Smoking is never good to one’s health. But if you think smoking cigarettes or exposure to second hand cigarette smoke is the only hazardous thing a human being can be exposed to, think again.
Today, medical practitioners from physicians to nurses and technicians are also exposed to surgical smoke. This is caused by the use of certain medical equipment that creates a smoke byproduct known as surgical plumes that contain carcinogenic chemicals.
This issue is now currently being addressed and organizations have recommended the setting up of local smoke evacuation systems to improve the quality of the operating field.
How Dangerous is Surgical Smoke?
The Occupational Safety and Health Administration (OSHA) has noted that every year, some 500,000 medical workers that include surgeons, nurses, anesthesiologists and surgical technologists get exposed to laser or electrosurgical smoke. These so-called surgical plumes contain carbon monoxide, polyaromatic hydrocarbons, and a variety of trace toxic gases that are harmful to a person’s health. Being toxic gases, they can lead to irritation of the upper respiratory system and have been shown to carry live bacterial and viral fragments.
A study published on PubMed.gov of the National Center for Biotechnology Information revealed the case of a laser surgeon who suffered from laryngeal papiillomatosis as a result of exposure to laser plume. A DNA hybridization of tissue from the 44-year-old surgeon’s tumors showed the presence of human papillomavirus caused by inhalation of virus particles in laser smoke. The researchers discovered that the physician had given laser therapy to patients with anogenital condylomas in the past.
Another case involved a gynecological operating room nurse in Germany who had assisted several times in electrosurgical and laser surgical excisions of anogenital condylomas. The 28-year-old nurse also developed a laryngeal papillomatosis which experts attributed to laser plume exposure after the excision procedure. This separate study noted that the risk of exposition is higher in gynecological interventions than in ENT due to the larger tissue masses involved and due to the fact the laser smoke escapes easier in the room air when applying an open approach.
Addressing the Problem
Amidst this alarming issue, innovators are already looking for ways to solve the potential problem. Dr. Noah Minskoff, a medical tech inventor said they have a number of issued patents for a hand-held smoke evacuation device for use in the OR and that technology is currently being developed and tested by InnovoSciences. “Historically, we think of a scalpel as the main instrument used in surgery, but that’s not the case anymore. The primary instrument is an electrosurgical pencil. It’s a small, hand-held device that looks like a blade, but really, it completes a circuit when used on a patient, and its used to cut and cauterize tissue.”
The problem, though, is that when it makes a cut, or is used to cauterize, it creates a smoke plume, Minskoff added. The smoke smells terrible, and it can’t be good for someone to be inhaling it all day. It’s ridiculous that surgical staff are sitting in the O.R. all day, inhaling this stuff into their lungs.
Additionally, if any fluids enter the surgical field of the pencil, it’s no longer a focused cut or cauterization that’s being made, because the energy from the pencil is distributed through the fluid. It can create an area of char and thermal injury to the patient, or it can cause the device to not work at all, explains Dr. Noah Minskoff.
“Our device will clip right on to the surgical pencil and evacuate any smoke or fluid that it comes in contact with. The surgeon can go on using the pencil, but now all the extra problems are addressed, so you can cauterize and stop bleeding without having to switch instruments, and there’s no smoke inhalation. I really enjoy seeing fundamental problems with the most commonly used items in the operating room, and trying to develop solutions around those problems,” he concluded.
Nursing organizations, for their part, have also called for the placement of smoke evacuators in all operating rooms. A smoke evacuation machine, however, is an expensive equipment with an estimated price of $1,000 at the minimum. The cost does not even include the use of disposable tubing for every case and filters which need to be placed on a periodic basis.
The Occupational Safety and Health Administration (OSHA), through its Blood Bourne Pathogen Rule, is also requiring managers in operating rooms across the U.S. to prioritize the evacuation of surgical plume. Smoke is normally released when cells are ruptured through the use of heated medical instruments such as those used for incision and coagulation of tissues. This being the case, healthcare workers need to be protected from the hazardous surgical smoke that contains carcinogenic chemicals.