising reflexive thematic data analysis approach. Findings: Research findings suggest that compliance with electrosurgical smoke evacuation is an important yet complex issue. Three major themes emerged from the data analysis. Firstly, education on electrosurgical smoke and electrosurgical smoke evacuation across disciplines. Secondly, attitudes and perceptions about electrosurgical smoke and electrosurgical smoke evacuation. Lastly, barriers and facilitators to electrosurgical smoke evacuation. This study highlights that effective electrosurgical smoke control methods are not being consistently practiced by diverse operating theatre personnel at the District Health Board with an inherent risk of exposure to hazardous electrosurgical smoke for operating theatre patients and personnel. Findings identified that although electrosurgical smoke evacuation is routine in open surgical procedures, it is poorly upheld in laparoscopies. The data analysis indicates that certain aspects of the District Health Board policy on electrosurgical smoke evacuation are ambiguous and require updating. Conclusion: This study revealed that the education of operating theatre personnel on electrosurgical smoke and electrosurgical smoke evacuation across disciplines with strong leadership support, is the key to influence positive attitude towards electrosurgical smoke evacuation. This knowledge is vital to overcome barriers for effective and consistent compliance with electrosurgical smoke evacuation to mitigate the effects of hazardous electrosurgical smoke on operating theatre patients and personnel.