Infectious Disease and Toxins Lurk in Surgical Smoke
Diagnostics and Procedures Despite the numerous smoke evacuation tools from device manufacturers, and smoke safety education programs, not enough hospitals are taking this critical hazard seriously.
Surgical lasers — and the blurred vision and recurrent cough that accompanied the exposure to them — were once part of the typical workday for Pam Tomlinson. A registered nurse, BSN, MEPC, Tomlinson’s insistent cough only grew worse. Other health issues crept in, until finally she collapsed and was rushed to the emergency room.
The diagnosis was sarcoidosis, a chronic lung disease that causes multiple lesions and inflammation. She was also diagnosed with emphysema, asthma and chronic obstructive pulmonary disease.
Tomlinson thought there must be a mistake. How could this healthy nurse who hadn’t smoked a cigarette a day in her life have a lung disease?
Essentially, while working when patient tissue was being cauterized, creating a foul-smelling and toxic plume of surgical smoke, Tomlinson had in fact inhaled the equivalent of 6 unfiltered cigarettes in just 15 minutes. In total, over 20 years working eight hours a day, she’d essentially inhaled one-and-a-half packs of cigarette smoke per day.
Where there’s smoke
Surgical smoke contains chemical toxins, viruses and bacteria. Some researchers think that sarcoidosis develops if the immune system responds to a trigger, such as bacteria, viruses, dust or chemicals — all elements that have been identified in surgical smoke plume. Without an appropriate smoke evacuation system in place, surgical plume can spread these harmful elements directly into the lungs of anyone in the operating room.
And it does. Surgeons and nurses who used electrosurgery to excise HPV (human papilloma virus) have turned up with these same HPV strains growing in their airway. Scientists have also found carcinogenic compounds, such as benzene and formaldehyde in collected samples of surgical smoke, according to Mary Ogg, MSN, a senior perioperative nursing specialist for the Association of peri-operative Registered Nurses (AORN).
“Tomlinson had in fact inhaled the equivalent of six unfiltered cigarettes in just 15 minutes…”
Surgical smoke is dangerous for patients, too. During minimally invasive surgeries, smoke limits the surgeon’s visibility, causing longer surgical procedures, and patients can absorb the toxic chemicals in smoke.
Taking a stand
As Tomlinson adjusts to living with chronic lung disease, she is undergoing treatment for her sarcoidosis, which OSHA has reportedly deemed to be caused by working in an unsafe environment that did not take steps to adequately evacuate surgical smoke. Tomlinson is also taking every opportunity she can to speak out against the dangers of surgical smoke that too many of her surgical colleagues and their patients are breathing in.
“Today, only half of practitioners are aware surgical smoke is a serious health hazard,” Ogg notes. She says inconsistent and inadequate smoke evacuation use and an unsafe reliance on surgical masks — even high filtration masks that still permit inhalation of surgical smoke particles — can put these professionals at risk.
“Nurses talk to each other frequently about the negative health effects of breathing in surgical smoke exposure,” adds Ogg, “but they can make a difference by speaking up beyond their own profession to raise awareness about this occupational danger.”
Lack of initiative
Comprehensive education and safety programs released by OSHA, NIOSH and AORN offer hope — notably via the Go Clear smoke safety education program. Still, Ogg worries that too few hospitals make smoke evacuation mandatory.
Hospital leaders can change this with support from all surgical professionals by trialing surgical smoke evacuation technology, educating staff and taking appropriate steps and safety measures to ensure surgical smoke safety is standard practice. Too often these practices are lacking or incomplete, Ogg says: “Surgical smoke safety is a workplace safety obligation that all hospital leaders should champion.”
She also believes patients can play an important role in these efforts by asking and requesting their surgeons evacuate surgical smoke.