tag:blogger.com,1999:blog-4968787219619380438.post8405972792767541524..comments2023-09-21T04:02:29.457-04:00Comments on Skeptical Scalpel: Surgical smoke: Is it dangerous to your health?Skeptical Scalpelhttp://www.blogger.com/profile/13206922456661320751noreply@blogger.comBlogger36125tag:blogger.com,1999:blog-4968787219619380438.post-21212745702836104942016-01-30T03:32:38.500-05:002016-01-30T03:32:38.500-05:00Hello Nancyinlux
Change is always difficult but a...Hello Nancyinlux <br />Change is always difficult but as theatre nurses, we have to persevere.I can introduce you to a company that will educate your colleagues in smoke evacuation Please write to me at <br />siesta0652@yahoo.co.uk<br />Thank you <br />Kathy<br />Theatre nurse London <br /> Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-65937838546273754122016-01-20T13:10:38.902-05:002016-01-20T13:10:38.902-05:00Good luck. Let us know how it turns out.Good luck. Let us know how it turns out.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-48365624467327713562016-01-20T12:49:13.916-05:002016-01-20T12:49:13.916-05:00im glad to have read all of these comments. i hav...im glad to have read all of these comments. i have also gone to some of the links and read what is there....I am really want to get smoke evacuators in use where i am working, but i have no idea where/how to start! I expect it will be a huge challenge, because most people just don't seem concerned. After what i had to smell today, and the amount of time....over two long cases, i feel disgusting. Wish me luck, in changing the attitude of my colleagues, and in another language and culture....AHhhhhhh!<br />nancyinluxnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-61185613775971635342015-12-10T20:25:46.967-05:002015-12-10T20:25:46.967-05:00I am writing a position paper on this issue and pr...I am writing a position paper on this issue and providing it for publication and taking action. I have already paid the price for not wearing the Oscar Wilde Mask and speaking the truth. I will not shut up. All smoke is bad. I am reaching out to work with Cal Tech on this and other issues. I write for a journal on these controversial issues. I did the largest number of GYN operations in California for 2 decades. I created an ethics based surgical concept. Repair the female body do not cut it all out. I learned this from study of Viktor Bonney of the UK. I am have a totally different view of the surgical world. Smoke kills. I got COPD from my exposure to Plume. I am pissed off I was not more self protective and did not cause more of a revolution in the OR. HPV not only is spread by actual transition to oral carcinoma does take place. The data we have is CRAP that says everything is ok. Patients and the entire OR is at risk also. I would order and evacuation machine and would hear...WE DONT HAVE ONE. So I would then order it through the laser company. The paper masks are not good enough. Plume gets in your eyes,nose,and mouth. I have a GYN ONC aquaintance and he had mutiple operations for throat cancer. Ofcourse all from HPV.<br /> I know and worked with Michelle Douglas on saving a woman from a hysterectomy for a simple fibroid. To learn his cancer came from oral sex with women was important but the press and media did not take it to the limits it should of. Females are carrying HPV and they all need to be checked for it. I will be releasing my medical treatment for HPV in 2016. I am not in belief that the vaccine is for everyone. Having a safe and clean sex partner is for everyone. Michael was extremely kind to tell the world but more of the story needs to be on air in the radio and in the National Enquirer to get the facts and data to the public. I know that my GYN Onc friend does not talk about it and refuses to believe he got it from laser plume. There is no question for any rational science nerd to think anything else than the fact that PLUME kills. Also every women needs to be tested for HPV when she has her pap. <br />When I wanted to start a revolution in this area of medicine one of my mentor a leading gyn pathologist (lie ...he was the leading one in the nation) when I told him my plan to create a cure and global program to end HPV he told me I would be "killed". He explained I was going to take the reason of the yearly gyn visit by women away and the ACOG would have me killed. So I slowed down. But I am over 60 and have enough rage in me to do this now. ALL SURGEONS are at risk and a real data base is needed. I am making a formal request for this as I did when I exposed hysterectomy abuse. It will take time to get the data and then look at it . Reality of this will be told. The ACOG and AMA all need to get on the band wagon . There is NO WAY that the numbers will show no correlation. This is science. You heat up the viral particles, split them and send them about they will take hold. Actual tissue particles floating about to stick to you and others. We need actual clean rooms to operate in and get with the SPACE AGE.<br /> I ordered the entire body suit. It was hot to wear but I did not cough and my eyes did not water. It was paper so clumsy. The experience needs to improve and we all need to become outer space travelers with our medical science today. How to not contaminate. I am glad some one took this on and gave some data to stir up the pot. I need to become a pain in the ass for OSHA. Action is needed . Wish surgeons would see that they need to act out side of the OR. Be Valiant...no mask can cover up your brain. Dr. Vikki Hufnagel MDhttp://drvikki.comnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-35179992133094456652015-06-10T22:01:41.276-04:002015-06-10T22:01:41.276-04:00Anon, you are entitled to your opinion. I'm no...Anon, you are entitled to your opinion. I'm not sure which studies you are referring to when you say lots of good studies. I hope you don't mean the one written by the CEO of a company that makes smoke evacuators. It's been two years since I wrote this post. To my knowledge, very little has changed. Why do you suppose that is? <br /><br />I agree the there's a lot of waste in hospitals, and resources could be better allocated. You must be aware that hospitals are overcharging patients and making tons if money. If staff were passionate enough about smoke, they would be demonstrating in the atrium lobby. They're not. Why not? Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-77360195970536167222015-06-10T18:13:38.456-04:002015-06-10T18:13:38.456-04:00Hi skeptical scalpel,
It's disappointing to me...Hi skeptical scalpel,<br />It's disappointing to me as one of your colleagues in the medical field that you would take the perspective of: unless it is proven to harm, let's not prevent. You as a doctor also rightfully should know the first rule of medicine: do no harm. When you don't know if something will or will not do harm (in this case, the "something" is smoke), but we know very well with LOTS of substantiated evidence that the contents DO cause harm (see above comments, lots of good studies above), you should know that there is definitely a reasonable risk of harm that hospitals should NOT take on behalf on their personnel. It isn't an issue of coming up with more money from thin air -- it is about resource reallocation. Instead of the thousands of other things we waste in the hospital (sutures, tools misused and thrown away inappropriately, wasteful use of PPE, many more), inefficiencies can be cut to make room for something even as simple as a convidien dial bovie-suction tool. Something as simple as that. But to you somehow, it's not worth it. It's either go hard - buy expensive smoke evacuation equipment - or go home. Why didn't you make a comment about other less expensive equipment? <br /><br />Finally, your review of studies is painful and disappointing. You're basically expecting someone to conduct some high level case control study - expensive and long and THERE IS LITTLE FUNDING for preventative research studies like this, not to imagine the long term nature of a study that waits for the development of lung cancer - and sitting around for this impossible study to happen. Waiting for this study that will never happen and saying until you see that, there is no need to take action. We wait until we get sick. <br /><br />Shame on you, seriously. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-54667596240387582072015-02-16T10:31:44.411-05:002015-02-16T10:31:44.411-05:00Anonymous, thank you for commenting. I apologize f...Anonymous, thank you for commenting. I apologize for the delay in responding, but I wanted to obtain a full text copy of the paper you referred to.<br /><br />There is nothing new in this paper except for linking surgical smoke to diseases such as Alzheimer's, collagen and cardiac diseases, and cancer. The problem is that the paper upon which that statement is based was not a study of surgical smoke but rather, a study of air pollution and vital statistics in Japan. I do not see how it is relevant.<br /><br />Even more concerning is the fact that the paper was written by the CEO of Nascent Surgical, a company that makes operating room smoke evacuators.<br /><br />I like the way the journal handled this. Here's the statement printed at the end of the paper: "As chairman of the board and an employee of Nascent Surgical, Dr Schultz has declared an affiliation that could be perceived as posing a potential conflict of interest in the publication of this article." Really, ya think?Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-7237371652205697902015-02-14T12:22:03.588-05:002015-02-14T12:22:03.588-05:00Chronic exposure to surgical smoke can transmit vi...Chronic exposure to surgical smoke can transmit viruses; lead to respiratory illness; and increase the risk of more serious conditions, including Alzheimer disease, collagen and cardiac diseases, and cancer. Despite this, surgical smoke plume capture and evacuation devices are often used sporadically or not at all, and do not necessarily reduce costs per procedure. In addition, the current choices for smoke plume capture are varied, and health care providers may make decisions about what type of method to use based on marketing materials rather than facts, leaving most clinicians and managers frustrated and cynical about supporting the effort to capture surgical smoke plume. This article presents current data and information that purchasing teams can use to help choose the best available technology for their practice patterns. It also provides analysis to help those responsible for choosing smoke evacuation systems make rational decisions in their quest to provide a clean, safe environment in the OR.<br /><br />An Analysis of Surgical Smoke Plume Components, Capture, and Evacuation. AORN Journal (AORN J), 2014; 99 (2): 289-98. (22 ref)Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-84417749370526429412014-07-29T14:38:01.005-04:002014-07-29T14:38:01.005-04:00Raul, thanks for the very interesting link to the ...Raul, thanks for the very interesting link to the report of 2 cases of HPV-16-related squamous cell carcinoma of the throat. These are by far the most suggestive I have seen implicating smoke as a cause of the disease. As the authors say, this is not conclusive proof. But a gynecologist who has an extensive practice involving such surgery might want to take the precautions noted in the paper.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-22334070668830525672014-07-29T11:14:06.752-04:002014-07-29T11:14:06.752-04:00http://www.journalotohns.com/content/pdf/1916-0216...http://www.journalotohns.com/content/pdf/1916-0216-42-54.pdfAnonymoushttps://www.blogger.com/profile/03826189034093413911noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-74259173546673105882014-07-21T08:02:03.579-04:002014-07-21T08:02:03.579-04:00Brenda, thanks for commenting. I had not seen the ...Brenda, thanks for commenting. I had not seen the Heinsohn paper. I read the abstract, which says, "These data show that the mucous membrane lining of the upper respiratory tract and alveolar macrophages in the gas-exchange region are likely to be exposed to aerosolized blood in the operating room. Until further research determines the potential of infected blood aerosols to transmit disease, the authors recommend the proper use of respiratory protection equipment instead of surgical masks because the latter do not offer adequate protection."<br /><br />It's been more than 20 years since the paper was published in 1993. Is anyone using "respiratory protection equipment"? Where is the "further research"? Where is the definitive proof that surgical smoke has caused even one illness?Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-91128123136586056842014-07-20T15:44:16.089-04:002014-07-20T15:44:16.089-04:00Have you seen this paper? "Heinsohn, P., and...Have you seen this paper? "Heinsohn, P., and Jewett, D. L. (1993). Exposure to blood-containing aerosols in the operating room: a preliminary study. American Industrial Hygiene Association Journal, 54(8): 446-453." <br />As a perioperative nurse I have my own personal "smoke story" and have long been a proponent of clean air in the operating room because of it. In 1996-1997 OSHA did develop language that would mandate smoke evacuation. There was a bill introduced into Congress and attached to an Omnibus Reconciliation Act. During final votes in Congress, that part of the bill was eliminated. Its a long story, but Dr. Ralph Yodiaken, who was the OSHA doctor at the time, left OSHA, the administration changed, and all work to that point was simply put on the OSHA website and is still there today. I was there at the time and part of the work and the effort. It takes a great deal of time (and money, and lobbying) to get something mandated by OSHA--neither of which most nurses have. It is a health workplace safety issue, and as you say, nurses and OR technicians are likely more at risk simply because of the greater time that they spend in the OR. Progress has been slow, but over the years more agencies and organizations have adopted the position that health care workers should be protected from inhaling surgical smoke. You quoted a figure of $1000 for a smoke evacuator. Not every operating room needs a dedicated smoke evacuator. Many cases that do not produce a lot of smoke can use an inline ULPA filter--much less expensive but still filters the smoke. Using room suction without an inline filter doesn't do anything to clean up the air. You should also read the paper on how room air currents distribute surgical smoke throughout the room in a matter of minutes, so you may think you didn't breathe the smoke, but if you were in the room, you did. I can send you that reference too--if you want it. Brenda C UlmerAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-12699286813402812242014-03-04T15:45:56.570-05:002014-03-04T15:45:56.570-05:00I'm not sure there are blood particles or tiss...I'm not sure there are blood particles or tissue in surgical smoke. I never went out of my way to breath the smoke, but sometimes it happened. It's happened to every surgeon, unless she never used cautery.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-22547368483854367832014-03-04T06:16:29.963-05:002014-03-04T06:16:29.963-05:00Regardless of what you can/can't catch from th...Regardless of what you can/can't catch from the smoke plume - Why would you want to breathe in other peoples blood particles and tissue ???? You don't go round licking peoples skin and drinking blood do you ! Unless your a vampire of course Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-17704919084533093152014-01-16T08:16:40.142-05:002014-01-16T08:16:40.142-05:00Curious, good questions. I am unaware of any studi...Curious, good questions. I am unaware of any studies that show an increase in respiratory tract cancers or infections in OR personnel. You would think that if such problems existed, they would have come to light by now.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-73965065785813487892014-01-16T01:23:13.386-05:002014-01-16T01:23:13.386-05:00I wonder how many perioperative personnel have exp...I wonder how many perioperative personnel have experienced above average incidence of respiratory/pharyngeal/laryngeal/sinus cancer? Also how often perioperative personnel experience upper respiratory tract infection compared to that experienced by the general population? Surely both could be studied then crosschecked against the workplace and environmental exposure. Does anyone know of any existing research in either query?Curiousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-707194563204024702013-09-18T12:28:34.070-04:002013-09-18T12:28:34.070-04:00When I operated, I didn't inhale the smoke.When I operated, I didn't inhale the smoke. Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-36477469728812615402013-04-06T12:52:50.736-04:002013-04-06T12:52:50.736-04:00Kathy, thanks for commenting. You say "surgic...Kathy, thanks for commenting. You say "surgical smoke s more harmful than cigarettes!" Please cite a reference for that statement. <br /><br />I looked at the Megadyne website but couldn't find anything to corroborate that. Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-29198547963955015322013-04-05T20:14:40.997-04:002013-04-05T20:14:40.997-04:00Dear Skeptical Scalpel,
Thank you for your comment...Dear Skeptical Scalpel,<br />Thank you for your comments. Special thanks to Kay from AORN and Romanschapter8. I am the UK nurse who raised the topic. I am fortunate to work in a private hospital with 8 theatres. In each theatre we have a smoke evacuator and guess what? They come from Utah! We tested it for Megadyne and our surgeons happily use it. Is it so wrong that we care for our colleagues, our patients and the whole surgical team not forgetting the company reps who are sometimes in the theatre inhaling this carcinogenic plaque. In most countries, cigarettes are banned in public places yet we encourage smoking in the theatres and surgical smoke is more harmful than cigarettes! In my clinical environment, we discourage the consultants from using suction to evacuate smoke. Our smoke evacuators are fitted with charcoal filters and no, they do not go into the scavaging system, we change our filters regularly. To all my fellow theatre nurses out there in the US if you have a smoke evacuator in your theatre, think about using it and encourage others. The research is out there, you only need to look for it. Ask Megadyne if you want, it's on Google. Thank you.Kathyhttp://profile.yahoo.com/E6DN6R6XIKPYP6MRIEZVMCE5N4/noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-50118227617841529632013-04-04T18:28:29.725-04:002013-04-04T18:28:29.725-04:00Kay, thanks for the thoughtful and obviously heart...Kay, thanks for the thoughtful and obviously heartfelt comments.<br /><br />Nurses could possibly be at greater risk since they obviously are in the OR for more hours, although we surgeons are usually much closer to the smoke source thatn scrub techs and certainly circulating nurses.<br /><br />I'm all for workplace safety and if we all had unlimited funds, I would be first in line to buy a smoke evacuator.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-82010953860673965882013-04-04T16:51:15.418-04:002013-04-04T16:51:15.418-04:00Hopefully hospitals that have smoke evacuators are...Hopefully hospitals that have smoke evacuators are using them. This original article is loaded with lots of misinformation. For example, OSHA DOES mandate that employers provide a safe workplace environment. They don't have to specifically comment on surgical smoke. Inhaling surgical smoke is a WORKPLACE SAFETY ISSUE so all surgical smoke must be evacuated properly. This comment section does not have enough room for the corrections for all of the other inaccuracies within that first article. Why are you trying to discount all of the hardwork so many of us have done to promote surgical smoke evacuation and clean air in the OR. My PhD research study on surgical smoke evacuation compliance shows that perioperative nurses are reporting twice the incidence of some respiratory problems in many facilities where smoke evacuation is not practiced. Perioperative nurses' exposure to surgical smoke is much greater than surgeons who visit the OR a few times each week. We must focus on providing safe workplace environments to surgical team members. (Kay Ball, PhD, RN, CNOR, FAAN - past president AORN.)Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-39946707819615717762013-04-04T10:07:19.991-04:002013-04-04T10:07:19.991-04:00Anon, thanks for the comments. You make some good ...Anon, thanks for the comments. You make some good points. But I don't think that most hospitals have the $1000 evacuators sitting around. <br /><br />I was not aware of the Journal of Plastic Reconstructive Surgery paper you cited. That is interesting.<br /><br />If indeed the plume amounts to the equivalent of 27-30 unfiltered cigarettes each day, would you not expect that there would be a higher incidence of lung cancer in OR nurses and techs as well as surgeons? That does not seem to be the case.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-85130635757875958922013-04-04T10:01:09.418-04:002013-04-04T10:01:09.418-04:00Sorry. The link you provided falls far short of a ...Sorry. The link you provided falls far short of a mandate. <br /><br />It says, "The research is *limited* on transmission of disease through surgical smoke, but the *potential* for generating infectious viral fragments, particularly during treatment of venereal warts, *may* exist. Researchers have *suggested* that the smoke *may* act as a vector for cancerous cells which *may* be inhaled by the surgical team and other exposed individuals." [I added the asterisks for emphasis]<br /><br />That reads more like a radiology report. <br /><br />The link goes on the offer "Possible Solutions" such as the ones you mentioned.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-14850192780925096902013-04-04T09:59:36.913-04:002013-04-04T09:59:36.913-04:00I think there are some things to consider relating...I think there are some things to consider relating to the cost analysis shown. Most facilities in the United States, Western Europe and Canada own smoke evacuation systems of some form already, so there would not be a 40m outlay. It is true that a disposable capture device is typically used but these are inexpensive and well worth the cost for protection. For anyone that has worked in the OR, that smell of burning tissue is a telling sign that gases are present. The powerpoint presentation shown above appears to demonstrate a spot check although it is not referenced, and does not deal with the variability within cases based on how much electrosuergy or lasers are used, the type of tissue being interacted with, and the duration.<br /><br />With regards to OSHA, although they indicate that there is no specific standards that exist that call out surgical smoke, they do indicate that applicable standards exist in 1910.134 (respiratory protection) and 1910.1030 (bloodborne pathogens). Additionally as romanschapter8 mentions above, the Joint Commission also has an applicable standard in the their Environment of Care Standard (EC.02.02.01) that addresses the management of hazardous gases while using cauterizing equipemnt and lasers.<br /><br />A recent article from the Journal of Plastic Reconstructive Surgery (Hill, D.S.2012) equated the daily secondary smoke exposure over 44 days in a Plastic Surgery suite and found that it amounted to 27-30 unfiltered cigarettes each day. Regardless of the difficulty of correlating viral and bacterial transmission directly to surgical smoke, smoke is smoke and known to be hazardous to your health. With regards to biological transmission, contrary to the powerpoint presented, there are studies that not only demonstrate the viability of virus in the plume (meaning that transmission is possible) but also when that virus was extracted from the plume and reinoculated in foreign tissue, growth occurred (Garden, et. al. 2002 Arch Dematology). <br /><br />The concern with saying that no direct connection has been made is that this is true of most viral transmissions. If you woke up this morning with the flu, could you trace its origin back to the exact source? True, even though the surgical case studies you reference indicate a similar DNA type to that of patients recently treated that does not definitively mean it came from these patients, but knowing it's present in the plume, why wouldn't we want to take precautions as we do with hand washings, gloves, etc?<br /><br />Just some points to consider. Waiting for additional people to definitively tie the plume to illness seems like a risk not worth taking in lieu of the evidence that exists. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-67975731012721674082013-04-04T09:06:13.601-04:002013-04-04T09:06:13.601-04:00OSHA Surgical Suite Module (1) recommends...
- Ha...OSHA Surgical Suite Module (1) recommends...<br /><br />- Have a smoke evacuator available for every operating room where plume is generated.<br /> <br />- Evacuate all smoke, no matter how much is generated.<br /><br />http://www.osha.gov/SLTC/etools/hospital/surgical/surgical.html#LaserPlumeromanschapter8https://www.blogger.com/profile/09243747121451230870noreply@blogger.com